May 9, 2007 SOCIAL SERVICES COMMITTEE

Pursuant to Standing Order 68, Wallace Young, MHA for St.

Barbe, replaces Terry French, MHA for Conception Bay South.

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

CHAIR (Mr. Ridgley): Order, please!

The first item of business would be to deal with the minutes of our last

session, which was the Estimates for the Department of Municipal Affairs.

We would entertain a motion that they be passed as distributed.

MR. BALL: So moved.

CHAIR: Moved by Mr. Ball.

All those in favour, aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, minutes adopted as circulated.

CHAIR: Once again, I would ask the members of the Committee first to

introduce themselves and then we will go to the minister and his staff.

Mr. Ball?

MR. BALL: Dwight Ball, MHA for Humber Valley.

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

MS MICHAEL: Lorraine Michael, MHA for Signal Hill-Quidi Vidi.

MR. COLLINS: Felix Collins, MHA for Placentia & St. Mary's.

MR. CORNECT: Tony Cornect, MHA for Port au Port.

MR. YOUNG: Wally Young, MHA for St. Barbe, sitting in for Terry French.

CHAIR: Minister?

MR. WISEMAN: Thank you, Mr. Chair.

Ross Wiseman, Minister of Health and Community Services.

MR. ABBOTT: John Abbott, Deputy Minister.

MR. STRONG: Jim Strong, Assistant Deputy Minister, Corporate Services.

MS THORNHILL: Pam Thornhill, Budget Manager.

MS HENNESSEY: Moira Hennessey, Assistant Deputy Minister, Regional Health

Operations.

MS JEANS: Jennifer Jeans, Assistant Deputy Minister, Public Health,

Wellness and Child Youth and Family Services.

CHAIR: Thank you.

Again I would ask people other than the minister, who will probably be

answering most of the questions, to introduce yourself before you speak, just

for the people downstairs.

I ask the Clerk to call the first article, please.

CLERK: Subhead 1.1.01.

CHAIR: Shall 1.1.01 carry?

I will turn it over to the minister, then, for introductory remarks.

MR. WISEMAN: Thank you, Mr. Chair.

I appreciate the opportunity to make a few opening comments, if I could.

This year, I am pleased that the overall budget for the Department of Health

and Community Services has increased by 10.3 per cent over last year's budget.

It brings our expenditure total this year to $2.2 billion. This represents a

monumental achievement and a testament to the Premier and his Administration of

an unwavering commitment to improve the health care system in this Province.

Over the last year there have been significant milestones in the area of

health and community services. Some of the more significant developments

include: the release of the Early Learning and Child Care Plan; the launch of

the new health line with offices in St. Anthony, Corner Brook and Stephenville;

quarterly public reporting and improvements in wait times for health care

procedures, and a commitment to wait time guarantee for cardiac bypass surgery

by 2010; the re-registration of the Province's population for continued MCP

coverage, which is an ongoing process; continued focus on health promotion,

including the release of new child food guidelines and awarding of wellness

grants to many community groups.

Significant progress has been achieved in implementing new information and

communications technology, including the continued rollout of a picture

archiving and communications system commonly referred to as PACS; that has been

across all regions of the Province. Today, digital images such as X-rays, CTs

and MRIs are accessible to radiologists in all parts of the Province; opening

new cancer centres in Gander, Grand Falls-Windsor, and the development of a new

satellite dialysis unit in Happy Valley-Goose Bay, Burin and St. Anthony;

improvements to the children's dental program to ensure universal access to

children under the age of twelve, and with a further expansion in this budget

year as well; the introduction of a new low-income drug program; key investments

in health infrastructure and capital equipment; organizational and operational

review of the Province's child, youth and family services system.

We have had a very aggressive legislative agenda this past year, including

the passage of a new Mental Health Care and Treatment Act, replacing

an act that

was over thirty years old, and a Pharmaceutical Services Act. We will continue

to build on these developments, along with the financial investments made in

health care over the past three-and-a-half years through new investments being

funded in Budget 2007.

Government's priorities over the next year include: continuation of major

capital projects, including the new long-term care facilities in Clarenville,

Corner Brook, Happy Valley-Goose Bay, and a new health facility in Labrador

West; strengthening the Province's child, youth and family services system, as

well as the implementation of a major enhancement to the Newfoundland and

Labrador Prescription Drug Program for individuals who have high drug costs.

We will continue with our investment in mental health and addictions and

related services. We will continue enhancing access to health services,

improving wait times in the Province, and we will continue strengthening public

health capacity in the Province as well. As well, we will continue to focus on

wellness and aging.

These are just a few highlights of the ongoing commitment by my department,

the regional health authorities, and the many boards, agencies and community

partners working together to improve the health and well-being of

Newfoundlanders and Labradorians.

I am proud to say that the level of co-operation with our partners is a

testament to this shared vision.

I will turn it back to you, Mr. Chair, and will be only too glad to answer

any questions from the members opposite.

CHAIR: Thank you, Minister.

I guess, Mr. Ball, will you be leading?

MR. BALL: Yes, sure.

CHAIR: We will allow fifteen minutes and then ten minutes from there on

in.

MR. BALL: Thank you, Mr. Chair.

On page 196, subhead 1.2.03., the

section on Medical Services, this being my

first year here, could I just get an explanation on why this is an individual

line item, an individual category, or what goes on in this particular category?

MR. WISEMAN: Maybe if I could, Mr. Chair, before we start - let me get my

headphone. I still have some difficulty hearing.

CHAIR: I am sorry. What page was it again, Mr. Ball?

MR. BALL: Page 196.

MR. WISEMAN: Thank you, Mr. Chair.

I am sorry. I apologize for that.

CHAIR: No problem.

MR. WISEMAN: The heat has affected my hearing. Could I ask you to repeat

the question, if you don't mind?

MR. BALL: No problem at all.

Page 196, I guess category 1.2.03., Medical Services, "Appropriations

provide for the management of physician services, and Provincial drug and dental

programs."

I am just wondering where this category fits in the overall health care

budget. What type of programs would be paid for from this particular section?

MR. WISEMAN: Jim, could you answer that please?

MR. STRONG: This activity is the cost for the leadership for medical

services. So, it is the Medical Services Division, the Director of Medical

Services and her staff who do the physician resource planning, manage relations

with the MLI. Also, it is the Pharmaceutical Services Division there, Director

of Pharmaceutical Services and her staff who operate the Newfoundland

Prescription Drug Program. Those are the two divisions that would be covered

here in this cost centre.

MR. BALL: The dental programs as well, I guess?

MR. STRONG: Yes, dental as well.

MR. BALL: Thank you.

On page 197, under 1.2.04., I see on line 05., Professional Services, we had

a budget of $22,700 revised to $207,000 and this year we are back to $13,000.

Could you explain why the expenditure there last year?

MR. WISEMAN: Again, Jim, could you...?

MR. STRONG: The expenditures were up in 2006-2007 because we had a

gambling addiction advertising campaign, and this is where those costs got

charged.

MR. BALL: Is that campaign finished now, or no plan to continue that?

MR. STRONG: I am going to ask Moira to speak to that one.

MS HENNESSEY: That was the campaign on gambling, VLTs. There were two

runs last year, one in May and the second in September, so that campaign is

finished now.

MR. BALL: No plan to do it for the following year, you mean?

MS HENNESSEY: (Inaudible).

CHAIR: Just a little bit louder, please.

MS HENNESSEY: During 2007-2008 we do have some new monies to undertake a

new public awareness campaign related to gambling, and we have not worked

through the details of that yet.

MR. BALL: For $13,000, do you that is going to be enough to cover that

campaign, or will that be paid for somewhere else, do you think?

MR. WISEMAN: It is a valid point that you made; it will not be enough to

fund that kind of campaign, but it is covered under the Regional Health

Authorities vote rather a separate line item here.

MR. BALL: Okay, good.

On page 198, under Policy and Planning, we have line item 05., again under

Professional Services, where we had budgeted for $103,500, revised to 76,000,

and up to $121,000. Is there a reason why we did not spend the budget last year,

and something we are putting back in that this year?

MR. WISEMAN: Again, Jim, could you comment please?

MR. STRONG: Most of that money is for the HealthScope reporting, and the

money for 2007-2008 is for HealthScope III, which is a public reporting of

health indicators. That is what that Professional Services money is used for.

MR. BALL: I am sorry. What was that again? Health what?

MR. STRONG: It is for public reporting of health indicators. It is money

set aside to do work on health performance indicators, and they will ultimately

be published. There was a new version of that planned for 2007-2008.

MR. BALL: Is that a provincial program, or does that tie in with some

national program?

MR. STRONG: HealthScope II and I were a part of some of the earlier FMM

agreements with the federal government. There is no commitment with the federal

government to do that in the future, but the Province is planning on continuing

to produce those new indicator reports.

MR. BALL: Do they be included with CIHI at all, or is that something that

is outside of that?

MR. STRONG: Outside of that.

MR. BALL: Under subhead 1.2.08., page 199, Transportation and

Communications, there was a $200,000 budget last year, $180,000 spent, and we

are back to $59,100. Does that mean the audits will be carried out differently?

MR. STRONG: Could you repeat the question, please?

MR. BALL: On page 199, category 1.2.08., line item 03., Transportation

and Communications, last year we budgeted $200,000, spent $180,000, and we have

estimates this year for $59,100.

MR WISEMAN: Most of that was associated with the re-registration of the

MCP. Additional cost includes excessive postage associated with the

re-registration process.

MR. BALL: Transportation and Communications?

MR. WISEMAN: Yes.

MR. BALL: So, re-registration of MCP?

MR. WISEMAN: Yes.

MR. BALL: Page 200, Memorial University Faculty of Medicine, do we have a

bursary program now, or scholarship program? Do we do anything with that now? I

see Grants and Subsidies there, $29 million. That is a grant, I guess, to

Memorial University. I am thinking of students. Do we do anything now in a

retention program for our Newfoundland students?

MR. WISEMAN: I will ask the deputy to comment on the bursary retention

program.

MR. BALL: Okay.

MR. ABBOTT: There is a bursary program for students, primarily for those

studying the specialities. That money is voted earlier in the department's

budget and would not be found in that particular vote.

MR. BALL: How much would that be, the total that we would spend in

retention and recruitment, I wonder?

MR. ABBOTT: Our physician bursaries budgeted this year are approximately

$1.3 million.

MR. BALL: Do they apply for those, or is there a certain criteria?

MR. ABBOTT: It is based on application. There is a committee that would

review all applications. A lot of those are returning service arrangements.

MR. BALL: Under

section 2.2.01., Professional Services, we went from

$984,000 to $1.4 million up to $2.1 million. Can you explain to me what kind of

activity is there?

MR. WISEMAN: Under 2.2.01.?

MR. BALL: Yes, line item 05.

MR. WISEMAN: Jim, could you comment on this?

It has to do with the new on-line adjudication program, but I will ask Jim if

he could give you some detail on that.

MR. STRONG: That would be two factors there on the increase. One is, the

Province signed a new agreement with xwave in terms of service contract for

processing pharmacy claims and, as a part of that, are moving from a batch

processing system to an on-line real-time processing system. That is a more

expensive system to run than a batch system.

The other factor that comes into play here as well is that the new contract

envisages a higher volume of prescriptions being processed because of the

introduction of the Low Income Drug Program, so there is more transaction

activity than it would have been in the past because of the additional

beneficiaries.

MR. BALL: Let me personally say thank you for the on-line adjudication.

MR. STRONG: You're welcome.

MR. WISEMAN: Most of that, by the way, is contract. The service provider

is xwave, as you are aware, and all of that goes directly to xwave.

MR. BALL: So the Allowances and Assistance in 09., an extra $30 million,

I guess closer to $25 million or something there, is that the actual dollars

spent on the program?

MR. STRONG: It is, yes.

MR. BALL: That is what I thought.

Physicians' Services, 2.3.01., on page 200 again, we see an increase of $12

million right there under Professional Services, line 05.

MR. WISEMAN: Under 2.3.01.?

MR. BALL: Yes.

MR. WISEMAN: Your question, I am sorry, was the increase from -

MR. BALL: From $206 million to $218 million, Professional Services.

MR. WISEMAN: That has to do with the changes in the increase as a result

of the MOU with physicians, together with increased utilization.

MR. BALL: Okay.

What was the increase in that, do we know? In percentage terms, I mean.

MR. WISEMAN: On the MOU it represents $1.8 million, about eight, seven,

eight - exactly.

MR. BALL: So the rest of it would be in increased utilization, I guess.

MR. WISEMAN: Exactly, yes.

As a result of that MOU, there is another $1 million in there for on call

physician fees.

MR. BALL: I guess one other question.

Under 3.1.01. - and this goes through the regional health authorities - I

just wonder, do we have a number on the accumulated debt now for our health

boards?

MR. WISEMAN: Yes, we do, actually. I will ask Jim to give you that total.

MR. STRONG: It would be about $119 million as of March 2006.

MR. BALL: Could I have a breakdown where that would be? Western, Central,

to -

MR. STRONG: If you give me a minute, I can look for that.

MR. BALL: Yes, no problem.

I guess, while you are looking for that, the debt servicing for that, is that

still done by the authorities or is that done by -

WITNESS: Yes.

MR. BALL: Okay.

MR. STRONG: It would be about $56 million for Eastern, $17 million for

Central, roughly $29 million for Western, and $18 million for Labrador-Grenfell.

MR. BALL: Eighteen?

MR. STRONG: Eighteen, yes.

MR. BALL: Thank you.

My time is about up now anyway, Mr. Chair, so -

CHAIR: You have a couple of minutes, Mr. Ball.

MR. BALL: No, I can pass it on right now, if you don't mind.

CHAIR: Ms Michael.

MS MICHAEL: Thank you very much.

If we can go back to the first page, page 195, 1.2.01., the salary line,

there was a jump in 2006-2007 by $100,000, which has been maintained. Was that

an unexpected new position, or what was that change in the revision?

MR. WISEMAN: Last year, there was a new position created in the minister's

office, a policy advisor, and that represents a piece of that. Second, as a

result of the government-wide reclassification of executive secretaries last

year - and that was retroactivity - that represented another $40,000 of that.

MS MICHAEL: Thank you.

Under Purchased Services the budget is $76,500, revised down, and back up to

$76,500. Did you have something not happen last year that you expect to happen

this year under Purchased Services?

That is on the same page.

MR. WISEMAN: That was associated with the pandemic influenza planning

process. We saw that decrease down by $46,000 but it is going back up again

because we need to continue with that.

MS MICHAEL: Okay.

The next page, please, 196. I know in a lot of the salary categories it will

be that there was a new person hired, or new position, but I am going to want to

know what the positions were, if you don't mind. The first section, 1.2.02.,

the Salaries are up $100,000 from the budgeted.

MR. WISEMAN: We are into subhead 1.2.02. now? Is that the

section you are

talking about?

MS MICHAEL: Yes, 1.2.02.

MR. WISEMAN: Under Corporate Services?

MS MICHAEL: That is right.

MR. WISEMAN: Your question is?

MS MICHAEL: Salaries are gone up over $100,000 from last year's budget.

MR. WISEMAN: Right.

We had step progression. The salaries in step progression amounted to

$30,700. We have a provision in there for severance to be paid out - which we

anticipate some retirements - and that represents some $37,500. Then, $32,400

represents - when we do the budgeting process, we may assume that a person is

going to be working in the position at step two or three of the salary scale, if

there is a position change, and then there is a person coming in at a higher

level and we need to reflect that higher level of the person coming in. Those

three amounts add up to $100,600. That represents that $100,000 that you are

talking about, in those three figures.

MS MICHAEL: Okay. Thank you very much.

I wondered about the Employee Benefits, but I realize the Employee Benefits,

line 02., must be for all the employees in the department, is that correct, in

Health and Community Services? Because it is quite a high amount for Employee

Benefits.

MR. WISEMAN: Jim, could you comment on that for me?

MR. STRONG: Basically, government is self-insured as far as workers'

compensation is concerned, so this $300,000 represents payments to the

Workplace, Health and Safety Compensation Commission for an employee in the

current year, if they had an injury, but as well past employees of the

department who are still getting benefits from the commission.

MS MICHAEL: Right, but I am assuming it is for all the employees in the

whole department, not just for those who work under Corporate Services.

MR. STRONG: Yes, that is correct.

MS MICHAEL: I saw that amount and said, good heavens. Then I just

realized what happens there, so that must be it.

The Professional Services are quite high. What would be the Professional

Services, under Corporate Services? Because it was $1 million budgeted last year

and still $1 million for this year.

MR. STRONG: Basically, in our budget every year we budget here $1 million

for small federal-provincial cost-shared agreements that may come up during the

year. What we have found over the years is that, at some point in the year, a

division might reach an agreement with the federal government for a small

cost-shared agreement. This $1 million here provides us the appropriation to

enter into those agreements.

MS MICHAEL: Okay, thank you. That is quite clear.

My final one on that page, I think, is the next section, 1.2.03. The

Purchased Services have taken quite a jump from last year, both from the Budget

and from the Revised figure. I am wondering what you are anticipating in this

year that would make it go up so much.

MR. WISEMAN: That is under Medical Services you are talking about?

MS MICHAEL: That is correct, yes.

MR. WISEMAN: Okay.

MS MICHAEL: Medical Services, 06.

MR. WISEMAN: Give me a moment, now. I am just trying to reconcile my book

with your Estimates book here now.

Your question was the $203,000, wasn't it?

MS MICHAEL: That is correct, yes, Minister.

MR. WISEMAN: We have the advertising for the HealthLine, $185,000.

MS MICHAEL: How much?

MR. WISEMAN: It is $185,000. Then, there are some miscellaneous

divisional requirements there for $18,900. It brings the total to $203,000.

MS MICHAEL: Okay, thank you.

May I do the same as my colleague - point out something very helpful? I had

to, before my mother died, use the HealthLine one night, and I have to say it

was a very effective experience.

MR. WISEMAN: We are getting a fantastic response from that. It has really

been phenomenal, actually. I think the last time I saw something on it, was it

203,000 calls? It was a phenomenal number of calls that we had received in a

very short period of time. It is well above what we had anticipated. It has been

well received.

MS MICHAEL: I was skeptical, I have to say, about how effective it could

be; but, having gone through it myself, it really was. Just to let you know.

Page 197, General Administration,

section 1.2.05.

MR. WISEMAN:

Section 05?

MS MICHAEL: Yes, 1.2.05.

Looking at the salary line, it has gone up a fair bit from the budgeted for

last year, by $207,000. Would these be new positions, or -

MR. WISEMAN: Jim, could you comment on that? Because that is the medical

services salary, I think, isn't it?

MR. STRONG: The increase is about $206,000.

MS MICHAEL: That is right.

MR. STRONG: There is one position transferred in there from another - as

part of just a movement internally. That is an infection control nursing

consultant position. Then there is funding there for a Clerk IV and a health

promotion consultant. Then the balance of funding, $54,000, is for step and

salaries increases.

MS MICHAEL: Sure.

Are you already in the process of advertising for the Clerk, the two

positions that you mentioned?

MR. STRONG: I don't know.

MS MICHAEL: You don't know. Okay, thank you.

I think that is all on that page; I just want to check. No, my other question

was covered by Mr. Ball.

All right, page 198,

section 1.2.07. - no, it is okay. My note here, yes, you

covered that with the answer you gave to Mr. Ball, so I think I am all right on

that one.

Page 199, the next page, 1.2.08.; again, it is the Salaries. If we could have

an explanation of - again, I am presuming there must be some new position there

because it is $3,224,000, up from $2,882,000.

MR. WISEMAN: That increase cost reflects increased staff requirements for

the Low Income Drug Program.

MS MICHAEL: Right.

MR. WISEMAN: That is the office in Stephenville. So, it reflects two

things. One is the new hires, but it also reflects the annualized costs for

people brought on from last year.

MS MICHAEL: Okay.

That is right; that is where the work is being done is in Stephenville, isn't

it, for that?

MR. WISEMAN: Exactly.

MS MICHAEL: Then, under Transportation and Communications, this one is

quite a movement downward, from $200,000 budgeted last year to only $59,100 this

year. I am just curious as to why.

MR. WISEMAN: That is under 03?

MS MICHAEL: Yes, 03.

MR. WISEMAN: Again, this was the registration process. We had increased

cost last year as a result of the increased postage costs. That should diminish

this year.

MS MICHAEL: Okay, thank you.

It is always nice to see that, isn't it, the cost going down?

MR. WISEMAN: It is not always going in that direction, is it?

MS MICHAEL: No.

On page 200, which is

section 2.3.01. -

MR. WISEMAN: That is the Medical Care Plan, Physicians' Services.

MS MICHAEL: That is right, Physicians' Services. That is correct.

MR. WISEMAN: Okay.

MS MICHAEL: I was looking for an explanation for the three categories.

Well, I think I have number 09. now from Mr. Ball's question. What would the

Grants and Subsidies be in this particular category under Physicians'

Services? What would that be covering?

MR. WISEMAN: Funding in this particular area is to cover salaried

physician payments and the Canadian Medical Protective Association subsidy,

which is the insurance cost, in excess of what has been prescribed by the

physician. We pay the differential for salaried positions.

MS MICHAEL: Right.

CHAIR: Ms Michael, we will pass the baton now, if you don't mind.

I am not sure who is next.

MS MICHAEL: No problem.

I think Mr. Butler is probably next, is he?

MR. BUTLER: With regard to the on line ones that we have here, both of

them covered off on every one of them that I had ticked. My questions now would

be more or less general questions, I guess.

CHAIR: I am sure the minister would be open. Relate it a bit to the

financing (inaudible).

MR. BUTLER: Most definitely, Sir.

MR. WISEMAN: Never off track, are you?

CHAIR: Even in a general fashion.

MR. BUTLER: Minister, back in 2005, and again in 2006, I asked questions

with regard to the long-term care facility in the Carbonear-Conception Bay North

area. I guess the dollar value was placed on it last year through Minister

Osborne, when he stated very clearly that there was $500,000 to look at

priorities on the Avalon.

I am just wondering, was that money spent last year? Between $500,000 and

$600,000 he mentioned. I am wondering what was done, what came from the study or

what have you. Is there anything ongoing even this year, new funding in the

budget for the same project?

MR. WISEMAN: To answer your question, there was an evaluation done last

year. Eastern Health had engaged a consultant to help them with the evaluation

of health facilities on the Northeast Avalon and the Greater Avalon, actually,

extending out to your neck of the woods, out in Conception Bay North, to

evaluate the long-term care facilities particularly, and to come forward with

some recommendations as to what enhancements needed to be made, some commentary

about the conditions of existing facilities, but also some suggestions as to how

we may configure the system on a go-forward basis to address both the long-term

care facilities that are needed in the area but also looking at some of the

acute issues that need to be dealt with in the long term as well.

That was kind of a comprehensive evaluation for Eastern Health on health

facilities in the region, which would have included your area of interest, which

would have been a new long-term care facility for the Conception Bay North area.

Obviously, as you are very much aware, the facilities that are out there now

have been there for a while and we acknowledge, and have acknowledged for some

time, that some of the facilities have some shortcomings. Despite there being

quality programming taking place with some very capable and competent staff,

there are some shortcomings in the facilities.

While this evaluation that was completed in some respects crystalizes that

view, it did not probably tell us a whole lot new, other than it put it in a

much more succinct fashion and provided an overview of the magnitude of the

capital requirements in Eastern Health.

I think it has already been acknowledged before. You mentioned you raised

this here several times in the past. I think it has been acknowledged for you

then, and I will acknowledge it again now, that there is a need to move forward

and to put in place a redevelopment strategy for the Northeast Avalon area, and

at some point in time in the future it will get dealt with. What we are doing

this year is - as I highlighted in some of the priorities that we are moving

forward with in this particular fiscal year - to finish off the projects in

Clarenville, finish off the project in Corner Brook, and start the one in Happy

Valley-Goose Bay, as well as some planning money for the redevelopment of the

facility in Lewisporte. We are still working on a priority sequencing of the

work to be done in the Greater Avalon area.

MR. BUTLER: Thank you for your answer.

It goes back to when Minister Sullivan was there, and Minister Osborne, and I

asked the questions those two previous years. I do not know why this money was

spent on an assessment, because the department must have done that. Carbonear,

Conception Bay North area, was number one priority back over three or four years

ago. It amazes me why that had to be done again. Don't get me wrong; I have

nothing against Clarenville, Corner Brook, Happy Valley, or whatever is going on

in Lab West. I know they need the service, but I fail to understand - and this

is three years I have failed to understand this, so I guess it is not sinking

into me very good - why someone, if there was a priority done - and it had to be

done through the department; it is not just someone out there saying it - that

you were number one on the list, and all of a sudden you drop by the wayside and

now an assessment has to be done again, either there was a poor job done back at

that time, or.... That is why I am asking the same questions, Sir, year after

year.

MR. WISEMAN: Just to put your question into the context of the report

that was done, I hope I didn't mislead you. I intended to give you the

understanding that the evaluation that was done, and the report and study that

was done, was not as much to determine whether or not it needed to be done at

some point but to put it in context for the Eastern Health Authority so they

understood the total magnitude of the capital requirements they needed within

Eastern Health, particularly in the Greater Avalon area - and in that reference

the Greater Avalon extends out into the Conception Bay area - and to look at

what would be the order of magnitude of that kind of extensive redevelopment

that would be needed in a number of facilities. The Conception Bay North area is

one area. Look around the City of St. John's, and the long-term care

facilities that are here, there are some issues that we need to be addressed as

well. If you look at the acute issues that are in St. John's, some of these

things need to be addressed as well.

Out in Carbonear there are some issues in and around the acute care facility

that is out there. Eastern Health would prefer that we make some investment to

change it, to make it much more efficient, the operation from an acute

perspective. That evaluation put in perspective what the greater project would

be for that entire region, so we wanted to get a sense of how we should

prioritize within the Eastern Region.

How those projects rank or compare relative to some of the other provincial

priorities, obviously the fact that some of these other projects are progressing

ahead of those, there was a recognition that some of these others obviously were

a greater priority.

That is one of the unfortunate realities of a budgetary process: you have to

make some choices, some decisions. There is only so much money can be spent in

any one given year, and you establish your priorities and move forward.

We have been making, I believe, in the last two to three years, some

significant investment in capital projects. We have major ones on the go right

now, and with what we envisage continuing to do in responding to the facility

requirements I think you will see, in future budgets, continued announcements

about advances, improvements, enhancements, renovations and new bills.

MR. BUTLER: I guess, Minister, all I can say to you is, I heard one of

your colleagues today, in reference to, I guess, the waste management control,

about the plans of the past, and he said: Now we have the money.

All I can say, Minister: Now that you guys have the money, we hope you will

look at that sooner rather than later.

The other one, Sir, I am wondering: Is there any funding in the Budget this

year to return the Alzheimer's unit to the Harbour Lodge in Carbonear, or, now

that the unit is closed, it will not be returning to that particular area of the

Province?

MR. WISEMAN: There is no money in the Budget this year to reopen it. To

be frank with you, to tie that to your first question, if we are looking at what

we need to do long term in that region, we would rather invest our money and

make decisions about investments in that region looking to the future and what

that future might entail. If dementia care is something that is needed in that

region, then obviously we would want to move forward with a new model.

I think what we are doing on the West Coast, in Corner Brook, with these new

bungalows reflects a new line of thinking, reflects a new model of care for

people with dementia, and, should we move forward out in your region, I suspect

we would forward with that same kind of model for the delivery of those

programs.

MR. BUTLER: Minister, I don't know which line this is on, but I know

you announced this year in the Budget that for the Kids Eat Smart program there

was an additional $250,000 over and above the $500,000. I think that is correct,

is it?

MR. WISEMAN: We did. Where you would see it in here would be under the

money, the grant allocation, to the Regional Health Authorities. We would flow

the money through the Regional Health Authorities and it would come out.

MR. BUTLER: Okay.

MR. WISEMAN: The exact dollar - Jim, you can help me with this.

MR. BUTLER: I thought it was in the Budget Highlights that there was

$250,000.

MR. WISEMAN: Yes, there was $50,000 from Health and $200,000 from HRLE;

that was the total provincial investment in the program.

MR. BUTLER: My question in relation to that - I know just a couple of

years ago, when the Opposition were asking questions, the answer at that time

was that they felt the Kids Eat Smart program had plenty of funding. I would

like to see more than this there. I am not downing that part of it, don't get

me wrong, but at that time they felt that there was plenty of funding there

coming from other sources, and government felt they would just stay. I was

wondering what has happened to see the additional $250,000 go in this year. I

know there is a greater need, there is no doubt about that, but just a year ago

we were saying there was plenty there because they had funding coming from other

organizations, community groups and so on.

MR. WISEMAN: From what I understand, and I will ask one of my officials

to comment after, they have done a tremendous job in expanding in the number of

schools. I know in my own district this past year they have expanded into two

new schools. They have been growing the program and many more schools are coming

on stream. This increased funding reflects two things. It reflects the increased

activity at each individual school in the program, but it also reflects growth

in the number of schools that have been added to the program. I don't know if

anyone has any data on the exact numbers.

The other thing, the other piece of it, the $50,000 that went in from our

department reflects a new guideline for the types of food that is being served,

and more emphasis on fruits and vegetables, in keeping with the new food

guidelines for the schools. That had an increase in enhanced cost. The other

piece, as I said, is the increased number of schools that are participating. I

do not know if you asked the question in the Estimates with HRLE, but the total

number of schools would probably be a piece of information that they would have.

MR. BUTLER: I will ask that in the morning.

MR. WISEMAN: Yes.

MR. BUTLER: I know under one of the headings, Minister, one of my

colleagues asked the question with regards to - I know you referenced the MCP,

the increase in one of the figures there. I was just wondering: Based on the MCP

part of it - we have had a lot of calls this year, I have anyway and probably

other people have as well - where they are changing over to the new MCP card, a

lot of people are having to come back and buy a birth certificate for whatever

reason. I do not know what the problem was in the system. I thought it was just

one or two people. I did it for my mother-in-law as a matter fact, got her the

card and had to get her birth certificate. I thought I was just one incident,

but there are many, many people.

I know it is probably not a financial figure, Mr. Chair, but I am just

wondering: Can you elaborate on what caused that problem?

MR. WISEMAN: Just to back it up a little bit, when the original

registration took place - I do not want to comment on what may or may not have

been accurate information in the file. If you are registered today as having a

particular date of birth and it was an error and you have been using the card

since its beginning with that mistake on it, now when you go to re-register you

fill our your form and on it, it asks for your date of birth. If you put in a

different date of birth than was in the system, you need now to justify why that

exists, because you want to make sure you are registering the same person.

Not everybody had their copies of baptismal certificates which were

acceptable and some did not have copies of birth certificates. Generally

speaking, most people had copies, if not of their birth certificates of

baptismal certificates, because the churches generally issued the baptismal

certificates and birth certificates came from the Registry here. There were

some, obviously, who did not have either and we had a difference in what was

already in the Registry as being a date of birth and what was now on the new

application. We had to reconcile that in some fashion, and hence the requirement

to get something to prove that you were, in fact, the person and that this was

your accurate date of birth.

MR. BUTLER: Minister, the only thing on that - and I thank you for the

answer - I know a lot of people received correspondence initially saying, we

will not accept your birth certificate, because, they said, you have to buy the

new one, but then afterwards they would accept them.

MR. WISEMAN: Yes.

CHAIR: Mr. Butler, given the extensiveness of the minister's answers, I

will not say lengthy answers, extensive and comprehensive, we allowed you a few

extra minutes in any case, but we can come back.

MR. BUTLER: Thank you.

CHAIR: I am sure there was a cost to that birth certificate, but I would

not be so kind to ask if you charged your mother-in-law.

MR. BUTLER: No, I did not. Unfortunately, it was $25, not the new $20.

CHAIR: So there was a financial implication to it indeed.

Who is up? Mr. Ball.

MR. BALL: It seems, consistently throughout the Budget and the Estimates,

you get your Salary line and right beneath that you have your Employee Benefits

line. There does not seem to be any rhyme or rhythm. Is that a percentage, or

how do you come to the Employee Benefits line?

MR. STRONG: The Employee Benefits line only covers off the cost of

individuals attending a professional development course, that type of thing.

Employee Benefits in a statutory pension, EI, that context, are all budgeted

centrally in government in the Department of Finance, so it really depends on

the division, the mix of staff there and the extent that there is a need to give

ongoing professional development to them.

MR. BALL: Is it fair to say it is solely professional development or

would there be something else included in that?

MR. STRONG: It is primarily that. We spoke earlier in this session about

the occupational workplace safety commission expenditures, those types of

things.

MR. BALL: The MCP re-registration, I guess the deadline now, we are

expecting that to be clued up by the end of July. Are we still on target for

that?

MR. WISEMAN: There are about 35,000 people who have still not filed an

application. Right now we have new cards issued. As of April 27 we had 422,479

issued. We still have 45,347, to be exact, applications that we have on file

that we are trying to reconcile and we require additional information for. There

is some error, as I said a moment ago, in what was in the database and what is

now provided on the new application. We need to reconcile that. We are

corresponding and contacting the individuals to get some verification and

clarification on the differences in the data. We are still on target, and given

the numbers that we are processing on a daily basis we are very comfortable that

we will have, by July 31, anybody who is in the system registered. We have no

control of those who do not submit applications and there is still a pertinent

number of them out there, but we are still on target.

MR. BALL: Yes.

Out-of-Province transportation for people looking for diagnostic services or

something like that, where does that show up in the Budget?

MR. WISEMAN: That would be in the MCP budget, I think.

WITNESS: (Inaudible).

MR. WISEMAN: I have just been reminded it is under the Regional Health

Authorities Budget.

MR. STRONG: Subhead 3.1.01.09.

MR. BALL: Okay.

It is about $5 million. I guess we spent $6.4 million last year. Is there a

reason why that number has dropped?

MR. STRONG: There is more than medical transportation systems funded out

of that account.

MR. BALL: I guess that is what I was trying to get to. I am just trying

to get a figure for what we actually spend on Out-of-Province transportation.

MR. STRONG: The budget for that, for medical transportation assistance

for 2007-2008, is $1,708,100.

MR. BALL: I will not consider that an estimate.

Is there a particular region of the Province that we find would use that more

often than others, or is it evenly distributed do you think?

MR. WISEMAN: The Province or the provincial travel budget -

MR. BALL: No, I am talking about the Out-of-Province. Would you find a

particular region has to use it more than others? For instance, would Labrador

use it more than Eastern or Central?

MR. WISEMAN: Labrador would have more frequent travel under the program

because they are travelling in and out and travelling within Labrador from

Labrador City into Happy Valley-Goose Bay for diagnostic services or that they

would travel from Labrador into St. John's for health services. They would

have more frequent use. If you look at the population distribution in the

Province you have the larger portion of the population in Eastern Newfoundland,

so just on ratios you would assume that there would be larger numbers of people

leaving the Eastern part of the Province, out of the Province for health

services, just by population distribution. That is an assumption on my part.

MR. BALL: I was more concerned with the ones for Out-of-Province. Is

there any particular speciality right now that we are having a problem with

where we have had to take people, let's say, to Nova Scotia or Ontario or any

other province more than others?

MR. WISEMAN: I do not know if I can get an answer for your question in

terms of what particular diagnosis it would be, but it would be in the areas

where we now do not provide that speciality in the Province. In the areas where

we provide that service in the Province it would be a very rate occasion that

someone would have to leave. If we provide the service then they would not.

Those areas where we do not provide the service is where you would get the

frequent Out-of-Province travel.

MR. BALL: I am trying to remember myself what the agreement was that we

had with - was it St. Margaret's. What was that?

MR. WISEMAN: That was cancer treatment I believe, wasn't it?

MR. BALL: Cancer treatment, was it? Are we still involved in that service

now or -

MR. WISEMAN: To answer your question, the new bunker that is being built

at the Health Sciences Centre, at the H. Bliss Murphy cancer treatment centre,

is actually intended to respond to that. Correct me if I am wrong, John, but the

travel for those people going out is being paid for by Eastern Health because

they are not providing the service and it is not coming out of this block that

you are looking at here.

MR. BALL: Colon and rectal cancer, I guess we have an alarming rate in

the Province right now. Is there a screening program planned at all, or is there

any initiative ongoing right now or, I guess, in the development stage?

MR. WISEMAN: Moira can comment a little further for me if you want her

to, but the whole issue of a strategy in and around cancer, we have two

screening programs right now. As you are aware, the Province, together with the

Cancer Society and other stakeholders, is now in the process of developing a

comprehensive strategy to deal with cancer in the Province. That deals with it

from the prevention piece to the early detection right up through treatment and

into palliative care if necessary. There is a fairly broad approach looking at

cancer care for the Province, and screening becomes a piece of that whole

continuum. Any new initiatives that would grow out of that strategy, obviously

we would wait until the strategy is developed and identify where we need to go

as a result of that kind of broad stakeholder participation in developing input

into future directions.

MR. BALL: Any idea when that strategy will be in the department's

hands?

MR. WISEMAN: Early fall, if I am not mistaken. September, isn't it?

WITNESS: Yes.

MR. WISEMAN: Early fall.

MR. BALL: I guess in many areas of the Province - we do not hear it as

often as we used to - I guess, was the whole idea of health care professional

shortages. Are the numbers coming down now at all?

MR. WISEMAN: We have had some real good success in recruiting physicians.

We have had some real good success in retention. We found that with Memorial's

medical school, with their high numbers of Newfoundlanders in the program, or

high numbers of rural Newfoundlanders in the program, we are finding that the

retention rates have been really good. We have been able to keep more of our MUN

grads in the Province than we ever have before. You will hear periodically,

ongoing issues with family physicians being difficult to recruit. We have a

couple of practices out in Gander that are recruiting now to fill positions.

Right now, as of the end of March, we had some 985 positions in the Province,

the highest number we have had in our history; 481 of those are GPs and 504 of

them are specialists. In terms of total numbers we are better off today than we

have been in our history.

At the same time, as I have said - I will use Gander as an example because

that is a recent discussion that the people have been involved with. Two family

practices out there, two clinics, are trying to recruit replacements.

Periodically you will hear stories of that happening. I think right now, if you

look on the web page, we are doing some advertising because we now have a

centralized recruitment process for the Province. There are some seventy

positions that are being advertised on that particular website, for example. So

there is always going to be a certain amount of turnover. That has been our

history and that will be our future. There will be a certain amount of turnover

and there will always be recruiting.

We will have, in July, of those who are graduating from MUN's medical

school, twenty-two of them who will be graduating with return in service

commitments as a part of the bursary question you posed a little earlier. We

will have twenty-two graduates coming out this year who will be staying in the

Province as a result of that return in service commitment.

MR. BALL: Thank you.

There is $1.4 million in the Budget for insulin pumps, I guess, for kids up

to age eighteen. I was told yesterday to hold on because the Budget is not

approved yet, so I will hold on. Any idea what the $1.4 million breakdown is

going to be in terms of where you expect that to be in supplies versus pumps?

MR. WISEMAN: Moira, you can comment. I think there is a fixed cost on the

pumps, so we are estimating about a little over $4,000 a pump and we are

estimating about 100 to be purchased. I do not know the exact figure there, but

that was the ballpark I think, a little over $4,000 for the pump, but 100 to be

purchased. The rest you can see would come from the supply piece. The ongoing

supply piece, as you would appreciate, would be the greatest cost because it is

a recurring one. The initial purchase of the pumps would be the smallest piece

of the investment really.

MR. BALL: So in the $1.4 million there is no allocation there for

education or extra diabetes educators?

MR. WISEMAN: Not the diabetic educators, not in that budget. Moira can

speak to this as well, because in the last couple of years each of the health

authorities have made significant investments in diabetic education. The primary

health care projects have been really focusing on diabetic education. Most of

the regions now, in fact the four regions, would have a fairly good complement

of diabetic educators currently in place. Therefore, that particular budget item

you are talking about now is very much for the pumps and for the supply of

insulin on an ongoing basis. Hand in hand with that, we are just not going to be

buying pumps and giving them to people to start plugging them in to use them.

Obviously, as a part of giving them the pumps there is a fair bit of education

that would go with that. It is a given. It is not in the Budget because the

people who are already diabetically' educated are in the system today so

that education would be a significant part of a launch of the program. The line

item you are referring to actually goes to the purchase of the pumps themselves

and supplies the insulin.

Do you have a number there Moira in terms of what the cost might be?

MS HENNESSEY: The cost of the pump ranges between $6,300 and $7,000

depending upon the volume that you buy. If we buy 100 or more we can get them at

$6,300. If it is less than 100 it is $7,000. The monthly supply costs are in the

range of about $400 per month.

Just to add to what the minister said with respect to the diabetes education,

the program will be upgraded by Eastern Health so the diabetic education nurses

at the Janeway Hospital will provide the initial education to families and to

children, and then when these people return to various parts of the Province it

will be the diabetic education nurses in the various regions who will provide

additional education.

CHAIR: Mr. Ball, did you have more on the pumps because we are going to

move to Ms Michael? Do you want to continue on that topic?

MR. BALL: No, I am fine. Thank you.

MR. WISEMAN: It is a good thing you did not use my figure of $4,000 a

pump. I was off by $3,000.

MS MICHAEL: I picked up on that.

Thank you very much, Mr. Chairperson.

I have some more line questions and a couple of general ones.

Section 3.1.01, Regional Health Authorities, line 03, Transportation and

Communications: The budget has gone up, both the budget last year and the

revised figure. What are you anticipating this year to bring it up to $236,000?

MR. WISEMAN: Jim, do you want to comment on that for me, please?

MR. STRONG: This activity here, Transportation and Communications, would

cover the cost of staff who are working in rolling out the child care services

programs. It is the cost of the staff of the department meeting with staff from

the regions on program design, some conferences associated with different

program elements that are being introduced. It fluctuates from year-to-year

depending on what stage each initiative is at. That is why you see a fluctuation

from budget to revised to next fiscal year.

MS MICHAEL: It is a fair bit, $104,000 over what was spent last year.

What would be the new programs that would require this new travel for the staff

to have the meetings and conferences?

MR. STRONG: For intervention services, dealing with autistic services,

there are some quarterly supervisor meetings and teleconferences. The family

resource centre programs will be holding quarterly meetings.

MS MICHAEL: Could I ask - I used to know this figure, but I do not

remember it now: How many family resource centres are there under the provincial

government?

MR. STRONG: I do not have that figure here. I could get it for you.

MS MICHAEL: The family resource centres, are there any that are co-shared

with federal funding or do you have separate provincially funded ones and

federally funded ones? Are they all co-shared?

MR. STRONG: They are all federally funded, yes.

MS MICHAEL: Oh, okay.

Then, under Allowances and Assistance, there is a change of $1.5 million from

the budget of last year to the revised figure. That was quite a jump. What

happened last year that you did not anticipate? I am assuming there was

something that was not anticipated, because that is quite a jump from the budget

to the revised figure. That is line 06. under the same section, 3.1.01. -

It is Allowances and Assistance - 09, I am sorry.

MR. WISEMAN: There was a one-time settlement of $1.4 million as a result

of a Labrador health centre in Happy Valley-Goose Bay. When it was built there

was a dispute in the awarding of the contract and there was a settlement of that

legal dispute associated with that particular project. That is where this fees

comes from. Contract administration is done by Transportation & Works, but

because it was associated with a health facility it came out of this budget.

MS MICHAEL: I see. That would explain it.

Thank you.

Under subhead 3.1.02, Support to Community Agencies, I am just wondering what

would be - just to give me an idea of the community agencies that do get money

from the department to do their work. I do not want a comprehensive list but

just to give me an idea of the types of agencies.

MR. WISEMAN: I will just start reading down through some of them. Tell me

when you want me to stop.

MS MICHAEL: Okay.

MR. WISEMAN: We have the AIDS Committee of Newfoundland and Labrador; the

Autism Society; the Newfoundland and Labrador Association for the Deaf; the

Canadian Hard of Hearing; CHANNAL; the Canadian Paraplegic Association; the CNIB

rehab services; the CNIB vision care services; the CNIB Summer Intervention

Program; the Coalition Of Persons With Disabilities; Community Services Council;

the Community Food Sharing Association; the Community Mental Health Initiatives;

the Newfoundland and Labrador Foster Families; HIV/ AIDS Labrador Project; Au

pair; the Independent Living Resource Centre; Longside Club; the Newfoundland

and Labrador Lung Association; the Newfoundland and Labrador Association for

Community Living; Newfoundland and Labrador Pensioners and Senior Citizens

50+Federation; the Sexual Health Centre; Schizophrenia Society of Newfoundland

and Labrador; the Seniors Resource Centre of Newfoundland and Labrador; Single

Parent Association of Newfoundland; the Hub; VON; Turnings; seniors

programs......

MS MICHAEL: Okay, minister. That gives me a good idea. Thank you very

much.

MR. WISEMAN: A good cross

section of the community.

MS MICHAEL: A good cross section, right. Thank you very much.

Just a couple of more of these tedious ones.

Under subhead 3.2.01 - not a major question but it is a general one - line

01, Property, Furnishings and Equipment; a $12 million jump from the budget last

year. Would this be some special equipment that is going to be purchased this

year?

MR. WISEMAN: Yes. This is medical equipment for facilities. What we have

done is, for example - I mentioned earlier about the two bunkers at the Dr. H.

Bliss Murphy Cancer Centre. Obviously the new systems that are going in those

bunkers are going to be purchased this year; $5.9 million. In essence what this

is: Each of the health authorities provide us with their priority equipment

list, so we are able then to respond to some of those requests. Eastern is

getting $13,656,000; Central is getting $1,095,000; Western is getting

$5,072,000; Labrador-Grenfell is getting $802,000; and then we have a

contingency in there of $1 million because sometimes throughout the year some

piece of equipment will break. We do not know where it is yet but it will

happen.

MS MICHAEL: Right.

MR. WISEMAN: We have that in there together with some money we have set

aside, $300,000, to help health foundations across the Province do fundraising

projects. Sometimes we help match some of the funding that they raise. We have a

small amount in there to help with those. That is what gives us the two point

six. The increase is obviously because we are in a position to buy more

equipment this year than we did last year.

MS MICHAEL: Which is good.

MR. WISEMAN: Yes.

MS MICHAEL: Thank you.

Finally, the next section, 3.2.02. I taught myself to never assume so I think

I know the answer, but I will ask anyway. With the Professional Services and

Purchased Services, there is a jump of about $30 million in both cases. I am

presuming, with regard to the new construction and redevelopment, you actually

do have to get outside contracts to do that?

MR. WISEMAN: Exactly. That is what that figures represents.

MS MICHAEL: Right. So it all has to do with the planning and

construction.

MR. WISEMAN: Exactly.

MS MICHAEL: Tied to that then, you mentioned the different capital

projects and I am wondering: Do you have the breakdown, for example, of how much

money has been put aside for the work in Labrador West on the facility there in

this year's budget?

MR. WISEMAN: In this year's budget we have allocated $2,250,000 for the

Labrador West project.

WITNESS: (Inaudible).

MR. WISEMAN: Oh, I am sorry. I was just going to give you the wrong

figure. That is covered under Professional Services and Purchased Services.

MS MICHAEL: Right.

MR. WISEMAN: What I am giving you now is double that actually. That will

give you $4.5 million for Captain William Jackman; $2.2 million under

Professional Services and $2.2 under Purchased Services.

MS MICHAEL: Okay, thank you.

I cannot remember the figure that had been allotted in the past year for

Labrador West. Has all that been spent? It seems to me that there was an amount

of money allocated last year but nothing actually happened except the testing of

the ground, et cetera. Was there money allotted in last year's budget?

MR. WISEMAN: Not -

MS MICHAEL: No. So this is the first money that is actually -

MR. WISEMAN: There was a bit of money allocated last year, though it was

more to do with some problems of the current facility that they have down there.

MS MICHAEL: Right, okay.

MR. WISEMAN: But not for the planning piece.

MS MICHAEL: So the $4.5 million is the first new money that is going

towards the redevelopment?

MR. WISEMAN: Just let me verify that before I tell you definitively, but

I think you are right.

There was $300,000 in last year's budget to deal with the site selection

process.

MS MICHAEL: Okay, thank you.

Just one more question of a more general nature. I think we all know that

there have been some problems - I do not know if problem is the correct word -

in some of the health care facilities, including the senior citizens' homes,

et cetera, with regard to permanent and temporary positions and some with regard

to nurses, nurse practitioners, et cetera. I think I did hear you say, I do not

know if it was tonight or in a Question Period in the House, that there has been

some move towards trying to get more permanent positions. Can you give us any

kind of a report on that?

MR. WISEMAN: What I may have referred to, in respect to the nursing

profession - very particularly, Eastern Health have made a move to make many of

their temporary positions permanent. In some cases, nurses wanted to stay in

casual positions, but they made a major move to create more permanent positions

or convert these temporary positions to casual.

I am not certain if we have an exact number by region about what has happened

with that, but I know each of the authorities, as a part of their recruitment

and retention strategy, have done two things. One is to make that conversion

that you just referred to, and the second is to come up with various incentive

schemes to attract new people to their organizations. One of the things that

they have found that they had to do is, when they recruit to recruit permanent

full-time positions because they were not as attractive to be recruiting in the

temporary positions. They have done both of those things.

MS MICHAEL: Are there any brand new positions, period, being created? I

would assume there are some, but do you have an idea of a plan around trying to

increase numbers of positions whether they are temporary or permanent?

MR. WISEMAN: I think this year, for example, I understand from

conversations a couple of days ago with Eastern Health, that they have made an

offer to any new nursing graduate this year who wants a permanent job, we have

one for you. There is a total of 200 that we have created as a result of the

recruitment initiatives of the authorities.

MS MICHAEL: Brand new positions?

MR. WISEMAN: Yes.

MS MICHAEL: Very good. Thank you very much.

CHAIR: Okay, Ms Michael, we can go back to you again.

Mr. Butler, are we going back to you?

MR. BUTLER: Minister, I know in one of your questions a little while ago

you were referencing the doctors that will be graduating. I thought you said

there were twenty-two who would be staying here in reference to return to

service. I was wondering if you could elaborate on that? What time frame does

that mean they stay here in the Province? Is it a year or two years, or do they

move whenever they want to move? I think I misunderstood what you were saying.

MR. WISEMAN: The reference I made to twenty-two was, there were

twenty-two graduates this year who had a return-in-service commitment to stay in

the Province based on the number of years that they received funding, so it is a

match. If they receive funding for two years, they stay for two; if it is three,

then it is three. It is a match for the return to service.

Ms Michael, I just want to correct - the deputy just reminded me of an error

in what I just told you a moment ago. There are 200 graduates but not 200 new

nursing positions created.

MS MICHAEL: It sounded good to me.

MR. WISEMAN: Eastern Health, I think, had a little over 100 who they

themselves had recruited as a result of the 200 graduates coming out, and they

had, in fact, been successful in recruiting. Some of those they recruited were

to replace vacancies they would have had, so it may not necessarily be new

positions added but new people recruited.

MS MICHAEL: Okay.

So, you are not sure of how many new positions they had.

MR. WISEMAN: We could get that number for you, actually, the number of

new positions created as a result of the budget process. We will get that for

you.

MS MICHAEL: Okay, thank you.

MR. BUTLER: On that same vein, Minister, that was one of the questions I

had to ask; because I have spoken to some of the nurses at the Carbonear

Hospital and what I am hearing is that within the next eight to ten years

possibly just about all of the people working there now will be of age of

retirement or what have you. They were expressing a concern that hopefully there

will be a plan to entice those nurses to stay here in Newfoundland and Labrador.

Is there any return-in-service in the same way as you referenced with the

doctors as, per se, with nurses?

MR. WISEMAN: The deputy can just elaborate on this for me a little bit. I

know that Labrador has come up with a program for their recruitment efforts for

the Labrador Region, where they are providing a bursary scheme, but the other

three authorities, to my knowledge, have not come up with a bursary scheme.

Maybe you can comment further for me.

MR. ABBOTT: Eastern Health is looking at something to parallel what

Labrador-Grenfell has been doing for sort of the hard to fill, primarily in the

rural areas of the Eastern district. They are looking at how to retain, one, and

then attract new. It is an evolving piece and we are doing a lot of analysis and

discussions with the nursing profession and the unions as to how we can maintain

our workforce.

MR. WISEMAN: One of the things we have done, too, our chief nurse that we

hired a couple of years ago is now heading up a group of stakeholders as a part

of a human resource planning process looking at nursing, yes, but looking at

some of the other health disciplines as well; because we do, as you just

mentioned, acknowledge the demographics of our workforce and the need to start

looking at planning for their retirements.

MR. BUTLER: My next question I am going to put in three parts because,

when you answer, it will all be tied together and it is not like I am trying to

push three questions the one time.

Government announced last year that it was putting together a pandemic plan.

I think in Budget 2006 they committed to $4.7 million. I was wondering how that

plan is progressing. In 2006, as well, I think there was $800,000 to be added to

stockpile the treatment that would be kept on, in case such a thing should

happen. The last part of the question is: I also understand government was to

hire thirty-nine new health nursing positions over the next two years just for

that particular program. I am just wondering - that would include I think it was

$1.5 million to begin that process - how the full influenza planning, the

pandemic plan or whatever you want to call it, is unfolding with regard to, I

guess, the treatments being stockpiled, as well as the thirty-nine public health

nurses who would have been hired just for that purpose alone.

MR. WISEMAN: I will ask the deputy to comment, but thirty-nine public

health nurses would not have been hired just for that program. They would not

have been dedicated to the pandemic influenza.

I might ask you to comment in terms of the current status. I understand

thirty-two have been hired out of those thirty-nine. You can probably give us an

update on the preparedness process.

MR. ABBOTT: In terms of the pandemic planning, each of the health

authorities and the department are engaged on a daily and weekly basis on the

planning exercise, and we have come a long way in the year. In terms of our

pandemic plan, we will be out in the near future with that plan. It will have to

be presented to Cabinet, reviewed, and then a determination made as to its

release.

One of the reasons we delayed the release of the plan was waiting for the

federal government to release theirs, which was done in December. This time last

year we were assuming it was going to be in the spring, but they pushed theirs

off and we needed to adjust ours based on their planning because they are tied

in on many fronts, so that piece is going. There is a lot of planning activity

at each of the boards, and that is a positive thing, and we do weekly reports on

all of that planning activity.

In terms, then, of the antivirals and the stockpiling, we have those in place

here in the Province, and we work with the federal government in terms of

storage, but they have a limited shelf life so we will have to talk to the

federal government about replenishing that in future years.

In terms of recruitment of positions, we have recruited both at the

department for planning purposes, we are working with the new office under the

Minister of Municipal and Provincial Affairs, and we are working in terms of

recruitment of staff in each of the regions, so each of the regions have

emergency planning officials in place.

As the minister said earlier, of the thirty-nine public health nurses, we

have recruited, I think, around thirty-two of those, and the balance we expect

this year. It was quite successful and well received.

MR. BUTLER: Like I mentioned here in Budget 2006, it was $800,000 for the

stockpile of medication. Is there extra funding in the Budget for 2007 to

continue on with that, or is that sufficient to look after the needs, God

forbid, if anything should happen?

MR. ABBOTT: There is no additional money for that purpose, but we are

continuing discussions with the federal government as to when that should be

replenished, and we will be seeking federal funding for that.

MR. BUTLER: Very good.

Mental health and addiction services - last year, I think, the new act came

into place, and in this year's Budget, I believe, it was $1.6 million. I was

just wondering: When will this amount be actually spent on the act, and how will

the framework unfold in relation to that amount of money that was announced this

year?

MR. WISEMAN: Your question is, how are we going to spend the money?

Simply put.

MR. BUTLER: Simply put.

MR. WISEMAN: Well, this year we have included - $2.4 million is the

total. As a part of that particular budget there is the new Eating Disorders

Program that has been established, a provincial program that has been

established. This year it is going to be $228,000.

Then we have the issues around gambling. We have a new investment in gambling

that we talked about a little earlier. The Member for Humber Valley talked about

the spending on the advertising, so we are making continued investments in the

gambling program.

There was $800,000 itself going into the policy framework, another $800,000

when we proclaim the legislation and our responsibilities in compliance, and

$575,000 in total for the problem gambling initiatives, and the $228,000, as I

mentioned, about the provincial Eating Disorders Program.

The policy framework, the $800,000 into the policy framework, includes six

positions at the Regional Health Authorities. Two will be addictions counsellors,

two mental health case managers, and two administrative managers. As well, that

will include some grants for the Canadian Mental Health Association and the

Schizophrenia Society, as a result of funding some public awareness campaigns

that they will be engaged in, and also to support the Mental Health Advisory

Committee that has been established.

The $800,000 to support the new legislation includes: three new assertive

case management teams, two patient rights advisors, education and training of

health care providers, and the data reporting that will be necessary.

That is how we are spending the money with respect to the framework itself

and the initial new bodies.

MR. BUTLER: Thank you.

Minister, last May government introduced its Early Learning and Child Care

Plan. I guess we hear from time to time there are still problems within that

particular - if I can use the word - industry, for lack of another word at this

time. I know we have heard the department saying that there have been 500 to 700

child care spaces created. I was just wondering if there is a list and a

breakdown of those, and are they real spaces or is it subsidies that have been

approved?

MR. WISEMAN: I tabled in the House yesterday, I think it was, a list of

the new spaces that have been created since 2004, so we have the spaces.

The other question you had was around the subsidy figure.

MR. BUTLER: Sorry, Minister, to ask, but I didn't realize. I didn't

see the list.

MR. WISEMAN: That can provide you with the number of spaces, but in that

same period there has been a total of 555 subsidies created as well.

MR. BUTLER: I am sorry; I didn't realize that was there. I apologize

for that.

MR. WISEMAN: That is no problem. No, no, don't apologize.

Did you get a copy of it, then?

MR. BUTLER: Yes, I did.

Thank you.

MR. WISEMAN: Okay.

MR. BUTLER: My next question has to do with fibre.

MR. WISEMAN: You should eat lots of it.

MR. BUTLER: I don't know about this, but I am going to ask.

The health care system - and I am referencing the fibre optic deal, I guess,

through Persona. I am just wondering, if that were to take place, what

improvements would we see in services and delivery, and are there any gaps now

that we are lacking because we do not have those extra lines, I will call them,

for lack of a better word - I don't think that is the right word - fibres or

whatever? I was just wondering, was your department contacted to pass along any

information with regard to this deal, and was it just submitted or was it

requested, or maybe neither one of them. I don't know; I am just asking.

MR. WISEMAN: Just to answer your first general question, one of the

things in the very beginning when I talked about the new initiatives and some of

things we have accomplished, I talked about the PACS system. One of the critical

issues for us with the technology, especially with imaging technology, is our

ability to be able to transmit across the Province between health facilities,

between physicians' offices, good quality imaging. So, if we are doing an MRI

or a CAT scan, or a general X-ray or an ultrasound, and it is being done on the

Northern Peninsula or the West Coast, we need to have the ability to be able to

have that image displayed at any physician's office anywhere in the Province.

To be able to do that with the kind of resolution that we need for a radiologist

to read a film that has just been taken, or a picture that has been taken, in

Port aux Basques, in order to have a radiologist here in St. John's or in

Corner Brook or in Grand Falls anywhere read that with clarity, we need

bandwidth. In order to get the bandwidth that protects the resolution, we need

to have the capacity as being proposed in that new initiative.

Without having that capacity and that ability to be able to transmit like

that, then you obviously will not have the ability to use the full application

of electronic health system. If we are looking at where we are going, and some

of the things we are doing with (inaudible) health then that is going to be

something that is going to be critical for us.

To answer the second question, which was: Was there a direct request? It was

before my time as minister, so I don't know.

MR. BUTLER: Would your officials be able to answer that, seeing you were

not there at that time?

MR. ABBOTT: I guess the simple answer is, no, we were not involved in any

of the discussions.

MR. BUTLER: Thank you.

CHAIR: Mr. Butler, are you finished on that point?

MR. BUTLER: Yes, on that point.

CHAIR: Okay, I am going to go to Mr. Ball.

MR. BALL: Minister, a few months ago, maybe weeks ago now, we committed

to taking

part in the new federal wait list reduction program in terms of

cardiac care. I guess there are still probably four, maybe five, other

components to the wait list reduction program. Is there a plan for us to

participate in a more active way in the other strategies?

MR. WISEMAN: Are you talking about the areas where we are now measuring,

we are establishing benchmarks?

MR. BALL: Yes, cataract surgery, hip replacement.

MR. WISEMAN: Just to separate the two things for you: The First Ministers

agreed upon a series of programs and services where we would start working

towards establishing benchmarks. Each jurisdiction would start to measure their

performance relative to those benchmarks, and we would report on them on a

regular basis to the people of the country. We will continue to do that as a

part of that overall process and we will continue to make enhancements in the

wait times. We have been doing quite well actually, in terms of our reporting

relative to the rest of the country on those areas where we are bench marking

and measuring ourselves.

Separate and apart from that, and not necessarily related , and they are not

one and the same, the guaranteed wait time initiative is not the same as the

benchmark project. Obviously, if you are going to guarantee a particular service

within a very specific period of time, which is what the guaranteed wait time

does - and we have selected cardiac surgery, cardiac by-pass surgery - then it

is obviously a service that you have measured. You are actually seeing how well

you are performing. That service was selected from the benchmark group.

I think it is important to acknowledge and recognize that when these services

were established, that they would be a part of that benchmark project, it was

never assumed or agreed upon or discussed that they would automatically, at some

point in the future, roll into wait time guarantees for each and every one of

these programs and services. The notion of having a guaranteed wait time was an

initiative by the federal government and it was on their insistence that each

province would do it, and to get us to do it they tied some funding to it. The

benchmark projects, in as much as yes we did select one from that pocket to do

the guaranteed wait time with, are not necessarily one and the same.

If we were to, in future, go down a road of adding new programs or services

to a wait time guaranteed list I suspect it should be done in a much more

comprehensive view than when we approached this particular one. This was a one

of, done as a result of federal government holding out a carrot, then beating

you with a stick and saying, you have to take it. That is why we did it.

MR. BALL: I understand that particular initiative ends in 2010?

MR. WISEMAN: No, it does not end. What it means is that we have to have

the guarantee implemented by 2010. What we have is, between now and then to

ensure that we have the capacity with the increased infrastructure to allow us

to actually meet that benchmark in a guaranteed fashion. If we cannot do it here

in the Province, we have to send these people someplace else to have it done

within the guaranteed time.

MR. BALL: I cannot help but wonder what the penalty would be. They could

not actually undo the bypass surgery, I guess, could they?

MR. WISEMAN: No.

MR. BALL: The interest charges on the Regional Health Authorities - it

was interesting, but I did not realize until this week that the municipalities

are going through some similar situations in terms of debt financing. I am just

wondering if there has any consideration given to the department to consolidate

this debt similar to what the municipalities have done and take this out of the

hands of the authorities. I always felt that should be front-line health care,

and to see money spent on debt servicing just kind of flies in my face. I do not

know how you feel about that.

MR. WISEMAN: It is interesting. I generally give the specifics of it, but

as a general comment first: Interesting enough, we gave you the figure in terms

of accumulated debt. From the servicing perspective, Eastern Health is probably

the best example to use. They are not incurring any debt-servicing cost at all

because of the cash flow issues, because of the way we advance the money to each

of the authorities. With the volume they have and their budget, with their cash

flow, it is not costing them any money for service debt. It is a paper debt; it

is not a bank loan.

MR. BALL: Forgive me, but I would see that as a missed opportunity for

the authority. They could invest it and make some more money.

MR. WISEMAN: Then, at the same time, if they were to do what you suggest,

we would consolidate a debt that would become a bank loan and then we would have

a debt-servicing cost. That is coming out of the public coffers and out of

general revenue, and that is money that we do not have to spent anywhere else.

So, that is the other side of it.

MR. BALL: I have seen the cash surplus for the Budget this year so I do

not think we are going to have that problem.

One thing, I guess, I have a little bit of familiarity with given the

background is the turnaround time on special authorization approvals for

prescription drugs. I am just wondering if there has been any consideration to

adding some people to that particular department so that we could actually put a

benchmark there as well. Right now it probably takes a minimum of ten days by

the time the form gets in there. I received a call this morning from a

constituent who was having a problem with it; there was a new medication. To say

you have to wait ten days, it seems like too long a time.

MR. ABBOTT: Mr. Ball, your point is well taken and it is something that

we are looking at because we do want to improve on those and we have been

talking to the association on that point as well.

The immediate challenge for us would be recruitment of pharmacists and that

is a bit of a challenge for us to get the numbers we would need at any point in

time. We have directed our director of pharmaceutical services to address that

issue. If we can recruit some additional pharmacists to help us with that, then

that is something we will do.

As we discussed earlier, before the session began, in terms of getting the on

time system in place, it will help free up some of their current work to focus

really on what is a quality added piece that we expect our pharmacists to do and

get them out of the administrative roles that they are involved in. It will be

some time before we get this where we want it.

MR. BALL: Thank you.

Just as a suggestion, maybe some of the guidelines that are used in the

approval process might need to be looked at. It may not necessarily mean adding

bodies, it might mean some changes in the guidelines.

The speech language services: I understand this year less than $400,000 spent

on five new positions. I am just wondering if the recruiting process is started

on that. The other question on that would be: Where are the positions located?

MR. WISEMAN: The answer to your first question, the regional health

authorities would have been involved or would be responsible to initiate the

recruitment process. Where they are in that process, I could not answer that to

be honest with you.

In terms of where they are going, there is going to be one in Carbonear, one

in St. John's at the Janeway, another in Grand Falls-Windsor, Corner Brook and

Labrador West.

MR. BALL: I guess one final question - I looked at the clock and it is

8:37 p.m. We finished last week in an hour and thirty-seven minutes.

HST on home care: I am just wondering if there has been any consideration

from the Province - I know there would need to be involvement from the federal

government on this as well - but I am wondering if there has been any

consideration given to trying to get that HST removed from home care?

MR. WISEMAN: It is probably more of a question for Finance, and, Jim,

maybe you can comment. To my knowledge, it is not something that we have

initiated at the department level, but whether Finance has pursued it -

MR. STRONG: The minister is correct, that policy around HST would be the

Department of

Finance's responsibility. I am not aware of any recent discussions in that

regard.

MR. BALL: I would encourage a letter of support. At least try and move it

to zero rated, if they do not want to remove it at all, just to put it at zero

like they do with some other services.

That is it for me.

CHAIR: Ms Michael.

MS MICHAEL: Just a couple of questions around the child care spaces. In

the centre-based non-profit spaces there was a loss of twenty-four spaces in

Eastern rural and a loss of forty-two in the Labrador-Grenfell Region. Do you

have the specifics on what the loss was? It looks like there were maybe closures

of a whole centre, or more than one, maybe, in Labrador-Grenfell.

MR. WISEMAN: I think your observation about what it is may be the case

but, rather than say maybe, let me find out for you exactly where those numbers

were in the communities and what the circumstance would have been around each of

the cases. We will get that information for you, but I think you observation is

probably an accurate one.

MS MICHAEL: Okay.

Once we know that, then, I may have more questions to put to you.

MR. WISEMAN: No problem.

MS MICHAEL: Under the regional family child care spaces there were 150

new spaces created out of nothing in Western, and that seems a pretty round

number. Was there a specific effort by the department to get that to happen, and

are they located throughout the region? I am just interested in this round

figure of 150.

MR. WISEMAN: I can't tell you exactly where they are located but,

again, I can give you that information - when I give you the detail on the other

closures, I can tell you exactly where they were.

The other part of your question was in terms of: Was there a concerted

effort? Yes, there has been, and the department, together with the authorities,

has been working very diligently to expand the capacity that we have in the

system. That was, as you can very apparently see, a successful campaign by

somebody.

MS MICHAEL: You don't know the details? Because it is just curious to

me - because this is a bit harder to get the family child care spaces to all of

a sudden have 150, that round number in this period of time. It would be

interesting - well, not only interesting, I would like to have the details on

how that happened.

MR. WISEMAN: I think in Western, don't they have an agency? They have

an agency in Western, so they would have been the catalyst for that kind of

growth, I suspect. Again, I don't like using the words I suspect, but I will

confirm it for you and give you exactly the communities which they are in and

the numbers associated with each.

MS MICHAEL: Right.

MR. WISEMAN: I will be able to give you that information, together with

the loss in the non-profit pieces, very specific detail.

MS MICHAEL: And the information on the agency, if there is an agency.

MR. WISEMAN: Yes, there is one over there.

MS MICHAEL: Thank you so much.

That is it for me, Mr. Chair.

CHAIR: Thank you.

Mr. Butler.

MR. BUTLER: I just have three or four short questions.

I want to go back to the $800,000, the figure that was used during the

questioning on the pandemic. I am just wondering: What does that cover off, if

something should happen, this $800,000? How many people will that take care of,

or is there such a figure in place?

MR. WISEMAN: John, you can answer that.

MR. ABBOTT: There has been a lot of analysis done by the Public Health

Agency of Canada on appropriateness, how many and what percentage of the

population may be affected in any particular pandemic situation.

What we are modeling on first and foremost is what percentage of the

population. It ranges between 20 per cent and 30 per cent of your population -

some numbers are a bit higher - that may be affected at any one time. Our

numbers, then, on $800,000, and you were looking at this over a several month

period - I am just trying to do the math here, now, because I did have that

number, but - we are looking at probably in the range of, I would say, $10,000.

I will have to get that for you because I do have that number in the office.

That is how the calculations were done in allocating.

We then have to, over the next period of time, determine appropriateness:

who, when, those kinds of things. Those discussions are still ongoing and there

is no perfect answer here. We are trying to get it right based on the experience

that other jurisdictions across the world are looking at.

MR. BUTLER: The next question, Minister, is the $2 million - that was

this year, I think - to improve access to health care services by extending the

hours of operations for the MRI. Why I ask that question is: Does that mean the

operations for MRI would go beyond the regular work day? I will give you an

example.

I have not been there myself, but I know of cases where people went for an

MRI and they are there probably waiting for an hour and there is nobody going

in, and when you come out there is nobody waiting there to go in. I am just

wondering, when you say you are going to extend this service - to me, if you go

for blood work or an X-ray, the lineups are there and people are constantly

going, but when you go to an MRI it seems like, based on the average time that

my wife has been there, I figure that as many as they would see in one day would

be probably two or three people. I am just wondering, when you say extended, is

it...? When you say extended, I figure the staff are there for the full work

day, does that mean they are going to work overtime?

MR. WISEMAN: No. What we are doing is, we are going to jump from eight to

sixteen hours a day and we are going to add new technologists to add that

additional support.

MR. BUTLER: Is there any reason, once someone goes and has their MRI

done, that someone can't be there waiting to go in again? It seems like there

is a lot of space in between there. I am wondering, by jumping from eight to

sixteen hours, is that the problem that is there or can more be done within the

eight hours, I guess, is what I am trying to ask.

MR. WISEMAN: To my knowledge, and again I understand and appreciate if

the officials have different information, but to my knowledge the capacity that

the system is going, the unit is now going full out so there is no down time in

that we are waiting two or three hours between patients. As I understand it, the

scheduling system that is in place now provides them with the - obviously, there

are the issues of breaks and lunchtime and that kind of stuff that gets factored

in, but, as I understand it, the system is now working at peak capacity. Is that

correct?

WITNESS: The programming (inaudible).

MR. WISEMAN: Yes.

MR. BUTLER: Would I be fair in asking how many people do you think go

through an MRI in the run of an eight hour day as per the

schedule now?

MR. WISEMAN: That is a fair question, but (inaudible) has that answer.

MR. ABBOTT: Mr. Butler, I think the number is roughly about eight to ten,

depending on the nature of the procedure at that time. As you can appreciate, it

is a very complicated piece of diagnostic equipment, so for each patient it has

to be reprogrammed, re-calibrated for that particular diagnostic procedure, so

it is a start, whatever, making sure the machine is clean, all those kinds of

things, but that is what we are looking at there. It is roughly eight to ten.

Extending hours can obviously - and that has been well received where we have

done it.

MR. BUTLER: Very good.

The second-last question, with regard to paramedics, I guess when it comes to

the Health Sciences as well as the private operators on the outside - I know

there were demonstrations last year from both groups - I am wondering, has

everything settled down and everything been taken care of and everybody is

happy?

MR. WISEMAN: Everybody is happy.

MR. BUTLER: Everybody is happy, both groups?

MR. WISEMAN: You probably heard the announcement we made back in January,

some time, or the first part of February, that the issue being evaluated in St.

John's, we have now identified a solution for that and Eastern Health is

moving forward with the implementation in terms of the location of ambulance

bases and expanding that so everybody is not dispatched just from the Health

Sciences. That piece of work is in progress now and the staffing associated with

that is being done.

We have an agreement signed off with the private ambulance operators and the

community health operators. I think there may be one or two operators left to

sign off, but the agreement is done, negotiated, and funding is flowing to them.

That is just a very recent development. They have obviously had a successful

negotiation so I am assuming they are happy. That seems to be working well, I

have not heard anything to the contrary. That is moving quite well.

MR. BUTLER: My last question has to do with when an assessment is done

for home care. Minister, you know yourself, I met with you one day - and I am

not going into any names or any explanations on any particular situation, but

when it comes down to the bottom line - and since then, I have met with other

people from the department. I must say, I had a good response from the lady out

in Whitbourne office. She came in here and met with us.

I will give you an example, and the minister knows what I am referring to.

You take someone who was a professional, like a retired teacher, and he has his

pension coming in, and not a large pension. When this assessment is done, it is

calculated on the bottom line as if he was in receipt of Social Assistance. He

is a bit higher than that, but then again he is not in a position to be able to

pay what he is requested to pay. In the particular situation I am referring to

it is $900 he is going to have to pay. The $900 that he has coming in, I am just

wondering has the department looked at - and I know the bottom line is right

across the board, whether it comes from someone who is in receipt of benefits

through HRLE and so on, but it seems so unfair to an individual like him. I know

there are probably hundreds like him. Has it ever been looked at that the bottom

line would be raised up and give a break there for someone like that? You know

what I am referring to.

MR. WISEMAN: I know exactly what you are talking about, actually. It is a

good question that you have asked, and you and I have just had a recent

discussion around it.

That whole area of home support, there are a number of issues that we just

finished. Last year we did a very extensive consultation on healthy aging in

seventeen different communities and held a provincial forum then in June. That

issue around home support came up in every single community that we were in. It

has been raised by family members, seniors themselves who are in receipt of care

and providers of services. There are a number of aspects to it: one that you are

now talking about which deals with the whole issue of the person's

contribution to the care that they get; what you use to establish that base line

to work from; what you factor into that equation; what expenses you allow and

what expenses you do not allow; what the base should or should not be; the whole

issue of the amount of money that is provided, the amount of money that you have

to provide to pay the people who provide the care to you; and the cap that is

put on that, that there should or should not be a cap, that whole debate.

Another issue was the training being provided to home care, home support

workers, what level of training they should have and what they should be able to

bring to that position.

There have been a range of issues that have come up through that process. I

think one of the things that we learned from that and will be committing to do

as a part of that process is to re-evaluate the home support program. I think

what you have identified here this evening is one element of that but there are

multiple elements to the home support program that we need to have a look at to

determine whether or not it is providing an appropriate response to the people

who need it, whether the financial assessment process is done fairly and

equitably, and the process we go through to evaluate the level of care that is

needed. There are some who suggest that people need more care than they are

getting and others suggest that some people are getting care that they do not

need. There is a whole evaluation of that home support program that we need to

go through and will be embarking upon to ensure that it reflects the reality of

the day and it reflects a reasonable and an appropriate response to the people

who need it.

MR. BUTLER: That is it for me, Mr. Chair.

CHAIR: Are there any further questions from any members?

Ms Michael.

MS MICHAEL: I lied. I am allowed to use the word about myself, but it is

because of the home care issue being discussed.

Have you looked at, or was it brought up, the fact that you have agencies out

there that automatically put up their fee when it is not really observable why

they are putting it up? I am aware of an agency, personally aware of an agency,

that every year for four years in a row put their fee up by $1 an hour and yet

the worker was not getting that money. I know that there were no changes in the

administration at that agency, no new staff or anything. They may have one

vehicle that they use for their own business, but as we know the workers pay

their own transportation. It was because I personally experienced this that I

will put it personally. It was quite disconcerting to see this happen four years

in a row without any reasoning. I know that there was no one for me to have

recourse to, there is no regulation of that. Is that something you are going to

start looking at?

MR. WISEMAN: To be honest, that is the first time I heard that issue.

MS MICHAEL: Privately, I will give you the name of the agency.

MR. WISEMAN: The challenge, I suppose, is that it is a private business

and it is a competitive business. There are many people out there providing the

service. The market forces, to some extent, will influence what people will

charge in the private sector. We do not have an ability to regulate the fees

that they charge.

I guess, to use the jargon of those who are in the business, their pricing

reflects their costs. It also reflects the quality of the product that they

provide. It also reflects, I guess, the competitiveness in the marketplace. If

the market can suffer it, sometimes you see it charged. So a number of factors

will come into play there.

Whether we would entertain regulating it to the extent that we would put a

cap on what people will charge, that is probably a fairly extensive intrusion

into the private sector. We can control what we will pay for it. If we are

buying the service we can control what we pay for it and we can put a cap on

what we pay for it, but if they cannot provide it for that then they will not

give you the business. When someone is out there providing service to the

private sector, the public, and they want to charge a particular fee and there

are people out there who want to buy it for that, it would be difficult to

regulate it to the extend that you have a cap on it.

MS MICHAEL: I will not go there, but we could get into a whole discussion

about having the marketplace determine services that are needed by people.

The thing is, I know people do not have choices. Trying to get home care is

very, very difficult, just like with child care spaces. It is not easy. People

will stay with an agency because the devil you know is better than the devil you

do not know. This agency does not put any money into training. There is nothing

going on that is creating better workers than in other agencies, et cetera.

I think it is a major problem area, Minister. I think you know that from

consultations you have had. I really would hope that you would start very

seriously looking at it. If you ever want to consult with me, after four and a

half years of taking care of my mother and home care, I would be really - well

actually eight years of dealing with this agency - I would be really happy to

sit down.

MR. WISEMAN: I appreciate that comment.

To reiterate the point I made to the earlier question, it is an issue that we

are really tuned into based on our consultations and we do need to do a complete

evaluation of what we are doing in that area.

MS MICHAEL: Just one more point and then I will be quiet. As you know

this is something that is very close to my heart.

One thing that is not looked at: You cannot look at someone's gross income,

you have to look at what the expenditures are. If somebody is paying, say, $500

or $600 a month on medication out of that income, to me that should be

considered when looking at, can that person also afford home care. So, just

another aspect.

MR. WISEMAN: Oh, it is a big issue, no question at all.

CHAIR: Mr. Collins.

MR. COLLINS: Mr. Minister, with respect to personal care homes and

portable subsidies, you and I have discussed this on a number of occasions. Can

you just bring us up-to-date on the status of portable subsidies now, bed

subsidies in the Province? Does the bank of portable subsidies include the whole

Province, or is there a bank in Eastern Newfoundland, Central Newfoundland and

so on? In other words, if someone passes away in the system and a portable

subsidy becomes available, are people eligible for that all over the Province or

are there banks within certain areas of the Province? I do not know if I am

making myself clear or not.

MR. WISEMAN: The total number of subsidies, to take the broader picture

first, this year there is no change in the total number of subsidies in the

system. Whether it is fixed bed subsidies or portable subsidies, there is no

change in that program. The numbers are constant in terms of the fixed bed ones.

The increases that we have had last year: I think there were 200 and something

new portable subsidies last year.

I will just give you the number of subsidies now currently in use. In the

Eastern area and the urban area, we have 285 fixed bed subsidies and forty-five

portable subsidies currently in use. In the rural area, there is a total of 253

fixed bed subsidies and 279 portable subsidies in use. That means that in

Eastern you have a total of 538 fixed and 324 portable subsidies. That is those

that are in play in the Eastern.

In Central, we have in play out there 148 fixed and 322 portable. That is

what is in play out there.

MR. COLLINS: They are regionalized.

MR. WISEMAN: Across the region the same thing will apply.

In the Western you have sixty-six fixed and 198 portables, and in the

Labrador-Grenfell area you have fifty-five fixed and forty-nine portables. Right

now in play in the system we have 807 fixed bed subsidies and 893 portable

subsidies, but they are done within each of the regions.

I think your question is very specific. If someone were to move on in a

facility on the West Coast, then that subsidy stays within the West Coast; the

portable piece. The fixed obviously stays with the institution but the portable

stays in play in that region.

MR. COLLINS: What is the average waiting time at this point in time,

Minister, if you were waiting for a portable subsidy in a personal care home,

say the Eastern?

MR. WISEMAN: I am not sure, Moira, do we have that data? We can find that

out for you. Obviously, the fixed bed subsidies, the wait times are -

MR. COLLINS: I am interested in the portable ones only.

MR. WISEMAN: The fixed bed is that the wait time is more an issue of

choice. If a person does not want to go to that fixed bed then they do not go.

The portable piece, we will get that information for you.

MR. COLLINS: That is good.

Thank you.

CHAIR: Mr. Ball, do you have another point?

MR. BALL: You mentioned during the home support program, the home care

program, that there were some consultations and maybe an assessment done. Is

that process started, and if so, when do you expect to see it finalized?

MR. WISEMAN: My comment was, as a result of the consultations that we had

we garnered a lot of insight into the whole home support program. One of the

things that we have recognized from that is that we need to start to re-evaluate

that program. It is a process that we will start between now and the next fiscal

year.

MR. BALL: But not this year?

MR. WISEMAN: You will not see any material changes in that program in the

current fiscal year, no.

MR. BALL: Okay.

CHAIR: Are there any further questions?

Minister, do you have any concluding remarks?

MR. WISEMAN: I just want to thank everybody for the level of their

questions, and obviously their interest in this department and what we are doing

in terms of programs and services we are providing to the people of Newfoundland

and Labrador. Thank you for the level of interest and also the level of insight

you obviously have into the issues that you wanted to explore with us.

Thank you very much.

CHAIR: Before we call the subheads, I would like to also thank the

members for being so well-prepared and the minister and staff for their

professionalism and thoroughness and forthright answers.

I will ask the Clerk to call the subheads.

CLERK: Subhead 1.1.01. to 3.2.02. inclusive.

CHAIR: Shall subheads 1.1.01. to 3.2.02. carry?

All those in favour, aye'.

SOME HON. MEMBERS: Aye.

On motion, subheads 1.1.01. to 3.2.02. carried.

CHAIR: Shall the total carry for subheads 1.1.01 to 3.2.02? Shall the

total carry inclusively?

All those in favour, aye'.

SOME HON. MEMBERS: Aye.

On motion, Department of Health and Community Services, total heads, carried.

CHAIR: Shall I report the Estimates of the Department of Health and

Community Services carried without amendment.

All those in favour, aye'.

SOME HON. MEMBERS: Aye.

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

CHAIR: Thank you.

The next meeting of this Committee will be tomorrow morning at 9:00 here in

the House at which time we will consider the Department of Human Resources,

Labour and Employment.

MR. WISEMAN: The questions that were posed this evening that we said we

would get answers for, we will distribute the responses to the Chair who will

distribute them to you.

CHAIR: Thank you, Minister.

On motion, Committee adjourned.