Social Services Committee — Department of Health and Community Services — 5 November 2010

2010-11-05

Newfoundland and Labrador — Committees

May 10, 2011 SOCIAL SERVICES COMMITTEE

Pursuant to Standing Order 87, Kevin Pollard, MHA for Baie Verte-Springdale, replaces Kevin Parsons, MHA for Cape St. Francis.

The Committee met at 9:00 a.m. in the Assembly Chamber.

CHAIR (Hutchings): Good morning, everybody. Welcome to the Estimate Committee this morning, the Social Services Committee. This morning we will be hearing the Estimates of the Department of Health and Community Services.

Before we get started, I will go to my right and ask the Committee if they can introduce themselves.

MR. YOUNG: Wally Young, MHA, St. Barbe.

MR. RIDGLEY: Bob Ridgley, MHA, St. John's North.

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

MR. POLLARD: Kevin Pollard, MHA, Baie Verte-Springdale; six-foot, 220, a Maple Leaf fan.

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

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

CHAIR: Thank you.

Before I go to the minister, he is free to make - when we do call the first heading - any comments, or we could proceed right into questions from the Committee. As well, at that time I will ask the minister to have his staff introduce themselves. Also, I will remind you, any time you are answering questions that you identify yourself each time for the benefit of Hansard so they can pick up exactly who is speaking for recording purposes.

I will ask the Clerk to call the first heading.

CLERK: 1.1.01.

CHAIR: Shall 1.1.01 carry?

With that, Minister, I will go to you.

MR. KENNEDY: Yes, we are open for questions. Would you like for me to introduce everyone or they can introduce themselves?

CHAIR: Yes, you can introduce your staff first then we can go right into it.

MR. KENNEDY: We will start with you, Bruce.

MR. COOPER: Bruce Cooper, Deputy Minister of Health and Community Services.

MR. KENNEDY: Jerome Kennedy, Minister.

MS TUBRETT: Denise Tubrett, ADM, Corporate Services.

MR. WAKEHAM: Tony Wakeham, ADM, Regional Health Operations.

MR. GAULTON: Luke Gaulton, Communications Manager.

MR. TIZZARD: Mike Tizzard, Manager of Budgeting.

MS KING: Tracy King, ADM, Policy and Planning.

DR. ALTEEN: Larry Alteen, Director of Physicians Services.

MS SHUTE: Tracy Shute, Executive Assistant to the Minister.

MS STOCKLEY: Colleen Stockley, Director of Pharmaceutical Services.

CHAIR: Minister, are we ready to go to the Committee?

MR. KENNEDY: Yes, we are.

CHAIR: Okay. Committee members.

Ms Jones.

MS JONES: Thank you, Mr. Chairman.

Good morning, everyone.

I guess what we will do is we will probably start right with the first heading and we will go to

section 1.2.01. Under Executive Support within the department, it looks like this year you have increased your budget for Salaries in that department. Can you tell me what the reason for that is? Is it new positions or is it automatic increases?

MR. KENNEDY: There was new permanent funding allotted for an associate deputy minister. Dr. Cathi Bradbury, who had been working in our department, was put in the position of associate deputy minister. The previous deputy minister, Don Keats, had retired and Bruce Cooper came in an acting position. We felt it was important from a medical perspective. Dr. Bradbury has been in the department for a long time. She has been involved in negotiations with the NLMA back to, I think to 2001, and so she is very familiar with all aspects of the medical system. She continues to have a family practice herself once a week.

We felt that having her knowledge of the medical system and the relationship with doctors, in an associate deputy minister position, would complement Bruce's role then as a deputy minister. So that resulted in an increase, I do not know the exact increase but for a permanent position.

Also, we had created new permanent funding for the assistant deputy minister for population health. When you put that in with the salary increases which include salaries associated with the associate deputy minister and the medical consultant, because they are members of the NLMA and would have been subject to the same raise as everyone else, this would result in the increase I think you are seeing there.

MS JONES: Okay.

Also, under that particular

section 06., for Purchased Services you had budgeted $76,500, you went over that by $108,500.

MR. KENNEDY: Sorry, I am having difficulty hearing you, Ms Jones.

CHAIR: Is everything working properly?

MS JONES: Can you use your headset?

CHAIR: Can we use headsets, or do we have headsets here?

OFFICIAL: Yes.

MS JONES: In 1.2.01.06. Purchased Services increased by $108,500. Can you tell me what that money was spent for?

MR. KENNEDY: Yes. There was one-time advertising in relation to the position negotiation services and there had been an amount of that that was transferred from Corporate Services. That is the actual $108,000 that you see there.

MS JONES: What kind of advertising?

MR. KENNEDY: This would have been, I guess, during the negotiations there were ads. The medical association had ads and we had also taken out certain ads. I am trying to remember if there were TV ads, but there were certainly ads in the newspapers, yes; and TV, yes.

MS JONES: All of the $108,000 was for advertising?

MR. KENNEDY: Well, it breaks down. It was actually more than that, I think. What we have here is – I do not know if we have the break down. Do we have the actual break down of how the money was spent?

OFFICIAL: (Inaudible).

MR. KENNEDY: It was $172,000 for advertising; there was a total of $206,000. The print was $68,000, radio was $67,000 and TV was $35,000, which amounts to $172,000.

MS JONES: Moving on to Corporate Services, 1.2.02.; again, Salaries under Corporate Services increased by nearly $175,000. Can you tell me what new positions were created in Corporate Services?

MR. KENNEDY: Yes. This was additional resources in relation to the IT

section and there were projects during the year, financial related projects. There were a number of summer students. Each year we hire a number of summer students. They are unbudgeted and they would have been charged to Corporate Services. That would add up to the $175,000.

MS JONES: What did you do in IT? Did you create a new position there? Was it permanent or temporary?

MR. KENNEDY: Denise will take that.

MS TUBRETT: No, it was not a permanent position. It was work that was done to support – we have an information manager in the department who liaises with the regional health authorities with respect to some of the systems they operate, CRMS being one of them. We had some additional support throughout the year to help him.

MS JONES: What other temporary positions do you have in Corporate Services? It is showing that you are spending about $300,000 on temporary positions.

MR. KENNEDY: Denise, perhaps you can take that question. I cannot read this chart.

MS TUBRETT: There are twenty-five permanent positions in Corporate Services and there are three temporary positions. One is a management analyst, one is a director of corporate initiatives, and the other is a Clerk III.

MS JONES: When you say temporary, what does that mean? Are they there for a year? Are they there as long as you need them? Are they there for three months?

MS TUBRETT: There are two types of temporary positions in government. One is the type of temporary that you bring in for a certain period of time to do a particular piece of work, then there are other temporary positions that there is temporary funding there and you can go through the process to make them permanent. In some of these cases, we do not have permanent PCN to create the position and we need to go through a series of steps in order to create the position permanent. So at any given time, the temporary people we have on the ground, it could be either one of those reasons.

MS JONES: Okay.

Going back again to Executive Support because I am noticing there as well that you are spending nearly $690,000 in temporary employees, and I am wondering what positions they are. It looks like, I do not know if maybe the two ADM positions you just told me about are temporary, maybe that is what it is, but it did increase by almost $400,000 this year, just in temporary employees.

MS TUBRETT: Actually, the associate deputy minister, although it is intended to be a permanent position, at Budget time we did not have the appropriate paperwork for it to be a permanent position. So with respect to the Salary Details, it is showing up as a temporary position. That will be something that we will correct next year. Obviously, it is the department's intention to have that position as a permanent position.

MS JONES: Okay. Are there are any other temporary positions under Executive Support?

MS TUBRETT: Yes, there are. The majority of them would be associated with the communications division. There are two positions there with respect to the communications division.

MS JONES: How many communications people do you have in the Department of Health?

MR. KENNEDY: Not very many right now because what happened is our communications director recently went off on maternity leave, we have a second communications manager who went off on maternity leave, and we recently had a third communications manager who has gone somewhere else in government. So what we have right now: Jennifer Tulk is the Director of Communications and Luke is there, I think, as the only communications manager right now. It is not a lot for a department of this size.

MS JONES: You have the two temporary positions, what are they?

MR. KENNEDY: They are not filled right now.

MS JONES: Normally, you would have five people.

OFFICIAL: Four.

MR. KENNEDY: Four, I think.

MS JONES: Okay.

MR. KENNEDY: Yes, four.

MS JONES: I guess the people who have left for a period of time, those positions will be backfilled I am sure, will they?

MR. KENNEDY: I am not certain right now. The difficulty with the communications is that all obviously has to go through the Public Service Commission and it takes time to do that. Our director and our manager, quite frankly, could be back from maternity leave by the time the positions get filled. We will see - I would like to put someone in there on a temporary position but at this stage we have been two or three months without those positions being filled. Quite frankly, we are making an assessment as to whether or not we can get by without filling them, because we have the summer coming up when things tend to slow down. So far, I am quite satisfied that we are doing okay.

MS JONES: Okay.

Again under Corporate Services, 03., Transportation and Communications, your budget for that increased this year and you spent nearly $190,000 more than you anticipated. Can you tell me what that was spent on?

MR. KENNEDY: Yes, and I think this came up last year. I am not sure if it came up in Estimates last year but it certainly came up in the House of Assembly with our Prescription Drug Program. When we did our numbers, it became clear to us that the uptake on the Prescription Drug Program was not what we felt it should have been. We felt that the program was good; we had the Access Plan and the insurance plans.

What we did is engaged in a fairly aggressive campaign in terms of making people aware of the program. There was a one-time cost for household mail which was not budgeted for and so that was a significant aspect of it; that was $32,000 there. In this account, there are also phones, postage, cellphones, conference calls; I think the whole department is billed to this particular head of budgeting.

MS JONES: Okay, so part of it was spent on promoting the drug programs?

MR. KENNEDY: Yes.

MS JONES: Okay.

MR. KENNEDY: I would say 20 per cent; $32,000 when you put in the postage.

MS JONES: Okay. What did you say the rest of it was spent on?

MR. KENNEDY: Yes, we have the phones. All of the phones in the department are paid out of this account. BlackBerries, the same thing, are paid out of this account. Essentially I think - and Denise can perhaps add certain detail - all of the phones in the department are not charged to each individual division but go through Corporate Services and they are not budgeted for in Corporate Services. All of the phones are charged to this account but they are not budgeted, so this is where the increase I think would have been at this point. That is something obviously we will have to fix next year in terms of the budgeting for this particular division.

MS JONES: How many phones are out in the Department of Health (inaudible)?

MR. KENNEDY: I would have no idea. I do not know the answer to that. I do not even know if anyone -

MS JONES: Under the Prescription Drug Program - you just mentioned it - I am just wondering, I can wait until I get to the heading or I can ask you some questions about it now -

MR. KENNEDY: You can go ahead, any time you want.

MS JONES: Okay. Last year you gave us a breakdown, for example, of the amount of monies that were spent on various drug programs across government. Could we get a breakdown of that again for this year?

MR. KENNEDY: Just one second, we have to jump ahead to our book here now.

You are asking about the different types of plans? I think the information we gave you last year would have been -

MS JONES: Yes, it included people with access, assure, low income.

MR. KENNEDY: In the Foundation Plan - and Ms Stockley is here if anyone has any questions in particular because we thought the drug plans and drugs might be an issue. She can answer any specific questions about the plans or the types of drugs. We know, for example, we budgeted a total of $140 million in 2010-2011 and we have budgeted now $148 million in 2011-2012. That is broken down then to our various plans: the Foundation Plan and the 65Plus Plan are about $59 million, $52 million respectfully; extended card plan, Access Plan, Assurance Plan, and special needs, best practices, and claims adjudication.

So, this is where we have all the plans, they are broken down by the numbers. When you add it all up, it was $140 million for 2010-2011; $148 million for 2011-2012. I think what you will see there is that some of this are the new drugs we have added for this year although we are not, at this point, aware of all of the new drugs, that could change as move through the year.

MS JONES: Okay.

Do you have a problem with giving us the breakdown? How much is being spent on each of the programs or plans and so on?

MR. KENNEDY: No. There is certainly no problem with that. That is something you should have access to.

MS JONES: Okay.

Can you tell me how many people right now are on the Newfoundland and Labrador Provincial Drug Program compared to last year? How did our numbers go with all the advertising and promotion?

MR. KENNEDY: We have here, under the Foundation Plan - that would have been the former income support plan - 45,600 beneficiaries. Now, this is the information I have available to me as of February 17, mid-February, I think. Actually, the information as of April 12 – I was looking at some earlier information; I will give you the most up to date - we have 46,000 projected beneficiaries in 2011-2012. The actual number for 2010-2011 was 45,842. The 65Plus regular in 2010-2011, I will use again the numbers, was 47,099. The Access regular was 21,813.

Select Needs, such as cystic fibrosis and growth hormone deficiency, was seventy-nine. The Assurance Plan was 5,582. The Assurance Plan DCO, drug card only, would be 1,224 and the extended drug card was 995, for a total of 122,634 in 2010-2011.

MS JONES: Okay. Can you tell me what percentage of those is paying less than 5 per cent, for example, under the co-pay program? How do the numbers break down in terms of, how many are paying 5 per cent or less and how many are paying 10 per cent, 20 per cent, or 30 per cent? Can we get the break down of that?

MS STOCKLEY: Approximately 15 per cent of insurers on the Assurance Plan have a co-pay of 5 per cent or less.

MS JONES: Fifteen percent?

MS STOCKLEY: Approximately 15 per cent, yes.

MS JONES: What about the other categories? Can you provide that to us?

MS STOCKLEY: Approximately 27 per cent have a co-pay of 10 per cent or less.

MS JONES: Keep going.

MS STOCKLEY: The average co-pay over the Assurance Plan is 29 per cent. That is taking into consideration all of the people who are covered under the Assurance Plan.

MS JONES: That is what the patient pays, an average of 29 per cent?

MS STOCKLEY: Exactly.

MS JONES: Okay. I am just going to get back to the numbers here for a second again.

Under 04. Supplies section, under Corporate Services, again you spent over $122,000 more than was budgeted. Can you tell me what that was spent on?

MR. KENNEDY: Yes, this is basically just the funding for office supplies for all divisions in the department that are charged here and then the transfer made as required. Again, all of the divisions within the department go to Corporate Services to be paid.

MS JONES: Okay.

Under Professional Services you actually budgeted $1 million last year. You did not spend it but you budgeted it again this year. What has that money been earmarked for?

MR. KENNEDY: Yes, what we have here, this is funding that provides throughout the year - because obviously, as I am sure you are aware, within the budget if you do not have monies in your budget then you have to either transfer, go to Treasury Board or move from one division to another. What we have here is $1 million that is a contingency fund for unanticipated federal or otherwise funded projects.

In other words, if a project comes up in the year, there is a federal project and we need – and this happens for example, oftentimes in the addiction division, then there are monies here that we can access for these projects. It is offset, by the way, by federal revenue. It depends on each year, and last year obviously the $1 million was not utilized but it is something we have there as a contingency fund.

MS JONES: Okay.

Again, in Purchased Services you have increased your budget this year by over $900,000. What is that for?

MR. KENNEDY: There are two – okay, sorry, we have –

MS JONES: (Inaudible).

MR. KENNEDY: Yes. This is the $106,600, or are you talking about the -

MS JONES: No, I am talking about 06. It is more like $800,000 your budget has increased this year over what you spent last year, 1.2.02.06.

MR. KENNEDY: 1.2.02.06. Okay, I have you. I have two figures. We are in Corporate Services; we have the revised and the budget.

MS JONES: Yes. Well you actually spent $992,900 is what it is showing. This year you are anticipating spending $1,195,500.

MR. KENNEDY: Okay.

MS JONES: Yes, I have it calculated wrong there I think.

MR. KENNEDY: That would be an increase, by my –

MS JONES: A couple of hundred thousand dollars, yes.

MR. KENNEDY: This right here $992,900, the difference in that is how much, $106,000, isn't it?

OFFICIAL: Almost $200,000.

MR. KENNEDY: Oh, $200,000, okay.

MS JONES: Yes.

MR. KENNEDY: This is an increase for lease costs. We have the Newfoundland and Labrador Prescription Drug Programs in Stephenville and Grand Falls-Windsor and the leases expire in 2011-2012. We are looking at the numbers now. These increases are due to that part of it and also there is cost pertaining to departmental renovations.

I think, Denise, as you will see when you are going into the main entrance now to the Department of Health that is changed. Also, if you look at it - it is actually worthwhile to visit the department. We are so short on space that there was an open area that we took and made offices out of. All of this would result in the increased cost.

MS JONES: Okay. The offices that are up for renewal or their lease expires in Stephenville and Grand Falls, I think you said.

MR. KENNEDY: Yes.

MS JONES: You are anticipating it is going to cost more to retender the offices there?

MR. KENNEDY: Yes, I had a look at the numbers the other day. Actually, I was surprised somewhat by the numbers, they seemed high to me. Some of these leases, and Tony will be able to answer this question, but some of these leases would have been, I am just going to use a figure, $13 a square foot, would now potentially rise to $20 or $22 a square foot. That is part of the issue. That will add up over a period of time to significant sums of money.

Tony, is that a fair assessment as to where the increases are coming here?

MR. WAKEHAM: Yes. I think the current lease rate at Grand Falls-Windsor is $16.45 a square foot. We are budgeting somewhere around $25 based on the past when you go to tender. Similarly in Stephenville, it is currently at $16.87 and we are looking at $22 a square foot. So that is where the increase is. The same square footage, the same space, it is just the increased cost of leasing. Now it might come in lower, but –

MS JONES: Okay.

Lorraine , did you want to ask any questions before I move on?

CHAIR: Ms Michael.

MS MICHAEL: Thank you very much.

I think all of the questions under that

section I had have been answered, so I will just move on to the next section.

1.2.03. Medical Services, the main question there would be around subsection 06. Purchased Services. You must have had a major expenditure last year, because the budget was $7,900 but in actual fact $220,900 was spent, so if we could just have an explanation of that line.

MR. KENNEDY: Again, that comes back to the advertising campaign for the Newfoundland and Labrador Prescription Drug Program, the Access and Assurance programs. I think we referred to earlier, that was $172,000 I think is what we said. In Purchased Services, that was certainly the major increase.

MS MICHAEL: Okay.

MR. KENNEDY: Did I say the NLPD…

MS MICHAEL: You did. You said the access and assurance campaigns, yes.

We are going to find expenses for those campaigns have happened in two or three different places in the budget?

MR. KENNEDY: Yes, you would.

MS MICHAEL: Obviously, yes.

When you talk about the management of physician services, could you just describe what that means for me, please?

MR. KENNEDY: Sorry, that is -

MS MICHAEL: Under 1.2.03. Medical Services, the explanation is: Appropriations provide for the management of physician services and the drug and dental programs. The drug and dental are clear to me, just an explanation of what the management of physician services means.

MR. KENNEDY: We have, for example, a Director of Pharmaceutical Services, Director of Medical Services, Director of Dental Services, and Assistant Director of Medical Services. Their salaries come out of this budget. I think, for example, our Director of Dental Services is paid a - is it a salary he is paid or is it an actual stipend?

OFFICIAL: (Inaudible).

MR. KENNEDY: He is salaried. That is where we have all of these positions or – yes, on staff. It also would include the pharmacists. We have a number of government or departmental pharmacists who would be included here also.

MS MICHAEL: Specifically, with regard to physician services, what would be the services that are offered to physicians under this budget line?

MR. KENNEDY: Perhaps Larry, you could take that question.

DR. ALTEEN: The management of physician services relates to managing the MCP system itself. So the payments to physicians and managing the salaried position system, plus the liaison with the health authorities related to physician services as well. There are a number of other payment plans for physicians that are under that rule.

MS MICHAEL: Okay. So it is basically payment plans for the physicians.

DR. ALTEEN: Payment plans and delivery of services in some aspects, yes.

MS MICHAEL: Good, that is clear.

Thank you very much.

Under 05. Professional Services, what professional services would you require in this department? Because it is a big item, $579,000.

MR. KENNEDY: There are a couple of fairly big ones in terms of the on-line adjudication system.

Who could explain? Colleen will explain that.

MS STOCKLEY: The on-line system is a system that is managed by xwave by contract with the department. That allows beneficiaries of the NLPDP, Newfoundland and Labrador Prescription Drug Program, to go to their pharmacy counter with their drug card or their MCP number and get their medications and just pay their co-pay.

MS MICHAEL: Okay, great.

Thank you.

MR. KENNEDY: There is a number of (inaudible) $64,000, and then the implementation of the document management system is $100,000. Now, there are others I can outline for you but those are the two bigger amounts in that $579,000.

MS MICHAEL: Okay. What would cause that line to fluctuate? Because the budget is $579,000 but last year only spent $450,000. Why would that fluctuate?

MR. KENNEDY: Perhaps you can comment on that, Denise.

MS TUBRETT: The main reason, I guess, would be that the budget we had is less than what we needed. For example, the on-line adjudication, we needed less in 2010-2011 than what we had planned for. There may have been other – for example, the document management system implementation was budgeted for but it did not proceed during the year. So that is budgeted for next year.

MS MICHAEL: Okay. So that explains that gap.

Thank you very much.

If we can go on to 1.2.04., please.

MR. KENNEDY: What heading is that?

MS MICHAEL: 1.2.04. Regional Health Operations, subhead 03. Transportation and Communications; the revision went up by almost $60,000 and now this year the Estimate is $298,600. What is happening under that line that is making that budget line go up so much this year?

MR. KENNEDY: In Budget 2010, we created an Aboriginal health division but we did not provide a Transportation and Communications budget. Obviously, if you are going to have an Aboriginal health division then travel to Labrador, especially, is a significant factor. That is the area that has resulted in the increase there.

MS MICHAEL: Okay, thank you.

Under subhead 04. Supplies; this may relate to the same thing actually, now that you have explained the Aboriginal health division, because the Supplies are going up significantly.

MR. KENNEDY: Yes. We have created in Budget 2011, an access and clinical efficiency division. That will provide funding there also. In this area, we are dealing with general office supplies, books, periodicals, et cetera, and the National Blood Portfolio for which we are the lead Province. The three of those would combine for the $73,000.

MS MICHAEL: Okay.

That will be a permanent thing I guess, will it?

OFFICIAL: (Inaudible).

MS MICHAEL: Yes, okay.

MR. KENNEDY: The National Blood Portfolio will not be because we are only the lead Province for that. Each province I think is there for two years, and ours will be up…

OFFICIAL: March, 2012.

MR. KENNEDY: March, 2012.

MS MICHAEL: Okay.

MR. KENNEDY: But, the other two divisions are permanent.

MS MICHAEL: Would be permanent, right.

Under 05. Professional Services, going up to $2.2 million. It is a big jump, so there must be something planned here.

MR. KENNEDY: Okay. That is heading?

MS MICHAEL: Subhead 05. Professional Services.

MR. KENNEDY: Yes. There will be a significant increase in this. This is increasing the awareness and the access to mental health and addictions. In this Budget we had put in significant funds for increasing awareness in mental health and addictions. As you will see from the Budget, there was approximately $1 million allotted for the awareness and e-mental health campaign, and $230,000 of that will be in relation to awareness. The awareness, where we have not determined yet exactly how that campaign will roll out, we have to look at what is the most efficient and effective way. Is it TV, newspaper, Internet? We have budgeted $230,000 for that.

MS MICHAEL: Okay.

MR. KENNEDY: Access and clinical, it is just wait times. It is just a fancier name for the wait times division. There is $990,000 there and $66,000 for the Canadian Blood Portfolio.

MS MICHAEL: There is a whole division working on the wait times?

MR. KENNEDY: Yes. We have created a new division. I think there are four or five people being hired. It will be looked at. The difficulty with the wait times, when you simply look at the situation in one regional health authority, then you are not looking at the Province as a whole. For example, when you look at the wait times for – I will use emergency rooms; that is something we are all used to - the reasons for emergency room wait times in St. John's, whether it be at the Health Sciences or St. Clare's, could be totally different than the reasons for wait times in Burin.

What we want to do is make sure that we have a provincial prospective on this and that there is a consistent policy throughout the Province. Because when you are looking at trying to solve wait times, whether it be the orthopaedic surgeons hips and knees replacements, which we have to do work on in St. John's, you will see that there is a fluctuation from the wait time reports. It can take longer in St. John's, we can be behind, but in Gander it can be within the national benchmarks. This division will now monitor, on a provincial basis, wait times on everything from CT scans to MRIs, to orthopaedic surgery to emergency rooms.

We really want to tackle this issue. It is one that, from my perspective as a minister, once you are in the system, I do not get as many complaints. The e-mails that – now we do, obviously, there are hundreds, if not thousands of people going through our health system every day, but the care provided by the doctors and nurses and individuals, once they are in the hospital, is generally very good. Where I receive the complaints, as the minister, to my BlackBerry is getting into the system: the wait times for everything from CAT scans to emergency rooms. So, this division is in place to deal solely with wait times.

MS MICHAEL: That is really interesting. I agree with what you are saying, even from my perspective. The complaints that we get very often is trying to get in, but once people are in and being treated, I get so many comments about how well they are treated and how excellent the staff is in our health care system. You always have people wanting to make sure – I understand they are not complaining about people who are working in the system because once they get in there they get excellent treatment, and so I think it is a really important point.

MR. KENNEDY: I should add that a function of this division will be to collect data. Because the problem with managing a system is that if you do not know the reasons for your wait times, like what is happening - if you remember earlier this year, something as simple, we went back and looked at the missed appointments for MRIs and CAT scans. Now, we can simply say that people did not show up, but there is a more systemic issue there. As a health system, we have to follow up. Maybe we have to come up with a system like the dentist's office. You have an appointment tomorrow, are you going to show up?

Because there is always someone, even on twenty-four hours' notice, if they can get that MRI, they are going to show up.

There are things internally; it is not simply a matter of missed appointments. We do not have, for example, the systems in place to ensure that people are showing up, as best we can. This new division will oversee on a provincial perspective. Because one of the concerns I had, when I became minister, was that there was no consistent policy on some of these issues. We have to, as a department, set the policy, and then it will be operationalized by the regional health authorities; but, you have to know what is going on in each regional health authority to be able to adapt a solution for that particular authority, or even within the authority.

MS MICHAEL: Right. It is an interesting point you are bringing up, and this point, I think, is a good place for me to bring it up. I have had some people within Eastern Health, in particular - not so much province-wide, but because Eastern Health is so large - come to me and what they do talk about is the lack of standards being the same, still trying to work with that issue. I am really glad to hear you using that language around the wait times, but are there any other initiatives going on with regard to standardization within Eastern Health?

MR. KENNEDY: Well, I do not know about only Eastern Health, but again, we have increased the numbers of people in our mental health and addictions services because that is a province-wide issue. We cannot simply look at what is happening in one area in isolation so that what we have to do, not only do we have the issues in terms of ensuring that services are provided and there are awareness campaigns in rural Newfoundland and Labrador, but then we have different issues on the Coast of Labrador in terms of delivering services there – in Lab West.

So, again, we are a provincial policy trying to standardize our approaches, trying to ensure that the services that are available in St. John's, Gander, Grand Falls, or Corner Brook are available in other smaller areas in the Province. How we are going to do that is obviously a challenge, but those are a couple of examples of how we are trying to ensure that there is a provincial policy and provincial perspective and approach in place.

MS MICHAEL: One of the issues that has been brought to me is - and it goes back to, of course, the fact when we had many more authorities and boards, et cetera - that you may find that the standards, even with regard to hiring might be different, even within the same authority, and especially Eastern Health because it is so large, and even the hiring of specialists may not have the same standards. Is that kind of standardization being looked at?

MR. KENNEDY: I was the Minister of Finance in 2009 and when I met with the board authorities, one of the things I found startling was that we had authorities bidding against each other for the same medical talent. In other words, Central Health – I am using them as an example, it could be Western or Lab-Grenfell – were bidding against each other and offering more money for a specialist to go to one or the other. I said: It cannot be like that; we have the same pool of talent.

So, it was after that we started moving toward our labour market adjustment policy and I gave directions then, when I became Minister of Health, to the authorities that you cannot do that. There has to be a standard approach and you cannot have Gander and Grand Falls, for example, bidding for the same doctor.

We have tried to ensure across the Province, but that was a startling example. Now what happens is that if you are going to hire, for example, you want to pay a signing bonus to a nurse in, I will use Port Saunders as an example because that arose, then the CEO of the health authority, it is brought to his or her attention, they then come to me. There are certain positions I have the authority, as minister, to sign off and say offer the $5,000 bonus. With the nurses, we do not need to go to Treasury Board on everything.

There are other situations where Treasury Board, in order to ensure a governmental perspective, has to look at whether or not we are going to provide signing bonuses, look at whether or not there can be retention bonuses, things like that. So that is, again, another example of how we tried to standardize across the Province to eliminate one authority. They were just doing their job, by the way, trying to find doctors and nurses and X-ray and lab people, but we need a standardized approach. So, we have also taken that approach in terms of the recruitment and retention of professionals also.

MS MICHAEL: Do you have people dedicated in the department (inaudible).

MR. KENNEDY: Yes, there has been a lot of work done in our workplace planning division. In fact, I think recently came to Treasury Board, it might have twenty or twenty-four groups of professionals. As opposed to going to Treasury Board each time you wanted to offer a signing bonus, we went in with a group and we identified hard-to-recruit, hard-to-fill positions.

Obviously - and again I will use Labrador as an example - in the recent Budget, when we announced the addictions and mental health personnel in Labrador, this came as a result of meeting with various people on the Coast of Labrador, especially the North Coast, who said to us: It is not enough to have your services offered in Goose Bay for the North Coast; we need people on the ground.

So, in order to get those people, though, it is not only the salaries and retention and signing bonuses, we had to provide everything from accommodations, to the mobile homes, to transportation, because obviously without Ski-Doos in the wintertime, they cannot get around. So, you have to adapt to the circumstance, and that is where the labour market adjustment policy has come in and we have a standardized approach to nurses, pharmacists, a lot of medical personnel, and then we still have the leeway, as Treasury Board, in overseeing the fiscal capacity of the Province, to allow for individual circumstances.

That is another example and one where we really have standardized in the short period of time what were very confusing policies out there within the health authorities.

MS MICHAEL: Okay.

I just have one more question under this section, if I can do that.

MR. KENNEDY: Okay.

MS MICHAEL: You have mentioned your concerns with regard to mental health and addictions. Last year you talked about an aggressive agenda and I think you are still indicating the aggressive agenda. Of course, I think publicly you have said that you have an advisory committee of the general populous to the minister on these issues as well. How has that work been going, and is that committee a committee that is just an ongoing committee or does it have a goal? Will it ever at a point make a report? What is that role?

MR. KENNEDY: I can honestly say Ms Michael that this committee has been much more active than even I expected them to be. The Chair is Vince Withers, and Vince, obviously from his own personal experience with eating disorders, has done unbelievable work in creating the Eating Disorder Foundation and getting that message out there. Our Dr. Ladha is the vice-chair. He brings to it, obviously, almost forty years of experience in dealing with the mental health system.

Then we have representatives of various communities: Jocelyn Greene is there from Stella Burry; Ron Fitzpatrick from Turnings; Mary Walsh is there as a representative of the public. We have representatives from the health authorities, Michelle Kinney from Nunatsiavut government. There are about ten or twelve, they just met yesterday. They were the impetus actually, I have to say, with the awareness campaign because a number of them had been at a conference in – it might have been London, Ontario where they were talking about the e-mental health and the New Zealand experience.

Especially, New Zealand has a very diverse geographic geography and also a high percentage of the Aboriginal populations. They had developed this e-mental health campaign that they were putting forward. A number of the advisory committee came back and said: look, we have to do this, we have to try this.

What we are looking at with this actual project, it can be everything from Internet counselling to e-mail counselling. It will be mental health and all aspects of addictions. I am not breaking the addictions, whether it be alcohol, drugs, gambling. It will show people where to go. There will be self-referrals. A lot of times people are confused: Well, what are the symptoms? Am I just sad, something has happened in my life? Am I depressed? I may not know the answer to that as a person who is encountering problems but a list, being able to access professionals.

The advisory council has been absolutely phenomenal in terms of pushing that agenda. The Labrador agenda, Vince Withers and a number of the council members travelled to Labrador and came back. Again, when we look at the high rates of suicide in some of our communities, this is an issue we have to deal with.

When I spoke to Labrador-Grenfell, I cannot say there was not a plan. It is just it has been ongoing for so long, some of these issues, that they did not see it. They were not as startled by it as someone on the outside looking in. They were very supportive, and so the council was very supportive of that initiative. Then, of course, in terms of the replacement of the Waterford Hospital, the first letter I ever got from the advisory council was on the need to replace the Waterford Hospital.

This is all about decreasing stigma, decreasing the discrimination and encouraging people to come forward and seek help, but providing the help and services that they need. I can tell you, this advisory council has been absolutely – it is a long way of saying they have been absolutely superb in terms of the work they have done.

MS MICHAEL: You have great people on it. I have to acknowledge that, you really do.

Minister, in relationship to all of that then, where are – I was just wondering about updates on the different things that have been in the pipeline now for a while. The construction of the new residential treatment in St. John's for children and youth with complex needs; the residential treatment centre for Grand Falls-Windsor; the planning and development of the adult residential addictions treatment centre in Harbour Grace. Where are all of these different plans?

MR. KENNEDY: I have to say, I am disappointed and not pleased with how we have handled the time it has taken to build these youth addiction centres. Part of it is when you have an aggressive infrastructure strategy and it is all done through a department, such as Transportation and Works, then - it is complicated in this case by the fact we had two authorities involved, Central Health with the youth addiction centre, Eastern Health with the youth with special mental health needs. Then you involve the department and consultants, and the procedure certainly has not been what I want it to be.

Part of the difficulty, quite frankly, is that the department should have been involved right from the beginning. That is not just with these facilities, but we tend to go to the consultants. The consultants will spend a year developing plans. We are still on track, we have identified the two - in fairness, we encountered some issues, for example, with identification of sites, but it has taken too long. That is, again, something I am looking at fixing up in terms of infrastructure. We are still on track with the Grand Falls facility, but we have been two years now and nothing in the ground.

MS MICHAEL: Right, yes.

MR. KENNEDY: That is a system that has to be improved, and the same thing with St. John's.

We have encountered certain problems. The problems we have encountered in Harbour Grace have been different. There is a school called, it was St. Paul's that was built about twenty years ago. Actually, quite a big school, and then when the denominational system disappeared that school was left empty and approximately ten years ago a youth group moved in there. We are trying to work with them to determine how we are going to situate them because they cannot coexist.

The addiction centre, this facility is about, as I say, twenty years old. It can be fixed up but the experts have told me you cannot have the addictions centre and the youth group coexist in the same building, which makes sense to me. There was also some kickback within the community in terms of not in my backyard, which we are dealing with. That is still on track but there certainly have been some problems with that, too.

It comes back to, Ms Michael, quite frankly, part of it is still the stigma that attaches. Again, I am not talking about specifically in any facility here. People do not see these as hospitals. They do not see them as an absolute necessity in terms of the treatment of mental health and addictions. What they see are people who are going to go, I do not know, commit crimes in their neighbourhoods. When really what we are doing - these facilities are based on facilities that exist in other parts of the country and also would serve not only a useful, I would say a crucial and a necessary purpose.

Certain people, in terms of the recovery process, need that recovery process. It could be from twenty-eight days I guess to sixty days. They need to be in a facility and essentially provided with intensive psychotherapy and the other aspects. It has been slower than I like.

MS MICHAEL: I just have one closing comment on this whole issue, then, to add to your sense of urgency - and I do understand your sense of urgency and I know it is a major concern that you have - but if there is one area where phone calls have been going up in my office and to me personally, even at home, is in the whole area of mental health and addictions. The number of people calling is going up because services are not there or when they need help it is so non-satisfactory. I am going to actually come to you personally and talk about some stuff; I would like to do that. The numbers are going up in my office, the phone calls.

MR. KENNEDY: The complexity of the issue goes back almost to the deinstitutionalization of the Waterford, whether it was the late 1980s or early 1990s, and unfortunately we allowed a lot of people to go out in the community without the supports that they needed in order to survive.

MS MICHAEL: Yes.

MR. KENNEDY: So, mental health and addiction issues oftentimes are not only the issues themselves but they are compounded by a lack of education, a lack of employment opportunities, lack of housing, and people living in poverty. Although these issues transcend boundaries, it is a very complex issue. Here we are now trying to catch up; twenty years of people living in some of these boarding houses. It is a very, very difficult area.

MS MICHAEL: That is the major issue because anybody who is on disability, and a lot of these people are on disability assistance, the disability assistance is a poverty level existence and so where they have to choose to live just adds to the complexity, as you were saying. The lucky ones are those who have families who can support them, but they are in the minority. Sometimes it is because of the whole thing of the stigma because sometimes they get rejected by families as well. We can go on and talk about this all day, but I am going to come to you and talk to you about some instances that have been brought to my attention.

Thank you.

MR. KENNEDY: Thank you.

CHAIR: Ms Jones.

MS JONES: I am just going to pick up on the mental health piece before we move on. With the Harbour Grace addictions centre, you guys postponed a call for proposals back some time ago.

MR. KENNEDY: Yes.

MS JONES: I am just wondering: Has a new call for proposals been issued or what is the status of that right now?

MR. KENNEDY: The new call for proposal has not been issued. There have been a number of complicating factors, I have indicated. This youth group that are currently in this facility do great work and they have anywhere from forty to sixty youth. It is called the SPLASH Centre. They have been there for a period of time. So we are trying to work with HRLE to see how we can deal with this situation because, obviously, if the youth group cannot be moved, well this facility is not going to be appropriate. So that is a complicating factor.

MS JONES: I guess that brings me to where I am. This is ten months now since all of this has been put on hold.

MR. KENNEDY: Yes.

MS JONES: I think it is time that the department made a decision as to whether they are going to be able to cohabitate in this facility or if you need to move on to look for another facility -

MR. KENNEDY: No, we have made that decision. I have had various experts - they cannot exist in the coexistence (inaudible).

MS JONES: Okay.

My question now is: What are the other options? What other options are government looking at? Are you still looking at putting the centre in that area? Are there other facilities that you can use? Because we have not seen money earmarked in the Budget, maybe it is there.

MR. KENNEDY: Yes, the money is there.

MS JONES: Okay. You can certainly point that out to me when we get to the capital construction

section of the Budget. We are trying to get a handle of what the timeline is here to actually do something progressive with this.

MR. KENNEDY: My officials were out in Harbour Grace two weeks ago with the HRLE people. The first step is: How do we ensure that this youth group is properly looked after? That decision will be made in the next few weeks. If the decision is that there is nowhere else or they cannot go anywhere else, we will then have to look for another facility or look at the possibility of building a facility. My preference would be, considering we have buildings in our Province right now, depending on the age, we can renovate this facility for $2 million as opposed to spending $10 million to build one. So, we will look at other alternatives, but that decision will be made in the next short period of time.

MS JONES: Okay.

Again, with the youth mental health facility, that has been tossed around for awhile. We know you are looking at Paradise; you are looking at the school there or whatever. What are the timelines around that as well? When are you anticipating that we could see this facility open and programs being offered? Was there any money earmarked this year? We know there was $5 million originally. We do not know if that was even spent yet or if it still there, and if it can be done for that amount of money.

MR. KENNEDY: We have run into difficulties in which I need Cabinet direction in terms of cost. We are going to do it, but in terms of cost.

MS JONES: Yes.

Paradise Elementary, the school there, that is being demolished, is it?

MR. KENNEDY: That would be the plan, yes.

MS JONES: Okay. That site would be used?

MR. KENNEDY: That is still the plan as we speak, yes.

MS JONES: Okay, for the facility. Is there any budget projection on what it is going to cost to do the youth mental health facility there?

MR. KENNEDY: I really cannot say a whole lot about that because it is a matter that is before Cabinet right now.

MS JONES: Okay.

MR. KENNEDY: What I can say to you is that the plans remain the same to build these facilities. We are totally committed to these facilities. There are issues there that have to be discussed, not in terms of building the facilities but issues that we have recently encountered.

MS JONES: Originally you had earmarked $5 million for that facility. Was there any additional money earmarked in the Budget?

MR. KENNEDY: In this year's Budget?

MS JONES: Yes.

MR. KENNEDY: No, I think, Tony, the amount was still $5 million we had allowed for in the Budget.

MR. WAKEHAM: Yes, that is correct. If we get out the tender, we will not spend the total cost of the project in this fiscal year because by the time you go out to tender. So the $5 million is still there for this year.

MR. KENNEDY: Yes, there are operating monies in the Budget too. Not only did we put in the infrastructure monies but there are operating funds in the Budget.

MS JONES: The teen addiction facility in Grand Falls, I think it was announced in 2009.

MR. KENNEDY: Budget 2009.

MS JONES: It was supposed to be completed by next year. I am just wondering what the timelines are for the project now, nothing has started or been done to date, and if you can give us a more detailed and specific update on where you are going with that facility.

MR. KENNEDY: What I can tell you is that it is our firm commitment to build this facility. I have indicated that I am disappointed with the process. I cannot point to any one reason why it has taken as long as it has. There are a number of lessons to be learned here and the department has to accept our share of that responsibility. Right now, there are certainly issues that will be determined in the next few weeks that will determine timelines. My hope with the sites identified is that we will still get to the point where land will be cleared and construction will start before this construction season is out.

MS JONES: Do you have a location in Grand Falls-Windsor?

MR. KENNEDY: Yes, we do. I am trying to remember exactly where it is. As you are driving out of Grand Falls, there is a big salmon somewhere. Do you remember that big salmon on the road?

MS JONES: Yes.

MR. KENNEDY: Well, I think, to the best of my knowledge, somewhere off in that area there is a piece of land. I can get you the details, we do have a site. It has gone through the municipal planning. There were some concerns expressed. It took some time with the Grand Falls council, then we had to go get municipal permission, but we do have a site.

MS JONES: It is a new site and new facility?

MR. KENNEDY: Oh, it is a new site and new facility, yes. It is the same thing with Paradise, new site and new facility.

MS JONES: Have you decided if the facility in Grand Falls will be a medical detoxification treatment facility?

MR. KENNEDY: The plans are all in place. I am not quite certain what you mean by medical detox in terms of a treatment. Colleen Simms, our Acting Director of Mental Health and Addictions, is not here today. What I can tell you is that it is a treatment facility that will be based on models that exist in other provinces. These kinds of facilities exist at least, I know, in Ontario, New Brunswick and Quebec and it will follow the models that are in place in these other provinces.

MS JONES: Yes, okay. That is no problem. Joy says we can follow up with your –

MR. KENNEDY: Yes, Colleen will certainly – any information you want in relation to the operating as long as it is not – and I do not think it does impinge on anything that we are doing in Cabinet. We will find that information for you.

MS JONES: A couple of other things under that as well. I wanted to pick up on the Labrador piece. I was pleased to hear your comments this morning because understanding the landscape in Labrador is really going to provide for better services for people. I am pleased to hear you say that when you create every new position in most of these communities you also have to create a whole gambit of other services that goes along with it. I think that is the reason in the past we have had trouble filling positions and keeping people in a lot of these communities to provide the services that people need.

In terms of the new positions that have been created in Labrador for addiction services and mental health, can you tell me how many positions and where they are going to be located?

MR. KENNEDY: Yes, I am going from memory here – wait, actually I do not have to go from memory. The $2.2 million investment will place five full-time mental health and addictions counsellors in Nain, Hopedale, Makkovik and Natuashish and provide the necessary accommodations and supports.

The issue I have heard from discussions with our Minister of Aboriginal Affairs who lives in Hopedale and in discussions with the Nunatsiavut government – and the reason I am focusing on the North Coast is that, as you are aware, the issues on the North Coast are different than the issues on the South Coast or in Labrador West. They are not necessarily the same. We are focusing on the North Coast of Labrador as a result of the information that has been provided to us, especially in high suicide rates. We are trying to get into these communities and put people on the ground.

That is what I heard in discussions with Minister Pottle, Minister Hickey and also the Nunatsiavut government. You need people in the communities.

It is not enough for people to fly in from Happy Valley-Goose Bay once a month or once every couple of months. As we move into these communities we will be looking at – I am in discussions actually as we talk about telepsychiatry in Labrador as a whole and the provision of those services. We are going to actually have people in the communities. In fact, I think there are one or two people in Nain as we speak. That was the major concern I had, we need people living in our communities.

MS JONES: Yes, and I will not argue with the fact that the greatest need probably exists in those communities but there is an extreme need in the South Coast of Labrador as well, especially for mental health and addiction services, and not just with adults but with young people as well. The suicide rates might not be as high but I am just thinking in the past month I had two cases of youth attempted suicide in my district.

MR. KENNEDY: I was not aware of that.

MS JONES: The problems are there, it exists. It may not be talked about as much, it may not be exploited as much, but people who work in the medical profession should know and understand the gap that exists there is that there is nowhere for them to go. They have to go to St. Anthony or to Goose Bay, and in many cases they get to St. Anthony and the only thing they can do is get a conference operator with a psychiatrist or something, or a psychologist in many cases. So, there is a huge gap.

I talked to the mental health nurse in my district and the caseload is extreme. They cannot keep up with it. I have just dealt with two families, one who had their child hospitalized here in the Janeway for an extensive period of time with eating disorders. It is becoming more common amongst young people right across the Province and I am seeing it more in my own district. I am not talking about children who are being absolutely diagnosed with anorexia or bulimia, or whatever, but with eating disorders in terms of image eating disorders and things like this.

It is really causing them tremendous problems and stress. There are a lot of these things that are going on. I just think there needs to be more of an effort made to improve mental health and addiction services in the southern region of Labrador as well. I do not know what the health authority is telling the department but I will certainly speak to them again because the gaps are there and they need to improve the service in those regions.

MR. KENNEDY: All I can say to you is, I have met with Labrador-Grenfell on a number of occasions on this issue and no one has raised this issue. The issues that you talk about in general are issues that exist in the Province but no one has pointed out to me. My focus and where I have been provided with the information is that we have a crisis situation in some of our northern communities. That is not the situation that has been pointed out to me by Labrador-Grenfell or anyone else. If you are telling me there is a crisis situation in that -

MS JONES: I do not think I used the word crisis, in all fairness, Minister, but I did outline there was a need and I think it needs to be dealt with. The resources are very few and far between in the southern region of Labrador. There are very few professional people there to deal with any kind of mental health issues or addiction services that people are dealing with. I am not arguing there is not a crisis in the northern regions, maybe there is. I am not passing any opinion on that.

I am passing an opinion on what I know, and I know there is a need in the southern region and I think that government needs to look at how they can improve the service to people in that area. I am not asking that there be a mental health nurse placed in every clinic but I think it is a bit unreasonable to expect that one or two of these professionals can handle the entire area because they are not able to do it.

MR. KENNEDY: Again, all I can tell you is the way this would come to my attention in the Budget process is that the health authority would bring forward - and I am not saying they even brought forward this issue of the addictions. It was raised to me, the concerns we have in Labrador West with the booming economy, the access to drugs in the Lab West area. There were issues over there. The health authority brought to my attention, and I am aware of the issues in Happy Valley-Goose Bay in Sheshatshiu in relation to these issues. I am certainly aware of the issues in the north coast.

All I can tell you is that the issues were not brought to my attention in terms of the South Coast of Labrador. We addressed the situation in the Budget with $2.4 million. Almost more than 25 per cent of the mental health and addictions budget this year went to Labrador, and it is only if we are aware of these situations, obviously, that we can look at them. I hear what you are saying in terms of the geography and the lack of resources, but these are issues that we will be trying to address. It has to go through the health authority, generally, to come to my attention.

They do not tell me, I guess, is what I am saying.

MS JONES: You talked about the young people with eating disorders. Do you have any statistics on where that is in the Province today? I have just talked to people very informally about this and people who work at the Janeway and so on. It is quite obvious that there are more cases popping up in the Province and more children who are being hospitalized for treatments regarding this. I am just wondering if you are tracking any of this in terms of what the stats are telling us right now.

MR. KENNEDY: Yes, all the stats are available. Vince Withers, as I have indicated is the chair of the mental health advisory council. Vince has been instrumental in bringing this issue to the forefront. The Eating Disorder Foundation, we have provided them with funding in the last couple of years. In fact, in 2010 we provided them with funding to go across the Province and to train medical professionals in identifying the symptoms of eating disorders. I understand that was very successful.

Then we do have Eastern Health, the facility here in St. John's that is working closely with the Eating Disorder Foundation. I would agree with you, even though we have made good strides, like any aspect of mental health and addictions, it is not something that you can let up on because of the gaps that have occurred in other years. So we can certainly find those statistics for you. Colleen Simms will deal with -

MS JONES: I would like to see where the numbers are.

MR. KENNEDY: What we are seeing, and I am hoping that the same thing will happen with mental health and addictions in general is that by encouraging, by awareness - and again Vince's personal experience is what spurred him to getting involved. We have seen many more people come forward and seek help as a result of this awareness campaign. That is the reason for this aggressive awareness campaign: to encourage people to come forward, to try to remove or decrease the stigma and to ensure people that you will not suffer for seeking help.

The numbers are certainly out there and I think that is a good example of how one man's work in conjunction with government support, establishing a foundation and then working with Eastern Health has resulted in many more people coming forward and seeking help.

We have, by the way, in the past sent people to facilities in other parts of Canada, if the treatment is necessary. That is something, I can tell you, that if a doctor comes forward to our department and says there is intensive or extensive treatment required for eating disorders, we send them, for example, to Homewood in Guelph, Ontario; that is one institute that comes to my mind where we have been sending people in the past.

MS JONES: Yes, we are aware of that.

In terms of addictions, can you tell me what the gambling addiction rates are now? Are they going up or down in the Province?

MR. KENNEDY: No, again, I would have to find that information. I am not aware of the rates and I am not sure that –

MS JONES: Are the revenues from gambling going up or down?

MR. KENNEDY: The revenues from gambling - last year, I know when I was Minister of Finance, I looked at the numbers. Obviously, we have decreased the number of machines. In 2005, the numbers show us that there was $117.6 million in revenue and in 2008 that had decreased below $100 million. Those are the latest numbers I have.

In terms of the actual rates of gambling, I do not know how you would even determine in terms of problem gamblers, unless people self identify as in any other addictions, whether it be alcohol and drugs. I will check to see if there are numbers, but I have always had difficulties with addiction rates because there are so many people out there who suffer in silence. We do not know that they have the addictions; they are not coming forward and seeking help.

MS JONES: Just based on your prevalence study that you did, you did estimations of the percentages of the population, I am just wondering, in reassessing that work and updating it, if those have changed.

MR. KENNEDY: Well, we are in the process of updating the mental health strategy and this year it will be a mental health and addictions strategy that will look at issues of addictions. Part of the problem, of course, in identifying is that you can have someone who is addicted to alcohol and/or drugs and/or gambling, so they can have them all. In this strategy, we will identify how we are going to approach addiction as a whole but then recognizing, for example, you have Alcoholics Anonymous who have numerous groups throughout the city

whereas Gamblers Anonymous certainly has not had the same success, to the best of my knowledge.

MS JONES: What is the status on the Waterford Hospital? What is the plan by government looking at -

MR. KENNEDY: Sorry?

MS JONES: The Waterford.

MR. KENNEDY: The status, yes. What we have done this year – this is a huge project that estimates could be up as high as $250 million at present. It will be a long-term facility. The beds will decrease, but the acute care will take place within the hospital settings. This year, the planning will take place. Any time you build a major facility like this you have to allow four, five, six years for it to be built from the time it is announced to the time it is completed.

MS JONES: What was the time frame?

MR. KENNEDY: Well, I am just going based on what I am seeing in other facilities. When you are talking a facility this big, it is a difference between building a million dollar facility as opposed to something this huge. We are looking at, my guess, anywhere from four to six years. You generally have a year of planning, and then you put your project together, then another year to start your site clearing and selection and then start building. A building like this will take, my guess, a couple of years to build, based on the experience I have seen in government so far with the construction of these types of things.

MS JONES: Can you provide us with a copy as well of the vacancy rate of family physicians and specialists in the Province now? We are just wondering if you have been able to recruit more people since the new agreement with physicians and some of those issues were resolved.

MR. KENNEDY: The latest statistics I have on our physician recruitment - and again I have it myself - September 30, 2010; we had 1,098 physicians, 543 family physicians, 555 specialists. That is an increase of 5 per cent over the past year, 1,042 in September of 2009, and 11.5 per cent increase since March of 2008. We do know that in 2010 there were nineteen graduates of the family medicine program practising in the Province and nine were practising outside urban St. John's. In 2010, of the thirteen specialists that finished their residency, eleven commenced practice in Newfoundland. So our numbers are increasing.

We can certainly attempt to find out. When you talk about vacancy rates, again, that becomes difficult. Larry, is there any comment that you have on that?

DR. ALTEEN: The information on the number of physicians in the Province, we should have the March 31 update done within the next, I would say, two to three weeks. We do it annually at the end of March, but it takes a while to get the information from the health authorities, both in the salaried physician and the fee-for-service physician side. The vacancy rates are a little harder number because those numbers tend to change over time based on the delivery of services.

We can compile some information around what each health authority presently has and what they feel their human resources should be in the particular areas of service delivery but there is a fair bit of work to be done at each health authority level to get those numbers straight. Sometimes there is the issue of I am going to say needs versus wants. In some of these areas it is challenging to get the right number as to what the mix should be.

MR. KENNEDY: The other issue in this year's agreement in the Newfoundland and Labrador Medical Association that should help in terms of vacancies for family physicians, I am trying to remember now the exact numbers on this but I think what we did, we built in a retention bonus for the family practitioners in rural Newfoundland and Labrador. I think one of our groups, our specialists had had a retention bonus but the way this retention bonus works, it is actually quite - I think Larry, $12,000 your first year. Then it becomes $24,000 your second year, it becomes $36,000 your third year and then $36,000 every year after. Am I correct on that?

DR. ALTEEN: Yes, that is correct. We have a system retention bonus. It is for salaried physicians. This year we put in a Labrador bonus. If you are a salaried physician, be it a family physician, has a certain bonus rate and a specialist has a certain bonus rate. Labrador is treated the same as if you went to Burin or St. Anthony. There was dialogue with the Medical Association - we did put an enhanced bonus system in place for Labrador. We also put in bonuses for fee-for-service physicians which did not exist before. If you were a fee-for-service physician working outside of the Metropolitan Area of St.

John's, we have a bonus system in place for fee-for-service specialists and fee-for-service GPs.

MR. KENNEDY: The point is with our bursary program, which has been successful with the return in service agreements, with the increase in size of the medical school, with the new NLMA agreement we expect that a lot of vacancies will be filled and especially in rural Newfoundland and Labrador, we will attract a lot more family physicians.

MS JONES: All right. That is all I have under that section.

CHAIR: Okay.

Ms Michael.

MS MICHAEL: Thank you.

I am just going to continue now from the Budget itself. The one I would like to go to is

section 1.2.06. Government Relations.

MR. KENNEDY: 1.2.06 is?

MS MICHAEL: Government Relations.

MR. KENNEDY: Yes, okay, 1.2.06.

MS MICHAEL: This is the one that I want.

MR. KENNEDY: Yes, I have it.

MS MICHAEL: No, I am sorry, a mistake. 1.2.07. Policy and Planning. I knew Government Relations did not sound correct.

1.2.07. Policy and Planning. I am sure there is a logical explanation but it is an anomaly that we just cannot figure out. I have to refer back to the Budget from last year to explain it. I am looking specifically at the subheading Supplies. Under Supplies it says the Estimates for this year is $60,100. It says last year the budget was $52,600 and it was revised down to $30,100. In last year's Budget document the estimate that we approved for Supplies under 1.2.07. was $402,600. There is an anomaly between the estimate that we approved for 2010-2011 of $402,600 - the copy of it is here - and what is stated here as the budget and revision for 2010-2011.

MS TUBRETT: In 2010-2011 we had approved $350,000 to implement interRAI assessment tool for long-term care facilities.

MS MICHAEL: Yes.

MS TUBRETT: Actually, sorry. It was a bit more than $350,000, but there was $350,000 put in Policy and Planning, Supplies for this purpose.

MS MICHAEL: Right.

MS TUBRETT: During the year when we had a better handle of what we were going to do with respect to implementation of interRAI, we realized this money was not to be spent in the department, that this should be spent in regional health authorities. So we moved the budget. A normal accounting procedure that we do in preparation of the following year budget, if budget amounts were budgeted in the wrong area, like this was, then we will restate the 2010-2011 budget so that it will be as if it had never been there in the first place. It will eliminate a variance. Down in regional health authorities that money has been moved and that is where it is this year, in 2011-2012.

MS MICHAEL: Okay, I knew there had to be a bookkeeping explanation for it.

MS TUBRETT: Yes, it is truly just a bookkeeping exercise with respect to how we make sure budgets are in the place that they ought to have been.

MS MICHAEL: Is the restatement rather arbitrary? It looks like it is because even the restatement of the budget and the revision is not even the same as the budget and revision for 2009-2010, for example.

MS TUBRETT: It is not arbitrary.

MS MICHAEL: It is not arbitrary?

MS TUBRETT: No, it was $350,000 that would have been moved to regional health authority, grants and subsidies.

MS MICHAEL: Yes, because what is there was $402,600 in the Estimates.

MS TUBRETT: Right, and there is $52,000 -

MS MICHAEL: What is there now is $60,100 is the new estimate; $52,600 is what you have there and you are saying that adds up. I guess that does add up does it, to the $402,000?

MS TUBRETT: Yes.

MS MICHAEL: Okay. That is where you got the $52,600 from.

MS TUBRETT: Yes.

MS MICHAEL: Okay, thank you.

The revision down to $30,100; that is only what actually ended up being spent under that line then.

MS TUBRETT: That is correct, yes.

MS MICHAEL: Okay, that is helpful.

Is that the same explanation for professional services also? Because the estimate that we approved last year was $348,300 and what is written – no, that is the same. That is all right, I saw that afterwards. They are all okay.

Okay, that was the big one. Thank you very much. That is helpful having that explanation. The rest are all right.

Under that section, under grants and subsidies, what are these grants and subsidies for?

MR. KENNEDY: Where?

MS MICHAEL: The same section, 1.2.07. Policy and Planning.

MR. KENNEDY: Okay, I have it. Sorry.

MS MICHAEL: The $470,000 grants and subsidies, what are these grants and subsidies for?

MR. KENNEDY: Yes, $200,000 is for the Healthy Aging Research Program; $200,000 is for Age-Friendly Newfoundland and Labrador Program. That is where we have the ten communities that we named as age-friendly communities. I think there are approximately – it could be up or down a little - ten grants for age-friendly grants or organizations that we recently announced. Then there is $70,000 for miscellaneous grants for senior organizations and retiree groups.

MS MICHAEL: I wonder, could we have a copy of the list of groups that received the grants and subsidies?

MR. KENNEDY: Yes. A news release went out. We can certainly provide you with that. News releases I think on the age-friendly. Wellness went out in one group. We certainly can provide with the groups.

MS MICHAEL: Just a list with all of them in one, I suppose that would be helpful.

MR. KENNEDY: Yes, no problem with that.

MS MICHAEL: Okay, thank you very much.

MR. KENNEDY: I can tell you the names of the communities if you have any particular questions.

MS MICHAEL: Sure, if you have them there.

MR. KENNEDY: Yes, I have them in front of me. I have the Town of Trinity, for example, the Town of Wabana, Town of New-Wes-Valley, Town of Happy Valley-Goose Bay, but the town could be an age-friendly community or they might have applied for an age-friendly grant.

MS MICHAEL: Right.

MR. KENNEDY: Perhaps I should provide you with the information later as to which communities, which organizations.

MS MICHAEL: Okay, thank you very much. That will be helpful.

This may not be the place to ask this, but I am going to ask it here because I am not sure where to ask about it. The adverse events task force recommended patient safety forums should be held in the four regions, possibly leading to permanent patient safety councils. Is this a recommendation that is active that is being looked at?

MR. KENNEDY: Okay, Bruce.

MR. COOPER: The focus of our work on the adverse events process right now is on occurrence reporting. We have planning ongoing to respond to the other parts of the report. So, as our focus has been on Cameron responses these past months and this year, in this fiscal year we are moving on to look at the adverse events to ensure that all of those recommendations are also responded to.

MS MICHAEL: Okay. So, we will look for further down the road for information on that.

MR. COOPER: Yes, that is right.

MS MICHAEL: Thank you.

Under 1.2.08.05. Professional Services, it is slightly overspent. You must have had something you did not expect, just an explanation of the extra $45,000.

MR. KENNEDY: Yes, you will remember from the Auditor General's report, the Auditor General identified certain issues in terms of the RHAs interacting with the department - capital equipment is one that comes to my mind - we were not overseeing as well as we should what was going on in the authorities. We had some accounting help in terms of how we are going to improve our monitoring of the RHAs. Obviously, we have a staff but the staff - as you can see from Denise trying to oversee a budget of almost $3 billion right now - sometimes do have to go outside. I think that summarizes essentially what we are doing here.

MS MICHAEL: Right. Okay, thank you very much.

I just have to go through my notes, some of them we have covered; I think we have asked all the questions around the provincial drug program that I wanted that came up earlier. The one question, though, related to the provincial drug programs: What is the status of the work being done with the federal government around developing a national pharmacare program? Were there any meetings over the past year around that?

MR. KENNEDY: Just one second, I am just trying to find my note on that, Ms Michael.

I want to make sure that we are talking about the same concept here. To me, a national pharmacare program would be the equivalent of the medicare program.

MS MICHAEL: Yes.

MR. KENNEDY: A universal, publicly funded and administered drug program for all. There have been reports, as you are aware I am sure, recommending the implication of the national pharmacare program, and this is seen as a federal responsibility. At the Health Ministers' meetings this year there were discussions of various types of programs to reduce costs. There were discussions of group purchasing, there were discussions, obviously, that centres around the generic drugs, but I have to tell you that there were no discussions at that meeting in relation to national pharmacare.

This is an issue that can be brought forward by any province or the federal government. At this point, I can say that we are not seeing what I would refer to as any significant or sustained interest in a national pharmacare program.

MS MICHAEL: Is the mainly on the federal government side or is it –

MR. KENNEDY: I do not want to put it all over on the federal government because the provinces can obviously bring forward. Yes, I think it is fair to say, from my perception – Bruce may have some comment, he deals with the other deputies - this is not an issue that is on the table right now.

MR. COOPER: No, I have nothing significant to add except to say that the focus of discussions among the FPTs has been about trying to generate more value through exploring options for enhancing group purchasing, so that has been really the dominant focus in the area of pharmaceuticals.

MS MICHAEL: What kind of headway are you making with that?

MR. COOPER: Right now, it is basically in the preparation of options for consideration of ministers.

MS MICHAEL: Slow process, I can imagine. Thank you.

Section 3.1.01, the regional health authorities, I do not really have questions on line items; I think they are all pretty straight forward. Could we have an update with regard to the deficits of the regional health authorities?

MR. KENNEDY: This year, Denise, is it accurate to say, from an accounting perspective, there is no deficit? What has been happening in the last number of years is that they are given their budgets. They will come in at the end of the year and say this is where we are in terms of - there are two types of deficits we are talking about here. There is the accumulated deficit that they would have inherited from predecessor boards and have brought forward and then there is the current deficit.

In the last number of years, what we will do at the end of the year is that we will pay whatever money then is out there to ensure that they start the new year with a balanced sheet, and that is where they are right now.

MS MICHAEL: They do not have an annual deficit now because you put in the money to make sure that it does not happen.

MR. KENNEDY: Yes, we put in the money.

MS MICHAEL: Do you have figures on that in terms of about how much you are putting in each year in order to keep (inaudible)?

MR. KENNEDY: We have seen, in the last number of years, the issues of the different authorities. Obviously, when you have Eastern Health that has a billion dollar budget, we expect that if there is going to be a deficit in the operating that it would be within Eastern Health. This year Eastern Health, at the end of the year, we had to put in $25.7 million; Western Health: $2.6 million; Central Health: $700,000; Lab-Grenfell actually balanced their budget for a total of $29 million. In the last number of years, there have been similar numbers - not in the last number, but the two years I have been minister it has been around that same (inaudible) –

OFFICIAL: A little less in 2010.

MR. KENNEDY: A little less in 2010.

MS MICHAEL: What is the status of the accumulated deficit and how that is being dealt with?

MR. KENNEDY: Denise may be able to give you the actual numbers. My recollection is that Eastern Health was around $70 million, the accumulated deficit. Is it a little bit lower now, Denise? The other ones again would be proportionately lower, but that is certainly something we can find for you. That accumulated deficit goes back over numerous years. It is predecessor boards, when all the boards came together, that inherited the accumulated deficit.

MS MICHAEL: Maybe we could receive information on what the status of the accumulated deficits are, if you could just send that to us.

MR. KENNEDY: We could certainly, yes.

MS MICHAEL: Okay. Thank you.

I think I will turn it back over to Ms Jones.

MR. KENNEDY: One second, we do have that information.

MS MICHAEL: You do have that? Okay.

MR. KENNEDY: Go ahead, Denise.

MS TUBRETT: At March 2010 it was $71.9 million for Eastern, $19.4 million for Central, $20.2 million for Western, and $20.7 million for Labrador-Grenfell.

MR. KENNEDY: Perhaps you could just give a little bit of explanation, Denise, as to where those accumulated deficits comes from and what they mean from an accounting perspective.

MS TUBRETT: Obviously, for the fiscal year ending March 31, 2011 there will be no increase in the accumulated deficit because the four boards did not incur any operating deficit.

MS MICHAEL: Right.

MS TUBRETT: The accumulated deficit will increase as a result of years when their operating results in a deficit which would get added to your accumulated deficit.

This is an historical deficit that has been there for, I would think since the creation of the boards. There have been times where governments have made decisions to pay down the accumulated deficits. I do not have the exact details of the age of this deficit, but it would have been over several, several years and the result of annual operating deficits.

MS MICHAEL: Right.

MS TUBRETT: The total is $132.2 million.

MS MICHAEL: Okay. Thank you.

Now I will turn it back over.

CHAIR: Okay.

Ms Jones.

MS JONES: Just on the accumulated debt of the board, could we get the information of where that debt has been for the last ten years for each of the board areas? For example, on an annual basis over the past ten years where it has been.

MR. KENNEDY: We can tell you, for example, that in the last two years there is no increase in operating. We paid off the operating deficit. At least in the last two years, and I think back in 2007-2008, again I am going by memory here, but I think it was around 2007-2008 that Eastern actually showed a surplus. Labrador-Grenfell has balanced their books this year. Western had balanced it the previous year.

Again, we can find the numbers for you, but my guess is we are going to go back into the former boards bringing forward the debt into the new authorities.

MS JONES: Okay. When the new boards started, when was that, 2004?

MR. KENNEDY: (Inaudible).

MS JONES: Yes, from 2004; from what their accumulated debt was and just an understanding of where it is today.

On the drug piece again; one of the questions I was wondering about is that the patents now for many of the brand name drugs or the more popular ones have expired last year. We know if you are using prescriptions that are being filled with generic drugs, the cost of prescription drugs are going to drop. Our research is telling us it is probably $40 less than a prescription that would be filled with a brand name drug, for example. We are just wondering if government realized any savings because of that transition in the drug program and if you are anticipating any savings because of it?

MR. KENNEDY: This issue of the patents ending and generic drugs is an issue that is of intense discussion at the Federal/Provincial/Territorial Ministers' meetings for the last couple of years. At the first Atlantic Ministers' meeting I met, there was a discussion, and what we are seeing across the country - in fact, Bruce was with me. Dr. Bradbury is not here, but at the meetings here in St. John's around September 13, 14, I think it was, at that point the provinces were going to look at this as a whole.

Ontario had moved into this and had encountered certain problems. The Western provinces have a buying group together, but other than Ontario, I do not think there has been any movement towards a full-fledged generic drug system. We recognize that there were savings out there. All of the provinces indicate that, but there was a committee put together – and Bruce, you can provide some details – that would report back to the ministers at the next meeting as to how we should proceed. You have the Atlantic Provinces, I think led by Nova Scotia, if I remember correctly, you had Ontario, and then you had someone from the Western group getting together to look at this from a national perspective.

MS JONES: What would be the issue? What is the issue?

MR. KENNEDY: Bruce?

MR. COOPER: The issue is looking at the power of combined purchasing, of group purchasing, and what impact that might have on being able to drive better value in the system. Generics, of course, play a significant role in the market in terms of establishing a gravitational pull towards lower value, which when a patent is eliminated that the brand name companies tend to move towards.

MR. KENNEDY: We have seen a decrease anyway. What happens is when the – and I do not know, Colleen may be able to speak to this. Essentially what happens, my understanding, is when the patent ends then what you will see is the company providing the brand name drug will bring the cost down in any event. So I think there are savings built in, in terms of that.

Colleen, do you want to speak to that?

MS STOCKLEY: Right now, under our current legislation in Newfoundland and Labrador we require a 25 per cent savings difference between – 25 per cent of the brand savings in order to get on the formulary, which as you probably know, applies to every person in the Province, not just people on the Prescription Drug Program. So, looking out as to the new drugs, or blockbuster drugs they tend to be called, that are coming off patent in the next few years, even if we just stayed the course and continued to require a 25 per cent savings, we would get $1.3 million savings in this current fiscal year 2011-2012.

That would increase as more and more drugs become available in generic form when patents expire.

We know in the next three years there are some more big molecules that are coming off patent. Then once we get to 2014-2015 it starts to become a little bit flat. There are not as many of these big ticket drugs that are due to come off patent.

MS JONES: Yes, I was looking at a report that was done by, I think Rogan Incorporated; you are probably familiar with them. They were projecting the savings in Newfoundland and Labrador - and they were doing this under different scenarios of course. They were saying over a period of about five years the savings would be anywhere between $35 million and $50 million.

MS STOCKLEY: It would depend very much on what kind of a model you have brought in. For example, Ontario has brought in a model where they get 75 per cent savings. They pay 25 per cent of brand, which is the flip of what we do. There are a lot of discussions going on about finding, I guess, a policy go-forward that is right for Newfoundland and Labrador, looks for value-added from the pharmacists in the Province, and as well takes into account the big issue for us is the rural nature of our Province and making sure that services are available to people in the rural areas.

As well, it is very important to take into consideration our kind of drug program. We have many people on the drug program who pay co-pays. It is different in other provinces, so there are a lot of things that have to be taken into consideration to find a solution that is right for our Province and for our folks here in our Province.

MS JONES: Yes. I guess the reason I am asking of course is if this was to happen, would there be savings for the patients? For example, we know - just from reading the study of course I could see there would be savings for government if they adapted certain models. Well, whatever model they adopted there was going to savings, right, but the savings would vary. What does that mean to the patient?

MS STOCKLEY: There would be savings for the patient but those savings would come out of the pocket of the pharmacist, depending on what kind of a model you use. That has been a lot of the issue that has come into play in Ontario. There have been a lot of problems in rural areas and a number of pharmacies having to close up shop. If that happened – of course, in many of our areas there is only one pharmacy, so we have to be very careful moving forward to find that right balance.

MS JONES: Yes. What is the Pharmacists' Association saying? What is their view on this?

MS STOCKLEY: We liaise with the Pharmacists' Association on an ongoing basis, actually. They are very much part of the discussion and giving us their views. They do not like a lot of the models that have been used in other provinces. As well, the message from them is we have to work together to find a solution that is right, a good balance for us.

For example – and particularly it is the rural areas that come up to be an issue – if you are saving a person a few dollars on a prescription but the local pharmacy has to close up and now they have to drive over an hour to get to a pharmacy, you have not really saved them anything. So, it is about, again, finding that balance that is right. There is a lot of discussion going on about that right now.

MS JONES: Thank you.

I have just a couple of questions regarding the methadone clinics. I am not sure; are there forty-eight clinics in the Province right now for methadone treatment?

MR. KENNEDY: Are you talking about clinics or the pharmacies that dispense them?

MS JONES: What do you refer to them as?

MR. KENNEDY: Well, the clinic would be the clinic here, the Opioid Treatment Centre here in Pleasantville. That is the only clinic. Then we have a number of doctors who prescribe methadone.

MS JONES: So we have one clinic, is it, and forty-something site for pharmacies?

MR. KENNEDY: To the best of my knowledge, yes. We can find that out. To the best of my knowledge, there is a main clinic. Then you have some doctors who prescribe methadone and then you have the pharmacies that dispense the methadone.

MS JONES: So, can you tell me what all of that means? If I am a patient, can you tell me how that works?

MR. KENNEDY: What that means is that methadone is of a concern to me. Again, I am going from memory. I think there are 600 to 700 patients on methadone in our Province right now.

MS JONES: How many?

MR. KENNEDY: Six hundred to seven hundred. There is a waiting list of at least 150. It caused me concern to the point that earlier this year I had a round table put together of experts to discuss this methadone issue. Also, there was a study done in terms of a jurisdictional scan for the country as to how methadone was prescribed and dispensed.

What came out of this round-table discussion was that we need increased services in methadone. The difficulty is we only have a number of doctors. I think there could be, to the best of my knowledge, two or three who prescribe who will actually deal with the patients. So we have a waiting list.

The concern I had in terms of commissioning, for lack of a better term, this round table was that methadone is one aspect in terms of drug addiction treatment. I had a concern that there were a lot of younger people who were being prescribed methadone. Methadone is a drug. Again, I do not know the exact terminology, but it is a drug. What happens is you are supposed to, in order to wean someone off – we see it used a lot for OxyContin, which is the one that comes to mind mostly in this Province, although I think in the mainland it has been used for many years in terms of heroine addiction.

What happens is you start off - and again I am just going by memory here - 100 milligrams could be the treatment or millilitres, then you try to wean someone down. I had a concern that that was not happening and as opposed to trying other avenues of addiction services whether it is counselling, self-help groups, or psychiatrist, people were simply looking for the methadone because the methadone could, in many cases, be the easiest way to battle addiction.

I have no doubt in my mind that methadone is crucial for a certain segment of our population, there is no doubt. I will use the example that again comes to mind. We have individuals who are going through our criminal justice system and they are committing crimes as a result of drug seeking, yet if methadone assists these individuals in not committing crimes, I suppose for lack of a better term, then there is a societal benefit to that. I have a greater concern, though, when you have people who are younger especially. We do know that there are a lot of young people; we had all of these statistics broken down.

The methadone is a tough issue. In fact, Dr. Nizar Ladha is currently the President of the Canadian Psychiatric Association, and I had a conversation with Dr. Ladha about this last week in terms of what is going on across this country. It is a tough issue and it is one that is not resolved. This round table certainly brought forward certain helpful suggestions but there is a lot more work to be done on methadone.

MS JONES: I guess what I would like to know is: Have we had any success with the program? Are we feeding an addiction in a different way? I do not know. How many people are going through the program and actually coming out with some form of rehabilitation?

MR. KENNEDY: I guess that is the whole issue, though, with addiction is how you define success. To me from my perspective - again, I hate to use the example of the individual who is committing crimes and going to jail - if that individual, for example, who does not commit a crime for six months, and my understanding is that people on methadone are working, the purpose of methadone is to allow people to socially adjust. In order words, their drug addiction, they cannot kick the habit in any other way that can allow them to be functioning members of society.

Whomever that is, if that is working, that is success; however, my question was the same as yours, whether or not the people who were being weaned off are to the point that they were not getting methadone. I do not think - again, I can certainly set up a meeting. Colleen Simms, our Acting Director of Mental Health and Addictions, could provide you with all of the information of what came out of this round table. My sense of it is no, in terms of its success for people who were actually not using any other drug or methadone, we did not seem to be getting there.

MS JONES: Okay.

You talked earlier about having one clinical site and the other services are provided either through a physician or the drug provided through a pharmacist. Are there any plan changes to the methadone program right now in the Province and how that program will be delivered to patients?

MR. KENNEDY: It is my understanding that it is difficult to recruit physicians to deal with this – Larry – in terms of the methadone treatment program. Do you have any information on that?

DR. ALTEEN: The issue with methadone is people who prescribe that must get a licence through the federal government. People, a lot of times, choose not to do that because dealing with the methadone clientele, again, not to stigmatize people, but it is a challenging area and lot of physicians choose not to do that in their private clinics. We have a limited number of people in this Province who actually have a licence to prescribe methadone and therefore access is limited in that realm.

Part of the challenge with this is if we are going down that road as a prescriber of methadone, you would want to do that in a setting where there are other health professionals because there is more to the treatment of these individuals than just prescribing a drug: long-term follow up, how many of these people are actually going to get weaned off methadone over time, as well versus people who need to be on it on a long-term basis. Some people are treated with this, they have addictions but they also have chronic pain. They have other ongoing issues and they may need to be on methadone for a long period of time.

It is challenging for individual physicians to spend the time dealing with this type of problem, so it needs an orchestrated, I guess, structure. The minister just alluded to in terms of what Colleen Simms' work has been doing in this area, and that an ongoing issue that is being addressed.

MR. KENNEDY: I guess to summarize, I am not satisfied as the minister at this point as to where we are with methadone, how we have started the work. It is going to require more work and we are continuing to consult with various groups in trying to find solutions.

If I am hearing what you are saying, Ms Jones, then the ultimate goal of the methadone program, although perhaps unrealistic for everyone, is to assist people in getting off the drugs they are on and not using any drug. We are not there yet.

MS JONES: Yes. I guess I will just carry on. I have all kinds of questions; I am not sure where to go.

Let's talk about the long-term care strategy. Maybe I will just start there to change the subject for a little bit. In 2008, you announced you were going to do a long-term care strategy. We have not seen it yet. I am just wondering what the status of it is. When will it be released? Has it been developed at all?

MR. KENNEDY: Yes, we announced that there would be a long-term care strategy. When I became the minister, Ms Michael asked me: Where was the long-term care strategy? It has turned out to be a very complex piece of work.

When I became minister, we basically put a full-time team in place to try to deal with the issue in terms of looking at not only the – we all know we have an aging demographic, but projecting that aging demographic into the future is what is done through our stats agencies. We then had to look at trying to project where people were going to be living in what areas of the Province. We looked at all of that, then we engaged in our consultations where we went out to the groups within the communities to hear what they had to say and what steps needed to be taken. We put forward a consultation document. That finished all around September, perhaps. We collated all of the information.

The best way I can put this is we have taken steps to implement the strategy, even though the strategy itself is not finalized. What I mean by that is we have to look at what I will refer to as a continuum of care. Having regard to the significant number of seniors, and our statistics are actually – I read them yesterday, I think, but I am trying to remember the exact statistic. The number of people in this Province who will be over sixty-five in the upcoming years is quite significant.

We started out with the infrastructure. We tried to get our long-term care infrastructure in place. We certainly are doing that. We are going to have facilities, but these long-term care facilities, even in the new facilities in St. John's will be 450 beds, Carbonear 250 beds, are not going to accommodate all of our seniors. The first step is how do we keep our seniors at home?

One of the amazing things I have seen is how much seniors do for themselves. There are over 100, 50 Plus groups in the Province right now. I was out to meet with a group the other day in Clarenville, and the amount of activity they are generating. Their socialization is crucial because not only are they having their card parties, dances and outings but it is reducing that social isolation of the senior who is remaining at home and then would obviously be more prone to, I would suggest, an unhappy or an unhealthy lifestyle. So it starts out with the prevention.

Then, the home care is a huge issue. We are trying to work our way through that. That is a significant issue in terms of the number of hours to be provided and, of course, the wages to home care workers; keeping people in the communities and keeping them at home. Then, we have to incorporate the use of our personal care homes. We have tried to again this year increase the monies for personal care homes. We also, in this year's Budget, tried to address the issues of the smaller personal care homes and the community care homes in the Province with the $2,000 per month subsidy.

We brought in a program for $1 million for isolation grants, whereby a personal care home, I think fifty kilometres away from the nearest personal care home would be entitled to a certain amount of money if criteria is met. The $2,000 a month goes to all homes with an annual average of less than fifteen residents.

Whereas the isolation grants, the criteria would have to be met. We have to try to incorporate our personal care homes and our community care homes.

Then, we lead into what has been a very tricky issue. It is the number of medically discharged individuals, or alternative level of care who are in our acute care beds. We are trying to address that, and recently one of the ways we tried to do that was buying more beds off Chancellor Park because they take Level III and IV patients. The personal care homes deal with Levels I and II. We cannot take people from it. Generally, if they are in the acute care beds in the hospital – again, Bruce can speak to this more. If they are in the beds in the hospital then they need long-term care.

You cannot put them in personal care homes. We opened up forty beds and we have reduced the number of people in our alternative level of care.

In this year's Budget we increased – Memorial had an agreement with the Corner Brook Long Term Care that they were going to have a research wing on the long-term care facility in Corner Brook if the Province did not need the beds. We said: Sorry, we need the beds, and we put $3 million there. We announced new protective care residences because in line with your long-term care facilities you have to have your protective care residences for mild and moderate dementia which then the protective care unit in these facilities will deal with the more serious dementia.

We are trying to look at it from the time the person is at home, staying at home as healthy as possible, leading into the long-term care facilities. That is what we tried to address. Each aspect of this, knowing that I have known in my mind - I see this strategy and the long-term care plan, the creation of the infrastructure, but there are areas where we still have more work to do. That is sort of the approach we have taken is that it is not wait for a strategy and then make the investments, it is make the investments that we know are necessary as we move towards the finalization of the long-term care strategy.

Like all these other strategies, it is not going to be a magic cure all. It will outline the steps we are going to take, it will outline directions. We will incorporate what we have heard from other groups.

Our age-friendly grants, that $200,000 this year we put out, I think it was another $200,000 in seniors' wellness grants besides monies that we put into the $500,000 grants to the communities. We are trying to take that global approach in the absence of the strategy but in terms of where the strategy is itself, perhaps Bruce can speak to that.

MR. COOPER: Yes, in terms of the actual document, the Long-Term Care and Community Support Services Strategy, as the minister indicates, we have had a lot of focus on shoring up various components of the continuum of long-term care and community support services over the past few years. Through that process, we have learned some important lessons about how our plan needs to evolve and what it needs to look like.

Fundamentally, we are planning for a circumstance that is somewhat influx. We know there are certainties around demographics in this Province. We have learned that some of the planning assumptions that we may have made three years ago underpinning various initiatives. When we plan it we use certain assumptions, when we implement it and then evaluate it we learn from that. We have learned a lot over the past few years about the proper time frame to use for our planning process and we are in the final stages of the document drafting process. Our commitment to Minister Kennedy has been that he will have something in short order that will be ready for his and Cabinet's consideration.

MS JONES: Okay.

You talked about using the facility over here; I forget the name of it again.

MR. KENNEDY: Chancellor Park .

MS JONES: Chancellor Park . Have you given other consideration to public-private partnerships for long-term care in the Province?

MR. KENNEDY: Actually, one important aspect of the original long-term care in the city itself is what we referred to as the faith-based homes: St. Pat's, St. Luke's, Agnes Pratt, and Masonic. Is that the four?

MS MICHAEL: Salvation Army, Glenwood.

MR. KENNEDY: Yes.

They provide about 600 or 700 beds. Essentially, we fund these organizations. They have their own board of directors, but we fund their operations.

MS JONES: They are not for profit, though, are they?

MR. KENNEDY: Sorry.

MS JONES: They are not for profit?

MR. KENNEDY: They are not for profit. They are, in fact, the pioneers in the provision of long-term care.

So, there are no other beds there. The difficulty with the long-term - and this is one, I think it was either Budget 2009 or Budget 2010, I think we put $2 million for the interRAI tool. The difference in the provision of services is quite startling and the interRAI tool would measure - right now, if you were in a personal care home Level I or II, the difference between Level II and Level III can involve a subjective component in terms of determining which facility you should be in.

Not only from a social perspective but from a financial perspective, the cost of long-term care far outweighs the personal care homes. The interRAI tool was meant to objectify that assessment so that we can ensure that in our limited number of beds in the long-term care facilities that people are there who should be there. There is no question, once you get to Level IV, if you walk through a long-term care facility, Level IV can be fairly easily distinguished. That distinction between Level I and II, or the personal care home, and then Level III is difficult to make, so we brought in the interRAI tool.

We have a lot of facilities that provide services to seniors but none that I am aware of – Bruce, you can correct me - at the same level as Chancellor Park in terms of being able to look after Level III and IV patients, having beds where they could take people out of the acute care setting. The difficulty is finding - if we could find other facilities or groups that could look after Level III and IV in terms of the current system, and we are not saying that the current system is entirely the way it should be, then we would certainly look at that. Is that a fair assessment, Bruce, what I am saying in terms of Chancellor Park being the –

MR. COOPER: Yes, absolutely.

MS JONES: On the personal care homes - and I realize that there was an increase in the budget - most of the personal care home operators I talked to, in all fairness, certainly feel that the increase did not cover off even the increases they had to pay out in minimum wage going up, for example, in the Province. What they are telling me is that government pays, on an average, about 81 cents an hour to keep an individual in a personal care home, and they feel that more needs to be done to support their services, from a government funding perspective.

One of the issues they continue to raise with me is the night security that they had, that government provided for and then removed, and of course now they provide for that service themselves. It seems like that one has been a real sore point for many of the personal care home operators, and I am just wondering if government has given any consideration to reinstating night security for these homes as a means of providing supports for the services they offer residents in the Province.

MR. KENNEDY: I would dispute your comment. This is not the place for debate today, but I will say to you that I have not heard – it is very important to keep in mind there are two different groups of personal care homes. There is the larger personal care home of fifty residents or more, very modern facilities, significant investments on the part of the individuals who own them. I have not heard complaints from them about the increase, because when you look at our numbers, we have gone from something like $1,114 to $1,800 in a mere seven years.

There is the other group of personal care homes of fifty beds or less, and a lot of them are in the thirty to thirty-five beds. They are the group that continue to complain. They complain that they are not getting enough money. They complain about night security; we just gave them $2,000 a month. If you have fifteen residents or less - because their own study demonstrated to us that the group that was in the greatest financial jeopardy were the smaller homes of fifteen residents or less. So, for thirty-odd of those personal care homes and community care homes, we have provided, I think, the equivalent or greater than the equivalent of night security.

So that is the issue. It is very difficult to satisfy some of these groups. They came to us with the smaller personal care homes saying that they were in jeopardy, that is what I heard during the long-term care consultation sessions, and they are the ones that we have provided not only $792,000 in funding for a Small Personal Care Home subsidy, but also a million dollars for the isolation grants. So, the fifty beds or more, I am not hearing any discontent from them. It is the smaller group of personal care homes - you are right - that continue to complain.

MS JONES: What is the $2,000 grant you are talking about?

MR. KENNEDY: There was $792,000 in this year's Budget, there was a news release sent out on April 20 to clarify. The $792,000 would breakdown so that there would be what is called a Small Personal Care Home Subsidy. There would be $2,000 per month for personal care homes and community care homes that had an annual average of fifteen residents or less. What happens is that they have to be a licensed personal care or community care home, have an average occupancy of fifteen residents or less, they have to be in compliance with provincial standards and have the ability to meet the current operational standard.

As we went through the Budget, my understanding is that there were approximately thirty of these homes that we have. There are ninety-seven personal care homes and fourteen community care homes in the Province. This new benefit, we expect, will go to twenty personal care homes and ten community care homes. Almost one-third of the personal care homes and community care homes in the Province would benefit from this $2,000 per month, the Small Personal Care Home Subsidy.

Then some of these others - same group - would benefit from the million dollars we had outlined in isolation grants whereby - I do not have those details in front of me; well, actually I do. To be eligible for an isolation grant, a personal care home must be located a minimum of fifty kilometres away from another personal care home, require financial assistance to remain operational, and meet certain other established criteria. One is you have to establish certain criteria,

whereas the Small Personal Care Home Subsidy, if you meet those criteria, you get your $2,000 per month.

Those are the initiatives that we have brought in to try to assist the homes that had been identified in a study provided by the small personal care home group as being fifteen residents or less.

MS JONES: Is there an application process developed for that program?

MR. KENNEDY: For the $2,000 per month?

MS JONES: No, the isolation one.

MR. KENNEDY: Bruce, is there a -

MR. COOPER: Yes, there is an application process that has been sent to all the regional health authorities that administer the program.

MS JONES: Okay.

Does it have a set of requirements or criteria attached to it? Because I just had someone call my office a few days ago saying they could not get an application and they did not know what the requirements were.

MR. COOPER: Okay.

MR. KENNEDY: The news release –

MR. COOPER: We are very clear on the application requirements. What the individual personal care home operator has to do is provide the RHA with their audited financial statements. The test is can we prove there is a financial viability problem, that this home is at some imminent risk. There is an assessment process that the RHA has to undertake. I will have to check to see whether we actually have what we would call an application, but there should be clear information out to the sector now on the eligibility requirements and who to call. Is that correct, Tracy?

MS JONES: A couple of questions about the community care homes too and then I will just finish up this piece of it. We have certainly heard a lot from them as well, minister, and they are concerned about their cost and maintaining the services they provide to patients with mental illness who live in their homes. They feel they have been bounced back and forth. They go to Eastern Health, Eastern Health says you have to go to government; government says you have to go to Eastern Health.

They are really looking for someone to sit down and meet with them, listen to their concerns and hopefully help respond to what their programs are. Have you had any contact with this group in understanding what their issues are and their challenges are right now?

MR. KENNEDY: We heard from them during the long-term care and community services consultation. I think the various officials in the department have met with the community care homes. We are certainly aware of their issues and we responded to their issues I thought with this, not only the $2,000 per month subsidy which most of the community care homes would get in the Province but also they would be entitled to $87 per resident. For some of these places, if you had twelve residents you are looking at an extra $36,000 a year that we provided in this year's Budget. We thought that we were responding to their needs.

MS JONES: Well, I guess it really was an issue of what their expenses are. What they are telling us is that the cost of providing the service is increasing very rapidly in the Province. The cost of food is going up, the cost of all the services are going up. They have not been able to provide for the minimum expenditure for some time and they are really finding it very, very difficult. That was the concern that was expressed to us and that was post-Budget as well as pre-Budget.

MR. KENNEDY: Yes, but there is only so far that we can go with this. There were significant investments this year in the personal care homes, smaller personal care homes and community care homes. We have invested significant money.

Financial viability issues, they are different issues than what we – some of the issues they have are not issues that can be solved by us. Community care homes are a different situation because of the clientele they have. Some of the smaller personal care homes, we have certainly reached out this year in this Budget and tried to make their lives easier but there is an economic reality to some of these homes and there is only so far that we can go.

MS JONES: Okay.

CHAIR: Thank you.

Ms Michael.

MS MICHAEL: Yes, I just have a couple of more questions in this area. The Budget allocated $250,000 for a review of home care. I am wondering, what is that review about and how does it relate? Does it relate to the strategic plan? What exactly are the guidelines for that review and who is doing it?

MR. COOPER: Since government introduced the income based model of assessment for home support we have seen a significant increase in uptake. For example, last year there were over 700 new clients above the previous year that came onto the service. This means we have to take a look at the program to make sure all of the eligibility criteria that we have set up are being applied properly. We need to understand the rationale for the growth. We also need to do some planning for further enhancements to the home support program.

Really, there is a two-pronged answer to your question. The first

part is we are going to review this policy, that has been in place now several years, just to make sure what enhancements, what tweaks do we need to make to ensure that it is working the way we intended it. That will also feed the second part of this which is the go-forward strategy.

MS MICHAEL: Okay. That is helpful.

Will the review – and I have a sense maybe it will not – look at the adequacy of the changes that were made, or some attempt to be made to look at who are people who are on the other side of the ceiling with regard to the financial assessment, those numbers, people who just might be right on the edge and still needing assistance.

MR. COOPER: We will be looking at the impact of this policy. Who benefits, how do they benefit? We will obviously have to understand: What are the problems that ou

Document details

Collection	Newfoundland and Labrador — Committees
Citation	2010-11-05
Type	committee
Volume / chapter	committees_standingcommittees_socialservices_ga46_11-05-10-ssc-hcs.htm
Language	en
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Source	PROVINCIAL
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