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May 2, 2022

SOCIAL SERVICES COMMITTEE

Pursuant to Standing Order 68, Steve Crocker, MHA for

Carbonear - Trinity - Bay de Verde ,

substitutes for Sherry Gambin-Walsh, MHA for

Placentia - St. Mary's .

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

for Paul Pike, MHA for Burin - Grand Bank.

Pursuant to Standing Order 68, Paul Dinn, MHA for

Topsail - Paradise ,

substitutes for Jeff Dwyer, MHA for

Placentia West - Bellevue .

Pursuant to Standing Order 68, Lela Evans, MHA for Torngat Mountains,

substitutes for James Dinn, MHA for St. John's Centre.

The Committee met at 6:03 p.m. in the Assembly Chamber.

CHAIR (Reid):

Okay, we're ready to go now, I think.

So the

first thing I have to do is announce the substitutes. The Member for Corner

Brook is substituting for the Member for Burin - Grand Bank; the Member for

Carbonear - Trinity - Bay de Verde is substituting for the Member for Placentia

- St. Mary's; the Member for Topsail - Paradise is substituting for the Member

for Placentia West - Bellevue; the Member for Torngat Mountains is substituting

for the Member for St. John's Centre.

That's

the list of substitutes. The first thing, I guess, the usual process – there's

no unaffiliated Members here, so I guess if someone shows up we can deal with

that later on. We'll have a break a little while into the process. What time did

we suggest for that, around –?

AN HON. MEMBER:

(Inaudible.)

CHAIR:

We'll see how things are

going; 7:15, 7:20, we'll try to have a break at the end of one of the headings.

Just a

few instructions there, a reminder to witnesses, departmental officials, always

identify yourselves and wait for the red light on your microphone to come on

each time. If the light doesn't come on, maybe just wave your hand so that the

Broadcast Centre identifies where you are.

Consistent with protocols effective in the Confederation Building complex at

this time, masks must be worn in the Chamber by employees unless they are

speaking. It is at the discretion of Members. Members and officials are reminded

not to make any adjustments to the chairs that they're sitting in. Also, the

water coolers are located up here and down at the other end, each end of the

House.

First,

I'm going to ask the Committee Members to introduce themselves and their

research staff as well. So we'll start right here.

P. DINN:

Paul Dinn, Topsail -

Paradise.

B. RUSSELL:

Brad Russell, Opposition Office, Director of Communications and Digital

Strategy.

L. EVANS:

Lela Evans, Torngat

Mountains.

S. KENT:

Steven Kent, Sessional Political Support for the Third Party.

G. BYRNE:

Gerry Byrne, Corner Brook –

beautiful and historic as it is.

L. STOYLES:

Lucy Stoyles, Mount Pearl

North.

B. POLLARD:

Benjamin Pollard, Political Staffer, Government Members Office.

CHAIR:

Next I'm going to ask the

minister to introduce the staff here.

J. HAGGIE:

Thank you very much, Chair.

John

Haggie, MHA for District of Gander.

What

I'll do is that I'll let my staff introduce themselves; I'll start with the two

online. So we can go to John McGrath; say a few words, John.

J. MCGRATH:

John McGrath, Assistant Deputy Minister of Corporate Services.

C. ANTLE:

Chad Antle, Departmental Controller.

J. HAGGIE:

Thank you, Chad.

Now to

my left.

A. MCKENNA:

Andrea McKenna, Deputy Minister.

F. LANGOR:

Fiona Langor, Assistant Deputy Minister of Programs.

G. SWEENEY:

Gillian Sweeney, ADM for Population Health and Wellness.

B. WHITE:

Blair White, Assistant Deputy Minister of Digital Health.

V. MERCER-OLDFORD:

Vanessa Mercer-Oldford, ADM for Regional Services.

A. ANDERSON:

Alicia Anderson, Executive Assistant to Minister Haggie.

M. O'NEILL:

Melony O'Neill, Director of

Communications with Health and Community Services.

CHAIR:

Okay.

I think

everyone has introduced themselves, right?

S. CROCKER:

Mr. Chair, it's Steve

Crocker; I'm online.

CHAIR:

Okay, Steve Crocker is

online.

To hear

the online participants, you'll need an earpiece. If anyone doesn't have one, we

have some extras up here. We can circulate those. Does anyone need one?

masks are mandatory for employees. The first order of business is the minutes

from our last meeting, April 3, 2022. Do I have a mover for that? I think the

copies have been distributed.

The

Member for Corner Brook; seconded by the Member for Mount Pearl North.

motion, minutes adopted as circulated.

CHAIR:

So in terms of time

allocated for unaffiliated Members, the same process we've been using is that at

the end of the session, the unaffiliated Members have 10 minutes each to ask

questions, once the Committee has concluded its business towards the end of the

meeting.

Does

the Committee agree to allow unaffiliated Members to have 10 minutes at the end

of the meeting? Okay, Members are agreeable to that.

So the

minutes are passed. The next thing we need to do is I'll ask the Clerk to call

the headings.

CLERK (Jerrett):

Executive and Support

Services, 1.1.01 to 1.2.02.

CHAIR:

Okay, and usually we give

the minister 15 minutes to make any introductory remarks.

J. HAGGIE:

Thank you, Mr. Chair.

I will not use all of my 15

minutes, conscious of the fact that Members opposite I am sure would wish to

pose some questions at the time rather than listen to me.

At the beginning, from my

point of view, I would like to point out that the staff you see before you, both

here and virtually, have been actively involved and continue to be actively

involved in our COVID response. Whilst in the media this may have subsided to a

dull roar, there is still an awful lot of work that is going on in the

background and I think some of the answers to the questions that will be posed

today can be answered by the statement I am going to make at the moment, that

these people have put down their pens from their regular work over the course of

the last two years and I would say 80 to 85 per cent of their time has been

preoccupied with responses to COVID in terms of operationalizing the orders when

we were under special measures orders and the state of emergency of the chief

medical officer of health and also liaising with the regional health authorities

and providing the logistic support necessary to mount what I would argue has

been one of this country's most successful responses to COVID-19 over the last

two years.

I say that not by way of any

excuse or diminution of the fact this budget will stand on its own merits. The

work they have done is of their usual, extremely high standard. This is the

third time they have done this in a two-year period and I think the results will

speak for themselves as far as the process is concerned.

Health and Community

Services is the largest of the government departments in terms of its

expenditure. We have and continue to try and shift further our focus to be on

outcomes rather than process and we are also committed with our older

initiatives and with the upcoming Accord to make sure we get the best value for

the dollar that we spend on health care, recognizing that whilst we compare

ourselves and are compared with other provinces, at least 48 per cent of our

population, effectively, live in areas where the density is the same as that of

a territory. So we are in a unique mix of fish and fowl when it comes to the

delivery of health care. That poses challenges from a delivery point of view,

but it also poses challenges from a cost point of view.

Historically, this

government and its immediate predecessor, which I was a part, have contained

health care expenditure to way less than the inflationary percentage each year.

This year, however, we do have a noticeable increment. Happy to talk about that

as the evening wears on. These are easily explicable by some of the changes that

we need to bring about, and also we have seen some federal money flowing through

our budget, which would account for our increased expenditures over the course

of the last little while.

But the

fact is, some of these expenses are baked into our budget because they are

factors outside the direct control of the Department of Health, and particularly

relate to labour costs. Of our budget, of the order of 65 to 68 per cent is in

actual fact related to salaries, and that makes us subject to the collective

bargaining process for the bulk of these individuals. That is one that is

managed by a different department, in conjunction with advice from this

department.

With

that really, happy to work our way through and see what questions come out, and

I will do my best to answer them. If they're really difficult, I'll pass them to

staff.

CHAIR:

The Member for Topsail -

Paradise.

P. DINN:

Thank you, Chair.

I do

appreciate the efforts made by staff during the last two years. Don't take that

as I'm going to be easy on you this evening, although it will be pretty

straightforward, no doubt.

I'll

just proceed. I have some general questions to get started with.

CHAIR:

Yes, as the first speaker,

you have 15 minutes.

P. DINN:

I'll go through some general

questions first, just to get those out of the way, and I'll proceed then to the

first section.

The

obvious question is: Can we get a copy of the minister's briefing book?

J. HAGGIE:

We will provide it

electronically, in the interest of preserving our forests.

P. DINN:

Okay, thank you.

In that

Estimates book, are there are any errors or omissions that we should be aware

of?

J. HAGGIE:

None that I am aware of.

Just for the record, in terms of sharing it, we'll certainly be making copies

available to the Third Party as well. It's accurate to the best of my knowledge.

P. DINN:

Thank you.

speaking to the attrition plan, is the attrition plan being followed? If so, are

there any changes over the last year?

J. HAGGIE:

The attrition plan still

exists. It is based mostly now on retirement, and some of that in actual fact,

in certain areas, has accelerated. We rely on the health authorities to follow

their mandate through the attrition plan. We'll be happy to provide details of

staff within the department, when we get to that point.

P. DINN:

Thank you.

How

many are currently employed in the department?

J. HAGGIE:

We currently have 271

employees, of whom 189 are based in West Block. The others are divided between

Stephenville and Grand Falls-Windsor.

P. DINN:

Okay.

And you

did mention retirements. How many retirements have we seen in the last year?

J. HAGGIE:

My understanding from the

information I have is …

Retirement, we have had 13 in '21-'22 for a cost of $176,700, compared with five

in '20-'21 fiscal year for a cost of $206,600.

P. DINN:

Perfect, thank you.

terms of vacancies, any current vacancies in the department, and how many, if

there are?

J. HAGGIE:

One moment, I have a – I was

looking for this before and I found the damn thing, knew you'd ask for it, and

now I put it down somewhere.

actually have a 5 per cent vacancy factor we factor in each year. We do,

however, have an increase of 16, which were new positions which were announced

in October for the bridging plan, as you may recall. And with that we lost seven

contractual positions that were pandemic related.

P. DINN:

Okay, and that's related to

this then.

So how

many layoffs have occurred in the department in the past year.

J. HAGGIE:

No one, to my knowledge, has

been laid off. Contractual positions terminated as a result of the end of the

pandemic.

P. DINN:

Okay.

And the

number of new hires?

J. HAGGIE:

New hires. Well, I lost my

place again now. I had 16 there for a minute. Hang on a second.

There

were 16 new hires. I can break that down or we could provide you with a list of

them. They're all essentially related to the bridging plan that was submitted to

Treasury Board before.

P. DINN:

Okay.

outside the bridging plan, that's where most all the new hires occurred?

J. HAGGIE:

No, we have an ADM for

Digital Health here behind me, and the 16 were in addition to that.

P. DINN:

Perfect.

And you

touched on this. So how many contractual or short-term employees are currently

hired with the department?

J. HAGGIE:

I have that here. We have

206 permanent, 30 temporary and 35 contractual, for a total of 271.

P. DINN:

Thank you.

And

talking about COVID, how much money has the department received from the COVID

fund and what was that amount used for?

J. HAGGIE:

We had a total COVID cost

for '21-'22 of $30,927,000. There is a variance there of – well, there's a

projected shortfall across COVID of $69 million; we have broken that down or can

provide that by health authority, should you wish it.

P. DINN:

That would be nice if we can

get that, I'd appreciate that.

Did the

department receive any funding from the contingency fund? If so, what was it put

toward?

J. HAGGIE:

Yes, we did. In actual fact,

that's where the bulk of it came from. We received money for COVID, which came

out of contingency, which was $69 million. We have had expenditures related to

the cyberattack which were just fractionally under $16 million. They were flowed

through to the health authorities and the Centre for Health Information.

P. DINN:

Perfect.

Just

moving into the actual

section now. I'm looking at 1.1.01, Transportation and

Communications. I note that in the budget last year it was budgeted for $40,000,

it dropped to $20,000 revised and you kept it at $20,000. What was the issue in

terms of decreasing that amount and keeping it there?

J. HAGGIE:

Technology. We do a lot of

our work through Zoom or platforms like Webex or the RHAs use Teams and it's

made a significant difference in our ability to utilize our time more

efficiently as well as less on the Transportation budget.

P. DINN:

Perfect. I was thinking

that, but we've still got to ask it.

J. HAGGIE:

No, no, fair enough.

P. DINN:

So just moving down here to

1.2.01, I'm looking at the Salaries and, of course, there was a difference last

year from the budget to the revised of about $300,000. What happened there to

cause that increase?

J. HAGGIE:

We now have someone who is

unfortunately not here tonight, an associate deputy minister of Health, in

addition to the ADMs on executive and that's the change you see there, the bulk

of it.

P. DINN:

And just on that same line,

we see an increase of just shy of $83,000 for the coming year. Is that an

additional position as well?

J. HAGGIE:

Is that on 1.2.01?

P. DINN:

Yeah, Salaries, and that's

just going from the revised of last year to the current estimates.

J. HAGGIE:

Yeah. Essentially, the variance is a cumulative effect of the addition of a

senior position in associate deputy minister and an additional media relations

manager, so our communications staff have increased as well.

P. DINN:

Okay, thank you.

Just

looking at Operating Accounts, we see an up and down and up there as well. So if

you can explain the drop from the budget to the revised of last year and then

the increase again to $25,000.

J. HAGGIE:

Sorry, what are we looking

at?

P. DINN:

Operating Accounts under 02.

J. HAGGIE:

Oh, 1.2.02, okay. Yes.

P. DINN:

1.2.01.02, I guess.

J. HAGGIE:

Now hang on, 01 or 02?

P. DINN:

It is just where we talked

about Salaries, 01; it is 02 we're talking about, Operating Accounts.

J. HAGGIE:

Okay, right. Yes, I got you.

So the

issue there is an addition. You'll see a reduction in –

P. DINN:

So that's the Transportation

piece, I guess, is it?

J. HAGGIE:

Yeah, well, I mean, again,

Transportation, we've taken out savings of $11,000. Supplies, we've gone through

zero-based budgeting exercise. Purchased Services, again, zero-based budgeting

we've gone down slightly.

P. DINN:

Okay, thank you.

Just a

clarification, we're going to 1.2.02 or no? Is it finished?

CHAIR:

1.2.02 is my understanding.

J. HAGGIE:

That was called as well, I

believe.

P. DINN:

Okay, so I'll continue on

then.

we're looking at 1.2.02, we're looking at Salaries again. We're look at the

budgeted amount there of $16,700,000, we'll say, and it dropped to $15.9

million.

J. HAGGIE:

Right.

P. DINN:

A decrease of about

$800,000. Can you explain that decrease, please?

J. HAGGIE:

The shift there for that

year, between the budget and the revised, some of those posts were held vacant

over the course of the year and some of them were used then to offset the

overage in Executive Support. The difference between the revised and the

Estimates have other reasons behind it and that is a money in and a money out; I

can explain if you want.

P. DINN:

Okay. And, of course, we see

it going back up in '22-'23.

J. HAGGIE:

Yeah.

P. DINN:

So what is happening there;

that is actually increasing more.

J. HAGGIE:

Yeah, there are 16 new positions that account for $1.2 million, offset by a

reduction in overtime from '21-'22 and the vacancy factor of around $330,000

because we didn't fill some posts because of COVID.

P. DINN:

Perfect.

I'm

looking at Transportation and Communications, we see there that you're going to

spend $78,000 more, apart from what you had last year. Can you explain that one?

J. HAGGIE:

Yes, the dollar change is

about $86,000. There are travel costs for the health professional recruitment

office, per bridging plan. Some money went out to Grand Falls-Windsor postage

budget. If you recall, there were a lot of people who, when they came to access

their VaxPass and results data, their MCP wasn't valid, so there's been a surge

in renewal of MCPs and those are provided by postage.

There's

just under $40,000 to increase phone budget for cellphones and landlines because

of our increase in staff and a small increase through zero-based budgeting of

about $3,000, which is based on previous year's actuals.

P. DINN:

Just to extend that a little

bit, when you talk about travel for recruitment and retention, how much is

exactly allotted to the recruitment and retention?

J. HAGGIE:

$25,000 for travel.

P. DINN:

I just assume that's travel

you can't do through Zoom; you have to actually go?

J. HAGGIE:

You have to go to national

conventions like the Society of Rural Physicians of Canada, the CCFP national,

these kind of things. These are places where you will build networks of

students, residents, these kind of things, that you will then use to capitalize

in future years for recruitment. You can't easily or even practically, I would

argue, based on personal experience, do that over the phone or through Zoom.

P. DINN:

No, I agree. I just would

have thought actually $25,000 would be on the low end of that.

J. HAGGIE:

Well, I think a lot of the –

it's going to be a mix, because there is a lot less still, for the coming year,

I would imagine in terms of face-to-face encounters, compared with say 2019 or

P. DINN:

Okay, thank you.

Just

moving along to Professional Services here and we see it was about $1.7 million

in the budget last year, which it dropped to about $1.4 million, that's about

$389,000 that wasn't spent. Then it jumps back up to $1.778 million. Can you

explain the up and down in that as well, please?

J. HAGGIE:

The savings were due to

savings related to various contracts. The Medical Consultants' Committee didn't

meet for MCP because of COVID so that saved us about $70,000. There was some

delayed expenditure on mental health-related initiatives, around $30,000. There

was some delay in expenditure related to ePCR and CME and we had delays with our

software solution for paramedicine, the regulatory aspects that we took in the

department.

The reason it's gone back up

again is a Personal Health Information

Act statutory review will occur this year. That accounts for $100,000 of it

and then there is a zero-based budgeting adjustment as well.

P. DINN:

So just on the same line,

I'm thinking of the Medical Association negotiations. Where were they accounted

for? Were they last year or this year? Are they still in this budget?

J. HAGGIE:

The contracts related to the NLMA negotiations were reduced expenditure, but the

negotiations themselves are actually conducted by HRS, Human Resource

Secretariat. We've never, in my experience here in previous occasions, had a

line item for expenditures, other than maybe some consulting contracts. And

there is one I refer to where we spent less.

P. DINN:

You went through a number of contracts: MCP, mental health, ePCR, CME –

CHAIR:

The Member's time has

expired.

P. DINN:

Oh, I'm sorry. Okay, I'm good.

CHAIR:

We'll move to the next

Member, the Member for Torngat Mountains.

L. EVANS:

Yes, thank you.

I'll just start off with

some general questions.

Has the new position for the

Assistant Deputy Minister of Health Professional Recruitment and Retention been

filled yet?

J. HAGGIE:

Yes, it has.

L. EVANS:

Okay, thanks.

J. HAGGIE:

Sorry, I misheard the

beginning. Maybe I should use my earpiece, forgive me. I'm not used to it these

days. I apologize.

L. EVANS:

Also, can the minister

provide an update on the plans to enable IVF services within the province?

J. HAGGIE:

There are discussions ongoing between Eastern Health and Newfoundland and

Labrador Fertility Services. The travel treatment subsidy for people who have to

go out of province went live today. The application process is up and Eastern

Health are operationalizing that. They have a PSA out about how it can be done.

Claims will be backdated to

the date I announced that the plan was coming. So anything after August 4, I

think, of 2021 is eligible.

L. EVANS:

Thank you.

Can the

minister provide an update of the two collaborative team clinics that are

supposed to be opened, one in Central and one in Western?

J. HAGGIE:

Yes, the one in Central and

the one in Western have locations identified. There are jobs posted, certainly,

for the Central one and I don't know that they have closed yet. There were

discussions in both health authority areas with the communities to try and

identify any unique needs for those communities to make sure that the skill set

matched the need.

L. EVANS:

Thank you.

The

closing dates for the RFP for a Health Human Resource Plan is April 8. Can the

minister comment on when we expect a decision on which of the four bids will be

selected. Also, can you comment on the selection criteria that's being used?

J. HAGGIE:

Not in detail to the latter.

The issue of when the decision will be made, my understanding is those are

fairly inclusive tenders or submissions, so that process is under way. I don't

have a timeline and my deputy doesn't either currently, so we're working through

it.

L. EVANS:

Thank you.

The

Health Accord is calling on an improved and more integrated IT system for the

RHAs. In light of the previous reports that highlighted long-term cost-saving

opportunities of such an upgraded system, does the department plan on conducting

a review of the IT systems used by RHAs just to gauge the need for updates?

J. HAGGIE:

I think it's generally

accepted that some of our systems – and there are a lot of systems in Health –

are legacy. One of the things we have done very well through the department –

and I think we'll improve upon there; we have an ADM of Digital Health – is the

ability to put interfaces and translators there to actually let one module that

wasn't designed to, speak to others.

Certainly I do know, for example, with the new acute care hospital in Corner

Brook, the health information system is going out to the market through the P3

process, but the requirements around scalability and interoperability will be

key, I think, in informing what the market currently has. We have plenty of

assessments; I think the next stage is to see what the Corner Brook acute care

RFP comes back with, because that's going to be our current market sounding.

L. EVANS:

Thank you.

The

Towards Recovery report called for

the adoption of harm reduction as a fundamental approach to mental health care

and addictions. That sentiment was also echoed by a group of MUN medical

students during their day of action earlier this year. Can the department

comment on the level of harm reduction and also trauma-informed care training

provided to front-line medical staff?

J. HAGGIE:

Both of those were key

recommendations from Towards Recovery .

I think even before the Towards Recovery

report was actually inked, we started down the road of harm reduction. We

introduced a free Naloxone kit policy; we have embedded harm reduction as part

of the key for really all elements. It's kind of like a lens that we have used

for each of the teams working on various areas within the mental health

Towards Recovery implementation

process.

Certainly, in terms of trauma-informed care and education and awareness about

that, that is an ongoing program in each of the regional health authorities. I

think it would be very hard to quantify it, because quite frankly a lot of those

things would have required staff to leave their acute care duties to physically

or virtually attend that training. My latest reports from staff, that has been

delayed but still under way.

L. EVANS:

Thank you, Minister.

The

last of my general questions: During the last Estimates there were seven FACTT,

which is Flexible Assertive Community Treatment Teams, mobilized with another

six planned. Have those new teams been mobilized?

J. HAGGIE:

Yes.

L. EVANS:

All six?

J. HAGGIE:

My understanding is all six

and I think there might be another two in the works.

L. EVANS:

Okay, thank you.

Just

going to

section 1.2.02, Departmental Operations, can the minister comment on

what plans the department has on streamlining air ambulance services as per the

Health Accord recommendations?

J. HAGGIE:

In this budget you will see

the base budget for air ambulance has been increased to reflect actuals. In

terms of plans for the future, we certainly have had frequent discussions with

the co-chairs. We're waiting to see what their blueprint produces before taking

any final ideas to Cabinet. But, certainly, in terms of options, we have worked

on several options for ground and for air. It's simply a matter then of putting

them into context and seeing what makes sense in light of the Health Accord

recommendations.

L. EVANS:

Okay, still staying within

the same subsection, under Purchased Services, last year the actuals were

$91,300 under budget, yet this year's estimate has increased by $18,200. What's

the reason for this?

J. HAGGIE:

That's a mix. There's

$20,000 in there for the operating costs related to the Health Professionals

Recruitment Office that was approved by Treasury Board, and then there is a

slight decrease through zero-based budgeting that balances out $18,200.

L. EVANS:

Thank you.

Under

Revenue - Provincial, what was the source of the extra $100,000 in revenue last

year?

J. HAGGIE:

This is in actual fact an

increase in MCP overpayments and refunds from vendors. So it's very much an ad

hoc issue. It's part of our audit process to go back to audit billing. There's a

very active program, for example, and the bulk of that was physician

overpayment.

L. EVANS:

Thank you.

I'm

finished.

CHAIR:

You have a minute and 40

seconds left.

L. EVANS:

I'm finished with the

questions for this section.

CHAIR:

Any other Members of the

Committee want to ask questions of this round before we move back?

The

Member for Topsail - Paradise.

P. DINN:

When I left off, I was

looking at Professional Services, and you spoke to savings and you mentioned

various contracts: MCP, mental health, ePCR, CME. Can we get a listing of those,

of what contracts are contained in that section?

J. HAGGIE:

Certainly.

P. DINN:

Okay, appreciate that.

It's

been mentioned a few times here, in Transportation and Communications and

Professional Services, talked about so much that's allotted to recruitment and

retention. Can we get a breakout of what costs are associated with the new

recruitment and retention process?

J. HAGGIE:

Certainly yes, we can give

you a breakout of the bridging plan post, the ADM costs and then the money

allocated for travel and for operating costs.

P. DINN:

Perfect.

J. HAGGIE:

They're all contained in

here, but we can –

P. DINN:

And some of that will

probably be in these questions I'm going to ask now. Just looking at Property,

Furnishings and Equipment, we saw you budgeted $62,100 last year, it went up to

$80,000 and it's dropped off. Is there an explanation for that?

J. HAGGIE:

Yeah, there was computer

equipment purchased for that because of people needing laptops rather than

desktops, and there was also some kind of routine purchases like desk chairs,

filing cabinets and, of course, the increase in body count as it were with the

staff.

P. DINN:

Would the new office for

retention and recruitment take in any part of that expenditure?

J. HAGGIE:

Actually, no, I think I may

have misspoken in that sense there. The projected revised is money that has been

spent. So in terms of some of the bridging staff, yes. Whether it's all of them

or just some of them, I wouldn't be able to tell you.

P. DINN:

Okay.

Looking

at Grants and Subsidies, I'm looking at the $891,000, basically, that was

approved in the last two years and the drop-off to a little over approximately a

quarter million, we'll say. Can you explain that, please?

J. HAGGIE:

That's accounting moving.

The money for tobacco control is gone out of the healthy living grants, which is

what you're looking at here, and it's moved to mental health and addictions

grants, which are under RHA Grants and Subsidies. So that money's not gone, it's

just moved on to a different head.

P. DINN:

Perfect, thank you.

Looking

at provincial revenue, we saw a $360,000 increase in the revised of $100,000 and

then drop off again to $360,000. Just an explanation for that jump and decrease.

J. HAGGIE:

The jump was $100,000 in

recovery of overpayments from physicians. This is an ad hoc revenue, so it does

vary modestly from year to year. So that is an estimate of what we could

probably get this year. It may be under; it could be quite a bit under. But it

also is reasonable, based on historical.

P. DINN:

Okay, thank you.

And I'm

good with that section.

CHAIR:

Okay, good.

Any

other Members have further questions for those headings? No, okay.

I'll

ask the Clerk to just remind us of the headings.

CLERK:

Executive and Support

Services, 1.1.01 to 1.2.02.

CHAIR:

Shall headings 1.1.01 to

1.2.02 inclusive carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

Before I carry that, I'll

ask Minister Crocker how he votes.

S. CROCKER:

In favour, Mr. Chair.

CHAIR:

Thank you.

Those

headings are carried.

motion, subheads 1.1.01 through 1.2.02 carried.

CHAIR:

So we'll move to the next

headings.

CLERK:

Client Services and Support,

2.1.01 to 2.3.01.

CHAIR:

Next headings are 2.1.01 to

2.3.01 inclusive.

The

Member for Topsail - Paradise.

P. DINN:

Thank you.

Just

before I start a general question on the drug program. In the budget, you

announced $8.6 million to fund new drugs under the Provincial Prescription Drug

Program to treat cancer and other illnesses. Can we get a list of the current

drugs and the new ones that have been approved?

J. HAGGIE:

Certainly the new ones won't

be a problem at all, yes.

P. DINN:

Okay, appreciate that. Thank

you.

I'm

looking at 09, Allowances and Assistance. If I look at this, you had an increase

of about $5 million over the previous year. Can you explain that increase?

J. HAGGIE:

This is the difference

between '21 budget and '21 revised, or is this the difference –

P. DINN:

Yes, you're right.

J. HAGGIE:

'22 actuals to the budget,

basically it's higher use of biologics in cancer chemotherapy and hepatitis C

that have driven those. Those are drugs which are not often prescribed in

necessarily large numbers in terms of some of the biologics and hepatitis C, but

they are hideously expensive. There are also new indications for Eylea Lucentis

for degenerative vascular eye disorders. There's a higher spend on pharmacists

administering vaccines, so that's figured in this area here as well. They were

very helpful during COVID, and that's why you see the cost.

P. DINN:

And I would suspect then the

new estimates are to account for that?

J. HAGGIE:

The new estimates are

related to the new drug therapies that are coming on board this year. In here

you'll see $134,000 for new oncology and $5.7 million for non-oncology

therapies. The bulk of oncology therapies are actually under Eastern Health,

because they fund the provincial cancer program. These would be those elements

that relate to the NLPDP and therapies that could be administered at home.

P. DINN:

Thank you.

Provincial - Revenue, so we see a little bit of a fluctuation there from $8.7

million to almost double and then drop back down again. Can you explain that up

and down there, please?

J. HAGGIE:

We get rebates under the

NLPDP from drug listing agreements. These are standard in the world of

pharmaceuticals. They vary and as you can see there, there is the variance.

P. DINN:

Okay. Thank you, Sir.

I'm

looking at 2.2.01, Professional Services: I see a huge variance there – well,

not so much from the budget and revised but you have jumped up to $405 million.

Can you explain that jump there?

J. HAGGIE:

NLMA Memorandum of Agreement

is the bulk of it: $27,426,000 is the new agreement with the NLMA and then there

are other elements in there so there is $5.5 million which is increased

utilization of the fee-for-service budget; $250,000 was reprofiled back from

departmental salaries because of less overtime.

On the

other side, we have reprofiled $1 million out of here. The Athena Health Centre

was funded through this Professional Services budget, but we have reprofiled it

to RHA grants for block funding for security from their point of view, from a

financial viewpoint, they were very keen on that and that was something that was

fairly straightforward; $4.7 million has been reprofiled to Central Health to

cover Health Hubs so that goes out of this area. Then we have added in some

family practice sessions with the new CTCs and that adds $312,000. So it is a

netting of those.

P. DINN:

I'll keep one question for

later.

looking at Allowances, 09, we see an up and then a down and up there again as

well. Can you speak to that, please?

J. HAGGIE:

Yeah. That is

out-of-province billing, so patients who are out of the province require care

and we reimburse the province for that care under reciprocal billing

arrangements. So payments on behalf of residents of other provinces for whom we

do the same, comes in under revenue. This is where the expenses go. You can see

that the budget and the revised dropped because of a lack of travel and we're

anticipating that travel going back to pretty well normal levels and added a

little bit, $500,000, for probably an increase in travel and utilization.

P. DINN:

Can we attribute that to

COVID?

J. HAGGIE:

I think that is probably

pretty safe, yeah.

P. DINN:

Okay.

Looking

at Grants and Subsidies, that's line 10, you budgeted for $117 million, you

didn't utilize all that, dropped by $2 million, but then you've increased it

again. An explanation on that. I believe you're increasing about $13 million

from the previous – it looks like.

J. HAGGIE:

Yeah, that's the salaried

portion of the NLMA MOA; that would be where that would appear. Included in

there as well is the NLMA get subsidy to their Canadian Medical Protective

Association fees. We provide a 75 per cent subsidy for physicians; it's a

retention and recruitment strategy, which has been there for some time now.

P. DINN:

Okay, thank you.

Looking

at the Revenue - Provincial, we see an up and down there as well; it went down

one-third and came back up a third. Can you explain that variance as well,

please?

J. HAGGIE:

Yeah. That's the

come-from-away crowd who get sick here, we'll bill their province. So, again, it

went down because of travel and we anticipate it going back up because of the

hopeful successes of Come Home Year '22.

P. DINN:

We all hope.

I'm

into the Dental piece, 2.2.02, and I'm looking at the Operating costs, they drop

by – just one second. Yeah, I see a decrease of about $3 million and then back

up again. Can you explain that as well?

J. HAGGIE:

We've attributed that to

COVID. But, you know, some of this was more discretionary than others and people

kind of voted with their feet.

P. DINN:

Okay, thank you.

I do

agree with you on the COVID. It's after affecting a lot when it comes to travel

and that, no doubt about it.

I'm

looking under 2.3.01.

J. HAGGIE:

2.3.01, okay.

P. DINN:

Memorial University Faculty.

J. HAGGIE:

Yeah.

P. DINN:

I'm looking at 10, Grants

and Subsidies, and we see a variance there; last year they actually needed

about, I'll say, $3.5 million or $4 million more and then we dropped it back

down to $54 million. Can you explain that, please?

J. HAGGIE:

We assisted them with a

projected operating deficit and a negotiated salary increase. The operating

deficit was a one-off and was after discussions with the faculty. One of their

accreditation criteria as a medical school is related to financial solvency and

we felt the risk of jeopardizing a satisfactory accreditation was not worth the

$2.5 million.

P. DINN:

Okay.

J. HAGGIE:

They had reduced that

deficit progressively on their own, but it was a question of they couldn't do it

all in that fiscal year. We've done it, and then the undertaking is that they

will continue with their expense reduction as planned.

P. DINN:

So just related to that, and

maybe it's a question for Memorial, maybe it's not, what measures would the

faculty be taking to stay within this budget?

J. HAGGIE:

Again, that question would

be better directed to the faculty. My understanding is that they have removed

discretionary travel where at all possible. They have looked at administration

support. My discussions with the dean would suggest that none of these

reductions in expenditure have impacted directly on faculty. But I'm speaking

here from memory and third hand. You'll get a better answer if you speak to the

dean or to the president of Memorial, should they come to Estimates.

P. DINN:

I appreciate it.

I'm not

going to squeeze one in in 20 seconds, so I'll pass it along.

CHAIR:

The Member for Torngat

Mountains.

L. EVANS:

Yes, thank you.

Under

2.1.01, the Provincial Drug Programs. So we're back there again now.

J. HAGGIE:

Yeah, no that's fine. I just

need to catch up with the placeholder.

L. EVANS:

When was the last time there

was a review of the income eligibility thresholds for the provincial drug card

program under The Access Plan?

J. HAGGIE:

I wouldn't be able to tell

you in detail. I know we have looked at them within the department. But in terms

of a formal review, I don't have that to hand.

L. EVANS:

Okay, thank you.

Under

the same heading, how many requests for an internal review of income support and

drug card cases were received by the department in the last year?

J. HAGGIE:

I don't know, but I can find

that out for you.

L. EVANS:

Okay.

Moving

on down to 2.3.01, Memorial University Faculty of Medicine, the

Towards Recovery report recommended

increasing health care professionals involvement in addictions medicine. The

report specifically calls for the MUN Faculty of Medicine to establish a

clinical program director of addictions medicine.

So is

the department still encouraging the faculty to make that change?

J. HAGGIE:

We want to develop a

provincial hub for addictions medicine and the academic backing for that, as it

were, would come from within Memorial. I do know there are people in the field

of addictions medicine with teaching positions related to Memorial who have

stepped up from a clinical perspective, but I wouldn't be in a position to

provide you with much more detail on the background. Certainly, we need to build

up that expertise locally and if that was the way that Memorial felt was the

best way to do it, then we would be happy to help them in whatever way we could.

L. EVANS:

The Member for Topsail -

Paradise was too efficient in asking my questions. So I have run out of

questions for this section.

Thank you.

CHAIR:

Does any other Member of the

Committee have questions they would like to ask?

The hon. the Member for

Topsail - Paradise.

P. DINN:

Thank you.

Just to finish off this

section on when we were talking about Memorial University, the faculty – and I

understand that they are thrown at the dean for questioning. But because the

shortage of doctors has been so huge and we are looking at ways to recruit and

retain and, perhaps, one of the best ways is to retain our own as you graduate,

do you see the grants and subsidy piece affecting the ability of the faculty to

increase seats for Newfoundlanders and Labradorians and, secondly, to keep them

here?

J. HAGGIE:

I think you make an interesting point about retention. I think family medicine,

particularly, is undergoing something of a resurgence of interest as a career

choice, and quite rightly so. We have had the first iteration of what is called

the CaRMS match. The Canadian Residency Matching Service placed 32 residents

into our 35 seats. The second iteration is not yet completed and the two

vacancies, according to my memory, are in Central.

We, according to CIHI, are

second only to Quebec in this country in our long-term retention of medical

school graduates from the province. I would like to be first, but we beat out

the others. Again, we are all in the same HR storm, but our boat isn't leaking

anywhere near as badly. I think the ADM of recruitment and retention will go

further to help with that. I do know that we are looking at ways to increase the

number of residents, particularly in family medicine, and I do know that there

are going to be challenges beyond a certain point.

There are also changes to

the training requirements for family medicine coming that will factor into that

which may impact any short-term decisions. We were talking to the College of

Family Practitioners as recently as this morning and there are changes planned

to the length, on paper, of a family medicine residency but equally there is

then talk of moving to competency-based training which removes the time factor.

Universities' post-graduate

training schemes have struggled with that, because they really don't know how to

do it. It's easier if you're a year one, two, three or four, but if you're in

year three and have all your competencies for year four and are on paper ready

to do the exams, the system nationally, the College of Physicians and Surgeons,

for example, can't quite cope with that yet.

It's an

interesting time from that point of view. I think in terms of a coordinated

response from – we've got the Department of Health, now with the ADM, and plans

for an umbrella. We'll have the RHA or RHAs singing the same song. We've

enlisted Municipalities Newfoundland and Labrador, because it's true, we can

recruit a physician but you attract a family. It's a lifestyle issue as much as

anything else for them.

We've

got the College of Physicians and Surgeons now who've agreed to join us to

explain the licensing process, and have also recognized that in certain

circumstances some of their requirements can be interrupted as a barrier to

applicants from out of the province, or even out of the country, and they've

committed to work with that. We're going through parallel discussions with

nursing regulators, College of Licensed Practical Nurses and myself and the

staff will be meeting in the near future. They're all interested in what they

can do to help. If all you hear out there are the negatives and the positives

don't get a chance to shine through, what you will see is it will become a

self-fulfilling prophecy.

The

College of Family Practitioners, for example, and the RNU have each said, we can

make this a great place to work and we've got ideas. We've listened to the NLMA,

they have presented some and we got a checklist to go back with them at our next

meeting. The RNU, the same, and the recruitment piece is just part and parcel of

it.

P. DINN:

I know there's a lot of

negative, of course. Opposition does a good job with that. But I will say when

you spoke a while back about welcome baskets, it's probably not far off, in

terms the grand seduction in getting individuals to come here, to stay here, or

not even come here, but just to stay here right out of school. But you mentioned

excelling in keeping graduates here long term. How would you define long term?

Is it once they get past their return-for-service agreement, or are they staying

here a lot longer than that?

J. HAGGIE:

I'd have to check with the

CIHI data that came from. My understanding is it was looking five, 10 years out

from training. Certainly, physician and health care workers in general have

changed from – I hate to say my day – where you went to a community and you

stayed there for 25 years. By and large now, families make a decision to move as

their life circumstances change.

So you

will see a young couple who likes the outdoors who will go to a rural area; once

they have a family, particularly once that family reaches a certain age, they

look around, schooling becomes an issue, extracurricular activities are really

important and they choose to go where those places have what they may be

particularly interested in, whether it's ballet or hunting or whatever. Then

later on, as their nests empty, they think again.

So you

will see periods where you'll have stability and you'll see periods where life

circumstances generate a turnover. And that's going to be true for all of the

health care professions; we talk about physicians simply because that's topical.

It's the same with registered nurses; it's the same with licensed practical

nurses and PCAs. Their qualifications are portable and our challenge is to

distribute them where they're needed or make arrangements to provide those

services somehow.

The

facts of the case are eight to 10 years in one spot and you're probably going to

find people are going to want to move.

P. DINN:

I'm good.

Thank

you.

CHAIR:

Any other Members of the

Committee have questions they'd like to ask on these headings?

Okay,

so I'll ask the Clerk to remind us of which headings we've been dealing with.

CLERK:

Client Services and Support,

2.1.01 to 2.3.01.

CHAIR:

Shall headings 2.1.01 to

2.3.01 inclusive carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

I'm

going to ask Minister Crocker for his vote?

S. CROCKER:

In favour, Mr. Chair.

CHAIR:

Thank you.

The

headings are carried.

motion, subheads 2.1.01 through 2.3.01 carried.

CHAIR:

I think we're about at the

point where we thought we'd take a break, so we'll take a 10-minute break. Is

that standard? Yeah, so we'll take a 10-minute break. We'll be back at 7:16.

Recess

CHAIR:

Okay, we're going to get

started again.

I just

want to check with the virtual participants to make sure they're still there.

Okay, they're saying they're there.

S. CROCKER:

I'm here, too, Chair.

CHAIR:

Okay, so I'm going to ask

the Clerk to move to the next series of headings.

CLERK:

Health and Community Service

Delivery, 3.1.01 to 3.2.03.

CHAIR:

Okay, so we're calling the

next headings, 3.1.01 to 3.2.03 inclusive.

I'll

look to the Member for Topsail - Paradise.

P. DINN:

Thank you.

we're looking at Purchased Services, under 3.1.01. I'm looking at between the

budget last year and the revised, it increased approximately $1.5 million and

then it dropped back down to the previous amount. Can you explain what was

happening there?

J. HAGGIE:

Two factors there. We

charter an air ambulance to take people out of province. We have a standing

offer kind of arrangement but it is done under charter. We spent $1 million on

that and there was another $500,000 in there for increased utilization and costs

related to HealthLine 811. That explains the $1.5 million difference.

P. DINN:

So for that whole budget

under Purchased Services, can we get a breakdown of the budget itself? The full

$14 million.

J. HAGGIE:

Sure. It is HealthLine, air

ambulance and interpretive services contracts. That is how it will break out

under headings, but we can get you the dollar amounts for each.

P. DINN:

Perfect. Thank you.

Looking

at Allowances and Assistance, I'm assuming this amount goes towards MTAP and

bursaries and such. You spent $2,000 less than you budgeted for previously and

then you increased it by $3 million, again. Can you explain that?

J. HAGGIE:

The decrease of $2 million

was a decrease utilization of MTAP due to travel restrictions. Then the increase

funding for family medicine bursaries in the bridging plan comes under the

difference between '21-'22 and '22-'23 budget.

P. DINN:

Okay.

Moving

along to 10, Grants and Subsidies, we see a fluctuation there as well. You went

up from last year's budget and then – well, you continued to go up. Can you

explain the gradual increase in the Grants and Subsidies?

J. HAGGIE:

The '21-'22 actuals over the

budget were pandemic costs, salaried costs, cyberattack not accounted for. There

were savings in other departmental areas that were flowed in. So that's the

$144,399,600 difference between '21 budget and '21 actuals.

terms of the $165 million, there is a shopping list in your binder that adds up

to that amount. Essentially, I can go through them if you want, but they're

things such as: Cancer Care Western, which is new so there'll be an increment

this year, which will ramp up in subsequent years; the Alcohol Action Plan of

$2.49 million; the Suicide Prevention plan of $2.46 million; Collaborative Team

Clinics, $7.8 million, rounded up; additional ambulance services in Eastern as

part of the bridging plan for paramedicine, just over a million; tech in ER,

$280,000; increase in cash operating grants of $45 million to the RHAs; $15.7

million in oncology drugs for Eastern Health. You've got $12 million there for

direct client costs and, like I say, they're all broken down in the table. It's

Equifax and so on and so forth. It rounds out to that when you factor in the

adjustments. There's a whole list here and we can provide it, it's in the

binder.

P. DINN:

Okay.

Just a

question on – because I guess this is where the biggest chunk of funding falls

for the department, what would be the cost of – because we have three

collaborative hubs operational now; I assume fully staffed, maybe not. What

would be the costs of operating a collaborative hub?

J. HAGGIE:

We're looking at anywhere

from $1.87 million to $2 million per hub per year.

P. DINN:

That's salaries, the works?

J. HAGGIE:

That's physician payments,

that's leases of buildings, that's clerical support, those kind of things. Now,

that's not a net increase, that's a shifting of money.

P. DINN:

Yeah.

J. HAGGIE:

Some of those people are

already employed, those physicians who take money out of, say, a sessional

budget for that time would be billing less for fee-for-service or there would be

salary savings from whatever other compensation that they're using.

Now,

there is some new blood coming in, but that's the whole purpose of trying to

keep our own physicians and lure them back, attract them back into family

medicine, because they've maybe gone off and done other things.

P. DINN:

Okay.

We talk

about, or it's been talked about, of course, the Centre for Health Information:

Is there any funding in this current budget to deal with upgrading of that

system?

J. HAGGIE:

There is money for IT

infrastructure for NLCHI and for the RHAs and I believe other departments would

also have some for things like OCIO, for example. There is money itemized in the

variance analysis for NLCHI so there is a line item there for cybersecurity

enhancements, for example. The integrated workforce management project has some

money in this list; eDOCSNL, which is the provincial electronic medical record,

there's an increment there for support; and then there's money there for ongoing

public health priorities. So there is money for projects within NLCHI.

P. DINN:

Okay.

I think

my colleague here mentioned the IVF program. I'm glad to hear that it's – I

think you said went live today.

J. HAGGIE:

The application process did.

P. DINN:

Right, right. So what's the

estimated amount or the budgeted amount for that, for the IVF program? Where

would I find it, or would that fall in this

section as well?

J. HAGGIE:

It's operated through

Eastern Health for sure; I'm not sure that it is broken out in these agreements.

One of

the things is we've put in a placeholder. Again, my guesstimate – and we'll get

the accurate figure for you – is it's just over three-quarters of a million. We

don't know what the annual uptake will be; we expect it to increase over time

because it's three-cycle eligibility and by and large my information is that

each cycle takes nine to 12 months to complete.

P. DINN:

Okay.

And the

Canadian Health Transfer grant.

J. HAGGIE:

Yeah.

P. DINN:

It's mentioned about another

additional $27 million for that. Is that accounted for here in this budget?

J. HAGGIE:

CHT transfers don't occur in here. You don't see them here. They go to

consolidated revenue. We do have targeted money from the federal government for

specific programs, but the money, as I understand, was allocated as part of a

change to the CHT. So that money is in general revenue.

P. DINN:

Okay.

I am just looking at some of

the financial questions here. It looks like you spent about – I think you may

have talked to it already, but let's hear it again, I guess. You spent about

$144 million or 5.9 per cent more than budgeted. I think you did talk about that

in a roundabout way.

J. HAGGIE:

I did. I actually listed it out, I think.

P. DINN:

That was the list you were going to tell me that was in the book.

J. HAGGIE:

Yeah. It was pandemic costs, salary increases, cyberattack not accounted for.

So we've had some pay

increases, and that would be where you would see that money for the difference

between '21-'22 budget and then the actuals and then I have referred to this

kind of shopping list, which is the $165 million that we have referenced and,

again, provided in here in detail. I am not sure how fruitful it is to go

through it line by line, but there are some gems in here.

I mean, there is $2.9

million for virtual emergency rooms in Central Health. There are the hubs in

Grand Falls-Windsor and Gander at $1.77 million. Those are, if you like, the

equivalent of walk-in clinics for people who, as yet, haven't registered or been

able to register with a CTC or find a primary care provider. Those see between

50 and 70 individuals per day, per site. So they are important, sort of, pieces

to sustain and bridge us until we get the CTCs widely spread and up and running.

P. DINN:

And you are looking at,

what, 35 of those? Did I read that somewhere?

J. HAGGIE:

My understanding from the

Health Accord is that it would be between 32 and 35. By and large they are

looking at population of between 7,000 and 9,000, but recognizing that in some

rural areas you might have to have a kind of CTC rural where they would only be

able, in reasonable travel times, to generate a population of maybe 5,000 or

6,000.

P. DINN:

Do I have unlimited time?

Because I notice all zeros up there. Or did you start the clock?

CHAIR:

You just ran out of time.

P. DINN:

That was quick.

CHAIR:

So you will get another –

P. DINN:

Yes. No, I'll come back. Thank you.

CHAIR:

The hon. the Member for

Torngat Mountains.

L. EVANS:

Thank you.

Just looking at 3.1.01,

Regional Health Authorities and Related Services. The Medical Transportation

Assistance Program has been repeatedly panned by residents of Labrador for not

adequately offsetting the costs related to air travel for travel to the Island

for treatment and testing. Also there have been changes announced in January

2021, but we know, as residents of Labrador, that this has done little to

improve the situation, unfortunately.

I was wondering if the

department was considering revising its policy to increase the caps for

reimbursement of expenses, or for providing an upfront assistance with air

travel.

I'll just use the example

now from St. John's to Goose Bay, which is the centre of Labrador, a ticket can

cost, one-way, up to $900. Usually it's around $600. But for people travelling

from Lab West, where there are fewer flights, the cost is much more expensive,

and for people going to Northern Labrador, a return ticket from Nain can be up

to $1,000.

A lot

of transportation for patients, it's not something you can really plan on, so we

were just wondering about these questions. Are you considering revising the

policy to increase the caps for reimbursement of expenses or providing upfront

assistance for the air travel?

J. HAGGIE:

Yeah, I mean we have

recognized the challenges faced by rural communities, and particularly Labrador,

where the airfare is such an issue and, I suspect, unfortunately will continue

to be one for the predictable short-term.

The

short answer is, yes, we are looking at those. There is we believe some

recommendation that will come out of the task force, but certainly we're trying

to look at a more equitable way of allocating funds, as I say, bearing in mind

we have done what we could within the budget we had at the time, back last year,

I think, if memory serves me correctly. But no, we're certainly looking at that.

L. EVANS:

Okay. Thank you.

Looking

at Allowances and Assistance you mentioned that last year's actuals were $200

million below estimated and that was because the MTAP travel was less due to

travel restrictions. To me that indicates $200 million because people didn't

actually travel.

J. HAGGIE:

I think it's $2 million

actually if you're looking at all answers and subsidies –

L. EVANS:

Yes, $2 million, I'm sorry

with the zeros.

So $2

million spent less in travel for patients. That indicates COVID did put a damper

on people being able to access health care.

That's

a yes?

J. HAGGIE:

Oh, well, I mean, we've said

that in terms of a variety of things, but people chose not to travel if they

felt they had any discretion about it. I mean, our message through Public Health

from the get-go was if you feel you need help, talk to your primary care

provider. If you feel you need help now, that message needs to go across and

then that's a discussion about clinical priorities about which we do not opine.

But the

facts of the case are it did put a damper on peoples interest in travelling and

obviously those were decisions they must have made personally to weigh the risks

and benefits.

L. EVANS:

Yes, and I'm sure some of

the appointments were cancelled because they were deemed less of a priority due

to the COVID restrictions as well. That would have impacted the travel for

people accessing MTAP as well.

J. HAGGIE:

Well, I think appointments were not made for a variety of reason. Sometimes we

had provider issues, in that there was COVID in the facility and it was probably

deemed less safe to attend. There was COVID in the providers and I'm pleased to

announce for the Committee that we are now down to less than 200 health care

workers who are actually self-isolating today because of COVID, which is the

lowest it has been in this wave and is a thousand less than at peak. And

sometimes the patients themselves decided not to travel.

So I

think it would be very difficult to generalize as to why some of these

appointments were not kept.

L. EVANS:

Yeah.

And we

are assuming that the numbers are this low; we can't really substantiate them

because of the lack of access to testing.

Looking

at the Grants and Subsidies there, last year's budget in the Estimates was

written as $2,455,509,000, but just looking at the book last year, in last

year's Estimate book, the Estimates for '20-'21 was written as $2,453,522,300.

So I think we gave a photocopy to you of last year's Estimates that show these

numbers. So there shows a discrepancy of $1,986,700. So I was just wondering:

why the discrepancy and what accounted for it?

J. HAGGIE:

Yeah, that was money that

was moved back from JPS for Health in Adult Corrections and it was restated

after the Estimates were published. That was a decision, if you recall, that was

made some years ago and was deferred and then was put into the beginning of

fiscal '21, so it would appear in our book but not the previous one.

L. EVANS:

Okay, thank you.

Under

Revenue, for federal, what was the source of the extra $30 million in federal

funding?

J. HAGGIE:

$42.3 million, in actual

fact, was the amount that was moved from Finance to Health and Community

Services, but there was a reduction in revenue of $12.2 million, so that nets

out at the $30 million. Some money came out from infrastructure but the

principal was federal program revenue that was sent over from Finance in that

fiscal year.

L. EVANS:

Okay, thank you.

For

revenue, under provincial, what was the reason for the $6 million loss in

revenue?

J. HAGGIE:

Reciprocal billing revenues

were down, so we didn't get from other jurisdictions the revenue for looking

after their patients because they never came. They didn't travel because of

COVID.

L. EVANS:

Thank you.

Section

3.1.02, Support to Community Agencies, under Grants and Subsidies, this year's

estimate is increased by $500,000. Just wondering what the reason for the

increase is.

J. HAGGIE:

That's related to the

sugar-sweetened beverage, and it's going into the healthy eating initiative.

L. EVANS:

Thank you.

3.2.01,

the Low Carbon Economy, under Grants and Subsidies; last year's actuals were

$325,000 less than budgeted. I am just wondering what the reason for that was.

J. HAGGIE:

That was delays in receipt

of project approvals; it was a cash flow issue.

L. EVANS:

Thank you.

3.2.02,

Low Carbon Economy, under Capital, Grants and Subsidies – last year's actuals

were $4,610,000 less than budgeted; however, this year's Estimates have

increased by $1,045,000. So just wondering what the difference was.

J. HAGGIE:

Those are cash flow

adjustments again, related to delays, so they mirror the Capital of which the

previous question was the Current.

L. EVANS:

Good, okay. Thank you.

3.2.03,

Building Improvements, Furnishings, and Equipment, under Grants and Subsidies –

this year's estimate has increased by $5 million. Just wondering what the

explanation for the increase was.

J. HAGGIE:

We asked for that. In actual

fact, we would have probably liked a little bit more, but that is to replace

aging equipment, principally radiology equipment, which is getting to the end of

its working life. A lot of these scanners and things like that have a defined

age, and we've asked for an increment now conscious that a lot of these are

going to age out over the next few years, and that's the delta that we got this

year.

L. EVANS:

Okay, thank you.

And

that's the end of my questions.

CHAIR:

Okay, thank you.

Before

we start a second round, are there any other Members of the Committee that would

like to ask a question in the first round?

Not

seeing any, we can move to our second round.

The

Member for Topsail - Paradise.

P. DINN:

Thank you.

Let me

catch up where we were.

J. HAGGIE:

Yeah, I've lost my place so

please tell me –

P. DINN:

No, I'm just asking some

general questions actually.

We're

talking about combining the RHAs. Do you have an estimate or a forecast estimate

of what their financial position is expected to be at the end of this current

year?

J. HAGGIE:

No, it's difficult to be

sure. I mean what we're aiming to do is to remove duplication and to get better

value for the dollar we spend. How that will shake out really depends on the

work of the transition team.

P. DINN:

So in relation to that, do

we know if, this year, they'll record any deficits?

J. HAGGIE:

Let me have a look. There

probably is something somewhere about that. I don't have any information

specifically on deficits. My recollection is that comes through Public Accounts,

but I'm going to get – oh, here we go. Maybe I do have something after all; I'm

just not looking at the right page. Hang on a second and I will just see what I

can tell you.

yeah, we do have a breakout – silly me. So the difference between the original

expense limit and the actual expenditures breaks out for each regional health

authority. We can supply these for you in a table.

P. DINN:

Perfect.

J. HAGGIE:

You're looking at around $89

million for Eastern; $14 million for Central; $8 million, $9 million for

Western; and $9 million for Labrador-Grenfell. For example, in Eastern Health –

and it's mirrored in all of them – the bulk of single biggest item out of that

$89 million was $20 million for COVID operating pressures, $16.8 million for

COVID salary pressures, and $15 million for salary increases. If you add that

lot up, you can see you're looking somewhere at $50 million out of the $89

million.

P. DINN:

And there is funding

provided to cover those deficits?

J. HAGGIE:

The negotiated salary

increases, that flows through in the grant from us, and there is a mechanism to

flow that from Treasury Board.

P. DINN:

Okay, thank you.

I'm

just thinking of the integrated corporate services model, looking at

streamlining the delivery, the functions of these four authorities: payroll,

accounting, HR and such. In July 2017 you announced plans to implement a

province-wide shared services model for supply chain management in the health

care system, which includes procurement.

Can I

ask you this? How will this initiative be impacted by the new decision to go to

one RHA?

J. HAGGIE:

Well, I mean it will

hopefully lead to standardization so that when you have purchasing requests,

they work from a common dictionary. Prior to that, MEDITECH, which is the

background module for doing the inventory and stock control, had over 400,000

items in their dictionary in 4,000 headings. So by the time you do the math, you

see that there's a considerable number of similar products within the same

category. So this should make that role easier.

terms of the other elements about standardization of HR scheduling, we have

initiatives in place, after discussions with the RNU, for example, about

workforce management software. So that's a piece there. We've been moving in

that direction and I think this will just help accelerate it and standardize it.

P. DINN:

Okay.

And

I'll put this all together. Can you give us an update on where we are in

implementation? I suspect we're only in early phases of it. But is there any

indication of the amount of savings and potential job losses?

J. HAGGIE:

We are not looking at

affecting front-line delivery at all, in terms of the numbers that we need. We

know we need more and we've increased our LPN enrolment by 70 per cent.

Actually, more than that, I think. I think PCAs was 70 per cent and LPNs was 90

per cent. We saw that coming and we did that a couple of years ago. So, for

example, in Central their entire graduating class from CNA, which graduated just

before Christmas, they're all employed. All 30 of them got jobs. And if we

hadn't had done that back in 2018-2019, you can see we would be in a much worse

position.

So the

front line is not where we're looking to do anything except make people's lives

easier to access standardized booking for holidays and vacations, to enable

people to use that kind of HR module in a way that works from them and their

collective agreement. And that's the challenge of tuning it.

terms of savings on the back end, obviously there'll be duplication. Quite

frankly, it's going to be a process that will take a year or two. The transition

team haven't really got themselves in place yet. We have a CEO and that's it.

I think what you will see

happen is what's been happening now, that people will either find a new job or a

different one within the same umbrella organization, or they will retire rather

than go that route. So I'm not necessarily seeing that as anything other than

just a robust amalgamation.

P. DINN:

I agree. There will be a reduction and some duplication. You mentioned HR and

you've just hired a candidate for the ADM position for Recruitment and

Retention.

Is that position solely

dedicated to physicians or is it one that's going to be dedicated to front-line

staff across the four RHAs or the one RHA?

J. HAGGIE:

It's health human resources. It's not specific to one field or another. We know

topical issues or access to family doctors, shortages of RNs because of a whole

variety of reasons, but we also know that we have challenges with respiratory

therapists, with hospital-based pharmacists. We have challenges with medical

physicists. They don't grow on trees. We've got a gem in Eastern Health here,

who is doing some real cutting-edge work with a cyclotron in a way that maybe us

people outside the field would never have known. Those people are going to be

really hard to find.

Health human resource

professionals, people with accounting background, if they decide to move out of

health that's our problem because they will be moving to another job in this

province. There is no shortage of jobs. The shortage – if you do like I did last

week when you talk to your constituents – is people to employ. I have

construction companies that can't find labourers; I have aviation companies that

can't find mechanics or pilots, the list goes on.

P. DINN:

Just on the Centre for

Health Information, which of course focuses on eHealth and provides health

information, that will become a part of the department. That will move into the

department. I'm just wondering is this a positive move? Can you explain why it's

a positive move? How do you hope to accomplish this? How will it improve the

delivery of eHealth services?

J. HAGGIE:

How is the subject of a

consultation process. Work is under way. We need experts in the field of IT to

suggest how best to do that – who goes where and does what. So that work is back

and being analyzed.

I think from sitting where I

sit, real-time decision support is crucial and having that information, the

dashboard at your fingertips within the department, certainly stuck in my mind

during COVID. I think by integrating better that real-time decision support with

NLCHI structures, as they exist at the moment, it's a lot easier if we do it

this way. You've seen the department now has an ADM of digital health, digital

information and management.

The

electronic health record, the electronic medical record need to speak together

seamlessly, needs to be standardized across the province. I think, again, it's

reduction in duplication, HR, payroll, these kind of things. We can have one

mechanism that does it rather than four or five.

P. DINN:

So related to that, and from

my experience and I'm sure with any department – will I get my question in?

CHAIR:

Depends on how quickly.

P. DINN:

With anything with IT,

there's a big training curve for it. So I ask you this: Can you give me an

update on implementation. Any savings, any job losses?

J. HAGGIE:

We're not anticipating job

losses; we're anticipating people moving with their skills. They have skills we

don't want to lose. I mean, I talked about pilots and ambulance drivers who we

can't hire because there's no one to hire and we're dealing with that through

the recruitment and retention strategy, but there are huge private business out

there who look for these individuals. They are valuable; we need to keep them.

We need their skills.

terms of dollar figures around savings, I've come to the conclusion that we may

not actually end up saying: Minister Coady, here's some money back, we didn't

need it; but here, this is the better value we're getting for those dollars that

we spend. That, I think, is as much, if not a more important gain than simply

moving some numbers around on a balance sheet. Well, I think that's probably

heresy to say in an Estimates Committee.

CHAIR:

Okay, we're going to move to

the next questioner.

Anyone

else have questions to ask in this round? Do you have more?

P. DINN:

Yes.

CHAIR:

Okay.

P. DINN:

Thank you for that.

Just

related to, like I said, the implementation and you talk about getting the right

staff. I know in my past career when we dealt with like provincial engineers,

they always left and went to greener pastures, especially when the oil industry

started, because of their benefits, because of their wages. We know from the

cyberattack how important good IT, good supports and good security are.

So do

you perceive – and you're talking about people moving but, again, there'll be a

demand on that – any increases in the cost in terms of salaries for these

individuals?

J. HAGGIE:

I think that's totally

unpredictable from where I sit at the moment. I mean, people move, but we are

actually seeing also repatriation of Newfoundlanders and Labradorians. If you

look at the data from Immigration, Population Growth and Skills, some of our

increase has been from people who have chosen to leave Toronto, have chosen to

leave Calgary and have come back to a lifestyle they want to live in

Newfoundland and Labrador.

Again,

in terms of the specifics of the Centre for Health Information, the work from

the consultant is being analyzed. I think that will be very helpful, if not

crucial, in deciding on how to do the implementation, because there'll be a

sequencing to this that makes sense of matters. We'll leave that to the experts.

P. DINN:

Thank you.

Will

there be any money there for upgrading the MEDITECH? Is there any money here to

upgrade the MEDITECH program?

J. HAGGIE:

Our aim at the moment is to

see how the Corner Brook acute care HIS RFP goes. That's going to be our test

bet, because at the end of the day that's going to tell us what the market is

like. It's the best way of doing a market sounding, is to say here's a

hundred-and-whatever-bed hospital, 150 beds, tell us what's available.

NLCHI

and the RHAs have been very good with their networking in terms of translating

and integrating things. There are some systems out there that have been bought

fairly recently, and the direction from the department through the RHAs is that

these have to be scalable, they have to interoperable and so the newer systems

should not be an issue.

We do

recognize that legacy systems provide a challenge, both in terms of their

integration and in terms of their security. Those are, not disparagingly, kind

of geek questions; I leave it to them to tell me in language ideally I can

understand, and we'll deal with that. But we do know that we need to look at our

IT infrastructure. I think with having one RHA and one department looking after

that, you've got far less fingers in the pie and you're far more likely to get

it right at a price that is reasonable for the people of this province.

P. DINN:

So related to that, in terms

of the one RHA – and you've hired, from all I've heard, and I know the

gentleman; a great CEO to look after that from Eastern Health – are you

replacing that position, though, within Eastern Health?

J. HAGGIE:

Those are discussions we've

been having with the board. Obviously, the work of Eastern Health, as it

currently is constituted, needs to continue. We're engaged in discussions with

the current CEOs so that there is some stability in their lives during the

transition process, but we can't leave Eastern Health leaderless either.

P. DINN:

Thank you.

Just

let me move along because my colleague here got ahead of me this time; so that's

all good. A few questions here.

I'm

looking at 3.2.03. The question was asked about budget increase by $5 million.

Are we there, yes?

J. HAGGIE:

Yes, got it.

P. DINN:

So my question is what is

the impact of this increase? What's the relationship with that and the RHAs in

terms of is there an impact on the RHAs in that increase?

J. HAGGIE:

Well, that's money that will

be available for capital asks to the RHAs. Our information from them is that

there are pieces of equipment that are clinically important that need to be

evergreened, replaced, whatever the appropriate word is these days. This gives

them some more leeway in a new CT scanner or a new MRI or upgrading to match the

clinical demand and needs.

That is

where we went with that, but this is a generic pot. It doesn't just include

medical equipment and health-related equipment, but that is our main interest in

that delta this year.

P. DINN:

So the main portion of that

would be furnishings and equipment as opposed to building improvements.

J. HAGGIE:

No, it is building

improvements or health equipment improvements. So that is what comes out of this

pot. Our request through Treasury Board was for $5 million, and the case we made

was predicated mainly on medical and health-related equipment having to be

replaced. The background activity about keeping the roof from leaking still goes

on.

P. DINN:

I was just clarifying that

it was mainly driven by equipment.

I'm

just looking at the budget document and appendix – I don't know if you have it

in front of you.

J. HAGGIE:

No –

P. DINN:

I can pass it over to you.

I am

looking at Appendix VI. It is the

summary, restatements by department. Health

and Community Services in the original budget was $3,220,030,300. You had an

adjustment of just under $2 million – $1,986,700. Can I just get an explanation

of that variance?

J. HAGGIE:

Yeah, that money was

originally removed in the original Estimates because health in corrections and

the budget for it lay with Justice and Public Safety. That was a policy decision

that we move it into Health. That was part of

Towards Recovery and the action plan.

And in actual fact should have occurred earlier but didn't because of some

delays. Then COVID compounded those delays.

But it

was restated between the Estimates document from last year and the budget

document you see here. That's $1.9867 million.

P. DINN:

Yes.

So I

guess this is the last question. You mention at the onset of I think it was 271

departmental staff?

J. HAGGIE:

Yes.

P. DINN:

I think that's what you

said.

If I

look at the salary details and they're showing us 210 staff, I'm curious as to

why there's a difference of (inaudible) –

J. HAGGIE:

It depends on the day the

document was written. We always provide staffing numbers by date, because they

do vary significantly. We have hired a significant number of contractual staff

over the course of COVID. Some of their contracts have expired. So on any given

day, the number could be different by five or 10 individuals. Certainly for

example we've had a turnover in some of our claims processors in Grand

Falls-Windsor: they're retired; moved on. And so on the Monday you may find that

there are two missing, and by the Friday they've been replaced, or probably two

months later, the Friday, they've been replaced.

those are snapshots that I would encourage you if you have a number, look at the

date to see what you're comparing it with and look at the date on that.

P. DINN:

So it's not unusual to see a

discrepancy of almost, well, 60-odd people.

J. HAGGIE:

It depends on what the

category was. If was full-time, permanent then that number is about right.

Because that's the other thing, was it a reference to permanent full-time staff

of the department? Because that number's probably nearly accurate, plus or minus

one. But if you then say what else have you got in terms of temporary staff and

in terms of contract staff, you'll find it turns out to be 271.

P. DINN:

Okay.

I'm

just about done. I just want to say thank you for taking the time. I know you

were dying to be here tonight.

J. HAGGIE:

Wouldn't have missed it for

the world.

P. DINN:

Especially when the playoffs

all start.

So I am

done. I thank you for your time. I'm not sure about my colleagues here.

CHAIR:

Do other Members of the

Committee have any questions?

The

hon. the Member for Lake Melville.

P. TRIMPER:

Thank you very much, Chair.

Thank

you for the opportunity just to take a few minutes to also express my own

appreciation to this department. I think all of us as MHAs in this room know the

importance of this department. It dominates so much of the life of an MHA and I

thank so many of you across the way for your help in my office, and I'm sure all

those across the province.

I just

had a few additional questions. I just wondered – it's a bit of a theoretical,

and I think everyone in this room is hanging in their hat and hoping with a

great deal of optimism for positive change that will come with the Health

Accord. I just wondered if the minister could talk a little bit about how – is

this going to be on one extreme, thank you very much and full implementation, or

how do you see vetting this through, given so much work has been done by those

two co-chairs and all the supports and all the other contributions by yourself

and everyone else? Do you see a carte blanche acceptance, or are you vetting? I

see that you're already moving on so many of the other recommendations to date.

I'm just wondering if you had any thought on that.

J. HAGGIE:

I think the reason they

chose the word “accord” was that their principal document in their view and in

the view of all stakeholders – the task force is over 150 individuals, although

the core group is considerably smaller – was that this would be an accord. An

agreement amongst all the members of the task force that this was what they

felt, what they saw and a consensus opinion.

I don't

think anybody who's read that report or/and spoken to the co-chairs really would

take much issue with that direction at all. I think in terms of what happens

with the implementation plan, which is part B, the blueprint, I think several

things will play into it. One will be the pacing of it in terms of certain

elements. I mean, we could wish we had another 200 social workers or

psychologists or councillors, or whatever that core group is. We're not going to

get them tomorrow and it would be a fallacy to think we'd get that kind of

number over a period of anything less than three or four years.

It is a

five- to 10-year plan. This is the goal; this is where we want to be. Now,

whether you go that way to get there or this way, or this way, I think is one of

the things that as government you would have to discuss. Because some of it will

also be tied to investment and new monies. The budget for the accord plan B

doesn't exist because we don't know, in granular detail, what's in it. We've

spoken about the CTCs. That money in some respects may have to be new now. But

that money will come in from other sources later as existing practitioners join,

bring their patients with them and onboard themselves into this process. It's

far easier at the moment to start with the gaps where there is no coverage, for

example, and build a CTC from scratch.

Our

challenge, and the challenge of the accord, and the challenge of the department,

and the NLMA, and the College of Family Physicians, for example, is to figure

out how to take a person who's five or 10 years into practice, doing things

their own way, and say, do you want to join this, and if so how do we make it

work for you? That's going to be a slower process.

So I

think if you take a snapshot in time of the accord, you'll say, well, you've

cherry-picked; you've left this, this and this out. But to be fair, that, that

and that may not be possible until you've done A, B and C over here. And you

know the challenges about sequencing things, as well, and it may well be that

Harbour Breton, St. Alban's, Connaigre gets attention faster than another group

of communities who feel they're just as badly off. But the objective view from

the RHA is that that is a bigger need, a bigger pressure at that time, and

that's the awkward bit because you've got to manage the messaging around it.

I think

no one is in agreement with part A, but part B will be where the rubber meets

the road with implementation.

P. TRIMPER:

Absolutely.

Minister, I wonder if you could provide an update on one item that I know

frustrates probably both of us, and anyone who's aware of it. That's the

professional certification of new Canadians who come to us with the academic

qualifications, the experience, and they are doing much less than what we need

them to do. I just find this a shocking hurdle that is very frustrating, and I

look at a certain minister who is also here in the room. I'm just wondering if

you have any comment or update on that.

J. HAGGIE:

Well, I know I can speak

personally; we've certainly reached out to, for example – and it's just an

example, it's not the be-all and end-all – the new Registrar of the College of

Physicians and Surgeons, and she has acknowledged that there's a challenge with

their processes, and also once wants to be part of the solution; she wants to

come to recruitment fairs.

In the

specifics of overseas sort of graduates, as it were, there are mechanisms here.

I know Dr. Adey's predecessor did want to look at broadening the act to allow

different categories of licence here than the ones we currently have, and

certainly that kind of stalled lately; we're in the process of working through

that.

continue that discussion with Dr. Adey. We have opened a dialogue with other

regulators as well because, as I said earlier on, we talk about doctors and

nurses, but they're really a metonym for the whole health care provider field.

We need RTs, we need paramedics, we need advanced care paramedics and we need

medical physicists, yada yada yada.

So I

think, to be fair, they have a tightrope to walk and a balance to hold. Their

prime aim is to safeguard the public well-being and interest, but they also know

and have actually said, you've got to have some care providers to actually deal

with care issues. So somewhere in the middle a reasonable person will land.

P. TRIMPER:

Certainly provinces – and I

asked a question of it in the House a few months ago. When Ontario announced a

sort of accelerated mentoring process, some jurisdictions just seem to have

figured this out. Anyway, I just wish everyone the best because we need them.

Two

more questions I am going to try to get in. One is a COVID question; I have to

ask a COVID question. Why are we going forward with a longer waiting period for

that fourth dose, for that second booster, versus other provinces? We're looking

at, I think, it is a minimum of 20 weeks versus others at 12 weeks.

J. HAGGIE:

That's based on advice from

Public Health and the science table, which I think includes immunologist and

virologists. If you remember, that was the gap, or pretty well the gap between

the original course of vaccination and booster dose one. That is a clinical

question; we don't influence that directly in the sense of if the Public Health

team says 20 weeks, we're not going to argue. We might say could it be 21 or 22

or does it need to be 18, but we're not going to go and say something completely

different.

I think

each of the jurisdictions does their own numbers, crunches their own numbers,

and sees their own need. We are in a better situation; the wave came to us

first, has passed over and is now heading out there. So the question is if these

boosters wear off, when is the next wave coming and should you actually time

your booster to give you the best protection then when your risk of getting the

disease is going to be higher rather than simply stick to a plot. And those are

the factors –

P. TRIMPER:

The gamble lies in the – of

course with every week and the fatalities that we are seeing as a result of the

latest wave of this virus, that is the trade off, of course –

J. HAGGIE:

Well, I mean, the

hospitalizations lag behind the case numbers. We have seen the hospitalizations

start to drop. Deaths and ICU stays lag behind hospitalizations. We, according

to our modelling, expect that fall in those areas to come now so those numbers

should start to tail off.

But,

again, Public Health make these recommendations. They are based very much on

NACI guidelines, and I don't see much daylight between the two.

P. TRIMPER:

Thank you.

Minister, do you have a metric that just can help put in perspective how much

this province spends on locums – doctors, nurses, other specialists we need –

flying in regularly who aren't resident to this province?

J. HAGGIE:

We can certainly look for

that. We don't have an easy metric in the sense that that's done very much at an

operational regional health authority level. We do know that we are building

collaborative relationships with other jurisdictions whereby someone will come

in nominally as a locum, but they're coming for two months every six months and

they are like visiting regulars. They have a clientele as it were; they have a

practice built up.

They

come to provide specific expertise or specific relief in a specific area, and

they do it with a medium- to long-term commitment. I think the challenge is they

would be called locums as well from out of the province, but in fact they add a

huge value beyond the two months or whatever that they provide.

It is

possible to find out what proportion of the MCP budget goes on locums. I'm

certainly happy to provide that for you. I don't actually have it to hand. You

can then do the percentages based on fee for service versus salary.

P. TRIMPER:

Thank you.

I'm out

of time.

CHAIR:

I think we've exhausted the

time for questions.

CLERK:

Health and Community Service

Delivery, 3.1.01 to 3.2.03.

CHAIR:

Shall headings 3.1.01 to

3.2.03 inclusive carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

I'll

ask Minister Crocker how does he vote.

S. CROCKER:

In favour, Mr. Chair.

CHAIR:

Okay, carried.

motion, subheads 3.1.01 through 3.2.03 carried.

CLERK:

The total.

CHAIR:

Shall the total carry?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Again,

I'm going to ask Minister Crocker how does he vote.

S. CROCKER:

In favour, Mr. Chair.

CHAIR:

Those are carried as well.

motion, Department of Health and Community Services, total heads, carried.

CHAIR:

Shall I report the Estimates

of the Department of Health and Community Services carried?

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

I'll

ask Minister Crocker how does he vote.

S. CROCKER:

In favour, Mr. Chair.

CHAIR:

Carried.

motion, Estimates of the Department of Health and Community Services carried

without amendment.

CHAIR:

This concludes our Estimates

meeting on this department. It's always interesting to see the congenial nature

of these meetings and the back-and-forth dialogue; it's something the public

doesn't get to see that much. It maybe shows a different side of politics.

I don't

know if the minister has any input, or any Member of the Committee has any

closing comments?

J. HAGGIE:

No, I'd just like to thank

everyone for the time and quality of the questions. I look forward to seeing the

same collegiality at about 1:48 tomorrow.

CHAIR:

Unless anyone else has

anything, any comments, thank you all very much.

We need

a motion to adjourn, apparently. So moved by the Member for Topsail - Paradise.

That

has to be seconded as well. Seconded by the hon. Member for Mount Pearl North.

All

those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

Motion

carried.

The

Committee is adjourned until Friday at 9 a.m.

On motion, the Committee adjourned.