Social Services Committee — Department of Human Resources, Labour and Employment — 5 August 2014

2014-08-05

Newfoundland and Labrador — Committees

May

14, 2008

Social Services Committee

The Committee met at 5:30 p.m. in the House of Assembly.

CHAIR (Hutchings): Good evening, everybody.

My name is Keith Hutchings, MHA for the District of Ferryland and Chair of

the Social Services Committee meeting this evening to hear the Estimates for

Health and Community Services.

First off, just a couple of housekeeping duties here or maybe first I

will ask the Committee to introduce themselves, starting at my far right.

MR. PEACH: Calvin Peach, MHA, Bellevue.

MS SULLIVAN: Susan Sullivan, Grand Falls-Windsor-Buchans.

MR. CORNECT: Good evening, minister.

Tony Cornect, District of Port au Port.

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

MS JONES: Yvonne Jones, the District of Cartwright-L'Anse au Clair.

MS BUCKLE: Joy Buckle, researcher.

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

CHAIR: Okay. I would ask for a motion from the Committee to approve the

minutes of May 13, 2008, Department of Human Resources, Labour and Employment.

MS SULLIVAN: So moved.

On motion, minutes adopted as circulated.

CHAIR: The format we will use - which is, I think, agreeable to

everybody. In a minute I will refer to the minister and he can take fifteen

minutes for any opening comments. As well, I would ask that staff be introduced.

I would also remind staff that when they are giving any information that they

identify themselves each time, for the help of Hansard, before you speak. I

guess that is it.

I will ask the Clerk to call the first subhead.

CLERK: 1.1.01.

CHAIR: Shall 1.1.01 carry?

I will turn it over to the minister.

MR. WISEMAN: Thank you, Mr. Chair.

Good evening, and welcome to this Estimates committee meeting. We are going

to be talking about Health and Community Services and hopefully, by the time we

are through, committee members will have an insight into some of the things that

we are doing in the Department of Health and Community Services and some of the

activities of our regional health authorities. Certainly, I do not need to

remind people to feel free to ask questions.

Let me introduce my staff. To my left is the Deputy Minister, Don Keats; to

his left we have Jim Strong, who is the Assistant Deputy Minister of Corporate

Services; and then we have, starting at the back, Glenda Power, Director of

Communications for the Department; Dr. Cathi Bradbury here, she is the Director

of Physician Services; Joy Maddigan, who is the Assistant Deputy Minister of

Policy and Planning; then Karen Legge, who is the Director of Financial

Services. The empty chair - who is going to be joining us in a few moments -

will be Moira Hennessey, who is the Assistant Deputy Minister for Regional

Health Operations.

I just want to, Mr. Chair, if I could, make a couple of opening comments. I

will not be very long. I will not take my full fifteen minutes, to allow more

time for some questioning, but I think this year we - when the Minister of

Finance brought down this year's budget, I think we once again saw some

significant investments in our health budget. For four consecutive years in a

row we have had significant increases in the Health and Community Services

budget for the Province, now bringing the total budget for the department to

$2.3 billion. In the last three years in particular, I think we have seen some

record increases as a percentage over all.

In the last year, particularly, some of the things that we have enjoyed

rolling out, that grew out of last year's budget, was the introduction of our

new drug insurance program, the Healthy Ageing framework, our new mental health

and addictions program. We have had some key investments in some health

infrastructure, which has included long-term care facilities in Corner Brook,

Clarenville and Happy Valley-Goose Bay; the provincial addictions centre in

Corner Brook, which is now completed and they have recently moved in to. We have

had dialysis service opened in Burin, in St. Anthony and in Happy Valley-Goose

Bay. In fact, I think it was two weeks ago in Happy Valley-Goose Bay that

service was launched there. All of these things rolled out as a result of last

year's investments.

We put some $40 million last year into capital equipment throughout our

health authorities. Last year saw us complete the re-registration process for

MCP coverage for the Province. We made some significant investments in the

Child, Youth and Family Services system last year; again, improvements in our

medical transportation and assistance program, all growing out of last year's

budget. A dental bursary introduced last year to give us a tool to be able to

attract more dentists to the Province and to be able to expand our dental

program, which, again, was an announcement last year in the expansion of the

dental program for people between thirteen and seventeen years of age, families

on low income.

We saw last year our Regional Health Authorities introduce a new eight-week

graduate orientation program to support the nurses who are coming into the

system. Last year, we saw also the proclamation of the new Mental Health Care

and Treatment Act and the new Regional Health Authorities Act just recently

proclaimed.

Last year, as well, we saw the continuation of some of the capital

investments I alluded to earlier and we spent some $112 million. In Budget 2008,

we are now providing for another $79.1 million investment in this year, as well

as some $33.5 million to go into some high priority maintenance and repair

areas. We have new facilities that we are going to be building coming up this

year. We have identified a new infrastructure program, a new project for Corner

Brook, a new hospital for the City of Corner Brook serving the West Coast area

and the Northern Peninsula.

We are going to start planning for new acute care services in St. John's -

not new acute care services but planning a new program review for acute care

services in St. John's to look at the programs we provide, the facilities that

we need to provide them on a go-forward basis; looking at replacing some of the

long-term care facilities in St. John's with planning money to start this

year. We are looking at renovations to the Central Newfoundland Health Facility

in Grand Falls-Windsor, some planning money this year going out.

So, there are some significant changes in investments and infrastructure. I

will not go through the long list of projects we are going to do this year but

just to allude to some of the major ones that we are going to be undertaking.

Throughout the evening, no doubt, we will explore some of the other ones.

The maintenance and repair budget; there has been a lot of discussion around

the maintenance and repairs budgets for health authorities in recent years, and

some questions around the current state of repair. This year we are investing

$33.5 million to start to address some of those repairs that have been

identified. Obviously, I need to be cognizant of the capacity the system has to

be able to manage maintenance and repairs, the extents of maintenance and

repairs while we are maintaining a level of service. There are certain

logistical considerations. Obviously, as well, the human resource capacity

within our authorities for people who are involved in facilities management to

be able to manage such projects and see them through to their completion.

These are just some of the things, Mr. Chairman, of the kinds of things that

we have been doing from a facilities and a budgetary investment. From the human

resource side of things, we are looking at expansion of the medical school to

facilitate an ability to enhance enrolments to make sure that we are able to

attract Newfoundlanders and Labradorians to stay in the Province after

graduation. We are doing the same thing with nursing, attracting new qualified

nurses to stay in the Province, always an important issue for the Province.

Expanding the School of Nursing is consistent with our thinking and ensuring

that we have, not only educational opportunities available for Newfoundlanders

and Labradorians but providing that kind of training for them will only, I

think, support their desire to stay in the Province.

We are investing more money in enhancing home care programs. This year we

will see, with some of the investments we are making, an ability to be able to

expand some chemo programs within the community so people can stay at home to be

able to receive that kind of care. Additional investments in home support

services, so we are able to - some $10 million has been allocated this year to

be able to expand home support services; another $6 million to be able to

increase the salaries being paid to home support workers. A continuation of the

investments we have made each and every year in the last four years, Mr.

Chairman.

These are just some of the highlights of some of the things that, no doubt,

we will explore a little bit throughout the evening but suffice to say that as a

department, as a minister, I am extremely pleased with government's investment

in health. As a Province, I think we should be pleased with the general

direction we are headed with new initiatives. From a planning perspective, we

are very much in the final stages of a strategy to deal with cancer. We are now

involved in a strategy development looking at chronic disease management. We

rolled out last year the Healthy Aging Framework. So we have been doing a

significant amount of work in trying to map out what the future will look like.

With the investments we are making as a government and the budgetary support we

will have for those initiatives will give us the ability to be able to move

forward with their implementation.

With that introduction and those few comments, I am now available for any

questions.

Thank you.

CHAIR: Okay.

From the Committee, Ms Jones.

MS JONES: Thank you, Mr. Chairman.

Thank you, minister, for the overview of some of the investments in your

department. As we go through the estimates, some of the questions I have may be

relevant to some of that information that you have already provided, so I beg

your indulgence in providing me with additional information around some of those

initiatives. I certainly want to thank your officials for being here this

evening as well.

Just a general question to start off with because the health budget has

reached, no doubt, a record level in the Province in terms of investment and

spending. Over the past ten years, what have been the increases in that budgeted

amount year over year? I do not know if you have that information with you or

not.

MR. WISEMAN: I do, yes. I have about a ten-year history here.

MS JONES: For some reason I thought you might have that at your

fingertips.

MR. WISEMAN: You did, did you? Maybe you heard me allude to it earlier

today.

Just going from the profile - I can share with you this evening, back in

1999-2000 for example, the department's budget at that particular point was

$1.23 billion. I just commented earlier that we have now exceeded $2.3 billion

today. So over that period there has been some significant growth.

MS JONES: Yes. Do you have the breakdown for the year over year? That is

what I was wondering.

MR. WISEMAN: Oh yes, sure. Well, if you want me to walk you through

sequentially, start to finish, the points I just raised with you, the two point

dates I just raised. In 1999-2000, it was $1.232.4 billion; in 2000-2001,

$1.317.1 billion; in 2001-2002, $1.478.6 billion; in 2002-2003, $1.534.1

billion; in 2003-2004, $1.662.7 billion; in 2004-2005 $1.665.3 billion; in

2005-2006, $1.786.0 billion; in 2006-2007, $1.888.9 billion, and 2007-2008,

$2.161.4 billion. This year, the budget approved the other day brings us to

$2.341.0 billion.

If you look at incremental increases that represents this year, the budget we

are dealing with this evening represents an 8.3 per cent increase over last

year. Last year represented a 14.4 per cent increase over the year before, and

2006-2007 represented a 5.8 per cent increase over the previous year. The year

before that, in 2005-2006, there was a 7.2 per cent increase over that previous

year. So in the last four years you can see some significant growth in health's

budget.

MS JONES: Can I ask what the federal government contributions have been

over those periods as well, the percentage of contribution of transfers?

MR. WISEMAN: I would have to get that for you. That is something we do

not have with us this evening.

MS JONES: Okay. What about for this current year? I know how much federal

transfer makes up the full budget here, it is all drawn out in a pie chart, but

in terms of the amount of federal transfer that currently goes into the

Department of Health and Community Services.

MR. WISEMAN: Maybe I will ask Jim if he has that information.

MR. STRONG: If I understand your question correctly, you are asking how

much is transferred in terms of fiscal transfers into the Consolidated Revenue

Fund -

MS JONES: Yes. Well, I think there is 27 per cent into general revenues

of federal transfers. I am just wondering, what percentage of that would be the

Department of Health and Community Services?

MR. STRONG: That information is collected and maintained by the

Department of Finance. We would have to ask that department to get that

information.

MS JONES: Oh, okay. So there is no one here from Finance that does your

budgeting piece who can answer that?

MR. STRONG: No, because those are considered fiscal related revenues

which are their responsibility.

MS JONES: Oh, okay.

MR. STRONG: The only federal revenues we track are related to department

expenditure programs where we have cost-shared agreements with the federal

government.

MS JONES: Okay. Well, obviously, we can find it out by adding up all the

numbers ourselves but I just thought you might have it there in your notes or

something; that is why I asked.

MR. STRONG: No, we don't.

MS JONES: Okay.

I am going to start actually with

section 1.2.02., which is under Corporate

Services. I am going to skip right over the Minister's Office because I know

that he is doing diligence in his office. I will start with 1.2.02.; I want to

start with the Salaries. This year you are going to spend about $1.5 million for

Salaries, and according to the salary and earnings book, $225,000 of that is

projected to be used for overtime and other earnings. I am wondering why you are

anticipating that level of overtime, because if you look at the previous year's

salary estimates that was not accounted for?

MR. STRONG: Most of that money relates to provision for severance

payments and paid leave associated with individuals who will be retiring from

the department. That allocation is not specific to the Corporate Services

Branch. It is an allocation for the whole department, all staff in the

department. Very little of that money would actually be overtime. It would be

negligible.

MS JONES: Okay, because it is under the heading overtime and other

earnings. What you are telling me is that it would be used for severance pay?

MR STRONG: Yes, and paid leave. It would be the other earnings portion of

that heading.

MS JONES: I am sorry?

MR STRONG: It would be the other earnings portion of that heading.

MS JONES: Okay.

MR. WISEMAN: It would also include severance and any unpaid leave that

had not been used upon retirements.

MS JONES: Okay.

So you must be anticipating some retirements this year?

MR. WISEMAN: Yes, we are.

MS JONES: Also under that section, the Transportation and Communications

portion, you actually spent $200,000 more than you had estimated. I am wondering

first of all what the overrun was, what transportation or communications costs

you incurred that you did not budget for in the past fiscal year.

MR. WISEMAN: You might recall last year one of the comments I made at the

introduction, one of the achievements last year was the re-registration of the

MCP, the re-registration process. So there was an MCP mail out cost last year of

some $155,000 that contributed to some of that.

The second piece was, a major contributor there was, one of the things we are

trying to do is to consolidate all of the - within our regional health

authorities there is a number of computer software packages that are being used

to pay clients various client benefits, particularly some of the people who get

home support services or supporting in the community, so we are now moving

forward with a new client pay module. It will standardize the process across

each of the authorities, and to some extent within the authorities, because one

of the things that has been talked a fair bit about in the House is the whole

issue of some of the transition issues during consolidation of health

authorities and some of the financial software consolidations, a piece of that,

so we set up a project team to assist with that implementation. Some of this

cost associated with the $216,000, $70,000 of it is associated with that project

team doing the implementation of these new client pay modules.

MS JONES: Okay,

The re-registration program under MCP, is that now concluded? I think the

date has passed I know that - because I have gotten calls from people who

did not re-register and when they went to seek medical services they found out

that they could not access the service without a user pay, without this card.

In that process, how many people re-registered? What was the differential

between the ones on the books before and the ones after?

MR. WISEMAN: I don't know, Glenda, if you can recall the total number

that we had registered last year. We were estimating it to be about 506,000 or

something. I think we had a little under 500,000 register, was it, Glenda? I am

not sure of the exact number. I wouldn't want to leave you with a fixed

number, but it was slightly less than the Stats Canada figure that we were using

as a forecasted number. We could get you the exact number that re-registered

last year - I don't have it with me an exercise that we concluded last

year.

Your reference earlier to some recent calls that you have gotten as a result

of the re-registration process, now they will all re-register and at some point

they will all be on a five-year renewable period, but in order to facilitate the

staggering of it some had their re-registrations come up this year.

MS JONES: Okay, so the numbers were actually down. I think that was the

intent of the re-registration, because a number of people had left the Province

or moved away and were still holding their MCP cards in this Province.

MR. WISEMAN: Exactly.

MS JONES: While we are talking about the MCP cards - another question,

too actually, this issue came up just recently with regard to ambulance

services for out-of-Province people who are visiting and are residents who are

visiting other provinces. It was brought to my attention about the cost of the

bills that they received.

For example, if I was in Ontario and I had taken sick and had gotten an

ambulance, I would have paid the full cost of that service. This was a case

where there were individuals visiting home, who had moved to Ontario, and they

had gotten sick and required an ambulance and they paid a full amount; I think

their bill was a couple of thousand dollars for that service.

Is there any reason why there isn't a seamless process under MCP whereby

each province can be billed off in a case like that? If I go in the United

States, I always check to make sure I have full insurance coverage and things

like that, but every time I get on a plan to go to Ontario or Quebec or

somewhere, I never think about those things. I just always thought that I was

automatically covered.

When this person came to me, I almost doubted what they were telling me, to

be honest with you, because I didn't realize it was an issue. I am just

wondering why there isn't a seamless process whereby provinces can I don't

know what you call it, but - co-bill or co-pay at the end of the day so it is

not the actual patient who has to incur that cost up front.

MR. WISEMAN: The short answer is that the medical transportation within

any province is not an insurable service. It is not a service that is identified

under the Canada Health Act. What we have within each of the provinces is an

arrangement among ourselves for reciprocal billing for all insured services. As

people travel to this Province from other jurisdictions we have no ability to

bill their equivalent of our MCP for that service, and vice versa. When people

are in other jurisdictions from this Province, because it is not an insured

service, it is not a part of the reciprocal billing arrangement that we have

with each of the provinces.

If you just note the difference - for example, if you are in the Province

today and you go to see your family physician, you just present your MCP card

and the service is insured and no money exchanges hands between you and your

physician because it is an insured service. However, if you call an ambulance

this evening and they come and pick you up, what basically happens is you pay a

flat amount and the Province picks up the tab for the rest, but it is not picked

up as a part of the MCP process because it is not an insured service. It is a

part of our budgetary process, and we allocate the funding for it as something

we would do in our Province. The financial arrangements would vary across the

country as to what portion users pay and what portion is picked up by the public

purse, but it is not an insured service.

MS JONES: Is that just on medical transportation or is that on other

services as well?

MR. WISEMAN: Medical transportation happens to be one of them, but there

may be some services that are provided in some jurisdictions that are not

there may be some provinces that cover certain programs under their insurance

scheme that may not necessarily be covered in our Province.

Dr. Bradbury may want to comment further, but there may not be very many

variances between jurisdictions as to what is insured and what is not, but there

are some differences between jurisdictions and what is considered an insured

service. The ambulance piece is not covered in any jurisdiction as an insured

service, but there may be some others.

Dr. Bradbury, you may want to comment.

DR. BRADBURY: There are provinces, for example, that will insure

chiropractic, naturopathic services, physiotherapy, so there are some variations

between provinces. Another example is that our Province has our children's

dental program. There is no other province in Canada that insures dental

services. So there are variations between the provinces as to what is covered in

addition to what is required under the Canada Health Act.

MS JONES: In terms of reciprocal billing, I know in my district, for

example, where we border on the Province of Quebec, we have a lot of people who

use Quebec hospitals and facilities, and I guess that is why it came as a bit of

a surprise to me. I know that my constituents go in there, they present their

MCP card for Newfoundland and Labrador, and the billing is done through a

corporate service between government to government. I just automatically assumed

that it covered everything. So, the fact that it is not an insured service, I

guess, causes me to wonder: has this ever been a discussion between Health

Ministers in the country that they would look at making it an insured service?

MR. WISEMAN: I don't know what may have taken place historically. I

have been the minister just a little over a year. I have not had that

discussion. I am not aware that ambulance services have been a topic of any

discussion universally across the system, because it is not insured in any

province, so it is not one of these where any province has insured it and

covered it. As Dr. Bradbury has just indicated, in our Province, where we have

the children's dental program, we are the only ones in the country to do that.

Others have not followed that lead, but at the same time no one has taken the

lead on the medical transportation piece.

MS JONES: Okay.

Now that I have raised the issue with Blanc-Sablon, and the hospital in

particular as well, or the Quebec billings - because I know there are some of

them in Western Labrador as well, probably more money coming in from Quebec than

is being paid out, because I know a lot of people in Fermont use our facilities

in this Province - those billing amounts, have they gone down over the years? At

what levels are they being maintained now?

MR. WISEMAN: Jim, I don't know if we have made any comparisons of the

trend of that over the years. I don't know if you can comment about any

trends.

MR. STRONG: What I have observed I have not done a detailed analysis

recently, but what I have observed over the years - is that, depending on the

changes in the medical staff complement either in Blanc-Sablon or in St.

Anthony, there is some movement of those residents of Quebec between our

Province and Blanc-Sablon in receiving service. For example, I think two or

three years ago there was a significant increase in services provided by our

Labrador-Grenfell board. When we inquired into the board about it, it was due to

a decrease in physicians temporarily on the Quebec side of the border, and those

residents came and sought services from our Province.

MS JONES: Would you be able to provide me with the breakdown on a

year-to-year basis, say, going back to 1999, for instance, of those billings?

How much we would have been billed for by the health care system in Quebec on an

annual basis going back to 1999?

MR. STRONG: I will try and get that for you, if we have it in the

department, yes.

MS JONES: Okay.

MR. WISEMAN: What we will provide you with is the sum total of the

reciprocal billings ranging between Newfoundland and Quebec in that ten year

period. It won't be broken down by facility but by Province. You will know,

then, what Quebec billed us for and what we billed Quebec for.

MS JONES: Yes, that is the information I am looking for.

MR. WISEMAN: Okay.

MS JONES: The reason I asked for it, actually, Jim, falls in line with

what you just said about service changing, and providers of service changing,

because we went through a period where we did not have physicians, for example,

in Forteau, where there were full complements in Quebec, and that made a

difference. Now that the complement and there has been a shift of professionals

in Quebec hospitals, some of the people who normally would have seen patients in

Labrador have moved on and did other things and started other practices, I am

just wondering how much that shift contributed to the change in service in terms

of where people were going and seeking health care services. That would be my

reasoning for wanting to look at the numbers.

CHAIR: Ms Jones, if we could probably move on to someone else?

MS MICHAEL: Do you want to finish that section?

MS JONES: (Inaudible) but I don't want to take up all the time.

MS MICHAEL: (Inaudible) finish that section, sure.

CHAIR: Okay.

MS JONES: Also under that section, last year you had budgeted to spend $1

million in Professional Services. You only spent $100,000. I am wondering what

it had been budgeted for and why it did not get spent.

MR. WISEMAN: This budget category here is almost like a plug figure in

anticipation of what might unfold with the federal-provincial agreements on

various funding things. We had $1 million in there last year without being able

to forecast accurately what it might be used for, but on annual basis there are

arrangements between the federal government and provincial government on various

initiatives. This was put in here to allow some funding to be budgeted for, for

the Province's use, if such an arrangement would have surfaced. Last year it

did not happen and that is why you see the difference between $1 million and

$100,000.

We just put the $1 million back in there again this year in anticipation that

something like this might surface throughout the year and we want the

flexibility to be able to take the federal government up on the offer and have

the chunk of money to work with.

MS JONES: Is that why the federal revenue that you had estimated at $1

million but you didn't receive - is that the same monies that you would be

referring to, partnership agreements?

MR. WISEMAN: The revenue side of this would have been the same thing,

yes, because it would have been matching money as a part of a shared arrangement

with the federal government.

MS JONES: Okay, yes, because you had budgeted $1 million and had received

$39,000.

What was the $39,000 for that you did receive from the federal government?

MR. WISEMAN: The Aboriginal Health Initiative.

MS JONES: Under the Purchased Services, you spent $888,000 last year. Can

you tell me what services you obtained for that?

MR. WISEMAN: Maybe I will ask Jim if he has a breakdown of that full

expenditure item there.

MR. STRONG: Purchased Services for last year, that $888,000, is broken

down into a number of categories. The two biggest ones would be for rent - that

would be about $395,000, department rent space in Grand Falls-Windsor, Belvedere

here in St. John's, and in Stephenville and the other significant

expenditure item there would be for printing costs, and that would be about

$424,000. That would be printing, again, for the whole department, for all

programs.

MS JONES: Okay.

MR. STRONG: There are a couple of small items, advertising and repairs

and maintenance that make up the balance.

MS JONES: The rental space that you are paying for in Grand Falls,

Stephenville and St. John's, what is housed in those spaces?

MR. STRONG: What is housed in those spaces?

MS JONES: Yes, what offices are there?

MR. STRONG: In the Stephenville office we would have the application

processing team for our Newfoundland and Labrador Prescription Drug Program, so

all applications, irrespective of the component, are processed through there.

In the Grand FallsWindsor office, the staff there is responsible for

processing the fee-for-service claims for the MCP program, and there is a small

team there that also handle client registrations for MCP as well.

The Belvedere property, the staff that are there are the Medical Services

Division, the Pharmaceutical Services Division, and also there is a public

services office for the MCP program so people in St. John's and Eastern

Newfoundland, their applications are processed through the staff there. That

would be the staff complement at that site.

MS JONES: This year you are budgeting almost $100,000 more under that

same heading. Is there additional space being acquired? I am assuming that most

of it will go to maintain the same space and your printing costs; will it?

MR. STRONG: Well, the lease costs are long-term leases, so the lease

arrangements have not changed per se, but we have $100,000 in the budget this

year for some renovations at the Belvedere site, to improve the reception area

that deals with clients and also to better utilize the space that is in the

building for the existing staff and divisions.

MS JONES: Okay.

MR. STRONG: So that would be a one-time cost.

MS JONES: In Furnishings and Equipment this year, you overspent by almost

$60,000; well, you did, by $60,000. Was there anything in particular that you

had to buy?

MR. WISEMAN: We had a number of staff changes that required ergonomic

assessments to their desks because of unique circumstances. As a result, there

were some additional furnishings purchased to accommodate those staff.

MS JONES: Okay.

This year you are budgeting a little less.

MR. WISEMAN: That was as a result of some changes last year that we may

not anticipate this year.

MS JONES: Okay.

The revenue that you collected - you budgeted to collect $125,000 and you

collected $560,000 - what was that for?

MR. WISEMAN: Some of it, the bulk of it, $195,000, had to do with the

recovery from a transfer that went to the Faculty of Medicine from a previous

year that came back in this year. There was another piece of $92,000 that came

from a flow of some money from the Bliss Murphy Cancer Foundation that came

about as a result of the department funding the atrium out in Grand FallsWindsor

Cancer Clinic, and the money was just flowing back from the foundation to cover

that cost.

MS JONES: How much was that?

MR. WISEMAN: It was $92,000.

MS JONES: What was the rest of the money from?

MR. WISEMAN: There is another $66,000 that came as a result of a

reimbursement for some vaccines that occurred in 2006-2007, and there was

$75,000 that was Jim, what is the acronym CCHOTA? What is it? These

acronyms, I don't know who creates them but, I tell you, this is the longest

one I have seen for a while, CCHOTA.

MR. STRONG: I will refer that question to Cathi, because I think she

probably knows that one.

DR. BRADBURY: It is probably easier to describe it in what it is known as

now, which is CADTH, which is the Canadian Agency for Drugs and Technologies in

Health.

MR. WISEMAN: Fundamentally, the full amount that I have just accounted

for you there relates to items that we recovered last year as a result of

activities in the previous year, that would have ordinarily been accounted for

within that fiscal year but just did not occur in time.

MS JONES: The money from this Canadian agency of drug and health, why

would you collect $75,000 from them? What would be your connection there?

MR. WISEMAN: As I understand it, they are part of the assessment process

that we have to do for our prescription drugs, the new ones going onto the

market, and we pay a fee for that. This would have been a reimbursement of an

overcharge on that, I believe.

DR. BRADBURY: During the last three years the medical consultant to the

department, Dr. Ed Hunt, was the chair of the board of CADTH, and as chair of

the board he was allocated a support person. These are the funds from CADTH,

then, for the hiring of this support person in recognition of his chair duties.

MS JONES: He has retired now, hasn't he?

MR. WISEMAN: (Inaudible) until the end of the year.

MS JONES: That money is reimbursement from last year, is it?

MR. WISEMAN: What you are seeing

MS JONES: He wouldn't have a secretary this year.

MR. WISEMAN: If I just kind of summarize what Dr. Bradbury had indicated,

Dr. Hunt was fulfilling - this wasn't anything to do with his role within the

department. As a result of his role in the department he was part of a national

board, and this money was flowing back to the department as a result of that

reimbursement while he sat in that voluntary role on a national board. He is now

retired and this Province doesn't hold that chair's role in that board, so

this doesn't have anything to do per se with the operation of the Department

of Health and Community Services.

MS JONES: The transfer from the Faculty of Medicine, the $195,000, what

would that have been for?

MR. WISEMAN: It is a duplicate payment that was made to the faculty the

year before.

MS JONES: For what? What was the payment made for, the duplicate payment,

or the original payment?

MR. WISEMAN: I don't know if Jim might be able to answer what the

detail was.

MR. STRONG: I don't know the reason for the duplicate - the original

purpose for the payment but, as a part of our review processes, our internal

controls, we picked up that this had happened and we recovered the money back

from the faculty.

Basically, the Financial Administration Act says that, when you do that, you

have to put it into related revenue if it relates to a prior fiscal year. That

is why that is showing up there.

MS JONES: The money you collected from the Bliss Murphy Cancer

Foundation, you said, was $92,000. Why would they have paid that back to the

Province?

MR. WISEMAN: As I understand it, when the atrium was built in the clinic

out in Grand Falls-Windsor that was a project to be funded by the foundation.

So, to facilitate the establishment of that atrium, or the building of that

atrium, money was flowing from the department to facilitate the process and the

department was then reimbursed by the foundation for the project.

MS JONES: Okay.

CHAIR: Ms Jones, are you almost finished up?

MS JONES: That is all the questions under that section, yes.

CHAIR: Okay, great.

Thanks.

Ms Michael.

MS MICHAEL: Thank you very much, Mr. Chair.

Before I start the line by line of 1.2.03., could you just explain to me,

Minister - and you may have explained to Ms Jones but my mind may have been

somewhere else - the client referral and management system pay module, what

exactly it is.

MR. WISEMAN: Many clients of Health and Community Services in the

community - persons with disabilities, for example, who live in the community

have varying supports, and people who live in alternate family care arrangements

have various supports - the family is providing the care for them, and there is

a range of services that they have, an entitlement that they get reimbursed for

and paid for.

MS MICHAEL: Right.

MR. WISEMAN: Each of the health authorities had a variety of computer

software to be able to facilitate that payment.

What we have developed now is a standard module that will allow us to use

that across all of our health authorities. What this will now do is give us a

standard payment mechanism, an ability to track, an ability to trend, and an

ability to monitor payouts consistently across our four authorities.

MS MICHAEL: Thank you very much.

It just was not clear to me exactly what the pay was about, but I fully

understand that program, of course, so thank you. That helps.

If I can just look at 1.2.03., the line by line under this, the salary line

in last year's budget was budgeted at $1,956,300, the revision was $1,678,700,

and now this year it is back up to $1,883,700.

Is it that you had a vacancy that now you are going to fill? What is the

reason for the fluctuation over the three lines?

MR. WISEMAN: Last year, the difference in the budget and the revised

budget was $277,000. That came about as a result of: one, there was an

organizational review in the department, in Pharmaceutical Services, which

created an adjustment. In addition, there were a couple of vacancies that we had

in the department. Then, we had some overtime that got paid out, and then there

were some adjustments for pharmacist salaries. The net effect of those changes

came up with the $277,000 that I just referred to.

The dollar figure associated with this year, the additional $72,000 over last

year's revised figure, some of the additional costs, one of the things that we

just talked about then was the discontinuance of Dr. Hunt's role on a national

board which will see some adjustments in the salary, which keeps it down below

the $1,956,300 from the previous year. We have some add-on costs because there

are some salary adjustments as a result of the 3 per cent increase for April 1

to June 1. Then, as a result of some reclassifications in the department, there

are some additional costs associated with that.

The net effect of those things gives us the $72,000 that you see as a

differential here.

MS MICHAEL: Thank you.

Under subhead 03, Transportation and Communications, $108,000 was budgeted in

2007-2008 and only $45,000 was spent. Now, this year $129,300 has been budgeted

again. What were you expecting that did not happen last year, and what do you

expect for this year?

MR. WISEMAN: Travel is one of those areas where you can sometimes rely on

historical practices, and that is sometimes a good measure especially if the

people involved in an area do the same activities year over year so it is very

predictable. Others, it is the response to the demands that would occur in any

one given year. Therefore, if you have a savings it is kind of a bonus. Normally

when you are trying to forecast what it might be, you would look at the

activities involved in this division or department, the individuals involved and

the nature of the interaction that they might have. Any travel that might exist

within the Province, but also any involvement they may have with national

organizations or bodies, the requirement that they would have to ensure that

they are part of a national system, sometimes all factor into that. It is always

difficult to forecast with a high degree of accuracy. That is what we are seeing

here and that is why the fluctuations.

MS MICHAEL: Right. I am curious though why you would go from $108,000 up

to $129,300 unless there was something that you were anticipating. Why change?

With that kind of an explanation usually the figure stays at $108,000 and

$108,000.

MR. WISEMAN: I do not know if there is anything in the Medical Service

there, Dr. Bradbury, that is going to be extraordinary this year that would have

given rise to that kind of change.

DR. BRADBURY: With the stabilization of the dental plan and the hiring of

the dental director there are now some meetings that he will be attending that

will be covered under this program. The other areas: with the closure of the

Office of Primary Health Care some of the travel associated with that will now

come under the medical services branch.

MS MICHAEL: Thank you very much.

I am curious, though, since you mentioned it: With regard to the Director of

Dental Services what would the travel be? What would be the meetings that he

would be going to?

DR. BRADBURY: There are national meetings that are held in the different

provinces with regard to dental programs. As I stated earlier, it depends on if

it is an insured service or not but everybody has a program.

MS MICHAEL: That is what I was wondering. So whether it is insured or not

they all have programs. I was curious about that actually when the minister was

talking about no other province having insurance, but surely they must have

dental programs and they do. Thank you.

Under Professional Services, that is subhead 05, last year the budget was

$352,100 and it was revised up to $572,500 and this year coming back down to

$381,000. What was it that happened last year that caused the Professional

Services to be higher than anticipated?

MR. WISEMAN: One of the things that we did last year was - I commented on

it at the beginning - the roll out of the new insurance program, the

prescription drug program. As a result of that we needed to have some systems

upgrades to our computer system, and X-Wave has the contract for that. Because

of those enhancements we had some increased costs last year.

MS MICHAEL: Okay, thank you.

I do apologize if there are times that I am going to refer to something that

you mentioned in the general, but this is

MR. WISEMAN: I did not give a level of detail that you would want in the

announcement, so that is fine.

MS MICHAEL: No, that is right. Thank you.

It is not a big amount but under Purchased Services there was some

expenditure in the revision that was not anticipated. What would that have been?

That is subhead 06.

MR. WISEMAN: Again, this is primarily for printing services, advertising

and miscellaneous expenses. The exact breakdown I do not know if we have a

schedule here, Jim, to be able to provide the commentary on the full fifteen?

JIM STRONG: No, I do not have a schedule, Minister.

MR. WISEMAN: We could provide that for you if you wanted. We could do

that.

MS MICHAEL: It is not a major one. We will ask for some breakdowns on

other things, but it is okay for this one.

Under Revenue, what is the source of this provincial revenue?

MR. WISEMAN: Most of this comes from agreements we have had with

pharmaceutical companies to cover the cost of some reviews and the effectiveness

of certain prescription drugs.

MS MICHAEL: What exactly is the nature, then, of those agreements?

MR. WISEMAN: For example, just to comment on the $215,000 differential

from last year, we had an arrangement with a drug company to look at utilization

and looking at an Alzheimer's monitoring program. That $65,000 would have been

the dollar amount associated with that. We will have drug utilization research

projects that are funded by the pharmaceutical industry, and that is what this

revenue source would allow us to do.

MS MICHAEL: So the research is not being done by the pharmaceutical

company?

MR. WISEMAN: No. They are providing the funding for us to do it.

MS MICHAEL: To do it.

MR. WISEMAN: Exactly.

MS MICHAEL: Then, would you contract others to do that? That is not

research we would do in-house, is it?

MR. WISEMAN: Maybe Dr. Bradbury could comment on who might have carried

out, let us say, for example, the Alzheimer's monitoring project. Who would

have carried that out on our behalf?

DR. BRADBURY: I am not certain. There is the Newfoundland Centre for

Health Research as well as the research group over at Memorial. One of those two

sites, I would assume.

MR. STRONG: (Inaudible) some departmental costs, if it was extracting

particular data from the computer system or a compilation of information.

MS MICHAEL: I am going to ask the question: is it using the drugs of that

pharmaceutical company that the research is being done on?

MR. WISEMAN: This would not be a circumstance where we would be used as a

marketing tool for a pharmaceutical company. This would be research that we

would use to obviously benefit the people of Newfoundland and Labrador and would

be a piece of research that would be used for all residents of the Province, but

also be used by the health system; not just for the benefit of the

pharmaceutical company, nor would it be used to promote the products of the

pharmaceutical company.

MS MICHAEL: But the company that does give you money for the research,

even though you are not promoting it, are you using their product or are you

using other products?

MR. WISEMAN: It would not be a circumstance where the research funding

would be tied to the utilization of keep in mind that the products we would

use under our prescription drug program, and these would be the only ones that

we as a system would pay for, are done as a part of a national evaluation and

they are added to the formula as a part of that national evaluation and not tied

to any kind of research funding that a company would provide. There is a real

separation between those two transactions. One is deciding what goes in our

provincial formulary and, b, what kind of money we would accept from

pharmaceutical companies for research.

MS MICHAEL: Okay. And that is what the research is tied to, making

decisions around what gets added to the formulary?

MR. WISEMAN: Exactly.

MS MICHAEL: Thank you very much.

Maybe I can go on to the next one. I could ask Yvonne: do you want to ask any

questions on that section? I do not mind stopping if you want to ask something

on that section. That might be a good way to do it.

MS JONES: Under Medical Services?

MS MICHAEL: Under Medical Services.

MS JONES: No.

MS MICHAEL: Well then, I will continue to 1.2.04.

MR. WISEMAN: Sure.

MS MICHAEL: Thank you.

This question always comes up every time, of course, the salary line. Under

1.2.04, subhead 01, Salaries, again, are you anticipating new personnel under

the Regional Health Operations?

MR. WISEMAN: Yes, there are two new positions that we will have

contractually in place this year. One: given the significant amount of

investment we are making in infrastructure, we need to be able to have someone

in the department with the skills set to assist us in managing that kind of

infrastructure investment. The Department of Transportation and Works, on behalf

of government, is responsible for the tendering process and managing the capital

investments of government. This is someone who we want in-house to work with us

and with the health authorities in defining some of the programming issues and

defining the kind of capital investment we need to respond to those programming

issues. That is a person we are going to bring on this year.

Secondly, we are going to bring on a new Aboriginal health consultant to help

us, as a department, look at some of the Aboriginal health issues that we need

to be responsive to and look at the whole issue of Aboriginal health with us.

MS MICHAEL: Have you advertised already for that second position or do

you have the money there but nobody

MR. WISEMAN: This is a budgetary process now. We just got it approved in

this year's budget and we will be proceeding now to fill both these positions.

MS MICHAEL: Very good.

The others are pretty straightforward.

Subhead 05: in the budget for last year $88,000 was budgeted this is

Professional Services but you spent $422,600 and then for this coming year

the budget is only $13,000. There is a lot of difference there. Can we have an

explanation?

MR. WISEMAN: Sure. I will just walk through the dollars that are tied to

that.

Last year we had some contracts related to the implementation of the new

mental health legislation and we had a couple of people on contract with us to

help us with that piece. We had a new gambling and addictions awareness campaign

that we conducted last year. The first item I identified was $120,000, the

gambling and addictions awareness campaign was $165,000 and linked to that there

was a public awareness campaign around addictions services that was $50,000. We

did a prevalence study in three regions of the Province that cost us $44,000,

and then we conducted a consultation process on substance abuse on which we

spent $26,000.

MS MICHAEL: Thank you.

But in this year it looks like there is not a lot budgeted.

MR. WISEMAN: No.

MS MICHAEL: So you are not going to have any more of these campaigns.

Recently, didn't I see something about addictions? I cannot remember what it

is that I am thinking about. But you do not have any campaigns planned for this

year?

MR. WISEMAN: I am just trying to think where this might be budgeted under

Jim, there is a

MS MICHAEL: Because I saw something recently. A statement from you, I

think, wasn't it?

MR. WISEMAN: I am not sure. Where is that being budgeted?

MS HENNESSEY: The money is actually budgeted under subhead 3.1.01,

Regional Health Authorities and Related Services. The money is allocated within

our Mental Health and Addictions budget, but because these are professional

services, contracts, the money is transferred onto this account. If we do some

additional ones this year, you will find the same thing at the end of the year.

MS MICHAEL: Very good. Thank you very much.

MS POWER: Can I just add you mentioned you might have heard something

recently. Actually, there was a media advisory out today that the minister will

be announcing details of a new campaign tomorrow morning.

MS MICHAEL: That is it. That is what I saw, yes.

You know you are doing that, do you?

MR. WISEMAN: I got worried when you asked the question, because I knew I

was announcing something and I did not know where the money was in the budget to

do it.

MS MICHAEL: Very good. So now we know you are announcing, and we know

where the money is.

MR. WISEMAN: Yes.

MS MICHAEL: Thank you very much.

Under Purchased Services, I am assuming that is sort of the classic answer of

knowing you are always going to have to do Purchased Services. What would be the

nature of the Purchased Services under Regional Health Operations?

MR. WISEMAN: The items that we are talking about here in it is 06 you

are talking about now, right?

MS MICHAEL: Yes, that is right. I am sorry.

MR. WISEMAN: Most of this is cost of printing and some other

miscellaneous expenses.

MS MICHAEL: Sure.

MR. WISEMAN: Most of it is printing.

MS MICHAEL: In most departments that seems to be what it is, actually.

Then, in the revenue from the federal government, is this part of their

regular Health and Social Benefits Transfers? Last year you were hoping for

$141,200, I guess, but you only got $25,000, and this year

MR. WISEMAN: This deals with a very specific arrangement, not the normal

federal-provincial transfers.

MS MICHAEL: Oh, okay.

MR. WISEMAN: This was a federal agreement for the addictions program.

What this item here is very specific to that particular program.

MS MICHAEL: Okay, related to the addictions.

MR. WISEMAN: And the other one, there is a transfusion transmitted

injuries surveillance initiative that was also part of this funding pot.

MS MICHAEL: What exactly would that be?

MR. WISEMAN: I believe, and Dr. Bradbury might comment on it, it has to

do with blood transfusions, is the - and I gave you that answer by assuming the

reference, by definition, I assume would have meant that, but we can clarify

what that actually means for you but

MS MICHAEL: Please.

MR. WISEMAN: Yes, we will.

MS MICHAEL: Okay.

MR. WISEMAN: But fundamentally though, to your earlier question with

respect to - this is not a part of the normal transfer of federal funding. This

would have been a one-off agreement to do with a particular initiative to the

Province that the federal government may have been involved with.

MS MICHAEL: Okay. If we could have just an explanation of what that

second program is.

MR. WISEMAN: Sure. Yes.

MS MICHAEL: Okay.

Well, I will turn it over, Mr. Chair.

CHAIR: Okay.

Ms Jones?

MS JONES: Just a couple of questions on that section.

You talked about the $44,000 that was spent to do the prevalence studies in

three regions. What regions were they done in?

MR. WISEMAN: We did Bell Island, Fogo and the South Coast, the Connaigre

Peninsula area.

MS JONES: Connaigre Peninsula?

MR. WISEMAN: Yes.

MS JONES: Was any of that released publicly, the documents from the

study?

MR. WISEMAN: There has just been a recent study. Moira, I will ask you

just to there has been a very recent study that we have had concluded.

MS HENNESSEY: The study has just been received in draft by the department

yesterday. So it has not been released at this time. We are in the process of

reviewing the draft.

MS JONES: Okay.

MR. WISEMAN: (Inaudible) in due course we will be able to release it

publicly and you will get a full view of the document at that time.

MS JONES: Yes. Thirty days, is it?

That study though would have had recommendations attached to it I guess, too,

would it?

MR. WISEMAN: This would have looked at - I have not seen the draft -

MS JONES: I do not remember the terms of reference for it, so I cannot

recall.

MR. WISEMAN: Moira, you have seen the draft but I think this would have -

the prevalence study would have looked at prevalence and not necessarily been

looking at appropriate responses (inaudible) action?

MS HENNESSEY: The minister is correct. That is really looking at the

prevalence of addictions in these three areas of the Province, and I guess from

that we will look at what some potential recommendations may be for service

delivery in these areas. The study was received yesterday. It is currently with

our addictions consultant and I have not read the document at this time, so I am

not able to share any of the information.

MS JONES: You talked about the gambling awareness campaign there, and one

of the issues that was raised with us a while ago had to do with the board that

was set up for the video lottery terminal players. The Atlantic Lottery

Corporation had a board set up, government had a representative on it, but there

was no representative from Health and Community Services. I think the

representative was from Business, a business rep from the Department of

Business. It was raised with me because I guess it was a concern in terms of

video lottery gambling in the Province and gaming business all around I suppose,

in that people were more at risk for addictions and so on because of some of

those games that are out there.

The question was raised with me: Why would the Department of Health and

Community Services not have someone on that board to monitor the health and

welfare of people, and society in general, in terms of what they are planning

and so on would be? I do not know if you have been approached on that or not, or

if it is something you have given consideration to.

MR. WISEMAN: As I understand it, there are two people on that board. The

Atlantic Lottery Corporation you are referring to, I believe, is it? I think

there are two people from Newfoundland and Labrador on that board. One is an

official from the Department of Finance and the other person is not a government

employee but it is someone from the community who has been appointed to that

board. They represent the interests of the Province and the views of the

Province, and some of the views that we have in Health and Community Services

around the actions and activities of that corporation, or any other department

of government, then they would be the voice for that.

The vehicle that we would have as a department to ensure that any thoughts we

would have with respect to the operation of that corporation were brought to

that table, we would use those two people that we have appointed to represent

the interests of Newfoundland and Labrador at that table. The interests of our

Province goes beyond the financial interest, obviously, in the corporation, but

to include the issues that the social responsibilities that the corporation

has so that their policy decisions are influenced by direction provided by the

Province, which would include health and any other department of government.

MS JONES: I would think that none of the Atlantic provinces have any

representatives from health and community services on the Atlantic Lottery

Corporation board at all, would they?

MR. WISEMAN: I have no idea of the structure of the corporation. I do not

have any active involvement with it but I understand that each of the Atlantic

provinces appoint to the board, and who they choose to pick, I guess, is up to

them. I am not sure if there is any criteria used, other than the province's

choice. We have two appointees, too, as I understand it. As I said a moment ago,

if there are issues that we as a department want to - I think it is important

for the corporation to be giving consideration to and it is our responsibility,

my responsibility as a minister, to ensure that that becomes a part of

government's direction to our two appointees to that board.

MS JONES: I am just wondering, knowing that video lottery terminals -

people who play those machines are probably more at risk for addictions than

other gamblers, others that gamble in a different fashion. Is it something that

you would give some consideration to, making representation to the corporation

to have a representative from Health and Community Services as a part of that

board?

MR. WISEMAN: The short answer to that is it is not the corporation that I

would need to make representation to. The appointments to that corporation are a

decision of government. The corporation, as an entity, is not interested in

deciding who should come on or what the criteria would be in selecting.

The Government of Newfoundland and Labrador has identified two people that

they would want to be on that board and their role as representing this Province

is to bring to that board table the perspectives of this Province. One of the

perspectives that, obviously, you are referring to now and the thrust of your

question has to do with whether or not there is a mechanism to ensure that those

individuals, when they sit at the board table and when they have discussion and

when they make decisions, is there an opportunity for the Department of Health

and Community Services to influence the input that that person has with respect

to the areas around addiction and the role that the corporation should play in

either education, awareness, addictions, interventions and those sorts of

things. I guess what I am saying to you is that because they are appointed by

government and they get their direction from government as to what issues they

should bring to that table and what the perspective of this Province is - and

there is a mechanism now for the department or me as a minister to have those

people who sit at that table bring our perspective to the corporate discussion

that the corporation would have.

MS JONES: Yes, and I can certainly see why the Deputy Minister of Finance

would be on the committee because it does pay dividends to the Province in huge

sums on an annual basis, but who is the private individual? Do you know who that

is?

MR. WISEMAN: I will think of his name now in a second. It is not an area

that we have a responsibility for in health, but a former city councillor here

in St. John's.

MS JONES: A former city councillor?

MR. WISEMAN: I will find it out for you. I should not be speculating but

I will -

MS JONES: Okay. I would be interesting in knowing because they are

representing our Province and health issues needs to be raised at that table.

There is no -

MR. WISEMAN: Yes, I will find it out for you. The Minister of Finance

obviously might know because I think his ministry has the responsibility for the

corporation, but I will find out for you.

MS JONES: Okay.

I am going to move to

section 1.2.05. Last year you budgeted nearly $3.5

million but you spent $1.3 million less than you had budgeted under Salaries. I

am wondering why that was?

MR. WISEMAN: If you could give me a moment to get my headset, I am having

a little difficulty.

MS JONES: Yes, I moved back from the mike, too. So it is a little bit

harder to hear I suppose.

MR. WISEMAN: As you get laid back I have to get more intensely involved.

MS JONES: Yes. I am quieter in the evenings.

MR. WISEMAN: What was that?

MS JONES: I am quieter in the evenings.

MR. WISEMAN: Are you?

MS JONES: Yes.

MR. WISEMAN: I noticed that the House is quieter as well, you obviously

incite others.

I am sorry, if you do not mind, I will ask you to repeat your question.

MS JONES: Under

section 1.2.05., Public Health, Wellness, and Children

and Youth Services. In your Salaries last year, you spent $1.3 million less than

you had originally budgeted for and I am wondering why that was?

MR. WISEMAN: Within the department itself - remember last year? In last

year's Budget we announced a significant investment to strengthen Child, Youth

and Family Services. A bulk of that went to the authorities and some of it was

allocated to the department to hire some additional people within the department

itself. That exercise did not get completed throughout the whole year. All of

the money that was allocated for the department's expenditure was not taken up

last year but it will all be reflected in next year's Budget because the

positions will be filled for this fiscal year that we are currently into right

now.

MS JONES: Can you tell me what positions they were that did not get

filled?

MR. WISEMAN: I can undertake to provide it for you. I do not have it with

me this evening but I can undertake to get that for you.

MS JONES: It would have been quite a few, it is $1.3 million.

MR. WISEMAN: Yes, there would be. There was something like eighteen or so

positions that were involved here and they were in that division, but I will

identify those for you.

MS JONES: This year I see that you have increased your budget again on

the salary side by almost $400,000; $350,000.

MR. WISEMAN: Last year's Budget would have come down around this time

and we would have budgeted for some new positions, and we would not have had

them on for the full year. One of the differentials you are seeing here is an

annualization over and above the $3.4 million.

MS JONES: Okay. So for the full year of

MR. WISEMAN: Now this is an annualization of some of those salaries, so

you will see a change as a result of that. There are some new positions

announced in this year as well that we will be funding that was not in last year's

budget.

MS JONES: Okay.

Under Professional Services, in that

section - before I go on, you are going

to get me the list of the positions, right?

MR. WISEMAN: Yes.

MS JONES: The ones that were not filled. Okay.

Under Professional Services, you spent $373,500. What services was that for?

MR. WISEMAN: We provided consultants who we brought on to do some work

for us, research work and evaluation work. For example, as a part of the

initiative we announced last year to strengthen Child, Youth and Family

Services, one of the pieces of that is a legislative review. The Child, Youth

and Family Services Act and the Adoptions Act are under review and the

evaluation of those reviews. There is some funding provided here for the health

promotion and wellness division to cover some contracts that we had for some

website design and some promotional campaign that we had established as well.

MS JONES: Under the Grants and Subsidies, you spent nearly $2 million

last year in grants and subsidies under that heading. What kind of grants or

subsidies would that be and who would be eligible to access them?

MR. WISEMAN: Which reference are you making here now?

MS JONES: 1.2.05, number 10.

MR. WISEMAN: Last year we would have made let me see if I have the

list here for you. Allied Youth was a couple of thousand; the Canadian Council

for Tobacco Control, there was a national conference that we helped fund for

$2,000; and for a census building workshop in Central Health there was $20,000.

There is a list of miscellaneous smaller amounts like that. This is a list of

community organizations. Let me just give you some of the highlights. Maybe I

can give you the list but let me just highlight some of them for you: the

Newfoundland and Labrador Provincial Perinatal Breastfeeding Coalition, we gave

them $50,000; the Lung Association for the Smokers' Help Line is $116,000; and

the Safety Services Newfoundland conference funding for $5000.

Within each of our health authorities we have health coalitions, a collection

of community-based organizations focusing on wellness. They are not all

necessarily employees of the health authority, but they are community-based

organizations. They are part of four regional health coalitions that we have and

they get together periodically for conferences and for meetings. Many of them,

because they are community-based organizations, do not have access to their own

large pots of money and so we provide some money for travel for those. There is

a total of $18,000 that was distributed among the four authorities for that.

Then there are a bunch of wellness grants we have provided: the Active Living

Committee in Western, $40,000; Body Imaging Network at MUN, $40,000; Boys and

Girls Club, $20,000; and the Change Island Youth Organization, $27,000. You

know, there is a list of community organizations like that that we have provided

grants to for various wellness initiatives.

Then there is a pot of money that we distributed through each of our four

health authorities, $50,000 each, that was used for health promotion wellness

initiatives throughout their respective regions. Then we had the Healthy Living

Schools initiative, and $30,000 went to Central Regional Integrated Health

Authorities for the Healthy Schools Initiative; $30,0000 in Western, $30,000 in

central, $60,000 in Eastern and $30,000 in Lab-Grenfell. The Kids Eat Smart

program was in there as well. That is the flavour for them now. I did not give

you the full list but we can provide that, but I just wanted to give you a

flavour for the kinds of initiatives that we funded.

MS JONES: Well you can send that list along with the other lists, all the

rest of them.

MR. WISEMAN: I assume someone here is taking a list of all the lists we

have to get.

MS JONES: Jim is on it.

MR. WISEMAN: Okay, as long as we have someone assigned the task.

MS JONES: Those grants and subsidies, are they automatically given out on

an annual basis or do they reapply?

MR. WISEMAN: These would be organizations that would apply on a project

basis. These particular ones here would be ones that we would have that they

need an annual application for.

MS JONES: Okay, and you have increased the estimate for that this year,

the amount of money budgeted. Were there a lot of applications coming in or is

it a big take up on the program?

MR. WISEMAN: Well, this year the Kids Eat Smart Foundation, there is an

increase in the funding to them. It is not a core funding per se but we have

been doing it every year now and there is kind of an expectation. We are

assuming we are going to do it and they are expecting us to do it, and they are

relying on it for the continued operation. This year we are increasing that

amount.

The Smoker's Help Line is another one that we have some funding in this

year, and the Alliance for the Control of Tobacco is in there as well. It is

going to receive a significant chunk of money as well.

MS JONES: So that would be mostly the increases that are built in there.

MR. WISEMAN: Just to give you a sense of how that breaks down: 1.25 is

for the Kids Eat Smart Foundation; the Smoker's Help Line will get $116,000;

and the Alliance for the Control of Tobacco will get $220,000. The remaining

$700 and some odd thousand will be for those kinds of grants that I just talked

about. I do not think I will give you any kind of a long list.

MS JONES: I do not have any other questions under that heading, so do you

want to move to Lorraine?

CHAIR: Ms Michael.

MS MICHAEL: Under the same head, subhead 04, Supplies: the budget for

last year was $312,100, and only $50,000 was spent, and then this year up to

$326,000. What are the supplies under that about?

MR. WISEMAN: This particular category here, most of the funding here goes

towards the cost of general office supplies, books, periodicals and other

incidental kind of supplies associated with the wellness and promotion supplies.

The program has been established for a while now so some of the supplies have

been accumulated and therefore we are not anticipating a big increase for next

year.

MS MICHAEL: But you only spent $50,000 last year and it is back up to

$326,000 this year.

MR. WISEMAN: Because of the nature of it. Sometimes if you do not utilize

it, then you are kind of relying on the supply you have already in the

inventory, and when it is used up you need to replenish it.

MS MICHAEL: Okay, so you want to keep the money in case.

That is all. Well, just one other question though: those supplies then, do

they go to schools; you know, the materials?

MR. WISEMAN: I am not sure if there is a distribution list, that someone

will get it on a regular basis. I suspect it is that as initiatives are being

undertaken in the various regions they are able to have access to those kinds of

supplies to be able to carry out the particular initiatives that they are

involved with; and we just provide them to them. I do not know for certain, but

I kind of doubt that there will be a distribution list that we are mailing this

stuff out to on a predefined basis.

MS MICHAEL: Right.

Will I go on then, Yvonne?

MS JONES: Go on, sure.

MS MICHAEL: Okay.

Under 1.2.06, Government Relations, subhead 05, Professional Services, what

are the professional services that you require under this head, because it is a

fair bit of money each year?

MR. WISEMAN: I have a list of the distribution for the $1.3 million. I do

not know who would want to comment on it in terms of how we actually do that

distribution. Jim, do you want to comment on that?

MR. STRONG: This is in the Government Relations Division and our

department participates in a number of national there are national,

ministerial and deputy ministerial committees that address particular national

interests in terms of health. This is the amount of money we need generally to

support our provincial share of the committees' work. A lot of it is national

work that is being done generally for those FPT committees. The Province's

contribution is in relation to their share of the national population. This is

the way the formula is done.

The other significant item there is you may have heard of the CIHI, which

is the Canadian Institute for Health Information. We make an annual grant

contribution to them and next year it is $323,000. All the provinces make grant

contributions to them along with the federal government and they produce regular

reports on the health system for the country as a whole.

MS MICHAEL: Would it be possible to get a breakdown? I find this very

interesting. This is not something I know about and I do find it interesting.

Could we get a breakdown of the various committees that the Province is part of

or that it contributes to?

MR. WISEMAN: Yes, sure.

MS MICHAEL: Thank you very much.

The next subhead, 06, Purchased Services: last year there was very little

budgeted and very little spent but this year $173,000. You must be anticipating

something this year, are you?

MR. WISEMAN: This year our Province is the lead ministry on social

services within that FPT group, so we would have additional costs this year. The

lead rotates between provinces and this happens to be our turn.

MS MICHAEL: What does that entail, Minister, being the lead province?

MR. WISEMAN: Well, fundamentally, the officials in the department would

provide the lead in liaising with other officials in other jurisdictions,

defining agenda items, doing the necessary preparatory work in advance of

meetings and providing the leadership, whether it is initiatives that deal with

some kind of research or profiling when it is happening, to be able to deal with

a particular subject matter. As a minister, your role then would be to chair the

meetings of, obviously, your colleagues as you meet across the country, and

facilitate bringing them together in and around issues. If there is something

arises that requires discussion among your colleagues on an issue, particularly

if it surfaces with an issue arising out of the federal jurisdiction, for

example, that we may want to respond to as a collective voice provincially, then

the role of the minister would be to provide the leadership to pull the people

together to have that kind of discussion and facilitate a process that would

financially provide a collective voice for the provinces; and that can happen.

Then there are the things that most federal-provincial-territorial groups

tend to have, agenda items that they are working on from one year to the next,

and provide some continuity in the activities that they may be engaged with.

The officials do those sorts of things, and the minister, who assumes that

chair role, facilitates those kinds of activities with their colleagues across

the country.

MS MICHAEL: Great. Thank you.

More work for you this year, then.

MR. WISEMAN: Exactly, yes.

MS MICHAEL: The provincial revenue, that $150,000, what is that related

to?

MR. WISEMAN: That revenue represents money that we received from the

other provinces to facilitate that.

MS MICHAEL: That is what I thought.

MR. WISEMAN: As much as you are the lead on it, everybody contributes to

the cost.

MS MICHAEL: I thought that is what it was.

MR. WISEMAN: Yes.

MS MICHAEL: I am ready to turn over if you want to do the next one, or I

can continue?

MS JONES: No, that is okay.

MS MICHAEL: Okay, good enough.

Under the next one then, 1.2.07, Policy and Planning, subhead 01, the

Salaries, again: there is a fluctuation there from budget to revised, in last

year's budget, and then up by $500,000 this year. If we could have just an

explanation of that, please?

MR. WISEMAN: I will comment on last year's one first. There were some

vacancies that did not get filled, representing about $140,000, and then we had

some partial year hires. We had anticipated that we would hire them at the

beginning of the year, but that did not happen, so we saved some money on that,

to the tune of $210,000. Then we added some additional positions to help us with

some workload; one on a contractual basis were we had an add-on cost of $68,000.

Then we had the announcement of the Task Force on Adverse Health Events. That

was an announcement that came midway through the year. The cost of that is

flowing through the department, so we had an add-on cost. With the netting out,

that is where we ended up with this ninety-seven difference.

As we move forward into the next year, your question was: Why were you up

again?

MS MICHAEL: Yes.

MR. WISEMAN: A big chunk of that is associated with the adverse events

task force, and the second piece is a piece of work that you have heard me refer

to several times with respect to the long-term care and community support

strategy.

MS MICHAEL: Yes.

MR. WISEMAN: We pulled together some additional resources to help us

expedite that process and to move it along faster, so that is adding $162,000 to

our cost. That is why the difference this year.

MS MICHAEL: Since you mentioned the strategy, what is your hope? I know

that you have told the media it could be early fall. Is that still your hope,

that you might have it ready by early fall?

MR. WISEMAN: Just to give you some sense of this is a fairly major

piece of work.

MS MICHAEL: I realize that.

MR. WISEMAN: One of the things, historically, if you look at the

long-term care community support system, the populations are predominantly an

elderly population and persons with disabilities. We have had the obvious one,

where we have had people get community supports, and what we know have is a

circumstance where we have different population groups get various types of

services. Some have some benefits, others may not have that same group, so we

need to reconcile that.

Secondly, then, we have some limited models of care for certain population

groups and we want to be able to look at broader options. We have historically

had long-term care homes and personal care homes, and some of these are well

established in the Province, so making sure that we have an appropriate mix and

the appropriate levels of care being provided in each of them, and the

appropriate population groups are being served.

As we start looking at models of care, then that is a big piece of work in

and of itself. Then, within each of those areas, one of the things that we don't

have in some cases is good standards in place for the I have heard you say

many times, with respect to the home support piece - standards of care.

When you talk about standards, you are talking about the qualifications of

people who provide this service, how it gets monitored, and how training occurs.

All of that sort of thing has to come into play, and that is a piece of what we

are looking at.

As I map this out for you, you can see the order of magnitude that we are

talking about here.

Of course, then there is the piece that has gotten some attention recently,

which is the financial assessment tool that we use. One of the things that we

want to make sure is that the client contribution is appropriate and reasonable

and consistent across some of these models; because right now, as we looked at

each of those models of care that we currently provide, and the financial

assessment process for each, there are inconsistencies, and that needs to be

corrected.

Then there is the question around what is an appropriate level of client

contribution for any model. That is a piece of work that we need to make sure

that we have appropriately nailed down, and consistent and fair and equitable,

and we need to understand what is the current best practice around the country,

what other models are being used in other jurisdictions, and what we should have

as a Province, given our uniqueness.

It is a fairly big piece of work. As a part of that, too, there is a whole

legislative and regulatory framework that goes with that. We have a fairly

detailed analysis done of the legislation and the regulations around each of

those areas, so we have a group of people working on drafting new legislation to

deal with such things as vulnerable adults, issues around consent, issues around

abuse and the protection of individuals, so that is a major piece of work that

is going on.

That is happening with a group of people they are tasked to do that

and these other things I have just mapped out, what we have tried to do here is

pull together some additional resources over and above what we already had

tasked to do it, to ensure that we are going to be able to expedite it.

I wasn't being coy or anything in the past when I said, don't nail me

down to a date because I can't give you a date.

I just gave you a sense, then, of the magnitude of this piece of work, so the

target is because some of it will have some budgetary implications for next

year and future budgets - I am trying to be in a position, and we are trying to

be in a position as a department, that we will advance this to a point where we

will be able to map it out for government's consideration in next year's

budgetary process, which is in the fall. That is why I am trying to use that as

the target here, so that is fundamentally an insight into not only what it is we

are trying to accomplish here, but some sense of the order of magnitude of the

project ahead of us.

MS MICHAEL: So we really cannot anticipate any changes, then, before next

year.

MR. WISEMAN: The piece here is one of - and we need to understand what it

is we are going to do.

MS MICHAEL: Yes.

MR. WISEMAN: I said some of it has some significant implications for the

budget, and that is something I want to be ready for the next budget year; but,

in any program area and service area, obviously when governments understand what

it is that needs to be done then sometimes if we are able to do it within the

current fiscal framework you are able to do it. If you are not able to do it

within the fiscal framework of the budget that you have been allocated, then

obviously you need to wait until the next budget year.

The challenge that I have today is telling you what we will define through

this process that has cost implications, whether or not we will have the

capacity within the current budget that we are dealing with here tonight to be

able to make those changes, with moving some money around, because that might be

a potential. I cannot tell you that with some degree of certainty because I do

not know. I am now prejudging what might come out of this assessment we are

doing, and I really am not advanced enough to be able to do that, to tell you.

MS MICHAEL: I know this is hypothetical, but I will put it out anyway. I

usually reject hypothetical questions myself, but I will still do it. If it

turned out, say, by November, that you had a good sense, as a department, of the

direction that you wanted to recommend to government and it didn't take a long

time to get that through, and maybe by January you had a sense of the policy

that you were ready to go through with, et cetera, and it could not fit within

the fiscal framework for the last three months of the year, would you consider

coming to look for the money because it is such an urgent situation?

MR. WISEMAN: Again, not to be coy about it but it is hypothetical, it is

probably a question you might want to ask me in November.

MS MICHAEL: Okay, I will remember that in November.

Now, where were we? That came up under 1.2.06., didn't it, that question?

No, it was 07., right; the salaries related to the strategy.

One other question with regard to the strategy, though. You mentioned a lot

of things in terms of parity and equity in terms of the service. Are you also

looking at the whole issue of workers in the different categories, and having

common job descriptions and pay equity? If you are doing personal care in the

home through a private agency and you are doing personal care in a long-term

facility, the work is the same. Will you be looking at equity in terms of

salaries for people doing the various pieces of work?

MR. WISEMAN: The piece around the standards will start to define the kind

of credentials people need to provide a level of service. The whole issue of

compensation and classification and position descriptions is a separate piece of

work all together, and I would leave that to the people in Treasury Board who do

that kind of stuff, and the health authority to provide services with respect to

the compensation schemes that they have for their various employees. That is not

a piece of work that our department would start to drill down into defining what

salaries would be paid and deciding what position descriptions would look like.

The people who have the operational responsibility and assigned tasks are the

best people to start developing position descriptions. We will start to frame up

the qualifications and issues around training that would be required.

MS MICHAEL: Right.

MR. WISEMAN: The compensation pieces will flow from that, but it is not

an exercise that I would envisage our department getting into, defining the

compensation piece.

MS MICHAEL: In looking at the standardization, if it is a standard for

personal care worker then the standard would be the same whether the person is

in a private home through an agency or whether the person is in a long-term care

facility. Would the standards be the same?

MR. WISEMAN: The standards that would be required for activities in one

model or the other, I wouldn't want to say that they would be the same across

all models, because functions may be very different. I had not envisaged that

we, as a department, would start getting into position descriptions and

compensation related issues as a part of this process.

MS MICHAEL: No, but with standards it is a bit different.

What about training?

MR. WISEMAN: I understand your question, and I am not sure that I have

thought it through far enough to be able to give you an answer tonight.

MS MICHAEL: Okay.

My question would also be the same with regard to training, because I know,

personally, from personal experience, as well as knowledge of the system, that

in the private sector, for example, people are being sent out to do personal

care for people on Level III needs of care and they are sending out untrained

people.

I had that personal experience myself, where I was expected one morning to

leave my mother in the care of somebody who had come from a fish plant and who

had no training, and was sent to take care of a Level III patient.

To me, it is a serious issue. If we are going to have standards, certainly

around training, then I think they have to be the same, because if somebody gets

identified by Community Services with regard to being Level III care, for

example, then we know what Level III care requires, whether it is Level III in a

person's home or Level III in a long-term care facility. If a social worker

from Community Services does that assessment and says somebody is a Level III or

a Level II, then the person who comes to do the work is doing exactly the same

work or should be, and should be trained to do it as if the person were

getting the care in a long-term facility.

I would like for you to really think about that.

MR. WISEMAN: I heard your point, yes.

MS MICHAEL: Thank you.

I will move on, then, in 1.2.07. Actually, probably the next one, again

Professional Services, subhead 05., what are the professional services under

this category that are required? Again, you had $501,500 budgeted, you spent

$91,000, and it is now back up to almost $600,000.

MR. WISEMAN: Most of this would be in the area of consulting services

that we provide. Most of the professional service categories would be consulting

services that we are engaging.

MS MICHAEL: Do you have any expectations this year, or is it that you

maintain about the same amount? You have gone up almost $100,000.

MR. WISEMAN: There are some pieces of work that we anticipate doing as a

part of the Healthy Aging Policy Framework that we rolled out last year, so some

things we want to advance as a part of that agenda, which would be a big

contributing item to this.

We have some allowances in there for some work that the Task Force on Adverse

Health Events would be doing, and we have some allowances in there for looking

at the human resource planning issues that we are going to be engaged in, so

these would be some of the larger ticket items that we would envisage doing in

this category.

MS MICHAEL: Okay, thank you.

Then, under Purchased Services again, that is a big jump there, too, of not

quite $400,000. Do you have an expectation around the Purchased Services for

this year that was not there before?

MR. WISEMAN: There is a piece of work that we are going to try to do this

year, and it grows out of the Healthy Aging Strategy that we talked about. It is

a piece of the long-term care and community supports piece as well.

We are trying to address some of the concerns that have been raised by unpaid

caregivers, so we have allocated a fair piece of money here this year to assist

us with some work that we want to try to do in that area. We know it is an issue

that we need to address. We have some thoughts on how we want to proceed, so

what this does for us here is gives us an allocation that allows us to be able

to proceed to do some things with it this year.

MS MICHAEL: Research into that, you mean?

MR. WISEMAN: A bit of research into that and we have some initial

thoughts as to what direction we may want to go with it. We just needed an

allocation to allow us to do it. This is a year which we want to move forward on

that front. This gives us a piece of money to work with.

MS MICHAEL: Right.

I support that wholeheartedly, may I say, somebody who has been there and

knowing how many women in particular are in that situation.

MR. WISEMAN: It is a big issue, no question.

MS MICHAEL: Yes.

MR. WISEMAN: We heard it quite loudly and clearly when we did the

consultations as a part of the Healthy Aging Framework development. So it is an

issue that we are very sensitive to.

MS MICHAEL: Under subhead 10, Grants and Subsidies. Could you just give

us an idea of what they are? Maybe if there is a list attached you could just

send us the list. You do not have to go through the whole list now but just give

us an idea.

MR. WISEMAN: We have some money going to the Newfoundland Centre for

Applied Health Research. It is research on aging. We have some money going to

the Newfoundland Public Pensioners' Association for a conference that they are

hosting. There is a Seniors Resource Centre. There is a fair and exposition in

Halifax that they are a part of and we are helping provide some funding for

that, $10,000. Then we have the Newfoundland Senior Citizens' Strategic

Planning in Labrador taking place. We are providing some funding to assist with

that particular piece. Then there is another piece of work that the Newfoundland

Centre for Health Information is doing on the impact of dispensing fees on

seniors, as a part of our Prescription Drug Program. There is a piece of work

that the Province was involved with, with other jurisdictions, developing a tool

kit that will help support communities who want to become more age friendly,

kind of a model. We have some money in there to assist with the development of

that kind of profile.

MS MICHAEL: Thank you.

If we could have that list that would be good.

MR. WISEMAN: Yes, we could do that.

MS MICHAEL: Thank you very much.

Thank you, Mr. Chair, I will take a break now I think.

CHAIR: Ms Jones.

MS JONES: I have a couple of questions under 1.2.07. It has to do with

the task force on adverse events. Who makes up that task force?

MR. WISEMAN: The task force was appointed as a one person task force.

Robert Thompson is the one person. He has with him some staff. I think there are

four or five people with him. There are four FTEs that have been assigned to

work with him, but it is a one person task force. The staff who work with him

support his activity.

MS JONES: What is the process by which he will do this analysis? Will he

consult with different groups? Will there be public consultation, invited

consultation? At what levels is that stuff going to be done?

MR. WISEMAN: We are going to have to put you on the mailing list for

press releases.

MS JONES: Yes, you should do that. I only get about twenty-five or thirty

every few hours a day.

MR. WISEMAN: To answer your question, there is a process right now -

there are a couple of things. One, there is an invitation for submissions. That

is part of - it is information gathering, intelligence gathering.

The second piece, there is a - I forget the date now. It is coming up soon.

Maybe someone can remind me.

OFFICIAL: May 26.

MR. WISEMAN: May 26 there is a forum being sponsored by the task force

that has put together a good cross-section of good resource people from across

the country to be able to present and facilitate a one-day symposium with a -

there has been a fair interest expressed in participation. There is a good

cross-section of the Province, both health providers, professional associations,

consumer organizations, special interest groups, have been invited to be a part

of that. I had a brief look at the agenda yesterday. It was very a aggressive

agenda, with some very insightful topics, with some very keen resource people

being brought together, people who are experts in the field across the country,

people who have gained some notoriety in the field and have been sought after

resource people across the country to contribute to that kind of discussion.

That is the kind of mechanism being used, together with the people who are there

on staff with them. There is a lot of research associated with this kind of an

issue and there has been a fair bit in recent years developed on this particular

event and to this issue anyway.

There is some current information that is evolving across the country. It is

a topical issue for all the jurisdictions. There has been a lot of recent

research and a lot of recent attention to the issue. So there is a lot of good

information that is available, that is very current. What they are doing is

pulling together that kind of information, that kind of profile, and together

with the people they are bringing together for the symposium, plus the

submissions that they are soliciting, will provide the necessary information for

Robert to be able to write his recommendations.

MS JONES: Okay.

Under the Healthy Aging Strategy work that you are going to do this year

around the unpaid caregivers, what is it you are actually doing? Is it an

analysis of other programs in the country, where the gaps are in this Province?

I am just trying to get an idea of what you are going to be looking at.

MR. WISEMAN: One of the things that we - as I just commented a moment

ago. When we did the consultations, and we heard it pretty consistent around the

Province, a lot of the care that is currently being provided is being provided

by family members and friends and neighbours and the like.

MS JONES: That is right.

MR. WISEMAN: It is commonly referred to as unpaid caregivers. They tend

to be closely associated with the family in some fashion, which is great to be

able to have that community support around, but it was important to recognize as

well that these individuals themselves sometimes need support because frequently

they are seniors taking care of seniors in lots of case. We need to be careful

that they get the support they need before they become clients as well. So we

need to create a balance here. There has been a number of suggestions that have

made as to what that should look like and there has been a fair bit of

discussion already taking place in the Province. Particularly, the seniors'

resource centres have been involved with creating a network around the Province

of support groups for caregivers. They have a fair body of knowledge themselves

that we want to try to tap into.

A piece of the work that we are going to be doing this year is more clearly

defining what are some of the first steps that we need to take to start

supporting and the kind of support that is necessary and then start mapping out

what we need to do on a go-forward basis in future years.

MS JONES: Okay.

That was all the questions under that section. So I guess I will move to the

audit section.

Again, there was some adjustment in salary this year over last year. I wonder

if you can give me the reason for that. It was adjusted downward over your

revised spending last year.

MR. WISEMAN: Some $46,000. There were some changes in that. We had a

couple of vacancies that existed which resulted in some savings but we had some

additional costs associated with it. For example, we hired additional

requirements for MCP registrations. We had some additional costs associated with

- we had some additional policy positions in policy, planning and research areas

and claims processing which added some costs, but then we had some vacancies in

some auditors; that resulted in some savings. Then we had some increased costs

in severance and some vacation and overtime paid out. The bottom line was we

netted out with a $46,000 cost reduction below what we had initially budgeted

for.

MS JONES: Okay. So there were no positions changed there?

MR. WISEMAN: No. It was miscellaneous things that gave net in and out.

MS JONES: Yes, but this year you budgeted $100,000 less than you spent

last year.

MR. WISEMAN: We have now completed the MCP re-registration process, which

is a piece of that, so we were able to pull that out. There have been a couple

of positions that have been added and some removed that have resulted in a net

savings of $82,000. We had some additional costs as a result of some

annualization of the salary increases associated with the 3 per cent increase in

April and the net effect of that is a savings of $153,000.

MS JONES: Okay. In Professional Services last year you spent half of what

you had budgeted. I am just wondering what service you accessed for that

$25,000?

MR. WISEMAN: That money is to be used to provide an audit review and an

appeals committee. That cost us $53,000, and then we had - I am just trying to

find the other piece here.

Jim, maybe you can comment on the nature of that service, that review

process, that appeal.

MR. STRONG: The $55,500 is comprised of $53,500 for the audit review and

appeals committee and there is a small provision of $2,000 for the Stephenville

assessment office. The change or the reduction there is just based on the number

of meetings. There was not a lot of money needed to pay for the appeals

committee. It was just less than what we had budgeted for, for the year.

MS JONES: Okay.

Under Purchased Services, what would that expenditure have been for?

MR. WISEMAN: The $50,000?

MS JONES: Yes.

MR. WISEMAN: I do not know if we have a

schedule here for that, Jim.

MR. STRONG: No, I do not have a

schedule here but generally, it would be

the miscellaneous expenses associated with running the three offices that we run

in Stephenville, Grand Falls-Windsor, and here at Belvedere in St. John's.

MS JONES: Okay.

What would be the provincial revenue you would collect under that head? You

collected $74,400 in provincial revenue?

MR. STRONG: That is an allocation for miscellaneous income that we would

get for such things as court attendants, or if lawyers request information from

the MCP system, then we bill them for the cost of providing the information.

These would be lawyers engaged in some sort of litigation or legal activity.

MS JONES: Okay.

I do not have any other questions there. Did you have oh, Lorraine is

gone. I guess she has no questions there either.

Under Memorial University, last year in the Faculty of Medicine the school

received less money than was budgeted. Actually, I think it was around $690,000

less. I am wondering why that was?

MR. WISEMAN: We had budgeted some money for faculty salaries for fringe

benefits, and they only required $169,300. So there was a reduction in their

requirement that we had budgeted for.

MS JONES: Why did they not require it, was it vacant positions they could

not recruit for?

MR. WISEMAN: I assume, yes.

MS JONES: Okay. You would not know what positions they were, would you?

MR. WISEMAN: No.

MS JONES: Okay.

This year you have increased your estimate there, so -

MR. WISEMAN: What we are doing, there is $2 million going in associated

with the expansion. We announced the expansion of the medical school, and there

is a couple of million dollars as a part of that, capital investment that they

need to put some planning money. There is also $800,000 in there for the

accreditation process that they are involved with, and we made a commitment to

provide some funding over a three year period. This is the third year of that

commitment. Then we had some salary increases that they need to fund, and there

is $400,000 associated with that. Then there is some professional development,

pension plan increases, energy cost increases, and some inflationary increases

that they have asked for. The total is $4.5 million.

MS JONES: I am going to move on to the Provincial Drug Programs, 2.2.01.

What contributed to the increase in Professional Services last year in that

program, and what kind of professional services do you usually seek under that

program?

MR. WISEMAN: Aliant provides some support for us for the software to

manage the system and we needed some additional work done last year to enhance

the system to accommodate the expansion of programs we announced last year. The

expenditure over and above budget, or the revised figure differential, is

associated with that.

MS JONES: Okay.

Normally, what professional services outside of that would you have, because

you are budgeted another $2 million this year.

MR. WISEMAN: Jim, have we got a list of the total of what we provide

under this, or how much of it is Aliant?

MR. STRONG: That is essentially the contract that the Province has with

Aliant for the online, real time drug processing system. That would make up the

bulk of that budget allocation.

MS JONES: That is the program that you would use to track medications

being prescribed in the Province so that there is not duplication of billings or

prescriptions? Is that the program that is used for that?

MR. WISEMAN: The piece we are talking about here is the online

adjudication that is taking place. When you go into a pharmacy and present your

card, then the pharmacy is able to immediately bill your card for that. They are

basically online with your eligibility for benefits and coverage because that

puts them directly online with the program.

MS JONES: So that would be especially for people who have drug cards by

the provincial government, I guess.

MR. WISEMAN: Exactly.

MS JONES: When you are going in, if you are under a co-pay system of

seventy- thirty that will come up on that system.

MR. WISEMAN: Exactly.

MS JONES: As Don will know, that is an issue that I am dealing with in

Labrador right now. We do not have the technology there so that people can go in

and actually get that reduction on their medication up-front and they are having

to pay for it and then claim it back through mail service. I guess, for a period

of time it was probably taking about three to four, maybe at the most up to six

weeks to get reimbursement. In recent weeks now we have been told now it is

taking anywhere from eight to ten weeks on an average to be reimbursed. We have

talked to your department through your deputy minister and we have also talked

to the CEO of the health corporation in Labrador about this, and we are hoping

that something is going to be done so that these people do not have that

financial burden up-front. I do not know if you can give me an update on what is

happening there or what the plans are.

MR. WISEMAN: Don and I had a discussion about this, this morning,

actually. You are right that is an unfortunate circumstance the people who live

in your district find themselves in. We explored this morning some options to

make sure that we correct that, because it is something that we recognize does

need to be dealt with. I will be in a much better position by the early part of

next week to give you a much more formal update as to where we think we will be

and how we are going to deal with it. Suffice to acknowledge for you that I

agree with your observation and we need to find a way around it so that it does

not happen. To be able to give you a definitive answer tonight I cannot, but

early next week I should be able to let you know exactly how we are going to

deal with that.

MS JONES: Are there any other regions of the Province that have this

problem? I know the North Coast of Labrador does and my district. Are there

other regions that are not on the system where they have to do the mail-in

rebates as well?

MR. WISEMAN: Well, the uniqueness that you would find in your district

does not exist in other parts of the Province. The North Coast obviously is an

area but in other parts of the Province, including the Island portion of the

Province and into Lab West and the Happy Valley-Goose Bay area, there is a

network of pharmacies and so it is a non issue. In your area what you are

talking about is the health authorities actually doing the dispensing because

there are no private pharmacies. This is an issue that grows out of that anomaly

in your area. It would happen in any other area where you did not have a network

of private pharmacies which you do in other parts of the Province.

MS JONES: Well, I will wait to get an answer. I know, from your deputy,

that it has been a concern and that they are working on it, but you know I just

cannot stress enough the urgency. I will tell you that almost every day in my

office I get a phone call from a patient regarding this program because they

have just been refused medication at the clinics because they do not have the

money and maybe they already have $600 and $700 tied up that they are waiting to

get reimbursed for. You know it is a problem and the people are buying

medications now like almost just on a weekly basis because it is taking so long

to get their money back.

MR. WISEMAN: I hear you totally and I agree with you by the way. It is

not an issue where we have some disagreement over whether or not we should

respond and to what we should do. It is an issue where we need to work quickly

to give you a solution. I will be in a better position to give you a definitive

answer both in what the solution will be but also timelines early next week.

MS JONES: Can I ask, as well, why it is delayed so much? Is it done here

in St. John's? I am not really sure if it is done here or done somewhere else,

the rebate?

MR. WISEMAN: Part of the piece of the xwave contract that we talked about

earlier, they are the people who facilitate the reimbursement piece and so there

are maybe multiple- I will not use the word multiple- several reasons why there

would be a delay. Neither one would be an adequate explanation for you or the

people that live in your district, but clearly ones that we need to address.

MS JONES: Okay.

Also under that, I want to ask about the special authorization drugs. It is

another issue, I guess, that we are getting more calls on than we used to in the

past; not that we did not get them in the past but it seems like in recent days

it is becoming more of an issue for people. I do not know if it is a longer

delay now in getting the authorization than it used to be, but have you guys

looked at a different process which people could use that would be a more timely

process in terms of accessing the medications they have been prescribed?

MR. WISEMAN: The issue of the administrative problems with the processing

time is something we have control over and an ability to influence, and that we

need to tighten up. The other piece in terms of concept though, of having some

drugs that are covered as part of a special authorization process and those that

are just open, just to comment on that for a moment. When drugs are approved for

the formulary there is a national evaluation process that we are a part of that

does that evaluation. So some products are deemed to be appropriate to put in a

program and have open access to them. Other drugs are deemed to be appropriately

prescribed under certain circumstance and that is where the special

authorization piece comes in. When a physician is prescribing a particular

medication it is covered under the program under certain circumstance. For

example, it might be a drug that you would use as a third option only when you

have tried one or two other options first. Therefore the special authorization

process, when the physician completes the documentation, indicates, here is the

diagnosis, here is the circumstance, here is what I have tried, it did not work

and now here we are. That then meets the criteria of prescribing the drug and

having it covered under the program.

There is no other mechanism to have the physician who is prescribing indicate

that they have met the requirements to have the drug prescribed in that

circumstance, because that is how it was included in the plan in the first

place. As a part of this approval process someone said this drug is a good drug

to put under your program if is used in this fashion and under these

circumstances and only when these events occur. What we need to do is look at a

mechanism to expedite that process because the notion that we would have special

authorization drugs is a standard program or a standard process that you would

find, whether it is a the provincial program like we have here for recipients of

because we have four different programs in this Province. If you look across

the country, other jurisdictions have similar provincial drug programs, and if

you look at those of us sitting in this room tonight who have an insurance

program through their employer to Desjardins, if you were to get certain drugs

prescribed to you under that program, the same thing would happen.

Every drug program, whether it is part of a private insurance company

providing it to people who have group benefits or if it is a part of a

provincial government who has it as a part of social programs, it is a standard

process. The notion that we would have special authorization is never going to

change. What becomes incumbent on us is to ensure that we have adequate

resources and mechanisms in place to ensure that that is not a lengthy process.

One of the other things that sometimes creates some difficulties is, when

information is supplied by the treating physician it may be incomplete. Maybe

the form was not totally filled out or maybe there is additional information

that is required that is not included in the first time around. Then you find

the people who administer the program are going back to the physician and

saying, we would like some additional information, can you provide this, this,

and this. There is that tooing and froing that occurs, and that creates some

delays.

The challenge, as I said, is trying to manage a process and streamline it,

because we are not going to eliminate the notion of having special authorization

drugs.

MS JONES: Yes, and I certainly would not want to do that. I see the need

for special authorization of drugs, and I know how the program works in terms of

after all the generic drugs are tried, and all this kind of stuff. I guess what

I am trying to put my head around is how that process could be more simplified

or done in a fashion that will not require two weeks or three weeks or a month

for a patient to have that kind of authorization.

MR. WISEMAN: At some point in time, when we have advanced electronically,

adequately enough and sophisticated enough that will allow us to have physicians'

offices online, which is the long-term vision, if we look at the long-term

future of using electronic technology in fact, there are some physicians'

offices now that have automated their files, automated their communications and

transfer of information between their offices and hospitals, for example, where

they access results from blood tests and x-rays. Some offices are linked like

that already, some are not.

A moment ago when we talked about the four hundred and some-odd thousand

dollars we spent to update the prescription drug program with Aliant last year

to accommodate the online adjudication, that was something that we did not have

two years ago, but we have it now. Now pharmacies are connected online with our

prescription drug program. We are able to pull up someone's profile and say,

okay, you have a 30 per cent co-pay and you have this approval and here are your

drugs. Everybody goes on and the pharmacy bills electronically and then they get

reimbursed quicker. The advances of technology allowed us to do that.

At some point we will have physicians in their own offices entering orders

for blood work on-line. Now, rather than giving you a requisition, letting you

walk up and present it at a counter and get registered, that will happen online.

Just like if you are a patient in a hospital and the physician comes down to see

you, they enter into the system a requisition to have your blood work done and

what they want done, we will advance to a point where the family physician in

their office will be able to do that same thing. As we make progress on that

front family physicians or any physician who is prescribing will be able to be

online with a prescription drug program, and that exchange of information will

be able to be done electronically as a part of the input process. We will

advance to a point where we will be there. I cannot tell you when but we are

making significant progress on that front, moving towards a complete electronic

health record.

In fact I can tell you that we are making much more progress than many other

jurisdictions on that front. We have had some real good success through the

Centre for Health Information and working with Canada Health Infoway in

accessing money. In fact, I will just share this little point with you. Through

Health Infoway the federal government provides a pot of money where

jurisdictions can make applications and the applications are reviewed on their

merit. It is one of the few programs the federal government has where they do

not distribute the money on a per capita basis. Because of the success we have

had and the progress we have made, and the capacity we have and the reputation

we have with the Centre of Health Information for doing good work, we as a

Province have been able to access much more money out that federal pot than many

other jurisdictions. In fact, I think, Jim, we are probably the tops in the

country in accessing pots of money for that, because our applications have more

merit than other jurisdictions. As a result of that we have been able to advance

our work in this area much faster than many other provinces in the country.

MS MICHAEL: What is the name of that again, please?

MR. WISEMAN: The federal government has established Canada Health Infoway.

They are a source of funding to help facilitate the use of computer technology

to create electronic health records.

MS MICHAEL: Okay, thank you.

MR. WISEMAN: In fact, last year you may have heard by announcement that

we now had achieved a total link with all of our diagnostic imaging services and

we say we are the first in the country to do it. Nova Scotia said they were

first but we were first. That will give you some sense of how we are leaders in

that field. I digressed a little bit, but it will give you some sense of the

vision for the future. The challenge for us in the interim is how we manage the

manual process now to make it smoother and faster so people like you describe

are not caught in a spot that they are today.

MS JONES: Under the Allowances and Assistance, obviously it was way down,

$30 million less than what you had budgeted for last year. Why was that? Drugs

removed? Less people?

MR. WISEMAN: No. This is one of those areas where being down here is a

good thing, not because of the financial savings but because we forecast a

certain utilization and a certain uptake on our programs and that did not

happen, plain and simple, which means that either (

a) a lot of people out there

have other drug programs, that they did not need to access our programs, which

is a good thing because these are means-tested and obviously reflect people who

have less capacity to provide drugs and other things that they need in life; and

secondly, the other piece is that those who have the cards are not needing to

use them as frequently which means that they are healthier than we thought they

were going to be and they are using less drugs. Simply put, this is not a bad

thing.

MS JONES: No. I am just curious about it because after your

re-registration or pre-registration of the MCP program I was just wondering if

there is a correlation here.

MR. WISEMAN: No.

MS JONES: Not at all, is it?

MR. WISEMAN: No. MCP is, as we all know, your access to the insurance

service in the Province, and every person, regardless of whether you have drug

cards, do not have drug cards or you need medicine or not, you get an MCP. If

you are a resident of the Province, regardless of age, all you need to do is

live here and you get one.

This budget item here, what we are talking about here, is a provincial drug

program that the Province provides to individuals on Income Support, seniors who

are in receipt of the Guaranteed Income Supplement or individuals who have

excessive drugs costs; and that is the insurance program we brought in last

year. Then the other one is for individuals whose income is below a certain

threshold. We have devised a mechanism to establish a co-pay for them. This is

totally unrelated to the MCP piece altogether.

MS JONES: I was thinking of it in terms of the numbers for registration.

MR. WISEMAN: There is no correlation.

MS JONES: Okay. What about the eligibility, the numbers of people who

would be eligible? I guess that would have increased this year based on the

changes in the program as opposed to decrease?

MR. WISEMAN: The assurance program that we brought in last year, that is

continuing to grow. It is difficult to say today whether or not we have peaked

where that is going to be, because that is the one where we have the cap on the

cost of drugs at 5 per cent and income thresholds of seven and ten.

The one that we had less uptake on than we thought initially was the Low

Income Drug Program that we introduced the year before last, where we had the

income threshold that was established at $19,000. We have now changed the terms

of those, and that is called now the Access Plan. The uptake on that we

anticipated to be about eighty-odd thousand people. That was a figure that we

took purely from income information from Stats Canada. Here is the number of

people who are below that income, so therefore assume that the bulk of them

would need the program. That did not materialize. It tells us a couple of

thing

Document details

Collection	Newfoundland and Labrador — Committees
Citation	2014-08-05
Type	committee
Volume / chapter	committees_standingcommittees_socialservices_ga46_08-05-14_20_health_20and_20community_20services_.htm
Language	en
Format	html
Source	PROVINCIAL
Identifier	b2e23dd3b2513ff9b7a472df0aca1eda8fbcf253

Source file is stored in the law ingest library (html).