Social Services Committee — Department of Education and Early Childhood Development. I'll just ask for a motion to accept those. MR. WARR: So moved. — 2 May 2017

2017-05-02

Newfoundland and Labrador — Committees

PDF Version

May 2,

SOCIAL SERVICES COMMITTEE

Pursuant to Standing Order 68, Mark Browne, MHA for Placentia West Bellevue,

substitutes for Betty Parsley, MHA for Harbour Main.

Pursuant to Standing Order 68, Steve Kent, MHA for Mount Pearl North,

substitutes for Tracey Perry, MHA for Fortune Bay Cape La Hune.

Pursuant to Standing Order 68, Lorraine Michael, MHA for St. John's East Quidi

Vidi, substitutes for Gerry Rogers, MHA for St. John's Centre.

The

Committee met at 9 a.m. in the Assembly Chamber.

CHAIR (Dempster):

Good morning everyone.

We'll

get started. Welcome to the Estimates for Health and Community Services

I want

to make note of three substitutions: Mr. Kevin Parsons will be sitting in for

Mr. Petten today; Mr. Hutchings will be sitting in for Mr. Kent. I'm not sure if

that's correct.

MR. KENT:

No, I'm sitting in for Mr.

Hutchings, I think.

CHAIR:

Okay. I've got the reverse

as long as someone is there.

Mr.

Finn will be sitting in for Ms. Parsley. Some people may be en route, so I guess

there are no minutes to

CLERK (Murphy):

Yes, there are.

CHAIR:

There are minutes. Okay.

Mr.

Browne is sitting in for Ms. Parsley. Okay.

We have

a set of minutes from Social Services Committee, May 1, Department of Education

and Early Childhood Development.

I'll

just ask for a motion to accept those.

MR. WARR:

So moved.

CHAIR:

So moved by Mr. Warr.

Thank

you.

motion, minutes adopted as circulated.

CHAIR:

We'll give the minister a

few minutes to introduce his staff and make a few opening remarks. I would just

remind people, for the purposes of Hansard downstairs, say your name at the

beginning each time you speak for the record.

Thanks

very much.

MR. HAGGIE:

Okay.

John

Haggie, Minister of Health and Community Services. To my immediate right is Ms.

Michelle Jewer, Assistant Deputy Minister, whose title may have changed in the

reorganization but essentially used to be corporate services.

To my

left, Mr. John Abbott, who is the Deputy Minister of Health. To his left is Ms.

Denise Tubrett who is the Assistant Deputy Minister for Regional Health

Services-ish.

Behind

Mr. Abbott is Ms. Tina Williams, Director of Communications for the Department

of Health and Community Services. Behind me is Ms. Alicia Anderson, Executive

Assistant to the minister. Behind Ms. Jewer is Mike Tizzard, the Controller

general of the department. Is that right, Mike?

OFFICIAL:

Departmental Controller.

MR. HAGGIE:

Departmental Controller. No

generals. Okay.

I don't

really have a lot of opening comments. Just to put it in perspective, the

Department of Health and Community Services is the biggest expense in

government. Over the period 2002 to 2017, health care spending has effectively

doubled from about $1.5 billion to $3 billion projected for 2017-'18. Our focus

has really been on trying to change the value we get for the dollars we spend

rather than focusing on absolute amounts. We've been talking about

cost-effective measures, innovative solutions in the short and long term.

In the

documents you'll see a number of variances for the department that can be

essentially explained with common themes. There's a decrease from the 2016-'17

budget to the 2016-'17 projected revised in the majority of the department's

Operating Accounts, things like Transportation and Communications, Supplies and

Purchased Services. This is really building on two things; one is the

expenditure management plan which was introduced 2011-'12 to reduce

discretionary spending. Then building on that is a zero-based approach that was

taken looking forward for 2017-'18. That cumulatively, those two measures,

account for a reduction of $510,700 over the course of that period.

The

department has also reduced its Operating Accounts by over $2.9 million, 57 per

cent compared with a baseline of 2011-'12. That is, again, a cumulative effect

from several initiatives. It was the first department to introduce a managed

print strategy. We have a very effective one might even say rigid inventory

control for office supplies. We've developed a policy regarding the purchase of

food and refreshments for meetings and we've increased significantly the use of

teleconferencing and video conferencing solutions.

I think

with that, it would probably be best use of the Committee's time if we were to

go through the Estimates book rather

than me to say anything else. Between us, I'll take the easy questions and the

really hard ones will go further back to the staff.

CHAIR:

Thank you, Minister.

So,

first responder, Mr. Kent, will have 15 minutes, and then for the remainder of

the morning it'll be 10 minutes back and forth. About mid-morning we will have a

five, 10 minute break, if that's okay with everyone.

Ms.

Michael?

MS. MICHAEL:

Madam Chair, I think you

were notified that I'm replacing Gerry Rogers for today.

CHAIR:

Okay. I don't have that on

my list, but for the record, Ms. Michael is sitting in for Ms. Rogers.

MS. MICHAEL:

Thank you.

CHAIR:

Mr. Kent.

MR. KENT:

You noted that Mr. Hutchings

will be sitting in for me. I'd be quite happy if he did, but I haven't been able

to find him yet this morning, so here I am.

Good

morning everybody. It's great to see some familiar faces. I said about two and a

half years ago that I never, ever aspired to be Health Minister, and I can

assure you I'm equally honest in saying that I never, ever aspired to be Health

critic. I avoided it for a year or so, but unfortunately have been saddled with

those responsibilities in the last number of months.

remain very passionate about health care. I learned an incredible amount during

the year I spent in the department, and I can honestly say the most talented and

passionate and committed people that I ever worked with in my time in public

service over the last 20 years were in the Department of Health and Community

Services. Some of them are sitting over with you this morning, Minister.

I've

got great respect for the work the department does. I didn't spend my career in

health care as you did, but even in the year I spent working in health care I

gained a real appreciation for the complexity and for the opportunity to impact

a lot of lives.

I know

we often focus on lots of the negative things that are going on in politics and

in government, and even in the health care system, but we don't focus enough on

the fact that the vast majority of people who have contact with the system have

positive experiences and their lives are improved as a result. So I won't go on

for too long with opening remarks, Madam Chair, but I did want to try and set

the tone for this morning.

Often

in this Chamber we get 45 seconds each to go at each other, and it's not

necessarily the most productive or informative. So I'm honestly hoping that this

morning we can have a more informed, productive dialogue, and I'll frame my

comments accordingly.

Anyway,

I continue to have great appreciation for the work the department does and that

the RHAs do as well.

CHAIR:

Mr. Kent, pardon me for a

moment. We just need to call the first I let you start without calling the

first clause.

MR. KENT:

No problem.

CHAIR:

It's a slow start here this

morning.

CLERK:

1.1.01.

CHAIR:

Shall 1.1.01 carry?

We're

going to move through this if it's acceptable to everybody, we'll just do it

by subheadings.

Mr.

Kent, go ahead.

MR. KENT:

Thank you.

Now

I'll speak to 1.1.01. Minister, if it's okay with you some of my questions are

sort of broad and impact multiple subheads, so I'll try and cover some of them

upfront. If you're comfortable and it makes sense to answer them that way, then

it may save us a bunch of time as the morning goes on but I'm comfortable with

whatever way you want to proceed.

One of

my initial questions related to 1.1.01 relates to some of the restructuring

that's going on in the department which I feel fairly confident in saying

couldn't have been easy. There are some sections of Estimates that have

significantly changed over last year. They're the ones I would have been

familiar with during my brief time in the department and ones that would have

been reviewed in last year's Estimates, even though I wasn't part of that

process.

For

example, some sections that are no longer identified separately include

Corporate Services, there are five: Corporate Services, Professional Services,

Regional Services, Population Health, and Policy and Planning. Now, just

anecdotally and just based on some of the discussion that has happened publicly

over the last month or so, I have some sense of how the restructuring has

happened but those five sections totalled about $30 million last year. I know

some of those responsibilities may now fall under the new departmental

operations heading but I'm having a little bit of trouble following the dollars.

I was

wondering if you might be able to begin by giving me some sense of where those

five sections are now included and identify where they could now be found.

MR. HAGGIE:

Sure. The departmental

reorganization essentially was phased and has resulted in the deputy minister

having three direct assistant deputy minister reports. What you will see in

1.2.02, under Departmental Operations, is a lot of those common functions that

you would have seen across Corporate Services, Population Health and the like

have been subsumed under that specific head there. Not all of them, because some

of the actual Grants and Subsidies dollars will still remain under, for example,

the provincial drug program. So there has been a homogenizing of those there.

It's

difficult to give you a categorical list simply because of the fact they've been

moved probably effectively twice over the course of the time. So it will pop up

from time to time, and I think the easiest thing to do is to highlight that

maybe as we go through and pick them up there.

MR. KENT:

Okay. Thank you.

Another

couple of upfront questions, I guess. In one of the other Estimates meetings

that occurred, we discovered there had been some technical or just mathematical

errors that had been discovered post-printing where some calculations had been

found that were incorrect and there are now adjustments being made or there will

be adjustments needed.

To your

knowledge at this point, are there any calculation errors that we should be

aware of? Or to the best of your knowledge, are the Estimates accurate as they

presently are presented?

MR. HAGGIE:

My understanding, and staff

will correct me, there are monies moved around from different heads as we've

alluded to.

MR. KENT:

Yeah.

MR. HAGGIE:

In actual fact, a bit later

on there's money moved in from outside, but I'm not aware of any mathematical

errors.

MR. KENT:

Okay.

MR. HAGGIE:

There may have been the odd

accounting adjustment but I don't think there's any

OFFICIAL:

(Inaudible.)

MR. HAGGIE:

Yeah. I'm receiving

assurances that we're good on both counts, no mathematical or accounting issues

identified between last year's budget and this.

MR. KENT:

I'm not surprised to hear

that.

Thank

you.

Also,

related to your opening comments and zero-based budgeting, we've heard lots

about zero-based budgeting in recent weeks. Some of our caucus members had an

opportunity to be briefed by finance officials in the last week or so. Through

that process, we became aware of the $510,700 number that you referenced this

morning.

I have

the line-by-line breakdown of where the savings came from through the Minister's

Office, through Executive Support, through Departmental Operations. We can go

through the details, certainly, but I guess what I wanted to ask you upfront is

can you tell us a little bit about what that process looked like.

understand the principle of zero-based budgeting. That, I get. But I'm just

curious, practically, as you went through the department's budget, what did that

exercise look like? I've heard multiple ministers say it will have little impact

on operations. I suspect when I look at the line items that are impacted, in the

case of Health and Community Services that's probably true, but I'd just like to

if you could give me a sense of how you went through that process, how you

tackled it and found the $500,000 successfully.

MR. HAGGIE:

Okay.

Yeah, I

mean, it was actually quite an interesting exercise because it got you down to

the level of operation in the department which was really how many telephone

landlines do you need? We identified quite a number that were effectively

redundant, so we removed those.

We then

looked at the new organizational structure and said, well, how many people do we

need to be able to contact out of normal working hours? If the answer was yes we

did, they were the folk who got the Blackberries. We shed 11 Blackberries over

the department because of that approach to that issue alone. Each of those

generates a certain cost per month. So that wasn't factored in.

started with a blank slate and said, well, we need X-Blackberries where X was 11

less than last year, but we didn't look at last year's as a point of reference.

We looked at the new org chart and said how many do we need. Similarly, voice

mail, you pay for that service. How many people do you need voice mail on those

lines?

For

example, as well, in Transportation and Communications, we looked at travel for

the minister for FPT meetings. For example, we know for a fact there are two.

The minister will travel only with one person. So that's two tickets, no more.

That's your baseline. How much is that reasonably likely to cost? Then, bear in

mind, we have still some face-to-face meetings in association with the details

of the Accord money, for example, or the opioid strategy. Factor in maybe one

meeting each for those.

That's

the minister's travel, and the deputy will have two deputy meetings for Health

at PT level. The deputy will not take more than one person. How many tickets? So

you build up the budget for Transportation and Communications based on that.

That

was the kind of exercise we went through. I don't know whether that's specific

enough for you but I think that gives you a flavour of how it was done.

MR. KENT:

No, that is helpful.

Thank

you.

I'll

move to some more of the typical questions. I probably won't finish, Madam

Chair, in my two minutes, so I'll turn the floor over to Ms. Michael.

One

upfront question, would it be possible to obtain a copy of your Estimates notes

following this session?

MR. HAGGIE:

Yes, sure. I mean would this

binder be the sort of thing you're looking for?

MR. KENT:

That will be great. I think

it will feel familiar but I still welcome it, as I'm sure my colleague would as

well.

MR. HAGGIE:

Not a problem.

MR. KENT:

Regarding the Salaries in

1.1.01, the variance is minor. I'm sorry, I've mixed up subheads. It's exactly

the same for 1.1.01.

Given

the time, I'll pause there, Madam Chair, and let my colleague ask her questions.

CHAIR:

Thank you.

Ms.

Michael.

MS. MICHAEL:

Thank you very much, Madam

Chair.

Just to

put upfront so we don't have to say that at the end; obviously, whatever is

asked by either Party comes to everybody, that includes the binders.

Thank

you very much, Minister. I know you'll co-operate with that. We got it last year

quite well.

I will

be asking line by line and then at the end of each

section I may have some

general questions. I'll put them in there as I go through.

MR. HAGGIE :

Okay.

MS. MICHAEL:

Thank you.

With

regard to 1.2.01, Minister

CHAIR:

Ms. Michael, we haven't

called that one yet.

MS. MICHAEL:

Oh, just on 1.1.01. I have

no questions on 1.1.01.

CHAIR:

Okay. No questions on the

Minister's Office.

Well,

if it's okay we'll call do you have more questions?

MS. MICHAEL:

It's too minor; the amounts

are very minor.

CHAIR:

Okay.

Ms.

Michael, do you want us to we'll just go back to Mr. Kent.

MS. MICHAEL:

Sure, that's fine.

CHAIR:

Okay.

Mr.

Kent.

MR. KENT:

Thank you.

Some of

these questions, again, cross over subheads but I feel it's probably more

productive to ask them upfront.

Minister, given the changes that have happened in the department, I was

wondering if we could obtain copies of the revised organizational charts

including your branches and divisions and their responsibilities.

MR. HAGGIE:

It's in the binder.

MR. KENT:

Great.

I was

wondering if you could tell us how many people are employed in the department

today, I guess 2017 versus 2016.

MR. HAGGIE:

MR. KENT:

And how would that compare

to last year? It would be slightly smaller I think.

MR. HAGGIE:

My recollection is it's not

much different, but we can get that number for you for sure. I don't actually

have it with me.

OFFICIAL:

I think it's 212.

MR. HAGGIE:

212, okay.

MR. KENT:

Okay. Thank you.

In that

total number, Minister, the 189, are all contractual positions included?

MR. HAGGIE:

Yes, there are three.

MR. KENT:

Would any temporary

It isn't. No, that was part

of the reorganization. What there is, is a list of positions and position

numbers that are there.

MR. KENT:

Okay.

related to the position numbers, as you went through your restructuring, I'm

guessing there were some PCNs that were eliminated. Could you confirm that was

in fact the case?

MR. HAGGIE:

I think there were. Yes, the

exact number we can provide you with. There was a net because there was a couple

created.

MR. KENT:

Right. So the new hires

We feel we're as lean as we

can reasonably be within the department.

MR. KENT:

I would tend to share that

view.

Madam

Chair, that's all I have on 1.1.01.

CHAIR:

Okay, we'll call that one.

Shall

1.1.01 carry?

All

those in favour?

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against?

Carried.

motion, subhead 1.1.01 carried.

CLERK:

1.2.01 to 1.2.02.

CHAIR:

Shall 1.2.01 to 1.2.02

carry?

Shall I

go to Ms. Michael now? We'll let you start here.

MS. MICHAEL:

Okay. Thank you very much.

Minister, under 1.2.01, obviously the big question does relate to the Salaries.

I don't know how complicated it is because I assume there has to be complication

with the changes that have happened, but maybe not so much in Executive Support.

If you could explain to us the variance between last year's budget and revision

and now this year's budget, please.

MR. HAGGIE:

Okay.

Essentially, the Salaries there include deputy, three ADMs, secretary to the

deputy, three secretaries to the assistant deputies, director of communications

and a media relations manager. The difference between that structure and the

previous year is a result of removing two ADM positions and the retirement of

the medical consultant. There were some moves to consolidate the support

salaries in there as well. So it's a net.

MS. MICHAEL:

Okay. So right now you have

MS. MICHAEL:

Right.

MR. HAGGIE:

in the more generic

answer, but specifically it was how many meetings would the deputy go to, who

would go with him, how many blackberries we need for what staff. So that's a

net, starting with a blank slate and working upwards.

MS. MICHAEL:

Right, thank you very much.

Moving

on to 1.2.02, you have given us an idea of the reorganization that's gone on. So

it's a bit hard here to get at differences in Salaries, et cetera. But again,

last year there was a variance of $120,000 difference between budget and

revision, and this year there's quite a drop: $414,200. If you can explain that,

please.

MR. HAGGIE:

The over expenditure between

'16-'17 revised and the budget is due to severance and paid leave costs, folk

that retired.

MS. MICHAEL:

Right.

MR. HAGGIE:

The projection for 2017

compared with the revised is a result of one-time termination costs in '16-'17

not being required in '17-'18, as well as changes from the management

restructuring, because the salaries that are included there are, for example,

we've got the departmental controller, we've got director of audit and claims,

pharmaceutical services, director of physician services, and there's a list

there which we can share with you when you get the binder. It's fairly well laid

out there.

MS. MICHAEL:

So basically I just want to

name this, because it's what our analysis tells us, and I think that's what

you're telling us, that the salary that was budgeted last year was basically the

salaries for corporate services, professional services, population health

professional services twice, regional services and policy and planning. Okay,

and that's still what's reflected in this year's budget.

MR. HAGGIE:

They've just been moved

under this one head instead of scattered across five.

MS. MICHAEL:

Okay, thank you very much.

That's helpful to get all that straight.

Under

Transportation and Communications last year underspent by $111,000, and this

year we'll still be below what was budgeted last year. Could we have an

explanation, please?

MR. HAGGIE:

Yes, sure.

We have

removed 36 land lines, 26 blackberries and 55 voicemails. So there's the

communications piece. The transportation piece, again, is an attempt to

stipulate upfront what the likely meetings are and specify numbers who will or

won't go.

There

was also money added to the travel budget from salaries and operating moved into

the department for Canadian Blood Services and mental health. They had been

previously posts that were under Eastern Health and were brought into the

department to reflect the provincial responsibilities.

MS. MICHAEL:

Okay, thank you very much.

Moving

on to Supplies, again, a reduction what would that cover, that line?

MR. HAGGIE:

Again, a zero-based budget,

so we have essentially removed any discretion as far as is possible and

practical. Some of it was based on historical estimates simply because we didn't

have any accurate way of tracking it; but if you look at the expenditure, for

example, on office supplies: paper and envelopes: $36,000; printer cartridges:

$13,000; nutritional items were for meetings and the like worked out to $20,500;

and general office supplies: $24,200.

Again,

we've got those broken down for you in the book, but that's the general flavour

of what that went to.

MS. MICHAEL:

Right, thank you.

assume this will be broken down in the book too, but I would like to ask a

question around Professional Services. Last year it was underspent by $516,000.

This coming year, it is budgeted at $348,000 less than the budget last year.

MR. HAGGIE:

Yes. The reason for the

reduction was there was basically less audit review and appeals. We didn't spend

as much on mental health review board fees, and some of those items were

budgeted as a contingency and we've removed those, so it's a net.

MS. MICHAEL:

Okay, right, so no more

contingency.

MR. HAGGIE:

Well, it was a contingency

for consultant help and we completed a lot of that work in-house and we think we

can probably continue to do that.

MS. MICHAEL:

Okay, thank you.

Under

Purchased Services, again, underspent last year by approximately $150,000 and

going up by $56,000 this year.

MR. HAGGIE:

Yes. We've actually

transferred some funds from the regional health authority to cover a lease cost

on Topsail Road. We've moving one of the mental health walk-in facilities. We've

saved money on the lease by taking over a lease from a different government

department, but to do that we transferred the money in from Eastern Health

because if we reassigned the lease, we would have had to renegotiate it. This

way it's still under a government department, so it is a cost-saving measure on

the lease. We also had some reductions from a zero base and there's some federal

money for drug treatment which ended which we don't see recognized.

MS. MICHAEL:

Okay, thank you very much.

Under

federal revenue you anticipate $60,000 federal revenue. What would that be?

MR. HAGGIE:

The agreement is for

transfusion safety initiatives.

MS. MICHAEL:

Oh, and that's the result of

MS. MICHAEL:

Okay, which would have been

covered by Eastern Health before and now it's here.

Okay,

thank you.

The

provincial revenue is down by $75,000. Can you explain that?

MR. HAGGIE:

It was based on a review of

actual revenues received. The budget was adjusted by that amount.

MS. MICHAEL:

And what are those revenues?

MR. HAGGIE:

Defaults on bursaries, MCP

overpayments and refunds from vendors, those are the three categories.

MS. MICHAEL:

So basically the same as

other years we've gotten that answer as well.

MR. HAGGIE:

Yeah.

MS. MICHAEL:

I'll ask one general

question: In your booklet or in the briefing notes, will you have information on

things like the average call volume for the HealthLine and those specific kinds

of questions or should we put those to you directly?

MR. HAGGIE:

I think those are not

covered directly in here. We can provide that information, but I'm not sure that

we'd be actually be able to answer specific questions accurately. I can give you

ballparks, but if you want the actual, the real numbers as it were, that's not a

problem.

MS. MICHAEL:

Right. Okay, well, we'll

decide what we'll ask here and what we might put in the letter and just request

directly.

Thank

you. I may want to come back after Mr. Kent.

CHAIR:

Okay. That's fine.

Thank

you, Ms. Michael.

Mr.

Kent.

MR. KENT:

Thank you.

I have

a number of questions that are a little broader. I appreciate Ms. Michael's

questions which saved me from asking them.

Minister, I was wondering if you could give us an update on the status of the

restructuring of the Medical Transportation Assistance Program and just give us

an idea of where we are with rollout of that.

MR. HAGGIE:

Yeah, there are some

specifics further down in line items relating to that.

MR. KENT:

Okay. I thought it was here.

Sorry.

MR. HAGGIE:

But essentially we're

looking at a common point of entry across both our department and Advanced

Education, Skills and Labour.

MR. KENT:

Yeah.

MR. HAGGIE:

It will be a phased process,

but further on you will see there has been some money transferred into Health

from AESL to cover parts of that transition. It's a work in progress and it's

started.

MR. KENT:

I definitely support the

concept of bringing the two programs together, as some of the folks here are

aware. Have there been any impacts I understand the budget shift has happened,

but have there been any impacts on staffing at this point? Have any personnel

moved from one department to the other, or have any jobs been eliminated on the

other department side to deal with the restructuring?

MR. HAGGIE:

At the moment, we've got one

person coming into the department from AESL but they're still on AESL's payroll.

They kind of come over and work with the MTAP folk.

MR. KENT:

Are there more staff working

in AESL dedicated to the program that are not coming over?

MR. HAGGIE:

Do you

anticipate changes to eligibility criteria for the program, and have any changes

happened so far?

MR. HAGGIE:

Well, the answer to the

second question is no. At the moment it's up in the air because there are some

discussions about financial eligibility issues in general because between us,

our department for our programs and between AESLs, we've certainly got two, if

not three different sets of criteria.

MR. KENT:

Thank you.

Would

this be the appropriate time to ask about the Deloitte home support review? Does

that fit here or does it better fit elsewhere?

MR. HAGGIE:

It would probably fit

further down under the RHA really because the money for home support is included

by and large it flows through the RHA and is managed by each regional health

authority.

MR. KENT:

Okay.

MR. HAGGIE:

In practical terms, it

doesn't really matter when you want to ask it because it's not specifically in

the book.

MR. KENT:

I appreciate your

co-operation. If you don't mind, then, I'll ask my couple of questions while

we're on the topic and not have to ask them again later.

MR. HAGGIE:

Fill your boots, as they say

back home.

MR. KENT:

Thank you.

I'm

just curious if you could comment on the overall cost of the home support review

and where you are with implementation at this point?

MR. HAGGIE:

Okay. The second part of the

question is that there is an update coming shortly about where we are with the

implementation, but the review actually had 24 or 25 points and it was presented

in such a way, they were grouped in terms of an implementation plan. So, really,

the kind of implementation plan was there. Currently, we have a staff member

engaged in consultation with stakeholders and the RHAs to get their feedback on

the nuts and bolts of actually running through that program.

we're in the beginning phases of setting the plan out in the sense of announcing

it. We're at that kind of final feedback stage. The report really contained an

implementation plan.

terms of the cost of that review, I would have to look around for someone to

give me the actual dollar figure.

OFFICIAL:

$250,000.

MR. HAGGIE:

$250,000.

MR. KENT:

Okay. Thank you.

to that, in the government's Way Forward

document there was a commitment to implement a home support action plan. Can I

assume then that's the update that's coming shortly?

MR. HAGGIE:

Yeah, they're all together.

The Deloitte report contained an action/implementation approach. That action

plan that you've just referenced specifically is going to be essentially that as

the foundation.

MR. KENT:

Thank you.

Switching to personal care homes, are you continuing with plans to expand the

Enhanced Care pilot?

MR. HAGGIE:

Yes. That was a little bit

delayed rolling out because of some logistical factors basically in terms of

paperwork and implementing it through the RHA. My understanding is there are 40

individuals in 24 homes who have already taken advantage of that. I think there

were somewhere in the region of eight new hires because of the money put into

the program. Yes, I'm receiving nods.

It's

been a slower uptake than we'd thought, but I think some of that was essentially

because of the delay in getting it rolled out in the first place. It really

probably didn't pick up steam until fall of last year.

MR. KENT:

Sorry, Minister, I didn't

quite catch the numbers. Can you give those again?

MR. HAGGIE:

Twenty-four homes with 40

individuals out of 100 places that were available in the first run.

MR. KENT:

Okay.

Well,

24 homes is considerably larger. I believe we started with like four.

MR. HAGGIE:

Three.

MR. KENT:

Three, so that's good to

hear.

How did

you select the homes, or was there an opportunity for all homes to apply?

MR. HAGGIE:

It was the latter. Any home

that was interested and it was usually client driven. If they had someone, it

was up to them to go to the local RHA to do that. I think there were some

challenges around initially communicating that, maybe. That may have led to a

bit of a slow uptake but we seem to have fixed those now.

MR. KENT:

What's the rate structure

for personal care homes that are participating? They would be paid a higher rate

for the enhanced care residents. I'm just curious what that rate structure looks

like.

MR. HAGGIE:

I could give you a ballpark

but we can get the exact figure for you.

MR. KENT:

Okay. That would be great.

Thank

you.

This is

another one where you may have to get the detail for me, but Chancellor Park,

which is familiar to some of the folks here I'm sure. I'm wondering what is

currently paid at Chancellor Park for a Level 3 bed.

MR. HAGGIE:

Again, I could give you a

ballpark but the exact figure we can find for you.

MR. KENT:

I appreciate that.

Thank

you.

Given

that this subhead covers NLPDP as well, I'm just curious if there are any

changes at all happening within the drug program in 2017-2018.

MR. HAGGIE:

The program itself, the main

thrust of it is to continue with efforts to use the national and regional

purchasing bodies to try and increase the proportion of generics, particularly.

Although, I think really we've got the low hanging fruit there at the moment. It

is, again, to try and use bulk purchasing to reduce the cost where possible, or

at least slow the rate of rise of cost through the drug program.

MR. KENT:

In doing so, as you work

through those processes at the Atlantic level and at the federal level, do you

anticipate making changes to our formularies as a result?

MR. HAGGIE:

I think the issue of a

provincial formulary; we effectively have that through the NLPDP because of the

listing process. I think from the point of view of the discussions at the

national level, we've seen the issue of the 117 essential drugs that World

Health Organization put out. One of the challenges, actually, is to Canadianize

that because of those 117 drugs. I think 40 or more of them are actually

specific for tropical diseases we would not see here but on a global scale

affect significant percentages of the population.

haven't engaged in any discussions along those lines specifically in any

granularity but it is part of the Pan-Canadian Purchasing Alliance discussions

of which we are a member.

MR. KENT:

Are there any plans to

consolidate the drug formularies? I understand and I appreciate your comments

related to the NLPDP formulary but there are still regional formularies. I'm

just curious, is it your intention to see those consolidated or are you

satisfied with the current structure?

MR. HAGGIE:

I think it may actually

occur de facto, because if you look at another piece, which is the shared

services concept, if you have a provincial purchasing system for the

institutions, which is a presumed, what I'm reading from your use of the word

regional formulary, then I think ultimately that would probably come to pass by

default.

MR. KENT:

Okay, and seeing as oh,

I'm out of time. I have a couple more questions, but I'll hold them for now.

CHAIR:

On 1.2.02?

MR. KENT:

Yes.

CHAIR:

Yes, okay.

Ms.

Michael.

MS. MICHAEL:

Minister, I'll try to not

ask questions that are so statistical that we'll put in writing, but I have

questions that aren't. I'm interested in knowing what the status of the

midwifery implementation is. We have the regs in place, et cetera, but what's

happening with regard to implementing?

MR. HAGGIE:

The first piece was to find

a consultant whose responsibility would be two-fold, which would be to help

craft the professional end of things, in terms of regulations, educational

requirement, then to work on a policy level. Once that framework had been done

and we anticipate that would be done by maybe mid to fall of next year, then

they would be responsible for helping recruit three midwives to the initial

pilot site, which will be located in a rural setting, probably Central.

They

would act as clinical lead and then move their policy development regulatory

piece to look at an urban site in the St. John's area somewhere. So the

interview process has been completed, and I think we'll be in a position to make

an announcement about the consultant in the not-too-distant future.

MS. MICHAEL:

So the implementation

coordinator is not in place yet, but you're in the process?

MR. HAGGIE:

I will hopefully be able to

make an announcement about that in the near future.

MS. MICHAEL:

Okay, thank you.

I'm

also interested in the rapid response team pilot project for seniors coming to

emergency rooms and wondering at this point in time what the outcomes have been.

I, just on a personal basis, know many friends actually four or five who've

really benefited from it. I'm just wondering how you've looked at it, how you've

evaluated how things are at the moment. Are the teams going to continue? Will

there be an expansion?

MR. HAGGIE:

There have been some

significant challenges on my initial read of the data in terms of making those

effective in terms of their stated goals. I'm pleased that you've had some

people who have had a successful result from those encounters. The report, the

jury isn't quite in, but I am pessimistic about their efficacy. On that basis,

given my other comments, then I think we'd have to look at a different way of

achieving the same ends.

MS. MICHAEL:

Can you give me some sense

of why you have that pessimism?

MR. HAGGIE:

Well, the figures I've seen

would suggest that each team sees less than four patients a week.

MS. MICHAEL:

Okay.

What

would cause that? Is that the nature of what gets presented to them (inaudible)

MR. HAGGIE:

I think they're in the wrong

place, quite frankly. They're in emergency department; they need to be outside.

MS. MICHAEL:

Right, okay.

MR. HAGGIE:

By the time people get to

the emergency department, the ship has sailed.

MS. MICHAEL:

Right, okay.

So it's

not doing away with the teams but looking at where they're located and how it

might

MR. HAGGIE:

I think they need to be

revamped as a minimum but, as I say, the jury is not quite in yet in terms of

what the data really show and what we're going to do with it. So I would reserve

final comment, but that's where my head is at the moment.

MS. MICHAEL:

Okay, thank you.

Because

the people I know for whom it's been effective, it's people who have had

accidents; friends who've fallen, sometimes in their homes, sometimes on the

street.

MR. HAGGIE:

And maybe that's a subgroup

for who that kind of approach would work but, by and large, it hasn't achieved

what we had hoped

MS. MICHAEL:

Right. I think that is

MR. HAGGIE:

Had been hoped when it was

set up.

MS. MICHAEL:

That's the group I'm aware

of because all the friends I'm talking about, that's their situation. So getting

through the service, being sent home, getting the home care immediately, being

able to do the physiotherapy, et cetera, at home has been extremely effective

for those people.

Thank

you. I am interested in a few other things that we've been waiting on for a

while, not just from your government, prior to you. The electronic medical

record, is this still being looked at? Is implementation being worked on?

MR. HAGGIE:

Yes, there are several

thrusts; NLCHI has the kind of electronic health record brief with regard to the

NLMA and their joint venture. There were 300 licences initially allocated. My

understanding is 60?

OFFICIAL:

Fifty.

MR. HAGGIE:

We have the early adoption

of 50. At the moment we've had some discussions with Telus about the

requirements under PHIA to be able to link all those and, hopefully, those will

be settled very shortly, but there are 50 licenses up and running currently as

stand-alone. There is a connection issue.

MS. MICHAEL:

And the goal is 300?

MR. HAGGIE:

There were 300 initially

allocated. There are 200 expressions of interest, but I think the rollout has

been a little bit slower. Some of it, I think, relates to network issues around

PHIA and who is the custodian and who the company have to have agreements with.

Rather than just NLCHI, it should probably be under the PHIA, the individual

practitioner who's using the licence because, technically, they are a custodian

under the law.

There

is a PHIA review ongoing at the moment. We haven't received that report yet.

MS. MICHAEL:

Okay.

MR. HAGGIE:

MS. MICHAEL:

Thank you.

I'm

also interested in and have great concerns with regard to our chronic disease

situation and needing a province-wide diabetes database. If you can bring me up

to date on the chronic disease and diabetes prevention and management programs

in the province.

MR. HAGGIE:

That really falls into a

strategy, a plan to deal with chronic disease in general as an umbrella. Whilst

diabetes has been very much a talking point simply because of its numerical

size, I mean we would envisage a stream for COPD, congestive heart failure; we

have the kidney program and also then diabetes.

terms of the specifics of a registry, we currently have a database. One of the

challenges has essentially been to get that converted from a database into a

registry. That had never been done with anything. Recently, we did that with the

Cancer Care Registry. That's become the database. Well, there were five, in

actual fact, which were amalgamated under the Newfoundland and Labrador Cancer

Care Registry.

That

process has been completed and now will act as a template for the other

diseases. Diabetes is the next one in the stream currently waiting for privacy

impact analysis, which the regulations, the legislation, stipulate has to

happen. That's been completed and I'm waiting to get that on the diabetes piece.

That's the final piece before then we put the package together and submit that

through the same process that we did with the Cancer Care Registry. So it's in

train, but it's one of those pieces where there's some crafting of regulations

and legislation needed.

MS. MICHAEL:

Okay, thank you

Could

we have an update on the chief medical officer review?

MR. HAGGIE:

I have no role in that,

directly; that's done through JPS. My understanding is the Office of the Chief

Medical Examiner was reviewed. I met Dr. Bowes, when he came over. My

understanding from comments from the Minister of Justice is that he expects that

report to be delivered to him in the near future.

MS. MICHAEL:

Okay, thank you.

A real

concern that I have: Government did commit to eliminating the IQ 70 threshold

for services to individuals with autism and create a provincial autism strategy.

Where are things with that? Because we all know autism is a growing issue here

in the province

MR. HAGGIE:

I think there's been a shift

in the way we've approached that in the sense that certainly in discussions with

Children, Seniors and Social Development, who have a significant role in this,

the idea is to look at functional capability and capacity for folk with

disability rather than diagnose these specific groups.

That

would roll into a more functioned-based assessment of people's exceptionalities

and abilities to cope in the community or with life in general. It has certain

implications that we are still trying to unravel between the two departments.

Again, it's an active file; it hasn't gone away. I think it's just a question of

there are more nuances to it than we'd anticipated.

MS. MICHAEL:

Well, certainly the

evaluation of functionality is the key thing. We all have enough knowledge of

autism to know that IQ is not the factor here

MR. HAGGIE:

No.

MS. MICHAEL:

but it's still there on

the books and we're still operating under it.

MR. HAGGIE:

The difficulty is the

temptation to blow it up is enormous, but you really have to have something in

place for when you do. You can't just leave a vacuum. The challenge is how to

craft assessments that are evidence based and tested and makes sense to both the

disability community, CSSD, ourselves and community services, and also education

because there's a piece in that there as well.

MS. MICHAEL:

And I do understand that it

will require more resources from an HR perspective. I think it will require much

more time doing an analysis if you're looking at functionality and social

interaction than just looking at IQ.

Thank

you.

CHAIR:

Ms. Michael, are you

finished with that section?

MS. MICHAEL:

Yes, I am, actually.

MR. HAGGIE:

Just maybe to help the process; a lot of the questions that you've referenced,

both Mr. Kent and Ms. Michael, they are actually covered under other heads as

well because of the way this structure has changed slightly. So there's an

opportunity to beat these to death a bit more, if you want to.

CHAIR: Mr.

Kent.

MR. KENT: No, I

appreciate that and I appreciate the minister's willingness to be flexible

because I think we'll be able to whiz through a lot of the other subheads by

allowing us to cover some of these topics. Ms. Michael covered a number of

topics that I had intended to ask you about.

While we're still under this subhead, I had a few others

noted that I'll ask and then we'll perhaps move on to other subheads, but I

think they'll be much quicker, given your co-operative approach to the process

this morning.

Minister, in response to one of Ms. Michael's questions,

you mentioned moving a mental health clinic and you referenced Topsail Road,

which I have a keen interest in. I'm just curious if you could tell us a little

bit more about where the clinic is moving and what's the impact on the Topsail

Road site.

MR. HAGGIE: My

recollection is that the clinic is on Ropewalk Lane and is going to Topsail Road

because the lease has expired. We could take over a TW lease with a property

that was suitable at a lower cost have I got that the right way around?

OFFICIAL: Yes.

MR. HAGGIE:

Sorry, people are talking behind me and I'm wondering if I'm digging myself a

hole here.

OFFICIAL:

(Inaudible.)

MR. HAGGIE:

Carry on digging, yes.

MR. KENT: They

used to cut me off when I'd do that.

MR. HAGGIE:

They obviously don't like me as much.

MR. KENT: I

doubt that. I think they probably like you more.

MR. HAGGIE: To

resume the lease was up, the space on Topsail Road was already in a longer

lease, is suitable and was underutilized.

MR. KENT: Are

we talking Mount Pearl Square or are we talking another site on Topsail Road?

OFFICIAL:

(Inaudible.)

MR. KENT: Oh,

west end, next to Jungle Jim's.

MR. HAGGIE:

They're virtually adjacent to each other because that was one of the reasons why

the move from Ropewalk Lane was potentially difficult because it services a

clientele who have significant transportation/mobility challenges.

MR. KENT:

Right.

MR. HAGGIE: So

we kept them there. The lease would have been held by TW and was still in its

early stages. So rather than reassign the lease to Eastern Health, we took the

money from Eastern Health into the department and reassigned the lease between

departments in government.

So effectively, TW still takes the lease; we pay TW on

behalf of Eastern Health.

MR. KENT: Okay.

MR. HAGGIE:

That's how the money flows, and it's open, by the way.

MR. KENT:

Sorry?

MR. HAGGIE:

It's open. The move has taken place.

MR. KENT: Okay.

So the clinic has moved but there's been no change in services, other than the

location?

MR. HAGGIE: No,

nothing. It's just a cheaper lease and a suitable space in the same area.

MR. KENT: That

makes sense.

OFFICIAL:

(Inaudible.)

MR. HAGGIE: Oh

yes, we did combine Ropewalk with another facility. What was that one?

OFFICIAL:

Again, it was mental health.

MR. HAGGIE:

Yes, we put two mental health clinics, one from Ropewalk Lane and another one in

the same building.

MR. KENT: Where

was the other one coming from?

OFFICIAL:

(Inaudible.)

MR. KENT: It

was on that stay, okay. So it's a consolidation but the clients are still being

served. So staffing is moved together; there are no cuts.

MR. HAGGIE: The

constraint was the clientele that we served were not able to travel at

significant distances.

MR. KENT:

Right.

MR. HAGGIE: We

have not altered any of the staff or any of the reporting structures.

MR. KENT: Okay,

thank you for the explanation.

You mentioned shared services earlier. I was just wondering

if you'd give us an update on where you are with implantation of the shared

services organization.

MR. HAGGIE:

There are documents in the system going up to Cabinet in the not-too-distant

future about initiating the first block of shared services, which would be the

block that was being worked on at the transition, which was inventory and supply

chain.

MR. KENT: So

inventory and supply chain hasn't been implemented at this point, but there's a

Cabinet Paper pending?

MR. HAGGIE:

Yes.

MR. KENT: And

the reason for the delay would be the fact that we got kicked out of government?

MR. HAGGIE:

Well, the reason for the delay was reworking some of the organizational

structure and there are some software challenges around IT. The question was the

affordability of some of the options, quite frankly, given the fiscal situation,

but we think we have a way to examine that, which will allow us to proceed with

setting up the organization.

MR. KENT: I'm

pleased to hear you are moving forward with supply chain and purchasing and all

that goes with it. I'm wondering, are you still committed to the consolidation

that was envisioned in the original plan? Are you still moving forward with the

rest of the shared services approach in other areas?

MR. HAGGIE:

There are, as far as I can recall, four or maybe five areas that were discreet

entities where there was duplication in each of the RHAs and kind of a low

hanging fruit that had been worked up the most was supply chain and inventory

MR. KENT:

Correct.

MR. HAGGIE: So

that's why we started with that. The others are in different degrees of

preparation and there are also different views as to their practicality in terms

of bang for your buck by moving to that kind of model. So we would see

moving ahead with certainly

one or two of the others, whether number five would ever be doable and I think

that was the IT piece, but I couldn't swear to that. But they were at different

levels of practicality, and some of that may be down to the fiscal challenges of

the up-front investment if you wanted to move to a common IT platform, for

example.

MR. KENT:

Yes, and that was actually

the next thing I was going to ask you about, because I recognize the significant

costs of consolidating a whole bunch of independently functioning IT platforms

that exist within the health care system. Meditech alone is quite complicated,

as I'm sure you've gained an appreciation for, if you didn't have one already.

I'm

just curious well, first of all, I'd respectfully encourage you to keep

pushing on the IT front because I think there are potential efficiencies and

savings that can be realized, even if it takes a number of years to get there by

consolidating those systems and processes.

Could

you give me an update on where you are with Meditech consolidation and dealing

with the technology challenges in the system overall?

MR. HAGGIE:

At the moment, the Meditech

piece, the last bit, was the amalgamation of Lab-Grenfell with Eastern Health.

Immediately prior, or probably around the same time, there'd been an

amalgamation of the Central-East and Central-West as they had been systems. That

was moved to Grand Falls-Windsor on the basis that their hardware was newer than

Eastern Health's, even though their software iteration in Central-East was newer

because Meditech, as you know, is a hardware and a software platform. It can't

be run on any machine; it has to be run on dedicated hardware.

At the

moment, that piece is paused essentially. There hasn't been any more

amalgamation of Meditech across the province. What has happened in the last

little while is the completion of the telepathology. That runs through a

different system analogous to PAX. The challenges there have been quality of

images, because the resolution there requires colour.

That's

rolled out, and I'm told in recent conversations with a couple of pathologists

that that's working very well, certainly on an intra-provincial basis. There are

some challenges in hooking up with outside jurisdictions directly on an

electronic basis because of the deficiencies in their hardware, not ours.

They're not up to date. Manitoba is the only other iteration that's got the

telepathology.

We're

looking again in a slightly different direction with a similar process for

non-invasive cardio respiratory data, so the Epiphany system. But in terms of

Meditech specifically, that's kind of paused at the moment.

MR. KENT:

Okay. I appreciate the

explanation.

final question related to this subhead well, not related to this subhead but

I'll ask it anyways is just to pick up on your commentary with Ms. Michael

related to EMR. Did you say there have been 200 applicants? There were 300

spots. There have only been 200 applicants from fee-for-service physicians? Is

that what I heard you say?

MR. HAGGIE:

There are 200 expressions of

interest and 50 of that subset actually have the hardware up and running,

software.

MR. KENT:

Two follow-up points. That

surprises me. I'd welcome your thoughts on why only 200 because my thought was

the 300 would be snapped up really quickly and there would be a demand for more.

So it's interesting that hasn't happened. I'll ask you one question at a time.

Can you share your thoughts on why that is?

MR. HAGGIE:

Wearing a hat I used to

have, I would suggest that given the demographic of a lot of fee-for-service

practitioners in this province, a significant number of them are at that: I've

only got five years; I'm not going to learn new tricks. I've got a system that

works for me, whoever takes over can look at that.

I think

there's an element of that because certainly we do have the same demographic

bulge in the fee-for-service physician population as we have in the population

in general. There's a significant predominance of practitioners in that 55-65

age group.

MR. KENT:

Okay.

MR. HAGGIE:

I think that's part of it. I

think to be honest the others are probably waiting to see the results from the

first 50. Word of mouth is going to be your best advertisement in that group.

MR. KENT:

Yeah.

MR. HAGGIE:

I think the full

functionality of the system hasn't actually become apparent yet because of the

discussions between Telus and the individuals concerned over this PHIA element.

But we think we've got that resolved and hopefully, once they get online and see

the connectivity piece which really is like night and day when you compare the

two systems, stand-alone versus connected I think the buzz that will generate

will be the next kick to get the other 150 onboard and then the next 100 may be

interested.

I think

probably the number 300 is about the right place to be for fee-for-service

physicians currently. We have only 589-odd primary care physicians in the

province and the 300 will probably take care of the fee-for-service ones.

MR. KENT:

Oh, okay.

Madam

Chair, can I ask for leave to just ask my final follow-up question related to

this?

CHAIR:

Are you okay with him ?

MS. MICHAEL:

(Inaudible.)

MR. KENT:

Can I just ask one more

question, Lorraine, if you don't mind, just quickly?

MS. MICHAEL:

Oh, sure, yes.

CHAIR:

Mr. Kent.

MR. KENT:

Thank you, Madam Chair.

Just a

final question on that issue I was receiving a small amount of pressure from a

number of salaried physicians who also saw value in accessing the system. So

given that there are only 200 fee for service have applied at this point, has

there been any consideration in places like Labrador West, for instance, just to

It would be the same

platform?

MR. HAGGIE:

Same stuff.

MR. KENT:

Okay, that's

MR. HAGGIE:

It's just how it gets the

money back to Telus.

MR. KENT:

That's good to hear. I'm

glad you're continuing to solve some problems that were lingering.

That's

it for me on this subhead, thanks.

CHAIR:

Okay.

Ms.

Michael.

MS. MICHAEL:

Thank you, Madam Chair.

Just

some questions, Minister, with regard to mental health and relating of course to

the report of the All-Party Committee, and just to say, just of interest to you,

last night I did attend the public forum that was held by the coalition on

mental health at city hall, and there were about 50 people. There were six

tables with eight at each table and then you had the committee and some others

there.

There

was a general, very positive reaction of the 50 people who were at the tables to

the report and I think had some good comments to make to the coalition, and they

were also members of your provincial advisory committee there as well.

So I

thought it was a very good session and we all encouraged the coalition to have

more of these sessions, but it was a very positive response, just to put that

out.

MR. HAGGIE:

Good.

MS. MICHAEL:

Having said that, the

province has committed to spending 9 per cent of the health budget on mental

health and addictions by 2022. How is that going to happen? What is your plan or

do you have it in place yet?

MR. HAGGIE:

No, the undertaking from

government's side was that there would be an implementation plan in place by the

end of June, and we're on track to deliver that. The budget did actually

allocate $5 million specifically for actions that would fall out of that plan.

addition to that, whilst we haven't finished our discussions with the federal

government, they have suggested that they would give us $2.5 million of the

mental health money pot for use on a fairly liberal basis outside of whatever we

agree subsequently in terms of mental health. Their emphasis is very much on

access for youth as a subset of mental health in general.

I think

at the moment we've made steps on that journey, but in terms of an exact plan, I

think we need to wait for the implementation plan to come out.

MS. MICHAEL:

Is the department working

with the RHAs in creating that plan?

MR. HAGGIE:

Yes. Not only have we done

that, as you will see from the new organizational chart, the director of Mental

Health now reports directly to the deputy minister.

MS. MICHAEL:

Right.

MR. HAGGIE:

We've tried to streamline

internally in the department to make sure that there is a ready route for mental

health issues to get the level of attention they need to get fixed.

MS. MICHAEL:

In the spirit of a lot of

the recommendations, but one in particular from the All-Party Committee, are you

Again, that's a specific

subset. One of our challenges that's highlighted in the All-Party Committee

report is really a grounding in addictions medicine within the province, and I

use that really with a small m as much as a large M.

One of

the recommendations is that there be some kind of academic lead within the

university to help build a body of expertise. To be honest, I think methadone as

a title may be outdated. I think I would much prefer to refer to opioid

dependency treatment as an umbrella term.

One of

the challenges is the potential for Suboxone and removing barriers to access for

that and making sure it is the really for youth, particularly. The evidence

would suggest, I'm told, that should be the first-line treatment rather than

methadone. I think rather than get hooked on the labels of methadone and the

baggage that that carries, I'd much prefer to see a more widespread availability

of opioid dependence treatment, not otherwise specified, and leave that to the

individual practitioners. As I say, I think the fundamental to underpin that

would be some kind of educational/academic base for addictions medicine.

MS. MICHAEL:

Okay.

Thank

you. I think that's the end of my questions at this point.

CHAIR:

Okay.

Mr.

Kent, you were finished with that subhead as well?

MR. KENT:

I was.

CHAIR:

So we'll call that, okay.

Shall

1.2.01 and 1.2.02 carry?

All

those in favour, aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, nay.'

Carried.

motion, subheads 1.2.01 and 1.2.02 carried.

CHAIR:

We'll do one more subhead

and we'll take a brief break.

CLERK:

2.1.01 to 2.3.01.

CHAIR:

Shall 2.1.01 to 2.3.01

carry?

Ms.

CHAIR:

We can have a break right

now if it's okay with everybody. We're about midway through the morning; take

six or seven minutes.

MS. MICHAEL:

If we could, that would be

helpful.

CHAIR:

Okay. Is that okay with you

guys?

Okay.

All

right, so we'll resume at 10:25.

Recess

CHAIR:

(Inaudible) are starting

with Mr. Kent, I do believe. Was that how ? Yes, Ms. Michael is okay with

because she did have four minutes on the clock but we'll start with Mr. Kent on

the 10 and go.

Okay,

Mr. Kent, 2.1.01.

MR. KENT:

Thank you.

For the

record, in the spirit of co-operation and openness, the Opposition currently

controls the majority of the Estimates meeting and would be able to vote down

the Estimates if we wish to do so, but in the spirit of co-operation, and given

the minister's tone and approach this morning, I'm not going to make a motion to

vote down the Estimates even though I have technically the ability to do so. I

hope that that's duly noted for the record.

CHAIR:

I'm noting that there is

some good in you.

MR. KENT:

There's more good in me than

the minister probably realizes, but that's understandable.

OFFICIAL:

(Inaudible.)

MR. KENT:

Yeah, right.

Let's

move on to 2.1.01; Minister, I don't have a lot of questions on 2.1.01 because I

already asked you this morning about NLPDP, but could you make a general comment

on the increase of, it is roughly $6.2 million in the Allowances and Assistance

line.

MR. HAGGIE:

The change is basically a

net. On the book here we'll give you the details of what that net is, but

essentially you have an annualization of the Smoking Cessation Program which is

a plus of $12,000. You have some annualization of budget deficit reduction

initiatives from last year which is a negative of $1.75 million. GRI

initiatives, the NLPDP reform around over-the-counter medications and changes to

the foundation in 65Plus, that's a negative of $552,000.

There

was funding back from the 2015-16 budget. There was $5 million taken out for

pharmacists for compensation and we did not achieve that so we put that back. We

haven't renegotiated that.

Projected revenues have increased due to an increase in expenditure for

therapies, PLAs. The average increase in expenditures coincides with this trend

and it's offset by an increase in revenue of $3.5 million. So there's a net

there, and that's explained in the booklet in a bit more detail.

MR. KENT:

Thank you.

MR. HAGGIE:

Rather than trying to

remember those numbers, if you're anything like me.

MR. KENT:

Yeah, no problem. I'll

review them in the booklet then.

I have

no further questions on 2.1.01.

CHAIR:

Mr. Kent, it's been called

up to and including 2.3.01.

MR. KENT:

Oh, okay. Well then I'll

carry on.

Minister, related to Physicians' Services, I recall the annual increases that

occur in that area even if you stand still, so to speak. Do you want to briefly

comment on the $12.7 million increase under Physicians' Services under

Professional Services?

MR. HAGGIE:

Yeah.

That is

an accommodation of a forecast provision for fee-for-service utilization and

manpower increases, and funding for the new agreement within the LMNA itself. So

that breaks out at $5.5 million for utilization and increases, and $7.259

million for the new agreement with the LMNA, the MOA.

MR. KENT:

So moving on to 2.2.02,

there's been a slight decrease in the Professional Services related to

dentistry. I was just wondering why that would be. We saw significant changes to

dental services last year, I've commented on that in the past. I'm just curious,

what changes are occurring to dental services in this year's budget, and is the

decline in Professional Services related to last year's decisions?

MR. HAGGIE:

There's no change to the

dental plan this year. The changes were as a result of an annualization of the

initiative from the previous year.

MR. KENT:

Okay, thank you.

Madam

Chair, you said to go as far as 2.3.01, is that correct?

CHAIR:

Correct.

MR. KENT:

I guess a general question

then on 2.2 and 2.3, the ones we just talked about. We had some back and forth

publicly around the budget process and anticipated cuts. While we have an

opportunity to actually have a conversation and I really appreciate your

directness and openness this morning. What I recall from going through this

process, when I sat in your chair, is that before we started the process we

faced a 3 per cent to 5 per cent increase just based on things like the issues

we just talked about: the contracts with physicians, demands on the system due

to aging demographics, other contractual obligations related to other health

professions and inflation. So based on that, to have what's effectively a status

quo budget overall, there would have had to have been some savings.

Now, I

tried to add up the numbers. We talked about, for instance, the savings related

to zero-based budgeting; we talked about the restructuring that's happened in

the department. That accounts for some of that savings, but there would still

have to be significant and I know we're not in the RHA budget yet, so I can

ask the same question then, but my question is: Overall in the system, how did

you find the savings, because the zero-based budgeting and the restructuring

wouldn't produce that 3 per cent to 5 per cent, based on my quick math.

Are the

RHAs simply going to run larger deficits, or have there been other savings

realized to get you to what's effectively a status quo budget overall?

MR. HAGGIE:

Well, I mean if you look

back at the trend for the Health budget over the last five years, in actual fact

the flattening started the end of 2012 really, and plus or minus 1 per cent

seems to have been where you've landed pretty well with every budget from 2013

right up to today.

I think

in general there has been within the department a very conscious decision to

say, what is the value of any dollar that we spend? We have done a very thorough

job, I think, within the department itself of looking at the dollars. I think

zero-base is a useful epithet. It's a useful label for it, but the concept of

actually examining what you're spending and avoiding spending things that you

don't need to you. What's your core business? So I think that's part of it.

I think

in terms of the drivers, quite frankly, the federal government may have had some

justification for saying that simply putting 6 per cent escalator per year

hasn't produced any increase in value.

MR. KENT:

I agree.

MR. HAGGIE:

I would flip that around to

say that in terms of the dollars spent, having a fairly static budget since 2013

has not produced any reduction in value from the consumer's point of view.

I think

really what we're doing is by an approach between the department and the RHAs is

to say where is the money going and is that a wise use of the money? When you

look and stand back globally, it's actually very difficult to pinpoint any one

thing in all those moving parts that's made the difference. I think the

difference is cumulative on lots of little moving parts where you have managed

to not spend more than last year.

MR. KENT:

Okay. I appreciate that

explanation. While I definitely don't have your experience, and you've been in

the portfolio for already much longer than I was, I do have some appreciation of

the challenges you face and, obviously, a unique perspective as a result.

When I

look at the overall challenges around system sustainability and the drive toward

system transformation, which is not easily achieved, when I see a request from

the NLMA which we've also talked about publicly, so I don't intend to rehash

that, but when I see a request like that that says, okay, why don't we step back

and do sort of an independent review of services, locations and do it in an

objective, independent way that would potentially make some of the really

difficult challenges we face maybe easier to deal with, I just wonder why

government wouldn't embrace that kind of approach.

So to

me and I'm saying this sincerely, it seems like a reasonable approach. I'm

just curious, is there an alternative approach you're taking that is the reason

why you wouldn't be open to pursuing the route that LMNA is proposing in terms

of that review?

MR. HAGGIE:

The LMNA and I, and the

department have been in discussions about their rebuilding NL, rebuilding Health

NL forgive me if I've butchered their title. The eight points or nine points

they bring out are policies that have been extent in the department from your

time and even before.

MR. KENT:

I agree to a degree.

MR. HAGGIE:

It's not anything new.

There's no magic bullet in there.

One of

the things that has been going on, and it probably predates my time, is a

realization again of looking, for example, in mental health or in primary care,

or whatever, looking at each of those areas as a piece, recognizing it's a piece

of a bigger puzzle, a bigger machine but saying, well, what are we doing here?

What is best practice and how do we line up with that?

I think

what you've actually effectively had is multiple internal reviews as a way of

life. Certainly in the department now it is not unusual for people to come to me

and say, we went back and looked at that and we found a, b and c, what should we

do about it/

So I

think on one level the machine has become much more self-examining in the way it

deals with itself. I think by providing some overview and some strategic

guidance in terms of where things go the machine will by and large do that.

Stepping back, if you look from Lalonde in '74 all the way through the more

recent iterations of Kirby and Romano and those kinds of things, they're all

sitting on a self somewhere saying exactly the same thing having gathered dust.

People have cherry-picked a bit here or a bit there and run with what they

fancied.

The

biggest example of that was the Barer-Stoddart fiasco of the early '90s where,

suddenly, we were going to have way too many docs, they put the screws on and

then we have a huge gap in primary care. That was an example of a report that

didn't do what it was supposed to because people cherry-picked the bits they

want and ignored the rest.

view, in general, is that big reports, by and large, have tended not to add to

the discussion in terms of moving things along sorry, they've added to the

discussion; they've not added to the action. Also, by and large, the bulk of

those have gathered dust, after delaying everything for 18 months or two years,

because people say we're not going to do anything now because we got this report

on the go.

In a

sense, we have colluded, in actual fact, perfectly legitimately I think, because

that's the other end of the argument on the issue around the All-Party

Committee. In a sense, you started that on a recommendation from the Third Party

and the consent of the House and ran with it. I think, on that situation, it was

perfectly justified because mental health, with the exception of Kirby, has been

ignored for 20 years, and that's your big review there that we've done.

You can

see, in a sense, that the discussion around mental health, all parties have said

let's wait for the report; let's wait for the implementation plan. There's been

a degree of, from the outside, community groups would argue paralysis; but, in

this particular case, I'd argue useful reflection and data gathering. But I

think out of mental health, a lot of that work has been done and done

repeatedly.

CHAIR:

Mr. Kent, I've been a little

bit lenient with the clock, and I know it's flowing good but I don't know if you

just want to hold that thought and go back to Ms. Michael.

MR. KENT:

With Ms. Michael's

permission, I'd like to ask one follow-up question, if that's okay.

MS. MICHAEL:

Fine with me.

CHAIR:

Okay, Mr. Kent.

MR. KENT:

I appreciate those comments,

Minister. The only thing I'd say in response is more an offer. I agree with you

on the mental health example. When I look at the challenges you face, when I

look at the challenges we face, I wonder if there are other issues.

What

I'd extend to you this morning is a sincere offer that if there's another issue

within health care related to the sustainability of the system or the kind of

transformation that's required, or even a more specific issue, if that kind of

collaborative approach would work to solve some of those challenges or to help

get us to a point where we've gotten with mental health, then that's something I

believe our caucus would be open to and I, personally, would be very open to.

Let's

face it, politics and party stripes aside, we all have a vested interest in

making the system better. When you talk about health care and when I talk about

health care, we're often saying much the same things about the general direction

and vision for where the system needs to go.

So if

those opportunities present themselves in light of your comments a couple of

minutes ago then I'd be open to a non-political discussion about that and

would rather be part of the solution than simply highlighting some of the

problems we know exist.

I have

no further questions up to 2.3.01, Madam Chair.

MR. HAGGIE:

Thank you.

CHAIR:

Thank you, Mr. Kent.

Ms.

Michael.

MS. MICHAEL:

Thank you very much, Madam

Chair.

Just

coming back to 2.1.01, Minister, a specific line item question: The provincial

revenue, could you explain what that's about and why there's been such a jump in

that?

MR. HAGGIE:

2.1.01, one moment and I

will find that for you. I can't turn the pages fast enough.

Provincial revenues: Projected revenues have increased due to an unanticipated

increase in expenditures for therapies that have PLAs. Does that answer your

question?

MS. MICHAEL:

No. Could you explain that,

please?

MR. HAGGIE:

Okay. The revenues from the

product licensed agreements are a slightly complicated issue, which I would

suggest somebody else would be able to answer better than I; it's a more

technical question.

MS. JEWER:

I can answer it.

MR. HAGGIE:

You can answer it? Fire

away, Michelle.

MS. JEWER:

What happened is when we sign PLA, product listing agreements, we get rebates

for revenue but we also have a corresponding expenditure because a new drug is

coming on. So what's happened, we're finding we're getting more rebates for

those drugs coming on, so revenue has increased. But there's a corresponding

increase in expenditure as well.

MS. MICHAEL:

Right, thank you very much;

that helps.

One

more question under 2.1.01; you gave information with regard to the smoking

cessation program in terms of the cost being annualized throughout the budget,

but could you just let us know what is happening with the program. Is it

continuing, is it doing well and could we have the figures for 2016 of the

numbers of people who went through it?

MR. HAGGIE:

The short answer is yes, we

can get you the figures. They're only globalized as a number in the booklet

here. But if you want the figures of people who have accessed the program, those

are fairly readily available and we can supply them for you.

MS. MICHAEL:

Okay, thank you very much.

I'll expect those, then.

2.2.01;

again, the only thing I'd like to ask here is something you will have to get to

us, I'm sure you don't have it there, but the number of family physicians and

you very much.

MR. HAGGIE:

The global number is 1,209

as of the day that was done because they do tend to move around a bit.

MS. MICHAEL:

Right.

Thank

you very much.

Dental

Services; here it's just a question, again, with regard to statistics. Could we

have this may be in your book as well, it probably is the expenditures and

number of clients in the Adult Dental Program in 2016 and the same thing in the

Children's Dental Program for 2016.

MR. HAGGIE:

We can get those. I don't

think it's actually in the book.

MS. MICHAEL:

Okay.

Under

2.3.01, is that included?

MR. HAGGIE:

Yes.

MS. MICHAEL:

Yes, it is. That's part of

what we're discussing.

There

is a big reduction in the grant to the School of Medicine, $924,600. Obviously,

the School of Medicine had to deal with that cut. Do you know how they've dealt

with it and how they've been able to make this adjustment?

MR. HAGGIE:

This was a

Budget 2016 announcement. If you

remember, the grant to faculty went down by 3 per cent that year to this year,

one and one. It was predicted, there is a net because of the MUNFA collective

agreement which adds to that and the annualization of a Faculty of Medicine

reduction plan which was in place already beforehand. The GRI piece from last

year is the bigger chunk of that.

There

is a breakdown in the book. Essentially, the Faculty of Medicine reduction plan

talked about things like elimination of rental space. They had a team in place

to oversee the expansion of the seats from 65 to 80. That team is now being

dismantled because that expansion is complete, use of teleconferencing and a

variety of other issues there. They're in the binder in a bit more detail, but

that explains it for you.

MS. MICHAEL:

Thank you.

That's

it, Madam Chair, for me.

CHAIR:

Okay.

Mr.

Kent, did you have anything else up to ? Okay.

Shall

2.1.01 to 2.3.01 carry?

All

those in favour, aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, nay.'

Carried.

motion, 2.1.01 through 2.3.01 carried.

CLERK:

3.1.01 to 3.2.02.

CHAIR:

Shall 3.1.01 to 3.2.02

carry?

I don't

know Ms. Michael, do you want to use your remaining four minutes and start?

MS. MICHAEL:

Yes, I can start off and use

that time.

CHAIR:

Okay.

MS. MICHAEL:

Okay, this one gets a bit

more complicated.

First

of all, just to ask this question then. Minister, I think the operating funding

for the Newfoundland and Labrador Centre for Health Information is not here.

That's new is it, coming in under this head?

MR. HAGGIE:

It's always been there.

MS. MICHAEL:

It's always been there?

MR. HAGGIE:

Yes.

MS. MICHAEL:

Okay.

Thank

you.

Coming

down, the Allowances and Assistance has gone up significantly, by $6,400,000, I

think yes. Could we have an explanation?

MR. HAGGIE:

That's a net effect. The

bulk of that is the transfer in from AES, which I mentioned earlier on for the

medical transportation.

MS. MICHAEL:

Okay.

MR. HAGGIE:

That's actually $7.4

million.

MS. MICHAEL:

Right.

MR. HAGGIE:

There is a reduction of

that, of workforce planning bursaries, which haven't flowed through the RHAs in

the time that we'd expected. So they've been credited against that. The bulk of

it relates to MTAP.

MS. MICHAEL:

Okay.

Under

the Grants and Subsidies, there is a variance between the budget and the

revision last year. This year it's going up by $14.7 million approximately.

MR. HAGGIE:

Yes, it's a net result.

I've

got a detailed annex in the booklet for the RHAs, but essentially it boils down

to increases from minimum wage and JES. For example, new initiatives in primary

care, mental health and addictions in the Home First Program. Some of the

repairs and renos were re-profiled to capital, and there were new contracts in

place for home support personal care and the private road ambulances. Some

management reduction set against that and some annualization from previous

budget decisions, but there's a full sheet breakdown in the back of the book

that tops up to $14.69 million.

MS. MICHAEL:

That's great.

Thank

you very much.

Under

the Federal revenue, where does this fit with regard to the agreement with the

federal government with regard to funding, because we have a major decrease of a

million dollars?

MR. HAGGIE:

Yes, this relates to changes

with relationships with Health Canada, Workforce Planning Canada and an

agreement entitled the Project for Enhanced Rural and Remote Training, PERRT.

Again, there's a

summary in the book and a detailed breakdown in the annex of

where those monies come from. So there are some increases in revenue from the

transfusion surveillance project, which would not have been budgeted, and the

breakdown is all there for you.

MS. MICHAEL:

Subsidies. I was just looking to my right, sorry, I wasn't pointing (inaudible).

MS. MICHAEL:

Okay, so under number 10

there?

MR. HAGGIE:

Yes.

MS. MICHAEL:

Yes, okay.

Thank

you very much.

Do you

have a plan yet in how that's going to work?

MR. HAGGIE:

For the primary care?

MS. MICHAEL:

Yes.

MR. HAGGIE:

We are discussing locations

for primary health care teams. You remember, we did announce in

The Way Forward one for Burin and one

for Corner Brook.

MS. MICHAEL:

Right.

MR. HAGGIE:

The emphasis on those,

really, is because of gaps. It's to put something where currently very little

exists.

I think

in addition to that there are, however, some lower hanging fruit, if you might

call them that, of primary health care clinics, which are really functioning

almost at the level of primary care teams. With a little bit of money and a

little bit of extra support, maybe an addictions counsellor here or a housing

support worker there, or some alteration of the technology to include the EHR,

they could become primary health care centres as well.

So I

envisage over the next little while two streams. The difficult problem areas

where obviously there's a challenge but also those areas and they exist

around the province where there's very high quality primary care delivered by

pretty well the team that we would have envisaged on the basis of a needs

assessment doing

cutting-edge primary care.

would be very straightforward to be able to support them just a little bit

further and to put primary care teams there and label them as such. Not just as

a labelling exercise, but really to encourage the development of the teams in

more challenging areas so they can see areas where it's succeeded because I

think the best marketing tool for those kinds of primary care teams is examples

where they work well somewhere else.

It's

not all doom and gloom. We have some really good, primary health care team

environments, even though they're not called teams. I point you to Central and

Twillingate, for example, Botwood just down the road. I'm not trying to create

problems by leaving others out. I know of those simply from a geographical

perspective, but they're not the only ones.

MS. MICHAEL:

Right.

MR. HAGGIE:

I think it's very important

from time to time not to focus on all the problems but to enhance some of the

potential solutions that are already working.

MS. MICHAEL:

With co-operation from Mr.

Kent, could I just ask one more thing, directly related?

MR. KENT:

Go right ahead.

MS. MICHAEL:

I thought of this before,

but also as a point that was brought up last night at the forum. Is there a plan

to have on the primary health care teams or primary health care centres I

prefer to use that term to have mental health included directly in the primary

health care?

MR. HAGGIE:

Personally, I see no

difference, philosophically or practically, between good mental health and good

physical health. I would regard the primary care centre as a single point of

entry to the health care system or the wellness system however you want to put

it. So if you go there with an addictions issue, a mental health issue, an

obstetric issue, the system works.

MS. MICHAEL:

Well, I mean that's what

exactly I'm looking for, and that would mean that part of the team then is

somebody to deal with there are people to deal with all aspects of health. I

totally agree with you philosophically on that.

MR. HAGGIE:

I would see that as being an

integral part of a primary health centre or however you'd like to label it.

MS. MICHAEL:

Is that in place at this

moment or do we have a lot of improvements to make even with the centres that

are working well?

MR. HAGGIE:

Well, I think if you look at

the downtown collaborative, their emphasis is probably as much on mental health

and wellness and addictions as it is on physical health. They're virtually equal

workloads and inseparable.

You go

to Botwood, for example, they have recognized that their challenge there is they

would need someone with an addictions background to help them out, and then they

would have the complete suite. You go further west and Springdale or the clinics

there, which are very there's a great emphasis on addictions and mental health

as part of primary care. It's not ignored, and certainly the newer practitioners

that are coming out are very conscious of tilting the balance to make sure that

mental health and addictions is included in every location where they practice.

MS. MICHAEL:

Right.

What I

would hope is that the work that's been done through the All-Party Committee and

through the recommendations would move us in that direction for a more holistic

approach to our health care, recognizing there are no compartments. You don't

put cancer over here and mental health over there, and something else somewhere

else.

MR. HAGGIE:

And that was clear from the

recommendations of the committee.

MS. MICHAEL:

Right.

MR. HAGGIE:

That was emphasized pretty

well on every page in some way or another.

MS. MICHAEL:

Right.

Thank

you very much.

CHAIR:

Mr. Kent.

MR. KENT:

Thank you.

Minister, the first specific question to budget lines that I'd like to ask you

relates to Allowances and Assistance. I suspect it has something to do with the

restructuring, but the amount budgeted this year is more than twice the revised

budget of last year. I am just wondering if you can explain why that would be.

MR. HAGGIE:

This is 3.1.01, line 09 is

Revenue, I presume, has fallen related to the expiration of a previous

agreement?

MR. HAGGIE:

MR. HAGGIE:

Yeah.

MR. KENT:

Okay.

What

about the child health risk assessments for school-aged children, can you give

us an update on that?

MR. HAGGIE:

The same, next spring.

MR. KENT:

And who would be responsible

for doing them?

MR. HAGGIE:

We are looking at community

level personnel but, again, we're trying to make that as user friendly as

possible so we don't restrict it to one particular kind of practitioner, given

the rural challenges we have with personnel sometimes.

MR. KENT:

What kind of deficits do you

anticipate the regional health authorities running this year compared to last

year?

MR. HAGGIE:

I'm hoping it will be zero.

MR. KENT:

I'll shake your hand if it's

zero.

MR. HAGGIE:

We have encouraged them to

do that.

MR. KENT:

I'd encourage my friends in

Gander to vote for you if it's zero.

MR. HAGGIE:

You have friends in Gander?

MR. KENT:

I don't have many friends

anywhere after the length of time I've been doing this work.

MR. HAGGIE:

I mean realistically

speaking, we have made the health authorities aware that they have a budget and

they're expected to live with it.

MR. KENT:

I don't want to put words in

your mouth, so I'll just ask a follow-up question. Do you anticipate the

deficits to be reduced?

MR. HAGGIE:

I would anticipate that as a

minimum.

MR. KENT:

Okay, that's good.

I don't

think that will be easy for the RHAs to achieve but I think it's a good goal,

and we'll see how that goes. Hopefully, I don't have to make phone calls to

people in Gander.

MR. HAGGIE:

I can give you some numbers.

MR. KENT:

I have a few, not many. It's

a lovely place, though.

I want

to talk about homes first, it's an initiative that I very much supported and

tried to find money for. I'm encouraged to hear recently that there has been

some money found for it. I feel like it fits very much with our previous close

to home strategy, and I know Eastern Health had a keen interest in pursuing

Homes First.

Can you

comment on what's envisioned as a result of the recent announcement? What will

that look like this year? Will it be specific to this region or will it be

province wide? What will that look like overall?

MR. HAGGIE:

Well, I think it's going to

look different in detail between an urban area and a rural area for sure. Some

of it, the challenge is to actually identify folk at a stage before they

decompensate. We had a discussion a little earlier about the rapid response

teams which, I think, were in the wrong place and a bit late.

MR. KENT:

Yeah.

MR. HAGGIE:

Essentially, my vision ties

in with the healthy living assessment in a sense that that's your screening

tool. What that would then do is allow you to identify those people who had

challenges and see if there are resources locally that can be employed to deal

with those.

It's a

very nebulous answer, but I think the answer is going to be very contextual in

terms of (

a) where you live and (

b) who you are. So something in the Member's

district in Cartwright L'Anse au Clair is going to have to look something

different than Nain or in Gander or, in turn, in urban St. John's.

I think

there are elements there in terms of the Home Support Program; there are

elements there in terms of social inclusion. We don't really have a mechanism

identified, for example, to deal with social inclusion; yet, that's one of the

biggest determinants of certainly mental, psychological well-being in the

elderly.

One of

the challenges I see with the Home Support Program is that a lot of the time the

hours equate to company and not necessarily care. We don't have a way of dealing

with that. I think there's a huge opportunity there for not-for-profits and

community groups to become involved.

MR. KENT:

I agree.

MR. HAGGIE:

I know in some areas there

have been small pilot schemes with the community hours, for example, from high

school students. What they've done is they've introduced them to personal care

homes, long-term care homes to put a link between the elderly and the young.

Whether that would work in downtown St. John's or Gander is very much dependent

on the environment there as well.

So it's

an approach and I think it also feeds into another element really, which is the

Health-in-all-Policies approach. These things aren't so much purely fiscal as

they're policy, they're social issues. It's sometimes very difficult to finance

and certainly almost impossible to legislate.

MR. KENT:

Agreed.

You had

previously committed to streamlining the financial assessment process for

community support services and long-term care services, which is a goal that I

do support. Can you give me an update on where you are in that process?

MR. HAGGIE:

That feeds into the home

support action plan

MR. KENT:

Okay.

MR. HAGGIE:

and that work is in

progress. I'm not sure whether that will be one of the first parts of an update

or whether it will be an announcement of a work in progress because, as you

commented on earlier on, there are sensitives around that.

MR. KENT:

I'd like to ask you a few

questions about long-term care but I suspect we'll run out of time. So I'm going

to let Ms. Michael continue with her questions and then I'll pick up where I

left off.

CHAIR:

Thank you.

Ms.

Michael.

MS. MICHAEL:

Thank you very much.

Continuing along with these types of questions; I do have some statistical ones

but I'll hold those. What we'll do is if the answers are in the briefing book

we'll look for them; if not, then we can go seek them rather than name them all

here. Some are general ones.

With

regard to the private paying of long-term care in 2017, will there be a fee

increase?

MR. HAGGIE:

There isn't one in the

budget.

MS. MICHAEL:

There isn't?

MR. HAGGIE:

No.

MS. MICHAEL:

Okay, because currently it's

$2,990 a month, I think.

MR. HAGGIE:

Yes.

MS. MICHAEL:

Yeah, so that's going to

stay.

MR. HAGGIE:

Off the top of my head, that

number is accurate and there's no plan to change it.

MS. MICHAEL:

Okay, great.

Thank

you very much.

A lot

of my questions, Mr. Kent has asked. That's why I sort of have to go into my

notes here. I'm sorry for the slight delay.

I'm not

sure this is something that the government could actually get a handle on, but

we would like to ask the question. Do we know the number of private paying home

care clients in the province, or is that something that's too difficult to

ascertain?

MR. HAGGIE:

A good question. I think we

can make a stab at finding out for you. It may be difficult but we'll make a try

and see.

MS. MICHAEL:

That would be good. It would

be very helpful actually.

Thank

Presumably, we would only be

involved with those people for whom we provide some financial assistance.

MS. MICHAEL:

Right.

MR. HAGGIE:

We don't know what we don't

know beyond that.

MS. MICHAEL:

Right.

Well,

you're going to make a stab at this

MR. HAGGIE:

We'll see. As I say, on

behalf of the staff, I honestly would have to make no promises there because

that may simply not exist.

MS. MICHAEL:

Right.

Okay,

thank you.

Again,

as I said, we have some statistical ones but we'll hold up on that.

In that

case, let's go to 3.2.01, the Grants and Subsidies, Building Improvements,

Furnishings, and Equipment underspent by $17 million last year and going up by

$2 million this year.

MR. HAGGIE:

The under spend was in

actual fact, was that the deferred revenues piece? Yeah, there was cash flowed

through to the RHAs which was used to offset those. So the budget piece from

2016 appears to be underspent. The work was done but the difference was made up

with deferred revenue from the RHAs.

MS. MICHAEL:

I'm not sure I'm clear on

what you mean.

MR. HAGGIE:

Okay. There was money flowed

through to the RHAs which was

MS. MICHAEL:

In 2016?

MR. HAGGIE:

In previous years.

MS. MICHAEL:

Okay.

MR. HAGGIE:

which was not utilized. So

the work was done but the RHAs were instructed to use what cash they had in

deferred revenue

MS. MICHAEL:

Got it.

MR. HAGGIE:

before they drew down on

the department's grant.

MS. MICHAEL:

Okay, that makes it clearer.

Thank

you.

Then

this year, what is the anticipation which has you putting an extra $2 million

over what you budgeted last year?

MR. HAGGIE:

The breakdown is in the

book, but essentially it's $20 million for Furnishings and Equipment, $10

million for Building Improvements, and $1.9 million for the EMR, which totals up

to $31.9 million.

MS. MICHAEL:

Okay, so all of that is in

the book.

Thank

you very much.

3.2.02,

could we have an explanation of the salary line there, please? It was underspent

by $573,600 and going back up by $505,000.

MR. HAGGIE:

We use staff from TW to

perform duties related to health care facilities. It was underspent last year

and the budget is an estimate of what is likely to be needed for the coming

year.

MS. MICHAEL:

Okay, thank you.

Under

Professional Services, again, there was a big under spend there and this year

going up radically. What ?

MR. HAGGIE:

The decrease essentially is

because some of the projects didn't go ahead. Weather, manpower shortage and

million, approximately, this year.

MR. HAGGIE:

Yes, similar cash flow

issues with projects. Again, it's probably better seen in a graphical display

MS. MICHAEL:

It's all explained.

MR. HAGGIE:

on the table at the back.

Again, if there's something that isn't self-explanatory we'd be happy to provide

some feedback.

MS. MICHAEL:

Thank you very much.

That's

it for the moment, Madam Chair. I may have a couple of more afterwards, but

we'll see what happens in further discussion here.

CHAIR:

Okay.

MS. MICHAEL:

Thank you.

CHAIR:

Mr. Kent.

MR. KENT:

Thank you.

I'll

start with long-term care. I would appreciate getting some current statistics on

Well, what we'll do is

MR. KENT:

I don't want to share with

Lorraine.

MR. HAGGIE:

we'll get two suitably

bound documents for you and your colleague as soon as we can.

MR. KENT:

Excellent. Okay.

wouldn't mind sharing temporarily, but two copies are probably more practical.

We've gotten a little more friendly since I've been over on this side but we

don't want to get carried away.

Has

there been any long-term care beds created in the past year?

MR. HAGGIE:

I'm not sure whether you

could say in the past year. I know Central Health repurposed 11 beds across its

region in the recent past from respite beds to permanent, long-term care beds.

terms of new builds; the new builds that you'd be aware of are the ones that are

(inaudible) the Corner Brook issue, and there is planning ahead for Central.

MR. KENT:

Can you tell us a little bit

more about the planning for Central? Will it be a similar model to what is

proposed for Corner Brook? Would it be the 120 beds that was previously

envisioned, or are you looking at something different?

MR. HAGGIE:

Well, there were two reports

for Central.

MR. KENT:

That's right.

MR. HAGGIE:

One of them predated the

other, and I think there was some debate or differences between the two. So at

the moment, staff have gone back and kind of asked them to update the numbers.

The

challenge in Central is it's physically the largest geographical region on the

Island. So the question then becomes one of distribution, because the big debate

of late has been about proximity to their community and travel for family as

much as actually accommodation itself.

there's always going to be a point where it's difficult to reconcile those two

competing economy of scale versus an economy of operation versus geography. I

think we would look to see what those numbers break down by community, and we

haven't got those finalized yet. It's coming in the near future.

MR. KENT:

Okay, thank you.

What

about Eastern Region? I suspect the wait-list in Eastern is I don't know if

it's still the longest, but I suspect it is. Is there a plan to expand the

number of long-term care beds in the Eastern Region?

MR. HAGGIE:

I think the short answer at

the moment is we've worked our way or between us from East to Labrador, to

West and back to Central. I think the issue of distribution of beds on the

Avalon is, again, something we would need to keep monitoring because, you're

right, the wait-list does fluctuate.

Our

current pressure points in terms of numbers in actual fact is currently

still Central.

MR. KENT:

Okay.

Switching topics completely, the PET scanner: Is there a new provider or is

there a new contract? I understand there was some time lapse with the original

proposal. I believe there was something new awarded in the last 12 months. Is

there anything to that? Has there been any change, or was there simply an

extension or renewal of the existing contract, or was there a renegotiation? Is

that something you can comment on?

MR. HAGGIE:

I don't have those details

quite honestly. I mean my understanding was that the scanner would be up and

running by May and that the cyclotron and isotope production would be online by

the fall. In terms of the contracts, I think I'd have to take a rain check on

has there been any progress made to create some more stability there?

MR. HAGGIE:

My understanding is that

Central Health has five physicians in the pipeline currently for recruitment

with various stages. Most of them, my understanding is and I don't know what

most means in this context have signed some kind of paperwork. One of them is

a Canadian trained obstetrician.

The

current obstetrician there is unavailable, certainly, for the next month or so.

In regard to other pieces of that puzzle, we have the midwifery project that we

mentioned earlier on, and Central Health would be part of that.

understanding at the moment is there are actually currently only two

obstetricians in Grand Falls. So it's important to be able to stabilize this

service across the Central district. My position has always been that we should

have vibrant antibaryon post-partum care in both sides.

MR. KENT:

Thank you.

probably need, Madam Chair, another 10 minutes. The clock has run out. I'll

pause to see if Ms. Michael has some additional questions.

CHAIR:

Ms. Michael.

MS. MICHAEL:

Thank you, Madam Chair.

Yes, I

do have one, in spite of what I said about statistics. You might have this one

because it is a bit of a crucial question. It has to do with people waiting in

acute care to get into long-term care. Do we have the numbers on those and the

percentage of acute care beds that are still being occupied by people waiting

for alternate care?

MR. HAGGIE:

I can provide you with a

snapshot set of data. I actually have one being passed to me currently. We have

those down at the bottom. Yes, okay.

We have

alternate-level-of-care patients here, but I don't have the percentage of those

that are waiting for long-term care beds. My experience is that as of March 31,

there are 285 people who are ALC, which represents 19 per cent of acute care

beds. Of those, traditionally and it varies by day and by jurisdiction, but

anything up to 50 per cent of those could actually be waiting for care in the

community. They may be waiting for a shower rail to be put in or a ramp to be

put to their front door rather than waiting for a long-term care bed.

MS. MICHAEL:

Right.

MR. HAGGIE:

It's unlikely they'll be

waiting for a personal care bed.

MS. MICHAEL:

Do we have any idea you

may not of that breakdown so that we can get a better idea of the ones who are

MS. MICHAEL:

Right.

No, and

we're interested in the long-term care because, obviously, it still remains a

problem. I don't have to tell you what's just happened in Gander with somebody

having to travel quite a long distance because of beds being needed in the

hospital for acute care. It still remains a big issue, as we know.

I think

I'll pause there.

CHAIR:

Mr. Kent.

MR. KENT:

Thank you.

Hopefully we'll cover it in the next 10-minute interval. I'll try and keep my

preamble short just like Question Period, although they don't let me up often

enough in Question Period. That's a whole other story.

Mr.

Speaker I'm practicing. Maybe I'll ask you something this afternoon, although

I don't think there will be anything left.

Minister

CHAIR:

You're in the wrong

profession, Mr. Kent.

MR. KENT:

Am I? My wife tells me the

same thing. We just don't have a good answer as to what the right profession is,

although I do need some professional help probably.

Air

ambulance, any new developments? I know the challenges. I know there's been some

controversy in the past year. I'm just curious if there's anything new on the

air ambulance file that you're willing to share with us at this point.

MR. HAGGIE:

Well, only that there is in

the binder an explanation of some variances in costs. Transportation and Works

have been challenged to keep one of their planes going and sometimes they've had

some crewing issues. So we've been outside and used the contracted alternative.

MR. KENT:

Yes, I'm aware of the

ongoing challenges with Transportation and Works and I believe there's a new

service delivery model required. Is that something that's still being explored?

MR. HAGGIE:

I think you'd have to ask

Minister Hawkins that in detail. We're simply the consumer of the product in

some respects. Certainly, from my point of view, I've made it plain that really

the Department of Health requires a one-number fix where you can ring and use it

in the instances where it is determined that air is the best form of

transportation.

The gap

in our service is nighttime and IFR rotary operations. We, in actual fact, are

very fortunate in having 103 in Gander because they fill that gap and they

actually do it at no cost to the province. So, in a sense, that may be an

opportunity rather than a cost.

We have

had discussions Transportation and Works and myself, our department about

how to ensure a reliable 24-7 service for fixed wing.

MR. KENT:

Okay. I'm glad to hear there

are still discussions happening on that.

Switching gears once again actually, let's stay on ambulances. I know there

were some previous questions by Ms. Michael related to Central dispatch and the

provincial ambulance service overall. It's another area where we've got a

challenging model and one that's not easily solved.

I'm

just curious if there any updates in terms of provincial ambulance service

overall, any changes coming this year, anything happening on that front?

MR. HAGGIE:

I think you're probably

aware that the contract with the ambulance operators I think expires this year

and we'll be starting negotiations again around that.

I think

if you look at the business model outside, it's tending to be a clumping of the

private providers. There have been some buyouts and changes over the last five

years which have consolidated the management structure of the bulk of the

private ambulances into two or three principal players as it were.

I think

really and honestly beyond that, I would see sorting out a provincial central

medical dispatch either in conjunction with the current 911 mechanism or through

some alternate would be the first brick, the first foundation in any changes to

the ambulance service. I think given discussions on a jurisdictional scan, there

is a feeling we could get better value for our dollar by looking at slightly

different ways of doing it.

MR. KENT:

I would agree with that.

Now,

switching gears completely, Steamplicity. I regularly get photos sent to me from

various people in various places in the health care system and some of them are

familiar situations that don't require any follow-up and others may require a

little more investigation. It's evident from some recent photos that

Steamplicity hasn't yet been fully implemented at the Health Sciences Centre.

I'm just curious what the status is and when you would anticipate a change in

food services at the Health Sciences?

MR. HAGGIE:

The problem with

Steamplicity, if I recall correctly and I'm sure there'll be people whispering

vigorously if I get it wrong was the challenges in getting the building sorted

out for the accommodation for the new equipment which, if I believe correctly,

is Mount Pearl, if I'm not .

MR. KENT:

I think it's Donovans, yes.

MR. HAGGIE:

Yes. So that's delayed its

implementation, but other than that the project is funded and is due to roll out

when those kinks have been ironed out.

MR. KENT:

Okay.

probably this year, certainly.

MR. HAGGIE:

Well, my understanding is,

yes, it will be over the course of this yea

Document details

Collection	Newfoundland and Labrador — Committees
Citation	2017-05-02
Type	committee
Volume / chapter	committees standingcommittees socialservices ga48 2017-05-02sscdepartmentofhealthandcommunityservices
Language	en
Format	html
Source	PROVINCIAL
Identifier	b8802c6f6c2185b1c678a05d3010e71523da6d8c

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