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May 11,

SOCIAL SERVICES COMMITTEE

The

Committee met at 9:03 a.m. in the Assembly Chamber.

CHAIR (Dempster):

Good morning, everyone. We'll get started.

Good

morning, Minister. I trust everyone is good on this beautiful spring day. I am;

it's the last Estimates for me. After chairing eight departments

MR. HAGGIE

Well, it's the first and

last for me for this season as well, hopefully.

CHAIR:

I'm especially good.

we'll start with the minister saying a few words, if he would like. Maybe we'll

preface that by having your staff introduce themselves, and then we'll have

people on this side introduce themselves. I don't think we have anyone subbing

in today.

AN HON. MEMBER:

Yes.

CHAIR:

Okay. Baie Verte Green

Bay, Mr. Warr for the record is subbing in for Carol Anne Haley for Burin

Grand Bank.

Minister.

MR. HAGGIE

Thank you very much, Madam

Chair.

I think

it would appropriate, as I seem to have a large number of bodies behind me, to

introduce them. On my right is Deputy Minister, Beverley Clarke; on my left

actually I keep forgetting your title off you go.

MS. JEWER:

Michelle Jewer, ADM, Corporate Services.

DR. ALTEEN:

Larry Alteen, Medical Consultant.

MS. TUBRETT:

Denise Tubrett, Assistant Deputy Minister, Regional Services.

MR. TIZZARD:

Mike Tizzard, Departmental Controller.

MS. HANRAHAN:

Heather Hanrahan, ADM, Professional Services.

MS. BATSTONE:

Angie Batstone, Executive Director, Regional Services.

MR. HARVEY:

Michael Harvey, ADM, Policy, Planning & Performance Monitoring.

MS. STONE:

Karen Stone, ADM, Population Health.

MS. ANDERSON:

Alicia Anderson, Executive Assistant to Mr. Haggie.

MS. WILLIAMS:

Tina Williams, Director of Communications.

MR. DAVIS:

Bernard Davis, Parliamentary Secretary to minister.

MR. COLLINS:

Sandy Collins with the Office of the Opposition, and Paul will be by in five

minutes. He is caught in traffic on the Outer Ring.

MR. REID:

Scott Reid, MHA for St.

George's Humber.

MS. MICHAEL:

Lorraine Michael, MHA, St.

John's East Quidi Vidi.

MS. WILLIAMS:

Susan Williams, Researcher, Third Party.

MR. WARR:

Brian Warr, MHA for Baie

Verte Green Bay, and I'm just about to leave.

MS. HALEY:

Carol Anne Haley, MHA, Burin

Grand Bank.

MS. PARSLEY:

Betty Parsley, MHA, Harbour Main.

MR. LANE:

Paul Lane, MHA, Mount Pearl

Southlands.

CHAIR:

Okay. So we'll hear a few

words from the minister and following that, I just want to remind people that if

your staff speaks, just start with your name for the purpose of the Broadcast

Centre downstairs.

MR. HAGGIE:

Thank you very much, Madam

Chair.

Essentially, the health care system is the largest and most important at least

I would argue of the systems we do manage as a government. Over the last 15

years, health care expenditure has gone from $1.5 billion a year to $3 billion

so it's doubled. That $3 billion budget for the Department of Health and

Community Services represents 35 per cent of the entire provincial budget

currently.

So from

our point of view, we are very conscious that we need to try and improve

efficiency, contain expenditures, yet manage to provide quality services at the

same time. So finding cost-effective and innovative solutions is important, both

in the short and the long term. That includes evaluations of what we do based on

outcomes so that we are doing things that make clinical and fiscal sense.

Through

the GRI, the Government Renewal Initiative, and budget 2016-17 processes, the

department, along with its four regional health authorities and the Newfoundland

and Labrador Centre for Health Information, as well as the Faculty of Medicine

at Memorial, have identified a number of potential saving opportunities that

will help improve the efficiency of how we do business, how we deliver health

care in the province.

preface the Estimates document, a

number of the variances contained in the

Estimates document can be explained with the same explanation under the

items on decrease in revenue from 2015-16 budget to the 2015-16 projected

revised. In the majority of the department's operating accounts, such as

Transportation and Communications, Supplies, and Purchased Services, there's a

decrease. This decrease is due to the department's expenditure management plan.

This was introduced initially in 2011-12 in an effort to reduce discretionary

spending.

The

department has successfully reduced its operating accounts by over 55 per cent,

or $2.3 million, since 2011-12. The following are some examples of the steps

that have been taken in the department to reduce those operating accounts. It

was the first department to implement a management print strategy, it's got an

established inventory control system for office supplies, we have a policy

regarding the purchase of food and refreshments for meetings and we've increased

the use of teleconferencing and video conferencing services to reduce travel.

Through these steps the department has become more efficient, but it hasn't

produced any impact on the services we provide as a department.

The

second item and second explanation that you'll find common to several pages is

you'll notice a decrease from the 2015-16 budget to the 2016-17 budget in the

department's operating accounts and the salary account. The main reason from

this decrease is due to the detailed line-by-line review that was completed

during this budget 2016-17 process. Through the review, the budget in a number

of areas was reduced to bring the budget in line with historical expenditures.

In the

case of salaries, the department has had a history of drop balances due to

vacancies and delays in recruitment. As a result, the salary budget was adjusted

through the line-by-line review. We'll continue to manage the department's

salary budget through those vacancies and delayed recruitment. In total, the

department has identified savings of $12.7 million in the line-by-line review. I

think those two explanations will pop up on a lot of areas. I thought it was

easier to introduce them at the beginning as a kind of theme.

Having

said that, Madam Chair, I think the time has come to hand it back to the members

of the Committee and yourself. We'll be more than happy to deal with the

questions as they come.

CHAIR:

Thank you, Minister, for

those opening comments.

I think

we'll go through each section; meander through, it's fairly long.

I'll

ask the Clerk to call the first subhead.

CLERK (Ms. Murphy):

1.1.01 to 1.2.06.

CHAIR:

Shall 1.1.01 to 1.2.06

inclusive carry?

Mr.

Davis.

MR. P. DAVIS:

Thank you.

Good

morning, Minister, staff, officials. There are a few familiar faces over there

from days gone by. Good morning, colleagues, and staff that join us on this side

of the House as well.

Thank

you, Madam Chair. I apologize for being a few minutes late. I had intended to be

here in lots of time before it started this morning but the Outer Ring Road is

the Outer Ring Road and when four cars pile into each other, that's what

happens. There's no getting out of it.

Minister, I apologize, again, for missing some of your introduction, but I did

catch your latter comments in regard to salaries. The very first item is your

own office. There is a fairly substantial reduction in the budget for Salaries

in your own office. Could you explain that one to us?

MR. HAGGIE:

Certainly.

We have

removed, effectively, three positions from the budget. The salary for the

parliamentary secretary no longer exists. The CA to the parliamentary assistant

was inappropriately charged to the department,

whereas it should be under the

House expenditures. There was a ministerial liaison position which had been

vacant since December 2015 which we have not refilled.

MR. P. DAVIS:

So your intention is not to

fill the liaison? That used to be a really busy office.

MR. HAGGIE:

It still is, we're just

working

MR. P. DAVIS:

But there's nobody there.

MR. HAGGIE:

We're just working longer

days for less money.

MR. P. DAVIS:

That was a real busy office.

And by the way and I meant to mention this, and I will your department,

obviously, is by far the most complex of any department and Estimates,

therefore, would be similarly complex. There are a number of areas that I wanted

to discuss in more detail with you today. My fear is that I may ask a question

that may not be in the right area or right category or the right subheading.

MR. HAGGIE:

Okay.

MR. P. DAVIS:

So instead of me asking you

every area for every subheading as we go along, if I miss one and there's a go

back to, I would trust you wouldn't have any difficulty with that. If we go

through a subheading and later ask about something and say, well, that was

already carried out in or that was already part of a

MR. HAGGIE:

I'll certainly do my best to

accommodate that, yes.

MR. P. DAVIS:

Thank you, Minister. I

appreciate that. I suspected you would.

well, under 1.2.01, under Executive Support, under Salaries again, a similar

circumstance there, about $150,000 change. Was that a position or positions

there?

MR. HAGGIE:

Let me just make sure I got

the right page. The salary budget in this area was decreased by year two of the

attrition plan and reallocation of funding to the new structure. So we have lost

$154,100 from the budget for that year.

MR. P. DAVIS:

Was that a position, then,

or positions? Under attrition plan then it would be

MR. HAGGIE:

I think it was I would bow

to, Michelle. Would that be you?

MS. JEWER:

It's not a position. The Department of Finance, through the attrition plan,

would have keyed savings from attrition in certain areas. But we don't know what

positions we're actually going to target until people retire. So we'll

reallocate salaries throughout the department when attrition becomes available.

MR. P. DAVIS:

So that's an expected

retirement I can refer to it as?

MS. JEWER:

Yes.

MR. P. DAVIS:

Okay.

What

level of eligibility for retirement exists under that salary heading? I don't

know how many positions there are. I'm assuming there are people who are

eligible to retire that you're expecting to retire?

MS. JEWER:

Pardon?

MR. P. DAVIS:

I would expect, then, that

there are people who are eligible to retire that you are expecting will retire

this year.

MS. JEWER:

Right.

In the

department I don't have the breakdown by division we have 26 employees that

are eligible to retire in '16-'17, and there are 12 positions underneath

Executive.

MR. P. DAVIS:

Okay, so 26 in the entire

department.

What is

the staff complement of the whole department?

MR. HAGGIE:

The total count is 208.

MR. P. DAVIS:

Is that pretty much where

it's been in recent years or is there no significant change?

MR. HAGGIE:

I would bow to people who have been in the department longer than I, but I'm

told not the past couple of years.

MR. P. DAVIS:

Okay, and 26 eligible to

retire. How many did you say in Executive Support? Did you give a number?

MR. HAGGIE:

Twelve.

MR. P. DAVIS:

Twelve. Okay.

MS. JEWER:

Actually, it's 15. Sorry.

MR. HAGGIE:

Sorry, 15. I misspoke.

MR. P. DAVIS:

Okay. And, of course, the

Employee Benefits and so on go on with that.

What's

Purchased Services under Executive Support?

MR. HAGGIE:

This area provides advertising- and communications-related activities for the

department. It also provides for meeting room rentals and taxis. That's really

what that head is. Some of it is regarded by us as somewhat discretionary. We

haven't got an advertising want at the moment but we weren't sure what the year

would hold.

MR. P. DAVIS:

Something may come up. Get

your flu shot or something.

Can we

move over to 1.2.02? Corporate Services is obviously a larger operation and also

a salary change there. It is more in line with what was revised for '15-'16.

Would that be more in line with vacant positions that haven't been filled or is

that what would I expect there?

MR. HAGGIE:

The revised decrease was

down to vacancies in Financial Services, IM and the MCP division in Grand

Falls-Windsor. Some of those have been filled.

MR. P. DAVIS:

So what's the change in MCP

in Grand Falls-Windsor?

MR. HAGGIE:

Three positions net loss.

The reasoning behind that was because they were essentially counter staff and

there's a very low walk-in volume in Grand Falls. Most of the staff there deals

with mail. The walk-in numbers were higher in St. John's. The alternatives for

folks there are call-in or online now.

MR. P. DAVIS:

So there's still staff in

Grand Falls-Windsor.

MR. HAGGIE:

Oh yes. Ninety per cent of the mail for MCP goes through Grand Falls-Windsor and

that's still a big part of the work there.

MR. P. DAVIS:

Minister, my thought on it

when I heard this that the walk-in service, there was very little uptake and

very little usage of it, was if there are other staff there and there's very

little usage, is that a function that other staff could do and just blend it

into existing staff?

MR. HAGGIE:

We looked at that. I think

the difficultly is in workload. The staff who are there in the mailroom, my

understanding is with the volume of mail, there really isn't discretionary time

to have them do a walk-in service as well. That was the rationale provided when

the discussion was had.

MR. P. DAVIS:

When you say there was low

usage, what kind of numbers would we be talking about? I don't know how long it

takes to process someone who walks into a counter or anything.

MR. HAGGIE:

My information was 10 a day

or less.

MR. P. DAVIS:

Okay.

When I

thought about it, I just thought, well, maybe someone else is doing work there,

and if it's only a small number of times during a day that someone walks in,

rings a buzzer, you stop what you're doing and you go out and serve the counter.

You're saying that wouldn't be possible.

MR. HAGGIE:

Well, it's a drop-box

service for folks who do want to walk in and leave material. There is a 1-800

number, there's an online number.

The

comparative really was the walk-in numbers in St. John's where, obviously, the

population is bigger but it was an order of magnitude greater. It was over a

hundred a day.

MR. P. DAVIS:

Okay.

I see

under Corporate Services the revised on Transportation and Communications was

about $100,000 higher and a similar Estimate, a little bit less, for this year.

What

does Transportation and Communications include under Corporate Services?

MR. HAGGIE:

We have significant costs

for telephone lines, teleconferences and postage.

MR. P. DAVIS:

Can the department explain

why it was higher last year than what was anticipated?

MR. HAGGIE:

Higher cost of postage.

Sorry,

I'm trying to work down the page here. I have some explanations.

MR. P. DAVIS:

That's fine. I understand.

MR. HAGGIE:

Higher cost of postage.

Volume and the costs have gone up over prior years.

MR. P. DAVIS:

When I went into Health as

the minister, it was five days before Estimates.

MR. HAGGIE:

You have my sympathy.

MR. P. DAVIS:

I relied heavily on the

people around you and the notes in front of you.

Minister, I see a reduction in Supplies, Professional Services and Purchased

Services. I just mentioned three of them; maybe you could just highlight those

for us as well.

MR. HAGGIE:

The cost of special office

supplies are funded out of this. We have tried to do our best through inventory

management to keep those costs down.

MR. P. DAVIS:

Professional Services, what

would that include? That's a significant reduction. There was little usage of it

last year but still a significant reduction budgeted for this year.

MR. HAGGIE:

The reduction, essentially,

is Professional Services within the Audit Services Division for appeals and in

Information Management for IT consulting services, both of which we don't

anticipate needing as much as in the previous year.

MR. P. DAVIS:

What kind of appeals would

that be?

MR. HAGGIE :

That is appeals for MCP payments and also NLPDP adjudications.

MR. P. DAVIS:

Okay.

So MCP

payments for practitioners, or would that be for billings?

MR. HAGGIE:

Practitioners.

There

is a contingency fund that was for federal-provincial-territorial agreement that

might arise during that year. There's $250,000 taken out of that because we have

felt there were no unbudgeted federal agreements, so we didn't budget the money.

So that's $250,000 of it.

MR. P. DAVIS:

Right.

that's the federal revenue. Is that the one you're referring to under the

revenue line below? There's $250,000 revenue from the federal government in

'15-'16 that didn't occur. It was budgeted and didn't occur, and not under

'16-'17.

MR. HAGGIE:

I think it might be wiser if Michelle explained this.

MS. JEWER:

Under Professional Services, there was $250,000 budgeted for

federal-provincial-territorial agreements that would come up during the year.

That's offset below by the $250,000 in revenue. So the net impact was zero. We

weren't using that budget, so we reduced Professional Services by $250,000 and

then reduced revenue by $250,000.

MR. P. DAVIS:

Got it.

Thank

you.

Under

Professional Services, the category of 1.2.03, there's about $175,000 change in

Salaries there. NLPDP doesn't come under this, right? Is this departmental

support or for NLPDP?

MR. HAGGIE:

Yes. This is the in-house support for the program, the administration of the

program, not the actual cost of the product it produces.

MR. P. DAVIS:

Yes, right.

NLPDP question should probably stay for 2.2.01, right?

MR. HAGGIE:

Right.

MR. P. DAVIS:

Salaries here under 01, can you explain the change from budgeted to revised and

also the new estimate?

MR. HAGGIE:

There are vacancies in Physicians' Services and the NLPDP office division. Some

of them have been filled and some of them haven't. So it's staff vacancies.

MR. P. DAVIS:

No staff reductions in the

area?

MR. HAGGIE:

No, recruitment is underway. Some of them are filled and some of them have not

yet been filled.

MR. P. DAVIS:

Okay. Thank you.

Professional Services under this category, can you explain that one? This year

$183,500, was $394,500 last year. It wasn't all utilized.

MR. HAGGIE:

There was $170,000 saved because it was funding that wasn't required for a

business analyst for the NLPDP. There was a management relationship with Bell

Canada for the Claims Adjudication System and these duties were handed over to

the director of pharmaceutical services for 2015-16.

MR. P. DAVIS:

Thank you.

Madam

Chair, it might be a good time to switch over to my colleagues, if you like.

CHAIR:

You're good with the ones?

MR. P. DAVIS:

Yes, I think, depending on

what they ask. I anticipate they might cover off the rest of it.

CHAIR:

Okay, all right.

Thank

you.

Ms.

Michael.

MS. MICHAEL:

Thank you very much.

Thank

you, Minister, and your staff for being here this morning. I look forward to the

rest of the time.

In the

interest of what you said in your opening statements, I'll be doing as my

colleague has done. I'm not going to be asking about small variations under

operations, unless there's a substantial one that looks like I'd want a response

to, both in the interest of time and knowing a lot of the answers are exactly

the same. So thank you for saying that in the beginning.

There

is nothing from the past ones that I need to add to. I think I have all the

answers. There just may be one in 1.2.03. I didn't quite hear the answer with

regard to the Professional Services and the variation there. So if you wouldn't

mind just repeating your answer. This is under 1.2.03.

MR. HAGGIE:

There was $170,000 which was

saved. The duties of a senior business analyst were absorbed by the director of

pharmaceutical services. The senior business analyst managed the contract with

Bell Canada for the real-time adjudication system, and the director of

pharmaceutical services took that role on this year in-house.

MS. MICHAEL:

Okay, great. That maintains

itself then.

Thank

you very much.

MR. HAGGIE:

You're welcome.

MS. MICHAEL:

On to 1.2.04 then; once

again, could we have an explanation of the Salaries first and indicting if

there's been a loss in positions through vacancies or attrition or whatever. I'd

like those details.

MR. HAGGIE:

There's a combination. There

were savings from the vote because of vacancies in the Acute Health Services and

Infrastructure divisions. The line-by-line would explain the decrease of 2016-17

from 2015-16. There are dropped balances in Salaries due to vacancies and delays

in recruitment.

MS. MICHAEL:

Again, in the interest of

time, I'm assuming because it's happened with all the other Estimates we

will receive your briefing notes for the Estimates?

MR. HAGGIE:

Yes.

MS. MICHAEL:

If that's the case, then

we'll get the details on how many vacancies and that would be in the briefing

notes.

MR. HAGGIE:

There are tables in here

that we're happy to supply.

MS. MICHAEL:

That's right. So I won't

bother to ask you that because if we're going to get the notes they'll be in the

notes.

MR. HAGGIE:

Yes.

MS. MICHAEL:

Great. Thank you very much.

Under

1.2.04, coming down to the Professional Services, a big drop there, $590,000

unspent under the revision and then this year only half of what was budgeted

last year; if we could have an explanation of that.

MR. HAGGIE:

They were less than budgeted

because we didn't avail of consulting work for acute care and long-term care.

The money that was spent relates to a shared services strategy and a supply

chain assessment, in addition to a HealthLine awareness campaign for the 811

number. The decrease is down to match historical expenditure.

MS. MICHAEL:

What was the impact of not

requiring the consultations that you had thought you would do?

MR. HAGGIE:

I think that was money that

simply was put there in case and wasn't spent. I couldn't speak to that because

I wasn't involved in the 2015 budget.

MS. MICHAEL:

Okay, thank you very much.

Under

Purchased Services, we have quite a drop there from what was budgeted last year.

Was there something special that was in last year's budget that was a one-off,

or ?

MR. HAGGIE:

There were reductions

because of the HealthLine advertising campaign, which we're not repeating. The

rest of it was down to the departmental expenditure management plan to remove

discretionary spending.

MS. MICHAEL:

Okay.

nothing to do with the HealthLine itself, but the advertising for the

HealthLine?

MR. HAGGIE:

Just the advertising. There

was a budgeted amount last year which was spent, which we haven't allocated this

year.

MS. MICHAEL:

Could we have a bit of an

update then on the HealthLine and the demand for it. Are you seeing that it's

being used well in the province?

MR. HAGGIE:

The utilization of the

HealthLine varies, but the average call volume is around 3,000 calls a month. I

visited Fonemed in actual fact when I was out on the West Coast. They have a

very impressive operation. They have successfully if you look at the calls

they receive, people who state that they need to see a physician or a primary

health care provider at the beginning of the conversation, 60 per cent of those

folks are manageable in other ways, usually self-care.

Some of

them then go on to have a recommendation that they seek advice from their health

care provider within a time period depending on the algorithm and the problem,

and about 10 per cent of them end up being recommended to go to emergency. So it

has actually had a significant impact amongst that population on emergency room

attendance (inaudible).

MS. MICHAEL:

Well, that's good to hear.

you're not going to be having an aggressive advertising program, will you be

monitoring the impact to see if there's a drop off of phone calls, et cetera?

MR. HAGGIE:

Part of the new contract with Fonemed includes cost per call and

performance-related issues like that. So, yes, the department will be keeping an

eye on that.

I see,

on a longer term basis, a much greater potential for using the line. I've become

quite a fan in the last little while.

MS. MICHAEL:

Right.

When my

mother was alive and I lived in the home with somebody who required a lot of

care, I had to use that a couple of times. That's a few years ago, but even at

the very beginning I found it was really excellent, actually.

MR. HAGGIE:

I mean it's very impressive from the point of view of the fact it's put a

significant number of jobs in rural areas. I didn't realize it, as a total

aside, but they're actually triaging patients for Alaska and Oregon from St.

Anthony.

MS. MICHAEL:

Right. Minister, last year

we had some discussion with regard to the Health Workforce Plan and there was

work going into that. Is that still happening?

MR. HAGGIE:

Yes.

MS. MICHAEL:

Could we have some details

on that in terms of the process?

MR. HAGGIE:

Maybe Ms. Hanrahan could give you the details from an operational perspective.

MS. MICHAEL:

Thank you.

MS. HANRAHAN:

The Health Workforce Plan was launched in July of last year. We have a

provincial committee involving the health authorities, MUN, CNA, NLMA; a

provincial, I guess, outlook. We've established 10 priority items that we're

working towards accomplishing. And those things look at leadership in the health

system, looking at our supply issues and where there are gaps, looking at our

attendance issues in the health system.

that's just a flavour. I won't go through all 10, but that's just a flavour of

the kinds of and we will provide a first-year update later in the spring.

MS. MICHAEL:

Okay. Thank you very much.

Moving

on then I just have to see where I am here. I have quite a number of questions

here; one in particular that I'm interested in. What is the timeline for the

implementation of the midwifery profession?

MR. HAGGIE:

The implementation working group has been struck. I don't have a firm timeline

on that. There're looking at best practices across jurisdictional scan and

trying to see what models would be most suitable for this province. I really

don't have a firm timeline. I anticipate something, hopefully, this year.

MS. MICHAEL:

Great.

I'm

just going to ask a question of clarification because you and I have both said

something different in public. This is not confrontation; I do want to get

clarification. I do have a decision direction note from the department that was

given to us when we asked for documentation. It's dated December 10, 2015, so it

was after the provincial election.

On the

last page of this note, on page 4, it says: The proclamation of the

Health Professions Act into force for

midwifery administerial approval of the regulations will not result in the

introduction of midwifery into the public health care system at this time. And

then there's a major redaction so I have no idea of what that sentence, the

implications. It implies a lot, but there's a redaction so I don't know. Then,

after that it says: Midwifery should be understood to be an add-on service that

would increase patient choice.

That

was the basis for my comment with regard to midwifery not being under the

regional authorities. Can you give me any update or any explanation of what's in

this note of the department?

MR. HAGGIE:

The delay in implementation was to allow expectant mothers and people who were

practising as midwives with a small m to make alternative arrangements.

Thereafter, the place of midwifery and how it's implemented across this

jurisdiction would really rather depend on the recommendations of the

implementation group, and then a funding model based on those recommendations.

So it's a multi-step process and that's probably the best answer I can give to

that just at the moment.

MS. MICHAEL:

Okay. Thank you.

I have

a lot of general questions, but I think what I'll do is I'm going to leave those

and just continue with the line by line for

MR. HAGGIE:

Okay.

MS. MICHAEL:

Oh, I don't have any more

time left right now.

Thank

you.

CHAIR:

We can come back to you, Ms.

Michael.

MS. MICHAEL:

We'll come back, yes. Thank

you.

CHAIR:

There are no more questions

on that section.

MR. P. DAVIS:

It's up to 1.2.06.

CHAIR:

To the end of the ones,

1.2.06, I believe.

MR. P. DAVIS:

I'm fine, if Ms. Michael

CHAIR:

Are you okay if Ms. Michael

finishes up that section? Then we call the vote on that.

MR. P. DAVIS:

Yes, absolutely.

CHAIR:

Okay. You can continue on

the ones.

MS. MICHAEL:

Let's see. I think what I'll

do is I'll wait. I may decide not to ask some of these so I'll wait. We can

continue on. When we get to the end of the 1.2

section oh, we're almost there,

are we?

Let's

do 1.2.05 first, okay?

CHAIR:

Do you have any more

questions up to 1.2.06 or can we call that?

MS. MICHAEL:

No, I do have. Yes, I didn't

realize you didn't have any more at all. Okay.

Under

1.2.05 then, which is Population Health I think the document, when I get it,

will show me the answer to my questions about Salaries. I guess there it's

attrition and vacancies also, so I won't bother.

OFFICIAL:

Yes.

MS. MICHAEL:

Under Professional Services

in 1.2.05, last year there was $655,000 budgeted, the projected revision was

$508,500 and now it's down to $120,000. So that's quite a drop.

Could

we have an explanation of what was required last year under Professional

Services that isn't required this year?

MR. HAGGIE:

The issue there was several.

There was a reduction in the budget as a result of the end of the contract for

the mental health anti-stigma campaign. That accounts for $300,000 of that

reduction. There's also been the environmental health strategy which didn't

occur, the methadone treatment policy and monitoring system has been delayed and

the secure treatment reviews in 2015-16 didn't take place.

That

legislation is under review for drafting. The all-party committee didn't spend

as much of its money as anticipated last year. I think because of the hiatus

around the election, quite frankly.

MS. MICHAEL:

Right. Well, the two things

you mentioned, in particular the environmental health strategy and the

methadone; are these not going to be done or are they part of the $120,000

that's budgeted for this year?

MR. HAGGIE:

They are part of the ongoing

budget. Those are still priority. Certainly, the methadone treatment program and

maintenance program is part of the ongoing work.

MS. MICHAEL:

Okay. Thank you very much.

I think

I have answers to some of the questions that are here in front of me.

Coming

back to 1.2.04, I will then ask a couple of my general questions. One is the

diabetes database pilot project at Western Health; what is the status of that

pilot project?

MR. HAGGIE:

I would defer to a member of

the staff for a more accurate update than my kind of 30,000-foot overview.

MS. MICHAEL:

Okay, thank you.

MR. HAGGIE:

Karen?

MS. STONE:

So that's no longer just a Western Health project; it's now a provincial

project. All the data has been validated, and we expect to be able to release

our first reports this spring.

MS. MICHAEL:

Right, thank you very much.

Minister, would your briefing notes include the following, and if not, could we

get these statistics I don't expect you to get them to now of the number of

personal care homes and beds by region in terms of the four health authorities;

the numbers of community care homes and beds as well; the number of nursing home

beds by region; and the number of people on the wait-list for long-term care bed

by region?

MR. HAGGIE:

There are some statistics in

your binder. There are the personal care home statistics; there are the

long-term facility beds and wait times. The others are not in the binder.

MS. MICHAEL:

Okay, but we could receive

them as well?

MR. HAGGIE:

I think it would not be too

difficult to find those for you.

MS. MICHAEL:

Okay, thank you. There's a

head nodding behind you, so

MR. HAGGIE:

Okay, so long as they're

nodding, I'm happy.

MS. MICHAEL:

You've got staff support for

your answer.

The

enhanced care in personal care homes pilot project, could we have an update on

that, please?

MR. HAGGIE:

The three pilot sites were

successful according to the evaluations I've seen. Patient satisfaction was

high. They dealt with and I better just check from memory exactly how many it

was, I think it was 24 24 clients, and basically we were pleased enough with

it to put money in the budget this year going forward to increase the number of

sites.

The

main limitation in the uptake was actually the geographical location of the

pilot sites. People were happy to avail of the idea, but they didn't

particularly want to go to those locations for family reasons.

MS. MICHAEL:

Okay, and will the notes

include the homes that are actually involved in this project?

MR. HAGGIE:

I think they're

OFFICIAL:

It's 100 subsidies.

MR. HAGGIE:

Sorry?

OFFICIAL:

It's 100 subsidies.

MR. HAGGIE:

Oh, the new homes, or the

existing homes in the pilot

MS. MICHAEL:

The existing and the new.

MR. HAGGIE:

Well, the existing ones are

in there. The new ones, we will have to wait, roll out, see what the uptake is

because it is discretionary and it's up to the care home operator to apply and,

as yet, that hasn't occurred.

MS. MICHAEL:

Okay.

I'll

have one more general question then. I could not let Estimates go without asking

for an update with regard to electronic medical patient records.

MR. HAGGIE:

There is uptake initially

from the work through the Medical Association. I think the first one certainly

went on stream in the fall, if I'm not much mistaken. I think it was in the late

fall. There are five more that I'm aware of who are in the pipeline. We're

trying to encourage uptake, but that's an issue for the NLMA and us. So it's

rolling out slower than I would like, but it's rolling out.

MS. MICHAEL:

Is the department and NLMA

working together on this?

MR. HAGGIE:

Oh yes.

MS. MICHAEL:

Right.

MR. HAGGIE:

And NLCHI.

MS. MICHAEL:

Okay, great. Thank you very

much.

CHAIR:

Okay, that's good; we're all

good on that section.

So I'll

ask the Clerk to call that.

CLERK:

1.2.01 to 1.2.06 inclusive.

CHAIR:

Shall 1.2.01 to 1.2.06

carry?

All

those in favour, aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, nay.'

Carried.

motion, subheads 1.2.01 through 1.2.06 carried.

CHAIR:

Shall 2.1.01 to 2.3.02

carry?

Mr.

Davis.

MR. P. DAVIS:

Thank you, Madam Chair.

Minister, is there any change in the seating allotments anticipated at the

Faculty of Medicine this year or in coming years in regard to its overall seats,

or any change in the ratio of Newfoundland and Labrador seats versus

international students?

MR. HAGGIE:

No.

MR. P. DAVIS:

No changes, okay.

There

is a change in fellowships and awards, a decrease. Can you explain that to me

and how that came about?

MR. HAGGIE:

Could I just get a little

bit of clarification? Are you referring to Memorial fellowship and other awards?

MR. P. DAVIS:

Well, I know they're under

the Faculty of maybe it doesn't come under this head. If it doesn't come under

this head, fine, we can park it, but I know there was a change in awards and

fellowships for students.

MR. HAGGIE:

That was a recommendation

from Memorial Faculty of Medicine if it refers to this particular budget. There

are some other bursaries and awards which come in later on, and I don't know

whether you are referring to that.

MR. P. DAVIS:

Is there a change in

bursaries and awards for students?

MR. HAGGIE:

For students for returning

service and recruitment initiatives, there is a change.

DR. ALTEEN:

There is a change in the

bursary program that we instituted back in 2014 that reflects more on increasing

the award to students who are going to more rural locations in the province and

for a three-year return of service commitments. That's to students and

residents.

In that

change in 2014, that's been implemented over the last couple of years, we

certainly have a fully utilized program this year. We just went through the

applicants recently, so those have been awarded this year. That's for students

who are going to wish to return to service in this province in various locations

and commit to being in that location for three years.

MR. P. DAVIS:

For two years?

DR. ALTEEN:

Three years.

MR. P. DAVIS:

Three years.

Dr.

Alteen, how far along in a student's progression in their studies would these

return to service agreements be put in place?

DR. ALTEEN:

We have two. We have one

that we put for the undergraduate medical education. So prior to your MD degree,

and I think there's about 30 of those that we have available each year. That's

for students who wish to, while they are doing their undergraduate medical

education, commit to staying in the province. It's not location specific.

When

you get into your post-graduate education, during your residency training, the

awards then occur in the last two years of your training, which is really when

most people are ready to make a decision as to where they might want to stay in

this province. That's where we focus the money in the program on.

MR. P. DAVIS:

It's full uptake as you

said?

DR. ALTEEN:

Pardon?

MR. P. DAVIS:

There's a full uptake in

utilization?

DR. ALTEEN:

Yeah.

MR. P. DAVIS:

I believe, if I remember

correctly, the NLMA partner assist in the

DR. ALTEEN:

There's another signing

bonus program where we utilize money that would normally go to physicians for

payment for providing services. We took some of the unused money out of the

2009-2013 agreement and did the signing bonus program. That's a separate

program.

That's

more to attract people once you finished your training and are interested in

coming to work in Newfoundland, and there are some requirements for that. That's

based on hard-to-recruit positions in the province, so where they've been vacant

for a period of time and the rural location.

MR. P. DAVIS:

While it's a little bit off

topic, but you raised it, what is the prevalence of hard-to-recruit areas in the

province today? Would you have that?

DR. ALTEEN:

It varies because a lot of

times it's based on geography and it's also based on the specialty. So there's

some specialties because of the subspecialization that's gone on in medicine

that have made it difficult, and I could take the example of general internal

medicine where we would need a number of those physicians in the province, but

training programs have geared more towards subspecialization in cardiology,

nephrology and so on. We've tried to encourage and this is occurring at a

national level as well to focus people more on the generalist approach to this

is what we probably need more in this province, and less subspecialization.

there are areas that are difficult to recruit but it varies from time to time.

It may be one location today and another location tomorrow. But the RHAs are

certainly trying to do a better job at focusing on our own grads. We've

increased our class size, and our first enhanced or enlarged class size will

come out in 2017 an extra 20 students a year and focusing on those and trying

to have those willing to go to various places in the province.

MR. P. DAVIS:

I believe that was the focus

and the intention, wasn't it?

DR. ALTEEN:

Yes.

MR. P. DAVIS:

When do they start to

graduate?

DR. ALTEEN:

2017 is the first graduating class. Then they'll have two to five, six, seven

years of post-graduate training after that.

MR. P. DAVIS:

We still hear, from time to

time, issues and complaints about some areas that I'm sometimes a little

surprised to hear, where people have trouble in engaging with a family doctor.

In Corner Brook, for example, not too long ago I heard concerns from Corner

Brook itself.

Are

there still urban areas like that which have the same challenges?

DR. ALTEEN:

There are still some urban areas, and Corner Brook is a prime example, where

we've done some work. But one of the challenges in some of these areas is

physical space for them to set up an office.

Most

physicians nowadays are not interested, necessarily, in the business of

practising medicine. They would like to go somewhere where they can hang out

their shingle, do their work and have somebody else look after the business

side. So we're doing some work and this is where primary care really comes into

play; some work in primary care where you may enhance that.

I think

that places like Corner Brook, Carbonear there's a few of them around the

province that we can do a better job of that. So I think primary care is the

real catalyst for making those changes. And most people want to work in a

collaborative practice with other disciplines. The day of the solo practitioner,

I think, has passed.

MR. P. DAVIS:

I know in rural parts of the

province we have clinics where the regional health authority would operate and

run a clinic and have doctors on staff to run those family practice-types of

clinics. So would that type of set-up be a potential future for somewhere like

Corner Brook?

DR. ALTEEN:

That's the challenge. Yes, in rural Newfoundland we do have those facilities

where we have the RHAs manage clinics and the physicians, be they salaried, they

would work in our facilities. But sometimes they're fee for service and also

work out of our facilities. The challenge is in urban centres it's not

necessarily been set up that way, but that's where I think primary care will get

us into a model where that type of thinking will occur.

MR. P. DAVIS:

Thank you.

Minister, if I can go to 2.2.01, which I think we're going to have a fairly

extensive discussion on because there are many concerns around drug programs. I

have a number of areas that I want to get some further information on.

I think

I'll start with seniors and over-the-counter drugs which we're hearing a lot

about. Can you give me a description or what changes are being made on coverage

for seniors who rely heavily on over-the-counter drugs?

MR. HAGGIE:

The change to the drug plan

under the NLPDP is essentially a withdrawal of over-the-counter drugs. It is

based on aligning the drug plan in this province with that of the majority of

our neighbours. We have been quite generous in the past.

MR. P. DAVIS:

What plan would that be

under, that the over-the-counter drugs are now available? Which of the

prescription drug plans?

MR. HAGGIE:

The only plan that remains

is a select plan where they're covered.

MR. P. DAVIS:

What plans did they have

before?

MR. HAGGIE:

It was available to all of

the plans under the NLPDP.

MR. P. DAVIS:

Do you know the total

savings anticipated on this, the total dollar amount?

MR. HAGGIE:

It's $2.6 million.

MR. P. DAVIS:

Are you able to tell me how

many patients and how many seniors were utilizing over-the-counter drugs under

the NLPDP or accessing over-the-counter drugs?

MR. HAGGIE:

One moment.

don't have that data with us.

MR. P. DAVIS:

You don't have that?

MR. HAGGIE:

No.

MR. P. DAVIS:

Would it be accessible? Would you be able to get it, do you think?

MR. HAGGIE:

Yes.

MR. P. DAVIS:

I see the chain going

MR. HAGGIE:

Sometimes I have to refer

MR. P. DAVIS:

Absolutely.

MR. HAGGIE:

because sometimes it's

difficult to figure out whether you can get that information.

MR. P. DAVIS:

I get the answer before you

because I can see behind you.

OFFICIAL:

You see the nodding heads.

MR. HAGGIE:

My children have left home

so the eyes in the back of my head have faded.

MR. P. DAVIS:

I don't want to make light

of it because we're hearing this a fair bit. We're getting response from people

throughout the province who are concerned about this that have been receiving

drugs. Some of them have, what they describe to them to be, fairly significant

drug costs.

What do

we tell them? What do we tell seniors who are saying I can't afford to purchase

these over-the-counter drugs which I've been told I need and should have and

have been approved under that plan. What do we tell those people?

MR. HAGGIE:

If, in the opinion of a

prescriber, a drug which is not funded i.e. over-the-counter now is

necessary, then there is a process under the NLPDP by which that request can be

assessed by a clinical panel.

MR. P. DAVIS:

I'm sorry, assessed by whom?

MR. HAGGIE

A panel for the NLPDP

process. It's a special authorization program process. I always get that last

word wrong.

MR. P. DAVIS:

So things like a doctor

prescribes vitamins, which we see commonly prescribed for, especially our aging

population, vitamins and other items that are prescribed regularly for ailments

that are quite common to our aging population. So those type of needed drugs

and I know from my own experiences with private insurance and special

authorizations, quite often they'll say, well, show us that you have this

prescribed and have been using this for a period of time and we'll approve it.

I know

I went through this recently when the provincial drug program changed. They

said, well, if you are looking for a drug that requires special authorization,

establish that it's been approved by the prior provider and we'll approve it as

well. So is that the type of circumstance that would happen here?

MR. HAGGIE

No, I think the test that I

understand would be somewhat more stringent. It would have to be related to a

diagnosis. So if you were looking for an iron prescription, for example, you

would have to have a clinical condition for which iron would be the therapy,

rather than simply a dietary supplement because you thought you'd have some iron

or vitamins, whatever it might be.

MR. P. DAVIS:

I always find these special

authorization processes and I'm talking about a private provider now. I always

find these special authorization processes to be time consuming and frustrating

from my own personal perspective, but I don't know how the NLPDP does that. What

would a senior who relies on these drugs how difficult would that process be

for that?

MR. HAGGIE

Well, simply it would be a

matter of discussing this at their next visit with their primary care provider,

whether it's a nurse practitioner or a physician, and going through on maybe a

drug-by-drug basis, if it's over-the-counter medication. This doesn't affect

other medications available under the plan; it's simply that category of drug

that is called over the counter. If, in the opinion of the prescriber, there was

a medical condition that required this prescribing, then a request could be

submitted through the special authorization program.

MR. P. DAVIS:

Okay. Thank you.

One of

the areas that we've heard from is personal care home operators who have

contacted us and said what's the change, what's being covered and what's not

being covered, and not wanting to get caught up in saying all of a sudden

they're stuck with bills or in a process that they can't get out of. We asked

for a list and got a listing that was fairly complicated. It didn't actually

provide a list of drugs. It was a lot of references look here and look here and

so on.

there a list available of what's no longer going to be provided under the

program or what would have to go through a special authorization program to get

approval? Is there a specific list of those drugs?

MR. HAGGIE:

Yes. In actual fact, the

Member for Conception Bay South had it in the House yesterday.

MR. P. DAVIS:

Yes, it's 64 pages of

references and material that: go here, look at this

MR. HAGGIE:

There is a list. It comes

out as a couple of pages.

MR. P. DAVIS:

Okay.

MR. HAGGIE:

We can provide you with the

link. It is just a pdf to download.

MR. P. DAVIS:

Yes, 64 pages of links I

think. I saw a lot of links that are on there. If you could have a look at it

just to see if there's a way to get it simplified, because what we had really

wasn't going to be much benefit to an operator or someone who's trying to make

these decisions because there was a lot of

MR. HAGGIE:

And that's a useful comment,

if there's a problem with the links to the website we'll fix that.

MR. P. DAVIS:

Okay, thank you.

My time

is up.

CHAIR:

Are you okay if I move to

Ms. Michael?

MR. P. DAVIS:

Yes, certainly.

CHAIR:

I gave you a couple of

minute's leeway because I did the same for her just now.

MR. P. DAVIS:

Yes, I just missed the clock

but I'm sure we're going to be on for a little while.

CHAIR:

Balancing out yes, no

problem at all. Then we can come back to

section two again, Mr. Davis?

MR. P. DAVIS:

Yes, absolutely.

CHAIR:

Okay, all right.

Ms.

Michael.

MS. MICHAEL:

Okay, thank you.

Just

for clarification, staying where we are with regard to the over-the-counter

drugs, I think most of what I wanted to ask has been covered.

For

example, I'm using an example here now, if somebody has been diagnosed with

osteoporosis and the supplement that you get supplements advise with regard to

calcium compounds that could be covered if a doctor shows there's been a

diagnosis of osteoporosis and the supplements are advised.

MR. HAGGIE:

The form can be submitted

and if the criteria are met, yes.

MS. MICHAEL:

Right.

I'll

just make one comment to say I understand the special authorizations and it's

really great, but when I look at the people who are affected by this change,

seniors, low-income people, sometimes people with low literacy levels, there's a

lot involved here that I think can become an impediment for some of them. I do

find this disappointing that this change was made.

Coming

on to one other thing well, actually it's the dental program. I'll save that.

It's the dental program I'm thinking about.

With

regard to the Smoking Cessation Program, Minister, is that program continuing in

2016?

MR. HAGGIE:

Yes.

MS. MICHAEL:

What's the uptake like in

that program in terms of numbers?

MR. HAGGIE:

That falls with Seniors,

Wellness and Social Development, the Smoking Cessation Program.

MS. MICHAEL:

Okay.

MR. HAGGIE:

The numbers, the minister there would be able to provide that for you more

accurately.

MS. MICHAEL:

Right.

I don't

know about you, and I don't know about Paul Davis either, but I am, on a fairly

regular basis, even having people stop me on the street and talking about

vaping. We're getting a lot of actually, I think this morning on CBC there may

have been a story about the whole thing of vaping as well.

MR. HAGGIE:

Sorry, I

MS. MICHAEL:

Oh, vaping, it's the

MR. HAGGIE:

Vaping. Sorry, I'm with you, yes.

MS. MICHAEL:

Okay, sorry about that.

MR. HAGGIE:

Yes.

MS. MICHAEL:

Okay. Yes, don't be afraid

to say. My voice drops. Usually it doesn't, but sometimes it does when I'm

thinking through something.

Are you

having any discussion in the department at all about it? There aren't any health

authorities anywhere, I don't think, in the country who are really dealing with

it. I don't know even what to think about it, because I have no idea and maybe

this is where research is happening right now. I don't think we have any

definitive word on what the impact of the nicotine is in another form. We know

the smoke, that's the one we've been used to dealing with, but is any discussion

going on in the profession or inside the department around the whole issue of

vaping?

MR. HAGGIE:

Yes, there is. Again, that's

being led by Seniors, Wellness and Social Development. I know they're very

active in this, and the minister and I have had conversations about it. So I

think there may be some developments in that line in the not too distant future.

MS. MICHAEL:

Okay, thank you.

That's

all I have for those two sections. So moving on, unless does Paul want to go

back to ?

CHAIR:

Well, it would be best, and

then we'll call that vote in the twos.

MS. MICHAEL:

Okay.

CHAIR:

Mr. Davis, did you have more

questions under this subhead of the twos?

MR. P. DAVIS:

(Inaudible.)

CHAIR:

Okay.

Are you

okay, Ms. Michael?

MS. MICHAEL:

Oh, no, I just realized I

have one question back to 2.1.01.

CHAIR:

Okay.

MS. MICHAEL:

Minister, you may be able to

give me the answer to this or not. It's not sort of a discrepancy, just on paper

we have very small change, as we've already noted, in the Grants and Subsidies

to the faculty; yet, in other budget documents outside of our Estimates, in what

we're calling the budget savings document, the 10 pages of all the different

initiatives under the budget and the savings. That document identifies

$1,778,900 with regard to savings in the operating grants under the School of

Medicine. So I'm wondering, those are savings, but the grant has remained the

same.

MR. HAGGIE:

Yes. They're offset.

It's a

question of funds in and funds out from different sources. So to offset those

savings, for example, the faculty collective agreement cut some of those savings

by over $900,000; accommodations for medical students and forecast for provision

of salary increases, then again offset by some current service level

adjustments. What you've got really is a shift of money, and the net effect is

what you see on that top line.

MS. MICHAEL:

Okay. Thank you.

For the

record, for anybody from the School of Medicine who may find out I asked that

question, I wasn't recommending the money to the Grants and Subsidies should be

lower. I just wanted to get an explanation of the discrepancy that seemed to be

there.

Thank

you very much. That's helpful.

That's

it now, yes.

CHAIR:

Mr. Reid, did you have a

question before we move out of that section?

MR. REID:

Yes, just in relation to the

allocation for Memorial University Faculty of Medicine. To go back to the

recruitment issues and the incentives being offered to medical students there,

just for my own information, could you explain the incentives that are being

offered.

Also,

in terms of nurse practitioners, are incentives offered to nurse practitioners

as well? Because I know in several circumstances in my own district, nurse

practitioners have provided a very good alternative to doctors.

MR. HAGGIE:

You're quite right. I think

the recruitment of health care providers across the spectrum is important. We

need a full suite of them.

I think

the department has something like 22 different bursary programs. They are aimed

at a wide variety of primary health care providers, and certainly nurse

practitioners are part of that suite.

There

are some for undergraduates prior to the end of their degree. In the case of

physicians, there are those for residents prior to the end of their

post-graduate training. The aim is to try and spread those incentives so we end

up with a balanced suite of health care providers.

addition to that, as Dr. Alteen referenced earlier on, there are signing bonuses

for, not just physicians, but other health care providers based on localized,

hard to recruit positions.

So the

short answer to your question is yes, we have a range of them.

MR. REID:

Thank you.

CHAIR:

Okay.

Can we

call two, or you're still in two?

MR. P. DAVIS:

I'm still up for questions

on two, yes.

CHAIR:

My apologies.

You

continue.

MR. P. DAVIS:

I think there might be some

questions back here, too, behind me actually.

If I

can go back to over-the-counter drugs for a few minutes; Minister, in personal

care homes, residents who are subsidized I would assume there are hundreds

throughout the province they're allowed to keep $150 a month for their own

personal expenses, clothing, hygiene products. Their grandchild may come to

visit and they want a gift for them. Their entire life expenses have to be made

under $150 a month.

Now

many of them, of course, if they need aspirin or if they use iron, because

they're trying to regulate their diet of course, they don't have a lot of

control over their diet in a personal care home because they essentially have to

rely on what's available to them. I know personal care homes try to cater to the

best they can, but in many cases we'll have seniors in personal care homes who

use iron, and laxatives they need to go with iron and so on.

It's

kind of hanging with me a little bit because I know lots of people in personal

care homes don't have any money left over at the end of the month and now

they're going to have this additional cost, for some may be a fairly big cost

for these over-the-counter drugs. I'm just wondering, what is your analysis or

determination been on what the impacts are going to be on these people?

MR. HAGGIE:

From a point of view of

data, it would appear on average that the cost of drugs under this plan to the

patient was around the cost of the medications themselves would be around $15

a month.

We are

aware of the issue of the comfort allowance. It's one of the things that as part

of a review of long-term care and the income and means testing for residents for

personal care homes and long-term care homes that the department is starting to

do some work on to see if there needs to be some adjustments, in the light of

the fact that a lot of those haven't been adjusted in some time.

MR. P. DAVIS:

Okay.

I would

expect we're probably going to hear that fairly quickly once the loss in drugs

and those extra expenses come. I hope that government is going to be well

positioned to adjust because a lot of them concern me. I have personal care

homes where I visit residents of my own. As you can probably appreciate, I'm

sure you do from your own history, sometimes when you visit them and they call

you aside and whisper in your ear and they talk to you about how tough their

circumstances really are. That's the ones we worry about.

I want

to talk a little bit about the Adult Dental Program. I know I asked you in the

House a little while ago about how many people utilized the dental program last

year. Are you able to give me that information today?

MR. HAGGIE:

Yes, 12,611 people accessed

the Adult Dental Program last year.

MR. P. DAVIS:

How many would have been

eligible last year but not eligible this year? Of those 12,000, how many of them

now are no longer eligible under the change in the program?

MR. HAGGIE:

We have 44,000-and-some who

are eligible under the new arrangements for the adult dental plan. If you

compare that with other jurisdictions, we're better than three and the same as

five more. So the exact number of which of those 12,600 are eligible under the

old rules and which would be eligible under the new rules, I couldn't give you

that figure.

The

utilization, in terms of numbers of the adult dental plan, has been pretty

consistent over the last three years, somewhere between high 11,000 and 13,000.

MR. P. DAVIS:

There have been comments in

the past that oral health and dental health is important to a person's overall

health. I know we had a short exchange in Question Period on it, but it's a

discussion that has come up to me a number of times by people who've either

utilized the program and now they feel different in their own lives, that

they're more willing to leave their home and go outside for a variety of

reasons, but it's added to the quality of life for them.

I'm

just wondering, do you agree with that, that adult or dental health, oral health

is important to a person's overall health and complements that. I expect you

would, but then what would be the impacts of people who are no longer eligible

and how will that impact them?

MR. HAGGIE

I think you can argue of

what level you decide to augment someone's plans, be it dental plan or drug

plan, and you have to bear in mind your ability to fund those.

The

facts of the case are we look after 44,000-and-some of the most vulnerable of

our population with a plan that is as good as, or better than, eight other

jurisdictions. I think, given the situation we find ourselves in financially at

the moment, whilst one might wish to do things differently, you have to live

within your means.

MR. P. DAVIS:

Yes, there's no doubt, you

have to live within your means. I appreciate that. I don't disagree with that.

It's the choices we make to live within our means are the ones that are worthy

of further discussion and any impacts on the people of the province.

Under

the 65Plus Plan, obviously, there would be benefits to seniors who have great

difficulties in making ends meet. People who rely on the GIS and the OAS,

obviously, they have to have both in order to be eligible for the 65Plus Plan.

These are our most challenging seniors who are trying to make ends meet. So

under the new policy and I'm seeking clarification, Minister. My understanding

is under the new policy people who have coverage under the 65Plus Plan would not

be eligible for dental care. Am I reading wrong?

MR. HAGGIE

The coverage is the

Foundation Plan only. There are some in long-term care who would also fall into

that plan who are outliers on the other plans, but it's a small number.

MR. P. DAVIS:

Okay.

people who are covered under 65Plus, the OAS and GIS won't be eligible for

dental care?

MR. HAGGIE:

Foundation, plus these

outliers only.

MR. P. DAVIS:

Okay.

The

same with the Access Plan, which are low-income families, they won't be eligible

for coverage either.

MR. HAGGIE:

Children are not affected by

these changes. The children's dental plan remains unchanged.

MR. P. DAVIS:

Remains the same, yes, okay.

So it's just adults and seniors.

I know

a couple of cases and I've heard the Premier speak about this publicly where

people have already begun the process. I'm told by people in the business in

dental care that this whole process can sometimes take many months, six months,

in some cases maybe up to a year to complete the process.

I've

heard the Premier make comments that people who've already had extractions and

so on, that they would cover them. Is that generally the policy overall now or

is that being done on an individual basis, or can someone who's already had

teeth extracted assume they're going to finish the program?

MR. HAGGIE:

Anybody who has begun

treatment prior to April will be eligible to have this completed under the old

criteria.

MR. P. DAVIS:

Good.

Thank

you.

I want

to move to prescription drugs, if I may. I know every year there are a number of

drugs that are removed from the formulary for one reason or another. Do you know

how many overall have been removed this year?

MR. HAGGIE:

I couldn't answer that

question offhand as to how many drugs we don't have it?

OFFICIAL:

(Inaudible.)

MR. HAGGIE:

No, we don't have the exact

number. I mean one of the challenges with pharmaceuticals is we budgeted $2.6

million for new drugs for this year. I think there's been much more enthusiasm

about trying to put drugs on, than take them off. There's a whole body of work

within the profession currently going on about what advantages new drugs may

have over old, and that's a professional discussion. I think it has to feed in,

and so we take advice from the Atlantic Common Drug Review, as I'm sure you

know, and the various national agencies that advise on cancer medications, and

medications in general, as to what to put on.

The

exact number that's come off, I couldn't give you at the moment but I'm sure we

could try and find that for you.

MR. P. DAVIS:

I know from my own

experience as well, that sometimes you'll find that with the one drug or a drug

taken off it's going to impact somebody somewhere or they say the new drug

doesn't fit their needs. Because quite often when drugs come off the formulary,

it's because something newer or better has come along or

MR. HAGGIE:

And the big debate there, to

go back to some debates I've had in the past, is that 80 per cent of new

medications are what are described by the pharmacists and the clinical

pharmacologists as me-too drugs. They are the same in terms of their therapeutic

abilities as older ones, it's just that because they're patented medicines they

cost a hell of a lot more than the older ones which have become generic. The

question, then, is: What is the science and what is the marketing behind the new

drug?

MR. P. DAVIS:

Right. Sometimes it's just a

better, more cost-effective especially.

MR. HAGGIE:

It's certainly more

expensive.

Now,

there is a big change in cancer chemotherapy, which our money, I think, will

probably end up going more towards this year, in that they're changing to oral

treatments for cancer medications.

The

advantage of that is that the current medications are given with a very

labour-intensive treatment with intravenous injections or infusions or ports or

extensive hands-on involvement. Now, if you can substitute those for oral

medications and pCODR, which is an acronym I can never remember, which is the

national body looking at this we may have more expensive drugs on the face of

it coming forward, but the service costs will be significantly lower because

these patients can take the pill at home rather than go to a clinic and have an

IV and this kind of thing.

MR. P. DAVIS:

Right.

MR. HAGGIE:

That's going to be a

challenge over the next year or so.

MR. P. DAVIS:

Thank you.

Can I

just add maybe one more and I think I might be finished on the Newfoundland and

Labrador Prescription Drug Program, if I may, Madam Chair.

The

other one is on catastrophic drugs. I know it's a very low number; very high

cost at times. Are there any changes in any of those circumstances?

MR. HAGGIE:

There are none. No.

MR. P. DAVIS:

Okay. Thank you.

That

was an easy one.

MR. HAGGIE:

Yes.

MR. P. DAVIS:

I think that's all I have.

MR. HAGGIE:

I just look for reassurance.

That was why I was slow speaking.

MR. P. DAVIS:

I was going to go on to

diabetic test strips and so on, but I don't want to use our time for that. There

are other items I want to get to instead.

CHAIR:

Would that be still in

section 2?

MR. P. DAVIS:

It would be, but I think we

can move on. Maybe if we have a half an hour or something leftover, which I

doubt

CHAIR:

Ask the generic ones then.

MR. P. DAVIS:

we can go back after, but

I'm fine.

CHAIR:

Ms. Michael, are you still

section 2?

MS. MICHAEL:

Yes, I have a couple of

questions.

CHAIR:

Okay.

we'll switch now to Ms. Michael.

MS. MICHAEL:

Continuing on with the

Dental Services. I was glad to hear you say that those who have begun the

process of getting dentures prior to April, that will be accommodated.

Has

that information been given to the providers? Because I am having people coming

to me saying I've had, very particularly, three different children of seniors

who have come to let me know they had gone through the process of having the

teeth removed because the dentures were going to be put in.

I've

had people this happened recently, over the last 24 hours, I think, on

Facebook, examples coming to me saying the provider has told them the funding is

not there. Have the providers, has the association been notified that this is

the case?

MR. HAGGIE:

Yes, is the short answer.

They've actually been notified several times. The folks on the end of the 1-800

line for any clients who might ring up have had that message for some time now.

I've

seen several mail shots, faxes, emails that have gone out to denturists and

dentists explaining what I explained to the Member opposite about how anybody

who was in the process of having work extractions or whatever that would then

lead on to denturists would be dealt with and they have. The old criteria

applied as long as it was done up to April of this year.

MS. MICHAEL:

That process had started.

Right.

I'm

really glad to hear that. Now I will start saying that officially as well.

MR. HAGGIE:

Thank you.

MS. MICHAEL:

From the minister.

As we

all know communications we think we've said it and said it and said it, but we

know that communications is complicated. So we have to continue finding all the

ways to get that message out. Thank you very much.

This is

just pretty straightforward. With regard to physicians, will your notes have an

update on currently the number of family physicians and specialists broken down

by salaried, fee for service and alternate payment arrangements?

MR. HAGGIE:

Yes, that is, in actual

fact, on page 45 and 74 of my briefing book.

MS. MICHAEL:

Wonderful. Thank you very

much.

How

many oral surgeons do we now have within MCP?

MR. HAGGIE:

Oral and maxillofacial

surgeons; we have four. Five sorry, I misspeak.

MS. MICHAEL:

Has that number gone up?

MR. HAGGIE:

Yes, we did have four. And

we've gone up incrementally over the last couple of years.

MS. MICHAEL:

Okay.

Thank

you. That's all I have for those two sections, Chair.

CHAIR:

Okay.

Mr.

Lane has a question.

MR. LANE:

Actually, I did have a

question, but I think Mr. Davis pretty much answered it. I was wondering about

the over-the-counter medications and some examples of what would be covered now

that won't be covered in the future. I'm assuming it's things like Tylenol,

perhaps laxatives, stool softeners, things like that. Is that basically what

we're talking about?

MR. HAGGIE:

There are a variety of

compounds or medications on that list usually bought over the counter for minor

self-limiting issues. It includes things like the medications you've referenced,

yes. That list, there seems to be some difficulty getting it, but we can make

sure that you have that.

MR. LANE:

Okay.

I would

just say I'm glad to hear that there is going to be review in the department

over the issue, because I do share the concern that Mr. Davis raised about the

seniors in a nursing home with only $150. I have a senior in my life in that

exact circumstance; I know how tough it is. Quite frankly, in her particular

case, she's lucky that she has me to supplement what she has to make sure that

she's never without, but I do think about seniors who don't have family members

that could do that.

MR. HAGGIE:

That was our thinking too.

MR. LANE:

Thank you. That's all.

CHAIR:

Okay, are we okay if we call

the headings now for

section 2? Yes?

CLERK:

2.1.01 to2.3.02 inclusive.

CHAIR:

Shall 2.1.02 to 2.3.02

inclusive carry?

All

those in favour?

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against?

Carried.

motion, subheads 2.1.01 through 2.3.02 carried.

CLERK:

3.1.01 to 3.2.02 inclusive.

CHAIR:

Shall 3.1.01 to 3.2.02

carry?

Mr.

Davis, Ms. Michael had left about seven minutes on the clock. Are you okay if I

start there or do you want

MR. P. DAVIS:

(Inaudible.)

CHAIR:

You're okay with that? Okay.

ahead.

MS. MICHAEL:

I'm starting, am I?

CHAIR:

Well, I was going to give

you your seven minutes that you had left on the clock and come back to Mr.

Davis.

MS. MICHAEL:

Very good. Okay, thank you

very much.

3.1.01,

starting with Professional Services; we have an increase of $300,000 in this

year's budget over last year's budget and revision. Could we have an

explanation?

MR. HAGGIE:

Yes, of course you can.

The

changes here are a contract for Institute for Quality Management in Health Care

for lab accreditation. It's been transferred from the Grants and Subsidies line

to the Professional Services line. The contract is per a Cameron recommendation.

The move was done as a result of an internal audit in government to show that it

should be accounted for in a different line.

MS. MICHAEL:

What was the contract,

Minister?

MR. HAGGIE:

It's for lab accreditation

for the Institute for Quality Management in Health Care. It's a $300,000

contract to ensure that national standards across the RHA labs are met and that

they are accredited. And this was a recommendation from the Cameron inquiry.

MS. MICHAEL:

Mentioning Cameron, it may

be a good time just to ask, we haven't had an update in recent times on the

various recommendations. I don't have it in front of me because there were

different times when some reports were going to be due, and I really haven't

looked at that document lately. So where are we with regard to the

recommendations?

MR. HAGGIE:

We can provide you with

that; that's no problem. The current one that's still being worked through is to

get all three hormone receptors done at the Health Sciences Centre. And the view

of the laboratory physicians there is until all three can be done there, they

all go out to one accredited laboratory. So they're all done in the same place.

They're

nearly there with the third one, but it's not quite ready to go operational yet.

MS. MICHAEL:

Okay.

Any

timeline for that, Minister?

MR. HAGGIE:

This year.

MS. MICHAEL:

This year. Okay, great,

because we do continue to get questions on that also. Thank you.

Under

Purchased Services there's an expenditure line now that wasn't there before, so

could we have an explanation of what this is, the $5,075,000?

MR. HAGGIE:

Okay.

Again,

Professional Services and Internal Audit have suggested moving line items into

here from other areas. So the air ambulance contract with PAL, which is $1.85

million; the HealthLine contract with FONEMED, which is $2.89

million-and-change; and interpreting services for visual sign language is for

persons with hearing or visual impairments for the RHAs those have been moved

in as an accounting change on the recommendations of the Internal Audit.

MS. MICHAEL:

Okay, great. Thank you very

much.

Mentioning the ambulances, I'll ask this question now. When will the central

medical dispatch centre for ambulances be set up?

MR. HAGGIE:

There is a report being

generated by a consultant on what central medical dispatch should look like, or

could look like in the province with some options. We have not yet received that

in the department. It is expected that we will receive that in the near future.

Once we've done that, then we can look at what the recommendations are, how that

would fit, and how we move forward with that. So we're still at the stage of

waiting for that report to be delivered.

MS. MICHAEL:

Okay, thank you very much.

Moving

down then to 09, Allowances and Assistance, there was a big drop from the budget

to the revised estimate of $993,600 and now in this year's budget we are

$379,000 under what was budgeted last year. So just an explanation, please.

MR. HAGGIE:

There is a list of savings

under there. The medical resident bursary incentive program uptake was lower

than anticipated and we saved $312,500 there. There was a lower than anticipated

use of signing bonuses for difficult-to-fill RN positions. That saved us

$281,100. The Medical Transportation Assistance Program didn't use $400,000.

That's a total of $993,600.

MS. MICHAEL:

Okay.

What is

the impact of this year's budget being $379,000 less than last year's?

MR. HAGGIE:

We have reduced the

bursaries in line with utilization, so there have been reductions in the

Bachelor of Nursing Bursary Program, the Signing Bonus Program and the

Provincial Physician Bursary Program.

MS. MICHAEL:

What do you see as the

impact of having fewer bursaries?

MR. HAGGIE:

Well, these were

underutilized so we've matched our budget ask or vote to the previous year's

expenditure. Obviously it's something we're going to have look at over the

course of the year and see how that rolls out; but again, given the financial

circumstances, money that was left as it were or dropped, it seemed sensible to

budget as prudently as we could and then go forward to see. The answer is it's

unknown.

MS. MICHAEL:

Okay, but you will be

monitoring, that is what is important.

MR. HAGGIE:

Oh yes.

MS. MICHAEL:

Thank you.

I'm

almost down to I only have 23 seconds left and I suspect Paul may be picking

up on some of my questions. If not, I can come back to them.

Thank

you.

CHAIR:

I was going to suggest a

five-minute break. Is that the wishes of the committee

MS. MICHAEL:

Good idea.

MR. HAGGIE:

That's fine with me.

Thank

you.

CHAIR:

and then we will come back

and start with Mr. Davis.

Recess

CHAIR:

All right.

Minister.

MR. HAGGIE:

Oh right, thank you. Sorry

about that.

misspoke earlier on. The savings from the over-the-counter changes is $3.3

million, not $2.6 million.

CHAIR:

It's $3.3 million, not $2.6

million.

MR. HAGGIE:

My apologies.

CHAIR:

Okay.

we'll start with Mr. Davis. We'll start the clock.

MR. P. DAVIS:

Thank you.

number of areas under this heading, Minister, I'm sure you appreciate I want to

go, but I just heard your discussion before the break regarding bursaries for

RNs. It was underutilized as I understand. Would that be right?

MR. HAGGIE:

Yes, it was.

The

Bachelor of Nursing Bursary Program was underutilized in previous years by

$281,000.

MR. P. DAVIS:

So is that a bursary program

for hard-to-fill positions?

MR. HAGGIE:

No. The Signing Bonus

Program was underutilized by $281,000. I don't have a figure about the Bachelor

of Nursing Bursary Program in terms of how underutilized that was, but it's been

reduced by $74,000 in the coming year.

MR. P. DAVIS:

So the signing bonus would

be for hard-to-fill positions.

MR. HAGGIE:

The signing bonus is for

hard-to-fill positions.

MR. P. DAVIS:

Am I to take it, then, those

are positions that still remain unfilled?

MR. HAGGIE:

Good question. There are

some vacancies still within the RHAs for RNs. The exact number I think is in one

of the tables in the binder.

Okay.

No, we'll have to provide you with that number. It's not in the staffing table,

my apologies.

MR. P. DAVIS:

My point, I guess and you

can comment if you're in a position to. If you're not, I understand. My thought

on the Signing Bonus Program, this is about hard-to-fill positions, similar to

physicians, trying to go fill those vacancies. Instead of reducing the budget, I

would have thought you would give consideration to increasing the signing bonus

or find a way to incentivize nurses to go to those hard-to-fill positions

instead of leaving them vacant. But to eliminate it seems like we're not making

any strides to help fill those difficult positions.

MR. HAGGIE:

We haven't eliminated it,

we've simply reduced it.

MR. P. DAVIS:

Well, reduced it.

MR. HAGGIE:

I think the issue of a bonus

from a philosophical point of view for signing is a moot one. It may help with

recruitment but it doesn't often help with retention, and therein lays your

challenge.

I think

if you go back to the whole concept of workforce planning, there are some

adjustments that probably need to be done in the light of that report, when it's

available. It may be wise to revisit these programs once that workforce plan has

been generated.

MR. P. DAVIS:

Your comment on recruitment

and retention is interesting, because I always felt that if you're able to

recruit somebody, then you have an opportunity to retain them. I remember a

Newfoundland movie not that long ago that dealt with that very thing.

I know,

personally and as you said it I'm thinking of a teacher who I know as a young

graduate from Memorial went to Black Tickle teaching. Not because she wanted to

live in Labrador, but because she wanted to gain employment as a teacher and

start her career. And 15, 16, 17 years later she's still teaching in Labrador,

not because she has to, but because she wants to. That's part of the recruitment

and retention process.

So I'm

just obviously interested. Any time there's a vacancy, I know it's a lot of work

to try and recruit for those, but I believe that sometimes recruitment turns

into retention as well.

wanted to move to another area. I know you received an email from a gentleman

and he's told me I could, he's been talking publicly as well Stephen Chard. He

got a response back from your office that at least your office has received the

email.

lives in Bonavista. I don't know if you're familiar with the case offhand but a

complex case. An 11-year-old son who has complex health needs: cerebral palsy,

epilepsy disorder, infantile spasms he references, which you likely know more

about than I do. He has a G-tube. He says he's had pneumonia maybe twice a year

his entire life and in his email to you he outlines he's had probably 80 to a

hundred X-rays since birth.

He has

explained I've spoken to the man and in the interest of full disclosure I know

him before now. He's a man who feels that the change in the X-rays, in his

particular case and others potentially as well, is going to have a significant

impact on his family and the potential health of his child.

question to you about this is that when you have a case like this in Bonavista,

is it really worthwhile from a health perspective for patients and also from the

cost perspective, not to keep the X-ray services there and those extended hours?

MR. HAGGIE:

The challenge and one of

your colleagues opposite brought it up in a rather general way during one of his

comments on the budget was that we accept, he said, that you can't have

everything everywhere. The problem is and the question is how you have that

line, if you like, or that delineation of services.

It's

been a difficult exercise going through the budget. I think the honest answer is

these changes are based on recommendations that have come from the operational

end of the RHAs and they're based on utilization statistics, basically. They are

based on, among other things, location, they're based on the busyness factor and

they're based on the proximity of alternative sources of care.

I think

you will always find, as you referenced earlier, there's someone who is going to

be impacted. That is an unfortunate fact with health care.

MR. P. DAVIS:

I know the X-ray changes

that are, I think, in Whitbourne, Old Perlican, Placentia, St. Lawrence, Grand

Bank and Bonavista I suppose it could be that in Grand Bank there's not that

great a distance, I don't think, to access X-ray services. But, in particular,

Bonavista and this family, one of the questions that he was asked is: Are you

willing to move. This is a man who, within the last five years, built a home

specific for his son's needs. They have their family supports around them which,

of course, alleviates pressures on the health care system.

One of

the points he made to me when I spoke to him was that in likelihood now, when

his child has been transported by ambulance before, a nurse has attended with

him. Now that the X-ray services are not in Bonavista, this could fairly

frequently occur where he has to be transported by ambulance from Bonavista to

Clarenville and, at times, he's been moved on to the Janeway. It's going to mean

extra resources for ambulance transfers, RN to travel with his son and so on.

He's questioning even if the savings will be realized because of his personal

circumstance.

Now,

they may not exist in any of those others areas, but at very least, Minister,

what I would ask of you is: Would you review this person's personal

circumstances, apply it to the change and then reconsider that change if the

case meets the needs or makes the case that yes, this is not a good reduction of

service for this particular area?

MR. HAGGIE:

I recall reading the

gentleman's letter and passing it over to staff for some comment so I could

respond to him, and, of course, we will do that. It's not like there will be no

X-ray services in Bonavista. What you're looking at is a reduction in hours.

The

evidence from the operational review, as I understand it, is that there are

actually very few urgent X-rays that have to be done outside the hours that are

scheduled; and, by and large, under those circumstances, the patients have a

clinical problem that is such that they would need a higher level of care

anyway. So that transport, that move would have taken place anyway.

Yes, I

will certainly undertake to look at the gentleman's correspondence and respond

to him. The facts of the case are whatever changes as you alluded to before in

the provision of health care you make will impact somebody.

MR. P. DAVIS:

I know you appreciate as

well that sometimes one size doesn't fit all. There may be modifications needed

to larger plans because there are those individual circumstances that should be

addressed. I appreciate that. Thank you, Minister.

Minister, if I can go to home care. There are some changes in home care this

year. Can you give me just an overview of what changes are taking place?

MR. HAGGIE:

I'm trying to find the

appropriate page here. I'll be with you shortly.

MR. P. DAVIS:

Yes, certainly.

MR. HAGGIE:

The home care programs that

we referenced in the budget were three. There was the enhanced home care

project, which the previous minister of Health had run as a pilot in three

sites: Golden Meadows, Gander and one other, which escapes me. They had been

very successful.

There

is money in the budget now to clone that and offer that service to other sites

to accommodate an extra 100 clients who would fall into the so-called level

two-plus, which would keep them hopefully from needing long-term care.

There

is a home first strategy, which is a more comprehensive one, which will roll out

over the course of the coming months and year which is designed to allow people

to age as near to home as possible. Then there are also some enhancements to OT

and PT services in the community to allow for folk who need those services to

stay at home rather than necessarily going into a personal care home.

those are the changes from a kind of strategic level that we have proposed.

MR. P. DAVIS:

I would think that the paid

family caregiver program would be part of that.

MR. HAGGIE:

The paid family caregiver

program is in there and has not changed.

MR. P. DAVIS:

Okay.

based on what you're saying then I would think that there is a possibility there

could be some expansion or continuation or extension of the paid family

caregiver program.

MR. HAGGIE:

That has not been on our

radar currently. It is there and I actually haven't seen an evaluation in terms

of the uptake of it, the benefits of it or the cost as yet.

MR. P. DAVIS:

Okay.

Any

changes on budget on the paid family caregiver program, do you know?

MR. HAGGIE:

No, there wasn't in this

year's budget. I was confused about some changes to minimum wage or is there a

consequence of minimum wage in home care, but no.

CHAIR:

Mr. Davis, seeing the time

on the clock, are you okay if we shift over?

MR. P. DAVIS:

Yes, absolutely.

CHAIR:

Ms. Michael.

MS. MICHAEL:

Thank you very much.

Minister, with regard to the Grants and Subsidies, basically the operating money

that the regional authorities receive, obviously pressure was put on them to

come up a variety of measures to save money because government wanted money

saved within the health care. There's no doubt that some of the measures they

came up with are efficiencies and efficiencies that may or may not directly

affect people's lives. Those are good. There are things I look at and I say,

well, that's a good idea.

When

the efficiencies come down to changing of services, the shutting down of some

services or lessening services, whatever, which do affect people's lives, I have

a problem. I'm wondering, in doing the exercise they had to do as the regional

authorities, did they sit with the department during that process and were the

discussions around, well, is that measure a good one in terms of impact on

people, or did the authorities just do this on their own without any

consultation back and forth between them and the department?

MR. HAGGIE:

It was a bilateral

discussion. We, in broad-brush terms, went to the RHAs as operational deliverers

of health care and said where would you see reasonable, reasoned economies to be

found. They brought back a suite of options and suggestions. Some of which were

fleshed out and some of which weren't. Some of which were feasible in the short

term and some of which required more implementation and mitigation planning.

What

you saw in the budget was those that had a combination of being accessible and

utilizable in the short term with mitigation or alternative strategies, which

really focused on trying to realign services where possible. There are ongoing

discussions about how and what should be done next, but essentially the key

message was to find efficiencies in operations, savings where you could, in

terms of the purchasing and the kind of backroom activities.

But as

far as the front end, front-line services, my instructions and my request was

that you looked at programs critically and said what is it that works, what is

it that you need, and what is it that you can't afford and that won't work and

is more of a want than a need. That was the hierarchy that was suggested to

them.

MS. MICHAEL:

One of the areas, and you've

just made an allusion to it, where I think money must have been saved would be

with regard to shared services between the authorities. Could you give us an

idea of how things are going, what exactly right now are the services that are

being share and where money is being saved in the sharing of services?

MR. HAGGIE:

Well, on a general level,

things that have been implemented revolve around buying groups. We have those in

place for, if you like, consumables such as dressings and the like. And also

there is a second buying group nationally, CAPsource, which is aimed at more

capital equipment. Currently, we're looking at ultrasound machines and

anaesthesia machines. We estimate for each anaesthesia machine, purchasing

through CAPsource will save us $50,000 per machine approximately. For each

ultrasound machine, we could save probably somewhere in the order of maybe

$30,000. Those are ballpark and I may be out a little bit.

As far

as a shared services organization or a shared services structure within the

RHAs, what has happened is the feasibility of this has been looked at. It was

felt that there were certainly four areas that were worthy of consideration.

Each of those four areas is a little bit more advanced. What has happened is an

implementation group looking at how to put in place a shared services model, and

the furthest advanced is that of purchasing and reconciliation of accounts in

that line.

The

other areas of interest which are a lot less fleshed out rely around payroll and

HR. They run around issues of IT. Those are not as well developed; they're still

in a concept stage. There is work being done in the department with some inside

resources to address these as well as a small body who've been tasked to become

a shared services team with a view to moving that forward.

MS. MICHAEL:

Right.

Do you

have a dollar figure for the savings that have happened with regard to the

shared services around the buying of consumables, for example?

MR. HAGGIE:

Denise, do you have the

number?

MS. TUBRETT:

We've saved significant

money through Health PRO and

CAPsource. The minister has referenced the money that we've recently saved per

anaesthetic machine. I think the cumulative savings on Health PRO

is in the order of $20-odd million. That's fairly substantial when you consider

that's savings that we get just by purchasing

MS. MICHAEL:

Could you repeat the amount

again?

MS. TUBRETT:

It's over $20 million.

MS. MICHAEL:

Okay, over $20 million.

MS. TUBRETT:

I don't have the exact

number with us.

With

respect to a shared services model, the work that we're doing with respect to

the shared services organization is based on work that Deloitte had done. They

estimated it's in the order of about $25 million once fully implemented, but

that's the work that we're currently doing trying to validate the savings that

can be achieved, actually achieved.

The

bulk of that $25 million is about another $12 million to $14 million associated

with buying differently. That's an overview of that.

MS. MICHAEL:

Great. Thank you very much.

It's

probably in your notes, and if so, then we'll get it when we see it, but I'm

just interested in what was the number of recipients by region of the MTAP, the

Medical Transportation.

MR. HAGGIE:

We have a number in the

binder but we don't have it by region. We could 2,993 unique patients in

'15-'16 went through MTAP, but we don't have that broken down by region. We can

find out for you.

MS. MICHAEL:

We should we able to get

that though, the regional, can we? Yes.

MR. HAGGIE:

Certainly by Island versus

Labrador.

MS. MICHAEL:

Right. Okay, that will give

us an idea.

MR. HAGGIE:

Because it's administered

provincially. I don't know whether that granularity would exist easily in terms

of which region within the Island.

MS. MICHAEL:

Right. Thank you.

And,

Minister, which clinics are closing because of the budget?

MR. HAGGIE:

There are a couple of

clinics that are only open on a part-time basis. There was the one-day-a-week

clinic in Hare Bay. They have two other clinics in very close proximity. There's

one in Carmanville which again, is not far from Gander or the Gander Bay clinic

and there's one which was only open two days a week in Hermitage. The patients

there would go on to Connaigre in Harbour Breton.

MS. MICHAEL:

Okay. None of these would

have been a diabetes centre.

MR. HAGGIE:

These were rural primary

care sites with visiting services.

MS. MICHAEL:

Right.

Okay.

Still under 3.1.01 just give me one second, please.

I think

I can move on to 3.2.0.1.

CHAIR:

Maybe given the clock, if

you want to just go back to Mr. Davis and then we'll start first with you.

MS. MICHAEL:

Yes, that will be fine.

CHAIR:

Okay. Thanks.

MR. P. DAVIS:

Thank you, Madam Chair.

wanted to talk about Medical Transportation Assistance Program. We know it's a

valuable program used by many in the province. What changes are taking place

this year? My understanding is part of it is being moved from Health to AES.

MR. HAGGIE:

No.

MR. P. DAVIS:

It's not?

MR. HAGGIE:

It's staying in the

department.

There

is a desire to look at cost of transportation across both departments. But that

is, at the moment, a desire rather than anything that translates into action.

MR. P. DAVIS:

Okay, so any changes to the

program overall?

MR. HAGGIE:

No.

MR. P. DAVIS:

Funding, or design and

delivery?

MR. HAGGIE:

No, it runs exactly as it

has in previous years.

MR. P. DAVIS:

Are there any systematic

issues that have come up on we hear stuff all the time about one size doesn't

fit all. But, overall, are there any issues that have been raised that are

ongoing or need a review that you're aware of? I guess there's not. I'm sure you

probably would have reviewed it if there was.

MR. HAGGIE:

Well, yes. I mean the

concept of transportation and the cost to both AES and Health and Community

Services has been raised. I think at some point the cost and the method of

delivery will be a subject for review, but that's not something that's on our

short-term radar at moment. I'm not aware of any significant issues that have

arisen lately with the program that haven't been the kind of background activity

that's gone on perhaps when you were in office, or your predecessors.

MR. P. DAVIS:

I've always known to be a

fairly strong uptake in utilization. The numbers are still high, there's still

good utilization of the program. Do you know how many people utilize it?

MR. HAGGIE:

It was 2,993 unique patients

in '15-'16.

MR. P. DAVIS:

Two thousand sorry?

MR. HAGGIE:

Two thousand and nine

hundred and ninety-three.

MR. P. DAVIS:

Two thousand and nine

hundred and ninety-three. Okay.

MR. HAGGIE:

In '15-'16. That's unique

patients, rather than trips.

MR. P. DAVIS:

Yes, I understand.

MR. HAGGIE:

Yes.

MR. P. DAVIS:

Minister, I understand

there's a lot of pressure on OBGYN services in Central. What's the status on

that now?

MR. HAGGIE:

There are active recruitment

efforts for both locations, in actual fact. The challenge is, as Dr. Alteen

referenced earlier on, a combination of critical mass and generalism.

One of

the things that the profession is not good at is encouraging and maintaining

generalism. From my previous roles I can wax lyrical about that. But,

essentially, it can be difficult for rural sites to attract specialists and

these are, both in Grand Falls and in Gander, areas that are having some issues.

We're working hard to try and fix them.

The

problem is, again, as was alluded to by Dr. Alteen, you have four or five years

of medical school and then you have five years as a residency program. So

there's a lead time to try and find individuals. We do have people who are from

Central who would be interested in coming back, but they're at stages in their

career that you've still got a lag.

MR. P. DAVIS:

That's also partially

because of the lack of critical mass?

MR. HAGGIE:

Well, it's far easier to

recruit a third physician for a group of two, than it is to recruit one when

there's nobody there speaking from personal experience.

MR. P. DAVIS:

OBGYN is now provided in

both Gander and Grand Falls-Windsor, is that right?

MR. HAGGIE:

Yes.

MR. P. DAVIS:

Has been any discussion or

plans or consideration on amalgamating to one location?

MR. HAGGIE:

There are rumours abound, of

course, but in actual fact, having spoken to Central Health, there is not only

no plan to amalgamate them, they're actively trying to maintain both of them.

MR. P. DAVIS:

Okay.

I'd

like to have a discussion about autism and any changes in funding or services

for individuals and their families and caretakers.

MR. HAGGIE:

I had a discussion actually

last week with Scott Crocker and Tess Hemeon from the Autism Society. What we

have in mind are some short-term discussions around, for example, IQ 70 as a

threshold for services. That has proven to be a significant barrier. The issues

they've highlighted about access to ABA, we are working through those.

There

have been significant reductions in the wait times between assessment and

treatment for children identified as being autistic. We're working to try and

further reduce those.

At a

more strategic level, there is a need and a desire to build a provincial

strategy. The discussion has been whether or not we should focus solely on

autism initially or try and build a more umbrella approach for all children who

are differently abled, and autism would simply be a part of that bigger picture.

There are pros and cons to that.

MR. P. DAVIS:

I'm sure Mr. Crocker was

more than happy to discuss all of that with you.

MR. HAGGIE:

Oh, we had a very

interesting chat. I learnt a lot and I think it was a very useful hour we spent.

MR. P. DAVIS:

I have a tremendous amount

of respect for him and the organization. I think they do fabulous work. They're

very dedicated, and of course their funding is always an issue for them.

Were

there any chances to their funding this year?

MR. HAGGIE:

Not that I'm aware of. They

get the bulk of their funding through SWSD. I'm not aware of any challenges

there.

MR. P. DAVIS:

Okay.

The IQ

70 is still a matter being considered?

MR. HAGGIE:

Oh, actively. Yes, it is a

problem.

MR. P. DAVIS:

Yes.

What

would be the alternate?

MR. HAGGIE:

Our approach is to step back

a little and say, what are the challenges any individual child has? This isn't

my field of expertise, but autism, I'm told, is a complete spectrum from

children who are just a little bit quiet and bright, to those who are very, very

difficult to manage and all point in between.

remember going to an Autism Society meeting in Gander, for example, and we had

some very heartfelt discussions with some parents there, particularly of those

children at that end of the spectrum. The challenge in the get-go is sometimes

you can't actually assess a child's IQ because of their autism; therefore, this

categorical approach doesn't work. So to step back and say well what are these

children's needs, kind of a performance/disability approach to any given

particular child and a wraparound of services that both start before school,

kindergarten and through the school and then transitioning into adult life,

because it's those transitions that children with autism seem particularly

challenged with.

MR. P. DAVIS:

Minister, is the number of

children being diagnosed with autism continuing to increase?

MR. HAGGIE:

Over time, there certainly

has been an increase in the diagnosis. Mr. Crocker and I discussed whether or

not this was an increase in awareness. Certainly, the numbers are growing.

MR. P. DAVIS:

Is that the number I think

to the point that probably you had a discussion on. Does that mean the actual

number of children with autism is growing or just the numbers that are being

diagnosed are growing, they existed before, just weren't diagnosed or picked up?

MR. HAGGIE:

There's a mix. I think we

agreed there was a mix.

I think

people in education and in health care are more sensitive to the possibility of

that diagnosis now. That will always generate an increase in incidents but there

is certainly some suggestion from multiple sources that the actual number of

diagnoses is increasing because the incidents are increasing.

MR. P. DAVIS:

I know SWSD probably has

more input or AES from an adult perspective. What involvement does your

department or the funding from your department have with adults with autism?

MR. HAGGIE:

I think the involvement has

been traditionally in well children screening. There is some doubt as to the

efficacy of that. It certainly picks up some children, but Mr. Crocker and I

also discussed the fact that there are a significant number that are actually

picked up when they enter the education system. Having teachers, kindergarten

and early childhood educators aware of the possibility of autism is certainly a

key part of any strategy going forward because the earlier these children are

identified, then it would appear from the data the better their prospects are

with early treatment.

MR. P. DAVIS:

Even if they're picked up

prior to the education ?

MR. HAGGIE:

Yes. Again, what modalities

of treatment are available, whatever they are and there are debates within the

autism community, as well as the scientific community, about what treatments are

best. There is no magic bullet, seems to be the main theme, but the general

consensus for all of them is that if they are picked up earlier they do better.

MR. P. DAVIS:

I don't know if you have it

with you, or maybe you can provide it to us in your materials after Estimates

today, about the numbers of diagnosis annually, or overall, the number of

children in the province who are living with autism?

MR. HAGGIE:

We could probably provide

you with those children who are referred for autism services under our auspices

in terms of psychology behavioural therapy, those kinds of things. I don't think

that would be too difficult to find. I think I've seen that table somewhere. We

didn't bring that with us today.

MR. P. DAVIS:

NLCHI, Newfoundland and

Labrador Centre for Health Information would probably have a better idea.

MR. HAGGIE:

We can certainly produce

some information for you.

MR. P. DAVIS:

Thank you.

CHAIR:

Are you good?

MR. P. DAVIS:

Time to change, yes.

CHAIR:

Ms. Michael.

MS. MICHAEL:

I'd like to come back to the

regional authorities. This is just shocking for me. I should have realized this

before.

The

federal revenue for this year is $2,009,600. Is that correct?

MR. HAGGIE:

Yes.

MS. MICHAEL:

Yes.

And

that's the total federal revenue for our health care? Where else does federal

money show up? Under no other estimates line is there any federal money.

MR. HAGGIE:

Federal revenue, it is in

the binder here and it's broken down. The money there relates to cost-shared

agreements with federal agencies. So the revenue from the feds, from a health

transfer doesn't appear in here.

MS. MICHAEL:

That's it?

MR. HAGGIE:

No, it doesn't appear in

here.

MS. MICHAEL:

It doesn't appear.

MR. HAGGIE:

No.

MS. MICHAEL:

Okay.

MR. HAGGIE:

It's not our department. It

goes through Finance.

MS. MICHAEL:

Do we know what that share well, I guess it's in the consolidated funds, in

that whole booklet where we can find out.

MR. HAGGIE:

My impression is, as of 2017

that will be approximately 18 cents on every dollar we expend in health care.

MS. MICHAEL:

Are they going to be using

the per capita system that the former federal government said was going to

happen?

MR. HAGGIE:

At the moment, there has

been no talk of changing that. There have been discussions at the

federal-provincial-territorial Health Ministers' meetings, and it's certainly

the position of this province and the Atlantic provinces, that formulary does

not serve our interests at all.

The

whole question of the federal government share of health care expenditure in the

province, if you look back historically, it was 50 cents on every dollar.

MS. MICHAEL:

That's right.

MR. HAGGIE:

It's gone down

progressively, certainly in the last I call it an agreement, it wasn't really.

It was kind of diktat in 2012, I think it was, essentially puts us on a

trajectory where the feds will supply 17 cents of every health care dollar.

The

position of the Atlantic health ministers I think it was supported generally

was that they should go back to 25 cents forthwith, with the aim of trying to

restore some further equity.

The

difficultly outside of Atlantic Canada, is there are jurisdictions who are quite

happy with the per capita. There are some who would like age and complexity of

chronic disease certainly, we're in that group to be considered and there

are others who don't want age but would prefer complexity.

I think

those different positions reflect the demographics of that population because

when the changes were made in 2012 accumulatively, I think it takes somewhere

over $200 million out of our revenue from the feds for the CHT there was only

one province that actually benefitted, and that was Alberta to the tune of $918

million positive. That was a source of some irritation, shall we say, at the

time.

MS. MICHAEL:

Right.

Allowing for the variations of positions of the provinces, is there, though, at

least an agreement that we need a new Health Accord?

MR. HAGGIE:

There is an agreement that

we need more money or a greater percentage of the health care dollars from the

feds. That's unanimous. Once you get beyond that, it would be difficult to say

there's a national consensus or a pan-Canadian consensus. There's certainly an

agreement in the Atlantic provinces that we're very much aligned, because our

problems are not that different

MS. MICHAEL:

That's right.

MR. HAGGIE:

looked at from outside. So

it would be a weighted formula. It would involve age and it would involve

chronic disease.

MS. MICHAEL:

Right.

Mentioning chronic disease, could we have an update on the chronic disease

policy framework?

MR. HAGGIE:

Ms. Stone, can you

MS. STONE:

The Department of Seniors, Wellness and Social Development are working on a

healthy living strategy which will complement our current chronic disease

framework that we have.

MS. MICHAEL:

Do you have any timeline for

that work?

MS. STONE:

I'm not comfortable speaking for Seniors, Wellness and Social Development, but

they've just finished a significant consultation process. I'm not entirely sure

what their next steps are.

MS. MICHAEL:

Okay, thank you very much.

I'm

finished with 01, and if Paul is as well, we could move on to 3.2.01.

CHAIR:

You can continue on.

MS. MICHAEL:

Okay, good enough.

CHAIR:

Use your time on the clock,

and then we'll go back to Mr. Davis.

MS. MICHAEL:

Great.

Under

3.2.01, it's pretty straightforward. We have a big drop in the budget line for

Property, Furnishings and Equipment. Could we have a justification for that,

please?

MR. HAGGIE:

Yes; $13 million was removed

from the capital equipment block and the communicable disease surveillance

management system project, which was $2.5 million, was removed. There was

dissatisfaction with that, and I think from a provincial and a federal point of

view, because we were trying to tie in the two.

There's

a forecast adjustment for the Electronic Medical Record project, which is a cash

flow adjustment. So the communicable diseases has been removed, the GRI removed

$3 million, and there was a budget decision from 2015 to remove $10 million.

MS. MICHAEL:

So when you say removed, you

mean completely gone or moved somewhere else?

MR. HAGGIE:

Just gone.

MS. MICHAEL:

Just gone, okay.

Under

the Health Care Facilities, 3.2.02, could we have a breakdown with regard to the

Salaries, if there are vacancies or retirements, et cetera, the number of

physicians involved in the drop of $570,000?

MR. HAGGIE:

The salary allocation was

for T&W staff who acted as project managers in Health. They oversaw the

infrastructure projects that were on the go. In 2016-17 there are fewer

projects, and we have reduced the estimate of the time that they would be

involved in the coming year.

MS. MICHAEL:

Right.

So I'm

assuming the drop in Professional Services and Purchased Services all have to do

with the projects that have been put on hold?

MR. HAGGIE:

One moment, I'll just get

there and have that.

The

revised was an allocation error in the 2015-16 Estimates. The further decrease

is simply due to the fact that the projects have shifted in terms of their

various stages. Some are in planning, site preparation, tendering or

construction. They lead different levels of funding as the project goes through.

I think 80 per cent of a project's funding goes through in the first 18 months,

and then it tails off fairly rapidly.

The

design funding for '16-'17 is for the Health Sciences Centre substation, and

project work for the water for the Corner Brook hospitals.

MS. MICHAEL:

Okay.

And the

Purchased Services, because there's a large drop there, too, of $25,724,000?

MR. HAGGIE:

Again, that's down to a

reduction in the number of projects and the fact that a lot of projects are

nearing completion. The PET scanner is on its last phase. It only requires $2.6

million this year, and that's basically to put the thing in and plug it in and

switch it on, as far as I can tell.

MS. MICHAEL:

That's the second one in St.

John's is it, or ?

MR. HAGGIE:

It's the first one.

MS. MICHAEL:

The first one.

MR. HAGGIE:

We don't have one. This will

be the first (inaudible).

MS. MICHAEL:

Oh, that's right, yes.

MR. HAGGIE:

Yes, and there's a cyclotron

built into that as well, isn't there?

OFFICIAL:

Yes.

MR. HAGGIE:

So that will enable

home-grown production of isotopes, which is probably the most sensible.

MS. MICHAEL:

Right.

MR. HAGGIE:

The Carbonear and Happy

Valley-Goose Bay long-term care projects are nearly finished. So the bulk of

their expenditure is gone, and there are fewer projects going forward.

MS. MICHAEL:

Right.

And you

may or may not want to answer this question. If you don't, that's fine. I know

there'll be some people in some part of the province who won't be happy with me

for asking it.

seems to me the information that I have, the research we've done, is basically

with a population our size and with the demands the PET scanner would have, that

it really isn't I don't think we need more than one in the province. Does the

department have a position on that, or ?

MR. HAGGIE:

I don't really think I'm

equipped to answer that question.

MS. MICHAEL:

Right.

MR. HAGGIE:

It's not my field of

expertise and I haven't done the research to do it justice by giving you an

off-the-cuff answer.

MS. MICHAEL:

Okay.

MR. HAGGIE:

You don't want a surgeon

talking about radiological matters.

MS. MICHAEL:

Right.

CHAIR:

Ms. Michael, I'll go back to

Mr. Davis.

MS. MICHAEL:

Yes, I actually have no more

at this point, I don't think.

CHAIR:

We've moved totally away

from the Estimates, I think, and the minister's been great with answering the

other policy questions.

Mr.

Davis.

MR. P. DAVIS:

Thank you.

I think

it's actually part of Estimates, but it comes up. If it costs money, it's part

of Estimates.

AN HON. MEMBER:

You didn't think that when

you were on the other side.

MR. P. DAVIS:

I did, yeah. Well, when I

sat over there, much like the minister's doing today, I was willing to talk

about anything that the department that there was a dollar sign to it or

should have been a dollar sign to it or wasn't, then in Estimates I was quite

willing to discuss it then. Much like the minister's doing today, and I

appreciate it.

CHAIR:

You have the choice to ask

whatever question you wish and then the minister chooses whether he answers.

MR. P. DAVIS:

Right. Yes, he's been very

gracious today so far and his staff as well.

Minister, now that we have that over, I have a minute gone.

CHAIR:

Would you like me to restart

the clock? The Chair maybe hasn't been fair.

MR. P. DAVIS:

No, that's fine.

Minister, we know that eating disorders and treatment and care are an increasing

concern in society today. What's the recommended treatment and care for persons

with eating disorders? I know it's (inaudible) it would be individual, it would

be very individualized circumstances and so on. What's the standard of care

across the province available for people with eating disorders and what's the

recommended care?

MR. HAGGIE:

Again, not delving into the

clinical world because it wasn't particularly my specialty, but these folk need

a variety of modalities of treatment depending on the nature and severity,

because within eating disorders there is a constellation of different types. In

general and kind of without prejudice, they would need access to psychological

services, social work and counselling, psychiatry possibly, may even need

internal medicine or gastroenterology.

It's

kind of a tiered response. I know the Eating Disorder Foundation is looking for

a specialist unit which would deal with the most complex of the complex. There

are, however, two beds in the Health Sciences complex allocated on the

psychiatric unit with access to the full support of the Health Sciences Centre's

internal medicine and investigative capabilities which currently deal with

those.

The

ideal I think, in the view of the Eating Disorder Foundation, would be to make

that into a full bedded, dedicated area. That is probably a goal that we should

work towards but, again, given the fiscal situation we are kind of moving in

baby steps.

We have

a bare-bones system which is dealing with the bulk of patients. There will

always be the odd patient in any discipline whose needs exceed that of the

provincial system to deal with whatever the discipline, and eating disorders are

no different. There we have the options that we have through MTAP and various

other things for people to go and get that. So that's kind of like a 30,000-foot

overview.

MR. P. DAVIS:

Eating disorders itself I

shouldn't say always troubled me, but in recent years is one of these areas

that as discussions increase, knowledge base increases. P TSD is another

example that I wanted to talk to you about.

Eating disorders is one of those that we seem to have a

better understanding today. I think we understand better today that if

treatments are in place it could shorten treatment, benefit the patient, quality

of life. And long-term, the cost of those treatments could ultimately be less if

the intervention happens earlier. Autism is similar in some ways to that, but a

little bit different.

So, Minister, when they make a case, I know it's a really

difficult one, but I suppose I'm looking for what if you look at what best

practices happen in other jurisdictions, how the patient outcome is improved by

having those services upfront versus later, is there a way to do that under what

resources you just mentioned, how those resources are available to the Health

Sciences. Is there a way to do that, having those resources around you?

MR. HAGGIE: I

think the skeleton is there, the embryo is there of what are generally accepted

as best practices elsewhere. There are some areas that need strengthening,

there's no doubt about it, and I've alluded to some of them.

I think the difference in some respects is an awareness now

that people with mental health are best regarded as being managed with a

recovery model rather than a cure model. What you have is you have individuals

who will have to manage and cope over a lifetime.

You're right, the early psychological supports and

interventions are going to be key in starting them down that road. The challenge

is always the resources locally, rather than necessarily the resources in one

particular area geographically.

It's the old analogy around the Waterford in a sense. You

don't want just to have a building there and say you fixed mental health. It's

all the stuff that you put in it and put around it. It's the same with mental

health in general and eating disorders, specifically.

The challenge is to try and find the resources as close to

home and there's certainly work to be done there. It goes back to sometimes we

have made some significant strides in access; it comes back to resources on the

ground and the demand versus the supply. That's a challenge, certainly, in a

fiscal constraint.

MR. P. DAVIS:

Can you give me any sense of numbers of patients either diagnosed or that

receive services that would be classified as eating disorders?

MR. HAGGIE: I

can get that for you. I didn't bring that with me. It's the same kind of

discussion, in a sense, as we had with autism. The numbers are there and they

are increasing.

MR. P. DAVIS:

They are increasing? That was my next question.

MR. HAGGIE:

Well, there is again, it's

the same discussion with autism. Is it an increase in awareness and diagnosis of

milder conditions? Is it an actual rise in the true incidence of a condition?

And again, I think it's a mix of two. Having spoken to the eating disorders

folks, I think they would probably agree with that statement. Not that I should

put words in their mouth, but I think that's basically the agreement we came to.

We'll find you those figures.

MR. P. DAVIS:

Yes, I appreciate that. I

think it's just worthy of acknowledging as well, similar to autism and a society

that does good work, the eating disorders group as well. I know they're very

dedicated and looking for those reliefs and benefits. I'm sure we all know of

cases personally where a patient wasn't successful in battling the disorder.

Maybe the outcome would have been changed if there was an improvement to the

services or earlier intervention available to them.

MR. HAGGIE:

I think in actual fact the

peer groups themselves provide a service that nobody else can because what a lot

of the discussion is around with the peer groups is that they serve two

functions. We've talked about this in the context of autism as well with the

society. They can serve the role as navigators to what can be a complex system

for people who are challenged and frightened, but also, they can provide a peer

support that nobody else can.

There

is a general acknowledgement that if you have a problem and you can sit with a

group of people who have walked that walk and gone down that path before you,

that you will get far more ou