April 30,

SOCIAL SERVICES COMMITTEE

Pursuant to Standing Order 68,

Lorraine Michael, MHA for Signal Hill Quidi Vidi substitutes for Gerry Rogers,

MHA for St. John's Centre.

The Committee met at 6:00 p.m. in the Assembly

Chamber.

CHAIR (Littlejohn): Good evening everyone, and

welcome to the Social Services Committee. This evening we will hear from Health

and Community Services.

Just for clarification to the committee, we have a

substitution tonight for a committee member. That is acceptable, unless it is

not acceptable to the committee. Ms Michael is substituting for the normal

committee member, Ms Rogers. Unless it is not acceptable to the committee, then

we can proceed.

Okay. Thank you very much.

Just some general

MS SULLIVAN: (Inaudible) or not.

CHAIR: No, Minister, I was asking the committee to

respond.

MS SULLIVAN: Okay.

CHAIR: It is agreeable? Yes.

Some general comments: just a reminder, before you

speak, please state your name for the recording and for Hansard.

Minister, we will give you the opportunity to have

fifteen minutes for opening remarks, followed by a member from the Opposition,

Mr. Ball, who will get fifteen minutes. Then, has been the practice of the

committee up to this point, it is ten minutes and ten minutes. We will go back

and forth until we are finished, if that is acceptable to committee members.

OFFICIAL: Yes.

CHAIR: Thank you.

Please wait until the red light comes on, on your mike

first and we can proceed.

Just before we open for the minister's comments

tonight, we have the committee minutes of the Department of Education for

approval.

Could I have a motion to approve the Social Services

Committee meeting minutes for April 26, 2012?

MR. CRUMMELL: So moved.

CHAIR: Moved by Mr. Crummell.

All those in favour, aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Contra-minded.

Carried.

On motion, minutes adopted as circulated.

CHAIR: Minister.

MS SULLIVAN: Thank you, Mr. Chair.

I am going to forego my fifteen minutes tonight. I

think we all know why we are here and we have already had opportunity to

introduce ourselves. I think it is more important that we get straight into the

review of the estimates for this year.

I thank you for your concurrence in allowing us to

start with French Services this evening as opposed to going straight into Health

and Community Services.

Mr. Jeff Butt is here with us. Mr. Butt is the Manager

of the Office of French Services and he will help facilitate the process there.

Rather than take fifteen minutes to set this up, I

think we can proceed.

CHAIR: Okay.

Dwight.

MR. BALL:

Thank you very much to the minister.

I really do not have any questions at all, so this is

going to be a short night for you, I guess. I will not use my fifteen minutes,

in particular, at least in asking questions right now.

MS SULLIVAN: (Inaudible).

MS MICHAEL: (Inaudible) but because not everybody

is bilingual I will I am taking that for granted. I am going to ask p oser

la question en franais n'est pas ncessaire.

Professional Services, subhead 05, I do not remember

and it could be there seeing anything in documents at this point that would

explain why that is going up to $350,800. It has been low. Last year, the budget

was $75,800 and was revised down to $66,000. This year, Professional Services

are $350,800.

MS SULLIVAN: Actually, that is more of a

bookkeeping item than it is anything. The increase in the 2012-2013 Estimates

reflect, actually, an increase in translation expenditures due to the

centralization now of Translation Bureau. They are invoicing OFS. The increases

will be offset by a matching increase in revenue through the Office of French

Services. They will now invoice out to the departments directly as opposed to

having invoiced departments previously.

MS MICHAEL: Okay.

Can you explain that again? The departments use the

services.

MS SULLIVAN: Yes.

MS MICHAEL: Why would it cost $350,800? I am still

not clear, Minister, on your explanation.

MS SULLIVAN: Okay.

Jeff, do you want to give the detail there in terms of

the overall cost of the $350,000?

MR. BUTT: Yes, I do not mind giving clarification

there. The Government of Newfoundland and Labrador has an agreement with the

federal Translation Bureau that we negotiate or renew on an annual basis. The

value of that agreement can vary anywhere between $200,000, $260,000 to $275,000

per year.

What we have done is we have asked for an increase to

our Professional Services budget because from now on we are going to be paying

for all translation costs on behalf of departments.

MS MICHAEL: Okay.

MR. BUTT: Then we will go and recuperate the money

internally through an internal invoicing process. Prior to this change, the

Translation Bureau would invoice all departments separately and it could lead to

some confusion. Invoices were going out all over government.

This is just a way, really, of making it a cleaner,

more efficient process. As Minister Sullivan stated, our revenue goes up by the

same amount of money. If we do not need to spend the money, we do not. So it all

matches there.

MS MICHAEL: Right. That is clear.

Thank you, Minister. That is helpful.

Just one more question under Grants and Subsidies. I

notice it looks like maybe $35,000 is kept there and $5,000 last year was spent.

What would be the type of grant or subsidy because it is very small that

would come out of that line?

MS SULLIVAN: Do you have the list there, Jeff, of

exactly what kinds of things are under Grants and Subsidies?

MR. BUTT: Yes. Again, I can explain that.

The $5,000 that we would have spent under Grants and

Subsidies, basically $3,800 just covers the Province's participation in the

ministerial conference on the Canadian Francophonie. It is just our contribution

towards the national secretariat of that FPT ministers' conference. Then the

remaining $1,200 is money that we would disburse at our discretion based on the

proposal. I believe in this past year it was $1,200 given to a Francophone

community youth gathering.

MS MICHAEL: Okay great, thank you very much.

If I may, Minister, just to say thank you for the

great service that Mr. Butt and the French language services provide, especially

the training. I continue to have staff that enjoys doing the training. One

actually received an A in her test lately.

MS SULLIVAN: I quite agree. The work that is done

by the Office of French Services is invaluable to us in many respects, but

certainly those courses have proven to be of a fair bit of benefit to all. The

translation services that the office provides for us as well are very, very

helpful. I know when we go to FTPs, that the work of this particular office has

been lauded by many across the country. So, I am very pleased with the work that

they are doing as well.

Thank you, Jeff.

MS MICHAEL: Thank you.

CHAIR: Any further questions, Lorraine?

MS MICHAEL: No.

CHAIR: We are good, okay.

Mr. Ball, that being done, I will give you your

fifteen minutes, and we will start if you wish to have the fifteen minutes.

MR. BALL: If it were okay with the minister, I

would just as soon move right into the line-by-line questions.

MS SULLIVAN: Absolutely.

MR. BALL: I would start first of all with the

number of permanent employees in your department last year or this year? How

many permanent employees would you have?

MS SULLIVAN: The number of permanent employees

would be 229.

MR. BALL: Temporary?

MS SULLIVAN: Temporary employees would be sixty.

MR. BALL: Six zero?

MS SULLIVAN: Yes, six zero, so that would give us

a total positions of 289.

MR. BALL: I guess as we break that down a bit, the

Minister's Office would be how many employees?

MS SULLIVAN: Five.

MR. BALL: Five.

General Administration, Executive Support?

MS SULLIVAN: I am not sure exactly what you mean

by general

MR. BALL: General Administration and the Executive

Support, I think it is

MS SULLIVAN: The broader category, I would have to

do some addition over here. I can provide you with the whole series of numbers.

We have it broken down by activity, so I have Executive; I have Corporate

Services, Professional Services

MR. BALL: Executive is fine.

MS SULLIVAN: Executive in the Minister's Office

would be thirteen.

MR. BALL: Thirteen.

Corporate Services?

MS SULLIVAN: One hundred and six.

MR. BALL: Medical services?

MS SULLIVAN: Professional Services is

thirty-seven.

MR. BALL: The RHAs, the Regional Health

Authorities?

MS SULLIVAN: Regional Services, not necessarily

out in the RHAs, but Regional Services, we are looking at twenty-three.

MR. BALL: Okay.

Public health and wellness?

MS SULLIVAN: Population Health: thirty-one.

MR. BALL: Government relations?

MS SULLIVAN: That is part of what we would have

incorporated under Policy and Planning, so we have fourteen in Policy and

Planning.

MR. BALL: Okay.

What we are trying to get to, of course, is the book

that we did not get last year.

The Audit and Claims Integrity department?

MS SULLIVAN: It would be under Corporate Services.

MR. BALL: Okay.

MS SULLIVAN: I do not have the breakdown here, but

we had a total of 106 there.

MR. BALL: Okay.

Can you tell me the total you plan to spend in the

department on the following this would be permanent employees?

MS SULLIVAN: The total would be, for permanent

employees, $15,207,870.

MR. BALL: Temporary?

MS SULLIVAN: The total cost for the sixty

temporary positions would be $3,542,530.

MR. BALL: What about overtime and any other

adjustments that would have come in during the year?

MS SULLIVAN: We have a breakdown of overtime, but

I do not know that we have it in here.

My staff are saying that we do not have it broken down

here. It is embedded in the overall cost in permanent and temporary.

MR. BALL: Okay.

What about for permanent and other adjustments, if

overtime is that included too? Is that the one number?

MS SULLIVAN: Yes.

MR. BALL: Okay.

The total employees then, what was that number?

MS SULLIVAN: Total permanent positions again?

MR. BALL: Total permanent, we have that number,

don't we?

MS SULLIVAN: Do you want the total overall

positions?

MR. BALL: Yes, sure.

MS SULLIVAN: It would be 289.

MR. BALL: If you want, we could follow through the

Estimates.

MS SULLIVAN: Okay.

MR. BALL: Under 1.2.01, Salaries, last year there

was $237,000. We just have a question about why it was not all used, or what

happened there.

MS SULLIVAN: The decrease would have been

$237,000. Is that what you are referring to there under Revised?

MR. BALL: Yes.

MS SULLIVAN: Basically due to vacancies in the

positions of the ADM of Population Health and the medical consultant.

MR. BALL: Population Health

MS SULLIVAN: Yes.

MR. BALL: and the medical consultant.

Okay.

In Purchased Services here, bullet 06, there was

$32,700, under spent again, savings there. Why was that, and what were the

services?

MS SULLIVAN: The savings of $32,700 in Purchased

Services, the breakdown basically had to do with a one-time expenditure that we

had there for $47,300 and that was in advertising and promotion for our MTAP. So

that was one-time spending there for promotion of the MTAP the Medical

Transportation Assistance Program.

MR. BALL: Okay. It is getting late in the day for

those abbreviations.

In Corporate Services, in Salaries, we see an increase

of $405,000. I am just wondering what the reason is for that?

MS SULLIVAN: Corporate Services, Salaries, if I

have the tab number sometimes it is easier, as well.

MR. BALL: Okay, I will try that. It would be

1.2.02.01, Salaries.

MS SULLIVAN: You are looking at the estimate

increases there?

MR. BALL: Yes.

MS SULLIVAN: Okay. What we are looking at there is

an estimate increase of $403,600 and that is due to annualization, for the most

part, of funding for the new Information Management Division, that entire

division, which was created in Budget 2011.

Additionally, in Budget 2011, under the Adult Dental

Health Plan, there was a new Medical Claims Assessor II position that was

created for fiscal year 2012-2013. That was in Grand Falls-Windsor at the MCP

office out there to assist with assessing the higher volume of claims that would

be expected under the new program. It also contains three months of

annualization of raises for management staff of 4 per cent that was granted July

1, 2011.

MR. BALL: So this has created some new positions I

take it?

MS SULLIVAN: There was the Medical Claims Assessor

II position. They were created last year, but they are fully annualized this

year.

MR. BALL: Okay, because you did not actually spend

all of the budget last year.

MS SULLIVAN: So we only had half the budget there

for 2011-2012.

MR. BALL: Two employees, is it?

MS SULLIVAN: One employee and five under the

Information Management Division.

MR. BALL: Okay, now it is stating to add up to

$400,000. I am just wondering why you guys over there have not applied for that

job.

MS SULLIVAN: You were looking for the job?

Sorry, there were five under Information Management as

well and the one for Medical Claims Assessor, and they would have started about

mid-year.

MR. BALL: Under 05 Professional Services, we see

there was over $1 million last year spent; $29,000, and now we are back over $1

million in the budget this year.

MS SULLIVAN: Okay. You are looking for the revised

was it, or the estimates?

CHAIR: That would be 1.2.02.05.

MS SULLIVAN: Okay, sorry.

You are asking again about the revised budget there?

MR. BALL: Yes, and the estimates, of course, going

from $1 million to $29,000 and back to $1 million.

MS SULLIVAN: That is a contingency fund

essentially for $1 million for federal agreements; any federal, provincial,

territorial agreements that we entered into over the year. That is 100 per cent

offset for us.

MR. BALL: Okay, you are going to have to explain

that.

MS SULLIVAN: By federal revenue. If there are

federal, provincial, territorial agreements that we need to enter into with the

federal government throughout the year then this money is there to allow us to

do that. The money is totally 100 per cent federally offset.

MR. BALL: Can I have an example of that?

MS SULLIVAN: A federal agreement; we did not have

any last year, obviously. You can see that is the difference here in the

revised. There are any numbers of federal agreements, not one of which will come

to mind at the moment.

MR. BALL: No, especially in the Corporate Services

area.

MS SULLIVAN: Pardon me? That is where that would

be funded, though.

MR. BALL: Yes.

The federal revenue, $1 million was budgeted last

year, it did not happen. We have it back in again this year.

MS SULLIVAN: Yes. It is because there were no new

agreements this year.

MR. BALL: Okay.

I am going to go back up to Professional Services. Did

we go through that?

MS SULLIVAN: That is Professional Services, yes. I

am sorry; I thought that was the tab we were looking at.

MR. BALL: Yes, 05. I am talking about Professional

Services.

MS SULLIVAN: Yes, right.

MR. BALL: I was confused here. What does this have

to do with the federal government?

MS SULLIVAN: It is late in the night.

MR. BALL: Yes. I have been talking a lot, too.

Okay, go ahead. Tab 05 Professional Services.

MS SULLIVAN: Yes, that is the one that I

addressed. What we have here the answer again, is that funding of $1 million

represents a contingency fund for any federal, provincial, territorial

agreements. Any federal-provincial agreements that we might enter into which

might arise during the year. The reason the $1 million was not spent was because

there were no agreements that we entered into last year.

MR. BALL: Okay.

One other question before we move on to Lorraine and

that will be under the provincial side there. The revenue last year was budgeted

for $150,000, the revised is $640,000, and budgeted in these estimates for

$350,000.

MS SULLIVAN: Okay. So that is 1.02.02.02. Were you

asking about revised or estimates again, sir.

MR. BALL: I guess we should go right across that

line.

MS SULLIVAN: Okay.

The revised from $150,000 to $640,000, I am assuming

is your first question there.

MR. BALL: Yes.

MS SULLIVAN: The increase of $490,000 is a result

of the department receiving higher than anticipated miscellaneous revenue for

items such as bursary default payments, repayments by health professionals, and

a larger volume of fees from law offices requesting medical records for people

involved with matters before the courts.

MR. BALL: Do you have any idea how many bursaries

we would have defaulted on last year?

MS SULLIVAN: Do we have those numbers? Larry, do

you have those numbers?

DR. ALTEEN: I do not have the exact numbers but we

have recovered significant dollars in bursaries. Respecting the fact that we had

one particular case where a physician went off to do speciality sub-training, a

four-year program, and did not return. We ended up recouping $250,000 from that

physician. So the amount of monies that sometimes are put into what are called

travelling bursaries, in that particular case. We recover, every year,

expenditures that we spend on that particular physician.

MR. BALL: Is there a penalty also associated with

that?

DR. ALTEEN: There is. There is a penalty for

default and there is also a financial penalty on top of that. It is a certain

percentage of the overall cost. It is not just paying back the money. It is

money plus a penalty. If it is a default that goes on for a period of time there

is interest that is charged on that penalty as well.

MR. BALL: Good.

OFFICIAL: (Inaudible).

MR. BALL: Yes, because let's face it; you lose

sometimes two or three years of recruiting because of individuals like that.

DR. ALTEEN: Right.

We do a significant amount of tracking to make sure we

are keeping on top of those physicians and know where everybody is. It is a fair

bit of work to do, but we do that on a regular basis just trying to make sure

that we have recovered what we deem to be recovered when people do not provide

their return of service to us.

MR. BALL: Good. Lorraine, do you want to

CHAIR: Just one second, Lorraine.

I have to do one piece of housekeeping.

Clerk, can you call the first heading, please?

CLERK: 1.1.01.

CHAIR: 1.1.01.

Lorraine, please.

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

Minister, still under 1.2.02, please. The subhead 01,

the Salaries I suspect I know the answer but I would like the details. In last

year's book, 2011/2012, the estimate for Salaries under Corporate Services was

$1,570,900 and this year the estimate is about $4 million more, it is

$6,273,900. Last year the estimate was just $1.5 million.

I am assuming there have been things moved into this

area. Could we have the details of what has been moved in and the reason then

for the $4 million difference between last year's estimate and now this year's

estimate?

MS SULLIVAN: That has to do with an organizational

restructuring we did in the department. I will get Denise to give the details

because she has some of them there with her today.

MS MICHAEL: Maybe we could broaden the question.

Instead of asking every time, maybe if you had an overview of the restructuring

and where we might see that, I think that might be helpful instead of us having

to pick up on it all the time.

MS SULLIVAN: What I will do is I will let Denise

answer the first part of the question and then Bruce can give the overall.

Hopefully, that will help to give the full picture.

MS MICHAEL: That would be very helpful, yes.

MS TUBRETT: As a result of the new organizational

structure, we had to do a reorganization of the estimates from last year.

Minister's Office and Exec Support stayed the same. Corporate Services

previously included Financial Services and Information Management. We added the

Audit and Claims Integrity activity to that activity, Corporate Services. So

last year you would see an activity Audit and Claims Integrity, now that is

included under Corporate Services.

Last year there would have been an activity Medical

Services. This year, that has been changed to Professional Services, which

includes divisions from several other activities in the department. Professional

Services includes Physician Services and Pharmaceutical Services, which would

have been there last year, but this year Health Workforce Planning is added,

which was moved from Policy and Planning. Office of the Chief Nurse was added to

Professional Services, which transferred from Policy and Planning; Dental

Services, which would have been in Medical Services last year, and Pathology and

Lab Services was a new division.

Regional Health Operations would have shown up in the

estimates last year. That would have included five divisions: Board Services,

Mental Health and Addictions, Access and Clinical Efficiency, Aboriginal Health,

and National Blood Portfolio. This year, that activity has been restated to be

called Regional Services. It includes Acute Health Services and Emergency

Response, which is a new division which is similar to the Board Services

Division from last year. Access and Clinical Efficiency is there from last year.

Infrastructure Management is a new division that was

created. Long-Term Care and Community Support Services is now in that activity,

moved up from Policy and Planning last year. The National Blood Portfolio

remains in that same activity.

Last year you would have seen an activity called

Public Health and Wellness. That is now Population Health. There are three

divisions that were there last year that are still there: Health Promotion and

Wellness, Public Health, and Chronic Disease Management.

There are six new divisions that moved in from other areas of

the department: Environmental Public Health actually, Environmental Public

Health would have been there last year, too Disease Control, Aboriginal

Health, Aging and Seniors, Mental Health and Addictions, and Public Health

Information.

Last year there was an activity, Government Relations,

which is now under Policy and Planning. Policy and Planning is also basically

carried over into 2012-2013, but it has some new activities added to it:

Government Relations, as I just mentioned, the provincial occurrence reporting,

and as well some of the changes I mentioned earlier. Long-Term Care is gone to

Regional Services. Aging and Seniors is gone to Population Health.

That pretty much captures the structural changes that

were made to the Estimates. That is why there were some differences in the

salary details as well. The salary details for 2012-2013 are not released yet,

and the estimate structure would have followed last year's Estimates.

MS MICHAEL: That is very helpful.

Minister, I am wondering, since it was suggested by

the Department of Finance, I am sure you do have the salary details now, would

we be able to get a copy of that, the breakdown for each section?

MS SULLIVAN: We do not have it with us, but

certainly we can get a copy of that.

MS MICHAEL: That would be great.

Thank you very much.

MS SULLIVAN: Okay.

MS MICHAEL: Okay. That is helpful.

MS SULLIVAN: Bruce, do you want to give the

overview?

MR. COOPER: Actually, in Denise providing you with

a sense of where divisions have moved and migrated into the new structure, I

think you pretty well have a good sense of the architecture of the department

now. The way the codes are set up is actually the structure of the department.

The only thing I would add is that as part of our

reorganization we went from originally seven branches to five branches, and made

some other integrations of responsibility where there was opportunity to

actually bring like functions together. We could provide you with an

organizational chart, if you wish.

MS MICHAEL: That would be really helpful. When we

tried to look for things it was really difficult to figure out where things

were. It would really help just from the perspective if we have questions and we

want to call a department to find out where exactly they are located. That chart

would be really helpful, too. Thank you very much for offering that.

I am not going to ask any general questions yet. I am

going to stick with the lines, and I am not going to ask anything about salaries

because you are going to get all of that information to us. Then if we have

questions maybe we could also have them answered, but I have a feeling we will

not. We just need to see what you have and that would be really helpful.

Under 1.2.03.05 Professional Services, you spent

$418,500 less than budgeted last year. Could we have a sense of what happened

there that you expected to spend money on but did not?

MS SULLIVAN: It was due to less than anticipated

consultant requirements in the Physician Services and Pharmaceutical division.

The budget has been right-sized now for 2012-2013 based on our best estimate of

what we think those demands might be for next year.

MS MICHAEL: Could you give us an idea of what it

is that actually covers?

MS SULLIVAN: The breakdown is

MS MICHAEL: The services that are offered, or the

management of the services.

MS SULLIVAN: Yes. We are looking at the big one

would be certainly in terms of senior business analyst contract, NLPDP system

enhancements, the Newfoundland and Labrador Interchangeable Drug Products

Formulary, the NIDPF, the expert reviewer there.

The 65Plus working group would be another area. I am

trying to see where the biggest ones would be. The pan-Canadian Oncology Drug

Review would be another one of the big areas in that.

MS MICHAEL: Okay, that is helpful.

Thank you very much.

MS SULLIVAN: You are welcome.

MS MICHAEL: Under 1.2.04, I will not ask a

question about salaries because we will get that information. Under subhead 05

Professional Services, you spent quite a bit less than had been budgeted for

last year. Actually, $1.4 million less than budgeted and now this year back up

to $1.5 million. What happened in that area?

MS SULLIVAN: Okay.

Basically, there are four reasons here that we can

look to, to indicate why the budget was revised for 2011-2012. The first one was

a savings of $250,000 for a review of the provincial ambulance program and that

review will not occur until this year.

The second is $250,000 savings in relation to the

review of the Home Support Program. While we did do a fair bit of review

internally, we did not need to expend monies at that point in time to do the

internal work that we did. For example, the audits that we conducted, Central

Health did a financial audit; Eastern Health did a financial audit with the help

of our department. There was a clinical audit that was done in Western Health

and so on. So, none of those required monies from the budget to be able to do

them because they were internal; however, this will be reprofiled' into this

year as we look to do an external review.

The big piece of this had to do with an $810,000

savings in the Access and Clinical Efficiency division. That new division that

was created, particularly as we looked at wait time and when we looked to

experts to help us in trying to clear up some of the wait time issues and the

health operations reviews.

We did spend $180,000 of the I think there was

$990,000, close to $1 million that was allocated there. We did spend $180,000 of

that. You will recall that we delivered our two wait time strategies within the

first 120 days, as we had planned on doing.

We had also, in that area, budgeted for $400,000 for a

peri-operative review in 2011-2012, which was completed by existing staff as

opposed to going outside. So that $400,000 in Professional Services was not

required. Then, the remainder of that is related to miscellaneous regional

health reviews that were not required in 2011-2012.

MS MICHAEL: Minister, could you give us an idea of

what the audit of the home support I know it was not done by the department,

but I am sure you have a report on that from the authorities. What exactly was

the essence of the audit of the home support?

MS SULLIVAN: There were a number of different

variances we found across regions that I recall as having seen. The results

certainly showed, first of all, some variances across Regional Health

Authorities that we need to look at and we need to tighten up. One of the

largest things we learned from those reviews had to do with the growth in the

programs, particularly with the home support end of that program. As a result of

the improved access to the programs, there has been a huge increase in the

numbers of persons now eligible for home support. That was one of the results of

what we have found.

We found, in particular, that the emergency criteria

as a requirement for admission to the program might need a second look at.

Certainly, as we have identified in the House of Assembly in the last week or

so, issues around the exemptions program and the fact that we need to do some

work around that. That was certainly identified, and there were also some issues

around consistent appeals processes throughout the program.

MS MICHAEL: Will the department be playing a

co-ordinating role around this? Because you have talked about the variances

under the various authorities, and that is a concern of ours that we do not have

consistency throughout. What role will the department be playing then in trying

to get some consistency in this area in other areas too, but we are talking

about his particular area.

MS SULLIVAN: One of the things that I think will

be most helpful for us there, and there was money budgeted in this particular

budget for it, is the implementation of the interRAI assessment tools. I believe

those assessment tools will help us considerably the MDS particularly in our

long-term care facilities, but the interRAI tool itself for assessment within

home support areas.

I believe that those tools will be very helpful for us

in terms of trying to assess needs and determine that clients get the best care

that they require. I think that tool, because it is the less subjective, more

objective, will be very helpful to us. Certainly, it is our goal to ensure that

consistency exists.

CHAIR: Thank you, Lorraine.

Dwight.

MS MICHAEL: Can I just ask one more related

question to that, please?

CHAIR: Dwight?

MR. BALL: Yes.

CHAIR: Okay.

MS MICHAEL: Are those tools now, the same tools,

in place in all areas or are you still working on getting it there?

MS SULLIVAN: The MDS tools are substantially

implemented throughout the long-term care facilities. We are working on the

implementation of the interRAI tools through the Home Support Program.

MS MICHAEL: Okay, thank you.

CHAIR: Dwight.

MR. BALL: Thanks.

Minister, when that happens, it will then be

consistent through all authorities?

MS SULLIVAN: That is our hope, yes.

MR. BALL: I will ask the question: What would

stand in the way for it not to be your hope?

MS SULLIVAN: Nothing will stand in the way of

that. We are committed to that.

MR. BALL: Good. The right answer.

Under 1.2.05, Population Health, of course the big one

that jumps out there would be 05, Professional Services and 06, Purchased

Services. Both of those categories saw significant variances. Do you want to

explain those?

MS SULLIVAN: So we are looking first of all at

Professional Services?

MR. BALL: Sure.

MS SULLIVAN: In the sense of the variance between

Budget and Revised?

MR. BALL: Yes.

MS SULLIVAN: I just want to make sure that we are

looking at the same numbers here. There would be a difference or a decrease of

$547,000, approximately, and that is made up of lower than anticipated

consulting services in 2011-2012 in various divisions, including the public

health division, the mental health and addictions particularly there around

the marketing campaign for raising awareness about mental health and addictions

and the health promotion and wellness divisions, as well. So, primarily it is

less than anticipated costs.

MR. BALL: So are those programs finished now?

MS SULLIVAN: No. If we look at mental health and

addictions and the development of the marketing program and things of that

nature, that is an area that we are very focused on and will continue to do

MR. BALL: What is the name of that program there?

Has it been christened yet?

MS SULLIVAN: Colleen, do you want to give us a

name?

OFFICIAL: We have been referring to it as the

e-mental health and awareness program.

MR. BALL: Okay, thank you. That is a good idea.

Under 1.2.05.06, Purchased Services, we seen the

budget virtually cut in half and now back up to $807,500.

MS SULLIVAN: Those two are linked actually the

Purchased Services here are linked with the Professional Services. There is a

$482,000 variance and I will explain it in two parts. The $82,000 variance is

the result of savings due to lower than anticipated advertising and printing

costs for the seniors' program, and the remainder of the savings, the $400,000,

is in relation to the Mental Health and Addictions Division.

We originally had funding of $630,000 in that area for

the development of the e-mental health and awareness program; $230,000 of that

is under Professional Services that we just discussed and then $400,000 is under

the Purchased Services here.

Significant work was done during the 2011-2012 budget

year and we are working with a group of consultants actually out of New Zealand

to do, I think, some pretty innovative work in that area. We will continue to

work on that, and that is why you will see that we are going to continue to move

some of that funding forward.

MR. BALL: I stand to be corrected, but this is

about developing a program or something?

MS SULLIVAN: Around e-mental health.

MR. BALL: At the end of the day, what is the

objective? What is it we are going to get let's say if we fast forward to next

year at this time, if we look back, what is it we expect to have?

MS SULLIVAN: There are two aspects to it. There

will be an awareness campaign and a Web design, which are the two main

components of this program, and we will put RFPs for both of them fairly soon.

MR. BALL: Okay, good.

Grants and Subsidies there, in bullet 10, are there a

list of those?

MS SULLIVAN: Yes. We can provide you with that

list if you like.

MR. BALL: Yes.

MS SULLIVAN: I am sure you do not want me to read

them all out to you, but we will certainly provide the list.

MS SULLIVAN: We will arrange for that.

MR. BALL: We can move on to the Executive and

Support Services Lorraine, I do not mind if you have anything left in that

particular category.

MS MICHAEL: No, that is fine. I have some

questions, so I will wait. They are not line items. I will wait.

Thank you very much.

MR. BALL: Executive and Support

MS SULLIVAN: Are we going back?

MR. BALL: I will draw your attention to 1.2.06,

again to 05, Professional Services.

MS SULLIVAN: Sorry, I missed the category.

CHAIR: Under 1.2.06, page 16

MS SULLIVAN: So we are going back?

MR. BALL: I do not think we are going back, are

we?

CHAIR: No, we are going forward.

MR. BALL: If you want to look at the page number,

it is page 16.6 in the Estimates.

MS SULLIVAN: Okay, I have found it.

Your question again was in relation to

MR. BALL: The Professional Services there, bullet

05. We went obviously from a budget of $1,100,000 down to $737,000, and then

Estimates this year at $615,000.

MS SULLIVAN: The variance there is a result of

several FPT initiatives ending and funding no longer being required therefore.

That is about $304,000. It is also the result of our attempts to right size the

budget for the department in that area. The bulk of it had to do with

initiatives that were federal-provincial-territorial initiatives that have

ended. Therefore, we do not need any monies to continue those.

MR. BALL: You know I am going to ask you the

questions: What ones have ended?

MS SULLIVAN: Which ones have ended? Do I have a

list of these? I think I might: the consultants' review of policy, HPV vaccine

evaluation and research fund, the National Pharmaceutical Strategy, the HIA

Secretariat, and the Atlantic Public Health Surveillance.

MR. BALL: Okay. That is pretty much it for that

category.

Memorial University, which would be 2.1.01, Grants and

Subsidies we will need a list of those. You do not have to read those out

either.

MS SULLIVAN: We do not have a list because all of

that goes to Memorial.

MR. BALL: Okay, so you just give them the money

MS SULLIVAN: We give them the money.

MR. BALL: and do not ask?

MS SULLIVAN: Oh, we ask.

MR. BALL: You ask for me then, will you?

Just one question about a couple years ago, a couple

of Budgets back there were some twenty seats that was for the addition to the

School of Pharmacy: Can I have an update on that to see where those are?

MS SULLIVAN: For the School of Pharmacy?

MR. BALL: Yes, back two or three years ago there

were some new seats. At the same time, there were new seats added to the Faculty

of Medicine.

MS SULLIVAN: Yes, I am just trying to get an

answer with regard to the pharmacy seats, first.

What is your question, specifically?

MR. BALL: At the same time the Faculty of Medicine

seats were announced, there were some seats announced for the School of

Pharmacy. I have not really heard anything about it since.

MS SULLIVAN: We are going to have to look into

that for you. I am not sure about the seats for the School of Pharmacy.

MR. BALL: Okay, no problem.

The next one is 2.2.01, Drug Subsidization, the

Provincial Drug Programs. The Professional Services there, we see almost well,

not quite a doubling of the budget this year, and that is for what reason?

MS SULLIVAN: The estimates there, the increase of

$1.6 million in there is for a new agreement associated with the on-line, real

time processing of claims that are submitted under our NLPDP. That previous

agreement just expired actually on March 31, and the new contract is in the

process of being finalized now for those services.

MR. BALL: You have a new adjudication system, you

mean?

MS SULLIVAN: It will be a new agreement in terms

of that on-line, real time sort of processing system there.

MR. BALL: I guess I have been away from it too

long.

Allowances and Assistance under 2.2.01.09, you see a

$10 million increase in those in that line item.

MS SULLIVAN: I am sorry; I am not seeing the $10

million.

MR. BALL: From the revised; the budget last year

of $149 million.

MS SULLIVAN: Okay, from revised to estimates.

MR. BALL: Yes.

MS SULLIVAN: There are four areas there of

increased investments. For NLPDP this year, of course, we spent a bit of time

talking about that in the last little bit; 65Plus enhancements, of course; the

new drug therapies; the new panel agreement and utilization increase would

account for that $10 million. Of course, that will be offset by the anticipated

generic drug savings of approximately $22 million as well.

MR. BALL: Do you have any idea how many new drugs

you will have come off patent this year then, because there should be

considerable savings?

MS SULLIVAN: Of the number of drugs?

MR. BALL: There has to be considerable savings

there.

MS SULLIVAN: Colleen, would you know the number of

drugs that came off patent this year?

MS JANES: I do not have the actual numbers that

are anticipated to come off here with me. We could get that. We have done some

horizon scanning, but certainly we know there are a number of major molecules

anticipated to come off patent in the coming twelve months. In fact, those have

been factored into the savings we are anticipating as a result of the new

generic drug pricing policy. A precise number, I do not have with me.

MR. BALL: Okay.

One of the problems around that whole program has

always been, and people would make the argument, that it does not respond fast

enough. Is there a mechanism or any consideration given to getting generic drugs

available to the interchangeable formulary faster? There should be a policy in

place for that.

MS SULLIVAN: We have made huge improvements in

that just in the last little bit of time. I do not recall exactly the numbers

but I know even in terms of how often our committee meets to take a look at

that, we have made huge improvements.

Colleen can expand on that, but your point is well

made. It is a point that we have been concerned about as well; therefore, we

have undertaken some work to see that that process is expedited.

Colleen, you can add to that around the detail.

MS JANES: The process for interchangeable review,

the review of new generics that come to market in

part is outlined in our

regulations. There are two processes we undertake, and we utilize an expert

review committee to assist us in each.

What we have done recently is change the frequency at

which that expert committee meets. Versus seven times a year, we have bumped

that up now to twelve times a year. That was in response to the knowledge that

we do have a number of significant drugs coming off patent and we wanted to try

to expedite moving those onto our generic formulary as quickly as possible. That

is the most concrete change.

We have also done a review of our administrative

processes associated with moving drugs on. There is some paperwork that needs to

move from point A to point B behind the scenes, aside from the actual clinical

review of the product. We are streamlining that to the greatest degree possible.

The frequency of the meeting changes is just very

recent, within the last month or two. It will take a couple of months before we

see how much we have gained in terms of our ability to list drugs more quickly.

MR. BALL: I have never seen an example, and you

might have lots of them, I do not know. It would be interesting to know how many

times a drug would be available generically and the committee would actually

refuse to put it on the interchangeable formulary. Does that ever happen?

MS JANES: It does.

MR. BALL: Really?

MS JANES: There have been occasions where we have

de-listed a drug that has been on the formulary because of reports of

substandard quality of the drug product. I would not say they are frequent, but

it does occur. Because of that we are very sensitive to some due diligence in

our process and relying on expertise of committee members who are physicians and

pharmacists and an expert reviewer to assist us with that process.

MR. BALL: I want to be clear here, you are telling

me that we would have de-listed drugs that FDA would not have put out a notice

of saying that they should not be on a schedule? We would have picked that up

here in our Province?

MS JANES: There are two distinct processes that

happen when a drug comes to market. Marketing license is one thing. Declaration

of interchangeability', which Health Canada does not do it is beyond their

mandate is a separate thing. That is what our interchangeable formulary is

about. It declares whether product A and product B can be switched without

consulting the physician. It is a separate process, and over the course of the

years we have certainly had occasions where we have had clinical concerns

brought to the committee.

We will not automatically reach for de-listing. We

will explore, and oftentimes we have entered into dialogue with Health Canada.

In some cases we have had pharmacokinetic analysis done to have a look at

product A versus product B in terms of how it is behaving and worked with Health

Canada to try to resolve some of that, but there have been circumstances in

which we have removed products from our interchangeable formulary over the

course of years. It is not extremely frequent. In fact, I would say it is quite

rare. It is a little more frequent to have products come to the committee where

they have expressed some concern and have asked for more information before they

will consider recommending a listing.

MR. BALL: Yes, that is fine. I asked that question

more as a matter of public safety than anything. I would be very surprised

CHAIR: Dwight, I am going to have to

MR. BALL: Yes.

CHAIR: Okay.

Lorraine.

MS MICHAEL: Thank you very much.

I want to go back to 2.1.01, which is the money that

is given to Memorial University Facility of Medicine. Because of the nature of

the grant, the fact that it is a lump sum that is given, I am curious as to why

there was a revision downward from the budget item. It went from $53.3 million

down to $50.8 million.

MS SULLIVAN: The $1.7 million, closer to $1.8

million of that variance related to savings in operating funding for the Medical

School expansion. The savings were realized due primarily to construction delays

there.

MS MICHAEL: Okay.

MS SULLIVAN: The remaining $700,000-or-so in

savings is related to accommodations for medical students in rural Newfoundland

which was not spent in 2011-2012 due to implementation delays.

MS MICHAEL: Okay.

To understand it correctly, it is not just that the

money is passed over. They also have to show that the money is going to be

spent.

This is just out of curiosity now. Do they get the

money at the beginning of the fiscal year or do they get it partway through or

monthly?

MS SULLIVAN: We flow that monthly, yes.

MS MICHAEL: Okay, very good.

Thank you very much. That is clear.

MS SULLIVAN: Denise is a tight steward of the

money.

MS MICHAEL: Okay.

Under 2.2.01; Minister, I would just like to get a bit

of information, and I really am asking it for information. There is a lot of

confusion in my mind because of all the things that have been in the media with

regard to our legislative change with regard to the pharmaceuticals and the

implications of the new legislation for the smaller pharmacies.

What I have been told and this is what I want

clarification on and what I have heard is that there is going to be or there

is a regulation with regard to pharmacies who apply for subsidization. If they

are in a certain range to each other, two pharmacies, for example, if they are

too close together would not both be able to get subsidization. Is that indeed

the case?

MS SULLIVAN: You are talking about the remote

subsidy here, which is valued at $1 million. What we have said here is that if

there is a retail pharmacy that is the only one in the community and it is

twenty-five kilometres or more away from another retail pharmacy, they would be

eligible for a subsidy.

MS MICHAEL: If the pharmacy that it is twenty-five

kilometres away from is in another community, does that count? It would seem to

me that if they were both in the same community I can understand it. I do not

know the distances here. I am just plucking them out of the air. Say you have

two communities, totally separate, and they each have their own pharmacy, but

they are closer than twenty-five kilometres. Do you mean that one of the

pharmacies might have to shut down because of not being able to get the subsidy?

MS SULLIVAN: We are still in the process of

working out all of those details and exceptions of that nature I am sure would

be something we would take a look at. I would suspect there are not very many

cases where we would have two pharmacies in rural Newfoundland that are within

twenty-five kilometres of each other in any case. Those are things we would look

at as we work through all of the specs with regard to the expenditure of that $1

million.

MS MICHAEL: Obviously, keeping a pharmacy in a

community is really important for the sake of people, in particular seniors and

others, low-income people, who may not have their own means of travel, et

cetera. I would hope one of our goals would be making sure we would never have a

community that has a pharmacy have to lose it because of our new legislation.

That would be awful.

MS SULLIVAN: Yes, and it would be speculative to

say that a pharmacy is closing down because of the new generic drug pricing

model as well. There are all kinds of reasons why pharmacies might or might not

close; however, when we sit down to work out the specifics of this $1 million

expenditure that is certainly one of the conditions we are looking at.

MS MICHAEL: Thank you.

We can continue asking questions on that. I wonder, we

do have a breakdown going back to 2010 of the numbers of people and expenditures

in the different programs, so the number of people in the Foundation, the

numbers in 65Plus, Access, et cetera, but our latest figures for 2010, could we

have more recent figures of the numbers of the people in the different drug

programs? You can both read it out and give us a copy.

MS SULLIVAN: Certainly.

MS MICHAEL: Thank you.

MS SULLIVAN: Okay.

What we have in terms of our statistics would not be

the number of people, but we have a listing of the number of valid cards that

have been issued.

MS MICHAEL: Right.

MS SULLIVAN: You are looking for the 2012 numbers?

MS MICHAEL: The latest would be great.

MS SULLIVAN: Okay.

Foundation numbers would be 45,766; 65Plus: 49,002;

Access numbers: 36,370; the special needs, we are talking the Cystic Fibrosis:

108; the Assurance program: 6,134; the Assurance DCO, that is the drug card

only, would be 634; and the extended drug card: 1,390; for a total of 139,404.

MS MICHAEL: Thank you.

There has been a fair jump in the past two years in

numbers. If we could have a copy of that as well, that would be great.

Before moving on further, I think what I would like to

do and it makes it a bit more interesting is to come back to 1.2.05,

Population Health. I would just like to ask some questions that I think are

related to programs under 1.2.05.

If I am wrong in thinking that what I am asking about

is under that head, perhaps you can answer the question anyway because this has

to do with not knowing the actual flow chart. Is the Healthy Aging research now

under the Population Health area? If it is, could we have some idea of the

research that is going on, the issues that are being addressed, and have there

been any reports that we could have access to?

MS SULLIVAN: Yes, to the generic question of

whether or not that is contained under that head. The answer is there, in the

affirmative. In terms of any reports that we have at this point in time Tracy,

can you give us some idea of any reports that we might have available at this

point in time?

MS KING: I did not bring the specific breakdown of

the research projects, but that is something we can easily provide for you.

MS MICHAEL: We would very much like to see that.

That would be great.

MS KING: Yes.

MS MICHAEL: Thank you.

Minister, with regard to the aging and senior

secretariat, I am presuming that also fits under 1.2.05. What is the budget

breakdown for the secretariat, the number of employees and budget breakdown?

MS SULLIVAN: We will have to get that for you and

send it over.

MS MICHAEL: That will be part of that information

probably that we have asked for.

MS SULLIVAN: Yes.

MS MICHAEL: Okay, that would be great.

Under the Healthy Aging Framework, what are the action

items? Where are things going there? Once again, do you have reports of that? Do

you have any kind of documentation that would give us an idea what you have been

working on under that?

MS SULLIVAN: I can tell you that under the

Provincial Healthy Aging Policy Framework we have expended $7.5 million in

Budget 2011. Some of the programs and initiatives under the framework: the

$400,000 under Age-Friendly Newfoundland and Labrador Grants Program would be

there, the Ageless Public Awareness Campaign we had launched in 2008 would have

been there, the Seniors of Distinction Awards would have been there I am doing

a scan of some basic notes I have here and the $200,000 in the Healthy Aging

Seniors Wellness Grants would be there. We can get you the details on all of

those, if that is what you were looking for, if that would be helpful.

MS MICHAEL: Yes, that would be very helpful. Yes,

please.

MS SULLIVAN: Of course, the Provincial Advisory

Council on Aging and Seniors.

MS MICHAEL: Right. That would be helpful if we

could have that detail.

A big concern for seniors, obviously, is housing. We

all know the housing situation we are in, in the Province. There are many

reasons why people, seniors in particular, are actually couch surfing. We do

have that going on. We have examples of it. We have people being evicted from

rental units because of costs going up, et cetera.

Under the various areas, the research, the work of the

secretariat, or the Healthy Aging Framework, is that whole issue being looked

at? Not being able to be housed would be a determinant of health. I am just

wondering: Is it an issue that has been identified in any of the work that is

going on?

MS SULLIVAN: It is not an initiative that the

Advisory Council itself has taken a look at to this point in time. We can see

what we can do about finding more information for you with regard to that

particular issue. I understand what you are saying and I am sure that is an

issue you are also going to bring up with Minister Hedderson when you get to

look at the Newfoundland and Labrador Housing Corporation itself.

We can speak in general terms, but I do not think that

is what you want in terms of affordable housing programs or any of that nature.

We can take a look to see, within the department, how it is we are responding in

these areas. It is a concern.

MS MICHAEL: It is a major concern because, as I

have said, it is a determinant of health, having shelter, having good shelter,

and not having to worry about having a roof over your head. I would be very

interested in seeing the council actually looking at this as an issue.

MS SULLIVAN: Of course, we can get the information

around the Affordable Housing Program and the 355 units that have been

specifically constructed or are specifically available for seniors and the

ninety-five fully accessible units. We can get you those sorts of information

and the fact we have partner-managed housing, upgraded homes for example, 1,400

households sorry, I was distracted by coffee. Eighty per cent of those 1,400

of course are for seniors. We can get you some more statistics around that.

MS MICHAEL: That would be helpful actually for us

to see what is in actual place right now. I would appreciate that.

Thank you.

CHAIR: Last question for this round, Ms Michael.

MS MICHAEL: That is fine, thank you. I will come

back to my questions.

CHAIR: Thank you.

Dwight.

MR. BALL: I will move down to 2.3.01, the Medical

Care Plan, and Physicians' Services. Again, line item 05, Professional Services.

MS SULLIVAN: Under 2.3.01?

CHAIR: Yes, 2.3.01.

MR. BALL: Item 05, Professional Services, we see

we were right on budget last year, so I imagine this is going to be a simple

question for you. We do see some increase this year, and that is for what

reason?

MS SULLIVAN: Negotiated increases with physicians

as per our memorandum of agreement.

MR. BALL: That is what I thought.

MS SULLIVAN: That is primarily where it is, and

expected unionization grants as well.

MR. BALL: Line item 10, Grants and Subsidies.

CHAIR: Same section, 2.3.01.10?

MR. BALL: Yes.

MS SULLIVAN: You are asking about the Estimates

there again in terms of the increase of $5.5 million? That represents an

annualization of a 6 per cent increase awarded to salaried general

practitioners.

MR. BALL: Okay. Their pay comes out of that line?

MS SULLIVAN: Yes.

MR. BALL: How many salaried physicians do we have

on the Island now?

MS SULLIVAN: How many salaried physicians? Larry,

any idea how many salaried physicians we have?

DR. ALTEEN: We do an annual supply report based on

March 31. Now, it takes a couple of months to get all of the data in. This

report is based on last year's annual supply, but we had as of March 31 last

year 1,096 physicians, of which 384 were salaried.

MR. BALL: How many?

DR. ALTEEN: It was 384 of the 1,096.

MR. BALL: Okay.

DR. ALTEEN: We should have another report sometime

in May. It will probably be mid-May by the time we have that report done for

this year.

MR. BALL: That is as of March 31, 2011?

DR. ALTEEN: Correct.

MS MICHAEL: (Inaudible).

MR. BALL: Sure.

MS MICHAEL: (Inaudible).

CHAIR: Yes, as long as it is agreeable.

Lorraine.

MS MICHAEL: Thank you.

Just so we do not have to go back to it, Dr. Alteen,

does that figure cover just family physicians or family physicians and

specialists?

DR. ALTEEN: That figure is family physicians and

specialists. The breakdown of salaried physicians for family physicians is 167,

and 217 were specialists.

MS MICHAEL: Thank you very much.

CHAIR: You are welcome.

Dwight.

MR. BALL: Thank you, Mr. Chair.

Under 3.1.01, Regional Health Authorities, Supplies is

$1 million less than last year. Is there any reason for that?

MS SULLIVAN: Yes, what we have done is a review of

our vaccine inventory and we have determined that the requirements for vaccines

for 2012-2013 we are able to meet our requirements there. As a result, that

vaccines budget was reduced by $1 million for 2012-2013.

MR. BALL: Good, and good expiry dates.

I missed one. I have to go back to 2.3.02 Dental

Services. In Professional Services again we are seeing virtually a 50 per cent

increase there. I think I know the answer.

MS SULLIVAN: Again, that would have been the

annualization in the negotiated increases.

MR. BALL: Lorraine, did you have any questions

around Dental Services?

MS MICHAEL: Yes, I do, actually.

CHAIR: Okay, Lorraine, go ahead.

MS MICHAEL: Thank you very much.

I have a couple of questions. What is the uptake

looking like now? A couple of years ago it was actually pretty low. Is the

uptake, with regard to our dental services, improving?

MS SULLIVAN: I seem to recall that it is

marginally improved, but I do not recall where those numbers are. If you give me

a second I am going to find them, or Denise is.

Okay, so what we are saying, the uptake on the program

now is considered to be exceptional, which certainly speaks to the need for the

program. As services are cyclical, exams are every three years and dentures

every eight, there will be expected peaks and declines in our expenditures, as

this is the case for the first three months of this year of the program.

MS MICHAEL: All right.

MS SULLIVAN: I think you were asking particularly

about the numbers, and I do not have numbers. I do not know if we can even get

numbers on the specifics there, but I have been told that the uptake is much

higher than it has been.

MS MICHAEL: Well, that is good to know. Have you

been doing any extra educational programs or anything, or informational

programs, to cause that to happen, do you know?

MS SULLIVAN: There is ongoing awareness always,

and we have some done some programming around informing the general public about

the availability and word of mouth without any pun intended here tends to

get this information out whenever and wherever, but I cannot recall anything in

particular that we have done. I am look for, Colleen

MS JANES: I can answer a bit of information

there would probably be more that we would have to look for. In terms of

specific numbers, on the overall dental program we would have to go look for

that for you in terms of how the uptake has grown over the years.

As the minister has said, on the adult dental program,

our experience has been that the uptake has been exceptionally good. We have

made some gains on the broader dental program as well. By virtue of the

attention the new program has gotten, I think that is also helping to build some

general awareness, but we are certainly looking at and recognize the need for

some broader information sharing to build awareness on the overall program in

general, as well.

MS MICHAEL: Great, that is good to hear.

I just have one more question in this area, and

especially because we are talking about adults and older youth you have

mentioned. One of the issues, of course, for older youth and younger adults is

the whole wisdom tooth surgery issue, and I am just wondering if thought is

being given to including wisdom tooth surgery in the eligible benefits, because

it really is a necessity when it becomes needed.

MS SULLIVAN: It is not something that was

addressed this time around. Always, when we look at evolving programs we look to

the professionals to advise us as to what the next needs are. So, certainly it

will be a consideration.

MS MICHAEL: Thank you.

CHAIR: Dwight.

MR. BALL: Thank you, Mr. Chair.

Back to 3.1.01, and line item 05, Professional

Services again; $130,000 last year, spent $696,100 and back to $130,000 this

year. The question is about the revision.

MS SULLIVAN: That is a rather complicated issue.

It is basically to cover off legal fees here on I think it was a $2 million

third-party liability claim. The lawyer representing the client represents us as

well. If there is a big recovery then the cost of that legal case is borne here,

and that was about the $600,000, I think.

Denise, can you give any detail with regard to that

particular claim? It was a third-party liability claim.

MS TUBRETT: I do not have the detail, actually,

for the claim, but it was a $2 million claim that we would have gotten from

somebody who would have been injured and we would have provided medical services

to them. We are a third-party in the claim process so then if there is any

settlement we will get a share of it as well. It is $2 million, which we have

received.

MS SULLIVAN: I thought it was $600,000?

MS TUBRETT: $600,000 in legal fees.

MS SULLIVAN: $600,000 in legal fees, yes.

MR. BALL: Yes. The rest of the $130,000, that is

just a number

MS SULLIVAN: That is just going back to our

regular estimates.

MR. BALL: Yes, line budgeting.

The Grants and the Subsidies there, line item 10, I

imagine this would be going to the four Regional Health Authorities?

MS SULLIVAN: Yes.

MR. BALL: I am wondering if you could provide us a

breakdown of the grants for each authority this year.

MS SULLIVAN: Okay.

For the four Regional Health Authorities, and I will

give approximate numbers unless you want the

MR. BALL: No, to the dollar is fine.

MS SULLIVAN: For Eastern Health, $1.1 billion; for

both Central and Western, $290 million; and for Labrador-Grenfell, $131 million.

MR. BALL: Western and Central, you said $219

million or $290 million?

MS SULLIVAN: I said $290 million.

MR. BALL: Okay.

The next question would be about the accumulated

deficits, where they actually sit now.

MS SULLIVAN: I am sorry, where they

MR. BALL: Where they are right now, the

accumulated deficits for the four authorities?

MS SULLIVAN: Accumulated deficits for Eastern

Health as at March 31, 2011 would be $71.9 million; for Central Health, $18.5

million; Western Health, $19.8 million; and Lab-Grenfell, $20.5 million.

MR. BALL: When will we get the more recent

numbers?

MS SULLIVAN: In June.

MR. BALL: In June?

MS SULLIVAN: Yes.

MR. BALL: Do you have any idea what is going to be

required to cover off the deficits this year?

MS SULLIVAN: For this year?

MR. BALL: Yes.

MS SULLIVAN: Okay.

For Eastern Health, $12.4 million; for Central Health

they are actually balanced, as is Western Health; and Lab-Grenfell $800,000.

MR. BALL: Okay.

So we need to send letters of congratulations to

Western and Central.

MS SULLIVAN: Good, hard work there.

MR. BALL: You got that right.

In 3.1.02, Grants and Subsidies again, that number has

not changed. I am just wondering what they are.

MS SULLIVAN: I am having trouble finding that one.

I need to back up, 3.1.02.

Your question again, I am sorry?

MR. BALL: The Grants and Subsidies, and you can

provide us with a list of that for later if you want to.

MS SULLIVAN: Yes, and I have pages and pages of

that. I would certainly be happy to provide it. If we are tired, I would even

read it out.

MR. BALL: That is for community agencies, so it is

nice to see that.

I did miss Debt Expenses, if we could go back to

3.1.01. That is line item 11, Debt Expenses. It has not changed much. I am just

wondering what that covers, what debt?

MS SULLIVAN: Debt Expenses, your question was

around?

MR. BALL: Where is that debt? It is $3.2 million.

MS SULLIVAN: Funding is included for debt expenses

which represent the cost of lease payments for the Province's health centres in

three communities: Burgeo, Port Saunders, and St. Lawrence.

MR. BALL: Okay.

MS SULLIVAN: Is that enough?

MR. BALL: Yes, I know now. I know exactly where it

is.

MS SULLIVAN: Harbour Lodge I believe is in there

as well. Yes, Harbour Lodge Nursing Home in Carbonear as well.

MR. BALL: Yes.

Now moving along; Health Care Equipment, that would be

3.2.01.07 Property, Furnishings and Equipment, $58 million. I guess that is an

assortment.

MS SULLIVAN: Yes. Do you want the breakdown?

MR. BALL: No, I am fine with that.

MS SULLIVAN: Okay.

MR. BALL: Professional Services in the next one,

3.2.02.05 Health Care Facilities

MS SULLIVAN: In 3.2.02 or 3.2.03?

MR. BALL: 3.2.02.

MS SULLIVAN: Okay, and Professional Services?

MR. BALL: Professional Services, yes, we see a

huge swing there.

MS SULLIVAN: Okay.

You are looking at Professional Services, and you are

looking at the revised from $23 million to $13 million?

MR. BALL: Yes, and then down to $9 million.

MS SULLIVAN: All right, and we are going to find

the same answer right throughout this whole subhead actually.

The department has a number of infrastructure projects

in various stages of construction and planning, like preparation and so on, and

as a result, each of those projects will require different levels of funding in

any given year depending on how prepared they are or how far along that

particular project is.

For example, in 2011-2012 we budgeted for the new St.

John's long-term care facility and the budget for the project dropped again.

Over last year's budget, that budget dropped this year as the project reaches

completion and so on. This is a Transportation and Works issue, more than it is

ours. We work in conjunction with Transportation and Works but more

realistically, because it is our project, the budget flows out of our coffers if

you will, but Transportation and Works actually has oversight on the project.

MR. BALL: Okay.

MS SULLIVAN: You will find that right throughout

this particular subhead.

MR. BALL: Then 06 in the next line, Purchased

Services.

MS SULLIVAN: Yes, that would be the same thing.

MR. BALL: The same thing?

MS SULLIVAN: Absolutely. In all of these,

everything right throughout this whole

section you will find the same thing. It

is TW primarily, and we flow the money.

MR. BALL: What is the percent completion now for

the long-term care site here?

MS SULLIVAN: Of which one?

MR. BALL: In St. John's.

MS SULLIVAN: Tony, do you have those with you? I

had them earlier, but I do not have them with me today. Long-term care is

MR. WAKEHAM: I do not know the exact percent, but

I can certainly get it for you.

MR. BALL: Yes, it is quite the building.

MS SULLIVAN: We will get that percentage for you.

MR. BALL: Okay.

CHAIR: Lorraine.

MS MICHAEL: Thank you very much.

I am going to start there and probably work backwards

with 3.2.02.

I think, Minister, if we have done our research

correctly, there were four new infrastructure projects in the 2011 Budget and

there were, I think, seven continued infrastructure projects. There may be more

than that; there were seven key ones that we picked out.

My question has to do with, for example, the

Waterford. In 2011 there was $4.5 million that was to begin the planning for the

replacement of the Waterford Hospital. In this Budget there is no mention of the

Waterford Hospital, so I guess what I am asking for is the status of the $4.5

million planning that was supposed to have started over this past year and is

that a continuing thing that is still going on.

MS SULLIVAN: Absolutely. You would have noticed in

this year's Budget that we invested $750,000 in the forensic unit at the

Waterford this year and that is because we intend to maintain and ensure that

the patients who are there are served by the best facility that we can have in

place at this particular point in time.

In terms of the monies that were allocated for

planning, that money will be reprofiled' and moved forward the $4.5 million I

seem to be recalling there.

We have a couple of committees in place. First of all,

there is a committee that involves my department, the Department of Health and

Community Services, Transportation and Works, and Eastern Health who have done

some preliminary work and in-house planning, if you will. We are in the process

right now of looking for stakeholders to serve in an advisory capacity as well.

So we will continue to work forward on the planning of that.

When we talk about some of these infrastructure builds

that we are looking at, it has been a long time since any government has

undertaken anything of this magnitude in terms of the Waterford Hospital, for

example. It is too bad Mr. Joyce is not here this evening, but the Corner Brook

facility as well.

Our job, I think, is to make sure that we are spending

the taxpayers' money as wisely and as efficiently as we can so what we are

getting for the taxpayer of the Province is the best facility that we possibly

can to serve the needs well into the future, and you have heard me say this in

the House and I will continue to say it: The planning that we are doing around

it is not simply about replacement. It is about ensuring that the facility that

we erect and the essentials that we provide in those facilities are going to

meet the needs of Newfoundlanders and Labradorians, not just today but well into

the future. So that does take some fairly detailed planning and it is that that

we are committed to.

MS MICHAEL: Have you set a date or any kind of

hopeful date for the replacement of the Waterford?

MS SULLIVAN: I have not set a date. Within the

department I do not think we have actually ever put a number on that. I have

heard that it takes many years to get the actual planning done and then to be

able to move forward with the construction but to my knowledge Bruce, unless

you have something to add to that we have never put a date.

MR. COOPER: Of course you need to have a plan

before you can move forward and understand what the date is, but certainly our

goal for this year is to conclude with a good functional plan and then once we

pass through that important gate and stage, we will be in a better position to

plan the full project.

MS MICHAEL: Have any consultants been contracted

to work with you in this planning stage, or is it all internal?

MS SULLIVAN: Not at this point in time. We have

done internal planning at the outset, but there will come a time when we will

need to go to external consultants as well. So that money is there that $4.5

million is there to be able to help us do that.

MS MICHAEL: Okay, thank you.

Moving backwards, it is sort of related to 1.2.05, but

not really from a line item, so you do not really need to go back there. I just

had a couple of more questions with regard to seniors that I wanted to ask. I do

not know if this one actually comes under your department or not, but it has to

do with the seniors in receipt of Income Support who were forced to take the

early CPP and now that has changed. That is not under your department, is it?

MS SULLIVAN: No, it is not.

MS MICHAEL: Okay, fine. We will ask that to the

appropriate minister when we get there. Where would that be, under Advanced

Skills?

MS SULLIVAN: I would think AES, yes.

MS MICHAEL: This is where it is really confusing

to know where to go with some of the issues.

MS SULLIVAN: Sure.

MS MICHAEL: So you think that is under Advanced

Skills?

MS SULLIVAN: I would think that.

MS MICHAEL: Okay, thank you.

A couple of others with regard to seniors with

regard to the Aging Advisory Council, have they done a report of activities yet?

Have they annual reports? I mean, if they do, we will go to them and get it.

MS SULLIVAN: They did just recently release it

seems to me that I have seen one of their reports recently or maybe it is just

in my process of getting fully immersed in the department that I have seen a

report, but there are reports from that group, yes.

MS MICHAEL: Where are they physically located, the

staff for the council?

MR. COOPER: They are in our department, West

Block, third floor.

MS MICHAEL: Okay. We were not sure if they were

actually there or not, so thank you very much.

Could we have an update this is not seniors, but

again still health on the mental health and addictions treatment facilities

especially the ones for youth, where things are in the planning stages?

MS SULLIVAN: A big priority it is something that

I want to see moving forward very quickly. I have let staff know that on a

number of occasions. So, where we are with that at this point in time, we have

completed the tenders. The tenders have come back. We are in the process of

reviewing those tenders for construction on both of those treatment centres in

Grand Falls-Windsor and in Paradise. They are being evaluated, and I would hope

that we are going to see something happen on that very, very soon.

MS MICHAEL: Okay, so the sites have been finalized

in both cases?

MS SULLIVAN: Site preparation has been done in

both places.

MS MICHAEL: Great.

Minister, I know that very often advisory councils

it is the practice; I know because I have been on advisory councils in the past.

They very often change with ministers. I am wondering about the status of the

mental health advisory council that I know was in place with the minister before

you.

MS SULLIVAN: The council itself is certainly still

in place. I think the full complement is there, so I have not changed that

council at all. I am very pleased with the work that is happening there.

MS MICHAEL: That is good to hear because I had met

with some of them and I know the issues that were coming up, so it is very

important that they are there. I am really glad to hear that.

One of the issues that I know has come up on the

council is the whole issue of methadone. For me, there are two different issues

and I think for some members of the council it is probably the same. One has to

do with the waiting list for methadone and what is happening with that. The

other has to do with the use of methadone and should methadone be used for

younger people in the same way it is for people who have had the addiction for a

long time.

I know there is a lot of research being done into

that. Knowing the nature of methadone, I think there is a real reason for being

concerned about putting teenagers on methadone. I would just like to know where

that discussion is at the moment, but I would like to know also about the

waiting list and what is happening with that.

MS SULLIVAN: Okay.

I can tell you that as of January of this year there

were 880 clients on methadone maintenance treatments in Newfoundland and

Labrador, which is roughly about the Canadian average as well. The methadone

clinic here in St. John's provides methadone to about 125 of those clients and

the others go to private physicians for the provision of that methadone. I

understand that a second part-time physician has been added to the clinic here

in St. John's and he has begun taking patients. There is some movement in the

wait-list there.

In February, 180 clients were waiting up to about

eighteen months, but the wait-list is reducing each week as that new physician

starts his practice here. Hopefully, we will start to see some improvements in

that wait-list.

I do not pretend to be a physician or understand very

much about the need to prescribe and at what age methadone is to be prescribed.

I would ask Colleen Simms, who is somewhere back of me Colleen can provide

some of the additional information, I believe, that you are looking for around

use of methadone and appropriate ages and times to use.

MS SIMMS: Yes, methadone is just one treatment of

course in a whole continuum of services that should be offered. While there may

be at times youth who do need to go on methadone, it is usually because of their

individual circumstances.

It is related to the fact that they may have been

using drugs for a number of years. There may have already been other things

tried. All of those things need to be taken into consideration, particularly for

youth who are under the age of about twenty-three or twenty-four when the brain

is still developing.

The important thing is to look at the continuum. There

are still times when that will be considered the first option for youth;

however, it is infrequent.

MS MICHAEL: Okay.

I am just wondering, Minister: Is that then monitored

by your department, the use of methadone with youth?

Your staff person said it is infrequent, so how do we

know it is infrequent? Is it because you actually do monitor?

MS SULLIVAN: Within the division itself, Colleen

can speak again more directly to the monitoring that is done. It is certainly an

issue we have been concerned about. The monitoring, Colleen, is done within that

division.

MS SIMMS: I can speak to it again.

Yes, within the methadone clinic in Pleasantville we

get regular statistics. Right now, there are only a small handful of youth who

are receiving methadone treatment and have been for some time. In terms of the

numbers the minister just quoted, a very, very small percentage of youth are on

methadone.

MS MICHAEL: That is good to hear. Thank you very

much.

A few more questions here, if I may.

MR. BALL: I have a few questions on methadone,

while Colleen is all warmed and primed back there.

MS MICHAEL: Sure, go right ahead.

CHAIR: Dwight.

MR. BALL: Thank you, Glenn.

One of the issues around methadone clinics is, of

course, we do not really have a prescriber on the West Coast at all now and it

is creating a huge problem. The closest prescriber right now would be in Grand

Falls with a significant wait-list there. I do not know what the department

plans to do there, or is there anything being done at all? It has been like this

from day one.

MS SULLIVAN: Recruitment is a difficult issue

there for sure, in terms of being able to find physicians who want to work in

this particular area.

Again, I defer to Colleen to give you some more

specific detail around what we are doing.

MS SIMMS: Yes, just to confirm that. On the West

Coast we do know that there is a particular issue there. We have a methadone

nurse who supports people who are receiving methadone maintenance treatment, and

we just recently set up video conferencing so that clients who are on methadone

can access their physician through video conferencing through Telehealth, but

that is not going to meet the full need. So we need to continue to look at that

for the West Coast in particular.

In Central, there is a physician prescribing. It does

not present as much of an issue, but for the West Coast we have set up the

Telehealth.

MR. BALL: Would that nurse be able to change

dosing?

MS SIMMS: No, she is there to support the client

and to assist with connecting with the physician who is in St. John's, and to

case manage because as you can appreciate, somebody who is receiving methadone

maintenance treatment is not just receiving the actual medication. There are a

lot of supportive services that should be in place as well, addictions

counselling, and follow-up.

The goal of this treatment really is to help people

get back into their lives, get back to education, and get back to their

employment. So, she performs some of those functions as well.

MR. BALL: Have you put any thought into having a

visiting physician?

MS SIMMS: I do not know that the Regional Health

Authorities have particularly looked at a visiting physician, but I do know

there has been a tremendous effort made in trying to recruit physicians. The

physician recruitment issue for this, in particular, has been problematic. That

is why we have gone to the Telehealth route.

MR. BALL: In all fairness, the problem is probably

ten years old. I do not think we have maybe once have we ever had a physician.

No, we have never had a physician out there to write methadone. There was a

psychiatrist out there who did it years ago, but I can guarantee you it is about

ten years now. Obviously, the recruiting is not going to work and seems unlikely

to work.

This is another example of where we get the

inconsistent service from, obviously, Western into Central and into St. John's

right now. I can assure you, it is a big problem out there, not having that

physician available. So, I would really like for you to look at, at least a

visiting physician.

In most cases, you actually have to bring all those

people into St. John's or into Grand Falls somewhere. You know the type of

clients we are dealing with here. There is not a lot of money involved and they

are highly motivated at least when they get to methadone maintenance

treatment, in most cases they are highly motivated and want to get on to the

next stage of their life. So, I think consideration for at least a visiting

physician would be something you need to look at, given the fact that there has

been zero success for many, many years now.

MS SULLIVAN: I am going to ask Dr. Alteen to

address that issue around recruitment, particularly out on the West Coast.

DR. ALTEEN: The issue is of importance, as you

have mentioned, in terms of the recruitment as well. Obviously, the stigma that

is attached to mental health, the difficulty that some physicians have in terms

of being associated with the prescribing and the challenges that come with that,

but I think as we build over time some stability in the physician workforce, I

think in different areas, we can do better jobs at engaging them in terms of

being involved with methadone treatments and with mental health issues in

totality.

In terms of the travelling perspective, when you have

limited numbers of providers it is very difficult to take your time and go

somewhere else but at the same time appreciating that moving all of those

individual patients from a community to another place is just as difficult. We

have been spending some time, not just in this area but a number of areas, where

we are trying to build a capacity for physicians to travel to different areas to

provide services rather than the population moving to where the physicians are.

It is an ongoing discussion we are having at the regional health authority

levels and certainly my discussions with the VPs of medicine at those areas

trying to expand on that.

One appreciates what you said, it does take a period

of time to try and get that engagement. Physicians, for whatever reasons, with

methadone have the option of saying I do not wish to prescribe methadone and get

involved with that. We have to break down that stigma and the difficulties

associated with that.

CHAIR: Lorraine?

MS MICHAEL: Thank you.

A few more questions, this has to do with regional

services. Again, it is not so much line items but to see where things are with

certain programs, et cetera.

Minister, we know there is going to be a pilot project

at St. Clare's that the NLMA, Newfoundland and Labrador Medical Association and

Eastern Health are going to be doing with regard to creating sort of this centre

with regard to seniors who come into ER and to provide a program that will be a

more holistic way of dealing with seniors.

Is the department involved with that at all, or is

this just NLMA and Eastern Health together?

MS SULLIVAN: I am assuming that you are referring

to the new wait-time strategy for the emergency room departments over there

where we looked at a community support service over there that would allow us to

provide to seniors who come into the emergency department a rapid response sort

of program.

MS MICHAEL: That is right.

MS SULLIVAN: What happens is that quite often

seniors come in and they need attention but they need someone to help them with

that attention at home. So, if a senior comes in and does not have anybody at

home who is able to provide that care to them, oftentimes what happens is that

the only other alternative is to admit.

What we have done with the rapid response is committed

to having a home support style program in place for them for a couple of weeks

so that somebody can actually be with them to help administer their care over

the period of the week or two where they would need that care, and that would be

necessitated as opposed to having to admit.

MS MICHAEL: Has that already started? I did not

think it had started.

MS SULLIVAN: Not started, but it is certainly part

of that new wait time strategy that we have put in place for them.

MS MICHAEL: Will all of the work that is being

done on the ER in St. Clare's allow for space for this program to take place? Is

that part of the consideration?

MS SULLIVAN: Yes. The space is not necessarily

what is needed there. It is the consultation and then the organization around

the home support that would be required to be able to send them home as opposed

to admitting.

MS MICHAEL: I guess what I mean by space, I think

actually space is required because if you are going to give special attention to

a senior who comes in, I think you would need dedicated space so they can be

dealt with quickly and not be just in the waiting rooms. From that perspective,

I think, in actual fact, the program is going to require space to have it

operate well.

MS SULLIVAN: One of the big issues we have

addressed and are trying to expand on is patient flow within our emergency

departments.

One of the other components of that particular

emergency department wait time strategy that we put in place would be the CTAS

evaluation that would allow us to evaluate patients when they first come in

whose time with a physician or a nurse practitioner does not need to be lengthy,

it might be something fairly simple. We are in that process, trying to design an

area of the emergency department where we can sort of channel them to go and

have that fast be seen a little bit more quickly and not be out in the general

waiting room population. We are very concerned about efficiencies within the

patient flow of our emergency departments and we are working toward that.

CHAIR: The last question, Lorraine, for this

round.

MS MICHAEL: Okay.

For this round, okay; the last question for this

round.

CHAIR: I am assuming it is this round.

MS SULLIVAN: There is going to be a bell, I am

sure.

MS MICHAEL: There are a few more.

The last question for this round; I know that we do

have the announcement on the wait times with regard to the joint replacement and

the ER, and that is good.

Do you have a long-term plan in place with regard to

some of the other wait times, especially to the wait times that have to do with

specialists, such as rheumatologists and physiatrists?

MS SULLIVAN: Certainly, through our Access and

Clinical Efficiency division, that new division that we have created over there,

one of the fundamental tasks of that division is to look at wait times

generally.

In terms of recruitment of physicians, that is an area

that Dr. Alteen looks after and does a very good job of looking after. It is an

area that we always focus attention on in terms of being able to attract to this

Province the physicians that we need in the areas in which we need them, and I

think the MOA that we struck last year has made a huge difference there. We have

more physicians practicing in Newfoundland and Labrador now than we ever did. We

have more nurse practitioners, we have more nurses, and we have more LPNs. We

are looking to fill the gaps in all of those areas, and it is a process.

MS MICHAEL: Could we have I am sure you have

documentation on where things are at the moment, how things have improved,

especially with the new MOA et cetera. That would be really great to have that.

MS SULLIVAN: Absolutely.

MS MICHAEL: So we get a sense of how things are

moving.

MS SULLIVAN: You are talking in terms of the

numbers of physicians that we have been able to attract and so on.

MS MICHAEL: That is right, yes.

MS SULLIVAN: Yes.

MS MICHAEL: And show a comparative analysis of

that.

MS SULLIVAN: Sure.

CHAIR: Thank you, Lorraine.

MS MICHAEL: Thank you.

CHAIR: Dwight.

MR. BALL: I will do one follow-up on that too,

that chart that you have mentioned there, it should include nurses and nurse

practitioners? Actually, I am not surprised that there are more nurses, not

surprised that there are more physicians but I am surprised to hear there are

more nurse practitioners.

MS SULLIVAN: We actually were out of the gate a

little earlier than many provinces, in Newfoundland and Labrador in terms of

nurse practitioners. While our number of nurse practitioners per capita may have

slowed down a little bit over the last two or three years, it is because we were

out ahead of everybody else. We have I think 105 my memory does not always

serve me well at this hour in the evening, but I think 105 nurse practitioners

right now.

MR. BALL: Yes. What I would like to see there, as

Dr. Alteen compiles that chart, would include all three disciplines. Of course,

nurse practitioners who are actually working because I knew some who were only

working part-time.

I am going to move some questions now towards some of

the long-term debt within the Regional Health Authorities again. The question

being, has there been any plan to retire this debt now? Some of this has been

around for quite some time. I know the current debt you do pay off every year

but some of it has been around since 2005 maybe or the six amalgamations of the

boards.

MS SULLIVAN: It is a complicated bookkeeping

piece. You are right in terms of year over year and the stabilization funding we

have been providing, that has been ongoing for a little while. Of course, one of

the things we challenge our Regional Health Authorities to do year over year is

to find efficiencies within their boards and to be able to operate within the

funds that they are allocated.

The long-term debt is a complicated piece of

bookkeeping that Denise constantly tries to explain to me. So I will let her do

it one more time.

MS TUBRETT: As you said, the operating deficits of

the Regional Health Authorities, their annual deficits, we deal with them

through stabilization funding. As the Minister pointed out, in 2011-2012 two of

the four RHAs had operating deficits. Two did not. Two actually had surpluses.

With respect to the long-term accumulated deficit,

that has been there long before the RHAs have in fact come together. I believe

they came together in probably 2004, 2005. Since that time, that actually has

not increased. If anything, it has been decreasing.

With respect to how to deal with it on a longer-term

basis, the plan would be to have the RHAs get themselves in a financial position

where they can start to pay down on the debt so they can reduce it. For example,

in the case of Central and Western this year, both of those Regional Health

Authorities will be making payments to reduce their accumulated deficit.

MR. BALL: Okay. So that was not balanced budgets.

That was actually surpluses?

MS TUBRETT: Yes, they were surpluses.

MS SULLIVAN: Small surpluses.

MR. BALL: Yes, okay.

MS TUBRETT: Central Health had $250,000 and

Western was $3.6 million. It is important to point out that the year-end still

has not closed off, so these are projected numbers. These numbers will vary. The

audited financial statements will not be completed until June. Until that time,

these are really projected numbers that could change either way. Generally, this

is the trend we would expect them to go in.

MR. BALL: Yes. Obviously, then what happens is

this carrying cost, this debt load is still paid for by the respective boards. I

am just wondering, since some of it has been around for quite some time, I would

imagine some of the interest on some of those loans is not that attractive.

MS SULLIVAN: This is the complicated part that

Denise keeps trying to educate me on. There is no interest. Again, I am going to

allow Denise to try to explain. Denise realizes it is a complicated piece, but

she will go through it again.

MS TUBRETT: From a financial perspective, the

balance sheet, this is really accounting oriented. From the balance sheet, this

is a paper debt to a certain extent. So there are no interest payments on it. It

is a culmination of assets less liabilities. Obviously there are liabilities

that RHAs are paying interest on in any given year, but their accumulated debt

is the liabilities less the assets at the end of the day. It is accumulative

over the years.

MR. BALL: When Eastern Health does their financial

statements and they talk about interest on long-term debt?

MS TUBRETT: That would be something different than

the accumulated debt.

MR. BALL: Okay. I was not aware of that.

MS SULLIVAN: I told you.

MS TUBRETT: Obviously, the Regional Health

Authorities will have debt payments they are making probably for mortgages, or

it could be any number of things. It could be lease of equipment, those types of

things. That is what they are talking about. This is the accumulated deficits of

each and every single annual year since the RHAs have been reporting.

CHAIR: Okay.

MS MICHAEL: Can I just ask a question there?

CHAIR: Sure.

Lorraine.

MS MICHAEL: Thank you.

My understanding is, if I am correct, that debt,

though, as you have described, does show up in a Consolidated Revenue Fund.

MS TUBRETT: Yes.

MS MICHAEL: In the Consolidated Revenue Fund you

then have a combination of debts that are real cash debts and the debts that are

the accumulated debts which are the assets minus the liabilities.

MS TUBRETT: Very good. I am impressed.

MS MICHAEL: Thank you. I am pretty good at that

stuff.

MS TUBRETT: Really impressed.

MS MICHAEL: Thank you.

MR. BALL: There is no cost to the authority for

that debt?

MS TUBRETT: There is no cost to the accumulated

deficit, but the RHAs do have debt-related costs they incur on an annual basis.

MR. BALL: Outside of all of that?

MS TUBRETT: Yes, and that would detailed on their

financial statements.

MR. BALL: Yes, that is fine.

We covered off the methadone. Community care homes

right now, there has been some confusion around some community care homes and

personal care homes, that they actually serve two different types of clientele,

yet the funding mechanism is the same. Is there any reason for that? It would be

Colleen, I guess.

MS SULLIVAN: I am sorry, I was not clear on the

question on which homes?

CHAIR: You have to go through the minister,

Dwight.

MR. BALL: Pardon me?

CHAIR: You have to go through the minister.

MR. BALL: Okay.

The community care homes I think what happens is

most of the program funding is actually compared to that of personal care home,

yet we get community home operators trying to make a distinction between the

two. I am just wondering why it is, as a department, that you basically took the

two and treated them the same, being the community care homes and personal care

homes, in terms of the funding.

MR. COOPER: Just to clarify, when you speak of

community care homes, you are referencing the homes that are largely out around

the CBS area

MR. BALL: Yes.

MR. COOPER: that are an important part of a

program of Eastern Health where they care for individuals who may have been

deinstitutionalized. You are asking for comparison between the community care

homes and the personal care homes?

MR. BALL: Yes, because the funding is basically

the same really, is it, per client?

MR. COOPER: I think there may be some nuances,

some differences, depending upon the needs of the client, but essentially they

are a very similar type of program. There are some different allowances that

have been put in place and different services for persons in the

community care home program because of their affiliation

with Eastern Health.

I just want to turn around to Colleen and see if she

can clarify anything there.

MS SIMMS: The community care homes were originally

part of the Waterford Hospital many years ago and then when the personal care

home guidelines came out and I am not sure of the exact year of those, but it

was at least eight years ago, somewhere around there, and I stand to be

corrected on that community care homes were made part of the personal care

home system. They have been part of that, so they have gotten all the same rate

increases, they have gotten all the same adjustments and benefits as the

personal care homes have.

There are some distinctions in the terms of the

population because those homes have people with mental illness, but they also

have people with intellectual and developmental disabilities as well. It is not

a pure distinction because you will see throughout the personal care home system

people with the same kinds of disabilities and challenges. I guess the beginning

of that program was a little bit different from the personal care home system,

but they came together roughly seven or eight years ago.

MR. BALL: Okay.

We will ask a few questions maybe around the personal

care home side of things. I am just wondering about the small homes. Last year

there was a grant for small homes. How did that program work out and what was

the uptake?

MS SULLIVAN: The uptake on that program, as I

recall it, for the small homes grant program was thirty-nine homes availed of

that particular grant. The isolation grant on the other hand, the uptake was not

very big; in fact, I think there was only one home that availed of that, if I am

remembering correctly. Is that the number?

OFFICIAL: That is right.

MS SULLIVAN: One home that availed of the

isolation grant.

MR. BALL: What was the isolation grant?

MS SULLIVAN: It is basically a grant for those

homes that are in communities that are isolated. They are a good distance away

from any other services that could be provided.

MR. BALL: Okay.

One thing that we have been getting that I have heard

a bit about in the last few months is about some of the assessment tools. Again,

it speaks to the consistency from one authority to the other. In this specific

case I know it has been a senior actually the calls came into our office. When

they started calling, there was actually two or three of them who actually came

in together. That was about preparing the assessment tool for placement into the

homes. There seemed to be a delay.

Central seemed to be doing a much better job. I know

some of the homeowners I have spoken with in the Central area seem to be doing

much better,

whereas some of the ones on the West Coast have been really

struggling trying to get through at least the financial piece of it. I do not

know if there is any role for the department to play there.

MS SULLIVAN: I am not sure exactly what assessment

tools you are referencing here.

MR. BALL: That would be the financial piece.

Typically it all gets bottlenecked at the financial piece, which is really the

last piece. What happens is the senior would go out and collect all of the

information through a medical. What happens then is the financial piece goes

through some person. This has to be completed. Once that is done, obviously you

get the approval to move into a home. I know it has been very frustrating for

some residents on the West Coast.

MS SULLIVAN: I think Tracy is aware of this

particular case and she can provide you with some clarification around that one.

MS KING: In Western Health last year there was a

particular issue where they were experiencing a period of delay. Western Health

has reviewed the issue that was causing an abnormal length of time for some of

those assessments. We expect if that issue has not turned around yet we see a

big improvement already was the last report I had. We think that issue has been

sorted.

MR. BALL: Good, that is nice to hear.

The Long-Term Care Strategy I am sure the minister

is not going to be surprised to hear about this we have heard is going to be

in a few weeks.

Is that still on track? When do you expect to have

that released?

MS SULLIVAN: The Long-Term Care Strategy is a

piece of work that is complicated as any piece of work I have ever looked at. It

is a strategy that is exceptionally important and it is a strategy that I have

committed to getting out. I will see to it that the strategy gets out.

I know you want me to put a date on it, my department

wants me to put a date on it, and I will not do it. I will tell you it is coming

soon. We are working I wanted to say around the clock, and some days I think

we are. We are working diligently at getting that strategy out.

Again, it is a strategy that is going to be in place

for some time. So while we can tweak it, and it will be a living-document

strategy, I really want to make sure the foundational pieces of it are as

thorough as we can possibly make it. I have committed to getting it out. One way

or another, that strategy is coming out soon.

MR. BALL: Well, it sounds like a commitment. I

hope it is not our names using the long-term care homes. It is important, I

agree, and it has been around for quite some time now. It is important that we

CHAIR: Time for one more question, Dwight.

MR. BALL: Yes, I want to go right back to Cameron.

There were sixty recommendations there.

Are all of the recommendations from Cameron

implemented now?

S SULLIVAN: We have fifty-five of the sixty

recommendations either fully implemented or substantially implemented. There are

three others that we are working on right now that we hope to be able to

implement in the very near future. Again, it is a work in progress and a work

that we are very focused on in ensuring that the correct work is done.

Accreditation of laboratories is one of the areas, and

I can report that the major laboratories in the Province have been accredited.

We are working forward on some of the smaller in fact, it was just this past

Friday that Tony and I, and the CEO at Central Health met to talk about some of

the issues around accreditation of our smaller laboratories. It was a real eye

opener for me, actually, to see some of the work that needs to happen in some of

our smaller laboratories in order to get them accredited.

It is something I can tell you that all of our RHAs

are committed to seeing through and the implementation of that accreditation

or the work to see that the accreditation is complete soon is certainly ongoing

and I expect to hear more everyday.

CHAIR: Thank you.

Thank you, Dwight.

Lorraine.

MS MICHAEL: Thank you very much.

A few more questions; I will stay with the long-term

care for a minute, but particularly with regard to the budget item in the

personal care homes. I think you have budgeted $612,000 for 100 new portable

subsidies.

I am just wondering, what is the ratio with regard to

the total number of subsidies compared to the number of people who you think are

going to be applying for subsidies? Do you think the $612,000 is going to meet

the need? What are the criteria that you use for making a decision with regard

to who gets subsidies?

MS SULLIVAN: The $612,000 does accommodate another

100 subsidies and I anticipate we will have full take up on that, on those 100

subsidies as has been the case in the last year as well when we had an

additional 100 subsidies.

The actual ratio, I do not know, but I am sure that is

a statistic we could work up for you to see what the list might look like in

terms of people who are looking for subsidies and the number that we have.

The current number of subsidies that we have now,

Bruce, is? How many Tracy?

MS KING: It is 1,712.

MS SULLIVAN: It is 1,712 subsidies, which is an

increase of 682 just in the last few years.

MS MICHAEL: This will add another 100 to that.

MS SULLIVAN: That 1,712, does that include the

2012 number of 100, Tracy?

MS KING: It does.

MS SULLIVAN: It does.

MS MICHAEL: Do you keep an account of people who

make application? Do you have a waiting list, for example?

MS SULLIVAN: We do have a waiting list, and I am

assuming we have an accounting of who is on that list.

MS MICHAEL: Right. If you do not have it at your

fingertips could we be given the number?

MS SULLIVAN: I know there are approximately sixty

on the waiting list.

MS MICHAEL: Okay.

Thank you.

So, you have allowed for some growth beyond your

waiting list.

MS SULLIVAN: Yes.

MS MICHAEL: Okay, thank you.

That is sort of the kind of information I was looking

for.

Minister, what are the criteria for people applying

for the subsidy?

MS SULLIVAN: Tracy, do you want to address the

specifics of that?

MS KING: Sure. Persons applying for a subsidy for

a personal care home undergo a financial assessment to determine their

eligibility. It is based on their needs, different from eligibility for home

support. It is based on their actual income and expenses moving into a personal

care home.

Persons qualifying for a subsidy are able to maintain

$150 of their income and, as well, the liquid asset thresholds apply. So an

individual person may maintain $10,000 of their asset in qualifying to move into

a personal care home. If you would like some particular information about how

the financial assessment works, that is a detailed process and we can provide

some information about how that assessment process operates.

MS MICHAEL: That would be good actually, to have

that written down. That would be great.

MS KING: Yes, sure.

MS MICHAEL: Sometimes the reason for us needing

this information is because when people call us when we have constituents who

call it is good for us to really have a good understanding of the process.

MS SULLIVAN: Absolutely.

MS MICHAEL: If we have that ahead of time we do

not have to be calling you all the time just to get a sense of what they are

dealing with and what we are dealing with. It helps us then to ask questions if

we have to call somebody inside the department. That is really helpful.

I had one more question around that. The assessment

tools that would be used for personal care homes, are you also trying to get

uniformity in those tools as well as in the other areas?

MS SULLIVAN: Yes, it is very important that we are

consistent from one area of the Province to the other.

MS MICHAEL: Right.

Minister, one of the groups of people who we do

continually hear from in our constituency offices are seniors who, sometimes

they lose their drug card. They do not physically lose it, but they no longer

are eligible because it is tied to eligibility for the federal GIS and sometimes

they lose the eligibility for the GIS. Sometimes they do not do their taxes on

time. There are all kinds of things that happen, and sometimes the income is

just slightly over the GIS cut-off and different factors can cause that to

happen too, even after they have had a card.

I know it is not in this year's budget, but are you

looking at trying to increase I know we have done it in the past, but we still

have an awful lot of seniors out there who need access to a drug card and we are

getting a lot of calls in our offices about that.

MS SULLIVAN: It is an ongoing issue. Whenever

there is a threshold, there is obviously somebody just on either side of that

threshold. So that is an ongoing issue for us.

MS MICHAEL: Which is why I am against thresholds,

you know what my stand is on that. That is the reason for being against

thresholds.

MS SULLIVAN: I do not know how better to do it. I

know you would want to talk about pharmacare, and when we can get the federal

government to come to the table to do that, then that would be helpful for us.

In the meantime, I think we have really stepped it up. If we look at $159

million annually in drug costs that we cover in Newfoundland and Labrador, I

think we have one of the most robust programs in the Atlantic province area in

terms of what we are doing and how we are covering and so on.

We are always concerned about people who do not quite

meet that threshold, and sometimes we can find accommodations in other areas. If

they have high-cost drugs, for example, then there is a program that can help to

look after that for them as well. It is always an issue, always one that we are

cognizant of and looking to find ways to help our population. That is what we

do. I think our goals are the same goals as yours, and that is to better serve

the residents of Newfoundland and Labrador. We do that to the best of our

ability.

Sustainability in the health care system, though, is

still something that we have to be concerned about here in Newfoundland and

Labrador. For me to go to budget defence and look for any more than 40 per cent

of the budget, I think I would be marched out of the room; and not because we do

not care, as Kevin Pollard would tell you, but because 40 per cent is a huge

percentage of our budget that we expend.

You have heard me say this many a time, and I am

probably going to say it again. We have doubled the cost. We have gone from

about $2.3 billion to $5.6 billion in a couple of years in terms of what we are

spending here in Newfoundland and Labrador, more per capita than anywhere else.

We have to find ways to do that, though, that allows

us to sustain the health care system of Newfoundland and Labrador. The best way

that I know to do that is to look for efficiencies. In finding those

efficiencies, not being able to take them back for Treasury, necessarily, but to

reinvest to make those people who sit right on the margins eligible for some

more of our programming.

MS MICHAEL: Do you want me to say the next

sentence then? You do not, but I am going to say it anyway: which is why I think

we do need an overall evaluation of our whole system because I think we would

find efficiencies. I am just going to make that statement because I really do

believe that.

MS SULLIVAN: I know you do. I have heard you say

that on a number of occasions in the House of Assembly. I just want to say this

one sentence as well, which is: if I remind you of what Hay recommended,

particularly in Western Newfoundland, we are going to see a lot of facilities

closed. I am not sure that that serves the overall good of Newfoundland and

Labrador.

MS MICHAEL: Yes.

MS SULLIVAN: That is a debate that we can have at

another time, and I am sure we will.

MS MICHAEL: That is right, exactly. I will not go

any further. I said I would say one sentence, and I said one.

MS SULLIVAN: I think I said two.

MS MICHAEL: I have a couple of more questions,

then.

In the budget, there is a $508,900 for additional

positions in the regional authorities for home support services.

What were you thinking about with regard to those home

support services? What exactly are you talking about for that money?

MS SULLIVAN: Primarily it is to deal with the

growth in the program. In order to be able to more efficiently get the

assessments done we need more people because we are seeing the numbers increase

fairly substantially since the new eligibility requirements. We do not want

people on a wait-list. If people are in need of home support, then we need to

get them assessed as quickly as we possibly can. That money is set aside

specifically to do that, to ensure we have enough personnel and enough human

resources out there to continue the assessment process.

Apart from the assessment process, we would also like

to get some monitoring and some evaluation done. Hopefully these positions will

help us in that area as well.

MS MICHAEL: Thank you.

We all know that dementia seems to be a growing

problem, and I think it is because people are living longer. That is the reason

we are seeing more dementia. There are other reasons too, but I think that is a

major factor.

I am wondering: What kind of a plan do you have with

regard to accommodations for people with dementia? A bungalow here and there to

help have somebody with dementia in a unit with all of the services that are

needed, et cetera, I do not think is meeting the need.

Are you actually looking at putting a plan in place

with regard to the care of dementia patients, in a way they can be near their

homes for their family's sake?

MS SULLIVAN: Yes, and yes. A bungalow here and

there in the meantime is a cost of $1.7 million, so it is not frivolous work we

are doing when we are constructing dementia bungalows. From the reading I have

done around the provision of care one might find in a dementia bungalow, it is

something I think we would all want for our loved ones. I would not want to

dismiss them as not being a significant contribution to what it is we are doing

around dementia.

MS MICHAEL: I did not mean it that way.

MS SULLIVAN: Okay, thank you.

However, as part of the Long-Term Care Strategy, that

is certainly a component we have to look at. We all recognize the aging

demographic in Newfoundland and Labrador and in the Atlantic Provinces

generally, but particularly here in Newfoundland and Labrador. With an aging

demographic will come some of those particular issues, particularly around

dementia.

I hate to use Tom Marshall's "stay tuned", but it

certainly is a piece of work we have dedicated a bit of time to. We are trying

to find more innovative ways forward to be able to address the issues around

dementia. There were huge concerns within the population of Newfoundland and

Labrador around that. There are huge concerns that we hear on a daily basis from

families who are struggling to look after loved ones who are experiencing issues

around dementia.

It is a piece of work we take quite seriously. We are

always looking for creative, innovative ways that we can find to focus that

closer-to-home kind of care as well, which is really the focus of our Long-Term

Care Strategy; it has to do with providing care in the most efficient way

possible, as close to home as we possibly can.

MS MICHAEL: One more question all these

questions have to do with care. You are obviously thinking intently with regard

to the Long-Term Care Strategy. I am concerned about the first available bed

policy that Eastern Health has in place. I do not know if the other three have

that in place or not, but I believe that there are other ways of dealing with

the issue of people needing to be in a facility and other ways in which make

sure that they are not in acute care beds in hospitals than just saying the

first available bed policy.

I am wondering if this is something that you are

looking at in the Long-Term Care Strategy and policy that I hope that you plan

on putting in place, because I think this is where home support does come in

while somebody may not be a candidate to be at home with home support on a

long-term basis, permanently, but could be short-term while waiting for a bed

that is closer to home. Is this issue of trying to keep people as close to home

and to their loved as possible part of the Long-Term Care Strategy that you are

looking at?

MS SULLIVAN: We are certainly looking at a variety

of alternatives and alternate models of care that can help to accommodate that.

Certainly, home support is one of those pieces, one of those components that can

make a difference there, and some of that can happen now. If you have somebody

who could not stay home, if they are supported in their own homes, then that is

something that is available to them now. That is not necessarily a new piece for

us; that is something that we can accommodate.

Again, they are huge issues. They are issues that we

tackle on a daily basis. Tracy and her department, on a daily basis, are looking

at those concerns and trying to find those ways. So I would invite and I

always want you to feel free to offer up the ideas and the suggestions that you

can. I think we are all in this for the same reasons, we all want to make a

difference, and we all want to do the right thing. So whatever ideas that you

have, whatever suggestions that you might have, bring them forward. They are

critical to our being able to provide that best care, but there are a number of

evolving models of care we are studying to try to find what might work for us.

We are not going to have a complete answer in one

model of care. We are going to have to look at a number of models on a continuum

that will, I think, meet the needs of our population out there.

MS MICHAEL: I will not go into details now, but

you and I both agree, there is a wonderful group of professionals out there

looking at the whole issue of long-term care. I really do think they include

people who have been involved in long-term care who have been part of putting

those together in other Provinces, nurses, et cetera. I would really recommend

you sitting with that committee, and I would love to give you that information.

MS SULLIVAN: That is all part of the work we have

been doing. That is ongoing work for us, always.

MS MICHAEL: Yes, but this committee in particular

I think would really be a good one for you to meet with.

MS SULLIVAN: You can give me the details on that.

CHAIR: Thank you, Lorraine.

MS MICHAEL: Thank you.

CHAIR: Dwight.

MR. BALL: Yes, I will just stick with that topic

for one question, actually: How many people would we have on home support now in

the Province?

MS SULLIVAN: Seven thousand seven hundred.

MR. BALL: Wow.

MS SULLIVAN: Every now and then a number comes

back to me, and then I hope it is accurate.

MR. BALL: I just want to talk about physicians

again.

We have discussed the number of physicians we would

have, but is there any particular area in terms of specialities right now we are

having problems with? Where are the shortages?

MS SULLIVAN: I can address it generally, but we

will defer to Dr. Alteen to give you the specifics of the areas. I have been

saying that we have 1,100 physicians. I found out tonight that we only have

1,096. I want to make sure now we get the numbers perfectly accurate.

DR. ALTEEN: We do have issues of concern, and this

is an ongoing process. Right now in the Province obviously rheumatology is of

some concern in terms of wait times and that. There is a new rheumatologist who

has started work in the last year in the Province and has made some difference

in terms of the wait times.

Urology, certainly in Eastern Health, is a concern.

Eastern Health has recently engaged with a physician to start a urology service

here this summer on a one-year contract, but he may commit himself to staying in

the longer term.

Part of the strategy with a number of these things is

trying to look at physicians who are in residency training positions presently,

both in the various specialities within Newfoundland and outside the Province

for some of the subspecialties, and engaging them through a bursary program and

through other means of returning to the Province. We have seen improvements in

that, but there are some particulars.

For example, internal medicine we have a lot of

subspecialists in internal medicine of cardiology, gastro-neurology, and those

sorts of things. The general inte