May 13, 2002 SOCIAL SERVICES COMMITTEE

Pursuant to Standing Order 68, Wally Andersen, MHA for Torngat Mountains,

substitutes for Roland Butler, MHA for Port de Grave.

The Committee met at 7:00 p.m. in the House of Assembly.

MADAM CHAIR (Ms Jones): Order, please!

I would like to bring the meeting to order. I want to welcome everybody this

evening, the committee members, the minister and his officials from the

Department of Health. I ask the committee first of all to move the minutes of

the last Social Services Committee.

On motion, minutes adopted as circulated.

MADAM CHAIR: I will start off this evening by asking the committee

members to introduce themselves by name and district and then we will ask the

minister to introduce his officials.

The hon. the Member for Burin-Placentia West.

MS M. HODDER: Mary Hodder, MHA, Burin-Placentia West.

MR. ANDERSEN: Wally Andersen, MHA, Torngat Mountains.

MR. MERCER: Bob Mercer, MHA, Humber East.

MR. MANNING: Fabian Manning, MHA, Placentia & St. Mary's.

MS S. OSBORNE: Sheila Osborne, MHA, St. John's West.

MR. ROSS WISEMAN: Ross Wiseman, MHA, Trinity North.

MR. SMITH: Gerald Smith, Minister of Health and Community Services;

Robert Thompson, Deputy Minister; Donna Brewer, ADM for Finance; Jim Strong,

Director of Financial Services. We have a couple of new faces. Moira Hennessey

was with us the last time. Loretta Chard was fortunate to be on holidays, I

think, the last time we were here. We captured her this evening. We have Lynn

Vivian-Book, Gerald White and Dr. Ed Hunt.

MADAM CHAIR: Thank you, Minister.

My name is Yvonne Jones and I am the Member for Cartwright-L'Anse au Clair.

This is the second meeting of the Estimates Committee for the Department of

Health and Community Services. We were not able to clue up in the last session,

so we will continue this evening from where we left off.

Normally, committee members will speak in twenty minute intervals or ask

questions in twenty minute intervals. We will go around and if you do not finish

in your twenty minutes you will have an opportunity to have another twenty

minutes, of course, until we conclude the business of the health estimates.

I will start tonight with the Vice-Chair, the Member for Placentia & St.

Mary's.

MR. MANNING: I am going to defer to the Member for Trinity North.

MADAM CHAIR: The hon. the Member for Trinity North.

MR. ROSS WISEMAN: Thank you, Madam Chair.

I welcome all the minister's staff back again. We will get this concluded

this evening for sure.

The last time we left off we were talking, or at least I was talking a little

bit about health boards' budgets. That is where, I think, we concluded that

day. I thank the minister for having tabled the budget letters that went out to

health boards last week. If I could, Minister, could we start by going back to

the health boards' budgets again? I think this is where I left off with some

questioning the last time, and just to help me in terms of fraying the

discussion, because I would like to use the budget letters, and more

particularly the schedules that you distributed last week, as a point of

reference for some discussion. I appreciate and understand the boards have not

concluded their year-end yet and that the figures you may give me in response to

the question are based on, what you know to be, the last monthly report you got

from boards and what you got from boards in terms of their estimates, but could

you walk through the fourteen boards with me and give me a sense of what they

estimate to be their accumulated operating deficits as of the end of March?

MR. SMITH: Either Donna or Jim has that information there.

MS BREWER: The Health Care Corporation of St. John's is projecting a

balanced budget position for the fiscal year 2001-2002.

MR. ROSS WISEMAN: They would have had an accumulated deficit -

MS BREWER: An accumulated deficit of around $21 million.

MR. ROSS WISEMAN: Twenty-one, the balance for the year.

MS BREWER: Yes.

MR. ROSS WISEMAN: Thank you.

MS BREWER: Mr. Wiseman, I believe we are circulating some information and

this particular table is in that information.

MR. ROSS WISEMAN: Okay.

MR. SMITH: This is the information that was requested at our last

session. We just had the one copy so we are getting it copied so we can

distribute it to everyone.

MR. ROSS WISEMAN: That is excellent.

MS BREWER: You asked the same question at the last session, Ross, and you

asked that it be tabled.

MR. ROSS WISEMAN: This was the accumulated deficit here. The other

projected -

MS BREWER: And the latest projections.

MR. ROSS WISEMAN: Okay, that is excellent.

The Minister is fairly prompt with his tabling of budget letters.

MR. SMITH: They are better than I am (inaudible) came over this evening

with them.

MR. ROSS WISEMAN: I thank them for that.

If I could just get back to some discussion we were having about these

deficits and forecasts for next year, particularly. In the budget letters that

went out, or the schedules that went out to most boards, there was a - I have

not looked at them all in any length of detail to be frank with you, but I had a

quick glance at some of them. I notice the layout talks about last year's

budgets and then some adjustments, but on the bottom it talks about these budget

adjustments for 2002-2003.

The annualization, that extra $5 million that you put into health care this

year, do you have a breakdown of how you distributed that over the fourteen

boards?

MR. SMITH: Not today.

MS BREWER: I can get that for you. I have some rough notes. I can get it

summarized for you or I can read out each one. It is up to yourself. Which would

you prefer? Would you want us to read out each one or would you -

MR. ROSS WISEMAN: It is only $5 million. Is it distributed equally among

all fourteen boards?

MS BREWER: No, the methodology we used is - there were three boards which

had indicated utilization increases on renal dialysis and the Cancer Foundation

had indicated a significant projected increase on the chemotherapy drugs.

The Health Care Corporation, in total, was provided a million dollars. That

left a balance of around $2.289 million and we allocated that among the

remaining boards based on their percentage share of drugs, med surg. supplies,

laboratory supplies, diagnostic imaging supplies. That was just a straight

mathematical calculation, but as I say, once I get back in the office I can do

you up a

schedule if you like, then you will be able to see those calculations.

MR. ROSS WISEMAN: I appreciate that.

This might sound like a selfish question because it happens to be relative to

the board that provides services in my district of Trinity North, but I am

looking particularly at the one that went to out to PHCC, and I am looking at

their schedule. You can correct if I am wrong, but it appears that it is the

only board that has an adjustment for a reversal of the stabilization funding

that was provided. On the bottom of the

schedule it says: an adjustment to

stabilization funding. There is $550,000 peeled back from that board's budget

but I did not see that same kind of calculation in the other boards. Could you

give me an explanation for that?

MS BREWER: When we allocated the $50 million, roughly around this time

last year, we did so on the basis of what the boards had indicated their

projected deficits were. When we finally received the peninsula's financial

statements - I think it was some time in September or October - their deficit

projection had come in a lot less than what they had indicated back in February,

in the previous. So, based on the information we had, we really gave them too

much of the $50 million. Basically, what we said to them is - they are

projecting to incur a surplus this year of around $1.1 million - we will cover

half of that and leave you with the remaining. On top of that we gave them an

inflationary adjustment, I think, of around $290,000.

MR. ROSS WISEMAN: So the 550 being peeled back in this fiscal year has to

do with the funding that was provided in the last fiscal year?

MS BREWER: Right, yes.

MR. ROSS WISEMAN: Which left them in a situation - as of the end of the

year, they were going to have a balance - they are looking at here of having a

surplus of $1 million.

MS BREWER: It is a surplus. It is a bracket number. It is a surplus

number, yes.

MR. ROSS WISEMAN: So they are projecting a surplus, as of March 31, of a

million dollars?

MS BREWER: Yes. Actually, I think, roughly it could come in as high as

$1.1 million.

MR. ROSS WISEMAN: Why would they - I know it is probably an operational

decision but I am not sure if you have had some discussion with the board. I

understand that they made some adjustments last year, and I think particularly

of Cross Memorial in Clarenville where they closed some beds last year as a

result of a budgetary initiative in the summer and they kept them closed for the

balance of the year as a part of their financial restraint process. Why would

they have done that, yet end up with a million dollar surplus at the end of the

year?

MS CHARD: Last year they would close six beds in Clarenville and Burin

and it was primarily due, Mr. Wiseman, to nursing staffing issues at the time in

being able to fill these nursing positions.

MR. ROSS WISEMAN: So you have beds closed in Burin and Clarenville and it

was more to do with the availability of nurses then it was budget?

MS CHARD: Yes, primarily.

MR. ROSS WISEMAN: So they had not made any adjustments. The reason I am

asking the question is I have had, over the course of the year, several

discussions with some members of the administration on sometimes very specific

kinds of issues and in the course of the conversation was broadened to more

general discussion about where they were. I understood last year that they were,

throughout most of the year, operating with a very tight budget. They had made

some conscious decisions about not filling certain positions because they just

did not have the resources to be able to do it. I am kind of puzzled now because

if I look at this figure here, there appears to be somewhat of a contradiction.

They are going to have a million dollar deficit,

whereas last year they were

operating under somewhat - they were defining as being restraint because of some

budget problems they were having. Now, to have a surplus, that is somewhat of an

ironic situation that they find themselves in.

MS BREWER: Their budget is in the range of $50 million; so a million

dollars, you are talking a 2 per cent variance.

MR. ROSS WISEMAN: They are fortunate, I suppose, in that they are the

only ones - by the look of this - that will end up with a surplus. Based on your

projections on this grid, they are the only board that will have a surplus in

this past year. Others have had small deficits or balanced budgets. A million

dollars is a fair chunk. I appreciate the rationale for peeling back the 5.5,

but you have now peaked my curiosity around the operational decisions that the

board has obviously made if they have curtailed some services on the basis of

what they are assuming to be an operating deficit and will have a significant -

either something is wrong in their forecast or something is wrong in how they

get management reports out on a timely basis so they would know where they are

themselves.

MR. THOMPSON: One thing Donna said earlier was that it was clear, partway

through the year, that for the previous year there was an incorrect estimate of

what the deficit was in the prior year, in a sense, therefore an overpayment of

what their grant would have been in the last fiscal year. But, it was not

necessarily clear. That does not necessarily mean they knew right from the start

of the last fiscal year that they were going to run a $1.1 million surplus. They

were engaged in restraint or careful management measures right from the start.

It would not have been until some point later on in the year that it would have

become clear the full amount of the overestimated payment would carry right

through to the end of the year. On a detailed level, it is something we would

have to followup more with the CEO to get a detailed explanation, but it is

clear to us that it was not until later on in the year that the picture emerged

clearly that the forecast surplus would be as large as it was.

MR. ROSS WISEMAN: I recall when the minister, in a press release in

September, was talking about the forecast deficits of institutional health

boards, and I think the figure at the time was around $18 million. Within that

grouping, PACC was there then as projecting a deficit, if I am not mistaken.

WITNESS: I cannot recall the exact -

MR. ROSS WISEMAN: They were forecasting a balance as of that time?

WITNESS: (Inaudible).

MR. ROSS WISEMAN: Okay.

The other issue - I think I asked this question the other day and it was in

isolation of knowing what these figures were, but I think my question, Deputy,

in responding to it you provided me with an answer and we talked a little bit

about it because I think my question was very much, if I recall it, based on the

budgets, the actual operating.... These letters show me the original approved

last year rather than the actual expenditures not on this schedule. I think I

asked the question based on the money that you are giving boards this year,

because it would appear there are in and out adjustments here. It appears that

most boards are getting roughly the same as they got last year in terms of

service provision, because the adjustment upward deals with mostly negotiated

salary increases, reclassifications and the like. In terms of real dollars going

into new programs, there is not much increase in any of these board budgets over

and above what they had last year.

I guess my question the other day was - not having seen this, of course -

based on the level of services that each board provided during last year, did

you foresee each board being able to maintain the exact same level of services

in this coming year as was provided last year?

MR. SMITH: It is certainly the expectation to the boards, and the

direction in the covering letter, asking to do precisely that; because our

expectation is that they will still continue to seek to find efficiencies within

their budget to maintain their present programming levels.

MR. ROSS WISEMAN: The letters that I raise some questions around are the

ones going out to the community health boards. Again, because I have some

knowledge of it, I suppose, in terms of the boards that operate within my

district, the Health and Community Services Eastern, as I look at their

schedule

- and only because I have, in the last four or five months particularly, phoned

a number of times representing constituents trying to access home care services

- I have some sense of the pressures and the bonanza they have had. The answer I

keep getting is that it is a budgetary consideration. They acknowledge that the

evaluation has been done and they recognize that the person needs a particular

level of service but the funding is not there to do it.

As I understand it from last year, just to confirm, your figures here show

that Health and Community Services Eastern was going to have about a $1.7

million deficit on last year's operation. They have a $1.7 million deficit

from last year and the level of funding that I am looking at here on the

schedule, other than the adjustments, is relatively the same amount. It seems to

reason that if you said to someone you have the exact same amount that you had

last year, and last year you had a $1.7 million deficit but do not do that this

year, then it would seem reasonable that the level of service they project to

provide this year will not be the same as it was last year, if you take that

kind of logic and run through with it. If they continue on the same track and

provide the same level of service that they provided last year, with the same

purchasing power, they will have a $1.7 million deficit again this year.

I will get back to the question I posed a moment ago. The level of services

the boards provided last year - because this kind of scenario and this kind of

example of Eastern Community Health would seem to contradict the statement that

you just made in terms of the expectations that they will, because obviously

Eastern Community Health is not going to be able to provide the same level of

service this year as they did last year, if they have to balance their budget.

MR. SMITH: Certainly the community health boards are viewed differently

from the institutional boards. With the community health boards, the figures you

have there and the budgets that have gone out to them, there are two amounts of

money that are not reflected in that. There is one amount for the Brighter

Futures program, which is a little over $4 million, and there is also the

stabilization fund of some $6 million. You are probably aware that we do have a

review under way right now with the operations of the community health boards,

the Goss Gilroy report which we are waiting on. We have asked them to have a

look at their operations and give us some direction. Once these other amounts

are factored in, I don't think you will see the same discrepancy that you are

referencing there now.

MR. ROSS WISEMAN: This Brighter Futures fund, did you say it is $4

million?

MR. SMITH: It is a little over $4 million. I think it is $4.1 million or

$4.2 million.

WITNESS: It is $4.2 million.

MR. SMITH: It is $4.2 million.

MR. ROSS WISEMAN: Can you tell us what that is?

MS BREWER: Right Futures.

MR. SMITH: It is Right Futures, I am sorry. I am thinking about the

earlier end of it.

My understanding of that program is, this is a program that is geared towards

individuals who were at one time housed in institutions - the Waterford - and

these are individual programs, so we are still awaiting the information from the

individual boards as it relates to the individuals so hen we can then disburse

the funds.

MR. ROSS WISEMAN: So they were originally receiving services within the

Health Care Corporation's budget, I guess?

MR. SMITH: An institutional setting (inaudible).

MR. ROSS WISEMAN: That is a transference of money from the institutional

budget, is it?

MR. SMITH: No.

MR. ROSS WISEMAN: Or is that new money?

MS BREWER: Many fiscal years ago there was a transfer.

MR. ROSS WISEMAN: So that $4.2 million has been sitting in the Health

Care Corporation's budget, because they had been providing the service up to

this point?

MS BREWER: No. What happens is that it is allocated to the boards

depending on where the clients are. The clients might move, some clients die;

there might be another placement. So basically when we get the caseload

information, which we expect to get within the next month, we will then turn

around and allocate that money to the boards. As far as the boards are

concerned, when they do their budget planning, it is what we call fully funded;

it does not impact their bottom line. Whatever expenditures they incur, there is

a revenue source to cover it.

MR. ROSS WISEMAN: Minister, the other day I called your office, your

communication person, to see if I could get a copy of the terms of reference for

the Goss Gilroy report because I wanted to get some sense of what that report

was intended to focus on. Is it a financial review? Is it a program review? What

exactly is that review to do?

MR. SMITH: Maybe I will ask Donna to answer that.

MS VIVIAN-BOOK: The Goss Gilroy report, which is due very soon to be

finalized, was to focus on areas where the biggest cost pressures were within

the Health and Community Services Boards, primary focusing on home support,

family rehabilitative services, and child, youth and family services, and to

look at those first of all from a financial lens of putting together a picture

over the last five years of having moved from the Department of Human Resources

and Employment, the former Social Services, into Health and Community Services,

to get a five-year profile on those program areas and the cost pressures within

those areas, and then to look more closely at those areas from a programming

perspective, and then to come up with recommendations in terms of how to manage

some of those cost pressures and where to go forward from here. We can provide

you with a copy of the terms of reference.

MR. ROSS WISEMAN: Can we talk a little bit about those home care services

for awhile? I said a moment ago that I found myself recently, particularly in

the last five months, I guess, having frequent conversations with the Eastern

Community Health Board around home care. I appreciate and understand and,

Minister, you have made several comments in the past about the pressures in that

area. No doubt, that is not going to change. All you need to do is look at the

demographic projections for the Province and the shifts that are going to occur,

and that is going to be a continued pressure for you.

In terms of the immediate, because I suspect that the money that you just

talked about - the $6 million of stabilization funding that has not yet been

allocated - and if we look at the accumulated deficits of the community health

boards here, that is roughly what it equates to. So, you could take your $6

million and you could provide it and you would then fund last year's level,

but you would not be funding this year's level. I say that because I am making

an assumption, and I do not think it is a quantum leap to jump from last year to

this year. I think we are going to see continued pressures in that area of home

care. So, if your stabilization fund of $6 million will only fund the deficits

from last year, then there is no latitude there at all for any increased demand

for that service. I know that probably your answer is going to be, wait until

the report comes out, but the real issue, the real question with home care, and

I won't share some of the examples tonight of the situations that I have had

to call on behalf of. I think every MHA in this House has had some or one or two

situations where people find themselves in desperate shape and desperate

conditions and not able to get home care until someone else falls off the list

or some client either is hospitalized or put in a long-term care facility, or

should die, and it then frees up the money. It has been my experience in the

last five or six months, that is pretty much the case in the Eastern region;

and, from what I have heard from colleagues, it is pretty much the case around

the Province.

Having said that, Minister, the forecast here of the $6 million

stabilization, are you realistically thinking that will satisfy that demand for

next year, or will we continue to have this cry from constituents that we now

have?

MR. SMITH: I think it is safe to say, as I have stated repeatedly, that

this is one of the areas where it is causing us a great deal of difficulty

trying to - to me, it is an area where there is a growing demand and, as you

pointed out accurately, it is difficult to see it as an area where there is

going to be any decline because, just by the demographics in terms of - I

suppose we are hoping that the review that is ongoing will shed some light as to

looking at some long-term planning in this area as to where we need to be

looking.

At the present time, certainly we would hope that the monies that are there

will satisfy the demand and I guess we have to try to - it is a cost driver that

we are trying to manage. At the present time, the level is at some $60 million.

It is a big ticket item in our budgetary process.

To your question as to whether or not it will satisfy the needs that are

there, we are hoping that it will, but if you were to ask me to say with

absolute certainty that we are going to be able to meet all of the demands, I

would not be able to give you that guarantee now.

MR. ROSS WISEMAN: You just used a figure of $60 million. Is that what we

spend on home care services across each of the boards, $60 million?

MR. SMITH: What is the total? Donna, do you want to speak to us on that?

MS BREWER: Yes, it is approximately in the vicinity of $60 million but

that is not just for seniors; it is also for the physically disabled and

mentally challenged clients as well. Also, there is some home support in the

child welfare program, primarily in the respite type services. All of those

together is roughly around a $60 million program.

MR. ROSS WISEMAN: Sixty million for the Province, that is what I

understood.

MS BREWER: Yes.

MR. ROSS WISEMAN: Madam Chair, I am just glancing at the clock. Before I

get into another line of questioning, I don't want to be encroaching beyond my

twenty minutes.

MADAM CHAIR: The hon. the Member for Humber East.

MR. MERCER: (Inaudible).

MADAM CHAIR: At the present time, the Member for Trinity North may

continue with his questions.

MS S. OSBORNE: (Inaudible).

MR. ROSS WISEMAN: If you want to ask some questions, go ahead.

MADAM CHAIR: The hon. the Member for St. John's West.

MS S. OSBORNE: The Perlin Training Centre, and other folks who are put

out in (inaudible), when they come out of Perlin - this is my understanding -

and they go to the employment programs that are there for them, is it my

understanding that they are just employed for a very short period of time and

then they are off the employment and on to EI? Does anybody have any statistics

on that?

MR THOMPSON: It appears we do not have an answer to that question. I

wonder, in fact, is it more a question for Human Resources and Employment than

this department, given they run the labour market programs for the disabled?

MS S. OSBORNE: Oh, do they?

MR THOMPSON: Yes.

MS S. OSBORNE: Okay. I was not sure because I know that they fall under

community services for some of the services that (inaudible) but then -

MR. SMITH: I am not sure, Sheila, what you were looking at but I know

that you are probably aware, that particular - and I can speak to the deputy

because that was in Human Resources.

The particular programs offered by them were under review. As a matter of

fact, there was some concern because the federal government is now of the

opinion, with these programs, that they want them community based and not in

kind of a closed shop type arrangement. That is kind of the model that they are

pursuing. My recollection of that particular area was that - as a matter of

fact, they did have a consultant looking at that to try and make a determination

because the federal government were putting certain conditions on the funding

they were providing and saying that they wanted to get away from this closed

shop type arrangement. These people were integrated into the broader community

which is the general approach that is being used with programs dealing with

people with disabilities.

MS S. OSBORNE: I am aware that. I am not in favour of it, having dealt

extensively with the Perlin Training Centre, but I have been away from that for

a few years now. I just wondered when people come from Perlin and go into

employment, and I fully agree with that, but I have heard some people who are

involved there say the employment is for such a short period of time. They are

taken out and put in jobs for a short period of time. When they are EI eligible

then their job is not there anymore. They are on EI and they are sort of not

doing anything. They are home for a good part of the day, probably with some

respite and things but their lives are not as fulfilled, even as they were at

the Perlin before they went out.

MR. SMITH: That was not my understanding of the intent of the program.

MS S. OSBORNE: No.

MR. SMITH: Again, as to the specifics, I really could not answer. That

would be -

MS S. OSBORNE: I heard a couple of people who were involved at the Perlin

say that this is the way it was going, and they are concerned. I guess they are

concerned the Perlin will close and that this is what will happen.

The other thing that I say, and I have said it at all of the estimate

meetings and publicly as well, we give a lot of people choices. People who came

from the Waterford into the Right Futures projects were given choices, whether

they wanted to go into alternate care or go into an apartment or whatever. I

agree with that, we give people choices. Even if the Goss Gilroy Report comes

out and says that the place should close or even if the federal government says

they are going towards integrating people into the community, but the people

want to stay there, then why don't they have choices?

MR. SMITH: Again, I guess it is a good question in terms - and I do not

know what the final outcome will be with regard - because, as you know, that

program has a long history and certainly was a real pioneer in terms of

providing those kinds of support to people with disabilities.

The concerns that have been expressed are based on current thinking.

Certainly, the literature today supports the idea of providing for these people

in an integrated type system to make them part of the community, not have them

exist in isolation. So, my understanding was - I do not think the intent was

that the Perlin would disappear. I think everyone kind of recognized - but what

they wanted was to have their programing more inline with what is now recognized

as the national norm. Of course, keeping in mind that there is federal funding

involved there and the fact that - you know, I guess whoever pays the piper sort

of thing.

MS S. OSBORNE: Calls the tune.

MR. SMITH: Yes. What they are saying is that they would like to see some

of these changes, but they have not just gone in there and made those kinds of

decisions. They have provided for that kind of transition. They do have someone

working with them. I think the understanding is to try and bring the programs

more inline with them.

MS S. OSBORNE: I understand from some people who were involved with the

Pre-Voc on Topsail Road that some of the clients, their programs and their

plans, are working out for them; but some of them are not. They are sort of

spending empty days with a respite worker alone. I mean, there is not a whole

lot that you can do. You can bring them to the mall. Some of them are not really

able to go to a movie. It does not do anything for them. Some can go swimming

and some cannot. It is my understanding, from talking to families of people who

were in the Pre-Voc on Topsail Road, that their lives are not nearly as

fulfilled now as they were when the Pre-Voc was open. So, I am still an advocate

of giving them choices. I know you have to look at it as federal funding and

things, but when I talk to people and they say - well yes, they do go out and

work, and they are delighted to go out and go to work but it just lasts for a

short period of time and then they are into EI. Basically, they are at home with

no stimulation at all.

I want to thank you for providing me with the out-of-province hospital

billings. I do not know if it is possible to determine how many patients have to

travel outside the Province for services that cannot be provided here. I did not

get a chance to look right through this. Is that provided in the information

that you gave me?

MS BREWER: You will get it from high cost items. There is an amount of

around $5 million, almost $6 million, that is in another category and the

problem being is that there are certain, what they call, standard in-patient

rates. We just know that a person, for example, is in Princess Margaret Hospital

as an in-patient, but unless they were having a high cost procedure we would not

necessarily know exactly.

MS S. OSBORNE: Okay.

MS BREWER: My understanding from my officials is that it would require a

lot of further analysis, but the majority - you would be able to see, for

example, the cardiac surgeries, the heart transplants and the liver transplants.

Those high ticket items are definitely isolated for you.

MS S. OSBORNE: Do we have access to how many people would be waiting now

in the Province for bypass surgery, for instance, or any other surgery?

MS CHARD: We have approximately 300.

MS S. OSBORNE: Is there any record of how long they have been waiting on

the list?

MS CHARD: Yes we do, and we can provide you with that information. That

is no problem.

MS S. OSBORNE: Yes, okay. It is just something that I am wondering about.

Lots of times I get calls from people who have had a heart attack and are

admitted to the hospital. Sometimes they have been there for thirty days, give

or take, waiting for angiograms. This diagnostic service is not available for

them. Do we have any record of how many people would be in hospital waiting for

angiograms, and how long they are there? What brought that to my attention

actually, was a friend of mine was there for thirty days.

MS CHARD: That information is available. I do not have it right with me

now but I can certainly add that to the information. No problem, we do regular

checks on that so it is not a problem.

MS S. OSBORNE: The Goss Gilroy Report is looking into Child, Youth and

Family Services. Do you know what the terms of reference for Child, Youth and

Family Services are?

MS VIVIAN-BOOK: The terms of reference for Child, Youth and Family

Services are the same as for the other programs. They are looking at it from a

financial perspective over the past five years and then looking at it from the

programming perspective. So there are no different terms of reference for one

piece over the other.

MS S. OSBORNE: I was under the impression, and I do not know the exact

details of it, but when a youth turns sixteen - say for instance they went to a

social worker and said: I am not happy at home, and it was determined that they

are not happy at home, then they are putting choices for youth. Is that right? I

do not know this -

MS VIVIAN-BOOK: After the age of sixteen, sixteen and

seventeen-year-olds, up to the age of eighteen, can enter into a voluntary

agreement. That could be in a foster home, it could be with Choices for Youth,

it could be a number of options, but it is a voluntary care agreement with

youth. We have over 200 youth who are currently in voluntary care agreements.

MS S. OSBORNE: The reason I asked that, I saw an

article in The

Telegram this week that Newfoundland did not do it, and I thought they were

doing it. That is why I asked it. So that is misinformation that was in The

Telegram article, was it?

MS VIVIAN-BOOK: Actually, our Director of Child Welfare, Marilyn

McCormick, did a national interview last night with respect to that. You are

right, our legislation does provide for voluntary versus mandatory. We do that

through consultation with youth, from best practice analysis, and feel very

strongly that was the right direction and progressive in terms of the direction

of our new legislation.

MS S. OSBORNE: I am hearing from some parents that the Choices for Youth

might be working for some of the youth but not working for some of the parents;

and these are very good parents. Having raised children myself who are,

mercifully, gone passed that age, had that been available - and I am being very

sincere. One of my sons did not like the rules so he said: I am going to go to

social services, I am not going to live in your house. Had that been available

he would have been gone. So I am just wondering, from the point of view of the

parents, are we doing the right thing for the children? I spoke to my son about

that, he is twenty-eight now and it was based on the

article that was in the

paper. I said: You would have gone, wouldn't you? He said: Oh yes, but I would

have been really sorry. You put up with me until I came to my senses. Things did

work out okay and he is happily married, et cetera. I am just wondering, are we

doing the youth a disservice by giving them - God, it is a hard way to say it,

some youth should not be in the homes that they are in, some should.

This one gentleman came to me, and I feel very comfortable with the fact that

he and his wife were providing a good home. Their child just does not like the

rules and they are now out. What are the incidents of that happening? This man

is really, really concerned. Like I said, I know and feel very comfortable that

it is a good home.

MS VIVIAN-BOOK: I cannot speak to it in any detail, but my understanding

is there are specific criteria. It is not entered into lightly and the family is

certainly involved in that. Situations of abuse would be an example where our

voluntary care agreement would be put in place. There is regular monitoring, it

is only for a very short period of time. There are checks and balances in there,

but if you have a specific question, I would certainly prefer to refer that to -

MS S. OSBORNE: I could probably, with this gentleman's permission, get

in touch with you to see - because he is really, really concerned that his child

is now out of his home. He said it was because, I think it is a daughter, did

not like the rules; had to clean their room, et cetera. I feel very comfortable

that this man, unless there is something that I do not know, but I feel very

comfortable that the child was in a fairly good home with rules that they did

not like, as none of them like when they are at that age.

MS VIVIAN-BOOK: That was certainly not the intent of the act.

MS S. OSBORNE: No, I realize that.

MS VIVIAN-BOOK: But if boards have a referral, certainly we would follow

up for you.

MS S. OSBORNE: Okay, thank you. I am finished for now.

MADAM CHAIR: Thank you, Ms Osborne.

The hon. the Member for Trinity North.

MR. ROSS WISEMAN: I want to go back to board budgets, just to follow up

on a couple of points.

I want to follow up on a line of questioning that I had the last time we met.

It is with respect to deferments. Last year in September boards were asked to

put together plans that would see them balance their budgets. By looking at the

grid you have given us earlier, most boards had some success, at least the

institutional boards, in coming in with balanced budgets. The $1.1 million is a

far cry from the $18 million that was projected in September. So, obviously,

that was a major initiative on someone's part.

As I understand it, from talking to a number of people involved with a number

of the boards around the Province, when those strategies were put forward in the

fall many of them included deferments of expenses into this fiscal year. So,

they were not really an adjustment in the level of service but merely the

deferment of a payment of some kind and a deferment of an expense that does have

to occur. If you, hypothetically, take $2 million from last year's budget and

say we are going to wait six months to write the cheque; come April 1 you wrote

the cheque. So, those deferments - and I did not get an answer when I posed the

question the last time with respect to those initiatives that came forward last

year in the fall. The cost restraints initiatives that boards identified, how

much of those initiatives could you attribute to deferments versus adjustment in

levels of service?

MR. SMITH: Do we have this, Robert (inaudible)?

MR. THOMPSON: I will hand-off to Donna to see in a moment what specifics

she might have. But, I do know that the deferral of - I would actually like to

cast it in a different term. It is the use of one-time measures in the last

budget year as a way to balance their budget. They were used by, maybe several

boards and only for a portion of their deficit reduction strategy. It was not

the main strategy or tactic used but it was more by exception. But, there were

some, indeed.

In that regard, those boards were not led to expect that they would have any

reinstatement or additional money in the following year to deal with that when

the expenditure arose again. They were told that, now they have more time to

start planning for how they will address that in the next year. On top of that,

we have to realize that any of the expenditure measures that they began halfway

through last year were also going to result in the current year in a full year

of expenditure savings, if you like. That was an offsetting factor to the use of

one-time measures last year, but there are no doubt some boards, maybe two or

three, that are identifying those kinds of issues for us this year and we are

asking them to recast their budgets for May 31 with a plan on how to address

reaching a balanced budget in the current year.

Donna, do you have any specifics on that?

MS BREWER: Yes, Robert, I had asked the board consultants to go back and

summarize based on the information in our files and, I guess, subject to

confirming some of the data with the boards. Right now what it shows is that

there was one-time savings of about $5.7 million. There was what we call ongoing

savings that resulted in cash flow savings in 2001-2002 of about $10.5 million

and those savings will result in annualized savings next year of around $15.3

million, so roughly the annualization. Where we are getting the annualization is

that some of these cash flow savings were actually position reductions that

might have occurred part way through the year, so you are getting the full value

of the annualized salary in those positions. Roughly, it looks like the

annualized value of the savings makes up for the fact that there were some

one-time measures. Like I said, these were summarized based on expectations of

what boards had planned to do. We will need a bit more time to go back with this

schedule and ask the boards to confirm the information.

MR. ROSS WISEMAN: So, if I understood you correctly, the answer to the

question around - and, Robert, I will accept your terminology - the one-time

measures amount to $5.7 million and the $10.5 million came about as a result of

adjustments in levels of operation, and the annualization of those adjustments

come to $15.3 million, and that is system-wide based on the institutional health

boards, correct?

MS BREWER: Yes.

MR. ROSS WISEMAN: If we break that down, that is a system's view of the

total, but if I could go back to - and, Robert, you used the term, I think, some

boards but not all boards use this one-time savings. I just think,

hypothetically, let's say, for example, one or two boards came forward in the

fall with a significant amount of their savings, or their balancing initiatives

or budget balancing initiatives were going to come from one-time adjustments or

one-time measures, that one board may not have made much of a contribution

toward the $10.5 million. In other words, the $5.7 million one-time adjustments

and the $10.5 million may not have been equally distributed over all boards. In

other words, if Board X came forward, and they were forecasting a deficit of $4

million, and said: We can take $2.5 million of that in one-time deferrals and

the other $1.5 million we will make some adjustments. That particular kind of

board, with that situation, would find itself, come April 1, somewhat

disadvantaged in some respects, I suppose, because they took a lot of their

initiatives; they were in a position to defer a lot of these costs to April 1.

You just indicated that there was no consideration in this year's budget to

give boards new money for that deferral and they had to come up with cost

savings in addition to that.

As I look at the operations in this past year, most boards, with the

exception of the Peninsulas, which is a real anomaly, the others just barely

balanced. So, if a board found itself in that position, they are going to be in

a bit of trouble this year unless you distributed that $5 million giving them a

greater piece of that $5 million than some others. I do not know if I am making

my question clear or not.

When you start looking at $5.7 million - and I agree with your comment that

the $5.7 million and the $10.5 million annualized across the system gives you

$15.3 million, and that sounds great system wide, but, if you look at

individuals boards, that may, in fact, put some boards at a disadvantage while

others may not be as much disadvantaged.

I guess my question is: Are there any boards in this list I am looking at

here, that had the bulk of that $5.7 million one-time savings adjustments? If

so, that board could be disadvantaged this coming year, correct?

MR. THOMPSON: What you are saying mathematically is correct; that could

be the case. I do not know if we have an analysis yet of what specifically would

be the numbers that swing one way and swing the other, unless, Donna, you can

produce that analysis.

MS BREWER: Looking at this schedule, Central East had $200,000 and it was

all one-time and there was no indication of any annualized savings. Central West

had $1.5 million in one-time and annualized savings of $800,000, so it seems

like those two boards would be primarily the ones that you would be concerned

about.

MR. ROSS WISEMAN: So if I look at the Central East and Central West

letter, Central West got a $535,000 piece of the $5 million, but that is for

inflation, program growth and supplies. So that would not obviously do anything

to compensate them for the $1.5 million in one-time savings they had from last

year, would it?

MR THOMPSON: The mathematics, of course, is partly numbers and it is

partly behavior as well, that there is a time and opportunity to make

adjustments. So, if we take those numbers, the $800,000 in permanent

adjustments, Donna is telling me, can turn into -

MS BREWER: The one-time is $1.5 million (inaudible) the schedule, and the

ongoing is $800,000 so there is a -

MR THOMPSON: The $800,000 can turn into a larger number on an annualized

basis. That is the annualized number, and then we add on top of that the

additional funding provided in the current year.

MR. ROSS WISEMAN: The $500,000.

MR. THOMPSON: Right, and then we ask the board to use those in addition

to any other measures that they may be able to identify in the current year to

bring about our total balance. That is the challenge that we have placed with

them, not since last week but rather since last September, when they knew that

some of the measures that they were using were to be one-time measures.

MR. ROSS WISEMAN: Don't misinterpret my precise questioning with

respect to the math, but I guess it speaks to my earlier question, which was

pretty broad, which was the level of service that we could expect boards to

provide in the coming year.

I guess, to be frank with you, I was having some difficulties trying to

reconcile in my own mind when I looked at some of these budget letters and saw

what they were getting in terms of their piece of the $5 million. Just knowing,

from conversations that I have had with many around the Province in the last

five or six months around what they had to do to come up with a balanced budget

last year - and I fully recognize and understood that many of them were one-time

savings - I was having some real problems trying to reconcile that in my own

head, when you make the statement that we are anticipating delivering the same

level of service but you do not give any additional money, and part of the cost

reductions last year were one-time deferments. You add it all up and it just was

not making a whole lot of sense. That is the rationale for my line of

questioning, not necessarily that I was questioning the math on this. I just

wanted to get a feel for it.

MR. THOMPSON: Understood. I would add, though, in that regard, that the

department has held all along, and that is why we undertook the operational

review of the St. John's Health Care Corporation in part, that, within the

$900 million or so that we provide to health boards, that there is, in complex

organizations where demands are shifting and surpluses are showing, always room

to identify additional savings measures. Of the $18 million that went down to

just a couple of million last year, all of those were accommodated essentially

without changes in service levels, client service levels, or quality. So, we are

challenging the boards again to pursue that. Of course, we are acknowledging it

is not going to be easy in every circumstance, but that is the strategy that we

are trying to deploy.

MS CHARD: If I could add just one more point, the other issue - and you

would be familiar with this from your work in the hospital field - is around the

whole area of utilization. We have a lot of varying practices that we want to

try to direct some activities toward as well. Sometimes we have to look at why

people are on waiting lists, or why service demands are up. We have a key piece

of work to do in that area because practices vary throughout. Some are efficient

because they are good in terms of their processes, and on others we certainly

have to do some additional work there.

MR. ROSS WISEMAN: I understand that. Actually, that is a good lead into

my next line of questioning, and that is the whole issue around accountability

of boards and reporting mechanisms that are in place. I guess it goes back to

last year in September. The fiscal year starts in April, and September rolls

around and you get the announcement that boards are on target for an $18 million

deficit. You are halfway through your fiscal year, and I guess on the surface

your initial question would be: How come you are into September before you find

out, and when do you find out?

The same thing as we talk about where boards are: some boards, as I said a

moment ago when I asked you the question about where they are with these

deficits, I recognize these are forecasted and some of them, when their audited

statements come in, some of these figures will change a little bit, and I

appreciate that, but this whole notion of how boards report and when you report,

what are some of the things that boards need to do to comply? What things do

they have to do to satisfy you and to provide you with, and what kind of time

frames do you find out where boards were as of the end of last month? This is

now May. Do you know where they were in April, or are you now knowing where they

were in March?

MS BREWER: Right now, our monitoring requirement is that the boards will

submit a first monitor report to us for April at the end of May. Usually, by the

time they close off their own financial statements, do their own internal

adjustments, it normally takes about thirty days from the month end before they

can prepare and send us information. Now that is the financial, the dollars,

basically, where they spent their money.

The thing that we want to work with them over the next month is, we need some

statistical data. We need statistical data so we can, you know, sort of look at,

like, work production per units, so we can help boards to not only compare

themselves to different units within their own organization but also, hopefully,

share some provincial numbers so they can start questioning themselves and see,

who is out there, (inaudible) the best practice, so that they can sort of learn

from each other and, as Loretta indicated, improve the utilization. It usually

takes about thirty days from the end of a particular month, and that will vary.

Some boards are further behind in that some boards might take forty-five days,

but the majority of boards will meet that thirty-day target.

MR. ROSS WISEMAN: That is done electronically, is it?

MS BREWER: Yes, for most boards, those who have the Meditech system. Last

year, the St. John's Nursing Home Board did not and Health and Community

Services Central, but they have since introduced that, so we expect they are

reporting to improve this fiscal year.

MR. ROSS WISEMAN: I would like to get into that a little bit actually. I

guess I will admit upfront I have a bit of a fetish about that issue,

Information Systems. You mentioned that the boards have been reporting financial

information for some time and are now starting to come on stream with the

statistical charter accounts. You will have the standards, that everybody will

be reporting in the same fashion.

I would like to talk a little bit about, and get some comments in terms of

where you are going and where you see yourself going on that whole issue of

information systems. We have heard a lot of talk about evidence-based decision

making, and now we are talking about getting good reliable data from boards so

we will know what we are doing and how we are comparing.

Let me ask you a very specific question first, and then maybe you can broaden

it, to talk a little more broadly. Firstly, the Center for Health Information:

As I understand, initially when it started to evolve it had a separate board,

but it was almost like an arm of the Health Care Corp. Can you give us some

sense of where you envisage that organization going, and what commitment and

what investment do you propose to give that organization in this Budget here?

MR. THOMPSON: The Newfoundland and Labrador Centre for Health Information

essentially operates as a board like many of the other boards, although it's

accounts right now, as you mentioned, are wrapped up with the Health Care

Corporation. They will continue to proceed to a more independent status, to

recognize it as a separate and distinct entity over time. That is how we view

the importance of this whole area of health information and accountability. So

that is where we will go with that organization. We continue to see it playing a

key planning role, a sort of essential planning role, in improving the quality

of information, continuing to build the electronic health record which they have

started with the Unique Personal Identifier; so to continue to build that, add

systems to it, and to generally attain that electronic health record over a

number of years. That is the general outline.

If you wish, we can get into some of the individual systems that are going to

contribute to that, and I could ask Donna to add to that; that is, if you want

to go there.

MR. ROSS WISEMAN: Could you do that, please?

MR. THOMPSON: Sure. Donna.

MS BREWER: The main focus of the centre now is on the development of the

electronic health record. The vision within this Province is very much

consistent with the vision across the country in terms of the beginnings of the

electronic health record, what they call Phase I, which is to provide

registries, client registries, a pharmacy network and a lab network. We are very

fortunate in this Province where we have a single platform called the Meditech.

A lot of our institutions already have what they call the key feeder systems. We

feel that we are very well positioned to demonstrate to Health Canada, if they

wanted, how an electronic health record can be implemented and achieve health

benefits. We feel that we are a good, I guess, test ground. We are small enough

that we can do something quickly, but we are also large enough that we could

show that we can make a difference.

We were just recently approved $800,000 to begin scoping of the Newfoundland

and Labrador Pharmacy Network which is sort of, I guess, step two of the whole

health information network. The UPI was approved and was implemented just this

last winter within the fourteen health boards. We are hoping that we will be

able to lobby the federal government. You may recall in September, 2000, the

federal government actually invested $500 million in our independent

corporation, Canada Health Infoway. It is my understanding that Canada Health

Infoway is doing it's business plan now and hopes to start being able to

address, make some strategic investments probably, as early as this fall. So it

is timely to have that $800,000 approved, that we can get our plans in place to

be able to lobby for some funding for that pharmacy network.

MR. ROSS WISEMAN: So $800,000 is coming from this Budget (inaudible)?

MS BREWER: Yes, it came out of the capital equipment allocations.

MR. ROSS WISEMAN: I commend you for that, by the way, minister. I said

earlier I have a bit of a fetish about this.

The comment you made about Meditech, I guess this reflects another personal

bias I have. Why is it that each individual health board - and I can see how it

originated - still today would hold licences with Meditech itself, as in one

provincial licence, and different health boards are embarking on very different

levels of investment in Meditech, so that you may have some boards pretty

advanced? They have put in place all the modules that are necessary that

Meditech would provide? Other boards do not have the same fiscal resources or

made different choices about how they, in fact, invest their money and may

decide, for example, not to put a nursing module on or not to put a utilization

module on, and may make choices to do something different. It is in the best

interests of the entire Province to have good information from across all boards

so that it is reliable, comparable and consistent from each board, so that one

board is not handicapped because they do not have the resources or make

different choices to invest in different information, a level of investment in

different information systems.

Has the department given some consideration to having that system become a

part of the Centre for Health Information or become a provincial system, and the

Province hold the licence and the Province be responsible for the communication

network that is necessary to link up all health facilities, pharmacies and

clinics? Because that is the eventual goal, as I understand it, which is a

fairly significant undertaking, a fairly significant cost, to start having

individual boards make choices in their individual areas as to what they are

going to invest and make choices about service deliveries or investing in

information systems. In fact, what we are trying to do is create a provincial

grid. Has the department given some consideration to making that a provincial

initiative rather than a board initiative?

MS BREWER: It is my understanding that the way Meditech licenses is

basically on the size of an organization. I think they even get down to how many

beds they have in an organization. So, whether each individual board is licenced

or whether it is provincial licence, I am not necessarily sure you are going to

get that much economy as a scale in terms of licencing. I guess it is difficult

to turn back the clock. I think if someone had had the vision ten years ago, you

know, if I had to do it all over again, I think we would have gone with the

provincial approach. That is what we are trying to do with the health

information network. The UPI is a provincial network. To have to go back now and

reinvest and redo all that IT structure that is there, I think we could work

with - the fact that it is all Meditech in terms of interoperability and being

able to have one system talk to another, it makes it easier than had it been all

different systems. To go back and redo Meditech, I do not see that happening.

I think what we intend to do is put the network sort of on top of it.

Communications and technology, everything is going to be linked. I guess I do

not ever see a day where we would replace, and have a provincial system that

replaces, what is currently there in the hospital system.

MR. ROSS WISEMAN: Or assume ownership for it?

MS BREWER: Well, a lot of it is leasing anyway. It is not even ownership.

You know, you are just paying Meditech the right to use that system and to get

the upgrades. What we will see as individual pieces is probably more

standardization; You know, that the data dictionary for peninsulas, say on the

lab side, will have to be the same as the data dictionary of the Health Care

Corporation. Unfortunately, when you had individual applications, there might

have been some modifications that may be troublesome as we go to run up health

information that is certainly not show-stoppered by any means.

MR. ROSS WISEMAN: Thank you.

Just one final area of questioning, Minister. With Dr. Hunt present tonight,

I want to go back to the discussion. I will qualify it by saying, I don't want

you to tell me what is in your strategic plan, but I do want to go back to the

discussion around primary care. You did share, in the last discussion, some

sense of what you might see as the model for primary care. You have used the

phrase, I think, yourself that: The primary care model that you will be

implementing will probably form the cornerstone of the system for the future. Do

you want to give us some sense, if you could, of what that might mean for, I

guess - because you have used the term teams in the concept of using other

health providers, other than physicians, to the level of the training which they

had. Are you in a position to share with us some sense of how you would see that

rolling out, and what that might mean for investment and training for

disciplines other than physicians?

WITNESS: I will ask Robert to-

MR THOMPSON: Your last part was, to address things other than physicians?

MR. ROSS WISEMAN: Yes.

MR THOMPSON: The primary health care reform: We are now coming to a

stage, after having completed pilot projects and the primary care advisory

committee, as well as good experience with nurse practitioner models and

training, and an evaluation of that program, where it is time to set out the

direction that reform should take throughout the Province. That is the stance we

are taking as we head into the Strategic Health Plan.

Clearly there will be some main elements. One would be interdisciplinary

teams. There is a physician component to that, clearly, which has many details

that will need to be worked out, and on top of that, how the physicians work

together with the whole array of other health care providers, most of whom,

currently, if you look at the array of health care providers, are already

employees of boards in one way or another. So there would have to be some form

of organizational design that will occur to make sure that those other health

care providers are linked together in a management sense. Then there will have

to be a model worked out, taking into account populations and practice protocols

of what kind of geography they will cover, and then, finally, how they deal with

cases when individuals present themselves, how they get sent to one kind of

provider or another, how these cases get dealt with on a team basis, how

providers refer their cases to each other and how they care for these

individuals or treat or intervene with these individuals as a team. Now the

specific protocols for how those teams will work and how cross-referrals will

occur, and exactly where these individuals will be located, that is a level of

detail that - we have not accomplished all that detail yet, nor will that level

of detail ultimately be in the plan, but it is something that we have to turn

our minds to right away.

That is where I will stop now. I will ask Ed: Do you want to add anything to

that description at this point?

DR. HUNT: I guess just to add that we haven't started it all

(inaudible).

MADAM CHAIR: Dr. Hunt, just one moment. There you go. It just takes

awhile for the camera to find where you are.

DR. HUNT: Okay, thank you.

Just to add to what Robert has said that, we do have an office of primary

health care created within the department. We have four individuals of different

backgrounds. One is a nurse, with a nurse practitioner background. There is a

physician. There is a health economist there. Then there is another lady with a

teaching background who has been working with the three sites around the

Province in the past three years in the pilot projects. So, they are working

hard to look at the protocols and what needs to be done, what kind of

relationships do you have with the board structures and how this whole thing

fits into the strategic health plan which, of course, has yet to be announced.

There is a lot of work to be done and it is important that it be done

correctly. They are concentrating on looking at standards - standards of care,

standards of practice - and also looking at how these different individuals

interrelate with each other. As you may appreciate, it can be a bit of a touchy

area because each profession has it own

interpretation of where its parameters

are and sometimes people do not want other people to step on their toes. So we

want to make sure, in primary health care, that we are not into a competitive

environment but one in which one profession enhances the other and each

professional is practicing to the highest of their skill set.

This is the challenge that the committee has. It is going to take some time

as well, as I said, to roll that out because there is a fair amount of work

involved. Their mandate is to have something, at least preliminary, to get going

later this summer or this fall.

MR. ROSS WISEMAN: Thank you very much, Mr. Minister, and I thank you,

Madam Chair, for your patience.

MADAM CHAIR: Thank you, Mr. Wiseman.

The hon. the Member for St. John's West.

MS S. OSBORNE: Thank you.

I just have one or two questions on Right Futures. You say there is $4.2

million allocated for that this year. How many patients or persons are involved

in Right Futures now as compared to when it started? It started eight or nine

years ago, I think, didn't it?

WITNESS: (Inaudible).

MS S. OSBORNE: Okay.

What is the success of the program? How are the folks doing who are involved

in the program? Do you have any records on that?

MR. THOMPSON: We will follow up and get you what information that we have

available.

MS S. OSBORNE: Thank you.

Home support emergency services criteria, the last paragraph: In all

circumstances clients shall be encouraged to consider personal care home

placement when the cost of home support exceeds the personal care home subsidy.

What is the maximum that goes into home support?

MS VIVIAN-BOOK: The ceilings?

MS S. OSBORNE: Yes.

MS VIVIAN-BOOK: The ceilings for seniors effective April 1 of this year

is $2,707.

MS S. OSBORNE: A month?

MS VIVIAN-BOOK: Yes. For persons with disabilities it is $3,875 a month.

MS S. OSBORNE: That is $3,875 for persons with disabilities.

MS VIVIAN-BOOK: And $2,707 for seniors.

MS S. OSBORNE: Okay, that's fine.

It says: Should the clients refuse to consider this care option - $3,875,

that would not be twenty-four hours a day is it, or is it?

MS VIVIAN-BOOK: No, it is not.

MS S. OSBORNE: How many hours a day is that?

MS VIVIAN-BOOK: Maximum hours is about fifteen to sixteen hours a day.

MS S. OSBORNE: That comes to $3,875 a month does it?

MS VIVIAN-BOOK: Yes.

MS S. OSBORNE: Thank you. That is all I have.

MADAM CHAIR: Thank you, Ms Osborne.

It seems there are no other questions from the committee members at this

time, so I will ask the Clerk to call the remaining subheads.

CLERK: Subheads 1.1.01 to 3.3.02, inclusive.

On motion, subheads 1.1.01 through 3.3.02 carried.

On motion, Department of Health and Community Services, total heads, carried.

MADAM CHAIR: I would like to thank all the committee members for their

participation in the Social Services Committee. That now concludes the estimates

for the six departments that we were dealing with.

Thank you very much for your cooperation. I thank the Minister of Health and

all of his officials for the time and the commitment that you have shown to our

committee in answering the questions and providing information at the level that

you have. We really appreciate that.

On that note I would like to ask for a motion to adjourn, please.

On motion, Committee adjourned.