CHAIR (Mr. Wiseman): I want to welcome all of you here. This is the Social Services Estimates Committee and tonight we are doing the Budget Estimates for the Department of Health and Community Services.

Before we get started, I am going to ask the Clerk if she would legitimize my sitting in this chair by conducing the election and then we will proceed then.

CLERK (Ms Murphy): Is there a nomination for Chair?

MR. COLLINS: I nominate Mr. Wiseman.

CLERK: Seconded?

MR. PARSONS: Seconded.

CLERK: All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

On Motion of Mr. Collins, seconded by Mr. Parsons, Mr. Wiseman was elected Chairman.

CHAIR: I thank the Opposition for nominating me and seconding my nomination.

I ask now for the nomination for the position of Vice-Chair.

MS JONES: I nominate Mr. Butler.

CHAIR: Mr. Butler.

MR. PARSONS: I second the nomination.

CHAIR: Congratulations, Roland; unanimous support of the Committee.

CLERK: You did not put the motion.

CHAIR: I am sorry, I have to put the motion.

All those in favour of the nomination of Roland Butler, the Member for Port de Grave, as Vice-Chair of the Committee, aye.

SOME HON. MEMBERS: Aye.

CHAIR: Contra minded?

On motion, of Ms. Jones, seconded by Mr. Parsons, Mr. Butler was elected Vice Chairman.

Now the Clerk will call the first head.

CLERK: Subhead 1.1.01.

CHAIR: Shall 1.1.01 carry?

Minister, I welcome you and your staff this evening, and I open the floor to yourself to make some opening comments and maybe introduce your staff. I leave that to you.

MS E. MARSHALL: The first thing I will do is introduce my staff.

To my immediate left is Deborah Fry, Deborah is the Deputy Minister of the department; to her left is Moira Hennessey, Assistant Deputy Minister of Board Services with the department; to my immediate right is Jim Strong, Director of Financial Services with the department; right here to my left, on the back, is Lynn Vivian-Book, who is also an Assistant Deputy Minister with the Department, Community Programs and Wellness; to her right is Carolyn Chaplin, Director of Communications with the department; to her right is Gerry White, also an Assistant Deputy Minister with the department, Intergovernmental and Strategic issues; and to Gerry's right is Dr. Cathi Bradbury, Director of Physician Services with the Department of Health and Community Services.

I do have a few brief opening comments, I will not take up too much time, just a short introduction, and then, I guess, we can move on to the questioning. It is my pleasure this afternoon to serve as Minister of Health and Community Services and address your questions this evening with respect to Budget 2004.

Provinces across the country are grappling with the challenge of meeting the increased demand on our Health and Community Services system with limited resources. As our government wrestles with an inherited deficit, it is incumbent upon us to invest wisely to best meet the needs of our population. With our current fiscal realities we must ensure that more of our strategic investments are directed to patient care, not just bricks and mortar. We will strategically invest available resources in areas to address better mental health services, new drug therapies, increased access to technology, long-term care needs of our seniors, and a stronger focus on keeping well.

This year my department will be working with the Health and Community Services system to develop a new mental health act and mental health strategy, create a new division of seniors and aging to foster a more comprehensive approach to planning for seniors, continue its initiatives to promote wellness and healthy living, and reevaluate the way in which we deliver our long-term care and supportive services. We will also embark on a journey of health reform looking at our systems design at a fundamental level. We need to demonstrate willingness for change to sustain our ability to provide public health care and adapt to the realities of changing demographics, technologies and economics.

Our government remains committed to a publicly funded accessible health and community services system. We continue to invest 45 cents of every program dollar in health care. The gross current and capital expenditure is just over $1.6 billion for 2004-2005. Our spending per person on health care in Newfoundland and Labrador is among the highest in the country. According to the Canadian Institute for Health Information, Newfoundland and Labrador is projected to spend $3,018 per person on public sector health care, up from $1,713 in 1995. This is $336 per person above the Canadian average forecast for 2003.

While specific details of the investments in health care are contained in the Budget Speech and departmental news releases, I would like to highlight the following:

There is $8.6 million additional investment in the Newfoundland and Labrador Prescription Drug Program for increased utilization and the introduction of a new chemotherapy drug, Gleevac, to help fight cancer. The additional funding brings the total investment in the Prescription Drug Program to $107 million for the current fiscal year.

There is also a $1 million investment in the Budget for provincial mental health services in response to the recommendations outlined in Judge Luther's report. This investment allows government to take immediate action on identified long standing gaps within our mental health system.

Four hundred and seventy-five thousand dollars has been budgeted in additional funding to increase the rates for personal care home operators. There is also $500,000 annual commitment for new social work positions for Labrador to enhance child protection services in Aboriginal communities. There is also $300,000 to begin planning for a new long-term care facility in Corner Brook, and there is a commitment to proceed with new satellite dialysis services in Carbonear and Gander and the MRI in Corner Brook. Funding has also been provided for a new Chief Nurse position.

Two hundred and fifty thousand dollars has also been provided for a "Healthy Children- Healthy Schools" program to ensure the school environment is conducive to healthy learning. The program will focus on physical activity, healthy eating and mental health and the direct development of guidelines and resources to promote healthy living and support curriculum and services in our schools.

There is also $1.6 million in early learning and childcare funding to improve access to regulated early learning and childcare programs and enhance childcare services for low income families.

Thank you, Mr. Chairman.

CHAIR: Thank you, minister.

Just by way of a couple of housekeeping things: We will first have the members of the Committee introduce themselves, and I think to facilitate the process, what might be beneficial is if we alternated, so that we would allow each person to maybe have the floor for about fifteen minutes, and then we can alternate the individuals. I am just looking at the time. We have set aside three hours for this evening's discussion, and we thought maybe that we would take a break after an hour and a half just to relax a little bit. We will just take maybe a five or ten minute stand-up break, and then we can come back and wrap it up.

Mr. French, if you could introduce yourself, and then each of you would introduce yourselves. I would ask that, when you are asking questions, for the benefit of the people who operate the audio system, when you are about to speak, if you could introduce yourself, so they can turn on your microphone. I would ask, if you would, Terry, start the introductions.

MR. FRENCH: Terry French, the District of Conception Bay South and Holyrood.

MR. JACKMAN: Clyde Jackman, the District of Burin-Placentia West.

MS GOUDIE: Kathy Goudie, Humber Valley District.

MR. PARSONS: Kelvin Parsons, Burgeo& LaPoile.

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

MR. BUTLER: Roland Butler, the District of Port de Grave.

MR. COLLINS: Randy Collins, Labrador West.

CHAIR: Roland is the vice-Chair. Did you want to start the questions?

MR. BUTLER: No, that is okay, I will turn it over to our critic, Sir, if that is okay?

CHAIR: By all means, it is your call.

Ms Jones.

MS JONES: Thank you, very much, Mr. Chairman, and thank you, Minister. I welcome you and your department officials this evening.

I am going to start by actually asking you a question that just arose out of your opening comments. You talked about spending on health care in Newfoundland and Labrador being the highest in Canada. I guess, I would like to ask you, what your opinion is in terms of what contributes most to this health care cost in Newfoundland and Labrador.

MS E. MARSHALL: It is a combination of items. I think change in demographics is probably a contributing factor. I think that there is quite a demand for services. I think that the geography of our Province also has an impact and I think, too, probably some of the - I do not know if products is the right term, but the fact that we live on an Island, that may attribute to some of the costs also. I would also like to think that part of the reason for the increased costs is that we do provide a better level of service, probably, than some of the other provinces.

Having said that, I think it is very important for us, as a Province, to look at what we are spending our money on, and how we are spending our money, and go back and re-evaluate what we are doing on an ongoing basis to make sure that, effectively, we are getting the best bang for the buck that we are putting into the health care system.

MS JONES: Is there any statistical information in your department that would also contribute to it? Are there any stats that outline that there is a higher level - I know there is a higher level obesity rate in Newfoundland and Labrador, but anything else, say, regarding heart disease, for example, and with regard to other illness, the use of drugs, and things like that. Is there information within your department to-

MS E. MARSHALL: I would say that there is a significant amount of information on certain aspects. For example, there would be information on heart disease in Newfoundland. Dialysis is something that is on the increase in Newfoundland, so there would be information on that, and on obesity and different things of that nature. I think the studies would show that compared to other jurisdictions, for example - it rates where we are in line with other jurisdictions. So, yes, in certain areas we are higher than the national average, and then in other areas we are lower.

My Director of Financial Services has just provided me with some information here. I have seen these numbers before, but I will just give you an example.

Smoking, for individuals over the age of fifteen, the national average is 21 per cent and ours is 24 per cent; drinking, 20.1 per cent for Canada and 29.1 per cent for Newfoundland; overweight, 47 per cent for Canada and 60 per cent for Newfoundland; physical inactive, again we are the highest in the country, 56 per cent compared to 49 per cent.

MS JONES: Were those numbers in a Canadian wide study released by the federal government, or what was the source of the information?

MS E. MARSHALL: I do not remember now where those - the Centre for Health Information, the abbreviated name is CHI, generates statistics on health across the country, so those statistics would have come out of that.

MS JONES: Was there any indication that statistics such as the ones you outlined, obesity, alcoholism and smoking, are going down or up in the Province? Was that indicated?

MS E. MARSHALL: I am speaking from memory, so I would ask my staff to correct me if I am wrong, but my recollection is that the statistics on smoking would be improving whereas those on physical inactivity and obesity would be on the rise. It would depend on what exactly you are looking at, what criteria you are looking at.

MS JONES: Okay.

I am having trouble hearing you, I do not know if there is a way they could turn up your microphone.

A few questions with regards to the request that has been made of health boards in the Province to submit cost-cutting measures to the department. Have all the boards in the Province now submitted their plans, I guess, for cost-cutting measures to the department?

MS E. MARSHALL: Yes. I believe what you are referring to is a request that I sent out to the individual health care boards in December whereby I was asking them to come in and indicate to me how they could balance their budget in the, well it would be the current fiscal year now, and how to recuperate their accumulated operating deficits and how they could start to repay them over a reasonable period of time. Actually, I did impose a time frame on that, and I believe - again I am speaking from memory - it was February. That is what I believe the time line was. All of the boards either met the time line or submitted their plans probably within a week or so of the request deadline.

MS JONES: I am aware that you have one external study underway by the Hay Group on the West Coast of Newfoundland and the Northern Peninsula boards.

MS E. MARSHALL: Yes, that is correct.

MS JONES: When is the deadline for submission of that study?

MS E. MARSHALL: The deadline for that study, again speaking from memory, was to be sometime in May, but because of the public sector strike that has now been revised to the month of July.

MS JONES: I can only assume, from the fact that there is an external study underway with the Grenfell board and the Western board, that you have not accepted their plan for cost cutting measures.

MS E. MARSHALL: Yes, that is correct. Also, with regard to the other health care boards, I have made no decision with regard to the other health care boards either.

MS JONES: No decisions have been made at all, yet?

MS E. MARSHALL: No, that is correct.

MS JONES: Are you intending to look at any other external studies of any of the other health boards in the Province?

MS E. MARSHALL: At the present time, no, I am not. There is no funding provided in the Budget for any other review, although I would not categorically state here tonight that there will definitely be no reviews carried out in the current fiscal year, because something may come up later on during the year. At this point in time, there are no further reviews anticipated of any other health care board.

MS JONES: It seems that you will have all of the information that you have requested by July. When will you be making a decision on how some of this stuff is going to roll out, with regard to how they deal with their accumulated deficits and so on?

MS E. MARSHALL: I would think sometime after that, after July. I do have the plans, as you indicated, and I have also visited all of the boards around the Province, but having said that, I am planning to do some more visitations once the House of Assembly closes for the summer, and go out in what I call the field and speak to the health care boards and other stakeholders.

MS JONES: Have the board budgets for the current year been finalized?

MS E. MARSHALL: That is something that we are now working on. Officials have been working, in consultation with the boards, which is probably the best way to put it, but at this point in time, it has not been finalized. They have been doing detailed work but I have not been privy to the work that they have done at this point in time. They are doing the detailed work on analysis.

MS JONES: When do you expect to finalize the current year budgets?

MS E. MARSHALL: Do you have any idea as to when it would be finalized?

OFFICIAL: (Inaudible).

MS E. MARSHALL: We think that will be a couple of weeks. In the past, it has taken varying lengths of time to finalize the budgets of the health care boards. My officials have advised me that they think it will be within the next couple of weeks.

MS JONES: Will there be a cut in the overall vote of allocated funds for boards this year over last year?

MS E. MARSHALL: Pardon?

MS JONES: Will there be any difference in the amount of money voted for board budgets this year over last year?

MS E. MARSHALL: The amount that is voted for the boards, I can get you that number. If you want to look on page 200 of the Estimates book, for the Health Care Facilities, this would be the hospital boards, primarily.

MS JONES: What is the section?

MS E. MARSHALL: It is 3.2.01, Health Facilities Operations. I think that is what you are referring to, on page 200. The Community Boards would be on the previous page, on page 199. They are budgeted separately.

The Community Services board, last year the projected expenditures was just over $253 million and this year we budgeted $256.8 million. For the Health Facilities, which would be the hospital boards effectively, last year we spent $943 million and the budget is $950 million.

MS JONES: Because of the public sector strike, there has been a backlog of, I guess, clinical appointments, diagnostic testing, heart surgeries and so on. You indicated, in the House, that you were asking the boards to provide a submission to you on what additional resources would be required. Have you received those yet?

MS E. MARSHALL: No, I have not. There has been nothing received from the boards. We do have ongoing discussions with the boards and we have been advised that they are rescheduling the missed appointments, the clinics, the surgeries, the tests, et cetera, but at this point in time there has been no request from any board, that I am aware of. Moira, you might correct me- no requests from either board.

MS JONES: Why would they be indicating, publicly, that there is a huge backlog but not be requesting any additional resources?

MS E. MARSHALL: I am sort of now second guessing what the boards would say, but the boards are, effectively, going through and doing their rescheduling. I would think that, at this point in time, they are just working with their numbers to see where they are with regard to rescheduling the surgeries and that. At this point in time, I have not had no official request for additional funding.

I think the other thing that might be a complicating factor is that we are presently in the process of determining what their budgets will be for the current year, so I would think that they are waiting also to see what their current budgetary allocations are. Again, as I have indicated, we are in constant contact with the boards, and within the past week I have had an opportunity to speak directly with two CEOs of the boards. As I indicated, we do have ongoing contact with them, but there has been no official request at this point in time.

MS JONES: Have you been updated recently on the backlogs in the Province?

MS E. MARSHALL: Yes, we receive information from the boards. I do not have specific numbers here with me now, but they are rescheduling things that were missed during the strike.

MS JONES: Can you provide me with a list of the backlogs, the number of appointments, that are currently on the list for clinical, surgeries, diagnostic treatments and tests?

MS E. MARSHALL: We would not be able to provide that tonight, but I can certainly get that information for you.

MS JONES: Okay.

I am going to move on to some items arising out of the Budget. Most notably was the cancellation of health care facilities in Grand Bank, primarily the cancellation of the hospital there. Would you like to tell me why government decided to do that and if you feel that there isn't - I can only assume that you feel there isn't - a need to have a facility in Grand Bank for the efficient and effective delivery of health care in that region?

MS E. MARSHALL: The primary reason for the cancellation was financial, that for the current fiscal year we decided to put the resources into programs and services. The increase that was given was in current operating dollars as opposed to capital dollars. The other reason for the cancellation is: I wanted an opportunity to have an assessment done of the health care facilities around the Province, to come up with a long-term plan as to exactly where our capital dollars should be put. I would like to say that, personally, I did not think that we needed a large facility down in Grand Bank as was envisioned. I did have the opportunity to go to Grand Bank and visit the existing facility, and I do agree that there are improvements needed in bricks and mortar in the Province, but I did want to have the opportunity to decide where that money should be spent.

MS JONES: You said you were having an assessment of facilities done. Has that been completed?

MS E. MARSHALL: No. That is not a formal assessment. I wanted to have the opportunity to go around the Province and visit the health care facilities around the Province. If there is a need for a formal assessment, then I would have that done, but I have not come to that conclusion at this point in time.

MS JONES: It is my understanding that you are proceeding with disassembling the steel that has already been erected for the Grand Bank hospital?

MS E. MARSHALL: Yes, that is correct.

MS JONES: Have you tendered that yet?

MS E. MARSHALL: No.

MS JONES: Can you tell me how much money was invested in the start of the hospital in Grand Bank and how much it will now cost you to disassemble the project, take down the steel work and remove it from the property?

MS E. MARSHALL: Yes. My recollection is that we spent approximately $3 million. I will ask my staff to confirm that.

OFFICIAL: That is right.

MS E. MARSHALL: Yes, that is correct, $3 million. We are having discussions now with Works, Services and Transportation regarding the dismantling of the steel and we are expecting that to cost about $300,000, but that is the initial estimate.

MS JONES: About $300,000, you said?

MS E. MARSHALL: Yes, I believe it is $300,000.

MS JONES: So, there is definitely no chance of reconsidering, or just placing this particular facility on hold, until you have had a chance to do more of an assessment?

MS E. MARSHALL: No, that decision is final. However, in saying that, I would like to indicate that I did visit the clinic in Grand Bank. That is quite an old facility and what we will do, in that regard, I do not know at this point in time, but just to inform the Committee that I visited that facility and I do recognize that we may have to do something with that. Whether it will be replacing or repairing, I do not know, because it is very early yet.

MS JONES: But it is your intention to keep that facility open in Grand Bank?

MS E. MARSHALL: At this point in time, yes.

MS JONES: I would also like to ask you about the cancer clinic in Grand Falls.

CHAIR: Excuse me. I remind the member that we talked about fifteen minutes, but I will give you a bit of latitude to finish off the question around the Grand Bank issue. We talked earlier about allocating fifteen minutes per person and to do a rotation. With that mind, I would ask if there is anyone else on the Committee who would like now to ask a series of questions?

MS JONES: Well, Mr. Chairman, I have no problem with rotating, and when it is my turn I will continue.

Thank you.

CHAIR: I would appreciate that, thank you.

MR. PARSONS: I have some questions, if it is okay.

Minister, before I get into the details, and I will be referring to page 191 of the Estimates, my colleague from Cartwright-L'Anse au Clair asked a question about the Hay report and you indicated that you expected to have the report by July of this year. Is it your intention to release that report to the public?

MS E. MARSHALL: I would anticipate, yes, that that report would be released to the public. My preference is that all reports of that nature be released publicly. That is the Hay report. The Labrador report was received either just shortly after I was appointed minister or before, and that one also was released publically.

MR. PARSONS: So, you are prepared to undertake to release that Hay report for the West Coast when it is available?

MS E. MARSHALL: Yes.

MR. PARSONS: Thank you.

Looking at page 191, under the Minister's Office, 1.1.01, first of all, it looks like the actuals for 2003-2004 for Salaries was $268,700, and this year you budgeted $251,900, which I believe is a difference of $16,800. What is the difference this year, what is causing this difference in salary?

MS E. MARSHALL: I will have to check now with my Director of Financial Services.

MR. STRONG: The former minister had a bilingual specialist (inaudible).

MS E. MARSHALL: The former minister had a bilingual communications specialist so that reduced the salary expenditures, but it was offset by the salary for the Parliamentary Secretary. In the Salary Details - I will see if I can find it here for you now to give you more information on it.

Mr. Strong, could you comment on that?

MR. STRONG: The revised is up because last year there was a bilingual communications specialist, who is no longer there in 2004-2005, and there is a Parliamentary Secretary now in 2004-2005, who was not there last fiscal year.

MR. PARSONS: You are suggesting the $241,900 of your 2003-2004 budget became escalated to $268,700 because of the bilingual person who was involved in the department.

MR. STRONG: They were in place originally, and then the Parliamentary Secretary was there for part of the year. The Bilingual Communication Specialist would have left before Christmas.

MR. PARSONS: Neither last year's salary details nor this year's salary details show anything about a Parliamentary Secretary. You are referring to the Departmental Secretary to the Minister, but under the details that I am looking at for Minister's Office, in terms of who is in there, it shows, for this year, a Minister, an Executive Assistant, a Secretary to the Minister and a Departmental Secretary.

MR. STRONG: Yes.

MR. PARSONS: That was the same as last year. The only difference I see from last year, in terms of staff, is that the Special Assistant Communications that was there last year in the Minister's Office at $57,243 is not there this year.

MR. STRONG: Yes, that is right.

MR. PARSONS: That is a $57,000 less expense in your salary component in the Minister's Office, yet the figures here only reflect an $18,000 difference between your actuals of last year and your budget for this year. Why would we have moved a person out who was making $57,000, yet our figures only show that we have an $18,000 reduction?

All other staff, according to what I am reading, from this year's Departmental Salary Details for 2004, all personnel in that department are the same as last year except for that Special Assistant Communications.

MR. STRONG: I will have to check my notes for that.

MR. PARSONS: Okay.

Minister, following up on that issue, I notice that the only person who was, last year, employed in the Minister's Office who is not there this year in the details is indeed the Special Assistant for Communications which added to the Minister's Office Salary Details by $57,243. That person, now called the Director of Communications, is listed this year under heading General Administration, Executive Support, and the cost for this year is $62,059. What is the rationale for moving the Director of Communications, last year called the Special Assistant Communications, from the Minister's Salaries budget to the Executive Salaries budget?

MS E. MARSHALL: The Director of Communications, my understanding was in the previous government that it was a political position. It is now a regular public service position. It was recruited through the Public Service Commission, and that position now reports to the Deputy Minister of the department and does only departmental as opposed to political work.

MR. PARSONS: Okay, that makes sense. I would still like to get the answers from the gentleman, Mr. Strong, if you can, as to why the difference there, because there is still a substantial difference there.

MS E. MARSHALL: Are you talking about the position that we spoke about a few minutes ago?

MR. PARSONS: You have given your explanation as to why the person is now under Executive Support versus Ministerial Office, i.e., one was political and now it is departmental. I accept that, not a problem, but I still cannot work the math on why a $57,000 position out of the Minister's Office only shows an $18,000 reduction in your salary bill?

MS E. MARSHALL: Yes, we will check that.

MR. PARSONS: I have not seen the logic of that.

MS E. MARSHALL: I have the salary details for 2003-2004 and 2004-2005, but I would need to get the revised numbers from Mr. Strong for the $268,000 in order to provide you with the information.

MR. PARSONS: Okay.

Under 1.1.01, again the Transportation and Communications, we had $50,000 budgeted in 2004, $30,000 actually revised, and now we are back to $50,000. Why the $20,000 increase being budgeted over what you spent last year?

MS E. MARSHALL: Part of the year was incurred by the previous government and the other half of the year was my travel. I know that I did not do very much travel in the six months of the last fiscal year. The $50,000 was put in thinking that we will have a regular year, this year. So, the budgeted is just the same as last year.

MR. PARSONS: On the Purchased Services issue, 06, from what you spent again last year, $5,000 to $16,000 this year, what is the rationale for that?

MS E. MARSHALL: Again Purchased Services provides for entertainment of dignitaries on behalf of the department. I can tell you, that I entertain very little, or I did last year, and that the same amount that was budgeted last year was put in for 2004-2005.

MR. PARSONS: Are you planning to do more entertaining?

MS E. MARSHALL: Not really, but the funding is there.

MR. PARSONS: The funding is there should you wish to entertain, is that what you are saying?

MS E. MARSHALL: Yes.

MR. PARSONS: Given a fiscally responsible government then, Minister, why would you budget it if you do not know you need it?

MS E. MARSHALL: As I say, I had six months in the department and the first six months were a busy time. I do not know what historically is required of the department on an annual basis. The funding is provided, but if it is not needed it will not be spent.

MR. PARSONS: Under the heading, 1.2.01, Salaries again, according to my figures from the actuals of last years to now we are looking at a $42,100 increase. I can appreciate, again, that those salary details would include that Director of Communications that has been put back into the Executive Support side, but I have difficulty with the figures if that person is being paid $62,000 and the figures here only show a $42,000 increase.

MS E. MARSHALL: There is one less ADM there, which would account for probably part of the difference. The salary costs for that ADM would have come out and then the -

MR. PARSONS: Director in?

MS E. MARSHALL: Yes, and there could be a bit of annualization, but to do a dollar for dollar comparison, I would have to - I think I will refer to Mr. Strong. He has more details on the salary dollars.

MR. STRONG: There were some changes in the executive personnel from last year, the new Deputy Minister, compared to last year's budget when it was prepared. Our medical consultant is in this vote as well and there were some increases that he got in line with the (inaudible).

MR. PARSONS: Under Professional Services, 05 of that heading, $50,000, what type of Professional Services would your department use?

MS E. MARSHALL: It provides for the cost of services associated with the department's communications plan. Again, I will have to refer to Mr. Strong for more detailed information on that.

MR. STRONG: We engage consultants occasionally for our communications plan. Likewise, the Purchased Services would be the purchasing of advertising.

MR. PARSONS: Under the revised last year, $167,000, up from the budgeted, $96,500, that you put back in this year as a budget figure, any particular reason it went to $167,000?

MS E. MARSHALL: Yes. There were some legislative changes made to our post-adoption services that promoted more open adoption, so that adult adoptees, as well as their birth parents, could apply for information. I guess, for the adult adoptees it would be information relating to their birth parents and in reverse for the birth parents to obtain information relating to the adult adoptees.

There was a flyer that arrived in the newspaper, and you probably saw it. It arrived with The Telegram. We did send out two flyers, which indicated the changes that were being made to the legislation, indicating that if adult adoptees or their birth parents did not want certain information provided they would have to notify vital statistics or the Department of Health and Community Services. It was either a disclosure or a veto with regard to the release of information. That was put out in a flyer to make people in the Province aware of it. As a result, again, of the public sector strike there was a delay. There was a deadline of April 30, and the deadline was extended as a result of the public sector strike, so I believe a second flyer was also inserted in The Telegram.

MR. PARSONS: On page 192 of the Estimates, Administrative Support, 1.2.02, $3,153,900 budgeted for Salaries, what is the explanation for this $84,900 increase in Salaries in Administrative Support?

MS E. MARSHALL: I am going to defer again to Mr. Strong for the details on that.

MR. STRONG: The budget is down from the original budget of $3.3 million. The increase from $3,069,000 to $3,153,900 would be primarily the annualization of salary increases, step progressions and things like that.

MR. PARSONS: Under the salary details for Administrative Support shown on page 140 of the Departmental Salary Details book, there are about thirty-seven or thirty-eight different positions noted there, starting off with the Director, Financial Operations ending with the Data Entry Operator; probably more than that, forty I guess. Are all of these positions currently filled?

MR. STRONG: No.

MR. PARSONS: Can you identify for us which of these positions are currently vacant?

MR. STRONG: I do not have that detail here but I can get it for you.

MR. PARSONS: You can provide that to us I take it. Whenever we ask questions and there is an undertaking to provide, I assume we will get this before the Budget debates close off, because this will be relevant to the Concurrence debates that we are going to be having in the House before we clue up the Budget. We need to have it in a timely fashion to deal with that.

MS E. MARSHALL: Just to make sure now: For account 1.2.02, for the sixty-eight positions that are listed as being permanent in the Salary Details book, you would like to know how many are filled permanently and how many are filled by other means?

MR. PARSONS: Yes, and to save time, not only do I wish to have that for the Administrative Support, but in all of the references in the Health and Community Service's Estimates that refer to employees. As listed in the detail's booklet, because that is only one heading, Administrative Support, could you provide me with a list for all of them and identify which of them are currently vacant. Is it your intention to keep some of these vacant or are they being advertised? I know in each department, for example, we may budget for all of these positions and for whatever reasons, cost-savings measures, we try as a department not to fill them if we do not have to so that we can indeed save some money. I am sure there must be some of these here that are currently vacant, and probably have been vacant for quite a while, and you have no desire or no intention of filling them immediately.

MS E. MARSHALL: Yes. There would be some that are vacant that would remain vacant, but there may also be some which are currently vacant which may be filled if we do have the funding.

MR. PARSONS: If you could give us some indication of which are vacant-

MS E. MARSHALL: Yes.

MR. PARSONS: - all of which are vacant and an indication of whether they are going to be advertising to be filled within this current year, or if you have made no plans to fill them in this current year; some indication of that.

MS E. MARSHALL: At this point and time, because we may, for example, think that we are not going to fill the position and then six months down the road we may.

MR. PARSONS: Things may happen that you may have well have to change your mind and then you have to hire. My purpose in asking, of course, is it gives a more accurate reflection of what your are budgeted up for, what you are geared up, for in terms of staff, what the cost of those staff would be if you had a full complement. We would know from day one, at the time that you do the budget, exactly how many vacancies there are, and we would have some indication of where you intend to go for the next twelve months. At least then it makes it easier, at the end of the year when we see the actuals for salary details, pretty easy then to say, well, it is quite accurate, that what was vacant was not filled and so on. I think it makes it easier and more accurate.

We will move on to Mr. Butler. I think my fifteen minutes are up.

CHAIR: Thank you for remembering and making my job easier. He keeps track of his own time.

MR. BUTLER: Thank you very much, Mr. Chair.

One of the questions that my colleague asked, with regard to the Grand Bank facility - and I think I understood you correctly when you said that the cost that was gone into it, at that point and time, was $3 million.

MS E. MARSHALL: Yes.

MR. BUTLER: And you are anticipating there will $300,000 to take the steel down. I guess that is to return the property to foundation there, and the full thing. What I am wondering, from that, once the steel comes down is there any value on how much money you might recoup from the sale of the steel, or will you use it again somewhere else?

MS E. MARSHALL: I have no estimate on that, but I have raised it with the Minister of Transportation and Works and we are waiting to hear back from them as to what we can do with that steel.

MR. BUTLER: The other thing: I know you mentioned in your opening remarks about the dialysis system for Carbonear and other areas, and I know your intention was that the one in Carbonear would be up and running this summer. I was just wondering if you could update me on that? Is that still the projected time?

MS E. MARSHALL: I think it is a little bit later, again because of the public service strike . I will just refer to Ms Hennessey - it is late summer?

MS HENNESSEY: Some time in the fall.

MS E. MARSHALL: It has been moved to this fall. We have hired the coordinator. There is a coordinator now on staff in the department who is coordinating dialysis services so that service will be available in the fall.

MR. BUTLER: So, it will be up and running this fall, and at least people will not have to travel back and forth this year?

MS E. MARSHALL: Yes, that funding has been provided for that.

MR. BUTLER: The other thing, minister: I know over the last several years long-term health care has been an issue, not only in our area of Conception Bay North but all around the Province. I was just wondering what is the status of the reviews that have been done in the past with regards to long-term health care for Conception Bay North area?

MS E. MARSHALL: I am somewhat familiar with some of the reviews that have been carried out in the past. We recently had a review completed of the personal care homes in Newfoundland, and that review has just come in. We are going to carry out a review now of long-term care in the Province. We are in the very, very preliminary stages of that, so I am unable to make any further comment on that except to say that we are anticipating carrying out a review.

MR. BUTLER: That would still include, I guess, the Conception Bay North area?

MS E. MARSHALL: Yes, that would include all areas, both Newfoundland and Labrador.

MR. BUTLER: With regard to the timeline of February that you gave to the various health boards with regards to a request as to what they plan on doing in balancing their budgets and so on, I was just wondering - I know you probably cannot provide all of the details this evening, but as you know there are some rumours circulating in our area and people are getting really concerned. One of the options that we hear in the area is the possible closure of twenty-five beds in that particular facility. I think it only has seventy-four beds, if I am not mistaken, somewhere in that vicinity. I was wondering, is there anything to that? Maybe you cannot diverge what -

MS E. MARSHALL: I heard that rumour also, but I can assure every member on the Committee that there have been no decisions made with regard to services provided by the health care boards. I did hear that the other day also, and I do not know where the rumour came from.

MR. BUTLER: Okay. I guess each and every year we hear about beds closing for the summer season. I am just wondering: Is there any anticipation of how many beds might have to close, not only in that area but all over, this summer? Will any hospital beds be closing? Usually, in the summer you hear of so many beds closing down. Are there any figures that you could release on that?

MS E. MARSHALL: I have not been informed by the boards. I can check with Ms Hennessey. Have you heard anything from the boards with regards -

MS HENNESSEY: (Inaudible).

MS E. MARSHALL: My officials have informed me that we usually hear from the boards in June and they will provide us with the information at that point in time.

MR. BUTLER: Okay. One of the problems that we have in our area, and I guess it is not only common to that area, and I do not know if it was ever looked at it, is with regard to general practitioners. I guess we are fortunate in some instances, as compared to other areas of the Province, in that we have quite a few general practitioners, but a lot of the residents in our area have to travel to St. John's to see a general practitioner. The people who are there are just booked up solid, and to make matters worse, a couple of doctors did move into the city and they even have to travel back to the area to look after the patients they had, because they could not get on with anybody else. I am just wondering: Through your department has that ever been looked at? I am sure it is not only a common thing in our area, some other areas are probably worst than that.

MS E. MARSHALL: Actually, what we find, just going throughout the Province, is that some boards seem to have more success than other boards in attracting and retaining doctors. I can tell you, that the number of doctors in the Province has increased over last year. While there may be a shortage of physicians in certain areas, I know in the area that you are referring to, sometimes people elect to travel to St. John's, they make the decision that they want to come to St. John's for medical services. I do not know if that is the situation you are talking about or if it is because physicians are not available in the district?

MR. BUTLER: Minister, what it is now is, the physicians that are there have such a big caseload that they cannot take any more patients. When a doctor moves out, they probably might have 700 or 800 to 900 , and they cannot get in with any of the other clinics, or some of the doctors in the same clinic where that doctor moved from. I know one particular doctor moved here to Mount Pearl, and those people are just left out. They have to travel to St. John's to see a general practitioner, unless there is an emergency and they go to the Carbonear Hospital, but they do not have a family doctor.

MS E. MARSHALL: I have not had any discussions with the seniors officials on the board that you referred to. I have had some discussions with other boards in the Province, and they have not been as successful as they would like in attracting many physicians. I do not know if Ms. Fry or Ms. Hennessey can comment on that further, with regard to the supply of physicians in the Conception Bay North area. I do not know if that has come to your attention.

Doctor Bradbury is going to speak.

DR. BRADBURY: We have noted that there is a decrease in general practitioners on the Avalon region. The number suggests that forty-four physicians were there last year and there are forty-two there presently, unfortunately, so that the location of general practitioners and the type and the amount of services that we provide - our problem is not only in specific areas within Newfoundland but across the country, and no doubt has resulted in national attempts and plans to look at primary care reform. Certainly this area has been prioritized by this government.

MR. BUTLER: I will move on to 2.1.01, Memorial University Faculty of Medicine, and follow down through that area. Under 2.1.01, I take notice - and there is probably a reason for - but there are no salaries allocated under that heading. Is there a reason for that, that I am missing? Are there supposed to be any there or not?

MS E. MARSHALL: You are talking about the Memorial University Faculty of Medicine?

MR. BUTLER: Yes.

MS E. MARSHALL: No. We provide the grant to the Faculty of Medicine and it is a flat amount. They have their own administration, they have their own financial statements and their own budget. They are part of the University. The Department of Education funds most of the University, but the Department of Health is unlike other jurisdictions in that the Department of Health and Community Services funds the Faculty of Medicine.

MR. BUTLER: Okay. Under Grants and Subsidies, I notice an increase of $1,030,100. I was wondering if you could explain what the increase is there? That is still under 2.1.01, Memorial University Faculty of Medicine.

MS E. MARSHALL: From the $21,753,200 there was an increase there attributable to salary increases and employee benefits. There is $500,000 there for pension reform. I was speaking to Mr. Strong about it earlier today, so I am going to let him comment on it.

MR. STRONG: That was funding for changes to the Memorial University Pension Act for indexing.

MR. BUTLER: Under 2.2.01, Drug Subsidization, I will ask the same question again. There are no salaries listed there, so I am just wondering how is that administered or who administers that.

MS E. MARSHALL: The costs that are reflected in that program are primarily for the actual costs of the drugs. The $956,000 that is there, I believe, is relating to the administration of the program at xwave.

OFFICIAL: That is right.

MS E. MARSHALL: That is correct, is it? Yes.

The processing is done through xwave. It is a longstanding agreement between the government and xwave. They do the processing of the claims that are paid out to the various pharmacists.

MR. BUTLER: Under Allowances and Assistance, 2.2.01, it went from $56,581,000 to $61,142,600. That is over $5 million. I guess that is where you referenced earlier, is it, about the new drug program?

MS E. MARSHALL: Yes. The only new drug that we approved this year was Gleevec, the cancer drug, and it was $800,000, and $400,000 of the increase was put under the Income Support drug program and the other $400,000 under the Senior Citizens' program. The rest of the increase is directly attributable to utilization, that there is increased utilization of the drugs and also a factor for inflation. There has been an extra eight point something million dollars put into the drug program, but only $800,000 million of that is for a new drug. The rest of it is, as I say, for increased utilization and inflation, when the cost of the drugs go up.

MR. BUTLER: Under subheads 2.2.02 and 2.2.03, Senior Citizens and the Special Drug Programs, there are no salaries mentioned. I guess that is the same as up under the -

MS E. MARSHALL: It is the same, yes. The staff who are involved in the administration of the program would be budgeted for under Medical Services.

OFFICIAL: Pharmacists.

MS E. MARSHALL: Pharmacists, yes.

MR. BUTLER: Under subhead 2.3.01, Physicians' Services, I think there is an increase there of $11 million. Am I correct on that? The budget was $169 million and it is up to $181 million.

MS E. MARSHALL: There was a new MOU entered into with the physicians. You probably may recall that there was a physician strike. There was a new agreement entered into with the physicians, and, of course, this led to increased costs. If you notice, by looking at that account centre there, the budget for 2003-2004 was $169 million, then it went up to $184 million, and then it went down to $181 million. It was because some of the increases that were negotiated in the new agreement were what we call front-end loaded. Of course, you get a blip in your increase, up to the $184 million, and then it fell back a little bit, to the $181 million.

Mr. Strong can correct me if I am wrong, because I am fairly new to the department, but I believe that the Professional Services section there, Mr. Butler, is fee-for-service. Some of the physicians are on a fee-for-service arrangement while others are on a salary arrangement. I believe 05 is the fee for service. The category marked 10, Grants and Subsidies, would be salaried physicians. I think the one in the middle there for $6 million has something to do with out of Province.

MR. STRONG: That is right. That would be for services received by Newfoundlanders in other provinces, insured services.

MR. BUTLER: Did you say, sir, services by Newfoundlanders in other provinces or ones who travel to other provinces?

MR. STRONG: If you use your MCP card in Alberta or another province, we bill.

MR. BUTLER: I guess under that same one would be, for instance, if there is anyone away receiving transplants or whatever, they can put their costs in and they will get so much reimbursed. Would that be under that same heading?

MR. STRONG: The cost of what we call out-of-Province payments for things like transplants would be in the Health Facilities Budget. This would be just for physician services.

MR. BUTLER: Grants and Subsidies: You have probably touched on that one because there is an increase there of $12,433,000.

MS E. MARSHALL: Yes, those are doctors on salary.

MR. BUTLER: Revenue, the same subhead, 2.3.01, there is an increase for $300,000. Is that money that is coming in from the federal people? The provincial revenue increase there by $300,000?

MS E. MARSHALL: Those are the revenues that we receive as a result of our audits.

MR. BUTLER: Could you explain that to me, when you say you received that from your audits?

MS E. MARSHALL: Some of the revenue is from audit coverage. We do ongoing audits of physicians and sometimes, as a result of those audits, we make recovery. Part of it is attributed to audit recoveries and the rest would be reciprocal billings, which is sort of the reverse of what we were talking about, Newfoundlanders being away. It is people from outside the Province who come here and receive services. We would bill their province and we would receive money

MR. BUTLER: So it is from billings, we will say, basically?

MS E. MARSHALL: Yes

MR. BUTLER: Subhead 2.3.02, Dental Services: I notice there is no - well there is a change, I guess, because the budget last year was $4,775,000 and now it is $300,000 less. Really, you have gone back to what the revised budget was.

MS E. MARSHALL: We put the budget at what the actual usage was last year. One of the issues with regard to this program is that we have some concern as to whether the program is reaching the children who it was intended to reach. We will be doing a review of that program during the upcoming year.

MR. BUTLER: Okay. Under Emergency and Transportation Services, 2.4.01: I will have to ask just for clarification. There are no salaries listed, but I guess it is the same as all the other -

MS E. MARSHALL: Yes, that is correct.

MR. BUTLER: Under Allowances and Assistance, there is a decrease there from $4,663,000 to $4,130,000. I am wondering why that cut is there.

MS E. MARSHALL: That is because we increased the cost of ambulance trips. The extra revenue that is being charged will be netted in against the expenditure and that is why the expenditure is being reduced.

MR. BUTLER: That is the increase that was announced in this year's budget?

MS E. MARSHALL: Yes.

CHAIR: I remind the member for Port de Grave that his time has - if you want a question to rap up before we move on.

MR. BUTLER: I only have another one there sir, and it is probably just as well to finish them right now.

CHAIR: I will give you latitude. Go right ahead.

MR. BUTLER: Under the same heading, 2.4.01, Grants and Subsidies, an increase of $4,162,700: I was wondering if you could explain that huge increase.

MS E. MARSHALL: That is similar to the physicians in that there was a new one-year agreement reached with the ambulance operators last year. That agreement resulted in an increased cost to the department. The contract expired the end of March past and it has been extended to the end of May, the month that we are in now, and we have commenced preliminary negotiations with the ambulance operators.

MR. BUTLER: That was going to be the final part of my question, but I think you probably touched on it just now. I was going to ask you how are the negotiations going now, because we hear different reports.

MS E. MARSHALL: Yes, we have started negotiations.

MR. BUTLER: Very good.

Thank you, Mr. Chair.

CHAIR: Thank you.

The hon. the Member for Labrador West.

MR. COLLINS: Thank you, Mr. Chair.

I have a couple of questions for the minister. I would like to start of by asking if, during the negotiations with the federal government or meetings with the provinces and the federal government for funding for health care, have there ever been any discussions held on funding the provinces differently than the way that they are funded now, in terms of the per capita funding?

MS E. MARSHALL: Most of those discussions would have been held with the Minister of Finance, but I can say that I have had one meeting with Mr. Peddigrew in which I discussed increased funding. In addition, I did have a telephone conversation with him a couple of weeks ago, again regarding increased funding for health care. As well, I have had meetings and telephone conversations with junior ministers also in his department, again aimed at increased funding for health care, not just acute care but also for public health and different other areas of health care.

MR. COLLINS: It seems to me, given our geography compared to P.E.I. or Nova Scotia or New Brunswick, puts us at a very unfair disadvantage in trying to deliver-

MS E. MARSHALL: You must be referring to the geography of the Province?

MR. COLLINS: Yes.

MS E. MARSHALL: That issue has been raised with Mr. Peddigrew during our discussions. In addition, some of the Territories also have an issue with regard to geography and we have been discussing that issue with them, as to some sort of joint discussions. I do not think I should say joint proposals. We have identified other areas or other jurisdictions that are concerned with that issue. We have been having discussions with them also, but it has been raised, yes, with the federal ministers.

MR. COLLINS: The Provincial Drug Program: I guess you have heard me address many times in the House the question of drugs for MS and Alzheimer's. Do you know if there has ever been any comparison done? I know the cost of providing the drugs upfront - we are the only jurisdiction in this country that does not provide any type of assistance to suffers of MS or Alzheimer's to help them with their medications, which, as you know, are quite expensive. Has there ever been, to your knowledge, any study done, sort of comparing the cost of providing the drug upfront in relation to what happens to people who do not take the drug, ending up in health care institutions at a greater burden to the health care system?

MS E. MARSHALL: I have read some studies with regards to the Alzheimer's drug. Again, I am sure that there are a variety of studies out there, but I have read several that have indicated that it is not possible to identify whether there would be savings as a result of using the drug. I would like to say that there are a number of drugs which we have been requested to add to the formulary; the MS drug, and there are also drugs for arthritis as well as the Alzheimer's drug. The decision has been primarily financial at this point in time.

Again, as I indicated, I have read some studies on the Alzheimer's drug which indicate that it is not categorically proven that there would be savings resulting from the use of that drug. We are doing a review of the drug program right now to determine whether we could identify savings to cover some additional drugs. In addition, the federal government has been, for some time now, talking about a catastrophic drug program which I would surmise will give us extra funding for drugs, but I do not know what the outcome of the discussions on that program will be. It is something that we are keenly interested in pursuing. At this point in time, the $106 million was what we allocated for the drugs for this year.

MR. COLLINS: Are you aware of the study that was done - I think this was just released recently - by Memorial University, the Division of Community Health at MUN? It is quite alarming really. It talks about the issue of the burden of expenses on cancer patients in Newfoundland and Labrador.

MS E. MARSHALL: That was released probably within the last month?

MR. COLLINS: Yes.

MS E. MARSHALL: Yes, I have read that. Actually, I had a meeting with Peter Dawe who is the President of the Cancer Society, and I also followed it up with a telephone conversation in which we did discuss the outcome of the study. I think it is a short paper.

MR. COLLINS: Yes, I think it is only a four-page executive summary and I think there are eight more pages to come.

MS E. MARSHALL: It was only recently released, so we are only just now looking at it. I think one of the biggest issues goes back to cost and whether we would be able to afford an increase through the Budget, but having said that, yes, we are looking at that study.

MR. COLLINS: As I say, it is quite alarming when you are looking at - and it is a pretty in-depth survey of 484 patients and 21 doctors.

MS E. MARSHALL: I believe it covered a three-year period also?

MR. COLLINS: It did.

It talks about some people having to pay over $5,000. I guess, one of the real alarming statistics that they have talked about is that, to reduce some of the out-of-pocket patient costs some cancer patients ration their medication.

MS E. MARSHALL: Yes, I discussed that with Mr. Dawe. They identified people who elected not to receive services in St. John's because of the expense.

MR. COLLINS: Because of the cost?.

MS E. MARSHALL: Yes.

MR. COLLINS: Is there anything in the plans right now to address that, even though, as I say, it has only been out for about a month?

MS E. MARSHALL: There was no additional funding provided in the Budget for that, but having said that, I have had, again I would say preliminary discussions with my officials on it. It is something that I will be following up, because the commitment was made to Mr. Dawe that I would be getting back to him.

MR. COLLINS: Sort of along that same line: there is a non-emergency medical relief fund in the Province that people have utilized from time to time, but again, according to the study, only 6 per cent of people have opted to use that. I am inclined to believe that the reason that number is low - and I run into it pretty regularly, on a weekly basis probably. In spite of all the people who do use it in my district, I still run into people in my own district and across the Province who are still not aware that there even is such a program. Is there any way that your department has looked at identifying that by making sure that information is available in doctor's clinics, at hospital rooms or other things?

MS E. MARSHALL: Actually, I noticed that in the study, and I have had, again because the report is new, preliminary discussions with Ms Hennessey. Ms Fry has just returned from holidays today, so I have not had an opportunity to discuss it with her, but I have raised that issue with Ms Hennessey, as to how we could make that program better known.

MR. COLLINS: Okay.

MS E. MARSHALL: Ms Fry has just passed me a note. She said the program is on the government website and the social workers at the cancer clinic are aware of it. Again, as you indicated, and as noted in the study, there does not seem to be a high profile with regards to that.

MR. COLLINS: It is not just for cancer patients, it is for anyone.

MS E. MARSHALL: I know that, but I believe the report was done for the Cancer Society.

MR. COLLINS: Specifically, yes, 6 per cent of their (inaudible).

MS E. MARSHALL: Yes, I read that.

MR. COLLINS: I noticed there wasn't anything in the Budget, but is there anything on the horizon from your department that would alleviate people in the Western part of Labrador in terms of availing of CT scans, mainly in Happy Valley-Goose Bay? As I have said many times here in the House of Assembly, we are the only people in Labrador who are not entitled to any type of assistance whatsoever, when we have to travel to the regional centre in Goose Bay to avail of a service that is not available in our own area. Every other person in Labrador has that, and Happy Valley-Goose Bay had the same subsidy prior to receiving the CT capabilities when they traveled to St. Anthony for that service.

MS E. MARSHALL: Are you referring now to the cost of transportation for people in Lab West?

MR. COLLINS: I wonder if it would come under transportation, because the health corporation - the reason I ask you that is, my first inclination was that it was probably to do with the Department of Transportation where it involved travel, but my understanding is that this cost is not directly through the Department of Transportation, it is, in fact, a cost that is absorbed by the Labrador Health Corporation. They, in turn, have informed me that they have no problem covering residents of Labrador West if they receive funding from the government to do so.

I could be wrong, I do not know this for a certainty, but I thought that it came and was billed - I know that in the financial report, the financial audit of the Labrador Health Corporation, air ambulance - and it is under air ambulance - is covered off under that.

MS E. MARSHALL: Are you familiar with that, Ms Hennessey? Can you speak to that?

MS HENNESSEY: (Inaudible).

MS E. MARSHALL: When you talk about their financial statements, you are not talking about the study that was done on Health Labrador by Deloitte and Touche, are you?

MR. COLLINS: No, the financial statement of the Labrador Health Corporation, the audit.

MS E. MARSHALL: The audit. It must have been in the management letter. I am not familiar with the document. I am just puzzled here now, because I read their financial statements and their management letters, but I do not remember seeing it referenced there.

MR. COLLINS: It is not referenced as such. That is why I had a bit of difficulty finding the exact numbers in the beginning. When I questioned a huge figure that was there, it was pointed out to me that it was the cost of bringing patients into Happy Valley-Goose Bay.

MS E. MARSHALL: From the Coast?

MR. COLLINS: From the Coast.

MS E. MARSHALL: From the coast, okay.

I would have to take that under advisement because I am getting into an area there now where I am not quite sure of the numbers that you are talking about.

MR. COLLINS: It is a subsidy by the Health Care Corporation.

MS E. MARSHALL: The concern that you have is that the subsidy should be extended to Labrador West, is that correct?

MR. COLLINS: We are the only people in Labrador who are not entitled to it.

MS E. MARSHALL: Did you say you had discussions with Health Labrador?

MR. COLLINS: I have had discussions with Health Labrador who told me that if government provided the funding for it they would have no problem expanding their program. The total cost to do that, based on the figures that we have, that the Chair of the Committee is well aware of, is a cost of $40,000, which is not a lot of money to government, but the $40,000 broken down to 100 individuals, many of whom do not have any insurance plans - if they are not working in the higher paying jobs in my district, they do not have vehicles good enough to drive to start with.

MS E. MARSHALL: Are your comments also in relation to the $40 fee that is being charged on the coast?

MR. COLLINS: Yes.

That is absorbed, that is a subsidy by the Health Care Corporation.

MS E. MARSHALL: We have been looking at that because, as you say, the fee for $40 is just on the Coast and it does not extend to Labrador West. The other thing is, we could also increase the cost, I guess, over on the Coast, but that is not the solution you are looking for.

AN HON. MEMBER: You got that right.

MS E. MARSHALL: You are looking for consistency, but consistency with the Coast.

MR. COLLINS: I am looking for consistency throughout the region that is serviced by the -

MS E. MARSHALL: Yes, you and I have talked about it.

MR. COLLINS: In other areas of Labrador, of course, it is in place to go to St. Anthony.

MS E. MARSHALL: There is no funding provided in the Budget to provide any type of subsidy to Labrador West, but I am well aware of the issue because you have raised it with me a number of times. Some of the programs, the travel programs, we will be reviewing during the program review and program renewal process, so that will be looked at, at that point in time.

MR. COLLINS: When will that take place?

MS E. MARSHALL: That will be taking place over, I would say, probably the next nine months or so. We will be looking at a significant number of programs in the government departments. For programs that are in my own department there will be certain select programs that will go into program review. That would be one of the programs because the Health Labrador Corporation, I do not know if you have read the report that was issued by Deloitte, but they also discussed the $40 travel fee for residents of the Coast of Labrador. That was addressed in that report and we are aware that is there and has to be addressed.

MR. COLLINS: Are there any other reviews going to be conducted, because I notice there wasn't anything in the Budget, speaking of the report on the Labrador Health Corporation, for a facility or a massive upgrade to the Captain William Jackman hospital, because it is in deplorable condition.

MS E. MARSHALL: Yes, I visited the hospital.

MR. COLLINS: I know you did, yes, and you could see for yourself what is going on there.

MS E. MARSHALL: Yes, I saw it for myself.

MR. COLLINS: Is there anything -

MS E. MARSHALL: There are no plans yet, but as I indicated to Ms Jones, I believe we are going to be looking at all of our facilities and doing a long-term plan as to what facilities need to be upgraded and where we need new facilities. That will be conducted during the current fiscal year. Also, as I indicated earlier, it was not my intention to hire any consultants or to incur additional costs to do that review, but that is something that I am hoping we will be able to do in-house, because there are a number of facilities around the Province; the hospital that you referenced, and also I spoke earlier about the Grand Bank clinic which is also in bad condition.

CHAIR: It sounds like a good question to end on. It sounds like a good question to break on. We said, when we started, we would take a ten-minute break halfway through. Let's come back together, then, at 8:45 p.m. We will take a ten minute break and come back and pick it up from there. I cannot offer you any refreshments, other than the water you have on your desk.

CHAIR: Thank you for your prompt response to the bells. I think when we finished off, the Member for Labrador West had just wrapped up his questions.

MS E. MARSHALL: (Inaudible).

CHAIR: By all means.

MS E. MARSHALL: (Inaudible) now on some of our discussions, and I know Mr. Collins was asking about the per capita funding and talking about funding for health care, and I just want to mention that there are meetings scheduled for the end of May with the Finance Ministers and the Health Ministers, jointly. Just to let you know, there is dialogue between the Finance Ministers and Health Ministers regarding the funding and whether it should be per capital funding or some other formula. I just wanted to let you know that.

MR. COLLINS: Maybe we would be served by the other formula, whatever it might be.

MS E. MARSHALL: Yes.

CHAIR: Thank you, Minister.

We ended with the Member for Labrador West. Who wants to go next? The Member for Cartwright-L'Anse au Clair. I am going to give you a few minutes to wrap up.

MS JONES: Thank you, Mr. Chairman.

It should not take me too long to do that, a few hours at the most.

I want to go back to page 197, 2.3.01, of the Estimates. My colleague asked some questions earlier with regard to the medical care plan. I just wanted to follow up with a few more questions, if I could? The fee-for-service for doctors has increased according to the numbers here, it increased last year. This year it is down a little bit but it is still an increase over the budgeted amount. Is there more demand for fee-for-service doctors in the Province today than there has been, and can you tell me how the percentage of expenditure for fee-for-service doctors has grown over the past four to five years?

MS E. MARSHALL: I do not have the breakdown. I can tell you that as of March 31, 2004, there were 948 physicians in the Province and fee-for-service accounts for 609 of those. I do not have the number for a year ago.

OFFICIAL: (Inaudible).

MS E. MARSHALL: Yes, I do here now. I gave the number of 609, so add those two together here now. It was 568 a year ago.

MS JONES: Is the fee-for-service retained doctors increasing because the permanent physician numbers are decreasing? Is that the reason for it, or are we adding more fee-for-service?

MS E. MARSHALL: The fee-for-service: anybody can come in and set up a practice with fee-for-service. I do think now I can turn it over to the officials, because they have a better history with the department. The most recent MOU that was negotiated with the doctors seems to have had some positive results in that it seems there are more doctors coming to the Province. The fee-for-service doctors has gone up. I am just trying to take a look here now for the salaried doctors. It was 346 a year ago for the salaried doctors and it is now 339, so that is close.

MS JONES: The fee-for-service doctors, has there ever been a tracking system on them? For example, are they all Province-based doctors or are they coming in from other provinces? I am just wondering, are there doctors that set up practice in the Province and do nothing else only fee-for-service in Newfoundland and Labrador and in other provinces as well? I am trying to get an understanding of how that works. I know they make a lot more money then salaried physicians. I guess it is more appealing, but I guess there is a little more travel.

MS E. MARSHALL: The fee-for-service would depend on your practice and how big your practice is. Tracking over the years - I do not know if Doctor Bradbury might be able to offer some information, but I do have some statistical information that I will just take a browse through while Doctor Bradbury is speaking to that.

DR. BRADBURY: Historically, about 30 per cent of the Province's physicians have been salaried, and in the past two to three years that number has gone up from 30 per cent to about 36 per cent to 38 per cent. We have seen two phenomenons over the past two to three years. One, is a net increase in the total number of physicians in the Province, as well as an increasing interest in salaried arrangements rather than fee-for-service.

MS JONES: What was the total salary increase negotiated this year for physicians, on a annual basis?

DR. BRADBURY: There was a three- year agreement that was signed, that was retroactive to October 2002, for a three-year period, and during that three year period salaried physicians were scheduled to receive an 18 per cent increase, 8 per cent in year one, 5 per cent in year two and a second 5 per cent as of October of this year.

MS JONES: What was the total amount of money on an annual basis?

DR. BRADBURY: For salaried physicians?

MS JONES: Yes, in dollars. For example, the 8 per cent last year would have been how much voted, and the 5 per cent this year would have been how much voted?

DR. BRADBURY: Between $8 million and $8.5 million.

MS JONES: That is annually, right?

DR. BRADBURY: Yes, but it was added incrementally over the three years of the agreement.

MS JONES: Under that same heading, you talked about the professional services in the billings, the MCP billings from other provinces. Do you have a breakdown of the billings from the Province of Quebec and do you have a breakdown of what billings are directly associated with the Blanc-Sablon Hospital System?

MS E. MARSHALL: They would have that information in the department, but I do not have it here. The information is broken down by province. You are just looking for the Province of Quebec?

MS JONES: No, I would like to have a breakdown of the billings from all the provinces or territories, and if there were any billings outside of the country.

MS E. MARSHALL: I would think there would be some from outside of the country.

MS JONES: Also, if you have a specific breakdowns of billings from the Long Point Hospital in Quebec, I would like to look at those because most of those would be from my district. I am interested in seeing that.

MS E. MARSHALL: Yes, okay.

MS JONES: The other question - this issue, again, was raised by my colleague, the Vice-Chair - with regard to the audit recovery, you guys said that this was a result of audits by physicians. Are these false billings being made by physicians themselves to the department? Is that what you are -

MS E. MARSHALL: No, not necessarily.

MS JONES: Can you explain that to me, please?

MS E. MARSHALL: I will have to turn it over, probably, to one of the officials to further elaborate, but if there is insufficient documentation, for example, to substantiate billings, we would make recoveries. I think the amount that was budgeted, or the amount that is in the budget, would have been about $150,000. Whether there have been any cases with regard to fraudulent activity, I am not aware of any. I do not know if there had been any prior to my arrival at the department or not. I could probably just turn it over to one of the officials.

DR. BRADBURY: In the history of MCP, there has been one physician who has been referred to the RCMP with regard to a fraud investigation.

MS JONES: Okay, thank you.

A question under 2.3.02, Dental Services. The government continues to subsidize dental services in Northern Newfoundland and Southern Labrador. Will that subsidization continue or is that part of the dental review that you are referring to as well?

MS E. MARSHALL: Those services and that program will continue. The primary concern that we had in the department was that the cost of the dental services is not born 100 per cent by the program. As a result, we were concerned that the program was not reaching, probably, the target we wanted to reach, because families were required to pay a certain portion of the cost. We were concerned that some children who should be receiving the services were not, because of the cost to the families. Therefore, we decided that during the current fiscal year we would be carrying out a review of that program.

MS JONES: I would also like to go back to the drug subsidization program again for a minute. Again these questions were raised by some of my colleagues this evening. In the budget you voted $8.6 million for an increase in the drug program. That $8.6 million increase, was that increased costs that were occurred last year with regard to drugs or is that what you are projecting to be a new increase this year?

MS E. MARSHALL: That is what we are projecting to be a new increase. Just to give you the numbers, in 2003-2004 the Budget approved $97.3 million. Our expected expenditures for that same fiscal year were going to be $98.3 million, so it exceeded its budget by about a million dollars. This year the budget is at $106.9 million.

MS JONES: With regard to the Alzheimer's drugs, that has been a huge issue in the Province, especially for the Alzheimer's Society and for families who have loved ones who are, I guess, affected by the disease. They launched a very aggressive campaign, in my opinion, towards the previous government of which I was a part, and now towards the government of which you are a part. It is my understanding that there was an Atlantic review done of two of the drugs that were being looked at, I guess, to be prescribed to Alzheimer's patients, and my understanding is that the Atlantic review policy, when it was completed, recommended that these drugs be added to the formula in each of the provinces and be provided to Alzheimer's patients. Is that not accurate?

MS E. MARSHALL: I am not familiar with that review. I am aware that all provinces do cover that drug, but I will refer it to my officials to find out if they are aware of the Atlantic review.

OFFICIAL: (Inaudible).

MS E. MARSHALL: My officials say, yes, that the Atlantic review did recommend that drug be added to the formulary, but that it was left up to the provinces as to when they would add that drug to their formulary.

MS JONES: Your department had someone sitting on that Atlantic review, is my understanding?

MS E. MARSHALL: The officials have confirmed that one of our pharmacists sat on that review.

MS JONES: It is my understanding, from the review and also from other information that I have been provided, most of it through the Alzheimer's Society I will admit, that although there is not, I guess, a 100 per cent confirmation that this drug will work in all patients they do indicate it does work in a percentage of Alzheimer's patients. They have also indicated to me that, if government were to add the drug to the formula for Newfoundland and Labrador, that pharmaceutical companies would provide the drug free to all patients for up to four months.

MS E. MARSHALL: Yes.

MS JONES: Physicians that I have talked to have indicated to me that within a four-month period they can determine if the patient will react to the drug in a positive way or if they will not. I do not know if you have given any consideration to the drug, based on the fact that that could be seen as a pilot project, and that it could be seen to give government an opportunity to, I guess, remove patients from the list that would not react in a positive way to the medication? Did you consider that when you made your decision?

MS E. MARSHALL: That is something that did come up during our discussions, but then, of course, we would be responsible for the cost of the drugs after the four-month period, and the financial issue was really the major impediment to putting that drug on the formulary. We are carrying out a review of that drug program and we are hoping that there will be savings identified, that we would be able to add some drugs to our formulary. I know we are discussing the Alzheimer's drugs here now, but we have also had a significant amount of representation from the MS society, and the Arthritis Society has also made strong representation to have drugs added to the formulary.

MS JONES: I have also been told by physicians and by members of the Alzheimer's Society that, for patients for whom the drug works, I guess, you would see them being able to stay at home for maybe two years longer to be cared for by their families, and that would certainly be a relief on government financially, if you do not have to pay for the institutional care. Have you guys looked at that option and that consideration when you made your decision?

MS E. MARSHALL: We have reviewed some studies which indicate that, that conclusion is not definitively supported, but having said that, that was not a deciding factor in deciding whether we would fund that drug. I realize we do have to look at the financial issues and whether there are countervailing cost savings, but I also think that a very important thing we have to look at is quality of life for the patients. The fact that the drug would support a better quality of life would be a very important factor.

MS JONES: Did you guys remove any drugs from the formula this year?

MS E. MARSHALL: Not that I can recall, no.

MS JONES: I am trying to recall now Bev Carter's new position. I cannot remember -

MS E. MARSHALL: Bev Clark maybe?

MS JONES: Bev Clark, I am sorry. She used to work in the department in John's.

MS E. MARSHALL: Yes, she is the CEO of Health and Community Services in St. John's.

MS JONES: I heard her in the media, I think it was one evening last week. It may have been at an OxyContin conference.

MS E. MARSHALL: Yes, that is correct.

MS JONES: She was talking about the fact that they had identified physicians in the Province who were prescribing drugs, I do not know if unnecessarily, but which could be deemed, I guess, unnecessarily, or prescribing certain drugs for certain conditions that may not have needed to be prescribed. She went on to say, in her talk, that a list had been compiled of these physicians. I am just wondering, Minister, have you been provided with that information as well?

MS E. MARSHALL: Not formally. Ms Clark did speak at the conference. I am awaiting the final report of the task force. My understanding is, that information will be included in the final report. She did take the opportunity to speak at this conference regarding some of the findings of the task force, but I have not received the task force report. We are doing some preliminary work within the department in anticipation of receiving that report.

I believe one of the issues she raised was, and my understanding is, that they will be proposing some amendments to some legislation that would facilitate addressing those issues, and while we have not received the report yet, we have done some preliminary work in anticipation of that recommendation.

MS JONES: When do you expect to receive the report?

MS E. MARSHALL: I was scheduled to meet with the task force, I believe, May 26, and I would expect to be receiving the report probably some time in June.

MS JONES: Will that report be public?

MS E. MARSHALL: Yes. The interim report was received, I believe, the end of January and we did make the interim report public. It would be my intention also to make that final report public.

MS JONES: Is there anything in the interim report that supports Ms Clark's comments?

MS E. MARSHALL: I believe there is some reference to it. I am just trying to think back to the report. My understanding is, what is going to be in the final report will be in more detail than what was in the interim report, but I believe the interim report did allude to this issue.

MS JONES: Minister, will you be looking at legislation that would penalize physicians who abuse the practice of issuing prescriptions?

MS E. MARSHALL: We have not come to a definitive conclusion. Again, as I said, I have not received the report so I do not know what exactly is going to be recommended, but we have started to review some of the legislation to determine what sorts of amendments we would look for.

CHAIR: I will just remind the member of her time.

MS JONES: My time is up. We will just move on.

CHAIR: If you are on a particular line of questioning that you wanted to conclude, that would be great, rather than cut you off in mid topic.

MS JONES: No, I think I am finished with the drug piece.

CHAIR: Okay.

The Member for Burgeo & LaPoile.

MR. PARSONS: Thank you, Mr. Chairman.

Minister, a couple of questions. I will need to go back and ask some specifics in terms of the actual dollar signs in the Estimates and whatever, but I also have some questions of a generic or maybe even philosophical bent. I would like to find out where you stand on some of those issues.

In your introduction you used the word efficiencies and you used the word sustainability. We are all aware that health care is the most costly department of government, and no doubt is the most costly service that we provide to the residents of the Province. In that light and in that context, there is a situation that I am aware of - and I made yourself aware of yesterday - concerning how different boards in this Province act and administer what I always thought was to be a policy made in the best interests of everybody equally and fairly. I refer, of course, to the Botox issue where apparently this is a neurological disease. I know nothing of the medical terminology, but it is a neurological disease that a lady in my district, for example, of Burgeo& LaPoile, had been diagnosed with and who required treatment. This particular individual I would classify as being amongst the working poor. They are not recipients of government assistance, but they have low income, and this is a very expensive drug. She was treated in Western Newfoundland at Western Regional a couple of times under her doctor's advice and then was subsequently told that she could not get any further treatments. Now, you do not have to be a rocket scientist to figure out that her and her husband, by looking at their financial statements, cannot afford to pay for these treatments, yet she needs these treatments. It has come down now, apparently, to the fact that she cannot get those treatments in Western Newfoundland because, for whatever reason, the Western board has decided that they do not have the money or will not fund this Botox treatment. Yet, she has been advised that she can come in here to St. John's and receive the Botox treatment. The end result is the same, i.e., this particular lady gets the treatment that she needs and should have, but she has to travel 2,000 kilometres return in order to get it. If we are operating under a system in our Province that is supposedly equality, fairness for all, and the issue of sustainability is not a factor here, because she can get it in the east but she cannot get it in the west - I am wondering: What do you think about that situation, number one, and what is wrong with our system as it currently exists to allow that to happen?

MS E. MARSHALL: First of all, I agree that if we have policies they should be consistent as we go from board to board. I was following up on that specific case and referred it to Ms Hennessey. After I spoke to you, I thought there was one case but apparently there is more than one case, so we are doing a review across the Province to try to get a handle on exactly what is happening. My position is that, as we go from board to board there has to be consistency with regard to the programs that we offer.

We have not finished our review yet, so I am not quite sure what happened out in Western. It appears that they may have been offering it and decided that they were not going to offer it anymore, and it may be because of financial pressures, but I have not had an opportunity to talk to the staff yet. Sometimes the boards do take action on different programs and we are not aware of them, but you are aware that they are having financial problems out at Western and it could be in response to that, I do not know, but we are following up on it.

MR. PARSONS: I am pleased to hear you say that you agree that policies such as that should be consistent from board to board. All boards are funded by the taxpayers' dollars, therefore if we have policies, I would think the rational and logical thing is that they would be -

MS E. MARSHALL: Consistent.

MR. PARSONS: - consistent.

This is another example where sometimes being economically and financially - for example, Western being allowed to make a decision concerning whether they do or do not cover Botox treatment has had an unnecessary, I would submit, negative impact on this family, beyond the fact of whether she did or did not get the Botox. By being told what she was told, she is going to get the treatments if we get it ironed out and if she can afford to come here. A lot of people who live - no offence to anyone who lives in St. John's - in St. John's, who work here in the Confederation Building and work in the Department of Health and other departments, do not truly appreciate that a lot of the decisions that get made, albeit they are right from a financial point of view, impact the ordinary citizen in the pocketbook. These people, as I say, who are the working poor, in the particular instance that I am referring to, in the sense they are finding it tough enough to get by as it is, have now got to travel to St. John's, and they either borrow from relatives, $2,000 or $3,000, to get in and get out.

MS E. MARSHALL: When we become aware of those inconsistencies we would followup and address them. I am aware of at least one other inconsistency between boards. When we do become aware of the inconsistencies we go back to the boards to try to correct the wrong.

Just on a more general note, and not in relation to the Botox issue, people who are not in receipt of financial assistance but require drugs that are costly to them, can also be financially assessed to determine whether they are eligible for any financial assistance. I realize that would not be in this case because, obviously, if Botox is offered in all the other boards then it should be offered in that board.

MR. PARSONS: To follow that line of thought, i.e. board policies, what boards should or should not be doing, I think it is public information, or certainly thought to be in the future, that we are going to see an integration of hospital boards the same as we have seen this year with our school boards being reduced from eleven to six or five or whatever. There is some thought that there may be a move afoot to reduce the number of hospital boards that we have.

Again, where, philosophically, do you stand on the issue of how many boards we need, should board members be elected or appointed, and what do you see as the efficiencies of boards? As I listen to the news media and look around this Province, I even see boards competing with one another, and I think of the board in Grand Falls - the official name of the board escapes me - versus Grand Falls-Windsor and who should get certain services. Where do you stand in terms of what is the best way to do this? Should it be all controlled by the department and do not let individuals have a say in it, on a regional basis, because they regional basis breeds competition as well? How do you see those things working in the future?

MS E. MARSHALL: I do not think that it is practical or that it is in the best interest of the Province to have all the health programs run from the Confederation Building. I do support a board structure. I do think that fourteen boards for half a million people is too many, so I do think we need to reduce the number of boards. I do not see it, though, as a cost-cutting exercise. I do not think that there is going to be a tremendous amount of savings or anything. I look at it more as efficiencies and a better continuum of services. I am especially interested in combining community boards with hospital boards.

Having said that, I have not made any firm decision as to where exactly we are going to go with regard to the boards, except to say that fourteen boards are, in my opinion, too many boards for 500,000 people. That is too fragmented.

MR. PARSONS: What is your view on elected versus appointed board members, and just the efficiencies of boards? In my former life I was a board member and a board chair and, in my experience, it is not the boards that, at the end of day, make the decisions. The boards take their advice and are spoon-fed with whatever the officials in the hospital you are working with tell you to do. I had serious questions while I was there, and even after I left, about what my role was, because you only knew what someone told you and you could only make decisions based on what they told you. The effectiveness and efficiencies of a board are, as you say, garbage in, garbage out, and whoever is putting the garbage in, or the information in -

MS E. MARSHALL: The role of a board member is very important, and I feel a bit sad when you say, what was the point of being a board member, that you just accept whatever is coming from the CEO. The role of the board member is to - I mean, it is the board that sets the strategic direction for the organization. As you know I was Auditor General for ten years, and I saw a good many instances where I felt the board was not sufficiently challenging the organization that they were a board member on.

What the solution is: I think you need to train your board members, but I think, too, board members have to realize exactly what their role and responsibility is as a board member, and it is not just to accept whatever the CEO offers up to you. As a board member you have a very big responsibility and those in the private sector who are now being sued are starting to realize how big that responsibility is.

The role of elected boards verses appointed boards, I have had some exposure to the elected education boards and also some exposure to the boards that were appointed, and, at this point in time, I think I would favour the appointed boards, but I think my deliberations are still out on that. I think with elected boards, it is a democratic process, so I can see the benefits of an elected board, but I have also seen some appointed boards do really well also. I would have to think a little bit more about whether an elected board or an appointed board.

MR. PARSONS: Given your thoughts on the reduction in the number of boards, if you have bigger boards - and just using Western again as an example, that I am most familiar with - because the boards are structured in such a way, at least at the present time, that they have representation from all over, that I would suggest, in and of itself, breeds competition amongst the board members. The whole concept of regionalization was not easily accepted, at least out West, you know, what Stephenville gets Port aux Basques does not like, and what Corner Brook gets Stephenville does not like. If you are going to make that region even bigger by, for example, bringing in all of the Northern Peninsula or expanding further west into Springdale, that even exacerbates the situation.

MS E. MARSHALL: I think, whatever structure you have in place, there are advantages and disadvantages. Years ago there was a separate board for every hospital or every facility, and I do not think that is practical especially in this day and age, that there has to be some integration of the system or of a region. While I realize there has to be regional representation on the boards, each board member has a responsibility not only to the region that they are representing but they have a responsibility to the whole board and to everybody who lives in that region. I would like to think that, as a board member, people would take their responsibilities seriously. It is to the common good of the whole board and not just their particular region.

How you address the issue of competition between various regions is something that will have to be resolved through the board members. If you look at Western board now, that covers such a regional area and you have competition. What we are saying now, if we move to a bigger area we are going to have competition. If you make them smaller, you are still going to have competition. If you look down on the Burin Peninsula you will see there is competition between Burin and Grand Bank and St. Lawrence. I do not know if we will ever get away from that.

MR. PARSONS: That is why I raised the question, though. Is the design, in and of itself, the proper one? If we stay with the model, board members, whether it is small or big or whatever it is now, we are still going to have that competing interest within the board. People do things, I would suggest, sometimes for their own interest, and not necessarily in the best interest of the whole region.

MS E. MARSHALL: But you get that whatever size your board is.

MR. PARSONS: Yes, that is what I am saying. Can you get rid of it by having some other model?

MS E. MARSHALL: I guess the other model would be, we will go back to having - how many boards did we have? - ninety-seven boards. Personally, I do not think that is an efficient way to delivery medical services, that you have just a little group here, a little group there, and you have your ninety-seven groups.

MR. PARSONS: I am suggesting, Minister, that we do not go back to the ninety-seven board concept and we do not keep what we have, but we look at a still newer model whereby we do not have input, that you come up with a structure that is bureaucratically run, period.

MS E. MARSHALL: What do you mean by bureaucratically run? From the Confederation Building?

MR. PARSONS: In other words, people whose jobs it is to run the institutions, and regardless of what area you are from and what your politics are, if you are responsible for Western it does not matter who appointed you. It is not a board that dictates what happens to that region, it is a bunch of people who are employees. It is their job to do things efficiently, to make sure we have a uniform provincial policy, to see that the money is properly spent, and not to be subject to the dictates of various directors who may have vested interests.

MS E. MARSHALL: But that too has bias. Just like there is board bias, there is bureaucratic bias. I have seen it at both the board level and at the bureaucratic level. I do not think there is one perfect solution. Having said that, there has been no decision made with regard to how the health care services are going to be -

MR. PARSONS: The reason I raise these questions is, I have been told that health care is going to get even more and more costly, that it is not a case of just throwing money at the problems, we have to find ways to fix the problems.

MS E. MARSHALL: Oh, yes.

MR. PARSONS: If that is one of the problems under the planning and policy areas that you have, are there brainstorming sessions where people actually sit down to try and see what is wrong with the system, how can we fix it, is the board structure that we are using wrong, and is there something else we can look at? Has that been done?

MS E. MARSHALL: Yes. Actually, it was done by the previous government of which you were a member. All across the country, provinces and the federal government are all grappling with health care, how health care should be organized, what services should be provided, how it should be funded and how we control costs. That debate goes on not only in this Province but it goes on in all of the other provinces. All of the other provinces are doing things similar to us, which are, looking at their board structures, looking at the types of services, looking at location of services, the skill mix of the health care providers, and what are the most efficient ways to deliver health care services. We have not reached Utopia yet, but there are a number of reforms and a number of initiatives that are going on throughout the country.

MS E. MARSHALL: You may dispute it, but I would see that the goals of that doctor would be the same goals that I would have. I would want to provide the opportunity that a physician, who is skilled in a certain area, could go to a certain area and retain their skills. You are saying that individual knows that they cannot retain their skills if they stay in a certain community, but if they move to another community, they can. That is one of the areas that we are looking at, and the term that is used is location of services, where we will go through a process of identifying, where should our services be provided, and rationalize as to, should the pediatric services be in this community or should gynecological services be provided somewhere else. Of course, one of the criteria that you would look at is where would your caseload be and would there be a sufficient caseload to sustain that doctor and enable that doctor to keep up their skills by practicing in that certain area.

MR. BUTLER: I have about four questions here, Minister. One is with regard to the personal home care facilities, the inspections. I guess it is though your department that those inspections are carried out. I will put all this into one question, with regards to the facility itself. I know a lot of the residents in those homes have various diets that they have to have, and I am wondering: Is there a follow-up or is that part of it inspected as well, to see that they get the nutritious meals they should have?

MS E. MARSHALL: Those homes are regulated by Health and Community Services. I am going to turn that over to Ms Vivian-Book because that is a fairly detailed question. I understand that there are annual inspections and probably Lynn could give a bit of an elaboration on that.

MS VIVIAN-BOOK: They are monitored through the Health and Community Services Boards from the programming side, which would take you to your issue of nutrition and special needs that particular residents have, but they are also followed through Government Services and Lands from the area of fire and life safety issues, and the licensing and monitoring is all done and coordinated through the Health and Community Services Board.

MR. BUTLER: I listened very attentively when yourself and my colleague here had the conversation with regards to the health care board structure, and I guess I am surmising here now if something should happen, with reference to any changes that may be forthcoming. I will just give you an example, and I am stretching it here now. For instance, in the Avalon Health Care Board in Carbonear, if there should be such a major change that it might be administered through St. John's or something like that - I am just looking at this hypothetically now - I am just wondering, do you think if something like that should happen, and not only in our area, that the local people, whether they are elected or appointed to the boards, in the stand that they take, I guess, for their particular areas, and they know the responsibility, do you think their impact would be lost, and the things that they fight for in the local area would be lost if we go to small with the board structure? For instance, we have the boards in our area and most of the people are from the immediate area, whether it be Placentia, Trinity, or the Conception area and so on. If that should disappear, and I am not saying it is going to disappear but if it should disappear, and be operated, for instance, out of Clarenville, St. John's or wherever, I know there would probably be one or two people from that area who might be appointed to a board in St. John's but I do not think they would have the impact in fighting for the needs of that area. Could that be considered when you look into this structure, if it should come to that point?

MS E. MARSHALL: I guess it does go back to the earlier conversation that I had, and that is, regardless of how the boards or how the structure is set up, there should be regional representation, and not only regional representation but also people with a diversity of backgrounds. Again it goes back to an earlier conversation, and while I realize that it would be incumbent upon a person from a certain region to represent their region, an effective board would be looking at services and programs in the best interests of all the constituents and not just in a select area.

MR. BUTLER: The other question I have is with regard to boards in various areas experiencing major challenges in recruiting adequate numbers of RNs and LPNs for casual employment. I am wondering what steps are taken. Are there any steps taken - I am sure there are, but I am wondering what they are - to keep our graduating nurses here in the Province? Only recently I know of a couple in my area who are just waiting to graduate and they are gone out of the Province. I am just wondering: Is there any plan in place whereby we can try to encourage those people to stay? I know it is very difficult when they are offered $40 US plus a signing bonus in the States. I am just wondering: Is there any plan in place?

MS E. MARSHALL: I will ask my officials to speak to this, but generally we leave it up to the individual boards to do their own recruitment. We will get involved if they ask us to. For example, there was an issue in Happy Valley-Goose Bay and Health Labrador did ask us to get involved, and we are involved along with the Nurse's Union and some other representatives. Generally speaking, in the area of nurses and the number of nurses we have here in the Province working, actually I believe we have the second highest per capita of nurses in the country. I think ours is the youngest workforce, too, which I was quite surprised to learn.

I do not think that that really addresses your question with regard to retaining and hiring our recent graduates, and I do not know if the boards - Moira, if you could help me out here with regard to attracting and keeping nurses. I am aware that we do not have significant problems right now except in select areas like Happy Valley-Goose Bay. Are you aware of any special programs that the boards follow with regard to hiring and retaining nurses?

MS HENNESSEY: (Inaudible).

MS E. MARSHALL: Ms Hennessey has confirmed that there are no special programs, but that we have been quite successful in filling the positions we have, and has indicated we are the second highest per capita.

MR. BUTLER: When you were responding there, Minister, you mentioned that the boards look after that, but I know quite a few of the boards are challenged now to bring their budgets under control and so on. I was wondering if there is any new initiative that may help them when they do have this problem?

MS E. MARSHALL: Actually, yes, there is one new initiative and that is, there was a new position created in the department, the position of chief nurse. We have not recruited for that position, we are still in the process of formulating the duties and responsibilities. All issues relating to nursing and nurses in the Province, of course, would fall under the responsibility of that position, and that position will be reporting - have we decided on the reporting structure, Ms Hennessey?

MS HENNESSEY: We are not certain yet.

MS E. MARSHALL: Not certain yet, but to an ADM. That is a fairly senior position in the department.

MR. BUTLER: Just to go back to one of the questions I asked earlier, Minister, with regard to the long-term care institutional services: I am wondering when a decision may be made, whether it is positive or negative, for the Conception Bay North area. Is there anything to be announced, say, over the next short period of time?

MS E. MARSHALL: I do not expect anything to be announced over the short term. There are two issues there. One is that we are going to embark on a long-term strategy for long-term care and supportive services. Of course, the other thing is, there would be budgetary allocations for next year. I do not know how that project would fair in relation to other projects in the Province. For example, the Town of Wabush has approached the department with regard to a long-term care facility, the one in Happy Valley-Goose Bay needs to be replaced or upgraded, so there is quite a demand there. What I would like to see is a provincial strategy with regard to setting some priorities in that area.

MR. BUTLER: This is my last question now. The preamble is probably a bit long, but I will try to get it all into one anyway. It is with regard to the Pharmacy Association of Newfoundland and Labrador. I have had some correspondence back and forth with the various pharmacists in my area, and to begin with, I have to say that they are not against an audit but they have a problem with the audit the way it was set up, I guess. They did go on and advise me that the previous administration recognized the services that they provide and various avenues whereby they save money for government. I know they received some correspondence and they had to respond by, I think it was March 18, 2004, and if they did not get those papers back they were not validated and were cancelled. I think it was requested that a small working group, probably, be together.

MS E. MARSHALL: Yes, there is a liaison committee established. There is an issue with the pharmacists with regards to the audit process and the provision of certain types of documents. That discussion is still ongoing. I am sure, as you can appreciate, when we conduct an audit you cannot share your audit procedures with the people who you are auditing. I have been saying to them, that there is certain information that I could not provide to them. We were going to go forward with some amendments to their legislation. That has not happened because I am still having discussions with the association. I, too, have received a massive amount of correspondence from pharmacists. I am working with the association to try to resolve the issues. In addition, there is a liaison committee that currently exists with representation from both the Pharmacy Association and my department.

I think their major concern - and I am sort of second guessing it - is that they were concerned that legislation would be brought forward that they did not agree with, and, of course, that would not happen.

MR. BUTLER: A couple of the issues they brought up with me were, the amounts that they were asked to prepare and send in at the one time, as high as 200 and 300 -

MS E. MARSHALL: Yes, the extent of photocopying was an issue.

MR. BUTLER: Yes, and the confidentiality of some of these.

MS E. MARSHALL: Confidentiality was an issue also, yes.

MR. BUTLER: Thank you.

That is it for me, Mr. Chair.

CHAIR: Thank you, I say to the member.

The Member for Labrador West, I understand you have one or two more questions.

MR. COLLINS: Just a couple of short questions.

Minister, I know you do not have it tonight, but would you have any statistics in your department as to the number of people in the Province who suffer from MS, and of that total number, how many are actually being covered under the provincial drug relief today?

MS E. MARSHALL: I would be able to get you some information on people who have MS from the files of the department. Actually, I asked somebody for that information myself. If people do not come forward and they are not members of associations or societies, for example the MS Society, if people are not members of a society, then, of course, they might not show up in the numbers, but I can certainly get you the data that we have in our office with regard to the number of individuals with MS.

MR. COLLINS: The second question is one that we have had some discussion on and I know it is not directly related to your department, but I do know you have some concern over this, the issue of the air ambulance when it comes to palliative care patients.

MS E. MARSHALL: Yes.

MR. COLLINS: Like I said, I have had some discussions with you on a case here and I know that you have expressed concern and compassion for people. I wonder if you have had any conversations recently with the Minister of Transportation.

MS E. MARSHALL: No, but I tried to catch you one day as you were leaving the House. It is something that you and I should discuss. The concern that I have, if we are doing that for your district and if that becomes a province-wide program, depending on the extent of the usage, my concern is that the air ambulance is going to be used exclusively for that purpose or almost exclusively for that purpose. I wanted to meet with you to discuss exactly what are the problems that you are having right now, because since I have been with the department, every request that you have made to me, I think that we have been able to assist. I wanted to speak to you about the process we have in place now and exactly what is wrong with the process and how we can improve it. Whenever you are ready to discuss it, I will be available.

MR. COLLINS: One final question: I know it is a problem in rural areas of the Province, in particular, attracting doctors and nurses, mainly because, I guess, if you are a doctor in a rural area you are sort of twenty-four-seven, and even if you go somewhere socially you are still being a doctor when there most times. I realize that you have only been in government since October, but I am just wondering whether or not - maybe some of your officials know - there has ever been a program in place, or if there has ever been consideration given to a program, for doctors or nurses, where financing of their education could be considered in turn for residency of a fixed term, to serve in remote or rural areas of the Province.

MS E. MARSHALL: Yes, there are some items of that nature. I am going to turn it over to Dr. Bradbury. Would you be able to answer that question? We do offer some bursaries.

DR. BRADBURY: There is an incentive bursary program that is offered. It is valued annually at approximately $1 million. About $600,000 of it is earmarked towards physicians who undertake additional training in general practice. That is perhaps the area that you would be referencing with regard to the rural program. There are bursaries offered to students that have set returns in service with them.

MR. COLLINS: Would that be offered through Memorial? I know there are some programs offered through the UNB, students from this Province who are out of Province studying to come back to the Province. Is that also applicable to students at Memorial?

DR. BRADBURY: The program, historically, has been taken by students studying here at Memorial. I am not aware that there are any sort of limitations to just Memorial students, but historically that is the group that has applied for them.

MR. COLLINS: Has that been successful?

DR. BRADBURY: The program has been in place, I should guess, probably going back into the 1980s. The default rate sort of varies. There are four different programs for general practice, psychiatry, medical specialities, and then fellowships for programs that are not offered in Newfoundland, and the default rate sort of varies between the various programs, anywhere between 5 per cent to 15 per cent.

MR. COLLINS: Those are all the questions I have.

Thank you.

MS E. MARSHALL: The budget provides $1 million for physician bursaries and incentives, so it is a fair dollar amount that is being provided.

MR. COLLINS: That would be subject - if they went under the bursary program, then it would be up to the Department of Health and Community Services to decide where they would serve in the Province.

MS E. MARSHALL: I think that is done through the health care boards. Cathi, is that right?

DR. BRADBURY: There is a selection committee for each of the bursary programs and when the students apply for the bursaries they indicate their areas of interest, where they would like to work in the Province. That influences, then, where and when the bursaries are awarded. The students then sign a return in service contract with the Deputy Minister, but the return in service contract is to the Province rather than to any one specific area.

MR. COLLINS: Of the people who have participated in that program, are many of them sent to rural areas of the Province?

DR. BRADBURY: They are not sent per se. Several years ago the contracts that these students would sign would be specific to an area, and the students asked that the contract be changed so that it be in general to the Province. The reason being is we were asking them to sort of sign up far to early in their careers for them to fully appreciate and understand where they wanted to go. Having said that, the areas where they are interested does factor into the committee's choice of who the bursaries are awarded to.

MR. COLLINS: Thank you. That is all I have, Mr. Chair.

CHAIR: There have been three hours set aside for tonight's session and it is now five to ten. I just had a discussion with the Member for Cartwright-L'Anse au Clair and I understand that both herself and the Member for Burgeo & LaPoile have a couple of other questions they want to pursue, and they think it will probably take an hour to do. If we do not do it tonight, then we have to reconvene at another time to do this. Minister, I do not know if you and your staff came prepared to extend beyond the 10:00 p.m. time. I understand that we can conclude this by 11:00 p.m., then we will finish it tonight and will not need to come back at another time. Barring your not being available, or the members of your staff not being available to do that, I think there is a desire to move forward and do this tonight so we will finish the session tonight.

MS E. MARSHALL: I would leave that up to the Committee. If my officials have other commitments, I will stay.

MR. PARSONS: I did not have any conversations with the Member for Cartwright-L'Anse au Clair as to whether I can get my questions in under the hour that she said. I am prepared to stay overtime. It does not matter how long it takes. I just did not want to be bound by the one hour necessarily and say that you think that I had gone over time or something. I have a number of questions and I do not know how long it is going to take me to ask them.

CHAIR: Depending on the answers. If the answers are brief, then we will be able to.

With that in mind we will proceed beyond this point. I say to the Member for Burgeo & LaPoile, if you want to pick up with your questions, and then we can move on to your colleague.

MR. PARSONS: Thank you.

Back to the Administrative Support section of the Estimates on page 192, in particular item 1.2.02, where it shows the Revenue - Federal, Minister, of $1 million. That is on page 192.

Could you explain what this is? Obviously, it was federal money. Where is this coming from, why, et cetera? It was not there last year.

MS E. MARSHALL: I think that might be funding for the pharmacy network. I am just going to take a look there now. Yes, that is $1 million we had budgeted for the pharmacy network. It goes back to the problems we are having with monitoring OxyContin and other types of narcotics.

MR. PARSONS: Has the federal government committed to this or is this what you hope to get?

MS E. MARSHALL: We are hoping to get the money. There is $1million. Health Canada and Canada Health info (inaudible) that there is money available. Whether we will get it or not remains to be seen, but we have put both the $1 million expenditure in the budget as well as the offsetting revenue.

MR. PARSONS: It is not, at this point, money that you know for sure you will have?

MS E. MARSHALL: It is not money in the bank at this point in time.

MR. PARSONS: Right.

Under that same section, in item 12 just above that, there has been a substantial increase in the IT in excess of $800,000. What would that be for?

MS E. MARSHALL: That is the $1 million in expenditure for the pharmacy network. We budgeted both the expenditure and the revenue.

MR. PARSONS: So, you have it spent, you just hope you get it?

MS E. MARSHALL: We will not spend it if we do not. I think Treasury Board will say, if we do not get the revenue we have better not spend the expenditure.

MR. PARSONS: That is the crossover there, the $1 million?

MS E. MARSHALL: Yes, that is right.

MR. PARSONS: Under Medical Services, item 1.2.03, in particular, they talk about $300,000 revenue from the feds, on the bottom. What would that be for?

MS E. MARSHALL: That is one-time Hepatitis C funding. The officials can correct me if I am wrong, but there was a commitment by the federal government a couple of years ago, I think it was for $600,000, and $300,000 was received in a previous fiscal year and then $300,000 is being received in the current fiscal year. That was the agreement that was worked out with the feds.

MR. PARSONS: I missed what that was for.

MS E. MARSHALL: Hepatitis C.

MR. PARSONS: Okay.

Unlike the other one we talked about up above, this is committed money? Because you cannot distinguish on the books -.

MS E. MARSHALL: Yes, that is right.

MR. PARSONS: On the issue I raised earlier about the salaries, we have a commitment that of all the salary positions listed in the Department Salary Details, you are going to provide us with the complete list, what is filled, what is vacant, and what the plan is?

MS E. MARSHALL: Yes.

MS E. MARSHALL: Well we had three layoffs during this fiscal year. That is one of the questions that you had. When you are talking about all of the positions, who is permanent, who is temporary and what is unfilled, when you start getting into positions, I am sure - we were speaking about it during the break - you will also get other categories, like people temporarily assigned or you might get a contractual in a position. I am just speaking from previous experience. You listed three categories, but there are usually other arrangements too.

MR. PARSONS: What were the three particular ones you referenced that were laid off?

MS E. MARSHALL: Pardon?

MR. PARSONS: You said you had three layoffs?

MS E. MARSHALL: Yes. There was one in at Confederation Building and there were two at MCP in Grand Falls.

MR. PARSONS: Because they were thought to be unnecessary or redundant? What was the rationale? Why three? How many employees, in total, are normally in the department?

MS E. MARSHALL: There are 225.

MR. PARSONS: So, only 3 of 225 were thought to be expendable?

MS E. MARSHALL: Yes, we were able to reduce our workforce by three.

MR. PARSONS: Under 1.2.04, Board Services, Salaries in that particular case - and I realize you are going to give me the details - but the salaries have gone up by almost $300,000. Why in this particular area?

MS E. MARSHALL: For Salaries, that is where the new Chief Nurse position is budgeted, in that $1,109,000. That is a new position with a new salary. There is also a second position there for the smallpox program, and that is federally funded. There is $80,000 provided - these are estimates - for the Chief Nurse and $60,000 for the position assigned to the smallpox program.

MR. PARSONS: I noticed again under that section we have federal money. What is that for?

MS E. MARSHALL: The $103,000?

MR. PARSONS: Yes, $103,000.

MS E. MARSHALL: The $103,000 would be primarily for smallpox.

MR. PARSONS: Under 1.2.05, Community Programs and Wellness, the Purchased Services heading, a substantial increase there of $305,000. What is this about?

MS E. MARSHALL: There was new funding of $200,000 provided for the new seniors' program that was announced in the Budget. That $200,000 is included in that $342,000. There is $100,000 targeted for programs for the schools, preventative type programs that concentrate on promoting physical activity and eating properly.

MR. PARSONS: Where would the funding be for the Breakfast Program coming up? Would that be your department?

OFFICIAL: (Inaudible).

MR. PARSONS: That is HRLE?

MS E. MARSHALL: Education.

MR. PARSONS: Under 1.2.07, Policy and Planning, again there is federal money. I take it we do not get our money from the federal government in one smack, we get it from all kinds of different little programs - is that right? - depending on what you successfully negotiate in any given year?

MS E. MARSHALL: Yes. Also, with the federal government there are different types of agreements. Even in the same program areas you may get different agreements and each separate agreement provides for different amounts of funding.

MR. PARSONS: What would the federal government be doing here, contributing $92,900 to policy and planning?

MS E. MARSHALL: It represents the shareable portion of the Addiction Services Program under the Employment Assistance for people with disabilities, as well as the alcohol and drug treatment and rehabilitation agreement programs relating to the Addiction Services Program.

MR. PARSONS: Under 1.2.08, Audit and Claims Integrity, again $900,000 for IT.

MS E. MARSHALL: I do not know if you are aware or not, but there was some news coverage of the fact that we had more MCP cards issued than there are people in the Province. We have been working at reducing those numbers, like weeding out the cards that are not bonafide, that have expired, or people have moved from the Province. The last time I checked, we still have probably about 670,000 cards outstanding. The $900,000 is provided to - I do not know whether we will reissue cards, but we have to go through a process to make sure all of the MCP cards that we have out there are bonafide cards and that the people actually live within the Province. It would like a re-registration process.

MR. PARSONS: Did I hear you say you thought we had 670,000 MCP cards in existence.

MS E. MARSHALL: Yes. Not I think, I know we do, because there are no expiry dates. The MCP card that you use is the one you probably received when you were born. There is no expiry date on it. It has been an issue for, actually, quite a number of years now, that the number of cards significantly exceeded the population of the Province. Of course, I was Auditor General at the time and I reported on it. I cannot quantify what it is costing us, but I suspect that people may be using their MCP cards after they leave the Province. For example, some provinces charge a fee, a monthly fee. I think Ontario used to have it and now they are going to bring it back, but they charge $40 or $50 a month for your card. I know of cases myself where people live outside the Province but they have come home for their surgeries and used their MCP card, I would suspect.

MR. PARSONS: Any idea on the amounts of dollars that we have - John Doe who is working in Alberta now, has a card and uses his card for treatment in Alberta, and we pick up the tab back here.

MS E. MARSHALL: I had some discussions with the staff internally as to how we can pick up some of those items through the audit process. I would think, in addition to people who live outside the Province coming home and using their card, it is quite possible that people living outside the Province and receiving services, for example in Alberta, that they are billing it to our MCP here in Newfoundland, through a reciprocal billing. We have had some internal discussions as to how we could pick up those problems, and we have been provided with $900,000 now to address this.

MR. PARSONS: There are two references - on page 193, 1.2.04, Board Services, there is a comment there, " Funding is also provided for managing the provincial road ambulance program and community grants." Then, over on page 198, in 2.4.01 it talks about the Road Ambulance. Why the two different references? Can you clarify this for me?

MS E. MARSHALL: This goes back to the issue that Mr. Butler raised, that the salaries for the staff that manage the road ambulance program, you will notice there are no salaries budgeted on 198, that the salaries of the staff who manage that program are budgeted for on page 193.

MR. PARSONS: Why do we have them broken down that way?

MS E. MARSHALL: I would say, it was always done that way and probably we are just continuing on.

MR. PARSONS: On page 201, 3.3.02, Health Care Facilities, we talk about, "Appropriations provide for major renovations to health facilities, as well as for planning and construction of new facilities". Regarding the long-term care facility discussed for Corner Brook, is the $300,000 that was referenced by yourself in your introduction, in here somewhere?

MS E. MARSHALL: Yes. It is in Professional Services, that $600,000. Officials will have to correct me if I am wrong, because this is from memory, but $300,000 is there for the Corner Brook long-term care ,facility. There is also $300,000 there for James Paton. In addition to that there is $940,000 budgeted for James Paton in the $2,040,000. It depends on the type of service.

MR. PARSONS: Under Professional Services, the $300,000 for long-term care in Corner Brook, what is going to be purchased by that $300,000?

MS E. MARSHALL: Actually, I have a list. I do not think I brought it, but it would be preliminary planning work. I do not know if Ms Hennessey can speak to that.

MS HENNESSEY: It is under capital.

MS E. MARSHALL: It is under capital.

MR. PARSONS: I understand, Minister, the design is actually done. Is the design done?

MS E. MARSHALL: The design? I was not aware that the design was done. Is the design done?

MS HENNESSEY: No.

MS E. MARSHALL: No, the design is not done.

The $300,000 will allow property investigations to confirm a site, a deposit on the land, geotechnical work, some preliminary design, and consultant fees.

MR. PARSONS: Thank you.

In regard to Western, the MRI situation, when is it anticipated that the MRI will be up and running?

MS E. MARSHALL: I checked during the later part of last week and I was informed that it would probably be sometime around December. The money has flowed to the Western Health Care Corporation. The cheque was sent out about a month and a half ago to them. At the present time, they are doing renovations to the gym. Because of the installation of the MRI, they had to move some staff, so they are doing renovations to move their staff out. They are expecting the MRI to be installed, I think, December month.

MS E. MARSHALL: I do not think there is anybody travelling business class. I sign most of the out of Province travel. Ms Fry has been delegated to review some of that, but all people, including myself, are required to take advantage of seat sales, and the only travel that is being undertaken is travel that is required. Every request for travel is scrutinized, looked at and discussed.

MR. PARSONS: Is there any set policy regarding any staff in the department using business class?

MS E. MARSHALL: The Deputy Minister has informed me that there is a policy, that if you travel beyond Toronto you are permitted to travel business class, but it is not the practice of the department to do it. Since I have been there as minister, I am certainly not aware of anybody travelling business class. I understand from Ms Fry that people do use upgrades. If people make personal arrangements that is up to themselves, but, no, it is not the policy of the department to pay for business class travel.

MR. PARSONS: Thank you.

I will turn it over to my colleague from Cartwright-L'Anse au Clair.

MS JONES: Thank you.

While we are under the heading 3.3.02, I will just continue there for the moment. You indicated that there was $300,000 budgeted here under Professional Services for James Paton, and also you referred to an earlier estimate in which I did not get the number. I am sorry, but you said there was another $200,000 budgeted?

MS E. MARSHALL: For James Paton, there is $300,000 budgeted under Professional Services, which is part of the $600,000. In the next dollar amount down, the $2,040,000, there is $940,000 budgeted for James Paton.

MS JONES: Just give me a minute now while I look that up; $2,040,000, I do not have that section. Could you tell me what section of the Estimates that is under again?

MS E. MARSHALL: I am sorry, it is on page 201. There is one activity there. If you go down to the third line, Professional Services, you will see the $600,000 there.

MS JONES: Yes, I see that one.

The other $200,000, where is that?

MS E. MARSHALL: It is the next one under that. It is the $2,040,000.

MS JONES: Okay, so there is $200,000 in that one?

MS E. MARSHALL: No. It is $940,000 for James Paton. There is also $800,000 there for Fogo Island.

MS JONES: What is going to be done at James Paton? I understood that the renovations were cancelled or deferred. I do not know, because there have been three different statements made on it and I am somewhat confused.

MS E. MARSHALL: I can give you a rundown of what has been budgeted for. As you are probably aware, this redevelopment has been ongoing for quite a number of years. I will just give you a rundown of the amounts. There are several items here: Fire rated windows, $185,000; $50,000 for the sprinkler system; consulting fees, $250,000; repair work, $120,000; the grossing station - I am not quite sure what that is - $20,000; $30,000 in work for the washrooms in emergency; furnishings and equipment to the total of $265,000; and there have been some specialty contracts that were awarded, I would think, under the previous contract and there is money budgeted to clue up those contracts; a total of $1.3 million.

MS JONES: When the Budget was announced, it was announced that renovations at James Paton Memorial would be deferred.

MS E. MARSHALL: Yes.

MS JONES: Okay. So this money that you are spending now is regular maintenance money?

MS E. MARSHALL: Yes. As I indicated, that redevelopment has been ongoing for a significant number of years, and this will effectively finish up the development, although not to the desired level as what the board would like to see. We are going to put this additional $1 million into it. Then, when we do our assessment of all of our health care facilities around the Province, we would take another look at James Paton to see if additional work needs to be done.

MS JONES: When you outlined to my colleague from Burgeo & LaPoile the $300,000 that would be used to start some geotechnical work and site preparations in Corner Brook for long-term care, did that $300,000 include the architectural design and blueprint work?

MS E. MARSHALL: No, it did not, but it included preliminary design work and not right through to (inaudible).

MS JONES: Is it your intention to do the architectural design and the blueprint work in this current budget?

MS E. MARSHALL: We have not been provided with the funding for that in the current fiscal year.

MS JONES: Under this section, as well, the Salaries decreased, I think, by $70,000. Was there someone laid off in this department or what position was lost?

MS E. MARSHALL: My staff have informed me that was salaries for staff in the Department of Works, Services and Transportation who were assigned to work on our capital projects, and that staff has since been reassigned to other departments. That is why there has been a reduction there.

MS JONES: The Grants and Subsidies have increased by $4,500,000. Can you tell me what those Grants and Subsidies are used for and why the increase this year?

MS E. MARSHALL: That is a global amount. It is for upgrading and renovating various health care facilities throughout the Province. It is repairs and renovations. I do not, at this time, have a list, as we have not decided yet what we are going to do with that funding. Is that correct, Ms Hennessey?

MS HENNESSEY: Yes.

MS E. MARSHALL: That $7.5 is a global amount.

MS JONES: Can we have a list of the renovation work that will be included under that subheading once it is prepared?

MS E. MARSHALL: As soon as we get it, yes. That would go through a departmental review process. Once that is done, yes, I can provide that to you.

MS JONES: Okay.

I have some general questions that I would like to get to now. One of them is with regard to ambulance services. In the Budget, you announced that there would be increased fees for road ambulance.

MS E. MARSHALL: Forty dollars.

MS JONES: How are those increased fees going to be collected?

MS E. MARSHALL: We would expect the ambulance operators to collect the additional $40. They already collect the other portion of the trip cost, so we would expect them to collect the $40. Effectively, that would come off the payments that are being made to the ambulance operators.

MS JONES: They normally collect the revenues?

MS E. MARSHALL: The initial $75. The original cost, or the previous cost, was $75, so the ambulance operators would collect that $75. Once we put through the increase of $40, then we would expect them to collect not only the $75 but the additional $40.

MS JONES: Some ambulance operators have expressed concern. They feel that, with the increased fee for ambulance services, less people will use the service and more people will speed on the highways to try and make the hospital in the quickest time possible, using their own vehicles. Is this a concern for you or do you believe that will be the case?

MS E. MARSHALL: If the ambulance operators have reached that conclusion or think that is what is going to happen, yes, that would be a concern for me. The issues have been raised. We are in preliminary negotiations now with the ambulance operators and my understanding is that they will be raising those issues at the table during negotiations, so we will be having discussions with them on that.

MS JONES: Ambulance operators who are under a grant system, because I understand there are three different pay services used for ambulance operators, but the ones under a fixed grant system have expressed concern that the increased fee will, no doubt, lower the number of clients or patients who they transport, making it a little bit more difficult for them to operate in the rural areas of the Province. Will that be given some special consideration during the negotiating process?

MS E. MARSHALL: As I indicated earlier, the agreement with the ambulance operators finish the end of March. Those issues relating to the fee increase and the concerns that they have, we indicated to them that they should raise those now during negotiations with the department. If that is a concern of the operators, then I would expect that they would raise that at the negotiating table when they are having discussions with officials.

MS JONES: How much new revenue do you expect to collect based on the road ambulance fees alone?

MS E. MARSHALL: About $1 million.

MS JONES: Extra this year?

MS E. MARSHALL: Yes.

MS JONES: Will that $1 million go to, I guess, increase ambulance services in the Province or to increase subsidies to ambulance operators?

MS E. MARSHALL: It will effectively decrease our expenditures for ambulance services. Having said that, over the past number of years the ambulance operators have received significant increases. Some of those increases have been put towards better training of staff and also better equipment. I do not have the numbers here now, but I think the program has probably tripled over the last number of years. It is a 125 per cent increase over the past five years. When we looked at increasing the fees, we also looked at what the fees were in other Atlantic Provinces. We are still the lowest of the four Atlantic Provinces, just marginally, but nonetheless it is the lowest rate in Atlantic Canada.

MS JONES: There is no intention, then, to put the new revenue back into additional subsidies for the ambulance operators?

MS E. MARSHALL: Effectively, we have, over the years.

MS JONES: The new money that we are going to generate.

MS E. MARSHALL: I think that will depend on negotiations for the upcoming year. To be honest and forthright, the funding that has been provided to the ambulance operators over the years has increased significantly. In 1997-1998 it was $5.3 million, and as of last year it had tripled over a six-year period.

MS JONES: The fee for air ambulance has increased as well. Can you tell me how much new revenue you will generate this year through air ambulance fees, what you are projecting?

MS E. MARSHALL: My Director of Financial Services indicates that he thinks it will be about $100,000, but I will have to confirm that amount.

MS JONES: I am sorry, what did you say?

MS E. MARSHALL: My Director of Financial Services has indicated approximately $100,000, so I would have to confirm that amount for you.

MS JONES: The air ambulance program now operates out of St. Anthony, I understand. I think that was all moved to St. Anthony a few years ago.

MS E. MARSHALL: There is one in St. Anthony and there is also one based out of St. John's . The one in St. Anthony operates under the jurisdiction of Grenfell and the one here operates under the jurisdiction of the Department of Transportation and Works.

MS JONES: Do you anticipate that will change, or will it stay the same?

MS E. MARSHALL: I do not anticipate that it will change at this point in time, although I can say that over the last fifteen years or so there has been quite a bit of discussion at different intervals, as to whether those two aircraft should be merged as some sort of common service. At this point in time we have not been looking at merging the services.

MS JONES: Can you tell me what the status of the Harbour Breton hospital is? The clinic.

MS E. MARSHALL: The Clinic? My understanding was that it was tendered last summer or last fall, but that the tender was cancelled. There is no money in the Budget for any work on that clinic for the current fiscal year. However, I have had discussions with the MHA for the area and at this point in time I did indicate to him that I would raise the issue with the CEO of the health care board in Cental West because that facility falls underneath that board. I did make that commitment to them.

MS JONES: I do not know for sure, but is there a clinic in Harbour Breton now? Was this replacing the clinic, or was it a new clinic?

MS E. MARSHALL: I am sorry, I was thinking you were talking about something that Mr. Langdon had raised with me. What clinic was it you were talking about?

MS JONES: I think it was Harbour Breton, was it, the one in Oliver's district. It is in Mr. Langdon's district.

MS E. MARSHALL: No, there is no funding provided for that in this year's Budget.

MS JONES: Was that the one that was tendered and then was cancelled?

MS E. MARSHALL: No.

MS JONES: There was nothing done on it, was there?

MS E. MARSHALL: This is something, Ms Jones, that happened before my arrival in the department, so I would like to turn it over to the officials to ensure that there is some continuity of what is being said.

MS HENNESSEY: About this time last year there was a public announcement by the previous government that there would be a new clinic in Bay d'Espoir, but there were no allocation monies in our budget at that point in time. In time, we were able to earmark some funding. There was a tender called and the tender was subsequently cancelled last November.

MS JONES: How much money was spent on that, do you know, on the design? Was there any money spent on it at all?

MS HENNESSEY: I do not know the amount.

MS JONES: The Grand Falls cancer clinic, what is the status of that? I thought it was cancelled, but I listened to the MHA for the Springdale area one day in the news, and after that I understood that it was only deferred and that it would probably go ahead in the next budget year.

MS E. MARSHALL: That project was cancelled. Having said that, there is a need for improved services out there for people who are receiving treatment for cancer. I have had some discussions with Mr. Keats, who is the CEO of the board and also the board Chair, that we would look at it again in the next fiscal year to determine where it is with regard to our priorities. The cancellation was because of financial reasons and not because there was no need for improved services out there.

MS JONES: You do not expect that you will be addressing that issue in this Budget year?

MS E. MARSHALL: I would not like to make a commitment one way or the other. I have raised it with Mr. Keats on the board, to ask him as to whether there are any alternatives or what other options there would be. I am having some discussions with him, but I would not be able to make a commitment one way or the other at this point in time.

MS JONES: A couple of questions with regards to Health Labrador. The preliminary study that was done indicated the need for more social workers in the Labrador board area. I realize that you announced the addition of three, was it, in the Budget? I cannot remember now.

MS E. MARSHALL: There is an annual commitment of $500,000 for new social workers.

MS JONES: Is all of that money coming from the provincial government?

MS E. MARSHALL: Yes.

MS JONES: It is?

MS E. MARSHALL: Yes.

MS JONES: It is my understanding that will create four new positions.

MS E. MARSHALL: No, we are expecting it to create six.

MS JONES: Six new positions?

MS E. MARSHALL: Yes.

MS JONES: I know the boards' budgets are not finalized at this stage, but is there consideration being given to increasing the Health Labrador board budget based on the fact that they are dealing with some really challenging issues within aboriginal communities, most of which are isolated, and that most of their expenditure is, I think, accumulated on the community health services side of their budget?

MS E. MARSHALL: Yes.

MS JONES: Is that being looked at and considered for further funding?

MS E. MARSHALL: We have not allocated the budget yet either for community services or for the hospital boards, the additional money for the social workers that will flow through Health Labrador, but whether there will be additional funding I would not be in a position to make a comment on that right now.

The other issue that we are addressing is with the federal government, and we have been having a number of discussions with the federal government requesting additional money to provide additional financial assistance to Health Labrador.

MS JONES: Health Canada is investing a significant amount of money in Labrador right now.

MS E. MARSHALL: Yes, that is correct.

MS JONES: Have you guys had any discussions with them on how you can kind of coordinate your service delivery for health care to some of these communities?

MS E. MARSHALL: Yes, we have had discussions with them. There are a number of people who have some role there. It would include Health Labrador, it would include the federal government, and also we have had some discussions with the Child Advocate. Ms Lynn Vivian-Book can probably provide some more information as to the discussions that we have had with the federal government. Lynn, you could probably speak to that.

MS. VIVIAN-BOOK: We are having ongoing meeting with both Indian and Northern Affairs, in particular with respect to the Child, Youth and Family Services side, and as well with Health Canada around the mental health addictions and additional pieces around that. We had planned a major meeting of all officials in Atlantic Canada with respect to the Innu communities. That was planned for April and that has to be postponed until June. What we are working on is bringing together all of the pieces, in terms of all the funding sources and all of those things, to coordinate that both in Labrador and in Atlantic.

MS JONES: With the establishment now of the Innu reserves, how will the health transfer money work? Right now, the health transfers are done through the Province for the Innu, or do they do it directly to the Innu Health Corporation?

MS VIVIAN-BOOK: A combination. For Child, Youth and Family Services there is a separate agreement with Indian and Northern Affairs, specifically, for other funding sources it comes directly through the Health Labrador Corporation, and then there is other federal funding for addictions and other pieces that comes through Health Canada, directly. There are commissions in those communities, as well as Health Labrador and Indian and Northern Affairs providing those services.

MS JONES: Once they come under reserve status, will they then be entirely serviced through Health Canada? What will be our role in providing health care then to the Innu reserves?

MS VIVIAN-BOOK: Some of the money, in addition to the other sources I mentioned, also goes directly to the Innu for services. Under reserve status, again there are different agreements for education. Different agreements on each will be devolved when the Innu are ready. They have requested that Child, Youth and Family Services be the first area of service to be devolved to the Innu, and that is what we are working on right now. With the Inuit in Labrador, there is a different set, in terms of the land claims negotiations and so on. It is a totally different scenario in terms of what services they wish to deliver and the timelines for that.

MS JONES: I am familiar with the Labrador Inuit one. Well, I would be, I guess, but I am not as familiar with how the transfers and how the service delivery will be done in the Innu reserves. I guess you guys are not all that clear about that either yet.

MS VIVIAN-BOOK: It is in progress.

MS E. MARSHALL: I have to admit that it is confusing and it is not straight line. We have had some discussions with the federal government on it, especially with regard to the services that we provide and whether we are being fully reimbursed for the services that we should be reimbursed for. It is an ongoing issue, but in my opinion we are underfunded by the federal government in that area.

MS JONES: The long-term care facility for Labrador, for Happy Valley-Goose Bay, has been an issue, not unlike other areas of the Province, I suppose. Is there any plan to deal with the situation in Goose Bay anytime in the near future?

MS E. MARSHALL: Not in this current year's Budget but, as I indicated earlier, we will be doing a long-term strategy for long-term care facilities in the Province. I visited that area and I agree that something needs to be done, but I visited quite a few areas in the Province and a lot of our facilities need to be significantly improved. What I would like to do is prioritize where we need facilities in the Province, and that would be one of the objectives of the long-term strategy that we are just moving into right now.

MS JONES: The funding for women's shelters comes under your department too, doesn't it?

MS E. MARSHALL: Some of it (inaudible).

MS JONES: Was the funding increased this year for the women's shelters component or just the women's centres.

MS E. MARSHALL: I do not think so. I can check it.

OFFICIAL: It is the same.

MS E. MARSHALL: It is the same.

MS JONES: So, there haven't been any funds made available for the women's centre in Hopedale, I think the request was?

MS E. MARSHALL: No.

MS JONES: I just want to get back to a couple of things in the Budget that I missed the first time around. I am just checking my notes here now, Minister, to make sure I didn't miss any very important questions I have here.

The primary health care projects, there is quite a bit about it in your Budget that you mentioned. Four point three million dollars, you say, is going to be spent again this year. Do you want to tell me how the primary health care projects work and if it is a service of delivery? How is it different from what we are seeing now in a lot of rural areas, for example, where they have small clinics and things like that?

MS E. MARSHALL: I will start off and then have one of the officials speak a little bit more on the details. There are seven primary health care projects throughout the Province. The boards, themselves, identified the area and came in with proposals. The total amount of funding that was allocated by the federal government was about $9.7 million. It flows over three years and, I believe, this is the second year of a three-year agreement.

MS JONES: I am sorry, I did not hear you. I did not hear what you said. How much did you say?

MS E. MARSHALL: It was $9.7 million in total from the federal government.

MS JONES: Over three years, you said?

MS E. MARSHALL: Over three years. The current year is the second year of that three years. I believe the amount that is budgeted this year is $4.3 million.

I am just going to turn it over to Ms Fry here. She can give you some more details on primary health care.

MS FRY: The primary health care renewal projects: this money that we have is one-time money from the federal government. It will be used by our primary health care office to help the seven regions, the first seven, do the consultations that they need to do to bring all of the service providers together to provide for a primary health care network in their area, which means increasing the types of service providers that work together in a community based system that provides first line primary health care services to a population. It includes more than physicians, it includes nurses, physio, all of the health care providers in a particular area.

There is a framework that has been agreed upon for all primary health care projects. Each of the seven have met the targets in terms of all of the accountability framework pieces that we have had to go through with them. There is funding for an additional seven as well this year. We are awaiting more projects to come in from the various boards around the Province. You are probably familiar with the first seven and where they are located. This is an incremental amount of spending and staffing that has been provided to the boards to get these projects up and running.

MS JONES: Have there been any discussions with the federal government about carrying on beyond the three years? What is the purpose of this? If the pilot project says that it is a good networking for medical professionals out there in the field and so on, are they going to carry on with the funding to make it permanent or will that be the responsibility of the Province?

MS FRY: It would be the responsibility of the Province, but primary health care renewal and primary health care networks are intended to provide a different way of delivering the service, so that within the existing envelope, provided that you do it in our primary health care model, we should be able to use this transition money once to create the new model and then we will see. For example, nurse practitioners, different skills, physicians, will work in groups. They will be able to have additional staff assist them. They will not, for example, have to do all of the community education blood pressure testing for persons with diabetes. A physician can be freed up to do other things that only they can do in their scope of practice.

It is a new model, a team-based collaborative approach to practice. Some of the studies, at least early on in Tabor, Alberta, have shown that the primary health care model has not only provided additional services within the existing funds, but has provided better quality of service to patients in that area.

MS JONES: When you talk about primary health care projects, it is just that, a service for the professionals. It isn't a new system created to replace any delivery of health care that is already out there existing through clinics, cottage hospitals or anything of that nature. Is that my understanding?

MS FRY: I guess so. It is a collaborative model of practice.

MS E. MARSHALL: Could you just repeat that question, just to make sure that we are on the same wavelength?

MS JONES: Primary health care projects, as I am understanding it, is established to provide a network of support for the medical personnel who are working within a respected region or area, and it is not intended to change, necessarily, the delivery of service that is being received through any particular location, such as a clinic or a cottage hospital. I guess what I am asking is: Is it a way of regionalizing health care delivery services in particular regions of the Province?

MS E. MARSHALL: It is reforming the delivery of health care. What it is in response to - I think the federal government is realizing that the health care system we have now is not sustainable and, in response to the Province's demand for additional money, it seems that they have a real interest in reforming the health care system, and it seems that this is where they are putting their money, into projects or areas which would encourage reform of the system. So, this would be a reforming of the system.

MS JONES: Within a particular region?

MS E. MARSHALL: Within a particular area, yes.

MS JONES: A couple of other questions on the Budget items. The increase in personal home care rates in the Province, how much do they receive now? What is the rate of pay? It is based on occupancy, is it?

MS E. MARSHALL: No, it is based on a per client basis and it is $1,112.70 a month. The rate increase, the additional funding that was provided in the Budget, is just for existing subsidies. It is not provided for expansion of the system. It translates into a rate increase of $25.40 per resident per month.

MS JONES: So there was no money there to add new residents and new subsidies.

MS E. MARSHALL: That is right, no new capacity.

MS JONES: How many personal care homes are in the Province right now? What is the number?

MS E. MARSHALL: Ninety-four.

MS JONES: You provided funding in your budget for a Chief Nurse position within the department. What would that person do?

MS E. MARSHALL: I mentioned this earlier, we have not formulated the position description for the Chief Nurse at this point in time, but I would see that the role of Chief Nurse would be having input into all issues that would affect nursing in the Province. That would include, I guess, anything from what is going on in the health care boards to public health issues to health and human resource planning. It would be a variety of issues.

We have had discussions both with the Nurse's Union, that is very supportive of the position, and also the Nurses Association.

MS JONES: Was there any money in this budget, for example, to convert more nursing positions from casual to permanent positions? Was there any money to, I guess, train more nurses at the School of Nursing, anything like that in the budget that we might have missed?

MS E. MARSHALL: There is no new money to convert casual nurses to permanent, but there was money in the budget for continuing on with training of nurses. Probably, Ms Fry, you could speak to the details. Would you have that information there?

There is funding in the budget to continue to train nurses. I do not have the information here but I can certainly get the information for you.

MS JONES: I am just wondering if there were new ones added, because I know there was a lobby from the nurses to add -

MS E. MARSHALL: I am just speaking from memory now, and it has been a couple of weeks since I looked at it, but there was a commitment, maybe, in the previous fiscal year to -

MS JONES: Last year there was.

MS E. MARSHALL: Yes, and I think that we have continued on with the funding and we may have increased the funding, but the details escape me at this point in time. I will get the information.

MS JONES: You can get the information for me, if you would?

MS E. MARSHALL: Yes. We were just discussing that there was a document. I can visualize it, but I cannot recall the numbers.

MS JONES: Okay.

A few other things from the budget. You announced the enhancement of the Mother Baby Nutritional Supplement. Is this just a carry over from the previous year's program or is that new?

MS E. MARSHALL: That would be in Human Resources and Employment. I think that is part of the financial assistance program in that department.

MS JONES: The Kids Eat Smart, is that in your department?

MS E. MARSHALL: That would be the Department of Education.

MS JONES: Okay.

Just a couple of other questions, I guess. In the blueprint that you guys outlined in the election, I have some questions with regard to some of the commitments that were made and the status of those commitments.

One of the things that you outlined was that you would employ more doctors and nurses in underserviced areas of the Province. I guess, I would have to ask you, Minister: With the recent situations that we have seen in the Province with the number of people being laid off and jobs being cut and so on, how do you think that this is going to affect the recruitment of more medical professionals, nurses and doctors in rural areas? I cannot see how the postponement of construction projects like we have discussed tonight is going to help expand services to rural areas of the Province. I do not know if you want to comment on that, because the commitment that I see you have made in the Blue Book is certainly not the actions I have seen in the Budget.

MS E. MARSHALL: I do not think that the actions you referred to are going to have a major impact on recruitment of doctors in the Province. We certainly have not seen it in the numbers that we have seen coming in. The number of physicians in the Province has increased. Speaking to physicians around the Province, and nurses and health care providers, there is a great deal of support for the reforms that were announced in the Budget. For example, location of services is a big attraction. Speaking to physicians and nurses, they are certainly supportive of that. I see that as being a major improvement to health care in the Province. I do not share the same concerns as yourself with regard to the cancellation and deferral of projects. Those projects that were cancelled or deferred were done so because of financial reasons, but still, as a government, we will be looking at where we do need those facilities in the future. I think we are embarking on a rationalization of the system, and speaking to physicians and nurses, there is support for that.

MS JONES: The Premier said earlier this year, actually it was this spring, when he was asked about bonuses being paid out, that they did not provide signing bonuses. This was not a hockey team, I think was the reference that he used. I am sure, Minister, you are aware, as I am, that there are signing bonuses paid out to nurses and other professionals in this Province when it comes to recruitment. Will you continue with that bonus or will that bonus be eliminated?

MS E. MARSHALL: We have no plans to eliminate those bonuses that you are referring to.

MS JONES: Also, in your blueprint you made a commitment to limit the waiting time for diagnostic and treatment procedures to meet standards deemed to be acceptable by the physicians themselves. You know, as I do, that currently we have longer wait lists in the Province today then we have had for some time.

I would like to know what actions you are taking, not just with regard to the recent circumstances of a backlog during the strike, but what is you long-term plan to deal with the waiting times for diagnostic treatment and procedures? You obviously thought it was a problem or you would not have outlined it as part of your platform.

MS E. MARSHALL: Yes. The major initiative would be location of services. That would include, not just services from physicians and nurses and other health care providers, but would also look at where our facilities should be located and where our equipment should be located. I would see that as the main thrust to address that issue that you just raised.

MS JONES: I can assume that you are undertaking a review of that now, to find out where additional diagnostic services and treatment equipment needs to be placed in the Province?

MS E. MARSHALL: Yes, that will all be looked at under location of services, yes.

MS JONES: You also talked about having an integrated personal wellness, physical education and physical activity, I guess, program as a broader part of health promotion and disease prevention. You committed to that. Is there a program being designed by your department now? Is there anything in the works on that?

MS E. MARSHALL: Yes. There were a number of initiatives in the budget and I think this is what you are alluding to. There is $250,000 for a program for a Healthy Children-Healthy Schools initiative, there is $250,000 for the Tobacco Control Program, $150,000 for regional wellness activities, and also $50,000 for teen wellness.

MS JONES: That is for all new programs and new money, or is that a carry-over of existing -

MS E. MARSHALL: The $250,000 for Healthy Children-Healthy Schools, that is a new initiative.

MS JONES: All of the others would be carry-over of existing programs?

MS E. MARSHALL: Yes.

MS VIVIAN-BOOK: The Teen Tobacco Team is focusing broadly now on wellness, but the supports for that program were in last year's budget, as well, carried forward.

MS JONES: You also outlined, in your blueprint during the election, that you would set up a professionally staffed crisis support service for individuals experiencing acute physiological distress. Has this crisis support service been set up? How much is being budgeted for it, if it is, and if it is not, when are you intending to establish it?

MS E. MARSHALL: There is nothing set up as of today, but there was $1 million in new funding provided in the Budget for mental health services. We are currently working on how, exactly, that money will be spent.

MS JONES: Some of that money will definitely go to the professionally staffed crisis support service?

MS E. MARSHALL: At this point in time, we have not made a definitive conclusion, but there was the short stay unit at the Waterford Hospital which recently opened, probably within the last month or so, and that has facilities for - is it about ten over there?

OFFICIAL: Six.

MS E. MARSHALL: About six beds over at the Waterford Hospital.

MS JONES: You also committed to establish a health quality council.

MS E. MARSHALL: Yes.

MS JONES: What would be the purpose of a health quality council? What would their job be?

MS E. MARSHALL: That would be to be aware of what is happening around the Province and ensure that the programs that are being provided by the Department of Health and it's boards meet certain standards. The council has not been established yet, but I have had numerous discussions with Mr. Wiseman with regard to the establish of the council.

MS JONES: What will be the cost of this council?

MS E. MARSHALL: We have not put an estimate on it as of yet.

MS JONES: You are saying they would be responsible to look at how government delivers and services people with regards to health care and the boards?

MS E. MARSHALL: That is correct.

MS JONES: Is that something that has been requested by the public?

MS E. MARSHALL: I have had, I would say, three or four people who have mentioned it to me, that it is something that exists in other jurisdictions.

MS JONES: The other one was an internet based health and wellness information network.

MS E. MARSHALL: Yes.

MS JONES: Has that been established?

MS E. MARSHALL: No.

MS JONES: Is it in the process of being established?

MS E. MARSHALL: That has not been established this year.

MS JONES: Is there money budgeted to do it this year?

MS E. MARSHALL: No, there is no money budgeted this year.

I am going to turn it back to my colleague for Burgeo & LaPoile, and I will let you know, Mr. Chairman, if I have any further questions (inaudible).

CHAIR: I was just going to say, this is interesting. I guess it is all in a sense of where we are going . Do you want to conclude your comments now, and that way we can move on to your colleague and he can wrap it up? Do you want to do that?

MS JONES: I would just like to have a couple of minutes to go through my notes, as I have a lot of then here, just to ensure that I have covered all the main pieces that I wanted to cover. While I am doing that, my colleague can clue up his comments, if that is acceptable?

CHAIR: (Inaudible)

MR. PARSONS: Just a few wrap up questions, Minister. On page 199 of the Estimates, under Community Services, for clarification, if you might, on the issue of Provincial Revenues. From what was budgeted in 2003-2004, $1,050,000, it went down to $300,000 actually under revised, and you have $300,000 in there again this year. Could you explain what revenue source this is, actually, and why we have gone from $1 million down to $300,000? That is on page 199, subhead 3.1.01, under the Provincial Revenue.

MS E. MARSHALL: My Director of Finance informs me that the difference between the $1,050,000 and the $300,000 relates to a budget item of $750,000, which is a special child welfare allowance that is no longer received by the department. It actually ends up in the health care boards. The $300,000 relates to revenue for gambling addictions.

MR. PARSONS: That $300,000 comes from where? The Department of Finance gives it?

MS E. MARSHALL: The operators.

MR. PARSONS: The operators pay it directly. It goes into the Department of Health?

MS E. MARSHALL: It does, yes.

MR. PARSONS: The $700,000 that we are talking about, where did it come from? It says provincial sources. You are telling me now that it does not come into the Department of Health anymore it goes into the boards, but where is the revenue generated from?

MS E. MARSHALL: From the federal government. That is the special child welfare allowance.

MR. PARSONS: Okay.

Under 3.2.01, on page 200, under the federal revenue there, it looks like they have increased by some $1.7 million. What is the rationale?

MS E. MARSHALL: Most of the funding there is relating to the primary health care centres that we were transition funding, that we were speaking about earlier. I said that it was $9.7 million over three years, and this is the middle year, so we get $4.3 million this year. So that $4.3 is in the $5,101,900. The amount that was received last year was a lesser amount.

MR. PARSONS: If we go back up for a second to item 10 under that heading, it shows Grants and Subsidies $945 million for hospital services, delivery of hospital and nursing home services in the Province. That probably, I guess, is the single biggest expenditure in your whole department.

MS E. MARSHALL: Yes.

MR. PARSONS: Is there a readily accessible chart showing how that $945 million is broken down among the different boards in the Province?

MS E. MARSHALL: No, not for this year. This is the budget allocation that I spoke about earlier that we are currently working on.

MR. PARSONS: So, that is how much we have this year to go to all of the boards and nursing homes?

MS E. MARSHALL: The institutional boards and the community boards are on the previous page.

MR. PARSONS: Yes, but you have not broken that figure out amongst them. You just know what the global figure is that you have to spend.

MS E. MARSHALL: What generally happens is, the amount is voted globally and then after the Budget gets approved the department goes through and breaks down the budget by health care board. That is the process that has been followed for many years. In some years that allocation is not finalized until well into the fiscal year.

MR. PARSONS: I guess that makes it fairly difficult for the boards, then? They have no idea either what their-

MS E. MARSHALL: Yes, and I made that comment quite often when I was Auditor General, because some years the amounts were not allocated until well into the fiscal year.

MR. PARSONS: If boards start of their fiscal year, April 1, not knowing - they have some idea of what their needs are and they do their budgets, but they have no idea, from looking at a global figure, what you are going to give them, and if they find come October that they have a shortfall, what do you see as being -

MS E. MARSHALL: The solution is to get it finalized before October or November. This is something that we are actively working on now, that those numbers should be finalized as early in the fiscal year as possible, so that the boards can get their financial information and know what they have for the current fiscal year so they can budget appropriately, et cetera.

MR. PARSONS: Under the 3.2.01 heading, let's go back down there for a second. It shows the provincial revenues increased by over $1 million. What is the cause of that? It is page 200, 3.2.01, under the revenue section, 02. The Province has gone from $10,800,000 to $11,912,200.

MS E. MARSHALL: I have the breakdown of the $11.9 million, but what you are asking for is an explanation as to why it went from $10.8 million to $11.9 million. I would need to get the Estimate notes from last year in order to do the comparison. I can tell you that in the $11.9 million, recoveries from third parties is $400,000, revenue from the vehicle levy system which replaces the third party liability program is almost $5.8 million, recoveries from other provinces for reciprocal billing is about $5.3 million, and then there is a federal government funded initiative for primary care to the tune of almost $400,000. Those would be individual items that are budgeted for this year, and in order to find out why it differs from last year I would need to go back and look at last years notes to the Estimates. I would have to get that information to you.

MR. PARSONS: My final question under 3.3.01: We had a Furnishings and Equipment expenditure last year of $25.4 million to this year being $4.5 million. What is happening here?

MS E. MARSHALL: The $4.5 million is as result of budgetary restraint. The money that was budgeted in previous years was funded 100 per cent by the federal government, and all of that money has been drawn down, so that in the current fiscal year there is no federal funding left . You can see in 2003-2004 the budget was for $26 million but the feds were going to contribute $25.5 million to it. There was three years worth of funding there.

MR. PARSONS: Why would be have a Furnishing and Equipment heading? Is says, "Appropriations provide for the purchase of furnishings and equipment for health facilities and community services." Why would we have a separate heading here of $4.5 million for this purpose and it is not already included under the $9.45 million that we give? I assume we just give them the money and they decide what property and furnishings they buy.

MS E. MARSHALL: What is up above is current. It would be regular operating costs. Then, what is down in the next account is capital, so that would be items such as hospital equipment and things of that nature.

MR. PARSONS: There is going to be, apparently, a major meeting this coming summer with the Prime Minster and the First Ministers concerning health care in the country. How does the process work, if there is an agreement by the federal government that there will be more money coming into health care? You have your budgets done now, you know what you budgeted for and what you are going to spend. If there is an infusion of extra money from the federal government, do you look at it just then and say, okay, what other priorities did we have we would like to deal with?

MS E. MARSHALL: Yes.

MR. PARSONS: Or do you go back and reconsider some of the things that -

MS E. MARSHALL: It depends on what the funding is provided for. If they provide for capital, then of course we would go back and look at our capital needs. If it was for operating we would go back and look at our operating needs. If there was an infusion of money, you know several millions of dollars, the most likely way it would be approached is, there would be a Supplementary Supply Bill brought into the House of Assembly that would indicate what the money would be used for.

MR. PARSONS: What difference does it make to the federal government whether they tell the Province whether you apply it to capital or to operating? You would think if they had the money they would give it to you and the Province would know its priorities best.

MS E. MARSHALL: The federal government, they themselves - well I do not know if they themselves - but they do have a big say in how the money will be spent, and that is what we are seeing now in different reform areas. In my opinion they are deciding where the money should be spent based on how they think health care should be proceeding in the country. They are great supporters of reforming the health care system, so that is why we see a lot of significant money going into health care reform, like the primary health care centres. I think what they are doing is, they themselves recognize that the system that currently exists in Canada, in all of the provinces, is not sustainable, and there is a lot of pressure coming from the provinces to provide additional money. I think the federal government sees that the only solution to making health care work in this country is to reform the system. That seems to me where they are putting their dollars at this present time, encouraging the provinces to reform the existing system.

MR. PARSONS: Minister, I just want to say thank you to you and your staff. You have given very detailed, comprehensive and informative answers. I look forward to receiving the information that we requested. They say knowledge is a dangerous thing sometimes but is certainly helps to clarify situations. We appreciate the contributions of yourself and your staff.

MS E. MARSHALL: Thank you.

CHAIR: Thank you.

There will be no other questions.

MS JONES: I just want to make a closing comment.

CHAIR: By all means.

MS JONES: Thank you, Mr. Chairman.

I just want to thank you, Minister, and your officials, for being here this evening and taking the time that we needed and thought was necessary to go through the Estimates.

MS E. MARSHALL: You are more than welcome.

MS JONES: I only ask that the information you have agreed to present to us be done so as soon as you possibly can, realizing that it will take a little bit of time to collect that information.

MS E. MARSHALL: Yes.

MS JONES: We certainly do appreciate that.

MS E. MARSHALL: You are more than welcome.

Should that information be provided to the members of the Committee through yourself, or do I provide it directly.

CHAIR: Provide to the clerks they will provide it to the members.

On that note then, I will ask the Clerk to call the subheads.

CLERK (Ms Murphy): Subheads 1.1.01 to 3.3.02 inclusive.

CHAIR: Shall subheads 1.1.01 to 3.3.02 carry?

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, subheads 1.1.01 through 3.3.02 carried.

CHAIR: Shall the total carry?

AN HON. MEMBER: Aye.

CHAIR: Shall I report the Department of Health and Community Services carried without amendment?

AN HON. MEMBER: Aye.

On motion, Department of Health and Community Services, total heads, carried.

CHAIR: With that, Minister, I want to, on behalf of the entire Committee, thank you and your staff for the insight you have provided in being able to respond to all of the questions. Thank you for taking the additional time and for the patience that you have had. Obviously, in a very short period of time you have gotten a good handle on the department. We thank you for the insight.

MS E. MARSHALL: Thank you.

CHAIR: To the Clerk, thank you for your patience and late night. To the staff who are recording this, thank you for your tolerance and strained ears in listening to what we have been saying.

I want to remind the Committee that we meet again tomorrow here in the Legislature to deal with the Justice Estimates at 9:00 a.m. Thank you, all, and we will see you in the morning. Thank you to the Minister and staff.

We need a motion to adjourn.

MR. PARSONS: So moved.

CHAIR: So moved.

Seconded?

MR. FRENCH: Seconded.

On motion of Mr. Parsons, seconded by Mr. French, the Committee adjourned at 11:21 p.m.