Health Committee on May 11th, 2010

[Leslie MacLean]

There's no question that some parts of some provinces are very difficult for us to recruit to, simply because they're difficult for the hospital across the street from our institution. For example, if we were running a competition in the prairies, we might well get people who apply who are very willing to relocate to one of our big cities. We have institutions in Edmonton, we have institutions in Saskatoon, and one just outside Winnipeg. But getting someone to go a little bit north can be quite a challenge for us. So, yes, that is always a risk for us, that people will see the ad and assume that's next door, that's Edmonton, and they'll apply. But we may be looking for them to go to Grande Cache. You're right, that is a challenge for us in terms of workforce mobility and trying to attract people to some of our more remote sites.

[Megan Leslie, NDP, Halifax, NS]

Where are the locations with the most difficult retention rates?

[Leslie MacLean]

For nurses, we have two sites in the prairies and one in Quebec where we've had difficulty in recruiting and retaining staff: Grande Cache in Alberta, Prince Albert in Saskatchewan, and Port-Cartier, which I mentioned a bit earlier. Those sites have been more difficult, certainly for nurses and for other health staff as well.

[Megan Leslie, NDP, Halifax, NS]

Okay. The numbers you gave us...for example, in psychology there is a 20% vacancy. Is that pretty static? Does it always have that composition, or does it change over time? Has it changed over time?

[Leslie MacLean]

In the last couple of years, where we've been tracking it quite closely, we've seen improvement in some regions and deterioration in some regions. It's also important to point out that if you have a small workforce.... We have a smaller number of institutions and inmates in Atlantic Canada, so losing one psychologist or one nurse in Atlantic Canada has a disproportionate effect, of course, for that region.

A year ago, we would have been having recruitment and retention issues for psychologists and nurses in the Pacific region. Our managers there are really to be congratulated. They've really put an enormous amount of effort into recruiting in the last year and have made substantial improvements in vacancy rates for both.

[Megan Leslie, NDP, Halifax, NS]

If I have time left....

[The Chair, Conservative, Joy Smith]

Quickly.

[Megan Leslie, NDP, Halifax, NS]

A quick question for Ms. Scott. If I understand this correctly, in your reimbursement program you would reimburse supplemental health services per provincial social assistance. That says to me that the people you represent are receiving different standards of health care per province. For example, in Nova Scotia, they may not get mental health treatment, but in Ontario they may. Am I correct in interpreting it that way?

[Dr. Lise Scott]

We are trying to align as much as possible to the services offered by the provinces. I wouldn't put it exactly the way you're putting it, though, because the provinces are relatively aligned between themselves too. You wouldn't have a situation where in one province you would receive mental health services and in another you wouldn't. Everybody would receive mental health services.

[The Chair, Conservative, Joy Smith]

Thank you.

Now we'll go to Mrs. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thanks very much, Madam Chair.

And thanks very much to our presenters this morning.

I just want to go to Ms. Scott. We'll just continue along the line that Ms. Leslie has started there. I was interested as well when you said that you offer services similar to what's offered on the provincial social assistance. You said that you try to align them as closely as possible with that. What are the differences? I know there are some differences in what provinces provide. Can you outline what the differences are as they affect your programs?

[Dr. Lise Scott]

I wouldn't know the differences offhand. If you wish to have that, I would have to do an analysis and provide it to the committee.

[The Chair, Conservative, Joy Smith]

If you could do that, Ms. Scott, and if you could submit it to the clerk, we'll see that it's distributed to everybody.

[Dr. Lise Scott]

Okay.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Ms. Scott, are you aware that the differences have caused challenges for your organization?

[Dr. Lise Scott]

I'm not aware that differences in our payments have created challenges for our clients. What I'm aware of is that our clients, as well as other clients, have challenges receiving services and having access to services if they are in an area where there are challenges for other recipients. They are submitted to the same types of challenges as the general population in getting access to care.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

You said in your opening remarks that you recognize the importance of the fee schedules and that you try to align those fee schedules as much as possible to the provincial schedules. How closely are they aligned? Are they more than the provincial fee schedules in most cases?

[Dr. Lise Scott]

In most cases, we try to align exactly to the provincial fee schedules. In some cases, we do pay more and in some cases we pay less. It depends on the service. We can provide that in the analysis that we will be providing to you.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Okay. Thank you.

So you're not the actual provider of care in any instance. Is that correct?

[Dr. Lise Scott]

That's correct.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

But you do have a third-party claims administrator, and your role then is to maintain oversight of that claims administrator's activities.

[Dr. Lise Scott]

Yes.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

How do you do that?

[Dr. Lise Scott]

At this point, I should also say that we have a new contract with a new claims administrator and that we are in a period of transition between the old claims administrator and the new one, who will be starting next January.

We do the oversight through the requirements that we had when we issued our request for proposal for the contract. We asked the provider to provide us with information monthly on the payments they make. We also audit our claims administrator and we reconcile all of the financial aspects of the contract. So we have a series of requirements for the claims administrator that we oversee on a monthly basis.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

So you have the contract with the claims administrator. Is the claims administrator the group that's responsible for finding the health care professional, or are you responsible for finding them?