Thank you, Mr. Minister. Do you want to respond to Mr. Nerysoo's comments? Proceed.

Thank you, Mr. Chairman. I share Mr. Nerysoo's concern. Our department is basically the patsy on this non-insured services issue. I have a terrible feeling that at times, we are getting between the federal government and the understandably irate patients, and boards. It is true that the federal government is putting the squeeze on us, and I believe it is happening in other parts in the country, off-loading and reducing these important non-insured services. We are the provider of those services, therefore, we get blamed when we have to either inform people that we cannot afford to pay the services, because we are not going to be funded by the Government of Canada, or when we go to the Financial Management Board, and say we are incurring over-expenditures, because we did not get reimbursed adequately by the Government of Canada for services we deliver in the region. I have a strategy that I am proposing to develop with aboriginal organizations in the Northwest Territories, and at the national level, to deal with this problem. Recently, with the help of the Keewatin Regional Health Board we have tackled the issue of dental services, which is also an issue of dental services in the whole Northwest Territories. It is going to be a difficult battle at the bureaucratic level, and I am not optimistic that we will achieve the kind of breakthroughs that we want in restoring services to the previous level. I think it is critical that there be a territorial/political strategy developed with aboriginal organizations from the Northwest Territories. I have talked to some organizations already about convening a meeting before the end of this calendar year to develop this strategy. Also, it is important that there be a national/political strategy. I have had the opportunity to discuss that matter with Ovide Mercredi, and Rosemarie Kuptana. They agreed, along with the Premier, that we also have to take this battle to the highest levels of decision-making in the country, and it may well have to be discussed at the First Ministers' Conference as a major

emerging issue which really affects aboriginal rights. Thank you.

Thank you. Are there any general comments? Mr. Koe.

Thank you, Mr. Chairman. I am also concerned, as all of us are, about the increasing health care costs. I have mentioned on more than one occasion, regarding the costs that are in dispute with the federal government, and the impact it will have on our bottom line. I am not satisfied that accurate numbers are being used. I have never been given proper estimates. It is my opinion that no one really knows what the actual costs are. It is a legal case now, and hopefully it will be resolved soon.

I am also very concerned about the potential off-loading on various coverage for aboriginal people, and I have always been concerned that we do not have equivalent coverage for Metis people. The issue has been raised many times in this Assembly, I am not sure what stage that it is in, and I am not sure it is in this budget. I somehow doubt it.

I have also looked at the terms and conditions of the Health Transfer Agreement when this government took responsibility for health transfers. One area of concern, is the provisions in the agreement for a new hospital in the Inuvik region. The Minister and I have had discussions on it during his visit to Inuvik, and I think there is room for new planning and incorporation of a lot of the ideas that were brought up with the board, and other organizations. Decisions have to be made very quickly as to how, and when, planning and start up for a new hospital begins. I know it is a capital item, but there is much impact on the O and M, and the planning of the department involved in this. Those are just some of the areas of concern that I have, I think they are broad, and I will leave it at that. Thank you.

Thank you. Mr. Minister.

Thank you, Mr. Chairman. To Mr. Koe, about his question regarding what is in the budget for Metis health benefits. There is $200,000 in the current budget, to do the enumeration of the Metis. This is a critical requirement, before we look at enhanced health benefits, and we are going to do that in cooperation with the Metis Nation. That is under way in the current fiscal year.

I just want to say on the non-insured, I have noted Mr. Nerysoo's advice about the need to have negotiators who may be independent from the process.

As far as planning for health care needs in the Inuvik region, I did have good discussions with the board and executive recently about their desire to make this a priority. We are hoping we can get the first phase under way, as early as January. This would be the needs assessment, the profile of the region, health status, what the wishes of the people are for health services, and it is clearly a priority of the board, and I will be working with them in that connection.

Mr. Chairman, I should not ignore Mr. Nerysoo's critical comments about the process for appointment for the board chair. Let us say that I have learned something from this experience. I have had an opportunity to work with the Gwich'in Tribal Council, and the I.R.C. while in Inuvik, and encouraged them to become involved in the restructuring of the Inuvik board, which is being considered. I hope that I will have their input, and cooperation in developing a new, and more effective board. It seems that we are pointing towards a strong executive committee mechanism. I hope their concerns about involvement, and representation, can at least be addressed as we look at restructuring the board.

Thank you. General comments? Mr. Ningark.

Thank you, Mr. Chairman. I am sure the Minister is aware of the important role played in our communities, by the community health representative, as I indicated early this morning. Mr. Chairman, it is well trained individuals who work very, very hard to provide community health education, deliver family counselling, and support, carry out inspections, consult with the various health professions. They are a very important part of the health care team in almost every community across the territories.

Yet, the salary paid to these talented, and hard working individuals is clearly, as indicated earlier, inadequate. Mr. Chairman, we should be encouraging aboriginal people to pursue careers in the health field, not discouraging them with salaries that are unrealistically low.

I want to ask the Minister of Health to assure me that he will carry out an immediate review of the salary framework available to community health representatives, and make sure that compensation, Mr. Chairman, reflects the role which they play in the communities. To me, they are very important people. Thank you.

Thank you. Mr. Minister.

Mr. Chairman, yes, I will undertake that review, and I certainly do agree with the Member that the C.H.R.s are vital in delivery of health services at the community level. I agree with everything the Member said about that. If you are not adequately recognizing that in the classification that is presently in place, then I would certainly be willing to examine and review that. Thank you.

Thank you. General comments, Mr. Arngna'naaq.

Thank you, Mr. Chairman. In the remarks that the Minister just made a little while ago, in his talk about the area of the Keewatin Dental Clinic, I understood him to say that the dental clinic is inferior, or is not of the same level of service as it was previously. I would like to know if, in fact, this is what he was saying. Thank you, Mr. Chairman.

Thank you. Mr. Minister.

Mr. Chairman, I would like to clarify my comments. The excellent services offered by the Kiquti Clinic probably are comparable to the previous level of service. There are some pluses with this new approach, in that, it is locally based and locally owned.

No, the problem, Mr. Chairman, is that the federal government is not providing the same level of funding that was provided when the service was delivered through the University of Manitoba. The Keewatin Health Board has put together an excellent service which is based on the previous funding levels, but we are not getting the money from the federal government.

It is not a shortfall of services, it is a shortfall of funds that is the problem. Thank you.

Thank you. General comments. Mr. Nerysoo.

Mr. Chairman, if I could maybe make a couple more comments. I do not want to take up too much time, but at the same time, I do want to raise a couple of concerns. Mr. Chairman, for those who do not know, the certified nursing assistants, I believe that is what they are called, seem to be in a situation where they are being, what you might say, removed from the delivery of health services in the Northwest Territories.

Now, it concerns me in that this is one area where northern residents can get into the medical field. In fact, we developed a program, here in the Northwest Territories, where northern residents were trained in that particular program. Now, I am hearing, and have had discussions on a number of occasions with individuals who are finding themselves in a position where they are being squeezed out of hospitals across the Northwest Territories, and not being a part of the delivery of health services.

Now, I do not know how the Minister is going to deal with this situation, but surely, there is a continuing role for C.N.A.s in the Northwest Territories. Maybe the Department of Health has to clarify, in its own policy, in its own direction what role that position is to play. Right now, it seems that we are not considering the expertise of those individuals. I think that is not helpful to the delivery of health services, particularly since most of the C.N.A.s are people who have been born and raised in the Northwest Territories, or at least, have a very good understanding of the people and the environment that they live in. I am concerned about that particular matter.

Thank you. Mr. Minister

Mr. Chairman, the department certainly supports the important role of the certified nursing assistants and we are happy to have been involved in the development of this program. These people are critical in hospital and senior citizens homes. I want to see the program linked with our professional nurse training programs so that, as we have done with classroom assistants in the past, we can build on these people to train them as nurses, so they can eventually replace the nurses that we largely import from the south.

Mr. Chairman, I believe the Member may be referring to the issue that has arisen in Stanton Yellowknife Hospital, and to my knowledge, that is the only place, right now, where we have a problem, where C.N.A.s are feeling that they are not being appreciated, shall we say.

I have received an expression of concern on the part of the Status of Women about that issue, and I am concerned. I want to tell the Member that I am working to resolve that issue with the Stanton Yellowknife Hospital board, I am hoping that it can be worked out. I am concerned about it, and I will take his advice that perhaps the policies of the department could be looked at with a view to ensure the appropriate role for these certified nursing assistants. Thank you.

Thank you. Mr. Nerysoo.

Thank you, Mr. Chairman. I just want to raise a couple of other concerns. Mr. Chairman, if the Minister might somehow try to address the matter of communication between the community health centres, the regional hospital boards, and then from there to Yellowknife, or whatever institution patients are being sent to, where expert advice is being sought on medical situations for a patient. Maybe I could clarify that for you.

There are many individuals in the communities who are expressing concern that they do not really know their situation after they have been diagnosed. The doctor says, yes, we are going to send you for an operation in Yellowknife. That is the end of it. People in the communities do not know when they are supposed to go, if appointments have been made, they have no idea that those things are being done. For instance, the most recent incident, and I will talk more specifically to the Minister about, was an individual who thought they had resolved a discussion in April of this year, was asked two days ago, by the nurse, what did the doctor tell you? She said, has the doctor contacted you? I always make the assumption that it is going to be the nurse that would contact the patient, and the doctor. If that is not the case, then I think we are in deep trouble because that is not fair to the patient. I would ask the Minister to somehow work this matter out. We talked about this particular issue last week in Inuvik about communication. It is not simply a matter of the communication between the board, and the departmental staff. It is communication with the patients, and the services that they are supposed to be receiving. I have recently received a concern where a patient was supposed to receive a specialized biopsy, in fact, it is a muscle biopsy. The University of Winnipeg has a list and it will be two years before they can even be considered. It seems to me that people do not know what they should be doing. It only came to my attention, and I thought it was interesting that this issue was raised this past April, the last communication from Winnipeg to them was a couple of days ago. Now that is really unfair to the patient. Particularly, since the patient is a young child and has no way to contact anyone the parents are supposed to do that. I raised this point, not to suggest that it is impossible to resolve the problem, but I wanted people here to understand that we have to improve communication with our patients. Our local health centres have to be as much responsible for that communication, as the deputy minister, or for that matter, the regional administrator. You cannot always rely on those two people, or the staff at headquarters, and in the region, to be solely responsible for communication. Those people have to assume some responsibility for that, as well. I just wanted to point that out to you.

Thank you. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, I think the Member's concern about communication between the health system and patients is very well taken. I believe it was a fundamental problem, for example, that was revealed during the abortion services' review, but the Assembly will see some very helpful recommendations in dealing with that problem. What is being suggested, which I endorse, is that one thing we have to do is provide a means of what I would call cultural sensitivity training to our physicians. This will be necessary, as long as we employ physicians who are not indigenous or northern people. We are now actively looking at ways in which we can build this cultural sensitivity into physicians, and health professionals' practices. We may even, possibly, consider ways of tying it into the licensing process, itself. I also agree with the honourable Member that communication problems with southern physicians is, perhaps, even worse. I recently heard a story about a fellow from Pelly Bay, who was asked to come back in two weeks, by an Edmonton doctor, to have his stitches taken out. This doctor had no idea how far away Pelly Bay was, or that there was a local health centre, which was quite capable of removing stitches without the necessity of such a big trip. We are also going to try to address the communication problems with southern physicians. One way of addressing that is to try and deliver as many services as we can in the Northwest Territories, and we have had some success in this direction already. At the local level, there are also problems. This is where the C.H.R.s are critical, and I will say to the honourable Member,

that I see a role for C.N.A.s, at least in some of the larger health centres, we may pilot some use of C.N.A.s, and I think they will improve the communication problems the Member is describing. Thank you.

Thank you. General comments? Mr. Arngna'naaq.

Thank you, Mr. Chairman. I just wanted to get further clarification on the question I was asking, in saying that the funding has been reduced, or has been cut by the federal government. I would like to know, is that the case for any other possible creation by private sectors of dental services in the Northwest Territories? That the federal government will reduce their funding if this was to happen in other cases? Thank you, Mr. Chairman.