Thank you. On interim observations, Mr. Speaker, a very serious stage of affairs presently exists within the administration of the territorial health care system. The Standing Committee on Agencies, Boards and Commissions, throughout the course of its review, has found disconcerting evidence with respect to the status of boards of management created under the Territorial Hospital Insurance Services Act for the purpose of operating health care facilities across the Northwest Territories. When responsibilities for health were transferred to the Government of the Northwest Territories in 1988, the decision was made to establish a system of health and hospital boards rather than centralizing authority for administrative affairs in Yellowknife.
The goal was to ensure that communities and regions would be able to take responsibility for the administration and delivery of the health care services required by their residents. After approximately four years, there are strong signals that the entire scheme is not unfolding as it should. There is a real risk that, unless significant adjustments are made in the prevailing approach used by the Department of Health, the development of a community based foundation for the administration of health care services may be headed for failure.
The Members of the Standing Committee on Agencies, Boards and Commissions were dismayed by the degree to which conflict between the health board and the Department of Health is exerting itself on our health care delivery system. When one regional health board chairperson was asked by the committee to identify the biggest stumbling block to meeting the health care needs of her region, she responded clearly and simply, "the Department of Health."
The specific problems are numerous and will be fully elaborated upon when the standing committee brings forward its comprehensive report at a later point during the third session. At the base of each of the concerns however, the standing committee recognises two common factors. One is the role of confusion and overly centralized control. Undoubtedly, there is a debilitating lack of definition surrounding the roles that should be played by the Minister, the department and the health and hospital boards. The Commissioner's agreement respecting the management of the retransfer of health services and even the Territorial Hospital Insurance Services Act are being interpreted differently by the boards and the department. This is leading to frustration and conflict -- I do not know why the microphone went off. This is leading to frustration and conflict and quite likely considerable inefficiency within the health care system. This becomes quickly apparent with respect to the strain which surrounds administrative functions at the board level.
The board sees itself as a board of management which should be allowed by the department to manage. Yet, almost without exception, the board representatives who appeared in January and in November repeated instances when they had felt plagued by demands for financial information, inconstant direction on the budget, administration and procedures imposed by headquarters. Clearly the Standing Committee on Agencies, Boards and Commissions does not wish to overlook the importance of monitoring and accountability. It seems as though for the Northwest Territories Department of Health these concepts are too frequently seen as an attempt to excuse over-zealous and misplaced commitment to central financial and administrative control.
The outstanding question is, who is really in charge of health care in my region? The board of the department's hospital and health facility division seems to impose itself on any effort to coordinate health care services or policies. That reflects the headquarters' attitude, which seems to assume that health or hospital boards will automatically fail to meet statutory financial management or operational criteria unless there is direct involvement of departmental officials. It engenders an attitude of suspicion and resentment among people who serve the board as appointed members or staff.
