Thank you, Mr. Speaker. Normally, the Premier advises the House as to ministerial travel, who is away and where they are. I would like to direct this question to the Government House Leader. I would like to find out where our Premier is.

Mr. Speaker, I have a report from the Special Committee on Health and Social Services. This is the third interim report of the Special Committee on Health and Social Services. During the two months since our last report, we have concentrated our efforts on gathering information. We held our first regional consultation, spending a week listening to peoples' concerns and suggestions in the Keewatin. We have started our major research project with the front line worker telephone survey now under way. This report outlines our activities and summarizes the issues raised with us by the people of the Keewatin. The last section includes recommendations which are based on what we have heard.

Our activities thus far, Mr. Speaker, include the front line worker survey, and telephone calls to workers across the N.W.T. which are now being made as we survey staff in front line roles in social services, alcohol and drug projects and community health. In this first round of interviews we are focusing our questions on workers' needs and job stresses as well as their perceptions of community issues. Committee Members spent the week of November 9 to 13, 1992, meeting with people in the Keewatin. The Members visited three communities, one in each constituency as selected by the local M.L.A. A great deal of planning went into ensuring that we offered a variety of opportunities for people to talk with us. Public and private meetings were arranged and two popular education workshops were organized.

We began the week in Rankin Inlet on Monday with meetings with both the health board and the Chamber of Commerce. On Tuesday three Members participated in an all day consultation with the elders' committee. Two others sat in on the first day of our regional workshop on alcohol issues involving representatives from the alcohol and drug programs in communities which were not on our itinerary. That evening we held a well attended public meeting, where we heard presentations from both individuals and community groups.

Mr. Speaker, on Wednesday I flew to Baker Lake and Fred Koe and John Ningark went to Repulse Bay. Co-Chair Richard Nerysoo and Ludy Pudluk stayed behind in Rankin Inlet to continue with the alcohol workshop and to meet with the Keewatin Regional Council. On Thursday, those in Rankin Inlet hosted a youth workshop, wrapping up their meetings on Friday with staff from the health centre and the Department of Social Services.

In Repulse Bay meetings were held with the social assistance committee, the health committees, health centre staff, the community education council, the hamlet council and senior students from Tusarvik School. On Thursday night over 36 people took time away from celebrating the success of the Nunavut ratification vote and, braving the room's stifling heat, shared their concerns and ideas at our public meeting.

In Baker Lake, meetings were held with the health committee, the inter-agency group and with local elders. On Thursday night a public meeting was held in conjunction with the local M.L.A. Over 100 people attended. On Friday morning I participated in the opening ceremonies of a regional youth conference.

Mr. Speaker, throughout our trip to the Keewatin we heard from a broad cross section of people: consumers, service providers, politicians and others. They all freely shared their concerns and ideas about their needs and various aspects of the delivery of health and social services. Some took advantage of the presence of M.L.A.s to speak on other issues as well. People spoke of the need for political leaders to be positive role models. Others wanted assurance that M.L.A.s would take action on the concerns raised by the public.

Mr. Speaker, I quote a front line worker, "We are hoping that the work of your committee does not end up with the rest of the work we have done, somewhere in the recommendations, which are ignored or put on the back burner indefinitely." Mr. Speaker, this section provides an overview of what we heard. We have organized the input, where possible, according to the target group that they primarily apply to: elders; children and youth; alcohol and drug abuse.

In almost every workshop and public meeting held in the Keewatin we were told of the importance of elders in the communities. As a link to the past, elders represent the heart and sole of the culture. They are looked upon with great respect and can be a great resource to others in their communities. Elders and others reminded us about the contribution they can make by passing on their traditional skills to young people. Some saw elders as a part of community efforts to help families and young people in crises. Interested elders could work with trained counsellors, each learning skills from the other. Such collaboration would make the help offered more relevant and effective to those in need of healing. Speakers expressed concern that not enough is done for elders. An example given was there are not enough volunteers to assist elders with daily tasks, such as shopping, snow shovelling or filling in government forms. People also spoke of the difficulties elders have in getting around their communities. Some suggested the need for home care services to help elders live independently as long as possible.

Many people expressed anxiety over the lack of residential facilities for the elderly in the region. The lack of interpreters and distance from families and friends led to communication and isolation problems for elders sent outside the region for treatment. These difficulties added weight to the call for the development of appropriate health care facilities within the region so that elders could be treated more effectively and closer to home. Mr. Speaker, I quote the Mayor of Rankin Inlet, Paul Kaludjak, "We would like our elders to remain in our community. Sometimes they require professional help that the family cannot provide. This creates family separation, unnecessary loneliness and confusion, as a result of moving away for care. This situation does not show respect to the elders and is very pitiful and unnecessary."

Mr. Speaker, people also raised the issue of the need for more timely medical intervention. Some speakers told us of sick elders being sent home from the nursing station with an incorrect diagnosis. When a correct diagnosis was later made, often it was too late for a full recovery. Elders complained of not being given preventative medical attention. Many elders also talked about the enormous burden of trying to care for themselves on the pensions which they receive. Due to high local costs of food and other goods they described their frustration at being unable to care for dependent adult children or to feed visiting grandchildren. With little money and no longer being able to hunt, they told us how difficult it is to provide for themselves let alone other family members in need.

The next section, Mr. Speaker, has to do with children and youth. Through their discussions, committee Members also discovered the importance placed on children and youth throughout the region. While the elders hold the wisdom of the past, the children and youth represent the promise of the future. Unfortunately, many speakers saw the future holding very little promise for many young people. They expressed grave concerns about the difficult issues which confront young people on a daily basis. A number of speakers identified the lack of jobs in their community as being a major obstacle to the healthy development of young people. Without the possibility of employment they noted that there is little incentive for young people to stay in school. Without a complete education which encompasses areas such as family violence, mental health, nutrition, sexual education, substance abuse and traditional lifestyles, young people see little hope of avoiding a life on social assistance.

Many observers felt that the connection between elders and youth must be strengthened. This must be done not only to ensure that traditions and language survive, but also to help young people to see options other than alcohol and solvent abuse and suicide. Speakers also saw a role for elders to help communities respond appropriately and effectively to young people breaking the law. Participants recommended increasing the resources being put into prevention initiatives such as sex education, including birth control and sexually transmitted diseases, such as H.I.V. or A.I.D.S.

With regard to education about sniffing and alcohol abuse the importance of education and increasing the variety of extra curricular activities was stressed. One speaker expressed her opposition to the fact that abortions and tubal ligations are free but the reversal of tubal ligation for a woman who wanted to have a baby would cost over $4,000.

At our youth workshop held in Rankin Inlet we heard from young people that they were bored. They say the lack of interesting activities and facilities are a contributing factor in many of their problems. With little hope of employment and nothing outside of school to keep them occupied, some youths talked about the difficulty of staying away from drugs and alcohol.

There was also a great deal of discussion on the issue of family violence and child abuse. The young speakers were concerned about the impact on the children and youth of today as well as the possible long-term ramifications for the entire community if treatment is not available now for victims. There were calls from some participants that family violence and child abuse must be brought into the open if the problem is to be dealt with properly.

Mr. Speaker, I quote Martha Grey, who appeared in front of us in Baker Lake. She said, "Let us talk about it now. Let us not be shy anymore. It will work out better if we talk about it now. It can be a very heavy project so let us start opening up." Again, there was talk of the need for proper facilities and programs for the region. For example, the available family violence shelter beds are not enough to meet the current demands. People also expressed concern over the lack of counselling available for men who are violent.

Mr. Speaker, the next section of our report deals with what we heard regarding alcohol and drugs. On the theme of alcohol and drugs, the speaker felt that political leaders should be positive role models. They felt that there should be increased regional and community involvement in planning and delivering programs. A number of people describe sniffing or solvent abuse as a problem in their communities.

There was a general call by participants at our regional addictions workshop that Inuit treatment models and a regional treatment centre must be developed. Together, these steps were seen as an important step in improving the effectiveness of treatment for people in the Keewatin.

Currently, all treatment beds are outside the region. A regional centre would enable clients to get help much closer to home cutting travel costs and facilitating after care.

Workshop participants were concerned about the lack of resources. They emphasized the need for more money to improve programs and wages. They called for the better utilization of resources and for providing increased personal and professional support for care givers.

The next section of our report deals with what we heard regarding social assistance. Throughout the Keewatin we heard concerns related to the various aspects of the Social Assistance Program. Many recipients described the great difficulties of trying to survive on the limited amount money that they received. All called for increased social assistance rates. Recipients shared their feelings of low self-confidence and self-worth. Many talked about the hopelessness of getting off the system.

There were comments made about the need to provide money for hunting expenses and not to take away people's earnings from carving or sewing. Speakers told us that clothing allowances were not enough to buy adequate winter clothing, others expressed confusion over social assistance payment options including supplier written cheques and priced monthly payments. The need for more flexibility and recovering costs associated with people's special needs was often raised.

Mr. Speaker, we heard a lot about care givers' concerns. Front line workers shared openly the challenges they experience as they serve their clients. In combination they add up to a reduced capacity to help at a time of increased demand. Many workers talked about their frustration at the lack of communication between themselves and staff from other agencies, departments or with their own senior management. They shared with us the stress that they experience due to the amount and kind of demand that their jobs entailed. They spoke of the personal toll that working in this area takes on them. They asked for more support and training to reduce burnout and high staff turnover. They spoke of being unable to respond to clients' needs because of lack of money or time or because of policy limitations. Many talked about feeling chronically short staffed. When co-workers leave their vacant positions are often unfilled for long periods of time. This adds to the already gruelling work load for those who remain. Such vacancies lead to demands on the remaining pool of front line workers to deal with situations which are completely outside their mandate and training.

One example involves nursing station staff being called out to respond to a domestic situation involving alcohol because there were no R.C.M.P. officers stationed in the community and the by-law officer only worked days. As members of the public start to deal with personal issues such as family violence, addictions and or sexual abuse, they look for help to heal. This results in an increased demand which, in combination with the overload faced by front line workers, negatively affects the quality of service received. Speakers specifically called for nurses' benefits to be improved and for more good housing in order to provide incentive for nurses to stay longer. Some suggested the creation of pharmaceutical technician and clerical administration physicians to free up more nursing hours for the benefit of patients. People also wanted more social services workers.

Mr. Speaker, the special committee also heard from a number of people who called for the development of the comprehensive child care system. They told us that making a day care or other child care services available in the community would have many benefits. It would create child care jobs and enable single parents to either continue their education or seek employment. The availability of organized child care would also lesson the burden on family members, such as elders and teenagers, currently pressed into servicing that role. We heard that many young women missed a considerable amount of school babysitting younger siblings.

Keewatin residents said that they wanted to see more education and prevention programs. People felt that most problems could be reduced or prevented through community based and developed prevention programs. In health some said that this could be accomplished by letting C.H.R.s concentrate on the prevention work they are trained for or by hiring full-time public health nurses.

As mentioned earlier, we were told that prevention should be more of a priority in responding to many different social issues. Many services already have some element of prevention. Taking children into foster care at least temporarily prevents further harm coming to them at home. A crises line volunteer listening to a suicidal person could help them choose life. What people wanted was more help available to people before they were in a major crisis. They wanted people to be able to find help sooner rather than later.

One example centred around the issue of family violence. People spoke passionately about the need for counselling for all family members, victims and offenders. To rid families and communities of this painful and costly problem means working with everyone effectively. Offenders need to learn non-violent ways of dealing with their feelings and explore how they learned to be violent. Women and children need support as they try to heal from their pain. Everyone needs to heal.

Respite care was also presented as a preventative service. People caring for family members with special needs asked for occasional breaks from those responsibilities. They wanted a free morning to buy groceries or a weekend off now and then. Such breaks would enable them to continue to provide care and prevent the need to place the family member in an institution.

Improving the quality and number of housing units was also seen as a preventative measure, reducing the stresses of overcrowding or eliminating the health risks associated with such conditions.

Mr. Speaker, we have a number of recommendations from our trip to the Keewatin region. The things the people of Keewatin told us they wanted were the basics. They said that they needed to warmly clothe and house their loved ones, to keep themselves and their families and to provide some support and care for those with special needs. They wanted jobs or some help in carrying on with their carving or hunting. What follows are the recommendations that emerged from what people shared with us. As we reviewed our notes, meeting transcripts and the written presentation submitted, certain compelling issues emerged. Some of these are reflected below in the recommendations. As this was our first regional confrontation, we will wait for more information from our research or from our later consultations before drafting recommendations on other issues.

First of all, we must talk and work together. We heard many different and sometimes conflicting views as to how people's needs could best be met. This is not particularly surprising given the cross-section of people we met with, each with his own perspective on what was wrong and how it could be fixed. It points to the need for widespread participation in stating their personal and community needs, brainstorming solutions and determining local priorities. Such a process will be the key to coming up with a shared vision and plan from the more scattered views held now. This participation must be more than consultation, more than asking for people's input while hanging on tightly to the power to make the final decisions. The process must be a collaborative one if it is truly to live up to our northern tradition of seeking consensus. In particular, specific steps must be taken to ensure that the people with the most at stake, those who consume and deliver the services, are invited to be active participants throughout the process. To best understand needs and consider how best to address them, needs the pooled expertise of such a partnership. The long-term impact of any intervention requires it.

People who use health and social services and those who work in those services must be active partners with the public and politicians in planning, delivering and evaluating such services. They must, therefore, be partners in the process of transferring control of services to communities.

The second recommendation concerns the amalgamation of health and social services. Mr. Speaker, often when we met with staff from either of these two departments, someone would ask us for information about the upcoming merger of the two departments. The staff look to us for answers. They had heard nothing official from anyone to counteract the rumours or to allay their fears of what might happen to them, their clients or their co-workers. Coupled with the ongoing stresses involved in working with people, the resulting uncertainty contributes to staff burnout and turnover. This is something all of us pay for, especially those who are most vulnerable, the clients.

Those people in charge of this process do not appear to be sharing this information with anyone, in spite of their own rhetoric. Reshaping northern government says that the implementation plan includes consulting with, and I quote, "affected staff on page 5." Based on what we heard in the Keewatin, this has not yet happened, nor has there been any announcement of how or when it might. All of this is rather frightening, given that the implementation timetable calls for amalgamation effective April 1, 1993.

Mr. Speaker, the department staff have valuable ideas on how things can be improved. Their insight comes from their daily experiences with the current system, seeing first hand what works and what does not. Many have shared those ideas with Members of our committee. They told us about being both optimistic and fearful of the amalgamation. Fear was expressed that one department would take over the other or that the move would not necessarily result in cooperation among various programs. On the other hand, they were optimistic about the prospect of being able to offer more holistic services to consumers, ones that help them meet more of their health and social needs.

The government projects that amalgamation will result in, "improved coordination and efficiency in responding to the user-driven needs." Their expectations of this departmental union are very high, yet they have not even started to talk to the people who will be the ones making it work. How can a government hope that this rushed arranged marriage will succeed with the wedding day fast approaching, when neither partner has yet been introduced to the other.

The government is also silent on how it is going to determine user or consumer needs. In outlining its approach to this task of reshaping government, it does not specifically list consumers of services among those to be consulted. Despite this apparent oversight it still sees an amalgamated department better serving the needs of consumers. How it plans to do this successfully without talking to either staff or consumers is, quite frankly, a puzzle.

The special committee, therefore, recommends that the government start working together with health and social services staff and clients to hear and make use of their respective ideas in any integration or amalgamation of the two departments. Mr. Speaker, Mr. Nerysoo will conclude this report.