Mr. Kakfwi.

Item 5, oral questions. Mr. Lewis.

Thank you, Mr. Speaker. My question is to the Minister of Justice and it has to do with wood cutting. I would like to thank the Minister for a detailed answer to a written question, but the written answer raises more questions, Mr. Speaker. The Minister's response indicates that ten retail clients in Yellowknife bought 500 cords of wood during this fiscal year. How do you determine whether someone who gets wood in Hay River, in fact, is a retailer just simply because he buys the wood there?

Mr. Kakfwi.

The question has been taken as notice. Item 5, oral questions. Mrs. Marie-Jewell.

Mr. Speaker, I have a question for the Minister of Justice. Mr. Speaker, I do not know whether the Minister of Justice is aware in respect to Mr. DuPerron taking leave without pay for educational purposes from this government, that apparently he quite quickly accepted additional full-time employment with the Government of Alberta. Mr. Speaker, it is my understanding that he commenced work with the Alberta Health department on January 4, 1993, on an 18 month term position and his office is located somewhere on the 13th floor of a Jasper Avenue building. He is attempting to work in the human resource services division, completing a human resource strategic plan and the establishment of a work force information network. These are projects which, as the Minister knows, have never been fully addressed in our own correctional system. Recognizing that the Government of the Northwest Territories has had to endure a certain amount of inconveniences, I believe, to support Mr. DuPerron's request for educational leave, can the Minister explain how he is working full-time for the Government of Alberta and on a leave without pay status with the Government of the Northwest Territories? Thank you.

Mr. Kakfwi.

Item 5, oral questions. Supplementary, Mrs. Marie-Jewell.

Mr. Speaker, normally if a Minister gives leave without pay they try to find out for what purpose before they support it. However, I would like to ask the Minister since he is not aware of the full situation, would he review this particular issue so he can provide a full report to the Members before the end of the current session? Thank you.

Mr. Kakfwi.

Item 5, oral questions. Mr. Lewis.

A new question on the same subject, Mr. Speaker. It is about wood cutting. I would like to ask the Minister of Justice since there is two prices for the sale of wood out of the correctional centre in Hay River, could he indicate whether the second price, the $55 per cord which senior citizens have to pay, applies also to senior citizens outside of Hay River? In other words, can senior citizens in Yellowknife buy cord wood in Hay River at $55 a cord?

Mr. Kakfwi.

The question has been taken as notice. Item 5, oral questions. Item 6, written questions. Item 7, returns to written questions. Item 8, replies to opening address. Item 9, petitions. Item 10, reports of standing and special committees. Mr. Koe.

Mahsi, Mr. Speaker. Mr. Speaker, I would like to present a report from the Standing Committee on Agencies, Boards and Commissions. This is the final report on the health and hospital boards in the Northwest Territories.

The Standing Committee on Agencies, Boards and Commissions has completed its review of health and hospital boards in the Northwest Territories. The standing committee held public hearings in Fort Smith on January 22, 1992, and organized a day of consultation session in Yellowknife with representatives of health and hospital boards on November 21, 1992. In addition, the committee has met on several occasions over the 14 month review period to consider written submissions and research material.

Based on this review, the Standing Committee on Agencies, Boards and Commissions finds that there are serious grounds for concern with respect to constraints faced by health and hospital boards in the Northwest Territories. This has the potential to negatively affect the administration of health facilities, programs and services.

Since the transfer of health responsibilities from federal to territorial authority in 1988 many northerners have held the expectation that health services would be operated, managed and controlled by regionally-based health and hospital boards. This has been accepted as an approach that would allow decisions regarding the regional administration and delivery of health services to be made by the people who are mostly affected by them.

The Standing Committee on Agencies, Boards and Commissions is concerned that this well reasoned approach is not working as it should. There is a disconcerting level of confusion about the roles which should be played by the Department of Health and by health and hospital boards. The standing committee also found that the degree of centralized control presented exercised over the boards by the department is in many cases excessive. This, in the committee's view, has led to counter productive conflict and strain within the health system.

An interim report, Committee Report No. 9-12(3), was tabled in the 12th Legislative Assembly on December 10, 1992, and indicated that "a serious state of affairs presently exists within the administration of the territorial health care system." Although there has been some initial progress toward the development of agreements defining respective roles for the department and the boards, the standing committee has found little evidence to suggest that the "seriousness" of this situation has lessen appreciably.

Clearly, some direction action needs to be taken to clarify and redefine the respective roles of the department and the boards. It is the standing committee's position that the Legislative Assembly could provide badly needed direction to this process by formally acknowledging that the boards are the primary agents for the management and delivery of health services to regions and communities across the Northwest Territories. The role of the Department of Health should more properly be one of supporting rather than directing the management decisions of health and hospital boards.

As noted in the interim report, a process is now under way to establish a "master memorandum of understanding" aimed at clarifying issues of authority and accountability. The Standing Committee on Agencies, Boards and Commissions applauds this initiative and takes the position that it should be considered a high priority for the Minister of Health and the boards. At the same time, however, the standing committee recognizes that changes in legislation and in the prevailing attitude which has been observed to exist within the Department of Health will also be required if existing problems are to be resolved.

Generally, the final report emphasizes that within a system in place that relies on "boards of management," it is important for the Department of Health to stand back and allow them to manage, providing technical assistance and support as required. This will necessitate a sense of trust and collaboration on the part of all health stakeholders that appeared to have been largely lacking to date.

A change in outlook will be necessary if the parties are ever going to be able to address the significant barriers which were observed by the standing committee to hinder effective administration within our current health system.

The Standing Committee on Agencies, Boards and Commissions was deeply concerned, for instance, with the apparent absence of territorial planning and direction with which to guide health expenditures and services. Although all health and hospital boards are presently engaged in planning initiatives to some extent, the standing committee observed that these currently occur in isolation. The committee noted that it is essential to develop better mechanisms for channelling boards' planning initiatives into headquarters where they can be coordinated within a larger territorial framework. However, needs assessment and strategy development cannot be centrally imposed. Health planning must be a regionally driven process.

The Standing Committee on Agencies, Boards and Commissions notes that there seems to have been much discussion about the balance between health board autonomy and fiscal accountability. The committee takes the position that increased board autonomy and internal accountability controls are not mutually exclusive. Indeed, the standing committee was rather impressed with the commitment that health and hospital boards have demonstrated to improving financial procedures and expertise over the years since the health transfer.

Clearly, the well-documented deficiencies which presently exist within computerized accounting and statistical systems, the amount of time board personnel have to spend dealing with information demands from officials in Yellowknife, and the inadequate funding base inherited from health transfer have been very real barriers to fiscal management by the boards. Also of concern to the standing committee was the current lack of incentive provided to the boards for appropriate administration. Accordingly, the Standing Committee on Agencies, Boards and Commissions is proposing that a new policy should be put in place to allow health and hospital boards to use budget surpluses to support specific projects aimed at improving health conditions or awareness in their regions.

The standing committee believes, as well, that there needs to be a renewed emphasis on human resource development within the health and hospital boards. Some specific concerns about boards' records of aboriginal hiring, staff training and interpreter/translator services were specifically considered during the committee's review.

By far the greatest area of concern regarding human resources, however, was the very unacceptable level of orientation and training that has been offered to trustees who sit on health and hospital boards. The Standing Committee on Agencies, Boards and Commissions was dismayed to observe that funding levels for boards training, departmental support and available information materials were all clearly inadequate. The standing committee believes that, to ensure that appropriate priority is accorded to board orientation in the future, specific statutory responsibilities in this regard should be established in legislation.

Members of the standing committee also felt that certain barriers exist with respect to the ability of boards to have effective input in the establishment of health policy and priorities. Additional mechanisms must be developed to enable health boards, as well as community, regional and aboriginal organizations to provide input to senior decision-making levels within our health system. Effort also needs to be directed toward a joint strategy for dealing with the erosion of non-insured health services. For these reasons, the Standing Committee on Agencies, Boards and Commissions proposes the development of a territorial health advisory committee.

The Standing Committee on Agencies, Boards and Commissions spent considerable time, as well, examining various models of the structure and organization of health and hospital boards. In this respect, the standing committee believes that the wide demographic diversity and range of health needs which exist between regions should be recognized by allowing each board to define the structure which best meets the needs of the people who live within that region or catchment area. The standing committee is also of the opinion that a priority should be placed on studying the potential election of health and hospital board trustees.

The Standing Committee on Agencies, Boards and Commissions was dismayed to note the delay which has existed with respect to appointments made to health and hospital boards. Appointments have not been regularly made and boards have had to cope with lengthy periods of membership vacancy. A more expedient and consistent approach to board appointment is necessary.

While many of the concerns which were observed with respect to health and hospital boards are complex and deeply rooted in the history of the territorial health system, the standing committee is of the opinion that solutions can be found. Members of the standing committee agree with a board representative's comments that, "placing blame is a waste of time and energy", and realize that now is the time to move forward toward new partnerships and effective health management.

---Applause

The Standing Committee on Agencies, Boards and Commissions wishes to acknowledge the thoughtful input received from all witnesses during the public hearings and consultation sessions. The committee would thank both the current and previous Ministers of Health for information and suggestions they have provided over the course of the review.

Mr. Speaker, the following recommendations are included in the standing committee's final report on health and hospital boards:

Recommendation No. 1

That the Legislative Assembly formally support that boards of management established under the Territorial Hospital Insurance Services Act are the primary agents for the management and delivery of health services to regions and communities of the Northwest Territories; and further, that the role of the Department of Health should be one of supporting, rather than directing, the management decisions of health and hospital boards.

Recommendation No. 2

That the Minister of Health should accord a high priority to the finalization of the memorandum of understanding clarifying the roles and responsibilities of health and hospital boards.

Recommendation No. 3

That the Minister of Health should seek advice from health and hospital boards across the Northwest Territories with respect to the amendments that should be made at this time to the Territorial Hospital Insurance Services Act or other statutes to ensure that health legislation reflects a philosophy supporting regional autonomy; and further, that the Minister of Health bring forward recommended amendments to the Act by the fall session in 1993.

Recommendation No. 4

That all requests from the Department of Health to health and hospital boards for budgetary, statistical and other administrative information should be made only by the deputy minister of Health; and further, that information requests should be limited in number and scope to only those which are essential for the efficient and effective operation of territorial health services; and further, that the time frame for board response to departmental information requests should be reasonable and established with due consideration to other priorities which have been identified at the regional level.

Recommendation No. 5

That the Minister of Health consult with the health and hospital boards to develop policies and strategies which allow surplus retention under circumstances in which boards clearly demonstrate appropriate fiscal management.

Recommendation No. 6

That the Minister prepare amendments to the Territorial Hospital Insurance Services Act to establish a requirement that orientation and ongoing training be provided to members of each board of management established under subsection 10.(1); and further, that the content of mandatory training should be established by regulations developed through consultation with health and hospital boards; and further, that the Minister bring the necessary proposed amendments and draft regulations before the Legislative Assembly by the fall session in 1993.

Recommendation No. 7

That the Minister of Health establish a territorial health advisory committee comprised of representatives from aboriginal organizations and the chairpersons of each regional board and hospital board in the Northwest Territories.

Recommendation No. 8

That each health and hospital board should be allowed to define its own structural framework, including the maximum number of members and system of community and aboriginal representation.

Recommendation No. 9

That the Minister of Health ensure that health and hospital boards remain fully constituted by filling membership vacancies through the timely appointments of members.

Recommendation No. 10

That, in accordance with rule 94(4), the Executive Council table a comprehensive response within 120 days of the presentation of this report to the House.

Mr. Speaker, that concludes the final report of the Standing Committee on Agencies, Boards and Commissions.

Motion To Move Committee Report 14-12(3) To Committee Of The Whole

Therefore, I move, seconded by the honourable Member for Yellowknife Centre that the final report of the Standing Committee on Agencies, Boards and Commissions on health and hospital boards in the Northwest Territories be received by the Assembly and moved into committee of the whole for consideration. Mahsi.

---Applause

The motion is in order. To the motion.

Question.

Question has been called. All those in favour? All those opposed? Motion is carried.

---Carried

Committee Report 14-12(3) will be put into committee of the whole today. Item 10, reports of standing and special committees. Item 11, reports on the review of bills. Item 12, tabling of documents. Mr. Todd.

Thank you, Mr. Speaker. I wish to table Tabled Document 94-12(3), the Department of Safety and Public Services details of revenue items.