Thank you, Mr. Chairman. This is an overview of health and hospital board issues in the Northwest Territories.

The Standing Committee on Agencies, Boards and Commissions wishes to express its dissatisfaction with respect to a very serious state of affairs which presently exists within the administration of the territorial health care system.

In an earlier report on health and hospital boards in the Northwest Territories, the standing committee commented as follows:

"When responsibility for health was 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.

"Members of the Standing Committee on Agencies, Boards and Commissions were dismayed by the degree to which conflict between the health boards 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 Standing Committee on Agencies, Boards and Commission has noted that, although some preliminary steps have been taken to define respective responsibility, concerns about the status and role of health and hospital boards have continued to characterize the territorial health systems in the interim report tabled two months ago. Perhaps to expect otherwise would have been, unfortunately, unrealistic. The specific problems are too numerous and too rooted in a history of poor communication and inter-organizational mistrust to allow an easy solution.

The Standing Committee on Agencies, Boards and Commissions was dismayed by the amount of evidence it received describing relations between the boards and the Department of Health as strained and unproductive. A number of very specific areas of dissatisfaction appears to arise from the interaction between boards and the Department of Health. To a large degree, however, each of these reflected two common factors: role confusion and overly centralized control.

Some of the information that has been brought to the attention of the Standing Committee on Agencies, Boards and

Commissions over the course of its review has been particularly illustrative.

For instance, at the November 21 consultation session in Yellowknife, a representative from the Baffin regional health board noted as follows:

"Between 1982 and 1988, the Baffin regional health board made sound progress, and only after the total health transfer in 1988 was there more centralization. This eroded the board's ability to have greater flexibility in resolving regional issues.

"Health boards are a common factor in managing hospitals everywhere in the world, but this has not always been appreciated by the department in the NWT, who are not aware that this is not a new process."

At the same meeting, a representative from the Inuvik regional health board offered the following view of relations between the Department of Health and the boards:

"I think the boards really are trying to do their best, but somehow, for some reason, we do not seem to be able to get our needs identified by the Department of Health. I really believe that. This is not a Department of Health bashing either. I believe that the people in Yellowknife do a great amount of very good work, but I think what they do not understand is that they have never lived out in the satellite communities. They do not know what it is like, nor do they understand that my needs in the western Arctic are very much different than the Baffin's needs or Keewatin's needs."

A written submission received from the Keewatin regional health board in June, 1992, summarized the problem in the following terms:

"There has been, and there continues to be, confusion on the part of the Department of Health regarding the role of health boards as an integral part of the delivery of health care services to the people of the Northwest Territories.

"This confusion on the part of the Department of Health official often leads them to intrude on the operating mandate of the health board.

"The partnership in the delivery of health care services is, for the most part, weakened when there is a continual conflict between the partners.

"In order for the health care system to fulfil its mandate to the people of the Northwest Territories, there must be the clear definition of the roles of the partners in the overall delivery of health care."

Board representatives, no doubt, have a vested interest in presenting a particular "side" of the story. However, similar objective evidence of systemic problems was found in the October, 1991 report of the Auditor General of Canada on his Comprehensive Audit of the Department of Health:

"The specific issue is the rivalry, sometimes bordering on animosity, between boards and the department. There appears to be a lack of trust, a one-way paper flow, poor communication and inappropriate control by the department. In our view, what should have been help and monitoring has turned into control. Monitoring is desirable and expected, but it needs proper information and performance system to provide the right kind of data. These have not been developed." Clearly, there are strong indications to the Standing on Agencies, Boards and Commissions that serious problems exist within the organization of the territorial health system, particularly with respect to the role confusion and control conflicts which surround the function of health and hospital boards. Thank you, Mr. Chairman.