Yes, thank you, Mr. Chairman. Departmental involvement was described by some board representatives as attempting to exert a controlling or delaying influence.

There was also concern over the observation that there is no system which channels the results of the excellent planning exercises which are taking place at the regional level into an overall framework for the delivery of health services in the Northwest Territories. Regional planning exercises often seem to be regarded by Yellowknife headquarters as "competing" with the overall approach which the department wishes to follow, yet that departmental framework has not been articulated.

The standing committee was concerned that this absence of direction has created a barrier to administrative effectiveness throughout the system. Without a well developed vision for health care delivery and health promotion, it has been difficult to coordinate such aspects as capital planning, program goal setting and community participation.

Further, the absence of a planning framework in this area worsens the role confusion which predominates the territorial health system and risks inefficiency through the duplication of services. This was pointed out by the Kitikmeot regional health board in the written submission provided to the standing committee in February, 1993:

"The KHB would add that the lack of territorial vision has also led to role confusion between hospital boards, health boards and the department -- hospitals appear to be expanding outside of the provision of acute care services, into continuing community care. This area is now serviced by health boards. We question if it is cost efficient and effective to duplicate community care expertise that currently exists in health boards and the department. Such duplication further compromises the department's ability to allocate scarce resources."

In addition, the lack of health planning has been an impediment to the appropriate allocation of human resources throughout the Northwest Territories. This was highlighted in the Auditor General's report:

"Getting the right kind of health care people to the places where they are needed across the territories is a major challenge requiring effective resource planning. All the parties and the people should know exactly what they can expect. From our survey results and press reports, we noted there was confusion about health care delivery in the regions, and residents are not sure what to expect.

When the Standing Committee on Agencies, Boards and Commissions took all this evidence into account, it found that a clear need exists for a comprehensive, easily understood territorial plan for the delivery of health services.

Planning Must Be Regionally Driven

At the same time, the standing committee wishes to emphasize that territorial planning must be based on the unique needs and priorities which exist within the regions. These are best identified by the health and hospital boards.

Planning cannot be an activity which is imposed. Right from the earliest stages of needs assessment, there must be a recognition that the people who live in the regions of the territories are the ones who best know what is necessary to have healthy families and communities. As the chairperson of the Inuvik regional health board pointed out:

"I also believe that if we have a department-run needs study, then we have a department-run answer and I do not believe that is what we want."

The Standing Committee on Agencies, Boards and Commissions was concerned to hear health and hospital boards express opinions that planning exercises have not involved a sense of "partnership" with the Department of Health. They have been seen as processes which have been developed in Yellowknife and implemented from a "top-down" perspective.

Over the past year, the Department of Health has devoted considerable attention to developing a process for a "health facilities and services review." A framework for this process was developed and included stages for: identifying key participants; collecting and verifying profiles which show population and service user characteristics; identifying opportunities to improve effectiveness and reduce costs; developing options and strategies; preparing action plans and evaluation criteria; and, assessing progress and reviewing plans.

Concerns were expressed to the standing committee that, even though the procedures called for consulting with "key participants" at each stage, the design for the review had been drawn up in headquarters and imposed on the regions.

For this reason, there was considerable initial concern over the process, especially in the Deh Cho region, where it was felt that the community had no control over the type of review that had been undertaken -- and in the Keewatin, where there were concerns that this approach would conflict or compete with regional planning efforts which were already farther advanced.

The Standing Committee on Agencies, Boards and Commissions is of the opinion that the time has passed when this government can say "We are going to study what the communities need ... this is how we are going to do it ... and this is the point at which the 'key participants' we identify are going to become involved." That centralized approach is too reminiscent of a previous era, and it is not likely to be accepted in the future.

A Territorial Plan For Health Services

During the Fort Smith hearings on January 22, 1992, the NWT Health Care Association, which represents all health and hospital boards, made a presentation which included the following recommendation:

"That the Department of Health take immediate steps to consult the health and hospital boards to implement shared planning programs for effective and efficient health services to the respective communities being served."

The Standing Committee on Agencies, Boards and Commissions agrees that it is essential for a plan to be developed. While the committee considers it the Minister's statutory and administrative responsibility to coordinate inter-regional planning, the content of any plan can only be developed through a partnership between her department and the boards. Health and hospital boards should have direct input, not only into the substance of the plan, but also into the process through which the plan will be put together.

I will now turn this section of the report over to Mr. Antoine, Mr. Chairman. Thank you.