Thank you, Mr. Chairman. Turning to board structure and composition, the Standing Committee on Agencies, Boards and Commissions spent a considerable amount of time during its review examining current structural frameworks of health and hospital boards in the Northwest Territories. The standing committee also considered whether it was in the best interests of the health system to have board members appointed by the Minister or elected by communities or regions.

The Structure Of Health And Hospital Boards

The standing committee is of the opinion that it must be recognized that the various regions served by health and hospitals boards differ considerably in population, community development and health needs. Accordingly, the standing committee felt that the structure of health and hospital boards should reflect the regional character of the people they represent.

During November consultation sessions, the standing committee was informed that a number of boards have undertaken very specific initiatives aimed at reorganizing themselves for better representation and efficiency. This is resulting in a situation where somewhat different structures are emerging for different boards.

In the Inuvik region, for instance, there has been a concern by board members that representation from each community and aboriginal organization has resulted in a very large and rather cumbersome board structure. Current efforts have been aimed at developing a proposed framework to carry out regular board activities through a streamlined executive committee, with the full board meeting once each year.

On the other hand, with the wider geographic area covered by the Baffin regional health board, the need for representatives of all communities in the catchment area to meet regularly has been given a different, and higher, priority.

As another example, the Stanton Yellowknife Hospital has proposed a model for board reorganization which incorporates formal representation from outside Yellowknife. This is in keeping with the hospital's blossoming mandate as a regional facility.

On the other hand, the board of management and H H Williams Memorial Hospital in Hay River has a smaller and more localized membership structure, which also reflect the historical and continuing involvement of the Pentecostal Assemblies Sub-Arctic Mission Society.

The Standing Committee on Agencies, Boards and Commissions believes that it is very appropriate for each health and hospital board to develop an individual structure which best reflects the character of its respective region. While the standing committee is of the opinion that the management capabilities of all health and hospital boards should be developed to equivalent levels, the way boards are structured should be flexible enough to reflect regional interests. In other words, neither the Minister nor the department should attempt to impose a certain membership structure on health and hospital boards simply for the sake of territorial consistency.

This was emphasized to the standing committee when the chairperson of the Keewatin regional health board noted that:

"I think one of the things we have to keep in mind is that board make up should not be unilateral. What works in our region, may not necessarily work in the Kitikmeot and may not work in the Baffin and, certainly, may not work in the western Arctic."

In general, the Standing Committee on Agencies, Boards and Commissions was very impressed with the priority that health and hospital boards were seen to place on recommending appropriate representation from all sectors of their community population. The standing committee noted a high proportion of aboriginal representation on regional health and hospital boards, as well as a recognition of the importance of increasing participation by aboriginal groups and individuals among the two predominantly non-native hospital boards in the western Arctic.

Some board representatives commented on the apparent need to increase sensitivity to cross-cultural communication within the Department of Health. They have perceived senior departmental officials as preoccupied with the notion that, "boards do not work because people do not say anything when they come to the meeting." The chairperson of the Keewatin regional health board stressed that:

"somehow we at some point in time have to get the message across to the department that because a unilingual person comes to a board meeting and does not talk a lot it does not mean they are not participating. It means they have a different method of approaching the issues we are dealing with."

The Territorial Hospital Insurance Services Act requires the Minister of Health to satisfy herself that the areas served by the health facility or facilities are adequately represented on the membership of the respective board of management. The standing committee believes that this requirement should not be seen to restrict the Minister from working with each health and hospital board to develop the sort of structure that it feels would best meet the needs of the region or community it serves.