One of these pertains to the number of aboriginal people currently engaged in health care careers in the Northwest Territories. During consultation sessions with the health and hospital boards in November, Members of the committee noted a uniform commitment on the part of board representatives to increasing the number of aboriginal people entering and finding employment in the health field.

The boards have experienced varying levels of success with respect to aboriginal hiring. The Auditor General reported that, although the proportion of aboriginal staff at regional health boards ranges around 40 per cent, the percentage working in hospital settings in western urban centres is much lower. This was consistent with figures provided to the standing committee by health and hospital boards during the November 21 consultation sessions.

In addition, it was brought to the standing committee's attention that a majority of the aboriginal people working for all health and hospital boards are employed in jobs that would be most accurately described as " support position," and generally at the lower end of the salary schedule.

The Standing Committee on Agencies, Boards and Commissions is of the opinion that the current level of representation by aboriginal workers within the health system is unacceptable. The workforce which delivers health services at the community level should be reflective of the population it serves. There must be a renewed emphasis toward achieving this goal.

The over-all strategy for attracting aboriginal people to work in the health system is probably best developed at a territorial level and coordinated by the Department of Health. In this respect, relatively little seems to have been accomplished.

However, it is important all stakeholders in the health system should see themselves as part of the solution. The Standing Committee on Agencies, Boards and Commissions believes that there is much that health and hospital boards could do in terms of promoting community awareness of health careers and in providing support to staff who are of aboriginal descent. A priority should be placed on identifying and implementing such strategies by each of the health and hospital boards.

Staff Training

The Standing Committee on Agencies, Boards and Commissions is concerned that current fiscal pressures should not result in less access to training opportunities for health and hospital board staff. Although board representatives were generally satisfied with current programs for training staff, there was some concern that funding shortages may limit accessibility and, therefore, impact on the quality of care and on staff morale.

As well, there was some concern in the Baffin region about the status of the outpost nursing program. Apparently, this is a training resource that has worked well in meeting the training needs of professional staff in the Baffin region but territorial involvement has recently been curtailed.

Interpreter/Translator Services

Members of the Standing Committee on Agencies, Boards and Commissions raised a number of concerns with respect to interpreter services that are provided within hospitals and other health care facilities throughout the Northwest Territories. There was a general apprehension that insufficient attention has been placed on ensuring a systematic approach to the delivery of these essential services.

It was noted, for instance, that the interpretation of medical terminology and treatment instructions requires a level of linguistic understanding and confidence that cannot be obtained through casual hiring or part-time interpreters. This is particularly important when patients who are not fluent in English are medevaced to southern medical institutions.

Of particular concern to the standing committee, as well, was the fact that interpreters in hospital settings are classified at a lower level than those in the territorial language bureau. as a result, there has been consistent difficulty at some hospitals with respect to recruiting and retaining persons for these positions. Board representatives indicate that this has been a serious point of contention for them, as well.

The Standing Committee on Agencies, Boards and Commissions is of the opinion that a major review should be undertaken by the Department of Health with respect to current adequacy and future directions for language services within the territorial health system. Thank you, Mr. Chairman.

Thank you. Mrs. Marie-Jewell.

Orientation And Training Needs Of Board Members

Thank you, Mr. Chairman. The

Standing Committee on Agencies, Boards and Commissions was dismayed and extremely dissatisfied with the level of support currently provided to persons who are appointed to sit as members of health and hospital boards. Funding for board training is inadequate. The level of consultative support received from the Department of Health is insufficient. Materials describing the statutory and operational responsibility of board members are outdated and untranslated.

The standing committee noted that, almost without exception, board representatives identified the unfulfilled orientation and training needs of their membership as a critical issue.

The Department of Health has produced a trustee manual which outlines many aspects of board members' roles and responsibilities. However, the nature of the language used within the manual becomes very technical in certain sections and the volume of material included within it makes it difficult to locate needed facts. Further, there is a need to update the manual, particularly since the recent amendments to the Territorial Hospital Insurance Services Act have altered the structure of the budgetary review process to some extent. But Members of the standing committee also found it incredible to note that this manual has never been fully translated into Inuktitut or other aboriginal languages. This is apparently in spite of repeated requests from the health and hospital boards themselves.

Several boards have attempted to develop their own orientation and awareness sessions through an organized series of briefings and seminars from staff. While this internal commitment can be applauded, the standing committee was extremely concerned to note that there is very limited information and support available for board members, either from the office of the Minister of Health or from the Department of Health.

In some instances, this may foster a need for board members to rely unduly on their senior staff for policy interpretation or abridgement of untranslated materials. It sometimes becomes difficult for board members to take an independent stance because they have not been provided with sufficient background information about their roles and responsibilities.

The issues confronting boards are complex and members require adequate orientation and training. Not only are they dealing with budgets of several million dollars, but they are also in a position of having to understand complicated and rapid changes in the health environment. This is not possible unless they are provided with the relevant information in a format that is accurate and easily understood. Speaking in Inuktitut the chairperson of the Baffin regional health board provided an

important example of this during the November consultation session when he pointed out,

"I have been told about AIDS and I would like to talk to my people to care for themselves. I think we have to be aware that a lot of Ministers just keep things to themselves when they should be talking to people about these matters."

Whether it is an unfamiliarity with current disease patterns or confusion about government budgeting principles and procedures, the fact appears that there has been relatively little central support for building awareness, management expertise and confidence for many board members.

The Standing Committee on Agencies, Boards and Commissions finds this to be unacceptable. The current situation is one in which the decisions of the boards become prone to departmental criticism because boards members are assumed to lack skills, experience or understanding -- while at the same time, those conditions are perpetuated through a lack of attention to orientation and training.

The responsibility for correcting this state of affairs lies clearly with the Minister of Health. Board members are appointed by the Minister under the Territorial Hospital Insurance Services Act and it should be incumbent on her to ensure that her appointees receive the information and support they require in order to carry out their difficult role.

During the January, 1992 public hearings in Fort Smith, it was noted that there could be a role for the Northwest Territories Health Care Association to play with respect to developing a framework for board members' orientation and training.

There may be merits to this approach. The health care association represents each of the health and hospital boards in the Northwest Territories and, through its affiliation with its national organization, is in a position to take advantage of work that has been already completed in other jurisdictions.

However, it should be recognized that, while the association may have a role to play in coordinating and delivering orientation or training, it is the responsibility of the Minister and her department to ensure that the jobs gets done. This should involve direct supervision of the allocation of funding and of the administration of any contractual arrangements with the health care association. This will require setting a high priority on orientation, training and support for board members.

A review of the amount of training and support provided to boards by the Department of Health since the 1988 transfer agreement has not inspired much confidence that the will exists within the Department of Health to recognize board orientation and training as a priority.

Accordingly, the Standing Committee on Agencies, Boards and Commissions is of the opinion that training and orientation of board members should become a formal statutory duty imposed upon the Minister by the Territorial Hospital Insurance Services Act.

Mr. Chairman, therefore this committee recommends, 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 of 1993.

Question.

Thank you, Mr. Chairman. The Standing Committee on Agencies, Boards and Commissions also reviewed the process through which community interests are represented in the formulation of health policy.

Input Into Health Policy By Health And Hospital Boards

Generally, health and hospital boards expressed a concern that the Department of Health is not taking their suggestions and recommendations seriously. During the November consultation sessions, several boards described situations in which important recommendations had been forwarded to senior officials in the department, without any formal response or action.

This should not be happening. Health and hospital boards have a unique perspective on the needs of their facilities and of the people served by them. It is important to ensure that these perspectives are taken into consideration when territorial health policy is being developed.

The Standing Committee on Agencies, Boards and Commissions takes the position that health and hospital boards report to the Minister of Health and not to her department. Accordingly, procedures need to be developed through which the boards can have direct input to the Minister's office without having to negotiate a series of bureaucratic channels. When health and hospital boards bring forward specific suggestions for policy input, they should be able to expect a timely and complete response.

Clearly, what is needed is a process through which any health or hospital board can issue a formal recommendations to the Minister on a matter of policy. Standards should be set within the Minister's office and the Department of Health which allow for the timely response to formal recommendations, and there should be a system for reporting the status of recommendations to the Legislative Assembly.

Territorial Health Advisory Committee

During the 11th Legislative Assembly, the previous Standing Committee on Agencies, Boards and Commissions tabled a report which recommended, among other things, the dissolution of a central advisory body, known as the territorial hospital insurance services board.

The former Minister, (Honourable Nellie Cournoyea), responded by introducing a bill to amend the Territorial Hospital Insurance Services Act during the Eighth session of the 11th Assembly. These amendments dissolved the central board and transferred its duties to the Minister. This bill was assented to on July 7, 1991.

The current Standing Committee on Agencies, Boards and Commissions is of the opinion that the 11th Assembly took an important step when dissolving the central territorial hospital insurance services board. However, a very valid concern was raised at the time the bill was under consideration by the 11th Assembly.

On July 4, 1991 the 11th Assembly's Standing Committee on Legislation reported on its review of the bill which eliminated the central board. The chairperson commented that:

"There was some concern expressed in both the survey input we received and also during the committee's discussions that the health system must reflect input from the aboriginal organizations or aboriginal people and must involve aboriginal people in the development of standards, policies and financial decisions at the senior level.

"Further the Standing Committee on Legislation was mindful of the fact that, if authority for the health system is to lie with the Minister of Health, regional health boards feel strongly that they should have direct access to her for communication and policy input. They did not want to see a process developed where the department is a filter between the Minister and the regional health boards."

That concludes my section.

The motion is in order. To the motion.

Question.

Question.

Question has been called. Mr. Patterson.

I have one brief comment on this motion, Mr. Chairman, which I think is a good one. The health boards in the Northwest Territories are represented by the NWT health care commission. It is that body that, perhaps, could be involved with this health advisory committee to advise on the non-insured issue. I just wanted to make that point. While I think the aboriginal organization representation is critical, perhaps the chairpersons of each regional health and hospital board could be represented through the association that already exists in this new committee. Thank you, Mr. Chairman.

Thank you. That was just a point. To the motion.

Question.

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

---Carried

Mr. Patterson.

Board Structure And Composition

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.

Mr. Patterson, I am told that you have to read the word "recommends."

Mr. Chairman, I should have prefaced that with I move that this committee recommends the motion I just read. Thank you, Mr. Chairman.