Thank you, Mr. Chairman. Without exception, all health and hospital boards indicated that the current state of information processing within the health system was a serious barrier to effective administration.

The standing committee was dismayed by the degree to which incompatible and inadequate systems exist. Equally disconcerting has been the apparent inability of the Department of Health to take a lead role in correcting these deficiencies.

Board staff have had to cope with a myriad of systems that are apparently incapable of exchanging information and do not meet administrative or planning needs. For their part, the boards appeared to have done their best in coping with the current situation, as many have successfully developed their own internal procedures for re-entering data or designing intermediate reporting formats. However, this has resulted in a system in which neither financial nor statistical information can be communicated and reported with efficiency.

The Standing Committee on Agencies, Boards and Commissions is aware that the Auditor General's report deals with the matter of health information systems at some length and that this has been a subject of considerable attention by the Standing Committee on Public Accounts.

Because this item fits more properly within the Public Accounts Committee's mandate, the Standing Committee on Agencies, Boards and Commissions does not intend to make a specific recommendation on the matter of information systems at the present time. However, it should be recognized that Members of this standing committee are of the opinion that specific corrective action should be considered a government priority.

Departmental Requests For Information From Boards

Health and hospital boards expressed a continuing concern, over the course of the review, with respect to the frequency and type of information demanded on a regular basis by the Department of Health. Board representatives found that the department, over the past several years, has forwarded numerous requests for administrative information, line-by-line budget substantiations and service delivery statistics. Without exception, the boards found departmental demands for information to be excessive and unnecessary.

During the November consultation sessions, for instance, the chairperson of the Keewatin regional health board pointed out that:

"We spend inordinate amounts of time justifying budget expenditures on a line to line basis that are five per cent over the budget item amount. In some cases, these are budget line items of $300 or $400, yet we have to justify a five per cent variance for those items. It is ridiculous when we are dealing with $20 million and $30 million budgets, to be worrying about $5 and $10. I am not saying that we wish to be financially irresponsible. I am saying we have to review the system and look at what it is we are attempting to do."

The Baffin regional health board described departmental monitoring procedures as "excessive" and a "constant irritant," while the chairperson of the Inuvik regional health board commented that:

"The control of the Department of Health line-by-line budget is also one of our greatest concerns... I think that, as boards of management we should be allowed to manage. If we are not boards of management, then please tell us so."

The standing committee is concerned that these demands for more and more detailed reporting represent a hindrance to effective administration at the regional level. Board officials have found that it is often difficult to complete activities that have been established as regional priorities, because of the time that has to be spent preparing reports for Yellowknife.

The chairperson of the H H Williams Memorial Hospital board astutely noted that, in addition to detracting from effective administration, this also has the potential to divert attention away from patient care, itself:

"I have been involved with health care in the Northwest Territories for 28 years now, off and on. I have seen such an incredible change that has taken place from the days when patient care seemed to be ultimate. Now we hardly ever hear the word. Patient care almost always gets forgotten in pursuing all the other things that have to be done, the documentation of what we do."

The Standing Committee on Agencies, Boards and Commissions is aware that certain information requirements are imposed on the Department of Health by the Financial Management Board and, in some cases, the standing committees and Members of the Legislative Assembly. Further, certain sections of the Financial Administration Act require the department to take responsibility for appropriate over-all fiscal management of the health system and this, in turn, requires departmental officials to access information from the boards. Upon reviewing examples of the number and type of requests, though, the committee has formed the opinion that the department's demands for budgetary details and the frequency of specific requests for statistical and administrative reports are, in fact, excessive.

To a large degree, the root of this problem may lie with the aforementioned inadequacy of information systems. If appropriate, well-working systems were in place, information could be centrally accessible without imposing additional reporting requirements on the boards.

Just as inadequate information systems are contributing to this problem, so too are departmental attitudes and procedures. The Standing Committee on Agencies, Boards and Commissions is of the opinion that the excessive line-by-line monitoring by departmental officials reflects a headquarters perception of health and hospital boards as incapable, undependable management bodies. There appears to be an unwillingness at departmental headquarters to stand back and allow the boards of management to manage.

This is further compounded by information flow procedures within the Department of Health. Currently, departmental demands for information about board operations are generated in a number of divisions and are forwarded from a number of staff levels.

Directors, associate directors, analysis, consultants, administration officers, medical officers and a range of other mid to senior-management officials in Yellowknife frequently pepper board administration with demands for information related to their latest internal work assignments. Often, information is required on relatively short notice. Sometimes information demands by one headquarters division appear to duplicate or overlap those made by other divisions. And, in a majority of cases, board administration is provided with very little understanding of why the data are required.

It is hoped that the aforementioned "master memorandum of understanding" (MOU) between the department and the health and hospital boards will clarify requirements that the boards must follow in forwarding information to the department.

Until the MOU is finalized, however, the Standing Committee on Agencies, Boards and Commissions is of the opinion that information flow between the boards and the Department of Health is in definite need of senior-level coordination. Members of the standing committee are of the opinion that this coordination should be achieved by channelling all departmental requests for board information through the office of the deputy minister of Health.

By establishing the deputy minister as the single coordinating source within the department, the standing committee believes that overlap in the content of information requests could be eliminated, better consideration could be given to reasonable time lines for board response, and headquarters information needs could be vetted to ensure that they were essential to the operation of the health system.

In summary, the Standing Committee on Agencies, Boards and Commissions believes that the number of demands for detailed information currently placed on health and hospital boards by the Department of Health are constituting a serious barrier to effective administration. While this situation will likely be addressed by an improved information system and role clarity achieved through the MOU process, the committee is of the opinion that senior coordination of information requests is necessary at the present time.