Agreed.

---Agreed

Please proceed, Mr. Zoe.

Mr. Zoe, did you move a motion yet? Was it a motion? All right. The motion is in order. To the motion.

Question.

Question has been called. All those in favour? We do not have a quorum here. Please ring the bell, bring them in and bring the business forward. Thank you.

The chairman recognizes a quorum. The motion is that the Legislative Assembly express dissatisfaction with the management response made by the Department of Health to the Auditor General's report and with the presentation of: information on the organizational structure, and information on human resource management, provided during the public review of the report. The motion is in order. To the motion.

Question.

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

---Carried

On with the report. Mr. Ningark.

Organizational Structure

Thank you, Mr. Chairman. My section covers the comments on organizational structure. The second chapter of the Auditor General's report deals with this. Some of the findings included, are very serious. There is a particular issue with respect to the relationship that exists between the Department of Health and health and hospital boards. The Standing Committee on Agencies, Boards and Commissions commented on this at some length. I should say that the committee review found almost exactly the same things as our colleagues on the Standing Committee on Agencies, Boards and Commissions. Relations are strained and members of the health system have not been pulling together. What seems to be the root of it is a concern that there is far too much central control. There is much confusion about the roles of health and hospital boards as compared to the role that is played by the department.

There also appears to be some positive things taking place. The standing committee was pleased to see this. The committee was especially supportive of the initiative to develop a master memorandum of understanding. It is felt that this MOU will establish a different framework for how decisions and responsibilities within the health system are carried out. This is fully ensured by motions that have already been passed during the Third Session.

Specifically, I will draw Members' attention to the motion through which this Assembly accepted the principle that boards should be the primary administrative agent and the department should take a more supportive, rather than a directive, role. It should be noted also that there were some witnesses who commented that their working relationship with the Department of Health has greatly improved over the past few months. It is possible that this has to do with direction from Ministers. It is also possible that it has to do with the attention that is being paid to the issue by standing committees, the Auditor General and the Legislative Assembly.

Regardless of the cost, the Standing Committee on Public Accounts is of the opinion that these are positive developments. A little later, we will have some specific motions that may help the process further. There are a couple of additional recommendations in terms of organizational structure that Members wanted the House to consider, even though we did not make specific recommendations.

First, the standing committee received an excellent presentation from the honourable Member for Nahendeh. One of Mr. Antoine's recommendations was that the department should consider decentralizing Mackenzie regional health services, perhaps as the first step forward toward the development of boards or other representative bodies in the Deh Cho and North Slave regions. The committee thinks the suggestion has a great deal of merit and encourages the Department of Health to study it in detail.

The second point is, during the public hearings, the standing committee heard another very clear and thoughtful presentation from a private citizen about shortcomings in the health insurance services regulations. Apparently, these policies penalize people who receive home care treatment. On page 29 of the committee report, the standing committee encourages the department to put a high priority on the re-evaluation and revision of the health insurance services policy and procedure in this respect. Perhaps, there will be an opportunity to discuss these findings further. At this point, I would like to stop so other honourable Members can make any general comments about this section of the committee report. Thank you, Mr. Chairman.

Are there any general comments? Continue, Mr. Ningark.

Thank you, Mr. Chairman. I have a motion. Recommendation two, amend policy for budget control.

I move that the committee of the whole recommends that the budget control and financial reporting requirement policies within the Department of Health should be reviewed to ensure that they reflect the improved financial management capabilities of health and hospital boards; And further that, where necessary, revision to policy directives should be developed in consultation with health and hospital boards and readied for full implementation by September 30, 1993.

Thank you, Mr. Ningark. Your motion is in order. To the motion. Mr. Ningark.

Question, please.

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

---Carried

Mr. Ningark.

Thank you, Mr. Chairman. The standing committee reviewed the policy framework which deals with health and hospital boards. Finally, we became a little concerned because certain policies have been developed and then suspended. We were also told that the other policies have been reviewed and revised in October, 1992. At this time, though, the committee believes it is important that all departmental policies which relate to budgetary control and financial reporting be reviewed. The review should focus on whether they need to be revised to better reflect the motions about board autonomy which have been passed during this current session. It is possible that the review of these policies can be tied in with the MOU process. That is up to the department and the boards.

The standing committee wants to see this completed by September so that these new policy arrangements are in effect during the last two quarters of the current fiscal year. I believe this recommendation, which assists the transfer of the responsibility, has already started with respect to the health and hospital boards. It is consistent with the Auditor General's finding and it is necessary for the continued improvement of a working relationship within our health system. I urge honourable Members to support this motion.

Thank you, Mr. Ningark, for your comments, but we already passed the motion. It was not necessary for you to speak to the motion again. Mr. Ningark.

I would like to make a motion, Mr. Chairman.

Go ahead, Mr. Ningark.

Thank you, Mr. Ningark. Your motion is in order. To your motion. Mr. Ningark.

Mr. Chairman, the Auditor General's report included a recommendation that the standing committee evaluate, in detail, over the course of this public review. The Auditor General recommended that the department should consolidate all areas where financial management is carried out. This would lead to additional efficiencies in terms of financial management and of greater specialization. The Standing Committee on Public Accounts spent a great deal of time examining this recommendation and asked many of the witnesses for their views of this during public hearings.

At this point, the standing committee would not support the consolidation of health insurance services within the financial and administration division. Our reasons are included on page 26, however there is a great deal of merit in incorporating a financial monitoring function presently carried out within the hospitals and health facilities division within the financial and administration division. This would allow better coordination of budget management and control, and may lead to fewer supps. It would also allow a more streamlined hospital division to get out into the regions more often to work as consultants rather than inspectors. This is something that many witnesses said was needed.

In many ways a great deal of problems which have been reported about health and hospital boards seemed to centre around the hospitals and health facilities division. Boards feel as though the officials in the division demand too much information, and are too interested in line by line budget control. For that reason, the relationship may have suffered in terms of professional and technical consulting which the departmental officials could provide.

The Standing Committee on Public Accounts is of the opinion that the services provided within the Department of Health could be greatly improved by consolidating these two functions. The department should not wait to do this. Even if the functional review of the department is started this can be taken right away, rather than waiting for the final results of the functional review. I would ask all honourable Members, including the Minister, to support this motion. Thank you, Mr. Chairman.

Thank you, Mr. Ningark. The motion is in order. To the motion.