Thank you, Mr. Chairman. I am being advised that we inform the health card holders now, but we could do a better job on that one. Thank you.

Thank you. Medical care plan, operations and maintenance, total O and M, $17.917 million. Agreed?

Agreed.

---Agreed

Medical Travel

Thank you. Medical travel, operations and maintenance, total O and M, $21.748 million. Mr. Gargan.

Thank you, Mr. Chairman. Is there any clear role which the CHR plays? I would like to find out from the Minister exactly what their responsibilities are with regard to their duties in the nursing stations? With regard to medical travel, what are the policies for people who have to drive out of town for specialized care? I would also like to know what your policy is with regard to vehicles at nursing stations, are those also used for the purpose of transporting patients to and from airports?

Thank you. Madam Minister.

Thank you, Mr. Chairman. I will ask Dr. Kinloch to respond.

Dr. Kinloch.

Thank you, Mr. Chairman. I will attempt to deal with the three or four questions asked by Mr. Gargan. The first of them, as I understand it, seeks clarification of the travel policy to obtain services which are not insured services, such as chiropractic. Our travel policy is that we pay for travel only to receive insured services at the nearest centre where that service could be provided. There would be no medical travel paid for seeking a non-insured service.

In terms of the travel support provided by health centres to patients, it has long been a policy, dating back to medical services branch, that the staff of health centres should not be taxi drivers. There are other individuals in the community who can take on that role and, indeed, in many communities there are arrangements which cover transportation of patients, in others there are private businesses that provide that service. It is not a reasonable use of nursing time to be conveying people back and forth to airports, except when there is a requirement for nursing care on route, in which case it is covered.

The role of community health representatives is primarily directed to health promotion and disease prevention activities with a heavy influence on health education, rather than the provision of patient care, making arrangements for non-insured services and providing any clinical services. This is different in the Northwest Territories than in other parts of Canada where CHRs have a somewhat broader role in the clinical area. We are convinced that the primary requirement in the communities is for health education, health promotion activities and taking advantage of the major skills which CHRs have in bridging the language and cultural gaps which may exist between nurses and physicians and the people they are trying to help.

Thank you. Medical travel, operations and maintenance, total O and M, $21.748 million. Mr. Gargan.

Thank you. Mr. Chairman, every day I am in Fort Providence I see the medical vehicle cruising around town, to the store and post office. I do not know if they are taxi drivers or not but they are doing those things. The point which I was trying to make, Mr. Chairman, is that in the event of an emergency we do not have an ambulance as such. You have to rely on the medical expert in that area to hopefully address the situation at hand. We do not have that at the moment. That is one of my concerns. If someone drops on the street and you do not really know what caused them to drop you would rather go to the nursing station and have someone look at the person. In many circumstances the nurses still say you are to bring the patient in. You end up in a situation in which you really do not have the expertise the nurses do. My concern is in that area.

You also have a situation with regard to compassionate travel. I am also wondering about that. Those are areas of concern, Mr. Chairman. Every year people come to me, even though it might have happened a year ago, a month ago, or it might have just happened, about these types of situations. I end up not being able to address it, because by the time you are able to address it a whole new problem arises.

Thank you. I believe that was just a comment. Mr. Gargan, was there a question? Would the honourable Minister like to respond to that?

Thank you, Mr. Chairman. The Member for Deh Cho has a good idea. Thank you.

Thank you. Medical travel, total O and M, $21.748 million. Agreed?

Agreed.

---Agreed

Thank you. Details of grants and contributions. Contributions, $88.197 million. Agreed?

Agreed.

---Agreed

Grants and contributions, $88.197 million. Mr. Gargan.

Mr. Chairman, I have a letter. I just wanted to ask the Minister a question. A request was sent to the department regarding taking over duties of CHRs. The Minister responded, "Since health education is an integral part of public health programs, and community health representatives work with and sometimes under the direction of other members of the public health team, examples are nurses and regional environmental health officers, regional nutritionists and regional health promotion officers, clerk interpreters, as well as community groups, to transfer only selected functions of the community health representative to the band council would fragment a comprehensive approach to public health services and may increase the cost of services. Therefore, the department is not in a position to support your resolution at this time."

My problem is, what is the difference whether you function out of a band office or out of a nursing station to deliver those programs? I do not see anything here that suggests it will fragment if you transfer it over to the band councils. I just do not see how it could happen. Even when Morris A kid was the regional director and before that there was another gentleman who we used to work with. When the transfer of the CHR program started going to the communities the suggestion was that it go to the community, not to the nursing stations. When the program was first delivered under Monique Begin, the whole purpose was for the community to start controlling their own health. I am not seeing that happen.

Your letter suggests that not in a million years are you going to see something like this go to a community board. Rather, your suggestion is, at this time, you are not supporting the regional councils with regard to their resolution to take over that responsibility. Exactly what is your department doing in that direction of community self-government, community self-sufficiency and community transfer initiatives? We are getting mixed messages here. Why would you be saying something like this and still suggest that you support the transfers?

Thank you. Madam Minister.

Thank you, Mr. Chairman. Yes, I do support community transfers, but in this case, as I said, local Metis associations were not in favour of having CHRs transferred to the band council. When there is opposition coming from the community, I am hesitant to transfer the position until things are worked out. Thank you.

Thank you. Mr. Gargan.

All right. Can I try again? Thank you. Mr. Chairman, I have not seen any kind of correspondence with regard to your department and the Metis Association suggesting there were some disagreements on that initiative. If there are disagreements, I am not aware of them. Do you have a copy of that letter right now?

Thank you. Madam Minister.