Mr. Koe.

What We Heard

Mahsi, Mr. Speaker. I would like to say a few words about what we heard. During our five days in the region people told us many things. Some of the issues echoed those we had heard in the Keewatin. Other concerns expressed were unique to the area. Underlying many comments was a central theme: people want more local resources, more access to services, more skills, more training and support for local staff and, especially, more local control over the services provided to community members to help them meet their personal needs.

On the other hand, we heard many calls for the Government of the Northwest Territories "to do something" about many things. It was as if some saw the territorial government as the only party who could take action to address many of the concerns raised. This was the case even when the mandate and opportunity was already there for the issues to be resolved locally. Much of what people saw as being wrong did not meet government policy or program changes, just local community action.

An example of this centred around concerns in one community about access to health services. Some residents noted the lack of reliable transportation to the health centre. They also told us their concerns with the current sick clinic schedule. They looked to our committee for resolution of these concerns. In a meeting with local health personnel we heard of their frustration that they could not get out into the community to liaise with local officials and gain community input. The staff wished for the establishment of a local health committee that could help them plan clinic hours and clarify other local needs and priorities.

Both residents and local service providers wanted the same thing. Neither group appeared to realize this however, because there was no communication between them. To resolve the issues facing them in their community, they need to start talking to each other. With some time to sit and talk together, the two groups will probably discover that they do want the same things. To allow that to happen, staff will need time away from their service provision duties and residents may need some encouragement to share their concerns with staff. Here, perhaps, the Government of the Northwest Territories could help by providing relief staff or skills training for local health committee volunteers. Such basic support for efforts to build on local strengths and abilities can play an important role in preparing communities for taking on more responsibilities in both health and social service delivery.

I would like to quote from Jim Antoine, MLA, "There is a real need to develop the communities to a level where they are able to even start thinking or talking about taking over programs and services."

A complicating factor is that there is not much ongoing support available to develop community leadership skills. Training in community development used to be part of the preparation for settlement and band councillors and administrators. Workshops on an approach to community development called "popular education" were offered through the Department of Health. They are no longer being offered. At Arctic College, out of a curriculum of 20 courses, social work students now take two courses in community development. Given this situation, there is little opportunity for training to help empower community members and to support them in their efforts to take more control over local services.

As far as we are aware, there is currently only one community development worker now doing such work. This lone worker is employed by the Status of Women Council and works with women's groups. Some northern consultants also have strong community development skills but few communities have the resources to pay for these services.

What follows is an overview of the major issues that were raised during our consultation. The issues are arranged according to the subject or to the target group to which they primarily apply.

Health Care Delivery

Improved access to services and more local control over those services were the most common issues raised in the area of health care delivery. There were many calls for the establishment of a regional health board. Concerns were strongly expressed that people did not feel as if they had meaningful input into the decisions being made about their health care. Some speakers did not believe the current regional health planning initiatives would be successful. They saw it as a process imposed by the department that was not accepted by the residents.

In Fort Simpson we clearly heard that residents did not want any reduction in their access to health services. Some called for improved and expanded services. We heard constructive suggestions about how existing community resources could be restructured so as to better meet local needs for services like extended care and home care services. Such suggestions may be of great help to the community health working group grappling with these issues, if they first deal with the issue of the credibility of the process.

In Hay River and elsewhere there were concerns expressed that the composition of the H H Williams hospital board did not reflect the profile of the population that it served. Some expressed strong concerns that the religious beliefs of the sponsoring body and of some staff meant that women have been denied abortion or birth control related services.

Various groups told us that they did not feel that they treated fairly by the health care system because of their age or ethnic background. Specific cases were presented to us where individuals were misdiagnosed or otherwise poorly served by the system.

People in small communities wanted more ability to respond to local health emergencies. They called for better communication to outside resources and for stronger pain medication to be available while they waited for help to arrive. People in all communities wanted access to a wider range of health services, including traditional health. We were told of cases of staff "jigging" the books to cover the costs of sending someone to a traditional healer. There were calls for more and legitimate access to such traditional methods of health care.

Participants wanted more resources spent on prevention. Both health care providers and service users called for more prevention, but we sometimes got the feeling that each party thought that the other group did not support it.

Residents wanted to reduce the turnover of medical staff. Home care was also supported.

This range of concerns about health care delivery suggest that the current health planning efforts in the region will be a challenging process.

HIV/AIDS

Some speakers expressed strong fear about getting AIDS. They wanted to know who had AIDS so they could take steps to avoid getting it. Some speakers wanted regional statistics released on people who are HIV positive:

"It will tell us and our children that this thing is very near us," helping make the issue more real and making the people more aware and more careful.

Others feared that they may be HIV positive but were afraid to get tested locally in case word got out that they were doing so. Some youth said that they did not have enough information on the disease. Social service workers raised questions about who could give permission for testing of children in foster care. They also called for training about AIDS and about how to work effectively and safely with HIV positive clients.

Mr. Speaker, I would like to turn over the next portion to my colleague, Dennis Patterson.

Mr. Patterson.

Thank you, Mr. Speaker.

Elders

One general observation about our meetings with elders was just how pleased they were that someone was interested in their situation. We got the feeling they seldom have a chance to talk about their needs and concerns.

There are growing numbers of elders in the region. To ensure that their needs are taken care of, planning is needed. Home care is seen as a preferred method of supporting elders who want to continue to live independently. Supporters noted that it is cost-effective compared to institutional care and results in better quality of life for elders. There were calls for the expansion of home care service in Hay River and for its establishment in Fort Simpson.

Concerns were expressed that current line-by-line funding arrangements allowed little flexibility to hospitals which also operate home care services. They cannot transfer funds to home care if demand warrants. As well, they may find themselves in a conflict of interest in such a situation. It was noted that if there are empty beds in the hospital, the institution may be hard pressed, from a financial point of view, to encourage care of patients in their own homes.

When institutional care is required, speakers called for regional access to level III and IV care. Elders living in the lodge in Fort Providence had ideas as to how their situation could be improved, pointing out some repairs needed in their facility. The elders asked that their smokehouse be moved and a wood stove installed in it, so they would be able to use it to prepare hides and to cook their own food when the weather was nice. There were calls to free up more of the staff's time to care for elders and for more collective preparation of food as is done in Rae. Elders we visited in the Hay River facility wanted more recreational activities and more field trips. Woodland Manor staff need funds to operated their donated van so they can take their residents out into the community.

Lodge residents wanted more country food to eat. Lodge staff said that they wanted to provide it but that there were some difficulties. Precautions need to be taken to ensure that the meat is safe. For example, we were told that wild meat had to be brought from Yellowknife as there is no way to get wild meat inspected or processed locally in an approved facility.

It was also pointed out that institutional beds need to be available to offer respite care for elders and others being looked after by family members. This would give such family care givers an occasional break and help prevent burnout and possible subsequent institutionalization of the elder. Calls were made for training to be offered to family members on how to take of elderly or disabled family members at home.

Many elders wanted more flexible access to health care. House calls were mentioned as one way to deal with the problems they encountered in getting to medical appointments. Many elders required transportation to medical and other appointments in order to maintain their independence. Some wondered why GNWT vehicles could not be made available to provide such transportation.

Elders also commented, as did others, about turnover of medical staff. One commented that she was tired of being a guinea pig for newly graduated doctors. There were suggestions that turnover played some role in cases of misdiagnosis of diseases such as cancer because medical personnel did not have the chance to get to know their patients. Cross-cultural training and community orientation were recommended for new medical practitioners. One person suggested that local health committee members could play an important role in this regard.

As we heard in the Keewatin, people had concerns about medevacs of elders. They wanted better briefing for patients and their escorts before the trip. They wanted to be sure that the escort could interpret for the elder and was assertive in dealing with medical personnel so that the patient clearly understood what was being said or done to him or her.

There were complaints about the seniors' wood subsidy. People told us that five cords were not enough to heat elders' homes throughout the entire winter. We were told that some elders left their homes and had to move in with relatives when the wood ran out. Such comments suggest that there is significant misunderstanding about the intent of this subsidy program.

If the wood subsidy is not intended to meet all the fuel needs for elders living in their own homes, then that fact needs to be clarified for recipients and their families and communities. Then if elders need more fuel, other ways could be found to gather the additional wood that they need to make it through the heating season.

Children And Youth

Young people who spoke to us shared a common concern that there were not enough constructive and fun things to do in their communities. They spoke of barriers that prevented them from enjoying activities, such as lack of public transportation or the costs of recreational programs. In each community youth called for a safe place that they could hang out. Most agreed that alcohol was readily available and that many weekend activities involved drinking.

Youth were concerned about others too. They wanted to be sure that single parents get the child care they need in order to be able to finish school and that victims of family violence have local safe shelters to which they can go.

Some wanted more information about all aspects of sexuality. They wanted more than just pamphlets; they wanted to talk to someone. Some who had gone through a week-long workshop on the topic spoke very highly of their experience and wanted more of these types of forums

Both children and adults raised concerns about child welfare. It was suggested that there was a need for more prevention measures such as family support. People who tell Social Services about children who need help should be told what action has been taken to investigate their complaint. To ensure quality care for a child while in the care of the department, some suggested that foster parents need to be given more training and support. This was echoed by staff who work with foster parents.

One child abuse counsellor told us, "We spend lots of money responding to the symptoms of (child sexual) abuse such as alcohol addiction but little on the root cause."

People pointed out that there were not enough services available to child sexual abuse victims or offenders. There was a call to treat offenders while they are in jail and afterwards so they can start to heal and not continue to offend. Resources are needed to pay for specialized counselling services to help victims heal. Staff expressed frustration that sometimes they needed to mask the abuse issues and label a client's problem as one of addiction to get the money to send the client for the help he or she needed.

Parents and professionals told us of the lack of services and funding for young people with special needs. We heard how the Deh Cho divisional board of education overspends its special needs budget allocation in trying to meet the needs of students. Despite this additional expenditure, parents told us that their children are still not getting services such as speech therapy that they need. We heard that the needs in the NWT for special services and support for students are 50 to 100 per cent higher than in other jurisdictions in Canada. In one school in the region, about 50 per cent of the students have special needs. There was also concern that assessments on children with special needs are often done in the south and the resulting recommendations cannot be carried out in some communities or are at odds with the NWT policy on inclusive schooling.

Some young people with special needs fall through the cracks. One young adult with a spinal cord injury is effectively trapped in his home. This is due partly to the cold weather and his health. As well, the back for his new electric wheelchair has been missing ever since he returned from picking the wheelchair up in Edmonton over six months ago. The back was to have been shipped two days later, but is still apparently on back order. Without this part, his mobility is restricted as he only has use of his manual wheelchair. His mobility is further impaired by a shortage of drivers and some winter related limitations of the local wheelchair van. Even if transportation is available, there are few buildings in his community that are wheelchair accessible. Finally, his rehabilitation is stalled and his condition is deteriorating to some degree due to lack of physiotherapy services.

A second example involved a young person whose treatment program in the south was shut down in a GNWT cost-cutting move. The youth was brought back to his community where some specialized services that he needs are not available. The youth's parents wondered what happened to the money saved by closing down the southern treatment program. They did not see evidence that it had been invested in providing appropriate services to people with special needs in their community.

The committee supports repatriating northerners with special needs from southern institutions where appropriate, and keeping the money spent on their care in the north. People should not be moved back just to cut costs, however, and then left at home without needed support and treatment services. We need to ensure that the person will at least maintain a comparable quality of life. Respite care is clearly an important service where family members are looking after the person at home.

The need for regional youth treatment services was raised as an issue. We heard of regional plans to act on this and offer such services on a pilot basis next summer.

Problems that arise with custom adoptions came up more than once. Situations were related where various benefits including band membership and child tax benefit were denied to children because the adoption paperwork had not been done.

Mr. Speaker, I would now like to turn the next part of this report over to my colleague, Mr. John Ningark. Thank you.

Mr. Ningark.

Alcohol And Drugs

Thank you, Mr. Speaker. My section is alcohol and drugs. Two main issues emerged in the area of alcohol and drugs. The first was the need for more money to pay for treatment. Secondly, there were demands for more attention to be paid to the lasting effects that drinking can have on children born to women who drink while they are pregnant.

People involved in the care and treatment of children suffering from fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE) spoke very strongly about their concerns for these children. Current estimates are that 25 per cent of children in the region are FAS and FAE affected. One speaker called for more study of this problem to more accurately determine its extent and to explore the effects it has on the children and their families. Others were concerned about the impact that FAE and FAS affected children have on the school, health and social services.

To reduce the incidence of FAS, there were calls for tough measures including laying charges of criminal negligence against women who drink while pregnant. Others see such punitive action as "blaming the victim." In a broader view, to be effective in reducing the incidence of FAS, we were advised to look beyond the drinking and respond to the underlying issues that contribute to women drinking during pregnancy.

We were told that treatment money usually runs out in December of each fiscal year resulting in treatment being delayed or denied. People wanted to be sure that there would be regional input into the Hay River treatment centre program and that there would be Slavey speaking counsellors there. They wanted appropriate child care to be available for parents seeking treatment. Alternatively, people suggested offering family treatment which involved the children.

After completion of any treatment program, many stressed the importance of aftercare being available in the recovering person's home community to help support their sobriety. They also stressed that the aftercare counsellors had to earn the trust of their clients. Speakers told us they could earn this by keeping confidentiality and by displaying their counselling skills. Some called for more outreach activities to be undertaken by local A and D programs such as weekend activities for children.

People supported the idea of a mobile treatment team to work out of the Hay River centre, offering a thirty day program in people's own communities.

Social Assistance

Just as in the Keewatin, the primary concern expressed about social assistance is that the food allowance is not adequate enough to ensure that people can properly feed their families. In our third interim report, the committee recommended an immediate increase in the food allowance. We pointed out that the present food allowance does not come close, in any region of the NWT, to the cost of purchasing a nutritional supply of food. Since the government has not adequately responded to this recommendation, it was not surprising to again hear concern expressed about the level of the food allowance.

Other limitations brought to our attention included the perceived lack of benefits available to relatives, other than natural parents, who are raising children. Some speakers thought that mothers with custody of their children are required to seek maintenance from the father as a condition of their assistance. This is not a program requirement. These concerns and misunderstandings suggest that more education of clients about program benefits may help decrease the frustration that some feel.

People wanted more resources allocated to work projects or retraining initiatives.

Mr. Speaker, I will now give the report to Mr. Dent.

Mr. Dent.

Front Line Workers

The motion is in order. To the motion.

Question.

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

---Carried

Report 12-12(3), Special Committee on Health and Social Services Interim Report No. 4 will be moved into committee of the whole. Item 10, reports of standing and special committees. Mr. Koe.

Mahsi, Mr. Speaker. The Standing Committee on Agencies, Boards and Commissions has an interim report on the Northwest Territories Power Corporation.

The Standing Committee on Agencies, Boards and Commissions, under the authority given to it by this House, has been reviewing matters related to the Northwest Territories Power Corporation.

Throughout the review process, the standing committee has been focusing on the following aspects: the mandate, organization structure and operations of the Northwest Territories Power Corporation; the composition and duties of the corporation's board of directors and senior management; working relationships between the board of directors and the Minister responsible for the Northwest Territories Power Corporation; statutory and procedural relations between the power corporation and the Northwest Territories Public Utilities Board; pertinent legislation, regulations and policy; current physical holdings, capital financing and the capital upgrade program; research, evaluation and development policy at the power corporation; models and procedures for community consultation and input; policies and procedures for effecting positive customer relations; and, principles and proposed approaches related to privatization of the Power Corporation.

The Standing Committee on Agencies, Boards and Commissions held initial public hearings in Yellowknife on November 25, 1992. At that time the standing committee invited the Minister responsible for the Northwest Territories Power Corporation, the Honourable Nellie Cournoyea, and senior corporation officials to appear as witnesses. Witness representation was also received from the Department of Energy, Mines and Petroleum Resources. The chairperson of the Public Utilities Board appeared before the standing committee as a witness, as well.

A subcommittee held public hearings on February 2, 1993, in Inuvik. These focused on future planning activities for the Power Corporation and, specifically, on policies established or research, evaluation and development. The Minister responsible for the Power Corporation attended as a witness, along with the chairperson of the board of directors and several senior officials. Witnesses representing the Union of Northern Workers also presented a brief commentary on the proposed privatization of the Power Corporation.

A second subcommittee held further open meetings and round table discussions in Cape Dorset on February 2, 1993, to focus on community input processes and customer relations policy. The hamlet council and other key stakeholders were represented at discussion sessions.

Public hearings were also held before the second subcommittee in Iqaluit on February 4, 1993, to consider current physical holdings and the capital planning process. Senior corporation officials appeared as witnesses during those public hearings. Representation was also made by the Union of Northern Workers at the Iqaluit hearings, again on the subject of privatization. The standing committee also heard from several other public witnesses, as well.

In addition, Members of the Standing Committee on Agencies, Boards and Commissions have also been provided with an opportunity to tour power plant facilities in Iqaluit, Inuvik, Cape Dorset and Lake Harbour. This has provided an invaluable perspective on the scope and technical challenges of operations within the Power Corporation. It has also conveyed an understanding of the differences which exist between communities with respect to the age and technology of their power plants.

Plans had also been made for a subcommittee of the Standing Committee on Agencies, Boards and Commissions to hold public consultations in Tuktoyaktuk and Aklavik. The standing committee very much regrets the fact that inclement weather prevented air travel and resulted in the cancellation of these meetings. Members look forward to visiting those communities should the opportunity arise on a future occasion.

The standing committee wishes to acknowledge the cooperation and thoughtful input received from witnesses during all public hearings and consultations.

This input, as well as the examination of planning documents, policy directives and statistics provided by corporation officials, will form the basis for future comments and recommendations arising from the standing committee's review. The committee will meet during the summer months for further public hearings and to examine the additional issues arising from information provided to date.

In addition to continuing its review of issues raised during initial hearings, further areas for committee examination include, but are not limited to: the record of return on shareholders' equity; the allocation of funds and human resources to support corporate administrative requirements; the framework for corporate decision-making; corporate activities to encourage and support the use of northern labour, materials and resources; contracting and purchasing policies and performance within the Power Corporation; the nature of the employee work environment; Power Corporation initiatives aimed at the introduction of cost-effective alternate energy sources; strategies undertaken by the Power Corporation to encourage energy conservation; levels of responsibility demonstrated by the Power Corporation in addressing environmental issues; accountability mechanisms, including a further review of the statutory authorities of the Public Utilities Board, the Minister, the Cabinet and the Legislative Assembly; relations between the Power Corporation and non-government utilities in the Northwest Territories; the potential for agreements with other jurisdictions, including potential for the sale of energy outside the Northwest Territories; rationale, principles and proposed approaches related to the privatization of the Power Corporation; and, larger issues related to the impact of the Power Corporation on corporate and consumer affairs in the Northwest Territories.

Mr. Speaker, the Standing Committee on Agencies, Boards and Commissions wishes to acknowledge the excellent cooperation and assistance received to date from the Minister responsible for the Northwest Territories Power Corporation and her officials, as well as from the Public Utilities Board.

The standing committee looks forward to completing its review and is confident that the current process will result in a constructive and well-documented final report.

Mr. Speaker, that concludes the Standing Committee on Agencies, Boards and Commissions' interim report on the Northwest Territories Power Corporation.

Motion To Receive And Adopt Committee Report 13-12(3)

Therefore I move, seconded by the honourable Member for Nahendeh, that the interim report on the Northwest Territories Power Corporation be received and adopted. Mahsi.

Motion is in order. To the motion.

Question.

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

---Carried

Item 10, reports of standing and special committees. Item 11, reports of committees on the review of bills. Item 12, tabling of documents. Item 13, notices of motion. Mr. Dent.

Item 13, notices of motion. Item 14, notices of motions for first reading of bills. Item 15, motions. Item 16, first reading of bills. Item 17, second reading of bills. Item 18, consideration in committee of the whole of bills and other matters. Tabled Document 2-12(3), The Justice House - Report of the Special Advisor on Gender Equality; Tabled Document 3-12(3), Report of the Commission for Constitutional Development; Tabled Document 49-12(3), Long-Term Staff Housing Strategy; Bill 5, An Act to Amend the Social Assistance Act; Bill 17, Appropriation Act, No. 2, 1993-94; Minister's Statement 34-12(3), Long-Term Staff Housing Strategy; Committee Report 10-12(3), Report on Tabled Document 21-12(3): Payroll Tax Act; Committee Report 11-12(3), Report on the Review of the 1993-94 Main Estimates, appearance by members of the commission for constitutional development, with Mr. Ningark in the chair.

Agreed.

---Agreed

Thank you. Are there any general comments? We will take a 15 minute break and then come back.

---SHORT RECESS

This committee will come to order. Mr. Todd, before we proceed with general comments do you wish to bring in your witnesses?

Yes, Mr. Chairman.

Sergeant-at-Arms, please escort the witnesses.

Mr. Todd, for the record can you please introduce the witnesses.

Department Of Transportation