This is page numbers 261 - 280 of the Hansard for the 12th Assembly, 7th Session. The original version can be accessed on the Legislative Assembly's website or by contacting the Legislative Assembly Library. The word of the day was social.

Topics

Committee Motion 26-12(7): To Adopt Recommendation 2, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 274

Nellie Cournoyea Nunakput

Thank you, Mr. Chairman. The budget for Health and Social Services has increased from $257.964 million in 1994-95 to $262.237 million in 1995-96, for a total increase of $4.273 million or two per cent. This is a significant increase in these economic times. The budget that is being presented for your review is a true consolidation of two previously separate budgets. It has been a major achievement to consolidate both the capital and main estimates in a few short months.

The consolidation at headquarters is now complete. There is an appropriate integration of both Health and Social Services functions throughout the department and it has been possible to eliminate 14 person years as a result of the reorganization, and to save money in operations and maintenance for a total savings of $1.2 million. These savings will help to offset some of the increases that are being recommended in this budget. I am convinced that the decision to consolidate was a good one and this is reflected in immediate cost savings.

The consolidation at the regional and community level will not proceed as quickly as it did at headquarters. That is because we will have to proceed carefully in the restructuring to avoid disruptions to the existing level of community service. A major priority over the coming year will be the development of a funding formula designed to provide equitable resources to all regions in both Health and Social Services. As well, it will be important to examine the existing governing structure for departments in the social envelope.

It is true that boards of management are expensive, but this price has to be paid to ensure a level of public involvement in the system and to make the system responsive to the needs of communities. However, having separate boards of management for health and education, along with separate community justice and housing committees, is not only costly, but may be fragmenting the system in communities to the point where there is not enough interagency cooperation for effective government.

I have been approached by the Dogrib region to try an experiment aimed at establishing one community services board that would combine health and social services and schools. This would recognize the fact that it is difficult to locate qualified residents to sit on a board of management with a large budget and it should also cut costs to a manageable level through a single board with an all-inclusive mandate.

Another reality we face is that we cannot maintain the existing levels of service without changing the way we manage. Our social funding is divided amongst three departments and the Housing Corporation. We know that if we are to achieve real gains, we have to work together and integrate our efforts. That is why the government presented the social envelope budget in one comprehensive package that outlined the major initiatives that the partners in the social envelope would undertake in 1995-96. A joint presentation was made to SCOF by the social envelope departments and the Housing Corporation and, by now, you will have a copy of the budget supplement document that summarizes the cooperative efforts that are under way.

Departments in the social envelope have also been involved in extensive consultations with communities to develop a community wellness strategy that will be tabled later in this session. Communities have told us that they want to play the lead role in determining what initiatives will work best for them and to decide how to spend the money that is available within their community. The challenge to the departments in the social envelope is to find ways of making funding mechanisms more flexible to allow this. The departments will spend the next year evaluating what is currently being done and modifying the terms and conditions attached to the programs to make them flexible and accessible.

In the meantime, there is a need to try new approaches to deal with priorities in areas such as family violence, early intervention and services to youth. That is why the social envelope Ministers recommended a community action fund to help community groups test their ideas. The viability of such a fund and the means of raising the money need to be discussed.

I hope these comments have put the Health and Social Services' budget into context with the overall directions of the social envelope. Mr. Chairman, the budget supplement document circulated to the Members gives a good description of the department's strategic directions for 1995-96. I won't go into any more detail now, but I am open to questions as the department's budget comes up for detailed questioning. Thank you, Mr. Chairman.

Committee Motion 26-12(7): To Adopt Recommendation 2, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 275

The Chair

The Chair Tony Whitford

Thank you, Madam Premier. Does the chairman of the Standing Committee on Finance have opening remarks? The chair recognizes the Member for Nahendeh, Mr. Antoine.

Standing Committee On Finance Comments

Committee Motion 26-12(7): To Adopt Recommendation 2, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 275

Jim Antoine Nahendeh

Thank you, Mr. Chairman. In last year's report, the committee expressed a great deal of concern about the then separate departments of Health and Social Services. Committee Members felt that the departments were not responding to the recommendations of this and other committees and, indeed, were not responding well to the needs of northerners. The diligent efforts of the dedicated front-line workers, such as nurses, social workers, alcohol and drug counsellors, and so on, will not be as effective as they could be without a strong, well-organized department structure backing them up.

The standing committee believes that the amalgamation of the departments -- as had been recommended by the Special Committee on Health and Social Services -- may provide the foundation to that well organized structure. Now that the new department has a strategic plan to guide decision-making, and now that they are also now responding to relevant recommendations -- including those made by this committee regarding early intervention and a school-based youth services model -- committee Members expect the senior managers of the department to improve in their planning and in relations with departmental employees. The emphasis on the "envelope" model appears to have helped, as well. This government has, with this budget, demonstrated a stronger commitment to improving social services to northerners.

There are still some concerns that the new department must address. Chief among them is the implementation of the amalgamation at the regional and community level. As discussed earlier, bringing staff from different departments together is a challenging exercise. Committee Members were concerned to learn that there is no clear strategy for implementation at the regional level. The committee encourages the department to take advantage of the resources

available in the regions and communities to make the merger go as smoothly as possible.

Health And Hospital Boards

With the new departmental structure comes hope of a new and improved relationship between the department and the health and hospital boards. It appears that a memorandum of understanding -- MOU -- will finally be signed this year, allowing the boards and the department to more clearly understand what their respective responsibilities are.

As well, the committee was encouraged to hear that the department is developing a formula for funding the health and hospital boards. This step is long overdue. It is important that the boards manage the resources available to them wisely and efficiently, and the current funding methods obviously do not encourage that. A funding formula will provide the framework necessary for the boards to start managing their resources more carefully, especially in a fiscal climate of growing cutbacks.

Finally, the standing committee is frustrated that progress on establishing health boards in the Dogrib and Deh Cho regions has been so slow. The department has a responsibility to ensure that all regions of the NWT are serviced by local health boards responsive to their needs. Further delay in this area is unacceptable, and the committee urges the department to make this a top priority for the 1995-96 fiscal year.

Mr. Chairman, I would like to turn this over to my colleague, Mr. Zoe.

Committee Motion 26-12(7): To Adopt Recommendation 2, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 275

The Chair

The Chair Tony Whitford

The chair recognizes Mr. Zoe.

Savings On Medical Travel And Out Of Territories Care

Committee Motion 26-12(7): To Adopt Recommendation 2, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 275

Henry Zoe

Henry Zoe North Slave

Thank you, Mr. Chairman. The committee would like to note the significant savings expected by the government on reduced medical travel and payment to hospitals outside the Northwest Territories. With enhancements to the capabilities of Stanton Yellowknife Hospital, more patients can be treated in the north, and the additional travel previously required to Edmonton and other centres is often not required. The new arrangement with the Royal Alexandra Hospital in Edmonton has already greatly reduced the government's costs for out-of-territories care.

Committee Members applaud the department's initiative in these two areas. However, the department can go further. For example, increased use of distance technology can provide improved health care services to community residents while reducing the need for travel. Appropriate enhancements to the use of local facilities -- such as the underused Fort Simpson hospital -- can also reduce the need for travel and provide quality health care to northerners closer to their homes. Finally, the department must do a better job in communicating with northerners. This is an area where health boards can excel; but it will not be possible in regions such as the Deh Cho and Dogrib regions that do not yet have health boards.

Medical Travel Co-Payments

A related issue that concerned committee Members is the planned increases in medical travel co-payments. Currently, when a resident of the Northwest Territories has to travel for treatment, a co-payment of $50 one way or $100 return is levied. The department has proposed increasing this to $125 and $250, respectively.

Committee Members recognize that, for many people, this cost is covered: either by their employer, especially if they work for the government; or by Department of Indian and Northern Development, if they are status. But those who are unemployed, non-status, or working for low wages and benefits, could be seriously affected by this change. For example, a patient who required three trips in a short period would end up paying $750 under the new rates, instead of $300 as at present. That extra expense could be difficult or impossible for some people to cover. The committee wants to see the department provide a way to avoid this rate increase becoming a hardship.

Committee Motion 27-12(7): To Adopt Recommendation 3, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

February 22nd, 1995

Page 275

Henry Zoe

Henry Zoe North Slave

The committee recommends, and I move, that the Department of Health and Social Services implement a cap on medical travel co-payments for patients who require multiple trips in a given period, and who would not otherwise be reimbursed for this expense by their employer or by the Department of Indian Affairs and Northern Development. Thank you.

Committee Motion 27-12(7): To Adopt Recommendation 3, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

The Chair

The Chair Tony Whitford

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

Committee Motion 27-12(7): To Adopt Recommendation 3, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

An Hon. Member

Question.

Committee Motion 27-12(7): To Adopt Recommendation 3, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

The Chair

The Chair Tony Whitford

Question has been called. I don't believe we have a quorum; no, we don't.

I see we have a quorum. When we began ringing the bells nine minutes ago, there was a motion on the floor and question had been called. I will call question again.

Committee Motion 27-12(7): To Adopt Recommendation 3, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

An Hon. Member

Question.

Committee Motion 27-12(7): To Adopt Recommendation 3, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

The Chair

The Chair Tony Whitford

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

---Carried

The chair continues to recognize the Member for North Slave, Mr. Zoe.

Institutional Facilities And Home Care

Committee Motion 27-12(7): To Adopt Recommendation 3, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

Henry Zoe

Henry Zoe North Slave

Thank you, Mr. Chairman. One of the department's biggest challenges is meeting the needs of northerners who, for one reason or another, cannot live well on their own. The challenge lies in balancing resources between institutional facilities on one hand, and home care and related projects on the other.

There are some cases where individuals need to be cared for in institutions, such as homes for the elderly or handicapped. But there are many cases where the best option is for the person to stay in their own home, in their own community, with support provided by a home care program.

Also, because our population is so small and scattered, we have to be careful when we commit large amounts of capital to building institutions. Committee Members noted the example of the new elders' residence in Deline; it is standing vacant most of the time.

This reflects two issues the committee want to highlight. First, the department should try to provide home care wherever possible, both to better meet the needs of northerners who require care but need not be institutionalized, and to save money over the high costs of institutions. As part of this concept, the government must continue to work with the federal government to address the problem of inadequate housing. Often, elders who could be served by home care are forced to move into institutions merely because their housing is inadequate, poorly heated, or poorly constructed. Second, when institutional facilities are planned, the department should exercise prudence and caution. New institutional facilities should be designed to be flexible. If a new building turns out not to be needed as an elders' residence, perhaps it can be used for other purposes.

The committee has noted the Minister's commitment to establish pilot home care projects. Committee Members welcome this initiative, as it is quite an important one, and look forward to the results of these projects.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

Henry Zoe

Henry Zoe North Slave

The committee recommends, and I move, that the Department of Health and Social Services report the initial results of the pilot projects on providing home care to seniors to the Standing Committee on Finance of the 13th Legislative Assembly in time for the review of the 1996-97 main estimates. Thank you.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

The Chair

The Chair Tony Whitford

Thank you, Mr. Zoe. We have a motion on the floor. The motion is in order. To the motion.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

An Hon. Member

Question.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

The Chair

The Chair Tony Whitford

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

---Carried

Mr. Zoe.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

Henry Zoe

Henry Zoe North Slave

Thank you, Mr. Chairman. That concludes the comments of the Standing Committee on Finance with regard to Health and Social Services. Thank you.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 276

The Chair

The Chair Tony Whitford

Thank you, Mr Zoe. Is the Minister responsible for Health and Social Services prepared to take the witness stand so we can go into detail? Sergeant-at-Arms, you can assist the Premier with her witnesses. Thank

you. Would Madam Premier please introduce her witnesses to the committee.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 277

Nellie Cournoyea Nunakput

Yes, Mr. Chairman, I have with me Ken Lovely, the deputy minister of Health and Social Services; and, John Doyle, who is the director of finance and management services.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 277

The Chair

The Chair Tony Whitford

Thank you, Madam Premier. Welcome, gentlemen, to committee of the whole. May we have general comments on the Health and Social Services program. The chair recognizes the Member for Yellowknife Frame Lake, Mr. Dent.

General Comments

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 277

Charles Dent

Charles Dent Yellowknife Frame Lake

Thank you, Mr. Chairman. I have a question for the Minister about her opening statement which I would like to get some clarification on before we proceed with the department. In her opening statement, she refers to a copy of the budget supplement document that summarizes the cooperative efforts that are under way. Mr. Chairman, I know that the Standing Committee on Finance has received a budget supplement document but the documents received by the Standing Committee on Finance are considered confidential. I wasn't aware that other Members of this House have been provided with this information yet. I think in order to consider the departmental budget, this document is essential. I was wondering if that document has been made available to all Members of the House yet.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 277

The Chair

The Chair Tony Whitford

Thank you, Mr. Dent. Madam Premier.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 277

Nellie Cournoyea Nunakput

Mr. Chairman, the reason I referred to it was that I assumed that it was distributed. Thank you, Mr. Chairman.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 277

The Chair

The Chair Tony Whitford

Thank you, Madam Premier. Mr. Dent.

Committee Motion 28-12(7): To Adopt Recommendation 4, Carried
Item 20: Consideration In Committee Of The Whole Of Bills And Other Matters

Page 277

Charles Dent

Charles Dent Yellowknife Frame Lake

Mr. Chairman, I do not believe that other Members have copies. Other ordinary Members have told me that they haven't seen the budget supplement document yet. I would suggest that it might be inappropriate for us to proceed until all Members have had a chance to have a look at that document and be prepared to talk about the department with the Minister. I think that it represents a significant course of action that is proposed by not just this department but by all the departments in the social envelope. I think it's important that all Members have that document in hand as part and parcel of budget consideration.