Thank you, Mr. Chairman.

Thank you. There was no point of order. Mr. Erasmus.

Thank you, Mr. Chairman. If we do not have these notes now, we are going to have to read it later on while other people are speaking and we are going to miss what everybody is saying. We can not do our job properly.

Thank you. As the Minister indicated he has a copy. It is being distributed to Members, and I believe there was no point of order, no point of privilege. I think two honourable Members know the rules. If they do not, then I understand that. I think two honourable Members were trying to gain the floor in an appropriate manner, if they did know the rules. If they do not, there was no point of order, no point of privilege. I will allow the Minister to complete his opening remarks. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, looking towards the future, we will be reviewing the opportunities for sharing services, considering different options for out-of-territories arrangements, determining whether the needs of the systems in the east and in the west will require different ministries' structures and functions, and whether the ministries of boards in either territory will offer services to the other territory. In the short term, Mr. Chairman, we have already had to make some difficult decisions in planning our budget. We have had to close facilities and reduce funding for programs. However, with the help of our stakeholders, we have also been able to strengthen our support to some urgent areas of need and to continue our emphasis on ensuring a continuum of care based on home, community, and regional resources.

One of our major challenges in the NWT is support for people dealing with addictions, particularly young people who use alcohol, drugs, and inhalants. In 96/97, we outlined a funding plan for treatment centres that will give the centres much more flexibility in program design and delivery and allow communities an opportunity for more control over treatment for people with addiction problems.

Phase two of this funding plan will provide 50 percent core funding to treatment centres, the balance will be based on occupancy. One treatment centre, Delta House in Inuvik, will lose its core funding. Funding to Northern Addiction Services in Yellowknife has also been reduced. While NAS has the flexibility to determine where program reductions will be made, it is anticipated that the major reductions will be in the detox area.

The problem of youth addictions continues to be a major concern across the Northwest Territories. However, the federal government withdrew its pilot program funding for the Youth Inhalant Abuse Program. Because this is such a critical area of concern, I have directed the department to support that program for 1997/98. In trying to reduce the problems resulting from addictions, the prevention and support programs provided by community projects are critical. To support this, the overall level of community project funding will continue, although the department will ensure a more equitable distribution of resources among communities.

Community control and participation is also important in caring for people who need help living independently. By strengthening our home care supports, people can stay in their home communities longer with less reliance on facility based care. The department can no longer maintain small hospitals whose beds are not effectively used. Consequently, the Fort Smith and Fort Simpson hospitals will be reprofiled. As well, the department will evaluate all eight to ten bed, long-term care facilities.

We have already concluded that 24 hour residential programs are unsustainable in three to five bed facilities and will be moving towards closing them. Consistent with our effort to provide a coordinated continuum of care and an integrated delivery system, work on the Inuvik and Iqaluit hospitals will only proceed when their respective roles within an integrated health system are clarified. Our objective in introducing these changes ensure the availability of care as close to home as possible, to strengthen home supports and, by reducing inefficiencies, ensure the long-term sustainability of the system.

The Community Action Fund was initiated in 1995 as a one year funding arrangement to provide resources for community groups to develop action plans for community wellness. This fund was extended for an additional year in 1996 to allow communities more time to progress with their planning activities. Many communities responded and have developed broad based plans for community action. However, it is now time to move from the more general planning activities to focus better on the areas where the most long term benefit can be realized. Consequently, the Community Action Fund has been eliminated from this year's budget.

A major new initiative designed to produce long term benefits by focusing on helping young children, the Early Intervention Initiative is being introduced in the coming fiscal year. Some of the activities funded under the Community Action Fund will qualify for funding under this new initiative. My colleague in the social envelope, the Honourable Charles Dent, will be speaking to the Early Intervention Initiative in his budget. It is an area where, by re-directing funding, we know long-term benefits can be gained.

One other area of continuing concern is the cost of medical travel. While most boards have managed to reduce the rate of growth, costs continue to climb. The department will give some relief to boards for medical travel. We will address the current funding shortfall and anticipated force growth next year. Despite efforts that have already been taking to reduce the inappropriate use of travel funding it is still apparent that we must press further. To accomplish this, the department will withdraw a portion of their funding for non-medical escorts. Mr. Chairman, with regard to medical travel as well as all other expenditures, it is important for spending decisions to be made at the point where the money is spent.

In the past, the department has held medical travel and other monies, while regional and front line staff have decided how these funds would be spent. This division of responsibility and accountability does not work. To rectify this, a funding allocations system is being developed so the department can fund boards equitably. This funding allocation system will also pave the way to an appropriate sharing of resources between Nunavut and the western territory.

Introduction of a formula based approach to funding will increase the accountability of boards for their expenditures. For the boards to be fully accountable for their decisions, they must also take responsibility for deficits and must be allowed to retain surpluses.

In addition to having greater authority over their budgets, boards also need access to timely and relevant information. To improve this capability and to help the departments and boards make good decisions, the department is improving its monitoring and compliance systems.

This will have the result of ensuring that community, regional, and territorial information is available on which decisions can be based. Mr. Chairman, I have highlighted some of the actions the department has taken in the 97/98 budget by working together and by taking responsibilities for health as individuals and communities. I am confident we can ensure residents of the NWT continue to receive high quality health and social service programs. Thank you, Mr. Chairman.

Thank you. I believe the Standing Committee on Health and Social Services is the committee that has reviewed this particular department. Mr. Enuaraq, do you have an opening remark on behalf of the standing committee? Mr. Ootes.

Point of Order

Thank you. I believe that the Minister wishes to respond to that and I will allow the Members who wish to speak to a point of debate. In this case I have Mr. Deputy Premier.

Mr. Chairman, I understood that the documents were at the Clerk's table before Mr. Ng had started to speak. We will ensure that all departments, all Ministers, after Mr. Ng, will distribute the opening remarks at the same time as the Minister starts to speak on the matter.

Thank you.

Thank you. Mr. Picco.

Thank you, Mr. Chairman. Mr. Chairman, passing out of the documents, we just want to point to the point of order by Mr. Ootes, which I think is a good one. It was

not translated and I think every Member here has the opportunity to be treated equally. If Mr. Arlooktoo gave a statement, for example, all in Inuktitut and passed it out in Inuktitut, I am sure all the Members would have raised a point right away and said that was not fair to them. We should not be infringing on anyone's rights just based on language. I would appreciate that, if there are any statements coming out that, they are translated. Maybe it was just an oversight, but it is not acceptable. Thank you, Mr. Chairman.

Thank you, Mr. Picco. Deputy Premier, Mr. Arlooktoo.

Mr. Chairman, just to clarify that the Department of Executive gives the statements to the Legislative Assembly and then it is the Legislative Assembly's responsibility to get them translated, I believe, or else we use the same translation services. To that end, on behalf of the Legislature, I would like to apologize to Mr. Evaloarjuk if he was inconvenienced. I would point out to the non-Inuktitut-speaking Members too that, because of the sentence structure, et cetera, it is impossible for anyone to follow through reading Inuktitut, while someone is speaking in English. It just does not work. Thank you.

Thank you. Point of privilege. Mr. Ootes.

Point of Privilege

Qujannamiik. We agree. What has been said has been noted. Thank you. The honourable Member did not have a point of order, but it was a good point to raise here in this forum. We will take the matter under advisement at this point. I thank the honourable Member. On behalf of the Social Programs Committee, Mr. Enuaraq, do you have any opening remarks? Thank you.

(Translation) Thank you, Mr. Chairman. (Translation ends)

Health and Social Services

Strategic Planning

The department provided a very good overview of its strategic planning process. Members of the Committee were pleased to see this work and believe that a strategic approach to the health and social services network is long overdue. We like the approach the department is taking in reevaluating just what is possible and what services the department should be providing. Although this plan is still in the developmental stage, Members at least have a sense that there is care and attention going into developing the options to be presented along the road.

We were also happier with this year's main estimates. Although it was not as fiscally ambitious as last year's plan. We believe it is more realistic and achievable.

As part of the main estimate's review, the department's project teams provided extensive briefings on the strategic work which is under way. These briefings were an excellent way to allow Members to understand and contribute to the overall departmental strategic direction, as well as more specific program directions. We believe the approaches outlined in the the briefings were fairly concrete. We have since discovered, through alcohol and drug funding allocations, that the project teams' work is still incredibly fluid. The Committee hopes that this year the department will be able to translate these projections for reductions and program changes into reality. We cannot afford to have the degree of slippage that occurred in 1996/97.

As the project teams carry out their work, there are some points we would like to raise. First, the Committee is supportive of the overall shift of emphasis from treatment to prevention. We recognize that, in the first few years, there will be additional costs before the impacts of the prevention efforts are seen in reduced treatment costs.

Second, we are concerned about the use of national averages in determining an appropriate level of health care, such as the number of beds needed for long-term care. While these averages give a starting point, we must also remember the extremely high levels of social problems we face here in the north. While we can work towards national averages in areas like bed space, we need to get our social problems down to the national average first.

Third, there are great advances in technology in the health field. The department is pursuing some of these opportunities such as telemedicine, while others, like electronic eye examination equipment, are still to be considered. The Committee encourages the program teams to view any and all options with an open mind, particularly if it can improve the quality of health care in a cost-effective way.

The Committee generally supports the strategic direction outlined by the Minister. However, this direction will require a major shift in the way health and social services are provided to northerners, and in how northerners think about these services. If this approach is to be successful, it must be understood and accepted by the public, the practitioners and the boards. Communication will be the key to allowing these fundamental changes to happen.

Alcohol and Drug Treatment

The Committee expressed the concern last year that there was a need for a new direction for alcohol and drug treatment. The department is now working on that new direction. The department indicated that at least one facility would be shut down to encourage greater use of the remaining facilities. Committee Members suggest this should be done carefully, addressing the current need and maintaining the current capacity in use. As the department addresses the surplus, it is crucial that it does not over-compensate and close too many beds. This is particularly important as centres are looking at their programs and determining what new approaches would make better use of their space.

For the treatment centres which remain open, there must be some core funding to provide them with stability. While we supported the move to a partial per diem rate, we do not support 100 percent per diem funding. As part of the program review, the issue of core funding needs to be considered along with other elements such as regional parity and rationalizing facility closures.

Although we think the idea needs more work, we are supportive of the initial suggestion to look at mobile treatment. The Committee agrees that there will be clients who stand a greater chance of success if programs are delivered closer to home. This would link all of the support network for an individual together to give long-term backup after the initial treatment is over.

In the past, northern treatment centres have not had the same degree of success as southern facilities. The lack of success often stems from the referral and follow-up services for clients. One of the current rehabilitation program's downfalls is the lack of proper client assessment. We need proper assessment and after-care to maximize people's chances of successfully completing treatment. It is important, as a starting point, for communities to enforce the existing policies requiring sobriety and community counselling before a referral can take place.

We also believe more thought is required before implementing the various funding pools for alcohol and drug programs and treatment. While there is a desire for regional autonomy, there must also be continuity in the use and established programs and services. The allocation of funding must ensure that continuity.

While there may be no reductions to the overall budget for community alcohol and drug funding, the department is proposing a more equitable allocation between communities. Some communities will see a significant increase in alcohol and drug funding, while others will see a decrease. While we support the move towards greater equity in funding distribution, we also encourage the department to be aware of the impact of this change on existing alcohol and drug services in some communities.

As a final component in ensuring stability in alcohol and drug treatment, we need to ensure that alcohol and drug workers are properly trained and compensated. The level of wages for these workers has been a concern for a number of years, which Members believe must be addressed in some way. The strategy for reductions and changes in alcohol and drug direction and funding has been in constant flux since we began reviewing this budget in October, 1996. The Minister recently indicated to the committee that further changes are being made. Given uncertainty of the final direction, we find it difficult to approve the alcohol and drug strategy.

Recommendation No. 10

The Standing Committee on Social Programs recommends that the alcohol and drug strategy in the Department of Health and Social Services should not be implemented until the final strategy is reviewed and approved by the committee.

FAS/FAE Strategy

The committee would like the department to pursue the two key priorities of the FAS/E strategy team. These priorities are:

- to pilot a comprehensive treatment program for pregnant women with substance dependency issues; and

- to develop and deliver a standardized, modular training program on FAS/FAE with materials in plain language.

The recommendations fit into the program reviews and priorities of the department. In particular, we see opportunities in the alcohol and drug programming reviews and in the early intervention program for supporting the key priorities of treatment for pregnant women and education/training on FAS/E.

Recommendation No. 11

The Standing Committee recommends that the Department of Health and Social Services support the two key priorities identified by the FAS/FAE strategy group.

Home Care

The department is suggesting home care as the entry point for all long-term care. We support this approach which is consistent with supporting people to live independently. As the planning proceeds on this program, we expect to see clear standards developed for the use of long-term care and the role of home care. This is a program where we can see great opportunities for productive choices for those accessing income support. It is one more thing which can be added to a list of possible choices in the material provided to income support workers.

Inuvik/Iqaluit Hospital Replacements

There has been significant confusion about the status of the Inuvik and Iqaluit hospital replacements. The Minister has indicated that the need and use of both of these facilities is part of the project review of the health network (hospitals and health centres). There is a need for concrete, decisive action on these facilities. We hope the Minister will be in a position to honour the commitments to build these facilities no later than 1998/99.

The Minister provided written confirmation that the agreement between the GNWT and the Federal Government will not be sunsetted on April 1, 1999. The Committee has asked the Minister for written clarification of the Federal Government's share of the funding and we hope that will be provided shortly.

We encouraged the Minister to consider alternative funding sources and methods of funding capital projects to allow these projects to proceed as quickly as possible. If the Minister determines it is possible to look at alternate funding, it may also be possible to use a similar approach to address projects which have been delayed such as the health centre in Arviat.

Recommendation No. 12

The Standing Committee recommends that a decision be made on the Inuvik and Iqaluit hospital replacements to allow the projects to begin no later than fiscal year 1998/99.

Mr. Chairman, if it is okay with you, I would like to ask my deputy chair, Michael Miltenberger, to continue with the report.

Thank you, Mr. Enuaraq. Mr. Miltenberger.

Yes, Mr. Chairman. Thank you.

Agreed.