(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.