Thank you, Mr. Chairman. I just want to briefly highlight some of the areas that I want to have further discussion on, when we hit the appropriate activity. I want to ask the Minister and his staff for updates on some of these long awaited reforms. We have been told this would be our third budget. We understand the broader strategic one has been ongoing for years and could carry us to division and beyond. I would like, as well, to find out what is happening with the Care Facilities Reform which we have been talking about and waiting for. I am also interested in information about the alcohol and drug reforms, changes that were made and how those are working. Have they met the goals that were anticipated when the changes were made? Mr. Chairman, I stay in fairly close contact with the board chair and the CEO in Fort Smith, and I am also very concerned about and interested in getting any further information on the kind of board support that is being provided or not being provided. There are apparent mixed messages in some areas in regard to what kind of reprofiling should or should not take place. I am very concerned about the department's latest messages that apparently it is not up to the department to decide what kind of service should be provided, but is up to the boards to, I suppose, guess as best they can as to what kind of services they might want to consider in terms of reprofiling. I am very concerned about the partnership arrangement that should exist, in my opinion, between boards and the department. There is clearly a coordinating function that has to be played by headquarters. I would like some information. I asked you earlier about the relationship between ORMED, FIS, and Star Master and the confusion that may or may not still be there. I should point out, Mr. Chairman, before I go on to some other questions I will be asking, there is a sense of apprehension in the community I represent in some cases, there may be another agenda that the Department of Health and Social Services has not put on the table in terms of the reprofiling exercise. I would, of course, like some information on that.

There are some child welfare issues that I think we have to address. Once again, the feedback I am getting from the South Slave and specifically the community I represent is that headquarters is not in a position to provide clear direction in terms of child welfare, the new changes that have been made and the function of the superintendent of child welfare itself. I was given an example that a social worker called on a serious child welfare incident; for example, and was told they should not be bothering the superintendent of child welfare because that is a very busy position and that basically the staff should figure it out themselves. I want to make sure that, in our amalgamation and the move toward bringing the departments together, we do not forget this very, very critical issue. It is such a critical one, in fact, that we made extensive changes to the Child Welfare Act to try to reflect the concern and the need to update. The concern has been passed on to me that we may be seeing, in fact, the disintegration of the role of social workers as we know it and that nurses are being trained to do apprehensions, but at the same time, you do not see that kind of plan being envisioned for social workers. Their role seems to be downgraded when, in fact, this is probably one of the greatest areas of concern in the Department of Health and Social Services.

I will have questions in regard to board development and what this means and the need for the department to in fact play a very clear leadership role. We cannot rely on Mr. Chang, who may be doing a very good job and happens to be teaching a curriculum that the department may agree with, to set the standard and make sure there is a coordinated and integrated approach to board development which I think we all recognize is critical if we are going to, in fact, have boards that are functional.

I would also like further information about the support services the department is setting up to provide board support. I am interested as well about this think tank the Department of Health and Social Services is involved in. We have folks, and I met one of them in the NorthwesTel Building, sitting on one of the higher floors in the NorthwesTel Building doing good things, apparently. What those are, I would be interested in knowing, and what kinds of plans and directions are they geared toward?

I would also like, Mr. Chairman, some feedback on the Healthy Children's Initiative, and I see we are still pouring hundreds of thousands of dollars into wellness. The concern has always been that we are pouring money into these areas, but we have no criteria for evaluation. Are we getting value for money or is this just free money for the communities to basically do what they will? This was the concern before, and I do not know if that has been addressed to alleviate that concern.

The final couple of issues, Mr. Chairman, that I would like to question further, when it is the appropriate time, are the vacancy rates by region for social workers and nurses. I understand there are some significant percentages of vacancy rates that cause me great concern. While they may not be evident in the riding that I am from specifically, if it is a problem across the north, then we should know about it, and we should take the steps to address that.

Finally, at the appropriate time, Mr. Chairman, I would like the Minister to indicate when he anticipates the Adoption Act being brought before this House so that we can conclude that final chapter of the Family Law Review and all the other good work that has been done.

As you can see, Mr. Chairman, I have a number of issues I would like to discuss. There is one I forgot. Of course, it is Trail Cross. I have very strong concerns about that as well, not just the actual physical structure but the program itself. I am hoping everybody is planning to be here at least for today to address some of the concerns I have. Thank you, Mr. Chairman.

Thank you, Mr. Chairman. Briefly, in the Minister's opening remarks he talked about the strategic plan that will provide vision for Health and Social Services for the decade to come, and he expects it to be, hopefully, completed in May, 1998. It would be nice to see before we actually get into division what we are heading into besides knowing that a plan is being worked on. This has been one of the concerns I have had as well, especially since the department will be working with the boards to develop a comprehensive business plan based on the strategic directions of the overall Health and Social Services system. There are a number of items there. My concern would be, as brought up earlier, last week, with the Inuvik Regional Health Board and my specific questions which I will bring up later on in the appropriate section which has to do with funding levels and Cabinet decisions as to how they impact those funding levels. It has been just over a year since the closure of Delta House. Although the Minister at the time in an Inuvik meeting made a commitment to support, as they now call it, a turning point helping them work on other initiatives. I am disappointed as are members within the community that the help that was offered did not seem to follow through down to the community when the crunch came. It was like pulling teeth in some instances. So I would have questions in that area. Although, they have moved to another area, they are trying to provide some services within the community when it relates to drug and alcohol, which has been severely reduced but they are still trying to provide some service to the individual. I will be asking questions in the appropriate section when it comes to the amount of funding we are spending in sending out patients. I am speaking of medical and travel dollars as well as costs for the individuals to be in another facility.

Hopefully, this framework we are talking about will establish a solid criteria where all health boards will know, and it will be clearly labelled and spelled out, that the process which is to be followed when it comes to health care for individuals in the Northwest Territories. Although there should be some flexibility, all people across the Northwest Territories should be eligible and able to receive medical health for items that are open and offered to all residents of Canada. Of course, I am interested in the process of the Inuvik Hospital and its financing, when it comes to the federal government. Hopefully, the Minister can update us as to what is happening in that area. I think that we have come a long way and the last two budgets we have gone through without a lot of discussion. We are moving in the right direction of giving communities control of developing systems, but once again, I must say there needs to be a framework in place where all health boards are expected to operate. Thank you, Mr. Chairman.

Thank you, Mr. Chairman. I would like to ask 1,000 questions on this department and especially in regard to health and social services, the Tl'oondih Healing Camp and child advocacy. Those questions have not changed my mind that something has to be done to the system to improve it versus making the notion that when we establish regional health boards now our problems are solved. All we have done is moved the control from one sector of the government to a newly formed sector. Yet the people in the communities still do not see changes they were hoping to see from anything they want in the way of developing drug and alcohol programs to how their medical service is going to be improved or the whole question about vacancies within the health system. In regard to my riding, the last time I checked there were three vacancies in Aklavik and two in McPherson. McPherson serves the Arctic Bay riding. At any one time there is only one nurse on call and she has to serve two communities. This has to be seriously looked at in regard to the quality of health care that we are presently delivering to the people in the communities.

There is the whole notion of devolving powers to the regional health boards that they were going to be closer to the communities. I will use an example, the Tl'oondih Healing Society, who has put forth four proposals to the Inuvik Regional Health Board looking for different funding to deliver alcohol and drug programs in the community of Fort McPherson. It has received only one reply to the latest proposal they put in just last week. I wonder if that is the case because they have a surplus in the regional health board's budget. A motion was passed in this House in which I received support from my colleagues and committee of the whole to recognize the Tl'oondih Healing Program and to direct the Minister to work to find sources of funding so the program could follow through. Very little has happened in that way to ensure that there are funds to carry on such a program.

The other area that I basically have concerns about is the whole area of community wellness and ensuring healthy communities. Because of the funding is presently being distributed to run alcohol and drug programs in the communities, the mental health workers to whom those funds have been distributed are so limited in carrying out that job in the communities that it is hard to even attract people to work within those different sectors because of the limited resources they have and the demands on them.

The other area I mentioned was Child Advocacy in regard to the children in our society, especially the ones who are under the care of this government, either being incarcerated in youth facilities or being put into group homes or what not. There has to be some system in place to ensure that children have an avenue to raise their grievances. I attended a conference in Winnipeg last year in which there were child advocacy groups right across the country. They have done a lot of good things. We hear the Liberal government stating that their main platform is children and youth. When it comes to this government, when you talk about child advocacy groups or things that could improve the system, working with other organizations across Canada who have developed the programs where they have legislation in the different provinces and who are able to have some clout and teeth in regard to making decisions in the way children are being treated when they are in custody of the government, when they are being transferred between correction facilities and young offender facilities or even in regard to the care they have been put in through foster care or whatever; there has to be an avenue there that they do have a group or agency where they can raise these grievances, so they are heard. We cannot continue to institutionalize our children to basically become another statistic on the wall of how many children we have in facilities or how many children have been taken away or how many are becoming street children. We see that in Yellowknife and other areas where you see a lot of runaways.

We have to look at what we have done over the last three years and see exactly if it is really working meeting the expectations that we all had when we put this new way of delivering health care to the people in the communities in the region. Is it working? Just like anything else, it is a process of learning and we have to continue to improve things to make them better. In the case of health care, what we have heard from the medical association from different doctors that there is a real crisis with regard to the health system in the north. There are vacancies in different areas of the infrastructure and in the whole area of health care delivery in general. We have basically taken the system which used to be one organization, split it up into four or five different categories and expected the same thing. We have to look at the whole area of community wellness and community health care in light of statistics in regard to events we have heard from the RCMP saying that they realize the cost to this government not only in the health costs but in the social costs in regard to justice is skyrocketing because of there are no programs for rehabilitation not only for the inmate himself but also to the people affected in the communities.

There has to be a mechanism that we can deal with these problems at home, in the communities and not to allow these problems to be resolved by just putting people in institutions. We have to find a way to find more funds and resources to be able to improve program delivery and services in the smaller communities. We say we are empowering communities by allowing them to deliver Community Wellness Programs and other programs but with the amount of resources they have and the limited human resources which they need to adequately do their job, it is not there. We have to seriously look at what has been done and exactly where we are trying to go. We have to take note that there are other factors we have to consider, such as the increase in birth rates, high employment rates we have in our smaller communities and the cultural differences people have from different cultural ethnic groups which are in the Northwest Territories.

The question I have asked the Minister over the last couple of years I ask sincerely because something has to be done to improve the communities I represent. Regarding a lot of these questions that I ask, no effort whatsoever was taken by your department to even try and consider some of these ideas. I will continue to ask questions, raise concerns, pass motions and nay this and nay that, but that is what I will have to do. Thank you, Mr. Chairman.

Thank you, Mr. Chairman. I would like to make some comments that we received from the Northwest

Territories Medical Association. Some weeks back they appeared before Members of the Legislative Assembly with concerns with regard to the provision of health services. I would like to just review some of those concerns they had.

The Medical Association, first of all, had some comments with regard to the Med-Emerg Report, following that with regard to the strategic plan and in general the state of health services in the Northwest Territories.

Perhaps I can just review some of those comments, then refer to a document by the NWT Nurses Association as well. The doctors appeared with us and they met with us for about two and a half hours to discuss their particular concerns. Most of their concerns were with regard to regionalization.

They pointed out that while there is no doubt some advantages to regionalization, there are also tremendous disadvantages. Their concern was mostly in the area of fragmentation of fiscal and human resources and discrepancies in the access to health care.

They are concerned about the changes being made in the delivery of health care by the regional boards and the potential for destabilizing the system. What they point out is that the people who are working within the system are the most important resource. The health care workers have kept the system going but the health care workers feel they are not being adequately supported in many cases by the regional boards. Doctor David Butcher, who is the president of the association, feels very strongly that economics is driving this system because the department has established a method of funding that we traditionally refer to as formula funding. He is of the opinion, along with his association, that funding should be done for programs, not just strictly by formula funding. That, because of this, the department's effort and approach is to strictly save money. The concern has to be with the quality of service being provided, not just with respect to the money. He stressed that. He stressed that the most important point to be made is the quality of health care and that any reforms or devolution of responsibility should focus on maintaining and improving the quality of health care.

He felt that models should be designed and if they are successful, fine, proceed with the next stage. If they are not successful, you have an ability to go back. Go back and regroup and redo it in a different way. He felt that there must be territory-wide standards and a need for leadership by the department in this whole area. Otherwise, each particular board can go in its own direction. One example that he made, and he stressed it very much, because he also has spoken on this area and I know everyone here is likely tired of hearing me speak on it; he made reference to it continually and that was in the area of breast cancer.

Now each board sets its standards and chooses what services to deliver, how to delivery it and each particular region can make that decision. He feels we need to ensure a plan is in place for appropriate training of staff for hospitals and clinics that there are adequate numbers of staff in place and that all institutions are credentialed institutions. Apparently, outside of one or two of the hospitals, none of the nursing stations or clinics are credentialed in the Northwest Territories whereas everywhere else in the country, they have to be.

Dr. Butcher was very concerned that we are placing a great deal of expectations on the boards, but they do not have the governance process in place. They also lack many, of what we would call, well-trained people to run the boards and to run the organizations. One of the examples used was the Keewatin. His term was, around the Christmas, January period, we had to send in a swat team because critical levels of staff started to fall off.

They made some very dramatic statements, Mr. Chairman. One of the doctors in our meetings stated that the system as a whole is in a critical state and needs a lot of attention.

Another point they made was there is a potential for professional liability to the boards. The boards are mandated to provide the health care, but we understand they are not adequately and in some cases, have no appropriate liable insurance.

The regionalization process has created a fear of loss of quality health care. That needs to be addressed and it has to be addressed on an ongoing basis. Now turning to the nurses' recruitment retention survey, a survey was done in 1997. It does not provide a lot of glowing reports. It is not a glowing report. It certainly is not a very complimentary report when it comes to the department and addressing their concerns and how the staff themselves feels about where they are at. Here, I have highlighted a few of their remarks, poor staffing leading to burnout, stress, heavy workloads, demanding jobs emotionally, long hours, high cost of living, lack of continuing education or in-service orientation, no education leave, no in-service on equipment and continuing education. That is just flipping through two pages. It carries on in that fashion, Mr. Chairman.

In here also is a report on nurse requirement and retention survey response done on the Keewatin in January, 1998. There is a table here that indicates that the most serious shortage of nurses is in the larger communities in the region is in Rankin Inlet, Arviat and Baker Lake. It is evident from this chart they have provided. There is no question in my mind that the department needs to pay attention to what the medical practitioners are saying. It is okay to have some rhetoric on it. I think when the medical association asks for meetings with the MLAs, and the nursing association presents reports like this, then there has to be an awareness that there are some serious concerns out there.

Finally, I would like to take a moment, the Yellowknife Stanton Regional Hospital is on a fund-raising drive right now to raise some $2 million plus and I commend the people who are doing that, but I have some concerns in that I hope this is not the trend of the department's attitude toward funding of medical needs in the Northwest Territories. While it can be done here, perhaps with Stanton, I am not sure that any fund-raising drive in one of the regions would be that successful. I do not think you can ask the Inuvik region, which is already suffering tremendously from a loss of people as Mr. Roland continually and very eloquently points out and very passionately that there are problems there. Now Iqaluit is going into a bit of a boom time. But again, the business community might not be there to support any fund driving system. So I guess my concern is that this does not be looked at as a precedent but from now on, okay, if we need anything we have to go into a fund-raising drive. That is not the way our health care should work. These items they are raising money for are very essential. There is a CAT Scan Program. The government in turn, if we get this CAT Scan here, the government itself will save many hundreds of thousands of dollars per year because of it because there is no travel anymore.

So those are my remarks, Mr. Chairman. Thank you.

Thank you, Mr. Chairman. Mr. Chairman, my general comments will be centred around what I feel is better monitoring now that we put in place cuts to the regions. Most of these cuts are through the boards. I feel this department should now be monitoring to see where it may be necessary to increase funds again in order to supply good quality health service to the communities. One of the obvious weak points is sufficient funds for the boards to recruit qualified nursing staff for the communities. I think it may even be necessary to ensure the boards have sufficient staff so they can rotate staff due to the remoteness of the communities and insufficient recreational activities and things like that for the nursing staff in the communities. Great consideration should be taken for the amount of work the nurses are required to do especially if there is only one in the community, if they are rotating, somewhere on holiday or other types of leave. It puts a big strain on the staff who is left. They do not really have all that much private time to themselves. They end up with burnout whereby eventually the nurses feel overstressed. In particular in small communities, there are a lot of night activities which, in the end, some of it require hospitalization or treatment by the public. Of course, the nurses are the ones that all this falls on. I think it has to be taken into consideration that these nurses should be allowed to have breaks, even twice a year. If they are satisfied with twice a year breaks, then perhaps we should be looking toward that, allowing the health boards to have sufficient funds to allow for this. It may not be necessary to give them breaks all the way to Edmonton. Even to a larger centre is maybe all that is needed. This could be tied in possibly with training and other functions that would have been funded anyway. I see this as one of the major shortfalls at this present time to ensure there are sufficient funds to the boards for full-fledged nursing staff.

The other thing I would like to see coming out from the boards, and I notice that Stanton Regional Hospital does this, is a newsletter to the public whereby the public has some idea of what is being done in the boards, what services are available, just a general newsletter. I noticed Stanton Regional Hospital was very informative on those particular points, and it was quite well received by the public. I notice that in the opening statement by the Minister, he refers to consultations on the strategic plan and that summary reports of these meetings are being prepared for distribution for participants and boards. I think these reports should be very informative to the MLAs as well. We know what concerns are being expressed by the communities even though we are not present at the particular meetings. I personally would like to see that happening.

The only other point that I can make, Mr. Chairman, is as I stated in questions to the Minister, early in January, I would have like to have seen in place, and the department is working that way now, some form of management group that would do a quarterly or semi-annual review of the boards and how they are progressing and whether or not there are any problems starting to surface. So that there is an early indication and the department has a chance to help out with the communities or with the boards to be able to respond to any concerns that are being expressed in the regions if those concerns are board related and assure that the boards are, in fact, taking into consideration concerns expressed by the communities. I think this would benefit both the boards, the public and the department in general. With that, Mr. Chairman, I am prepared to go through the department's budget. Thank you.