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.