Thank you. Page 16, Bill 20, Wildlife Act, clause 30(33).

Thank you. Can we agree that Bill 10 is ready for third reading as amended?

Thank you. Bill 10 is now ready for third reading as amended. I thank the honourable Minister and the witnesses for appearing before the committee.

Thank you. As we agreed at the starting of this committee, we will proceed with Bill 8, Health and Social Services budget, 1998-99 main estimates. Agreed?

Is the honourable Minister now ready to make an opening remark on behalf of the Department of Health and Social Services, Mr. Ng?

Mr. Ng, I know that time is of the essence but we have a translation here. Would you please slow down a bit. Thank you.

--Laughter.

Thank you, Mr. Minister, for your understanding again. You slowed down a bit. That helps. Appreciated. Thank you.

On behalf of the social program committee, I believe Mr. Miltenberger has an opening remark.

Thank you, Mr. Chairman. The committee was generally satisfied with the presentation of the main estimates by the department. The figures corresponded to those contained in the business plan and the capital plan as previously reviewed by the committee. The committee also noted that so far, the 1997-98 revised main estimates match the original estimates and hopes that this will continue to year end. The committee recognizes that the main estimates are a fluid document and those changes in the information contained within them will occur over the course of the year due to division related activities. In conducting its review of the 1998-99 main estimates of the Department of Health and Social Services, the committee made note of the following issues.

Hospitals and health care centres, the construction of the Inuvik and Iqaluit hospitals should remain a priority for the department. The committee is pleased that a funding agreement for the two hospitals is anticipated to be concluded with the federal government in the near future and that planning continues for replacement of these facilities. The committee wishes to be provided with the terms of the funding agreements for the two hospitals as negotiated by the department and the federal government and to be kept apprised of any developments regarding the construction of the hospitals. The committee also understands that the Arviat Health Centre was a victim of restraint in previous years and had to be rescheduled in the five-year capital plan. However, the need has become critical and the committee encourages the department to ensure that this project remains on track. The committee recommends that the department ensure that these projects proceed as scheduled and review all hospitals and health care centres as possible candidates for Private/Public Partnerships funding in the upcoming years, should that initiative receive approval from this Assembly.

Strategic Initiatives Fund, the committee was concerned that there was no real methodology as yet, by the department for accessing the funds available under this initiative. The committee agrees in principle with the department's position that $2 million of the $4 million fund to be allocated to address funding deficiencies for the Dogrib community services board, the Baffin regional board and the Keewatin board. However, there is a concern that by focusing initially on these three boards, they may have an advantage in accessing the other $2 million not specifically targeted at them. The committee is very anxious to review the department's plan for the access of funding available under the Strategic Initiatives Fund. The committee wishes to review the guidelines as soon as possible to verify that all boards have equitable access to this program.

National health care standards, the committee is concerned that under current fiscal restraint measures, the NWT may not be meeting the minimum national health care standards. With $4 million available in the Strategic Initiatives Fund, it is important that reference be made to the basic recommended standards when considering the funding allocation.

The use of remote technology in health care, the committee generally supports the department's efforts in this area. When properly set up and administered, these technological advancements can benefit the residents of the Northwest Territories. The majority of the Members of the standing committee were concerned, however, that this technology should not be used by the boards or the department as a method to reduce current levels of qualified medical personnel. Members are aware that this technology allows real time contact between the health practitioners but emphasizes that it should not be viewed as an acceptable step toward replacing a doctor with a nurse or a nurse with a nurse's aid. The committee looks forward to being supplied with more information on the successes and application of this technology in the Northwest Territories.

Mr. Chairman, I will ask my colleague from the social program's committee, Mr. Fred Roland, to continue and complete the report.

Thank you, Mr. Miltenberger. The honourable Member for Inuvik, Mr. Roland. Carry on please.

Thank you, Mr. Chairman. Program evaluation and monitoring board standards. The committee was pleased that the department is fulfilling its responsibility to ensure adequate access to health care and will be providing the boards with a measure of assistance. The committee was very concerned that all residents of the Northwest Territories receive equal access to all programs funded by the Government of the Northwest Territories. Members understand that the present funding arrangements allow the boards flexibility to deal with the concerns in their own jurisdictions. However, it must be made clear to the boards that they are responsible for the delivery of all programs funded by the government and cannot select programs to deliver. Over the course of the last year, it has become apparent that the devolution of responsibilities to the boards may have occurred at a rate faster than the board's ability to absorb the changes. Members feel that a uniform set of guidelines on the standards to which boards are expected to adhere would assist the boards to take on new programs and services. The committee looks forward to receiving some terms of reference for the program evaluation and monitoring division and would like to review copies of the guidelines and standards developed for the boards at the earliest opportunity.

Administration costs, in discussion with the Minister, the committee learned that administration costs averaged between 8 percent and 12 percent at the board of management level. It is hoped that this percentage can be reduced and that any savings realized can be used to deliver client-driven programs. The committee is optimistic that the program evaluation and monitoring unit of the department will be able to identify cost savings for the boards of management. While maintaining the independence of the present boards, the committee looks forward to being advised of progress on the reduction of administration costs.

Physician recruiting, the committee was pleased to hear that the department was working with the NWT Medical Association to develop a plan and report on physician recruiting for the NWT by the end of 1997. The committee looks forward to reviewing the report and discussing the recommendations made. There was a concern that competition among the boards for physicians may be contributing to the shortage of physicians. The committee encourages the department to work with the NWT Medical Association and the health boards to develop innovative solutions to address the doctor's shortage in the NWT and requests a brief overview on the current level of this shortage.

Health care dollars spent outside the NWT, as the Minister stated, $22 million is spent on health care for residents receiving treatment outside the territories. While the committee recognizes that it is not realistic to provide all services to the residents of the Northwest Territories at a local and regional level and that there will probably always be a need for outside services, Members feel that the government can improve on this figure. With the great strides made by the colleges in providing nursing programs over the past couple of years, there is an opportunity to repatriate more people to their home communities from southern institutions. The department must take a lead role in identifying those patients who can be repatriated and provide the local boards with the necessary level of support to reintegrate the patient back into their home community. The committee looks forward to progress on this issue as a reduction in the money spent on health care in the south and would appreciate receiving a breakdown of the $22 million spent on health care outside the Northwest Territories.

In regard to travel, this is an important issue to many residents of the NWT, particularly, in the east where travel costs are prohibitive. The committee understands the previous Travel Program was lax and that there were significant abuses. This being said, Members feel the government needs to refine its definition of compassionate travel and communicate this definition to the boards. The committee recommends that, as part of the department's development of the minimum standards and guidelines for hospitals and health boards, the issue of compassionate travel be addressed to ensure that criteria and guidelines provide for fair and equitable access. Thank you, Mr. Chairman.