No, what I had suggested is that there is further work needed. The work that is actually proceeding at this point in a very tangible way is between the medical association and the nursing association. There have been workshops and there has been some work started in terms of the whole approach to an integrated care provider team in a community and in a region. Coming out of those discussions is where we anticipate doing additional work in terms of the role for each provider and the training and supports needed for each. Thank you.

Thank you, Madam Chairperson. In those other areas, the first step is to recognize the fact that work has to be done in that area and the recognition is there, so I appreciate that. Another concern that was brought up by the medical association was the fact that changes to health care should be done to improve programs and services rather than just to save money. I was wondering if the recent changes in the last couple of years have been made primarily in an effort to save money or have they been made in order to improve programs and services? If it has been done to improve programs and services, can we get examples?

Madam Chairperson, I had this very discussion with a variety of organizations and what we continue to put forward to people is that we deal in a very real environment. We take the quarter of a billion dollars of resources that we have available to us to invest in supporting the health and well being of residents of the Northwest Territories. We attempt to use that quarter of a billion dollars to achieve the most effective gains for people. There has been a whole series of areas where we believe we are either accomplishing or able to accomplish an improvement to programs and services. There has been extensive expansion of home care programs in communities so that people can be maintained in their own home in their own community. We are achieving significant success at this point simply in being able to support the training of northern nurses. The work that is going on around the identification of core services, the improvement of clinical standards and the identification of training needs for social workers and counsellors, all point to areas of improvement in our view. In summation, what we have suggested to people that it is our burden to balance the fiscal realities to invest the quarter of a billion dollars wisely and to ensure that we measure the quality of care and seek to improve it wherever we have opportunity. Thank you.

Thank you, Madam Chairperson. It seems to me that perhaps one of the problems is that all these different areas are dealing with one particular part of a person and nobody is dealing with a whole person and coordinating all the different aspects of work that is being done. Is the department, having a look at this area to see if they could take a coordinating role to ensure the work that is being done? Everyone is working at different aspects. There is Education doing a little bit, there is RWED doing a little bit and Social Services and Health, they all affect the person and the person's health. Is the department looking at undertaking some type of coordinated effort?

Thank you, Madam Chairperson. Madam Chairperson, I believe the honourable Member from Mackenzie Delta also brought up this issue about coordination at a community and regional level. I believe I have outlined the interagency committees that a lot of the communities operate with right now that bring all the social partners in the community together under one group to deal with the common issues as it affects individuals within their communities. We have actively tried to provide the decision making, authority and resources to communities whether it is directly or through the boards, to try to stimulate and encourage some collaboration and spirit in order to try to eliminate or minimize some of the barriers that are there as a result of different departments trying to deal with individuals on more of a holistic case management basis instead of departmentally in a stove pipe type of delivery service. The amalgamation of Health and Social Services itself was another major step toward bringing together health care professionals and social services professional to deal again on a more holistic case management type of basis, trying to treat individuals and recommend solutions and provide services to our constituents. Thank you.

Thank you, Madam Chairperson. We do recognize this as an issue. Different boards are at different levels in respect to their capabilities, their knowledge of the responsibilities, how to carry out their responsibilities in relation to the people they serve, the CEO and the senior management of the regional health and social services boards. Over the past couple of years there has been a significant effort of all boards in trying to undertake trustee development through the NWT Health Care Association.

As noted in the past, Mr. Tony Chang, a former chair of the Stanton Regional Health Board, does undertake a significant amount of board development throughout the Northwest Territories from east to west. He works on the carver model, as it is called, and it clearly distinguishes between a board trustee's responsibility of making policy, setting direction for the CEO to carry out and having the awareness of the day-to-day operational functions are in the realm of the responsibility of the CEO and the senior staff but not board responsibilities. Having said that, we recognize that certainly a large majority, if not all of board trustees, when they come in have no background or no significant background in Health and Social Services. It is safe to say, they have a legitimate interest in that field otherwise they would not have put forward their names for consideration as a trustee. I would like to think they had some broad support from the group or the community they represent in putting forward their name to represent the interest of their community and of the regional health and social services board in trying to provide programs for their constituents. It is an area of board trustee development that we are continuing to work with the health care association, on in trying to firm up and coordinate and standardize some of the training so that it is consistent. We do recognize there are some individuals who are probably lacking as a result of turnovers. That is going to happen when you have as many boards as we do and as many trustees as we do across the territories. Overall, there has been a lot of progress made in trustee development. I can see it when I meet with the boards.

I recall one of the first Beaufort Delta Leaders meetings when I first became Minister. There was concern about the Inuvik Regional Health and Social Services Board at the time. The issue I mentioned yesterday about how large the board was, how ineffective it was, what could we do about it and what powers did they really have? I express to the Beaufort Delta leaders at that time, they basically do the delivery of health and social services in the programs they service for the whole Inuvik area. These trustees make those decisions. It caught the attention of the leaders and they recognized they had, not to say they were not capable individuals before that, to put forward individuals they knew would directly represent them. They also dealt with the issue of trying to make the board more effective by downscaling it to make it a smaller group who they thought would represent their interest. Since that time they have made tremendous progress as we do not hear very many, if at all, major issues come out of the Inuvik area in respect to the services being provided under the leadership of the trustees there, Madam Chairperson. Thank you.

Thank you, Madam Chairperson. On the two issues the Members has brought up, first on the monitoring evaluation of the board. The two facets, of course, are the board trustee development Mr. Ramsden spoke of earlier, having an individual monitor the appointment processes, what individuals have or have not undertaken, board trustee development. By the same token, we had mentioned yesterday about the monitoring evaluation unit. Two individuals specifically, geared toward dealing with the boards on a staff level to provide operational reviews and provide assistance if required, drawing upon the expertise of other individuals within the management of the Department of Health and Social Services.

For the issue of cuts and amalgamation, we know that when we undertook the amalgamation of Health and Social Services, there were some overlap and duplication in the administrative components. Both health boards and the Department of Social Services, at that time, had administration officers, regional superintendents, finance officers, clerks and et cetera. We understood that when they did do the amalgamation there were individuals impacted by that who either took the layoff packages or went to other departments in finding employment. The savings that were obtained from that, the boards put back into the programs staff primarily. In my area, they hired some staff development officers to support the social workers. Those are some of the reinvestments that came about as a result of some of those savings that were put forward as a result of amalgamation, Madam Chairperson.

Thank you, Madam Chairperson. I guess if the honourable Member is referring to in respect to services being delivered, we had spoken on this again yesterday, in that there is a statement of core services the department is working on in conjunction with the boards. It is close to being finalized. It is going to outline exactly what expectations there are for services to be provided by boards across the territories. Thank you.