It became apparent as the committee reviewed the departments within its envelope, that there were several different interpretations of what forced growth was. The committee heard that the department has submitted an estimate of $5.1 million to FMB for forced growth to be included in the department's main estimates. The committee also heard that, unlike the other departments in the social envelope, a four-month portion of the $5.1 million forced growth requirement was not factored in the interim appropriation.
The committee questions how it can be expected to offer valid criticism on the state of department finances when it is kept in isolation of important facts. In approving the interim appropriation, the committee will be essentially approving the department's budget for one-third of the year. Committee members believe that by not factoring in forced growth in the interim appropriation, possible belt-tightening exercises that should follow may be impossible to implement in the last two-thirds of the year.
Committee members were disappointed that all forced growth was not factored into the department's interim appropriation and that they were not informed of this omission from the outset of the review. It was only the questioning of the committee members that brought this matter to light. In the future the committee recommends that the department or the Financial Management Board provide notes that describe exceptions in the way the department presents its information.
Nurse Practitioners
Members were particularly interested in the development of a health care system that utilizes nurse practitioners, in conjunction with physicians, to treat patients in the Northwest Territories communities.
Committee members are well aware of the problems the boards and the department are having in attracting physicians to the North. Consequently, this doctor shortage has led to excessive waits for appointments at medical clinics and a resultant increased usage of emergency room services, particularly in Yellowknife.
Committee members believe if well-trained nurse practitioners provided front-line service and dealt with the minor complaints, that doctors would be able to concentrate on the patients that truly needed their attention.
There may be some resistance on the part of residents, used to dealing with doctors for every complaint, to a nurse practitioner based system. However, committee members believe that this is the best option that the department and the boards have in meeting the doctor shortage in the larger communities. After all, the community nurses have been providing quality health care to residents of our smaller communities for years and are the backbone of our rural health care system.
The committee strongly encourages all parties to seriously examine the role that nurse practitioners could play in the delivery of health care. The committee looks forward to reviewing an implementation plan for a Nurse Practitioner Program during the business plan.
Early Childhood Education and Programs
Committee members are very concerned that given the lack of money available for early childhood programming that there be a coordinated effort between the department, the Department of Education, Culture and Employment, the federal government and any aboriginal government delivering such programming. This coordination is essential if governments as a whole want to make progress in meeting the needs of our youngest residents and provide the children with the head start that they need to be successful in life.
It is the committee's hope that a proactive, cooperative approach could be developed between all levels of government involved in early childhood programming. The committee expects to review a coordinated effort on early childhood programming during the business plan review.
Undedicated Capital Funds
Committee members were very concerned that they were being asked to approve $200,000 for new capital projects in the interim appropriation. Members were uncomfortable with not knowing the specifics of what and where the project was to be located. Committee members believe that giving approval, at a time when other capital projects are being deferred, was tantamount to the committee giving the department permission to operate a "slush fund". This "slush fund" would not be subject to the oversight the committee exercises over other capital projects.
The committee also noted that the department is proposing $250,000 in carry-over funding in the interim appropriation for the possible renovation of the Territorial Treatment Centre in Yellowknife. In the minds of the committee members, the department's explanation of the variables needed to fall into place for this renovation to proceed meant little chance of a start within the four-month window covered by the interim appropriation. The explanation that one of the major variables involves decisions by a board outside the direct control of the government reinforced the committee's belief that the department's timeline for the renovation was overly optimistic. Committee members could not justify the inclusion of the renovation to the Territorial Treatment Centre in the interim appropriation.
In the future, the committee would like to see the specifics of major capital projects. It is believed that the department has had sufficient time to evaluate the condition of the infrastructure inherited from the federal government in the health transfer and that a plan to address the inadequacies should be in place.
Unless the committee can be convinced otherwise, the committee looks forward to being presented with a plan for new capital projects during the business plan review.