Thank you, Mr. Minister and your witnesses.

We will continue with the review of the Department of Health and Social Services. Does the Minister have any opening comments?

Thank you, Mrs. Groenewegen. Comments from the Standing Committee for Social Programs, Mr. Dent.

Thank you, Mr. Chairman. Mr. Chairman, the Standing Committee on Social Programs met on May 25th, 2000, to consider the 2000-2003 business plan and the 2000-2001 main estimates for the Department of Health and Social Services.

The department's business plan shows a high degree of correlation to recent departmental strategic planning exercise. The committee members were, however, disappointed by the lack of detail provided by the department as to how it intends to measure success in meeting its stated goals. Without knowledge of the starting points and defined targets, the committee, and indeed the department, has no method of measuring success in meeting goals and objectives.

As the members of the standing committee examined the business plan, it became apparent that, in many cases, it was a wish list for the department. The committee certainly hopes that the necessary funding can be found to make many of these wishes come true. The committee believes that it may not be appropriate to incorporate wishes as part of the business plan. These wishes provided committee members with an idea of the direction the department would like to take in the future. But if initiatives are seen as so important they are included the business plan, the funding should be allocated to them.

At the very least, the committee expects to see a strategy laid out for examining program priorities, so we know the department is looking at reallocation if new monies are not available.

Funding for Magnate Communities

Mr. Chairman, there was a concern on the part of committee members that magnate communities are not adequately funded under the present funding formula. Committee members were pleased to hear the funding formula takes into account historical spending patterns. The committee is hopeful these spending patterns capture true usage. Members are aware that many residents of the Northwest Territories make decisions on where they access our health care system based on the quality of services available in the facility.

For example, many residents of Fort Providence prefer to access Stanton Regional Hospital in Yellowknife, rather than H.H. Williams Hospital in Hay River. This leaves the committee to question whether new services, like the CAT Scan machine in Yellowknife, are adequately funded over the long term. Committee members will be monitoring and seeking feedback from their constituents.

Health Promotion Strategy

Mr. Chairman, we were disappointed that there were no apparent linkages between the Health Promotion Strategy and the Mental Health and Addictions Strategy. There is a belief amongst committee members that the issue of alcohol abuse needs to be front and centre in any Health Promotion Strategy. This is not apparent.

The communities have told MLAs and the Minister's Forum on Health and Social Services that their major health and social concern is the effect of alcohol on the community and its residents. The Health Promotion Strategy appears to be focused on tobacco cessation programs rather than the community desire to focus on addiction treatment. The committee notes that this community focus was strongly expressed in the Final Report of the Minister's Forum on Health and Social Services. The department's lack of reaction in this area is puzzling and leaves the committee to wonder if the headquarters function of the department is in touch with the desires of our communities.

Committee members were very concerned that written material produced under the Health Promotion Strategy be written in plain, simple English and translated into the appropriate aboriginal languages. This concern relates to the low literacy level of many of our residents. Government information must be presented in a format that residents understand. This concern should be related to the non-government organizations that are preparing materials funded from the Health Promotion Strategy.

Mr. Chairman, members were very disappointed that funds lapsed last year under this activity. While committee members do accept the reasons that the Minister and her officials provided for the lapse, it is still hard for Ordinary Members to explain to their constituents why over $400,000 lapsed under such an important activity. Some Member's constituents view lapses, as in this instance, as an example of why government funding should flow to the communities rather than being concentrated at the headquarters level.

Many of the initiatives that are part of the Health Promotion Strategy are undertaken by non-government organizations. The NGOs have expressed concern in the past that single-year funding for projects does not allow them the flexibility to do any forward planning. They hire staff to run programs, but can only guarantee employment for as long as funding is in place.

The NGO's staff, affected by year-to-year funding, are understandably apprehensive and in many cases seek alternative, stable employment. This of course leaves the NGO in the position of having to hire new staff. This constant staffing turnover reflects on the NGO's ability to deliver the program on behalf of the government. The committee notes that this is not an issue particular to the Health Promotion Strategy or even confined to the Department of Health and Social Services.

Mr. Chairman, the instability created by year-to-year funding is a serious issue for most NGOs and for the government departments on whose behalf the NGOs deliver programs. If the government is to meet the spirit and intent of Towards a Better Tomorrow, it is imperative that we build co-operative relationships with NGOs that deliver our programs directly to the people. An important part of any cooperative relationship is a stable, multi-year funding agreement. The Standing Committee on Social Programs has forwarded this concern to the Accountability and Oversight Committee who will be making a recommendation on multi-year funding agreements.

Mr. Chairman, members of the committee and residents of the communities that they represent are very concerned about the current state of addiction treatment in the Northwest Territories. It is apparent to committee members that the redesign of the addictions treatment program is ongoing. There is some question as to whether sufficient, dedicated program space will be available in the upcoming fiscal year.

Contrary to the understanding of committee members, based on discussions during the Interim Appropriation, it is possible that the Department of Health and Social Services will be unable to utilize the Northern Addiction Services (NAS) facilities in developing its Addiction Strategy. Members recall being assured that by the time the committee reviewed the business plans and main estimates there would be a viable territorial Addictions Strategy in place.

Members are concerned that in the overhead presentation one of the department's expected results for 2000-2001 was the development of a territorial strategy and action plan on mental health and addictions. No evidence was presented to the committee that suggested the department had an Addictions Strategy in place. Members must question whether any departmental efforts are being directed to actual addiction treatment support, or is the department concentrating on the development of their strategy and action plan.

Given the importance communities place on addictions treatment, it seems to committee members that, too much time has passed since the department has had an Addiction Strategy in place. This will be the second year that the department has operated in the absence of a territorial Addiction Strategy. This is not acceptable to committee members. Members are aware of the terrible toll that addictions take and believe that the time for action is now.

Committee members would like to see the territorial Addictions Strategy and action plan as soon as possible, so that they can offer comment and the department can implement as soon as possible. With NAS being successful in attracting federal corrections programming and funding to utilize the Dettah facility and the re-profiling of other addiction facilities, committee members must question where any programming under an Addiction Strategy, would take place. Members are interested in how the Addictions Strategy and action plan addresses facility needs.

In the case of the Franklin Avenue Detox Centre in Yellowknife, there is a viable proposal from four Yellowknife service providers to move the women's shelter to use this facility as part of a larger housing strategy. This would address emergency, transitional and hard to house needs.

Committee members believe the proposed strategy A Response to Housing Needs: Emergency, Transitional and the Hard to House prepared by the Salvation Army, the Yellowknife Women's Centre, the YWCA and the Side Door is precisely the kind of partnership with non-governmental organizations that is envisioned in Towards a Better Tomorrow. Committee members were disappointed to hear that there had been no meetings of the departments in the social envelope to discuss the proposal as of our meetings on the business plans and the main estimates.

Committee members believe that the previously mentioned organizations have taken the first step, they are co-operating with each other to meet a common goal. They have divided up responsibilities in this proposal to avoid duplication of services and in doing so avoid duplicate funding requests targeting the same client-base. This strategy may not save the government any money in the short-term. However, the organizations do anticipate that they will be able to do more with the funding that is currently available because of the division of labour.

In the opinion of the committee members, the example of the four social agencies coming together to formulate a strategy, utilizing and combining resources to meet a common goal should provide the departments in the social envelope the impetus to work in concert to respond to the proposal.

Members look forward to being informed of the resolution of the proposal by the four Yellowknife service providers.

Committee members also believe that the new mobile addictions units, while a worthwhile stopgap measure, should not replace community based mental health and addictions infrastructure. For healing to occur at the community level adequate permanent facilities are required. The department is asked to consider this in the development of its capital budget for the new Mental Health and Addictions Strategy.

Mr. Chairman, committee members were very disappointed in the lack of apparent cohesion between the Department of Health and Social Services and the Department of Education, Culture and Employment in early childhood development and children and youth programs. In examining the business plans of the two departments, it appeared that there were two different programs with two different agendas and terminology.

It was not apparent to committee members, through an examination of the business plans and main estimates, that there was any joint planning on these issues. It only became apparent that there was meaningful co-operation taking place when the Department of Health and Social Services provided a draft copy of the Children and Youth Agenda. This information was provided subsequent to the committee's discussion with the Minister and her officials on the business plans and main estimates.

Mr. Chairman, Members expect to see clear co-operation on these important initiatives in the next business plans for the Department of Health and Social Services and the Department of Education, Culture and Employment. It should be clear to anyone reading the document that the two departments are partners in the programs.

Members are also aware that there may be significant amounts of funding available from the federal government in the near future. It should be stated again by the committee that all service providers, government and NGO, need to co-operate to ensure that programs are not duplicated and that the children and youth of the Northwest Territories get the maximum use out of the available funding.

It was not clear to the members of the standing committee what role the Minister responsible for Youth has in the planning and future implementation of the Children and Youth Agenda. Committee members believe that the role of the Minister should be clarified for the public.

Committee members look forward to the opportunity to comment on the findings of the review of the Northwest Territories Child Protection Service completed by the Child Welfare League of Canada.

It is hoped that given the significant amount of money spent on hiring a southern contractor, the recommendations contained in this review will provide the department with many ways to improve child protection in the Northwest Territories. Committee members are committed to working with the department to improve the child protection services in the NWT.

In a related matter, there is concern on the part of committee members that the department may have too many initiatives and reviews going on at the same time. While committee members do see the need for the initiatives and reviews the department is working on, the concern is whether there are sufficient resources and staff to implement initiatives or analyze reviews. The committee would like to remind the department that members would prefer to see programs or initiatives that are an unqualified success, rather than programs and initiatives that do not meet their objectives.

Members will be examining future business plans to determine whether the department has overextended itself.

Members were disappointed to learn that the Metis are not included in the proposed Federal Aboriginal Home Care Initiative. The committee is pleased to note however, that an excellent, integrated home care system already exists in the majority of communities in the Northwest Territories. It is hoped that service providers will continue this co-operation at the community level.

There is also a responsibility for the department, the boards and local and aboriginal governments to work together within the existing system to improve the home care system and avoid duplication of services.

Committee members would like to remind the department that the projected doubling of the seniors' population in the next 20 years would place a strain on our home care system. The committee believes that it may be appropriate for the department to do some long-term planning in consultation with their partners in service delivery.

The committee is also interested in the establishment of a respite care system for the Northwest Territories. Many of our residents assume the responsibility for caring for their loved ones at home. These people need our support so that they do not "burn out". If these caregivers do burn out, it is likely that their loved ones would end up in a healthcare facility at a significantly higher cost to the residents of the Northwest Territories. Caregivers need an occasional weekend off. They need time to go shopping or to go to doctor appointments.

Respite care can be as simple as the community nurse teaching another relative how to care for the loved one or being able to place your loved one in a long-term care facility temporarily. The committee believes that more emphasis has to be placed on helping caregivers cope within their own communities.

Members are also concerned about the issue of palliative care. The doubling of the NWT's senior population in the next twenty years would logically double the need for palliative care options. The department is strongly encouraged to ensure that adequate training and palliative care options are available for NWT healthcare professionals and residents as the need arises.

Members are aware that other Canadian jurisdictions have policies and legislation in place that deals with the issue of palliative care. The department is encouraged to develop policies and legislation that would bring the Northwest Territories in line with practices in other Canadian jurisdictions.

The committee would like to commend the department for their success in repatriating NWT residents from southern institutions. Unfortunately, this success has eliminated capacity in NWT long-term care facilities and limited the ability to repatriate residents from southern institutions.

Committee members believe this need, coupled with the anticipated doubling of the senior population in the next 20 years, forces the department to analyze projected need and develop long-term care facility needs.

When the department does its analysis, the committee requests the department to also consider community wishes in developing its plan. Residents in communities without long-term care facilities are required to place their loved ones in communities within the administrative district (board) they belong to. In the case of Fort Providence, this means Fort Simpson. This makes it very inconvenient for residents to visit their loved ones because the majority of people go to Hay River for shopping and their other health care needs. Committee members believe that compassion and logic should be used in establishing which territorial facility is most appropriate.

Committee members also realize that community wishes cannot always be accommodated because of the non-availability at the preferred facility. However, an effort should be made to accommodate the family.

Mr. Chairman, with your consent, I would like to ask that the balance of the report be read by the Member for Deh Cho. Thank you.

Thank you, Mr. Dent. Mr. McLeod.

Committee members acknowledge the trend in self-government negotiations for First Nations and their partners to want responsibility for the social service delivery component and preferring to leave the medical responsibility with the boards. The major consideration being that, all participants in self-government negotiations realize that they have to work together to ensure continued service delivery to the residents that we all serve.

It will be a time of major change in the structure of how we deliver programs and services and there is a need for extensive consultation on the part of the department and other service providers.

Committee members believe that we have to do this right. Everyone's primary concern should be the health and safety of our residents. The change must not be allowed to jeopardize the health and safety of our residents.

It is noted that some regions have indicated a preference for a community services board model. Whichever model of health and social service delivery that is chosen by each community or region, it is important that there is an audit function within the system to ensure that program dollars are being spent correctly and that the health and well-being of residents are not being compromised.

In particular, it will be important for the departments that are funding community or regional service boards to provide monitoring and program advice to the boards and for these departments to co-operate with each other.

Committee members also believe that it is important that there be full and adequate consultation between all parties as the process evolves.

Committee members believe there are cases where the boards have been too strict in interpreting the Medical Travel Policy. Residents of small communities do not have the same access to the health care systems as residents of urban centres. If they do not agree with the diagnosis of health care professionals in their home communities or if they want a second opinion, they have no choice but to travel outside their community.

However, if the health care professional will not authorize medical travel for the patient to go to another centre, the patient has no choice but to cover all those costs themselves. Even if the patient's complaint or concern is borne out at this other facility, the regional health board will not reimburse the patient due to the lack of a medical referral.

This is unfair. Committee members realize that the health care providers in the communities do the best they can with the resources they have, but they can make misdiagnoses. Everywhere else in Canada patients can easily get a second opinion. Unfortunately, in some of our communities this cannot be done without leaving the community and bearing considerable expense. There needs to be some common sense applied to the interpretation of the Medical Travel Policy.

Members believe that there has to be a second opinion or "escape clause" in the Medical Travel Policy. If the patient does not agree with the diagnosis of the health care professional in their home community and travel to another community and receives immediate treatment, the patient should be eligible for compensation. Members also would like to see an appeal mechanism that allows the patient to appeal the decision of the board to the Minister.

Members were pleased to note that the Minister agreed that there might be circumstances that would warrant the repayment of medical travel expenses and that she was willing to examine the Medical Travel Policy. Members look forward to further discussion with the Minister on this issue in the near future.

On a related note, committee members believe that the department and boards must monitor medical travel costs in each community to ensure that they do not eclipse the costs of placing a doctor in the community. This is an issue that is of particular concern to the residents of Rae-Edzo.

The recent revelation that Human Resources Development Canada (HRDC) had been maintaining large amounts of information about Canadians raises concern with committee members about the ability of the department to maintain the security of their computer systems.

Members believe that the confidentiality of patient information is paramount. However, there are circumstances where the informed consent of the patient should be sought so that information can be shared with social workers if it is within the scope of an agreed upon plan of care for the patient. Protocols need to be developed to accommodate this requirement.

For greater public comfort, the members of the Standing Committee believe that the department needs a publicly stated computer security policy.

Recommendation 2

The committee recommends that the Minister develop a computer security strategy for the department that would restrict access to information and actual computer systems both physically and electronically;

And further, that this strategy should be communicated to the department and board staff and adequate training provided;

And furthermore, that elements of the strategy should also be communicated to residents of the Northwest Territories for greater public comfort.

The department has many ambitious initiatives that are dependent on new federal and territorial funding to be implemented. The members support the intent behind these initiatives and hope that funding can be found.

However, members were somewhat disappointed that the department had no contingency plans in place should the anticipated additional funding fail to materialize. Committee members believe that there is a need to establish priorities, so that the department can, if necessary, re-profile their programs using the available funding. At a bare minimum, the department needs to establish what the process would entail and who should be involved.

Committee members noted many of the same concerns that they had with the other departments in the social envelope. It is hoped that many of these concerns are one-time anomalies that can be attributed to the usual frantic activity that accompanies a change in government. The committee looks forward to the department addressing the following concerns in the next business plan cycle.

Some of the documents and studies that the department used to justify the business plan had not been previously supplied to the committee. Members of the committee can hardly be expected to offer meaningful comment on the business plan if they do not have the necessary background information. The Accountability and Oversight Committee will be making a recommendation on this issue.

Members are concerned that the level of detail in the department overheads are better than the information supplied to the committee in the business plan or main estimates. The business plans and main estimates become public records. The financial figures and statements that are used to justify these business plans and main estimates should also become part of the public record. Under the present system this is not possible. The Accountability and Oversight Committee will be making a recommendation to include this information in the business plan.

As with other departments, the committee is disappointed in the lack of baseline information and the lack of measurable targets and goals. The department has 12 years of baseline information. Without including this type of information, committee members are unable to measure progress, or lack thereof, in a department on a year to year basis.

The committee appreciated the Minister's commitment to provide this type of information for the current business plan. The committee looks forward to reviewing the new targets, goals and baseline information in the near future.

Committee members believe there is a need for clear targets that the department should try and achieve over a defined period. The Accountability and Oversight Committee will be making a recommendation on the need for all government departments to improve their reporting and measurement criteria for business plans.

The members of the Standing Committee on Social Programs are aware of programs in other jurisdictions that provide medical and financial help to permanently disabled residents. This assistance is basically a set amount, or pension, which when combined with all other sources of income allows the individual to not fall below a prescribed income.

In Alberta, there is the Assured Income for the Severely Handicapped (AISH) Program, which provides medical and income assistance to adults with permanent disabilities that severely impair their ability to earn a living.

People only receive AISH if they have exhausted all other possibilities for training, rehabilitation or employment. The current income support program in the Northwest Territories as administered by the Department of Education, Culture and Employment makes no allowance for this possibility. People with permanent disabilities are expected to make "productive life choices", like any other income support recipients, regardless of whether these choices represent any meaningful gain for the disabled persons.

In some cases, members are aware of residents receiving too much money from the Canada Disability Pension to be eligible for income support.

Regardless of the problems inherent in the delivery of the actual income support by the Department of Education, Culture and Employment, the committee believes that the Department of Health and Social Services does have a role to play.

In Alberta, AISH clients are also eligible for medical benefits such as prescription drugs, glasses, dental work and medical travel and ambulance services. Committee members envision a similar role for the department, in an integrated service delivery model, in conjunction with the Department of Education, Culture and Employment.

A recommendation to this effect was made in the review of the Department of Education, Culture and Employment and also applies to the Department of Health and Social Services.

The members of the Standing Committee on Social Programs believe that it is time for the departments to initiate the process to lead an informed discussion amongst NWT residents on the sustainability of care.

The cost of technology in the healthcare field and the expectations of patients increase every year. At some point, an affordability of care issue becomes apparent and enters into the discussion.

The department does have the opportunity to tie this discussion to the healthcare reform initiative.

Thank you, Mr. McLeod. With that, we will take a short break and come back in 15 minutes time.

-- Break

I will call the committee back to order. Madam Minister, would you like to bring in any witnesses?

Yes, I would, Mr. Chairman.

Thank you, Mrs. Groenewegen. Does the committee agree?

Sergeant-at-Arms would you escort the witnesses in, please?

Mrs. Groenewegen, for the record, could you introduce your witnesses, please?