Thank you, Mr. Speaker. Mr. Speaker, I would like to update this Assembly and the public on some recent actions I have taken to address concerns about our health and social services system.
Concerns about the sustainability of the health care system are constantly in the news these days, not just in the Northwest Territories, but across Canada and internationally. There are many external pressures on our system, pressures like the shortage of doctors, nurses and other medical personnel, the increasing costs of pharmaceuticals and new technologies and the health challenges presented by an aging population, to name but a few.
All of these issues have a direct impact on our Northwest Territories system, but we also have some concerns that are closer to home. Since I assumed the Health and Social Services portfolio just over a year ago, I have been increasingly concerned with a number of problems that have been brought to my attention by the department, by health and social services boards, by members of the health and social services professional community, and by Members of the Legislative Assembly.
Mr. Speaker, I would like to outline some of the issues that are challenging our system.
- • We have a very complex, fragmented system with multiple boards serving the needs of our 42,000 residents. This results in duplication, overlap and the loss of economies of scale.
- • Accountability relationships are also fragmented. The separation of the legislative and policy responsibility from operational functions makes it very difficult to enforce standards of care.
- • Significant downsizing in the department over the past years by previous governments has eroded our capacity to monitor and enforce standards, and provide administrative and clinical leadership and oversight.
- • An increasing number of health and social services boards are running operating deficits, yet are not able to provide us with accurate and timely financial information.
- • Concerns have been raised about the capacity of some boards to handle complex administration functions such as pay and benefits.
- • Finally, as you are all aware, the question has been raised repeatedly about whether the current structure of nine health and social services boards is the most effective and efficient approach. This issue was highlighted as a priority for action in the report of the Minister's Forum on Health and Social Services just over a year ago.
In addition to these financial and administrative issues, there are pressing concerns about the delivery of core health and social services programs. For a number of reasons, some of our health and social services boards are having great difficulty delivering all of the core programs for which they are funded and some programs are not always being delivered to standard.
I do not take these concerns lightly. As Minister, I cannot ignore concerns about the quality of service delivery, for which I am ultimately accountable. Nor can I ask this Assembly to approve budgets or supplementary appropriations if expenditure requirements cannot be accurately identified.
Mr Speaker, these concerns are not new, and over the past two years we have taken some pro-active steps to address them. Accountability requirements for boards have been strengthened, roles and responsibilities have been clarified and a business planning cycle has been introduced for the boards.
Given the increasing number of boards with deficits last year, however, it was clear that immediate action was required, and I have taken action.
- • Last fall, I requested the territorial Audit Bureau conduct an audit on the pay and benefits function in selected health and social services boards. Those audits are underway and the first report is expected in a few weeks. As a result of the initial audit findings and an agreement between the department and the board, pay and benefits authorities have been transferred to the Financial Management Board Secretariat.
- • In December, I contracted a consulting firm with a proven track record in the field of health care governance and administration to undertake a system-wide review. The review is focusing on four key areas: governance structures, accountability, service delivery and financing. One component of the review is an operational audit on the finance and management function in all health and social services. I have asked the consulting team to provide not only a detailed report on these functions but also practical, concrete recommendations for needed changes to our health and social service system, including recommendations on how the department needs to change its structure and operations to effectively support the system. This report will be completed by the end of June.
- • In December, I established a new clinical oversight function within the department under the direction of the newly appointed assistant deputy minister for population health and clinical services. This will allow the department to provide clinical leadership and more direct support and supervision to boards in clinical service delivery. We have already initiated clinical audits in two boards where problems have been identified.
In light of the continuing questions about board deficits, it has been suggested that I should take immediate action, even to the extent of having the department step in and take over the administrative functions from some of the boards. Mr. Speaker, my preference at this time is to continue to work with the boards to resolve these issues. I am of the view that we have very good people working in our health and social services system, but the system has some inherent flaws.
Instead of a knee-jerk, punitive approach, I would like to wait for final audit reports and recommendations from the system review and develop a well thought out action plan. That will allow us to optimize service delivery for our residents.
However, I am prepared to take action when circumstances require it and will respond appropriately to any issues requiring immediate action, as I already have in the case of the revocation of payroll authority in one of the boards.
In closing, Mr. Speaker, I would like to emphasize that although we face significant challenges, there are also many reasons to take pride in our health and social services system. We have many dedicated nurses, physicians and other staff in health and social services boards who deliver excellent care, often under difficult conditions, giving many hours beyond what would normally be expected of them. We have caring and committed trustees on all our boards. We have dedicated and experienced staff in our department.
Mr. Speaker, we all have the same objective -- to take whatever steps are necessary to ensure that our health and social services system delivers the best possible care to all residents in every community. Although the process of identifying the problems is painful and it is tempting to lay blame, we must keep our focus on constructive solutions. I am firmly committed to seeing this process through, Mr. Speaker, and I look forward to bringing a clear plan of action to Members as quickly as possible,
In closing, I would like to thank all Members, especially those on the Standing Committee on Social Programs, for their guidance and advice as we deal with these difficult issues. It will be important for us to continue to work closely together to improve the health and social services system for all of our constituents. Thank you, Mr. Speaker.
-- Applause