Thank you, Mr. St. Germaine. Mr. Roland.

Thank you, Mr. Chairman. I thank them for that information. However, I did hear today in the Minister's statement that the return of Non-Insured Health Benefits might not be as eminent as initially stated because of some news coming back from Ottawa saying that they will pay up some of the money. My understanding is that there still is half of it on the table to be discussed. So hopefully we will not bite the lion too soon.

Again, in the other areas, because one of the things that has been of particular concern right through the previous Assembly that I sat in was medical travel and how that fluctuated for quite some time, between years even.

I am aware that there have been initiatives undertaken by health boards and a number of health boards have gotten together to try to lower their costs and deal with an RFP that was put out. However, to my understanding, there is still no agreement out there and that initiative has had to be pulled and is going out again.

Now you get calls from everybody talking about their side of the story, but it is a concern that we can be operating this late in a year and have something that is as important as medical travel sit out until, for one reason or another, this whole thing is redone to the expense of both department boards and operators out there. So that is an area of concern.

The other one is in recruitment and retention. We heard mentioned earlier under recruitment and retention that there would be boards that would go out and find other boards in different places. I am aware that Inuvik Regional Health and Social Services Board has tried to go under recruiting initiations. When they put their plans into the department, they were told to hold off that part of the recruitment and retention team needed to go with them and there were some other requirements there.

I am hoping that it is not just requirements you have to meet but in fact that there is a working together to try to reduce costs in that area. I am not sure if somebody goes from the department with every health board when they go on a recruiting drive, for that can get fairly expensive unless you are actually working together to benefit the North. As boards are, it can be fairly competitive when it comes to recruiting nurses and doctors at the present time.

Those are a number of concerns in general right now and I will wait to go into detail on some of the specific issues. Looking across the government, we talk about fuel increases, the power costs to government and so on are still going up. So hopefully with these reductions that have come out when it talks about, in fact we might see it go up again another $5 million if any Non-Insured Health Benefits come backs on the books, so we could be looking at $187 in that area or more, and some of these other costs.

This government is planning to put out some new fees that would impact air carriers out there when it comes to how they bill this government. So we are going to see it there again. So I do not think that we will see costs go down in this area. In fact, we might be seeing more. Hopefully that has been taken into account in this number and there may be some projection built in, at least minimum, for the time being. Thank you.

Thank you, Mr. Roland. Madam Minister.

Thank you, Mr. Chairman. Mr. Roland refers to recruitment efforts on behalf of boards and the insistence in some instances of the department becoming involved. We agree with the committee that there needs to be more coordination in the recruitment efforts amongst boards, because otherwise you do have duplication of efforts and we do have dedicated personnel that are involved in recruitment and boards do not have that.

They do not have the same ability to oversee these kinds of things. I think that one of the instances that you referred to in terms of recruitment where the board wanted to get involved had to do with an attempt to recruit people who were coming from overseas, which was particularly complicated in terms of how they were going to get here, how they were going to be looked after when they got here, how they were going to address the credentials and insuring that their registration and in fact the number of people there might have been anticipating or are anticipating recruiting would probably be more than just for that region.

So it was a clear case where there was definitely value added by the department becoming involved in that, because there were a lot of complex considerations in that particular initiative. That is all. Thank you, Mr. Chairman.

General comments. Mr. Dent.

Thank you, Mr. Chairman. My comments are going to relate to the operation of Health and Social Services boards of management. I am encouraged that the Minister says that she wants to report to this House that health and social services are working well. I think that we all want to hear that report and fairly soon.

It sounded to me in her response to Mr. Miltenberger like she was not catching what he was trying to say. It was that we have an example where one department seems to have a very collegial relationship with boards. I know as recently as five years ago that the department in that case was very concerned about whether or not boards would be able to really provide the services here because almost every single one of them five years ago was in a significant deficit situation. However, by working supportively with boards, that has been turned around. All of the boards are now in a surplus situation and I think there may be a model there to take a look at.

I think that is really what we are saying. There may be ways to improve on the administration on how boards are doing it. I think we need to also take a look at how this government and the department in particular relates to boards.

I appreciate too that the Minister says she does not want to discourage volunteers who contribute to the administration of boards. I know that we have discussed at the committee level. It is something that concerns me. Because of the frustrations that I am sure a number of board members must feel in those boards in particular that are in deficit right now, the whole process for trying to deal with those deficits, the whole process for trying to get budget approved and I think there is a real problem here.

I was very concerned when I heard the Minister, in her statement on Friday, say that she was not expecting to have final answers in terms of how to deal with the boards and their deficits until June. I think that is way too long. I think that people have gone through most of this year without actually having an approved budget. I know that we have had some discussion about this, about whether or not we have approved budgets for all of the boards right now. In fact, the boards do not know whether or not they are going to have to recover the entire amount of deficit that they are building up this year. So I would say that by my definition, they do not have approved budgets if they do not know what portion of the deficit is liable to be covered and what portion is not.

I think that it is going to get more and more difficult to keep good volunteers working on these boards if they know that for a period of more than a year they are going to go without knowing just what the future holds in terms of the administration.

When we are having trouble recruiting, I think it makes it very difficult for the teams to generate a positive atmosphere around the health facilities, because the people at those facilities are concerned about the decisions the boards might have to make. If they are in fact going to have to recover entirely from these deficits from within the amount of funding that is being provided, it is going to mean dramatic cuts to programs.

I know the Minister has said that no cuts will be permitted that impact on patient services or services to the public, and I appreciate that commitment. I think the board members are increasingly frustrated because they do not see any possible way that they can in fact recover from those deficits without impacting on patient services.

I think that we are in a situation where we put a lot of dedicated volunteers on a number of boards in a situation where I am sure that they are about ready to throw up their hands and quit. I think that would be a very sad day if that were to happen. I think we could lose a lot of good experience.

I would like to ask the Minister if there is not some way in which we could deal with these situations. First, let us take a look at the Stanton board. We know that the board has been told by the department that closure of the surgical ward has not been approved. That was proposed as one measure that would have saved the board approximately $300,000 in a year.

Has the department told the Stanton board that at least that much funding will be added to their budget to allow them to continue the operation of that ward? Thank you, Mr. Chairman.

Thank you, Mr. Dent. Madam Minister.

Thank you, Mr. Chairman. Mr. Dent as well raises quite a wide variety of subjects. I will try and respond to some of them. His concern that we will not have recommendations to implement until June, I agree that is quite a ways off in view of the urgency of some of the situations we are facing. So we are going to attempt to get the recommendations from the Cuff review expedited if at all possible. We do not want to cut the discussions and the interviewing and the gathering of information short. However, I do agree with the Member that it does seem like that is quite a ways off.

In the instances where boards can show us that there were costs increasing that were outside of their control, forced growth, those kinds of cost drivers, we are obviously very open to receiving that kind of information and we know that can have quite an impact on budgets. We are committed to resourcing boards adequately so they can deliver the programs and services that we expect them to deliver.

However, I think it would be premature to suggest that there are not other problems which do exist that may be contributing to those costs. There is a lot of autonomy and a lot of authority that has been delegated to boards, so there does tend to be quite a bit of latitude in terms of discretion on how money should be spent. This is what has created a problem for us to some extent, that although the accountability in the big picture lies with the department, a lot of the authority in terms of the decision making lies with the boards. So I think that as a result of this system-wide review, we are going to be able to show you some of the problems that the gap in the system might create.

As far as the funding to the boards, every board is operating with a contribution agreement that has been signed and, albeit it is difficult where boards know that they have significant deficits and until those kinds of deficit issues are addressed, we know that it is troublesome to them.

The review is going to recommend the best approach to the funding, including an evaluation to the surplus retention deficit recovery policy that we have in place right now. So that is something that is also being looked at by this review as well. So we do not have any preconceived outcomes on what the consultants might have to say about that.

In comparing the education boards to health boards, health boards undertake a lot of functions that education boards do not. For example, pay and benefits is a fairly complicated, sophisticated function which education boards do not undertake, but health boards do regardless of the size. So when you do not have a centralized office that is providing those kinds of services, you do need quite a high level of capacity at community and regional levels to undertake and make sure those things are done properly.

When the Member talks about the collegial relationship between the department and boards in education, I have to tell you that I do not get the same sense. It was referred to as well in the committee's report when it talks about animosity and I cannot remember the other words that they used there between boards and the department. I am sorry, I do not have a sense of that particular...it is really difficult to kind of response to kind of anonymous, vague observations about things like that without any real detail around them. I do not know if it is even fair to portray that without something to back it up because it is difficult to respond to unless Members can be specific about it. That is not my sense. My sense is that in the years prior to when I was involved with this department, and certainly since I have been involved with this department, that the people in the department have played a very supportive role to the boards and have done everything really in their power to support the boards in the functions that they had to perform. So just a comment on that as well.

With respect specifically to the Stanton board, like I said, we are open to hearing about costs, expenditures, things that are driving their deficit, but we need good information if we are going to evaluate those explanations when they do come forward. We have a responsibility to ensure that it is good information because we cannot make decisions based on incomplete information. Thank you, Mr. Chairman.

Thank you, Madam Minister. Mr. Dent, I will put you back on the list. I know you have another question, but your ten minutes are up. Mr. Delorey.

Thank you, Mr. Chairman. Mr. Chairman, I am not going to go over the figures that the department has laid out in their budget. I see that a number of Members are covering that. I am going to approach it from a little bit of a different point of view right from the start with the the vision of the department. I can sympathize with the department with the many different areas that they have to cover and some of the very fundamental services that have to be provided to the people.

However, when you look at the vision of the department, self-reliant, healthy, well-educated individuals, families and communities doing their part improving the quality of their own lives, I think that whole vision says an awful lot to the people of the Territory if we can enforce that in some way.

The way I look at health and social services in today's age, unless we do get our people educated and get them to take some responsibility for their own lives, for themselves, for their kids, we are going to have a hard time keeping up with the cost of providing the service. We can throw as much money as we are throwing into the highway system and unless we get the people educated and be prepared to be responsible for their own lives and their kids, we may not be able to keep up regardless of how much money we put to it. That is not going to get any easier.

The way I see it in this whole Territory, as we open up the Territory to economic development, increase the populations, increase the payrolls, the money out there, all that has a very strong bearing on our ability to deliver social programs. I think it is going to be critical that we supply the education to the people and make it in the forefront as much as we possibly can for people to take some responsibility.

I see it as being a big challenge too and the people who are trying to provide our programs today, I think there is an awful lot of overload in the people we have out there right now. We are operating short-staffed whether it is doctors, whether it is nurses, assistants. We have an awful lot of shortages in non-governmental agencies that provide programs that are directly related with health and social services. In a lot of cases, we are not even able to provide the funding and the support that we should be giving to these very basic groups. When you have day cares, when you have women's shelters, intermediate homes, help for single mothers, it is all part of trying to get our people healthy and educated and looking after themselves and being proud of who they are.

In a lot of cases, we cannot keep up with the funding or we are not putting enough priority on it to do that. I think we have to get really serious about that and do it. I know we like to keep our communities healthy and give them the ability to provide the services, but I look at my own community and we are up to three weeks waiting time now just to get an appointment if you have a health issue, if you are sick. You phone and it is at least three weeks to get in to see a doctor. Well, in three weeks, you are going to be dead or you are going to better. Why even bother? Most of the time they do not even bother going. There are definitely problems in that area. I know that recruitment is hard for doctors and nurses, whatever. It is not only hard for the department here, but is tough right across Canada right now. That is what they are saying.

However, someway, somehow we have to find some doctors and some nurses. We have the hospitals. If we do not have the doctors to put in them, we are not doing much.

Although I sympathize with the department for having a hard time finding doctors and recruitment, if it is more money, whatever it is. Baseball teams seem to have one of the best teams, if they put the right money out there. The people do come.

So I think for my community, Hay River, it is high time that we get some doctors and nurses in there and have a good complement for the hospital because if we do not pretty soon, I can see us deteriorating from where we are now, from the people that are there getting frustrated, overloaded and not being able to answer to the people's needs. I think it is going to start showing up in a negative way if we do not do something positive for our people. Thank you, Mr. Chairman.

Thank you, Mr. Delorey. Mrs. Groenewegen.

Thank you, Mr. Chairman. Mr. Chairman, Mr. Delorey refers to the issue of personal responsibility and I think that is something that we do need to talk more about. You are right.

How much money will it take to address all of the needs and all of the problems? Are we making some progress on some of the challenges? Are the resources that we do have being spent in the most effective ways possible to obtain measurable results and outcome?

It is a really interesting question that Mr. Delorey raises in terms of how do we engage people to work with us and work with the system to take as much responsibility as they can to help secure their well-being.

You can make as many programs and services and opportunities available, but we have to encourage people to take the initiative to participate and be concerned about illnesses that are caused by things that are preventable and things that are lifestyle choices. That kind of discussion we need to do more work on because it is challenging to keep up.

It is not just here. It is everywhere. You just have to pick up any national newspaper and you can see that, in almost all of the jurisdictions in Canada, there is a real challenge to try and stay ahead of the needs that are always there.

Mr. Delorey also refers to the issue of funding and supporting NGOs and that is a very important part of our system because people who volunteer to work with non-government agencies, people who are employed with them, really help us in the tasks, goals and objectives that we are trying to reach.

We again want to really encourage them because they add a lot and we can certainly see the results of the good work that they do and the benefits of partnering with NGOs and the results that we are trying to accomplish.

The situation with the shortage of physicians in Hay River -- and now we certainly have a challenge in Fort Smith, as well -- the department is very attentive to those needs and we have had quite significant success in stabilizing the situation here in Yellowknife where, as most of you remember, I think Ms. Lee referred to it in her statement today, that it was only about a year ago when we were down to a very desperate situation here in Yellowknife as well. The problem is that when things get to that point, they continue to spiral down and deteriorate.

So we are hoping that with the standardized physician contract as a recruiting tool and trying to address some of the unique situations in some of the smaller communities that we can do more to make sure that the professionals that are needed at the community and regional level are there.

We need to really capitalize on the positive things about doctors and nurses and health care professionals, social workers, practising in the North. There is an opportunity to come here and, from what they tell me, enjoy a very varied and diverse practiced scope of practice and I think that is something that is attractive to them.

We think that our remuneration packages for professionals is very competitive right now and that is something that we have been attentive to because we do not want the lack of that to be a contributing negative factor to our recruitment efforts. So we think that is very positive.

I think that a well-structured, well-organized system is something that people will be attracted to as well. A system that is run in a very professional and modern way because that is very important to people's ability to carry out their jobs and certainly people will want to make sure that their work does make a difference and has a positive impact. We have to create the environment in order for them to do that. Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. General comments, Mr. Bell.

I am gong to save most of my comments until we get to detail, but I did want to touch on a few areas. A lot of it has been covered already in the committee's report.

Specifically first, recruitment and retention. I would echo the concerns that we have heard, that obviously we do not have the kinds of dollars where we can be squandering them at recruitment fairs, competing against various boards and various other northern, Northwest Territories boards because that is not going to get us where we need to be.

I know that the situation in Yellowknife has certainly improved, as Mrs. Groenewegen alluded to, from a year ago and Ms. Lee touched on that in her statement today. However, I think we can see how quickly situations can deteriorate. Things have moved very quickly in Fort Smith and I guess less quickly in Hay River, but we certainly have emergency situations in those two communities now.

I think one of the things that we have to be cognizant of is that, and I think we heard this at the ceremony in the Great Hall last week, physicians or health professionals, like any other occupation, will be key in recruiting and retaining professionals in the area.

People looking to come North will certainly look to the health professionals who are here and see how well we are supporting them and how well we are treating them and how competitive we are. Obviously, money is an obvious one. However, I think there are more factors than just money involved here.

Certainly we have to have adequate housing in communities for nurses if we are going to hope to keep nurses in these communities. It seems really obvious and simple, but I think we can do all of the recruiting missions we want, but if the situation is not adequate for them in the smaller communities especially, then we are going to have a hard time filling those positions.

So I believe that recruitment and retention has to probably be centralized in some capacity. Whether the boards can be doing this on their own may be another issue, but certainly there has to be some coordination here.

I would also like to see the department's initiatives tied into the Maximizing Northern Employment Strategy. I think the Premier had some very encouraging words in this area. Recruitment is one piece of this puzzle, but clearly if we can employ and hire Northerners, people who grew up here and went to school here and are interested in living here, I think that will be much more successful in the long run.

So I do not know if guaranteeing jobs is how we go about this. I do not know if that is feasible. However, we certainly have to make sure that we put the pieces in place for this Maximizing Northern Employment Strategy that can help us in this area.

I also wanted to speak quickly to the area of health promotion. I know our committee report does not touch on it as much this year and maybe it was not as highlighted for us, with all of the other things going on, but I think it is very important for us to realize that we do have a serious problem, obviously, in FAS/FAE.

I know we are going to spend some $2 million, I saw the newspaper article today on FAS, this year. However, I think we are really going to have to focus on this area. I think we are going to have to have people whose sole job revolves around helping us deal with education in the area of FAS.

I do not think we can look to the federal government for any help in this area. If the amount of money that they have earmarked for FAS is less than $2 million a year nationwide is any indication, it is really pathetic. I think this speaks to the fact that this is not something that is at the forefront for them, but it is for us. So it is going to have to be an issue where we take the bull by the horns and deal with it on our own. Clearly the federal government has not recognized the problem, and it probably is not a problem to the same degree in some southern jurisdictions as it is here. We have to have an effective way of dealing with this. I do not think they are going to be much of a help.

I have raised concerns with contracting. It is not specifically just to this department, but in the past couple of times there have been sole-sourced contracts go to southern firms. I will not dispute the Minister's insistence that we are talking about contracts that require a specific level of knowledge and expertise, and I have no reason to doubt that, and it is very possible that that expertise is not available in the North. However, some pieces of these contracts could clearly be done by northern contractors. I would like to see this government, not just this department, look to insisting that if we need a southern firm on some of these, northern firms can partner up with them to do some of the work.

If we do not look to do something like that, we will never build the capacity here, and this work will continue to go south. Not only is the money gone but the expertise is gone as well, and there is no passing on of any of this information. It is possible at this time that a contract of this nature, like the one that had to happen here, but if we exclude the North, clearly the next three times we need to do similar projects we will have to go south as well because we will not have any ability to deal with these things in the North.

I would like to see this department -- and maybe the Minister can speak to this, it is a political question -- but I would like to see the department truly try to involve northern firms in some of this work.

The last point I want to raise is the issue of the combination of the surgery and pediatrics at Stanton. I think we all know now that the department has insisted that the hospital reopen the surgery ward and separate these, but it is going to be a matter of finding enough nurses to reopen both wards, and there is an active recruitment drive to get nurses. I know I am getting a lot of complaints from constituents who have friends, who know people who may themselves have been at the hospital for surgery, and whatever the arguments may have been -- that there were economies of scale, that there were resources that could be shared by combining the two wards. We have had a lot of complaints and people say, "Can you imagine trying to recover from a surgery with lots of kids buzzing all over the place and being in a ward?" Especially for elderly people who are in for surgery. I do not see how this ever could have made any sense to anybody, and clearly the testimonies from people coming back saying, "What was going on here? How did this get this far down the pipe that we actually took the steps of, for a year, stop replacing nurses when they were leaving because we were planning to do this?" It seems ill-conceived. That is the response I am getting from constituents.

I know that we are looking to deal with this matter and hire nurses, and the situation is only going to improve or change as fast as we can hire people to fill these vacancies, but clearly I think this was a bad idea. I am glad we are looking to get out of it. I hope it happens quickly, especially for my constituents and all the people of the North, because it does not seem to make any sense. Thank you.

Thank you, Mr. Bell. Madam Minister.

Thank you, Mr. Chairman. Mr. Chairman, I concur with most of the comments that Mr. Bell makes. I could critique them and put my take on them, but I agree with him that the recruitment and retention, the competition amongst boards, and the duplication and overlap of the efforts of boards is not a worthwhile expenditure of time, money or resources; and that the level of satisfaction with health care practitioners who are already practising here is our biggest testimonial if you hope to be attracting more professionals to come here. That is the first thing that people who are thinking of coming here do, is talk to the people who are already practising here, so it does have a significant bearing on how they feel they are treated, whether they are appreciated, whether they are recognized for their work, and whether the environment where they work is conducive to them feeling they can do the best they can.

I agree with you that the recruitment and retention efforts at the very least to be coordinated by the department. Whether or not they need to be centralized is something that we continue to discuss.

The Maximizing Northern Employment Initiative is very exciting, and Health and Social Services are working very closely with ECE on this strategy. We do see in the long term that the training and employing of Northerners in the health care field is a very viable solution to the kinds of pressures we feel from the national and international competition for health care professionals.

FAS/FAE is an area where we should be definitely taking a leadership role and turning our attention as a government. Our statistics, as you know, still do indicate that 30 per cent of women who are pregnant in the Northwest Territories would still consume alcohol. That is very frightening, given the projected costs of providing support to an individual with FAS or FAE over the course of their lifetime, not to mention the loss of their potential as well.

The recently announced federal money, although any money is always welcome, certainly I agree with you that $850,000 per year nationally is not going to probably put a big dent in the problem here in the North. I think that we as a territorial government really need to pay close attention to this issue because the dividends and the return that we will see on investment now and early intervention in dealing with these problems will be very significant in the future.

I think that is all I have to say on Mr. Bell's comments. Thank you, Mr. Chairman.

Thank you, Madam Minister. Next on my list I have Mr. Nitah.

Thank you, Mr. Nitah. Mrs. Groenewegen.

Thank you, Mr. Chairman. The NIHB Program has been modified by the federal government. Policies have changed from time to time over the 12 years that we have administered it.

We administer it so when someone receives the services, we then bill the federal government to recover our costs. So there have been disagreements over billings, whether they should be allowed or not allowed under current policy and, at this point in time, we do not have a plan to turn this contract back to the federal government. Our intention now is to stay with it.

Now if the $5.5 million expenditure goes back into the budget, so will the revenue which we receive from this program as well. So it offsets the expense of it.

If Members have concerns about the Government of the Northwest Territories' continued participation in delivering this program outside of the financial issues we talked about, that may be a different topic for us to consider and to discuss.

The concerns that we had around the program were associated with the approximately $1 million per year that we had to subsidize in order to be the administrators and deliverers of these programs on behalf of the federal government. If those concerns are addressed, then I believe that we can continue to deliver it and the Government of the Northwest Territories may be the most effective and appropriate party to deliver that on behalf of the federal government, because people are certainly accustomed to the way that it is done now.

So we needed to have that discussion with the federal government and it has recently been more productive. If there are other concerns about the Government of the Northwest Territories fulfilling that role, then that is something that we would like to hear about as well.

For now, I think we can fairly safely say that if we can address some of these outstanding issues, we will continue to do it. We will continue to perform that task. I do not know what else. Let me see, I will take some notes here.

As to how you mentioned whether or not there will be a supplementary appropriation for the $5.5 million, our ability to expend that money would come back into the budget. I am going to ask Mr. St. Germaine to respond to that and just explain a bit. Thank you, Mr. Chairman.

Mr. Nitah.

Thank you, Mr. Nitah. Mr. St. Germaine.