Yes, thank you, Mr. Chairman. Mr. Chairman, today I am pleased to present the 2001-2002 Main Estimates for the Department of Health and Social Services.

For the 2001-2002 fiscal year, the department is requesting a total of $182.811 million. For the 2001-2002 fiscal year, the department has been allocated approximately $17 million in forced growth and new initiatives. Six million of this funding does not appear in our main estimates as it has been set aside in supplementary appropriation reserves pending completion of current system reviews and audits that will allow us to propose appropriate allocation of these funds.

The remaining $11 million in forced growth and new initiatives, which is incorporated in the estimates, is offset by the reduction of $5.5 million in funding for the federal Non-Insured Health Benefits Program, about which I spoke earlier today. Adding in other budget adjustments, the net increase shown in our main estimates is $7.3 million. The budget is allocated to five main areas:

• • Directorate and corporate services, $25.9 million, which includes system leadership and development, planning, policy and legislation, monitoring and evaluation, administrative support, program and service development, population health and human resources;
• • Health insurance programs, $33.4 million, which includes supplementary health benefits, physicians programs and out-of-territory hospitals;
• • Primary and acute care programs, $91.3 million, which includes inpatient and outpatient services, medical travel, public health and chronic care;
• • Children's programs, $10 million, including monitoring and evaluation of programs, residential treatment, foster care, child abuse prevention, early intervention and adoptions; and,
• • Community health programs, $21.9 million, which includes children in care and early intervention.

Just over half of the budget is allocated to the direct delivery of primary and acute health care programs, including inpatient and outpatient hospital services, public health, care for chronic conditions and medical travel. A further 34 percent of the funds is dedicated to children and community health programming as well as health insurance programs. The remaining 13 percent of the budget provides funds for department responsibilities and special initiatives.

The department's forced growth of approximately $4.8 million has been kept to a minimum. Nearly half, close to $2 million, of this growth is attributed to increased medical travel. We know that medical travel has outpaced our overall population growth, due in large part to our growing seniors population. Past experience tells us that forced growth in medical travel will continue to rise.

Other areas of forced growth include physician programs, board expenditure increases, immunizations, foster care, adult and child placements in southern facilities for specialized care and our required contribution to establishing a new national blood service.

The department is also requesting just over $6 million to invest in the following critical areas:

• • Investing in the primary care model by stabilizing the physician workforce, $2. 8 million;
• • Negotiating the extension of the nurses market supplementary for one more year, $1.5 million;
• • Improving child protection and family support services through the addition of extra staff and training, $1.2 million;
• • Providing additional staff to support expanding telehealth access in new communities, $222,000; and
• • Developing cost-effective and culturally appropriate supported living through a group home for the disabled, $280,000.

Additional funding has been identified for the department that does not appear in the main estimates. This includes new federal funding commitments through the Canada Health and Social Transfer announced at the First Ministers' meeting in September specifically, as well as new targeted funding for primary care, early childhood development and medical equipment. The Government of the Northwest Territories Maximizing Northern Employment initiative will also provide some funding to increase nurse mentorship allowances and guarantee the hiring of every new northern nurse and social work graduate.

Finally, $2 million has been allocated for each of the next three years to invest in early childhood development. The department is working with the Department of Education, Culture and Employment to develop an action plan, which will describe specific activities in the areas of healthy pregnancies and infancy, healthy parenting, early childhood learning and community supports. Along with Minister Ootes, I look forward to working closely with the Standing Committee on Social Programs to ensure that the early childhood development initiative provides all children in the Northwest Territories with a healthy start in life.

The department anticipates that as in past years, additional forced growth expenditures will arise in 2001-2002, particularly in the areas of medical travel and board operational expenses. Medical travel is by its very nature responsive to the needs of individuals requiring medical care and as such, can be difficult to forecast from year to year. As Members know, just over $136 million, over 76 percent of the budget, is allocated to our health and social services boards for the delivery of services. Board operational expenses have proven more difficult to forecast in recent years, with boards experiencing unanticipated deficits. The forced growth reflected in the main estimates represents the best information available for forecasting at this time.

The current system-wide review will provide recommendations to improve accountability and reporting at all levels of the health and social services system. Mr. Chairman, I want to emphasize that we have excellent people working in all regions and at all levels of the system, many of whom are working under very difficult conditions to provide the best possible services to residents. I would like to thank them on behalf of all Members of this House for their commitment and dedication. We need to ensure that in our desire to bring improvements to the system, we keep a positive and constructive focus aimed at making the system work better for the benefit of all people, not only those who need the services, but also those who provide them.

Mr. Chairman, I am very pleased to note in their report that the standing committee is prepared to work with the Minister and the department to address the problems and improve the situation. I welcome the collaboration and advice of all Members as we work together to improve our health and social services system for all residents.

Mr. Chairman, this concludes my opening comments and I look forward to a full and vigorous discussion of our budget with Members. Thank you.

Thank you, Madam Minister. Does the chair of the committee responsible for overseeing this department have any opening comments? Mr. Miltenberger.

Thank you, Mr. Chairman. The Standing Committee on Social Programs met on January 16, 2001, to review the 2001-2002 Main Estimates for the Department of Health and Social Services. The members noted a $3,414,000 increase under the compensation and benefits to cover the costs of the new collective agreement with the Union of Northern Workers, and a further $4,895,000 in forced growth for such things as medical travel, immunization programs, hiring of the first ten social workers to meet the recommendations of the Child Welfare League of Canada Report, foster care, southern placements, and enhancing independent living programs in the Deh Cho.

The committee also noted a $5,500,000 reduction under health insurance programs relating to the return of the responsibility for the Non-Insured Health Benefits Program to the federal government; a $54,000 reduction for physician programs and a $500,000 reduction related to the inability of the department to secure title to the former properties of the Northern Addiction Services.

Members had several concerns with the Department of Health and Social Services. These concerns were primarily in the ability of the department to provide quality information and the department's relationship with the boards.

The members of the standing committee expect departments to have clear plans based on blue-chip information, to be explicit in how they intend to implement those plans, and to report back on the results of changes and initiatives in a concise and informative way. For a number of years, the Department of Health and Social Services has been unable to provide quality information in both financial and program areas to the standing and special committees of the Assembly.

Over the past two years, there has been a slight improvement in the development and reporting of some general statistical information on health. However, adequate information necessary to make accurate and informed decisions about programs and expenditures continues to be unavailable or of poor quality. The department has consistently failed to demonstrate that issues were in hand and that there was a comprehensive approach based on top quality data.

Two issues were raised during the business plan review that, in the view of committee members, indicated that the department remains in a perpetual planning phase, unable to move forward on the hard realities facing the health and social service system.

The first issue was a contract to review health care sustainability being sole-sourced to a southern contractor with no tender process. The committee sees this as essentially a review of the governance system deciding which facets of the health care system the boards or the department control.

Members of the standing committee were concerned that not only was the contract for the review of health care sustainability sole-sourced, but that the chosen contractor was from outside the Northwest Territories. Members are always concerned when a contract of this size, $300,000, is awarded to a southern contractor. The concern is even greater when no other northern or southern contractors had the opportunity to participate in a competitive bidding process.

The results of the review on the sustainability of health care may now be in question because of the closed way in which the contractor was selected, and the resulting speculation at the board and other levels about why the decision was made. There is a concern that if the department hand-picked the contractor, they perhaps also hand-picked the results of the review.

The committee's second issue was the addition of two new senior manager positions, an associate deputy minister and an assistant deputy minister for population health and clinical services.

Members of the committee noted that they had been pushing for the department to increase its ability to monitor the clinical side of health care. It is hoped that the appointment of an assistant deputy minister for population health and clinical services is a first step in improving monitoring.

While the department did attempt to explain the need for the two new senior management positions, no explanation was provided why this was not identified as a critical need in October during the business plan review. Yet, members noted that the senior staff were appointed and in place by January.

The department indicated that there are emerging pressures on the system caused by the boards' deficits, and that the department is dissatisfied with the quality of information that they were able to provide over the last two years. It was also revealed that this led to the department being unable to provide the quality of advice, analysis and support necessary for decision-makers to make informed decisions. The department said this contributes to a growing sense that the system is out of control and the department believes that there is little it could do to make the necessary changes to sustain the viability of the health care system in the absence of quality information.

Committee members were told that the department required short-term senior management help to oversee operational and payroll audits for boards in difficulty, and to coordinate what is hoped to be the final review of the health care system for quite some time.

The standing committee agrees with the department that there are serious problems, both operationally and with the quality of information and resultant decision making. There was a suggestion that the latest governance review and the addition of the two senior manager positions would make the difference. Committee members sincerely hope this is the case and that the next business plan will see a department which is proactively dealing with the important issues that are part of its mandate.

Now that there is a shared understanding of the challenges facing the department and health and social services system, the standing committee is prepared to work with the Minister and department to address the problems to improve the situation.

The standing committee is disturbed by the apparent animosity, distrust and disrespect that seem to characterize the relationship between the department and the health and social services boards. In our opinion, this is having a significant negative impact on the health and social services system, and on the ability of boards to develop services for residents.

It is truly disappointing that the situation has reached its current low point, particularly since two years ago the department created the board support and health services division complete with a director position, tasked with the specific role of improving the reporting and overall relationship between the department and the health and social services boards.

The committee does not believe that the difficulties are a necessary outcome of having boards and a department involved in the delivery of services. If we look at the school side of Education, Culture and Employment, the boards are well established, in relatively good financial health, and maintain a cooperative working relationship with each other, the department and the Minister. The joint recruiting drive for teachers this January is just one example of how this type of system can work.

Of particular concern is the financial status of most health and social services boards. Although we are close to the end of the current fiscal year, some boards are still operating without budgets or deficit recovery plans approved by the department. At a time when we are encouraging advance planning, these boards are operating day to day. Fingers are being pointed in both directions with the department suggesting they cannot get accurate information from the boards to allow for decision making, and boards suggesting that the department does not have the expertise to adequately support them in either financial or operational matters.

It is critical for the effective functioning of our health and social services programs that a positive, cooperative relationship be established between the department and the boards. This will take considerable effort and leadership from the department, but it is essential. The members of the standing committee look forward to hearing from the Minister on what steps the department will take over the next six months to improve the quality of interaction with the boards and create a mutually supportive and respectful relationship.

Mr. Chairman, I would like to call on the deputy chair, the honourable Member for Deh Cho, to carry on with the reading of this report. Thank you.

Thank you, Mr. Miltenberger. Mr. McLeod.

Thank you, Mr. Chairman.

The standing committee supports the general concept of returning responsibility for the NIHB program to the federal government. However, that support comes with a number of concerns.

A smooth transition process from territorial administration to federal is important to those accessing the program. Members expect that a detailed transition plan has been developed to ensure continuity of service and would like to receive a copy of that plan by March 15, 2001.

Although responsibility for the program is being returned to the federal government, the Department of Health and Social Services continues to have a mandate to address the health concerns of all residents. This should include an advocacy role on behalf of residents with regard to the NIHB. In particular, the territorial government should monitor changes to the program and carry out the necessary lobbying to ensure that the needs of residents covered by NIHB continue to be met. This ongoing monitoring and advocacy role should be specifically assigned within the department.

Members are also concerned about the Metis health benefit program. This program was developed, in part, to complement the NIHB programming available to those status individuals. The committee would like a commitment that the return of the NIHB will not negatively impact on the level or delivery of the Metis health benefit.

The committee appreciates that the department and the relevant boards have addressed the medical travel concerns of Kakisa residents and have instituted a plan that everyone agrees on. However, this does not address the broader concerns with the medical travel policy. Residents of small communities wonder why medical travel does not apply when someone travels on their own initiative for medical purposes or seeks a second opinion when dealing with a serious medical matter. The medical travel policy, as it stands, does not address the inequities in access to medical services for those who happen to live in larger centres and for those residents of smaller communities who can only access a similar level of service at their own expense.

Committee members recognize that these are complicated issues and that medical travel is a major cost driver within the health and social services system. However, from a perspective of fairness and equity, if a second opinion reveals additional information which aids in the effective treatment of an individual, the individual should be compensated for the personal expense they incurred to obtain that second opinion.

Members raised this issue during the June 2000 review of the 2000/2001 Main Estimates but, as of yet, have received no response from the Minister. The committee requests a response by March 15, 2001.

The standing committee has repeatedly requested specific, detailed information from the department regarding the success of the various elements of the recruitment and retention plan. The department currently has a team of three full-time staff working at the headquarters level, exclusively on recruitment and retention issues. On October 27, 2000, the standing committee requested further information on the components of the recruitment and retention plan. To date, no response has been received. Without this information, it is difficult for the committee to determine whether the significant funding currently invested in this plan is having an impact, whether there are any more front-line health and social services workers and whether the length of time they remain in their positions is increasing or staying the same.

Nursing

There are two areas of specific concern regarding nursing. The first is the issue of the nurses' supplement. This supplement is nearing its end and the government will have to determine, once again, how to handle the issue of compensation for nurses.

Committee members are unaware of any specific work being done to find a long-term solution to the issue beyond the stopgap use of the nurses' supplement. There is also a lack of clear information regarding the effectiveness of the supplement in both recruiting and retaining nurses. The committee looks forward to information on how the department plans to address nurses' compensation, while acknowledging the impact of any such strategy on other occupations with similar recruitment pressures.

The second area of concern regarding nursing is the apparent lack of coordination in trying to recruit nurses. Committee members have been told of instances where one health and social services board will attend a recruitment event, only to discover that other boards are also there delivering a similar message. One of the elements of the recruitment and retention plan was supposed to be coordination of these efforts between the boards and the department. The committee would like to receive detailed information on what coordination takes place with the boards on recruitment.

Strategic Initiative Fund

The committee notes that the Strategic Initiative Fund has moved beyond its original purpose and is, by the department's own admission, funding programs which should be included as part of the base funding to boards.

This becomes readily apparent upon examination of the information provided by the department to the committee on the programs that are being funded by the strategic initiative fund this fiscal year.

While there may be some advantage to maintaining some discretionary funding that can be used to fund worthwhile projects, such a fund should not be utilized to pay for programs that should be part of the base. If a program funded under the strategic initiative fund is ongoing, or has become institutionalized as part of the core services that the board offers, the money to run the program should become part of the base funding to that particular board.

Members were of the opinion that the strategic initiative fund is being used to fund programming that could be considered as part of the core services that each board is expected to offer. The original intent of the strategic initiative fund was to help boards fund additional programming over and above what they are required to.

Concern was expressed that the way the strategic initiative fund is administered could be unfair to the smaller boards. The larger boards have the resources and personnel to develop and submit comprehensive proposals to access funding. The smaller boards, because of their inability to develop proposals, may be systemically penalized in accessing funds.

Should the strategic initiative fund be discontinued and the funding converted to part of the base, the Standing Committee on Social Programs will expect to see rationale presented that explains the fair and equitable distribution to the boards.

Thank you, Mr. McLeod. At this time, I would like to ask the Minister if she would like to bring in any witnesses. Madam Minister.

Thank you, Mr. Chairman. Yes, I would.

Sergeant-at-Arms, could you please escort the witnesses in? Madam Minister, for the record, could you please introduce your witnesses?

Mr. Chairman, with me today I have Penny Ballantyne, deputy minister of Health and Social Services, and Warren St. Germaine, who is the director of financial and management services. Thank you, Mr. Chairman.

Thank you, Madam Minister. Welcome, witnesses. General comments? Mr. Miltenberger.

Thank you, Mr. Chairman. This is the first department and we are dealing with one of the biggest budgets in government. It is a critical area that affects every man, woman and child in the Northwest Territories, and it is very clearly in a state of some distress.

Mr. Chairman, there is a sense, I know that in my constituency, and when you read the newspaper, listen to the radio and watch any kind of northern newscast, there are significant problems out there that this department has to face. There are a number of concerns, yet as we pointed out in our report, there seems to be a perpetual state of planning and study going on. The department goes from one high priced review to another, with no real long-term action to implement. I think there is a considerable amount of uncertainty in the department. There clearly seems to be significant friction in terms of the government side, administration side. Once again, we have chosen to bring into the North a southern contractor to give us the answers as to how to fix up the Department of Health and Social Services; how to make things better, how to get the system on track and functioning.

"Mr. Chairman, every dollar that we spend on consultant's workshops, meetings, travel and committees is another dollar that we take away from our health services. After all these studies, I think we know what we need and what we want to do. I know that we can work together to solve this problem and find a northern answer to this very northern challenge. I ask both sides of this House to do proactive work on this problem. I suggest that we start by using the data that we have already gathered and spend proposed funding for further studies on taking care of our people. Study time is over. It is time to get down to work. It is good to seek input from other people, but as leaders, I think that the people expect us to stop asking questions at some point and start answering them."

Mr. Chairman, that is a quote from Hansard, July 30, 1999, from Mrs. Groenewegen, the current Minister of Health and Social Services. I think it is as relevant today as it was back then, 18 short months ago when the debate was over the Med-Emerg Report and over the other studies that have been going on. Here we find ourselves still mired in significant problems.

Mr. Chairman, we have to somehow come to grips with the governance issues. As the Minister has pointed out, at least in my constituency and I think across the land if you look at her comments, the problem is not so much in many cases the clinical side or the service to the people, it is more the administration side, the ability of the department to work with the boards. Also, between the boards and the department to be able to count the money that is being spent, have the proper human resource practices.

It is doubly confounding when you look at education, for example. As we have indicated in our report, the divisional boards appear to have a fairly cooperative working, positive relationship with the Minister. The DECs all have surpluses. They do constructive planning together and they seem to get things done. When you look at the many municipalities, Fort Smith, Hay River, Inuvik, Yellowknife, and probably many of the smaller ones, the community councils, the community governments are able to run the programs, deliver services to all the people and do it in a proactive, constructive way. Yet year after year -- this is my fifth year at the table and probably going on my sixth budget -- we hear that and the problems seem to be exacerbated, that they are not near any conclusion.

I know and will acknowledge that there are things that drive the system; the doctor shortage, the nurse shortage. However, Mr. Chairman, clearly that is not where the fundamental structural problems exist.

We are taking all sorts of steps to bring professional people in and to keep nurses and doctors and social workers. What we cannot seem to get a handle on is how do we run administratively and from the government's point of view?

My concern is that the department sees the health boards as one of the sources of the problem. When you look at the Minister's statement to this House on Friday, February 16, 2001, there were six items listed. Five of them seem to clearly point to the problems with the health board. My question to the Minister has been where is the department in all this? These boards are the creatures in government. They are the creatures of the Department of Health and Social Services running under their many pieces of legislation.

When I look back to 1996, there was a unilateral, arbitrary decision made by Health and Social Services to turn over all the funding to health boards. It was basically done cold turkey. There was no clear audits done to say we the government are turning over the keys and the money to the health boards and here is how the numbers add up and here is the state of the union and the financial statement. Now from here on in, you folks administer it.

They just picked up the process and they picked up the money and the responsibility in mid-flow. I have been told repeatedly, at least in my constituency, that a lot of the problems that are being brought to light go back before the boards had the final authority and all the money to administer.

Mr. Chairman, I am hoping through the course of debate over the next day or two that we will get a clear sense that this is a shared responsibility, that we are not looking for a whipping boy. We are not looking for somebody to be the scapegoat. We are looking to provide a system that delivers high quality, stress-free health services and is not going to chew up and spit up the volunteers that sit on the health boards trying to do the job and that the people at the headquarters level, the people providing the leadership and overseeing the structure of this department and the very many pieces of legislation and policy that guide it can come to an agreement, an understanding of how they are going to do this. I for one am not particularly enamoured with the idea of re-centralizing, of putting all the pieces back in place and to disenfranchise and disempower boards.

The other concern I have tied in with this whole process and this big review that is going on, the Cuff review, is that there is no potential as far as I can see when I look at the terms of reference to look at other options like community service boards. I understand now that the government has pulled back from their review of regional administration and structure, but very clearly there is a relationship, what kind of regional structures you are going to have.

In my community, I think it is an option that should be looked at, the whole issue of a community services board. The South Slave, very clearly in my opinion, history has shown that regional operations do not do well, be they regional councils or divisional boards of education. Hay River has agitated long and hard for a number of years to pull out of the district education council, so it makes no sense to be looking at possibly trying to institute some kind of regional structure.

By the same token, I do not think it makes any sense just to possibly blow up the health boards and say that the problem is gone, now we will be able to do good work on behalf of the people of the Northwest Territories.

In my opinion, if everybody comes to the table, there is common ground here. I think communities are not going to give up and fight very hard to keep their hard-fought involvement and direction and control that they do have over health services at the community level. Thank you, Mr. Chairman.

Madam Minister.

Thank you, Mr. Speaker. Mr. Miltenberger has covered quite a wide range of subjects and I will attempt to address a few of them. He states that the system is in a state of distress and he has a sense of a significant problem. That is a correct assessment. That is what we are seeing as well.

We are seeing that because these problems have come to our attention, we need to take a proactive position with them and try to address them. There are many pressures on the health and social services system, and we as a government and as a department and myself as a Minister have a responsibility to ensure that there is a sustainable quality of service for health and social service programs in the Northwest Territories.

We are not arguing with that observation. We are stating that is the case and that it is now important to identify what the most appropriate solutions are to those problems.

Mr. Miltenberger refers to a quote from an old Hansard. In fact, I do very well remember...

-- Interjection

...only 18 months old, indeed. He has also used the phrase that we are in a perpetual state of planning. Well, the Cuff review was intended to take and is taking into account those previous things such as the Med-Emerg Report and the Minister's Forum on Health and Social Services, so that the information that was gathered as a result of those reviews will form a backdrop, or a background if you will, to the kinds of recommendations that are coming out now. We are looking for pragmatic recommendations.

As far as these being not made-in-the-North solutions to northern problems, I can tell you that we felt that the Cuff and Associates team was just the right mix of professional and experienced credentials that could help us come to a program or decisions about resolving some of these issues as expediently as possible. I guess if there are any more questions, we can speak more to that.

There were some advantages to having people coming in from outside, not the least of which are the credentials of the review team themselves.

As far as the comparison to the education boards, there are a few things that I want to say about that. First of all, of course, government-wide, we are happy that any structures that governance has put in place that they are working well and doing what they were intended to do. However, it is difficult to compare education boards and heath and social services boards. They are quite different and you also have to bear in mind that the Government of the Northwest Territories is not held responsible for health particularly for as long a period of time as we have had jurisdiction over education. So there is definitely an element of growing or evolving that capacity to deal with these things at a regional, community level.

So the Member's observation about the education boards working well, that is indeed good news. However, my focus is on how we can come back to this House and report that the health and social services governance structures and system is also working well. Definitely, there is a shared responsibility.

The Member refers to there being no desire to disenfranchise or disband boards. I think he used the words...I do not even want to repeat them. We have no intention of treating the volunteers who have come to the table to help us deliver these programs and services in the communities and in the regions with any kind of disrespect. We recognize that it is a shared responsibility and, as I stated before in the House and in my statement on the condition of the system, I do not believe that pointing fingers or trying to lay blame is a constructive exercise at this juncture.

I think that we need to stay very focused on constructive and positive ways of addressing this because we are at a time when there is a tremendous amount of pressure on this system. We can ill afford to negatively impact the morale of any of the people who work on our system at any level.

We should just, as I mentioned in the Minister's statement today on the physicians, be very thankful that we have been able to recruit and retain the level of professionals that we do have here within the department and also within the employees of the various boards. We certainly do not want to discourage any of those folks who we believe are doing the absolute best job they can do under very difficult circumstances in some instances.

So I agree with the Member that there is a common ground. It is our intention and it is my intention to take a very proactive stance and approach to the concerns that have been identified and find the best solutions that we can to those in cooperation with the Members of this House. Thank you, Mr. Chairman.

Thank you, Madam Minister. General comments, Mr. Roland.

Thank you, Mr. Chairman. Just a few points and a few items of concern that I have dealt with over the year and particularly with the department and how this budget might address them, or maybe it does not.

Something that is a big thing that I am looking at here is the projections and the changes in the fiscal situation. We have been looking at the end of March 2000 actuals, total operations and expenses for the department were $170 million. Main estimates for this fiscal year we are in started off when we passed in July of $175.5 million. Revised now, we are looking at $182 million. That is $6.5 million more since July.

As I see it in the main estimates now projected for 2001-2002, we are projecting less than an $800,000 increase. Is that realistic, in light of the growth this department has seen every year for many years?

I think the practice used to be we would always see a five percent growth, but are we realistically putting the accurate figures here? When I look at a one-year difference of almost $12 million to what we are predicting of $800,000, are we looking to budget outside of that later on? Maybe we can get some information on that area. I have a couple of other questions that I have later on, but specifically to that right now, Mr. Chairman.

Thank you, Mr. Roland. Madam Minister.

Thank you, Mr. Chairman. Mr. Chairman, the projections that we have been able to put together have perhaps not been as accurate as they could be. We have had to rely on information that had come to us.

When we look at it, 75 percent of our budget is devolved to the boards. We rely very heavily on information in terms of projections and we recognize that these projections may not be as accurate as they could be and that is the reason why we have a $6 million dollar supplementary reserve set aside, pending the final outcome of the information that we are anticipating to assist us with that information.

Another factor that makes it difficult to project costs exactly is that there are quite a number of expenses associated with delivering health and social service programs, which are not controllable costs.

Maybe if Mr. St. Germaine or Ms. Ballantyne have anything that they would like to add to that. That is just a general overview. Maybe the specifics of those differentials, maybe they could add something to them.

Thank you, Mrs. Groenewegen. Mr. St. Germaine.