Thank you, Mr. Chairman. Mr. Chairman, when Ms. Lee asks why we need to review the system, what is driving the need for a review and an action plan, I did identify some of these in a Minister's statement I made last Friday, but I will just touch on a few of them again.

Today, we have a very complex, fragmented system with multiple boards serving the needs of our 42,000 residents, so we have a relatively small population. We have everything from a community health board for a community of 300 people to a territorial board like Stanton, with a territorial role, with budgets of $48 million.

We have a lot of duplication and overlap and we do not take advantage of the economies of scale.

The accountability relationships are also fragmented. The legislative and policy responsibility is held with the department. The operational functions, which we have devolved to the boards, make it difficult to enforce standards of care.

There have been a number of things that have contributed to the erosion of our capacity to monitor and enforce the standards and provide administrative and clinical leadership and oversight. One of those things that has contributed to that, Mr. Chairman, is the downsizing within the department over the past years.

The things we are beginning to see because of a lot of the pressures on the health system are the operating deficits that the boards are experiencing. We want to be able to respond to those kinds of pressures, but we need a better way of accurately reporting what is contributing to that.

As I mentioned in my comments yesterday, some of the things that drive the deficits are things that really are out of the control of the boards. Some of the forced growth costs or expenditures that are not within the control of the CEOs that manage the facilities and the boards. In order to be able to clearly identify that, we need very good accounting and reporting structures in place.

A lot of the functions that we have devolved as well, such as the pay and benefits, are very complex. It is difficult for there always to be the capacity for stand-alone boards to be able to fulfill those functions.

When you consider all of the pressures on the system, it really is important that we find ways of making it as efficient and, as I said before, as good quality as possible.

Mr. Chairman, Ms. Lee also referred to a lot of the question around the review relating to governance. I just wanted to point out that the four key areas of the review are:

• • To optimize the effectiveness and efficiency of the Northwest Territories health and social services system today and for the future, which speaks to the sustainability;
• • To establish an appropriate accountability framework that clearly defines roles, responsibilities, and authorities;
• • To recommend a governance structure that supports the accountability framework while respecting strategic directions of Northwest Territories governments, which includes things like self-government negotiations and regionalization; and
• • To recommend an appropriate financing framework for the health and social services system. We are committed to ensuring the system is resourced so it is able to carry out the much-needed programs and services it delivers.

When we talk about the previous reviews that have been done, the reason why we say we are looking for very clear recommendations is, I will give you an example. Recommendations from some of the previous reports have tended to be fairly general. For example, the following recommendation and priorities from the Minister's Forum on Health and Social Services report entitled Our Communities, Our Decisions, "Initiate a new way of governing health and social services programs in the Northwest Territories."

This is characteristic of quite a number of the recommendations contained in that report. They are good recommendations, but we need to take it to the next step so we have a very clear action plan for implementing some of those former recommendations. Thank you, Mr. Chairman.

Thank you, Mr. Chairman. I want to refocus my question to the area of communities, especially the frontline workers who are usually the nurses at the health care centres. They are the ones who get the people coming in on a day-to-day basis.

One thing that I have always wondered is why is it that they are limited on the type decisions that they can make as an individual, especially when it comes to a situation when we talk about the possibility of medevacs. In my riding, there is a bus service that takes people from the communities to the regional health centre in Inuvik. Even there, they have to get permission from Inuvik. One thing I feel we have to do more of, especially as a government, is give more authority and responsibility to the people who are dealing with the patients on a one-to-one basis and make those decisions and give them the tools so they can make decisions without feeling threatened by someone above them or if they did something by saying, "Okay. We think that personally, you are not well. We do not want to take a chance, so we will send you to Inuvik," without them having to pick up a phone to phone Inuvik and ask what they think. If the doctor is coming in another three weeks, should that patient have to wait for three weeks to make a doctor's appointment?

I think we have to start finding ways to make better use of the people we have in the system. I think that is one of the frustrations we find with the frontline people, especially the nurses in our communities. When you talk to these nurses, they love what they do. The frustration that they have is when they are stuck in a position where they know the decision that they want to make is the decision that is not being supported by someone else. We have to look at allowing more flexibility in that area.

Another frustration you hear from frontline workers is having the tools to do the job that they are supposed to do. In many of the health centres, you do not have small things like a bus service or a small little vehicle to get you from point A to point B. A lot of the frustrations they get is that people are calling them saying so-and-so is sick and cannot make it to the health centre. They have to say sorry, there is nothing they can do. People assume because they are the nurse, they should come down to them. If the communities have the ability of having, not an ambulance service, but some vehicle that is accessible where you can have someone from the health centre go and pick up the individual and bring them to the health centre; it could also be used for the nurses to do their community tours. Many of these communities do not have the little things such as a vehicle to get them to do their job, to do their elder care, to go to home care where they go to the different elders within the community. A lot of these people have to find their own rides or walk to these communities.

Those little things we do to keep those nurses. The other thing is the facilities they work in. The big concern in Aklavik is sure, they know there is a new health centre that is going to be coming, but again, it is having to work within a cramped space. You have four people crammed into one little office, not having the luxury that other people have where you can go somewhere else and have that luxury. I think we have to improve the conditions these nurses are working under.

I think it is also important that we seriously consider looking at how we work within the First Nations communities. You talk to the nurses, the mayor, the chief, they seem to work together on community issues. However, it seems like when they need the tools or they need the resources to take on more authority and more responsibility, that is where they run into the problem with the red tape, or someone at the health boards is not responding or cooperating with them to do these unique things, to find ways to simplify the process or try to deal with these problems, especially where you have over-worked nurses and what not in the community, to try to find alternative ways of assisting nurses by having to either hire somebody to work part-time, be answering phones, or having somebody there that they can have just to be translating to an elder so they can explain to them what is going on.

Those little things that I see can go a long way to ensuring the health care of our communities.

Another area that I feel we have to do more of is start working in partnership with communities, especially First Nations governments such as band councils, in trying to access resource dollars that presently the federal government has a lot of.

I am talking about programs such as the aboriginal healing program. You are talking $100 million in that area. You are looking at programs such as Brighter Futures, community wellness. I think we as a government know we cannot do everything but if we pool our resources together, we are able to deal with these problems a lot better and a lot of the aboriginal communities I represent are frustrated because of the red tape trying to get the nickel and dimes out of this government, yet they are working okay with the federal government when it comes to the aboriginal healing program and other federal programs. So they are able to access those funds, but they are having problems accessing funds from this government.

There has to be a more cooperative and open process to allow for this government to streamline or pool the resources we have so we are able to get more mileage out of the resources that are out there, not only our resources but federal resources, so that we can pool our dollars and communities can deal with the front line issues, especially when you talk about problems we see in our communities; FAE/FAS, alcoholism, drug abuse. Those people need to have those resources so we can have healthy people who will assist us in the government. Without healthy people, it is costing us more money in the long run. So there are things we have to do to look at alternatives that are out there.

Another area is the alternative treatment program that you touched on. I for one have been hounding this House, especially in the 13th Assembly -- poor Mr. Ng, I think he is probably having nightmares about me today with regard to Tl'oondih. That facility is still there. It is being used by the aboriginal groups in the region, yet it is not being used by this government. As a government, we cannot afford to build new facilities.

We should start partnering up to use those resources and facilities that are out there where the aboriginal groups are using a lot of the resources they are getting through the aboriginal healing programs to run programs, regardless if it is the Inuvialuit or the Gwich'in. Again, that comes to looking at alternative treatment programs. Right now, we only have one treatment facility within the Territory. We have to start using those facilities that are out there.

I just want to touch on a few areas that we have been talking a lot about here. There is the whole area of reports, studies and what not. Since I have been here, we have been talking about the Med-Emerg report, which was back in the 13th Assembly. Then there was the Ministerial Forum on Health, which submitted a report to this House. Now we are doing another review on another report that is coming forth shortly. Again, I think that we have to start dealing with the problems that are out there. I am not trying to put as much emphasis, onus on studies, reports and what not. What we are seeing is we are being studied to death.

Our problems are compiling. It is costing us more to deal with these problems. Unless we deal with the problems that are there now, I do not think we can continue to put the resources and dollars into these reports. We have to start implementing the reports and the recommendations that come out of those reports, which a lot of good people and a good pile of information has been compiled over the last number of years. I think it is important that as a government we start implementing those recommendations that come out of these reports and not continue to one report after another report after another report. I for one am seeing that as a waste of resource dollars that could be better spent in the health care system.

I just wanted to make sure I got as much mileage out of my ten minutes. With that, I will leave it to the Minister to respond.

Thank you, Mr. Chairman. Mr. Chairman, I am sorry, I guess on some of these previous speakers, once they made their comments, my response goes against their time.

Mr. Chairman, Mr. Krutko raises a number of very good points. Just in respect to the review that is being done now and some of the reports that were done in the past, like I said, we are hoping that the recommendations of this review will be very specific and will build on the information that has been collected and reported on previously. Sometimes whether or not these reports and the recommendations get implemented or not has to do with the political will of the people who are serving at that time.

In her statement today, Ms. Lee talked about the necessity to find the courage and the money to implement some of these responses. I think that is a commitment that is going to be required on the part of all Members of this House is to work together to find the kinds of solutions we need, and then commitment again by us as a government to ensure that the system is adequately resourced in order to be able to do what it is intended to do. I suppose that is one of the other things that makes the particular recommendations that we are awaiting different.

Members of this House who were not here when the Med-Emerg report surfaced, there is a different Minister; there are different people at senior levels of the department in some instances. I remain optimistic that there will be the courage and the will to come together to make the necessary changes that we need to make in order to make the system better for everyone's benefit.

Health and social services is such an important part of people's lives. At no other time are people more vulnerable than when they are not well. People's health is something which is very personal and a person's ability to have the confidence that they can access good services is so important in a person's well-being. For people living in the North, I know that is a major consideration in quality of life.

So with respect to some of your points that you made about some of the reporting and communications structures, the way they are set up now where nurses may have a good sense of what needs to be done to address problems but need to seek approvals from other places and that whole chain of command, that is part of the reason why we are conducting the operational audits to identify those kinds of areas.

With respect to operational audits, I am going to ask Ms. Ballantyne if she could elaborate on the kinds of things that the operational audits are going to look into. Thank you.

Thank you, Mr. Chairman. There are a couple of areas, Mr. Chairman, that I would like to raise with this at this time in general comments. I am aware of previous work that was going on within the department to try to address some of the increased cost pressures the department was facing. I am not sure if anything has come out of the initiative that was undertaken, especially when I was involved in the department myself. As well, I have had opportunity to view the transcripts of the committee and there are a number of points there that -- I do not know how else to put it -- I am concerned with upon seeing some of the information.

Mr. Chairman, in particular in the area of cost drivers and pressures, we have heard this across Canada; of the costs increasing and one of the initiatives as well, as we were looking at in the 13th Assembly, was in the area of nurse practitioners. We have not heard much of that area for quite some time. I would like to know from the Minister if there has been any further work done in this area.

As we know, we have a lot of small communities that do not have doctors. We have nurses in these communities that have to take on a lot of extra duties.

Along that area to try to help remote communities out was the area of telehealth, so we would not have to medevac as many patients out because of the concern of diagnosis or misdiagnosis. There was work being done in that area and that is an area where again I have not heard much about as we go into year two of our term.

I know it was fairly new when we first looked at it in the 13th Assembly and some work was going on. I know there have been connections made with Inuvik and a few of the larger health boards. I am not sure if it was at that time being used to the best of its ability in a sense of reducing some doctor visits.

I have heard comments from individuals and from those involved in the field to a certain degree where patients would be seen by a doctor through the telehealth. They were quite impressed with being able to do that, but still having to come down and see the specialist in Yellowknife and be sent back home again. It is almost seeing twice. Once through the telehealth system and then coming back down and being seen again.

We can all pull examples out of stories we have heard or people telling us directly of some of the concerns of being flown down here and then being flown home the next day because they saw the doctor for 15 minutes. That is a concern. You would think those cases could be dealt with through the telehealth system instead of having someone on the plane down here and going back shortly afterwards.

I am not sure if that is associated with the fact that there has been a high turnover of doctors. It is a concern that is there and needs to be addressed. These are on the ground, day-to-day issues for health practitioners that impacts the department because of the costs of initiatives like this and the cost of medical travel.

I would like to know again, specifically in those areas of cost drivers and what we have done to promote nurse practitioners in the Northwest Territories. Where is that work going? Is it ongoing? Are we going to hear something soon? I know there has been some support initially from doctors in the Northwest Territories. I think that was conditional. I do not know if we have moved much farther than where we were over a year ago. So if we could get some information on that, Mr. Chairman.

Thank you, Mr. Roland. Madam Minister.

Thank you, Mr. Chairman. Yes, Mr. Roland identifies some areas were there has been some advancement and movement within the department.

First of all, the nurse practitioners. The department, the board, the college and the Northwest Territories RNA are working together to develop advanced nursing educational programs. I will be making a ministerial statement some time during the session on some of the nursing program areas.

The advanced nursing educational programs would include an introductory nurse practitioner course and a university accredited nurse practitioner program. A needs assessment of nurses registered in the Northwest Territories was conducted by the college, which was just done in November-December 2000. It resulted in the return of 227 surveys. Seventy-six respondents indicated an interest in the nurse practitioner program and 43 indicated interest in both Bachelor of Science in nursing and nurse practitioner programs. There is activity taking place around that and there is interest. Those are encouraging pieces of information.

Mr. Chairman, this fall the college is planning to deliver a 15-month nurse practitioner program. The introduction to nurse practitioners is ongoing now and they have three points that they have intake. At each intake point, there is three more people added to the program. Those start in September, February and May and that is ongoing now. So that is some of the information on the nurse practitioners.

With respect to the telehealth services, there is a plan underway to expand those services as well. You raise an interesting point with respect to the telehealth contact being made and then requiring a trip to the specialist. It seems that it may be adding to our costs as opposed to diminishing. That is quite possible that that could happen.

With the telehealth technology, what can happen is that more things can be diagnosed. However, the good news is that quite often it can be an earlier diagnosis. It does identify needs for face-to-face visits with specialists and physicians. It does require travel and follow up. Telehealth is not necessarily a big cost saver, but it certainly does enhance the system and enhance the quality of the service that we can deliver to Northerners.

With respect to some of the specifics around the development of the telehealth network, I am going to ask Mr. St. Germaine if he would describe some of that. Thank you.

Mr. St. Germaine.

Thank you. Mr. Roland.

Thank you, Mr. Chairman. Maybe if I could get a bit more information on the telehealth side. Was it because of not getting proper equipment or was it linkage for satellite sort of thing? Was it anything to do with the DCN or digital backbone, as it was called? It was a pretty flimsy one at that. Or was it more related to the cost of trying to set it up? Thank you.

Madam Minister.

Mr. Chairman, I will ask Mr. St. Germaine if he would respond to that. Thank you.

Mr. St. Germaine.

Thank you. General comments? Mr. Dent.

Thank you, Mr. Chairman. Mr. Chairman, rather than belabouring the issue about the similarity or dissimilarity between education boards and health boards, I guess we will just have to say that the Minister and I disagree about what level of similarity there might be.

I think we should be looking, though, at those areas of similarity, why there seems to be a better relationship, from the boards' perspectives, in education then there does in health. I still think it is worth investigating why that might be.

I would like to get back to the one issue that I had started in on, the issue of the recommendations from the Child Welfare League report. The Minister told me that there were ten additional workers, their salaries included in the $1.2 million in critical investments in this budget. Could the Minister tell me is that ten additional workers to the three or four that were already allocated in Yellowknife in the fall? Is this in addition, so we will actually see an increase in total numbers of 14 over what we had when the report was issued? Thank you, Mr. Chairman.

Madam Minister.

Thank you, Mr. Chairman. Mr. Chairman, the three employees who were added to the Yellowknife Health and Social Services Board last year were two workers and one support staff. If the board can accommodate those three in terms of their financial resources, we think it would be fine if they continued to have them.

The ten workers would then be in addition to that and unfortunately all of those, depending on where you live, are slated for the Yellowknife Health and Social Services Board.

Mr. Dent.