Mr. Miltenberger.

Thank you, Mr. Chairman. The Minister, I am sure not advertently, is trying to put words in my mouth in terms of some reference to more staff at the headquarters level, which is nowhere, anywhere in my comments is my intention.

My question relates more to the functioning of the department right through down to the boards, where there are clearly problems with the financial systems, administrative systems and management systems. I am not saying put more people into doing these functions that are not working. I am asking the Minister what particular steps in these key areas, what key changes does she plan to implement that is going to make these systems function properly, ensure there is a connection with the boards, allow the department to be able to count the money, to monitor and evaluate the programs that they are in charge of, the 26 pieces of legislation that they have that they are responsible for...the department is telling us the system is out of control. Are we sitting by to wait for Mr. Cuff to give us the chapter and verse on what we should be doing as a department?

It is very amazing to me that given the comments and the state of the department, we would be standing by with all of the talent we have in the North and all the talent we have in the government and the department, and basically say we need this particular gentleman to come in to cure these problems after the multitude, the plethora, the overabundance of studies and reviews we have had, some of which are not even cold off the press, such as the Ministerial Forum on Health and Social Services Review. As my colleague pointed out, the Child Welfare League one where there was no response to the 58 recommendations. One plane load of consultants barely leaves the tarmac heading back south and we have another coming in.

I am very concerned of this incredible reliance that seems to be on these folks to come in and tell us how to save this sinking ship of Health and Social Services. This is very critical. The programs and services we run are very important, as has been pointed out in this House and as everyone is aware.

Yes, I am going to meet with Mr. Cuff because he is here. I will not miss the opportunity to pass on my concerns. I am also very concerned about what the Minister and the department are doing right now aside from waiting for Mr. Cuff to tell them how to fix the problems in the department. Thank you.

The honourable Minister responsible for the Department of Health and Social Services, Mrs. Groenewegen.

Thank you, Mr. Chairman. Mr. Chairman, I feel that as the Minister, it would have been difficult to approach the situation without the kind of expert advice, without the kind of data the Cuff review team is collecting, to take an 'This is what I think' approach to this problem. I think we need to rely on good, solid information and recommendations from people who are experts in this field.

As to Mr. Miltenberger's comments about what I am doing right now, we have been very proactive. Last fall, I requested the territorial Audit Bureau to conduct an audit on the pay and benefits function in selected health and social services boards. Those audits are underway and the first report is expected in a few weeks.

As a result of the initial audit findings, an agreement between the department and the board pay and benefits authorities have been transferred to the Financial Management Board Secretariat in the case of one board. I would say that has been something that we have responded to without waiting for the Cuff review to come in.

Also, Mr. Chairman, in December, I established a new clinical oversight function within the department under the direction of the newly appointed assistant deputy minister for population health and clinical services. This will allow the department to provide clinical leadership and more direct support and supervision to boards in clinical service delivery.

We have already initiated clinical audits in two boards where problems have been identified.

Mr. Chairman, we have been taking action. We have been responding to information as it is becoming available to us. We have not exclusively relied on waiting for the Cuff review to come in. However, I do think that it is better to approach the solution to these issues with the Members on a broad basis, as opposed to piecemeal board-by-board. We need to look at the entire system. Thank you.

Thank you, Madam Minister. Mr. Miltenberger.

Thank you, Mr. Chairman. Could I understand the Minister to say then that the work, all of the information pulled together from the much reviled Med-Emerg report, or all of the work done by the Minister's Forum on Health and Social Services, or all of the work done by the Child Welfare League of Canada, is still not adequate?

In addition to all of the information prior to that, especially given the Minister's very strong opposition to any more southern people coming up to study northern problems and giving southern solutions to northern problems, is the Minister telling me that all of that information is for naught? We will just leave it on the shelf and we will go from scratch and have Mr. Cuff possibly reinvent the wheel? Thank you.

Madam Minister.

Thank you, Mr. Chairman. Mr. Chairman, we have been very clear in all of our communications to date. We do expect the information gathered as a result of the former work that was done that Mr. Miltenberger refers to, would be used in the current review that is being undertaken. The terms of reference for this review stress that the consultants are to build on the many existing reports and recommendations rather than starting from scratch.

This report is intended to come as an action plan, not general recommendations. The emphasis is on practical, specific recommendations that can be implemented.

Mr. Chairman, some of the most recent remarks Mr. Miltenberger has made with respect to northern solutions to northern problems, I would suggest that those are his words. He has made an issue of me putting words in his mouth, Mr. Chairman, which I will try not to do, but I would ask him to not put words in my mouth. Thank you.

General comments? Mr. Dent.

Thank you, Mr. Chairman. Mr. Chairman, yesterday when I was making general comments, I talked about the issue of boards and my concern about where the Minister and the department might be headed in terms of their relationship with boards.

I know that in her response to me, the Minister talked about what she saw as a difficulty with the accountability level being at the ministerial and the departmental level, with the authority for program delivery being at the board level. In fact, she referred to...one of the things she was waiting for in the Cuff report was some discussion about this gap. The Minister did indicate that using that very word, about the gap between those two areas, that she thought that this report would reveal some areas where there might be some concerns.

Again, she had rejected the suggestion that the committee has made that there is a similarity between health boards and education boards. The relationship between the Ministers here should be seen as pretty much the same, I would argue. We have education boards that have been devolved almost ultimate authority for delivering the program that is set up by statute and regulation. They are provided funds, basically block-funded. A formula is used to allocate the funding to the boards, but the funding, once it gets to the boards, is pretty well up to the boards to determine how it is actually spent. The formula is only there as a means to allocate the funds.

So the accountability is still there for the Minister and the government. They are responsible in this House to answer questions on the delivery of the program, and yet the Minister has very little involvement directly with the boards in how the program is delivered.

I think what we were trying to point out is that in one instance, one department in this government has managed to develop what seems to be a very positive working relationship and there is not a concern about that gap. There may be a concern, but they have found a way to deal with it and make sure that the program is delivered, and that the boards are supported properly in doing it. In making note of that and by trying to point out that the situation should not be any different with health boards, yes, the authority for the delivery of the program is at the board level and, yes, the accountability is with the department. The challenge is for the department and the Minister to find a way to support the boards adequately so that they can in fact deliver the program that they are expected to deliver.

I would like to move on to another issue and it is to follow up on the comments that were made by Ms. Lee and Mr. Miltenberger about the Child Welfare League report. I too made note of the supportive comments that the Minister made early on about this report. I would agree with her that it was a very good report. But she just now said that the one difference between the Cuff report and previous reports is that they do not make specific practical recommendations for action.

I would say, as Ms. Lee pointed out earlier today, that there are 58 specific recommendations for action contained in the report It Takes A Community. The Minister today said that there is $1.2 million in the budget for critical investments. I think again, as Ms. Lee noted, it is hard to see how much we are really seeing of those 58 recommendations in $1.2 million. I do not think it is very much.

I have a really specific question for the Minister. How many workers increase will be covered in the Northwest Territories in that $1.2 million?

Thank you, Mr. Dent. The Minister responsible for Health and Services, Mrs. Groenewegen.

Thank you, Mr. Chairman. Mr. Chairman, included in the $1.2 million critical investment, in response to the Child Welfare League Review, is ten additional child protection social workers.

Mr. Chairman, I should also clarify that when I was talking about the specific recommendations that we expect to receive as a result of the Cuff review, I was referring to less specific action recommendations in the Med-Emerg and the Minister's Forum on Health and Social Services. I agree with the Member that the recommendations contained in the Child Welfare League Review were fairly specific.

With respect to the response to the recommendations, the approach that we are taking is a phased approach, and that is why we have prepared a response which will be phased in over a three-year period. We want to pay some attention to hiring Northerners for these positions as well. At this time, we may be able to, if we are very lucky, identify ten Northerners to work in these positions that we intend to fund through this critical investment.

Mr. Chairman, the correlation or similarity between education boards and health boards has been raised here again today, so I would like to take the opportunity to -- although, as I said yesterday, I think that if education boards are doing well and working well that is something that should be celebrated and we are not wanting to take anything away from that -- but there are some fundamental differences between the boards. Granted there are a lot of similarities, but I would like to identify for the Members what some of the differences are.

Education authorities have a more limited scope than health and social services. They are responsible only for schools. Education, Culture & Employment has not delegated or devolved all program authorities to their councils. Health and Social Services has a very broad and complex scope of authority, including 26 pieces of legislation. Each education district is a fairly self-contained system. Educators require professional contact and the support from others, but on a day-to-day basis, they can manage their activities entirely within the system.

The health system consists of levels of integration, and communities need to be able to refer patients to regional hospitals, further on to Stanton, and professionals need to be in close contact, sharing information and resources.

The Education Act allows for the election of local education authorities. Divisional education councils include a representative from each elected local board. Health and social services trustees are appointed by the Minister, except in the case of Hay River, Lutselk'e and Deninu, where the department has agreements with the local or aboriginal governing bodies.

In the collective agreement, teachers have a separate bargaining unit. The NWTTA can negotiate based on the unique needs of their professional members. The NWTTA had three collective bargaining units, two in Yellowknife and one in the rest of the Northwest Territories. One-third of the education board staff are UNW.

Nurses and social workers are lumped in with all other public servants, which makes it difficult to accommodate their issues, and leads to recruitment and retention challenges.

CEOs of education councils and health and social services boards are considered to be deputy heads under the Public Service Act. They share the same delegated authorities. However, divisional education councils do not administer pay and benefits for their employees, except for casual employees. All pay and benefit services for indeterminate staff are provided by FMBS.

Both health and education boards are responsible for all human resources and labour relation functions, except for the Fort Smith board, whose pay and benefits authorities have recently been revoked.

The education field is not facing the same pressure in terms of an aging population, rising costs, new technology, international recruitment and retention challenges and forced growth. Education pressures are more predictable. Student enrolment can be predicted, based on demographic information, whereas medical travel is subject to fluctuation based on factors such as medical conditions and the availability of physicians. Thus, planning and budgeting is somewhat less of a challenge for education boards.

Education councils are funded through a formula based largely on student enrolment in the previous year, with an allowance for adjustments in the case of unanticipated fluctuations. Both types of boards are allowed to maintain surpluses and are responsible for deficits. Teachers in small communities have a slightly broader base of professional support than nurses and social workers, again mitigating recruitment and retention challenges somewhat.

Legislated education boards have been in existence since shortly after the Government of the Northwest Territories was established. Thus, it had a longer history and have had time to mature and stabilize. Up until 1985, they primarily acted in an advisory capacity. There was a period about ten years ago when education boards were facing deficits as well.

So, Mr. Chairman, as I said, there are some significant differences between education and health boards. I hope this information has highlighted that. Thank you.

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

Madam Minister.

Thank you, Mr. Chairman. Mr. Chairman, in Mr. Nitah's comments he has indicated that there are significant concerns on this side of the House. Mr. Chairman, I think it would be accurate to say that there are significant concerns by all Members of this House because I think we have a very fundamental responsibility to ensure the quality and sustainability of our health and social services system in the North. So I think this is a solution that we need to approach together and that is why I am hoping that Members will take the opportunity to have very open and frank discussions with the review team. It is difficult to implement a plan that is under construction at this time. So we are working on getting that plan. We've taken proactive measures to identify the problems and the challenges and now we are being proactive in coming up with a plan to address those.

Mr. Chairman, Mr. Nitah has touched on the non-insured health benefit program. Certainly we recognize the importance of these services and delivery of this program to status Indian and Inuit constituents. We are quite comfortable right now that some of the problems that have caused that breakdown between the Government of the Northwest Territories and Health Canada, that these factors have been addressed in our most recent discussions. If it looked like we were not going to be able to retain responsibility for delivering these we, as I stated yesterday, would be putting in place a transition plan which would ensure that there would be no disruption or interruption in the services that are provided under this program. As I said, right now we are fairly confident that the concerns can be addressed.

As to some of the change in the policy that contributed to the deficits and the subsidizing of these services that we have referred to as reaching as high as $1 million per year, I am going to ask Mr. St. Germaine if he might elaborate on some of those things that were disallowed due to policy changes and some of the disagreements over funding some of our claims. Thank you, Mr. Chairman.

Thank you, Madam Minister. Mr. St. Germaine.

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

Madam Minister.

Thank you, Mr. Chairman. Mr. Chairman, before we got to the point of requiring a transition plan, the negotiations with the federal government improved to the extent that we did not feel it was necessary to have a transition plan, because we did not feel it was necessary to give up responsibility for the delivery of the program.

As for the policy changes that have taken place along the way that the federal government has made the decisions on, they are responsible for establishing the criteria for this particular program. If Members are interested, my department and I would certainly be happy to set up a meeting with a representative or representatives from Health Canada to meet with MLAs to talk about some of the changes that may have occurred in the policy over the past several years.

Mr. Nitah raises the point of responsibility and whose responsibility it was to protect the rights of aboriginal people in terms of the kinds of things that were covered in the Non-Insured Health Benefits Program. It would be good to speak to Health Canada about that and I would certainly be pleased to arrange for that.

As well, we have offered and could extend it to other Members as well, for senior people in the Department of Health and Social Services to meet with Members tomorrow at lunch time to have a more in-depth briefing with briefing materials available, to shed some more light on this particular program and what some of the challenges have been in administering it.

I have already extended that invitation to Mr. Nitah. We are planning to get together tomorrow at lunch time. Certainly if any of the other Members have a particular interest in this NIHB and what the next steps are -- for example, a meeting with Health Canada officials -- we might benefit from that. I would be happy to have that discussion. Thank you.

Thank you, Madam Minister. General comments. Next on my list I have Ms. Lee.

Thank you, Mr. Chairman. I would like to take an opportunity here to add some of my views on the general issues surrounding our health care in the North. I have already commented in the House yesterday and today on some of these issues, so maybe I can elaborate on it and ask the Minister some questions.

Mr. Chairman, as I stated this morning in my statement, I do not have an objection in principle with doing a study. I did raise questions about whether or not the Minister is clear about what it is she is trying to get at through this review. What I meant by that is I recall getting a letter from the Minister explaining what this review was supposed to achieve. In that letter, attached was a nine page terms of reference. It is very extensive. It is basically asking for answers to almost everything under the sun.

That brings up questions on what it is the Minister is trying to achieve there. I think the overriding concern, what the Minister is trying to get at, is the governance structure in the Northwest Territories with respect to our health care management. In light of the fact that issue was also addressed in the other report, It Takes a Community, as well as being touched on in the Minister's Forum on Health and Social Services. I did not get a chance to read Med-Emerg, but I believe it was addressed there too.

Mr. Chairman, what I would like to tell the Minister is I recall about 11 years ago when I was a researcher for a committee on agencies, boards, and commissions, we studied health structure. I remember a consultant who was here from down south kept saying to me "the form has to follow function." I did not really know what he meant then, but when I think about it now, I think that is very apt in trying to address what we are trying to do with board governance.

I think we have to remember that whatever governance structure we have to deliver health care programs has to be there to serve the purpose. They are not just there to overtake or get in the way. I am not saying that they are, but obviously I believe very strongly that the bottom line for all of us here, and the Minister, has to be the delivery of services. If the structure we have now or the way we are doing things now, or cost overruns, or anything is going to cause having to make a decision to reduce programs in any way, we have an obligation to look at the total picture and make some really tough choices.

For that, I am supporting the study in principle, but I would like to hear from the Minister as to what has driven this need on her part to do this study and what it is she is trying to get at.

Second, Mr. Chairman, I just want to indicate that yesterday when I made a statement recognizing the long-term services of physicians in our Territory, I also mentioned casual discussions with doctors at Stanton. What I realize now is that we have a very fragile health care system in the North where we are lucky in many ways. Many specialists are here providing services and as a unit, they are able to provide more than what they could as an individual.

We have a system built and I believe very strongly that we cannot tinker with that. It cannot be a choice between whether we are going to have a surgery unit or whether we should just combine them because they make sense on paper. There have to be other decisions we could make on the overall structure of the health care system before we come down to one surgery every two days versus every five days. We cannot be talking about these issues at that level. There has to be something else we can do. Choices have to be between health care and maybe government employees going to conferences. I do not know. We have to look at the overall structure and what our priorities are.

In that way, I really want to stress the point that I hope the Minister is really clear about what it is she is trying to get out of this study. Second of all, that she keeps her focus on keeping the services and making sure we provide essential services with the structure in place to do that. I would be interested in hearing the Minister's comments to that end, and I will follow that up with some questions on the shortage of nurses at the hospital. Thank you, Mr. Chairman.