The Standing Committee on Social Programs has some concerns about the nurses in Edmonton that provide support and make health decisions on behalf of Northerners. The major concern is that these nurses are employees of the Capital Health Authority and that their first loyalty is to that organization.

Members are not concerned about the quality of care provided or recommended by the nurses. Rather, they are concerned that medical decisions may be made without regard to cost to the Department of Health and Social Services. One example would be a nurse recommending a course of medical treatment in Edmonton without realizing that the same course of treatment could be readily delivered at Stanton with a little planning.

It is understood that the contract with the Capital Health Authority is under re-negotiation. Members believe that it is an appropriate time to do a cost-benefit analysis of hiring our own nurses to deliver services to Northerners in Edmonton.

Mr. Chairman, at the appropriate time, we will move the following recommendation:

The Standing Committee on Social Programs recommends that the Department of Health and Social Services examine the costs and benefits of hiring our own nurses to deliver the programs that are presently provided by nurses employed by the Capital Health Authority.

The Standing Committee on Social Programs notes that the Minister will be coming forward with a supplementary appropriation to implement a 60/40 split with the health authorities on deficit reduction. This still means that each of the health authorities is responsible for 40 percent of their accumulated deficits with the exception of the Lutselk'e and Deninoo Boards, who will have any deficits wiped out prior to amalgamation with another health authority. Members also noted that the Minister stated that the new Sahtu Health Authority's share of the Inuvik Regional Health Authority's deficit would be the subject of negotiation. Members found it perplexing that the department would contemplate forming a new health authority in a deficit position.

The Minister's action plan calls for clarifying roles and responsibilities between the department and the health authorities by February 2003. The action plan also calls for the design and implementation of a revised funding model for the health authorities by April of 2004.

Members of the committee point out that the action plan makes it clear that accountability and fiscal frameworks for the health authorities are under development. There appears to be nothing to prevent the health authorities, under the current frameworks, from running up a further deficit prior to the implementation of accountability frameworks or funding formulas called for in the action plan.

The Minister asserts that the 60/40 split on the deficits of the health authorities coupled with the implementation of the action plan will effectively wipe the slate clean for each of the health authorities and provide them with a fresh start. The Minister also implied that the health authorities would be responsible for their own deficits less agreed forced growth increases.

Members are concerned that some health authorities, either before or after the implementation of the action plan, may initiate programs that put the authority into a deficit position. The point is ultimately the Department of Health and Social Services is responsible for the deficit that any of the health authorities accumulate. The government and the department cannot allow any health authority to cut essential services to the public to deal with a deficit financial position.

The standing committee looks forward to receiving copies of each of the health authorities' deficit recovery plans incorporating the 60/40 split on accumulated deficit.

The Standing Committee on Social Programs has commented on their concerns about the application of the department's medical travel policy in past reports to this Assembly.

Many of the complaints that MLAs get from their constituents are about the uneven application of the medical travel policy by the individual health authorities. As well, because many extended families have relatives in different health authorities, they talk about the differences of application for each authority. The lack of perceived consistency breeds resentment between communities and families.

Members of the committee look forward to the results of the review of the extended health benefits that is currently underway. There is hope that, as a result of this study, a clear, concise and evenly applied policy on medical travel can be developed and communicated to the residents of the Northwest Territories.

Members note that ten new child protection workers are budgeted for in this main estimate. These workers are being hired as a result of recommendations contained in the Child Protection League of Canada's Report on Child Welfare in the Northwest Territories from a couple of years ago.

At the time of the review of the main estimates at the committee level, the Department of Health and Social Services had not yet determined which communities would be receiving child protection workers. Members look forward to the promised information on where these workers will be posted and the rationalization for the department's decision.

Members are still concerned with the number of residents placed in southern institutions. It was noted in the Report on the Review of the 2002-2005 Business Plans that it was important for the department to continue to examine the costs of southern placements versus the economics of providing the service in the Northwest Territories. In our discussions with the Minister, he admitted that southern placements was one area experiencing forced growth and that he will be asking for a supplementary appropriation to deal with the funding shortfall.

The standing committee would ask that the department be ever vigilant in repatriating Northerners from southern institutions. The members look forward to reviewing the department's Continuing Care Strategy once it is finalized.

The Minister informed the committee that he would be coming forward with a supplementary appropriation to deal with an increase in the number of children in foster care. Members, along with the Minister, are concerned that the department cannot readily identify the reason for the significant increase in the number of children in foster care.

The Minister agreed with the committee that we had to establish the reason for the increase in the number of children going into foster care and develop a response to the strain on the system. The department is conducting a review of the cases and will be providing the committee with their finding once the analysis is completed.

Members were also concerned that there were disparities in the rates paid to foster care parents between the different communities. This is a concern that has been brought to MLAs by constituents. The department has agreed to do a better job in communicating the rationalization for the differences in foster care payments to foster parents.

Members noted that prevention and promotion is highlighted in the Department of Health and Social Service's vision and in Towards a Better Tomorrow. Members could not find prevention and promotion programs highlighted in the main estimates or in the business plans.

The department needs to do a better job in communicating the consequences of destructive behaviour to Northerners. People need to have an understanding of the costs of their behaviour on the health and social services system in the Northwest Territories.

In those communities without a hospital, access to a healthcare professional is restricted to office hours unless it is an emergency. If you have a medical problem you go to the clinic and wait to see the nurse. If you have not been seen by closing time you are asked to go home and come in tomorrow. The next day the same process could repeat itself.

The wait to see the nurses is also complicated by the number of programs, such as Well Baby and prenatal clinics that are run during regular clinic hours. While the nurses run these important programs, no one is seen in the clinic, which further compounds any patient backlog.

One Member had asked his health authority whether the clinic could be open in the evening. He stated that discussions with the staff of the nursing station had indicated that there were no objections to such a system. The health authority would not consider opening in the evening, citing union agreements prevented them from implementing such a schedule.

Members realize that it is not practical to staff nursing stations and health centres on a 24-hour basis. However, evening clinic hours should be considered to improve access to the healthcare system in the smaller communities. If it is true that union agreements do not allow such arrangements, this should be discussed during the current contract negotiations.

If the action plan is to be successful, it will be necessary to dramatically enhance the board support function at the department level.

Members expect to see a supplementary appropriation in the near future related to increases required to provide the proper support to the new health authorities.

It appears to members of the committee that the administration costs for the health and social services authorities are significantly higher than those incurred by the district education authorities.

This could be a false impression because it is not clear whether health and social services authorities consider the same items as administration costs as the education authorities do. Members are extremely interested in comparing administration costs between the two entities and in determining the reasons for any major differences.

The Standing Committee on Social Programs believes that there should be a standardization of what constitutes administration costs at the authority level between the Department of Health and Social Services and the Department of Education, Culture and Employment.

Mr. Chairman, at the appropriate time, we will move the following recommendation:

The Standing Committee on Social Programs recommends that the Department of Health and Social Services and the Department of Education, Culture and Employment work together to standardize, as much as possible, the allocating and reporting of administration costs at the authority level.

Members of the Standing Committee on Social Programs still see the development and passage of family violence prevention legislation as a major objective for this Assembly.

The Minister of Health and Social Services is strongly encouraged to press the Department of Justice to develop the necessary legislation.

Members noted that under grants and contributions for community health programs, there is a heading entitled Health Awareness, Activities and Education. This money is supposedly for organizations and local governments to promote increased understanding of health awareness, health related activities and education.

In actual fact, the $143,000 listed is a grant made to the Dene Nation and there is no other money available to organizations and local governments for health awareness. This grant followed the transfer of health programs from the federal government in 1988.

The Minister has provided the committee with information on the programs and services that the Dene Nation uses the $143,000 for.

In the future, members would like to see this grant properly identified as going to the Dene Nation.

Mr. Chairman, that concludes our report on the review of the 2002-2003 main estimates for the Department of Health and Social Services.

Thank you, Mr. Bell. Would the Minister like to bring in any witnesses?

Yes, Mr. Chairman, I would.

Does the committee agree?

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

Thank you, Mr. Chairman. I have with me Mr. Mark Cleveland, deputy minister of Health and Social Services, and Warren St. Germaine, director of financial and management services.

Thank you, Mr. Minister. We will go on to general comments. Mr. Dent.

Thank you, Mr. Chairman. Mr. Chairman, one of the areas that I am most interested in is an area that we did not hear anything about in the budget, as was highlighted by the committee report that Mr. Bell just read. That has to do with the child advocate. I was wondering if the Minister could update us as to the time lines? I know we were told that by the end of this fiscal year, we could expect to have some report, but knowing that we are going to be in session for half of the month of March, and then not again until probably June, I was wondering if there was any chance that he might have something to report to us on this initiative perhaps before the end of session?

Thank you, Mr. Dent. Mr. Miltenberger.