Thank you, Mr. Miltenberger. Mr. Roland.

Thank you, Mr. Chairman. As I stated, he talked about several important areas about putting more investment in, and this is an example of where we are actually seeing front line workers and staff added, which is a good thing to see.

There are a number of other areas that it went on to list. In the area of new initiatives, for example, standardizing physician contracts, and it lists about approximately $1.46 million; fully funding medical clinic, operating costs, another $1.4 million; accelerated development of new and revised legislation, $500,000; enhancing communicable disease control, enhancing access to cancer screening, development of on-call centre, enhanced Telehealth Programs. Now, my concern is that -- it is good to hear that we are putting more money into initiatives with health and social services. A concern that I would have is how much of this is actually going to front line people, to programs that actually help individuals on the street who are in need of programs and services through this government.

For example, I can name a few of these right off the bat, that I do not see actually increasing the staff front line. It is, in fact, more of an internal program changes -- standardizing physician contracts, will that give us more doctors? Or is that going to just clear up the situation that we find ourselves in here in the Northwest Territories? Fully funding medical clinic operating costs -- sounds like it is something we are catching up with and will not provide enhanced services. It might maintain them. Accelerated development of new and revised legislation -- that again, purely internal working and I am surprised to see that because we know in all departments right now, there are staff in place to deal with legislation, legislative proposals. When it says accelerated, I have underlined that because I want to know if that has anything to do with the Minister's announcements that he has made recently in changes to the Family Law Act, where he intends to move forward with some legislation that could be seen as quite controversial. Thank you.

Thank you, Mr. Roland. Mr. Miltenberger.

Thank you, Mr. Chairman. There were a number of questions there. I will do my best to respond to them all. Either directly or indirectly, what is being proposed, the intent is that it will improve or maintain services that are currently being provided to people. If we can deal with the physician contracts and ensure that the environment within the clinics is dealt with and it is off the table and it is not an irritant or an obstacle, then people can get about their jobs.

Telehealth is a service, as Mr. Braden indicated, that the nurses are saying is very important. The legislative base has been clearly identified by the department and by the Social Programs Committee over the last number of years as being out of date and inadequate, and has to be updated so that, in fact, we have the framework and legislative base for the people doing the work to operate with the proper authorities.

The other legislation referred to by my colleague, Mr. Roland, is a separate issue from this budget and it is not tied into any of the legislation being put forward by the Department of Health and Social Services in that context. In fact, I will be giving notice tomorrow for that particular legislation. Thank you.

Thank you, Mr. Miltenberger. Mr. Roland.

Thank you, Mr. Chairman. Another area in the revised legislation, I did not get it quite clear if the Minister was mentioning, for example, about nurse practitioners. Is that legislation being looked at and under development? That was a concern that was raised in this area. It is seen as an important initiative, or it has been in the past. I am not sure if there has been any further movement in that area. In fact, it sounds like it has almost come to a stalling situation where we have not seen movement in that area for a while. Is that going to be included in some of this legislative action?

Thank you, Mr. Roland. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I would like to reassure my colleague that the whole concept and issue of nurse practitioners is alive and well, and we are going to try to make it work even better. We do have interim legislation coming forward this session that will deal with the Nursing Profession and Pharmacy Acts to allow us to do collaborative pilot projects in that area. The longer term legislation is being drafted and will be going through the due legislative process in the coming months. That particular initiative is very important and we are making every effort to make sure that we can keep it moving -- not only moving but possibly more effectively than it has. Thank you.

Thank you, Mr. Miltenberger. Mr. Roland.

Thank you, Mr. Chairman. In the Minister's opening comments, he referred to the investment in these areas I spoke about, but he also talked about forced growth of $8.1 million needed to meet the increased costs of providing existing services. As we were going through some of the numbers earlier, it almost sounds like more of that could be considered forced growth as we are, in fact, cleaning up some of the areas and making changes, and not necessarily adding new or enhanced services that are out there. Can the Minister confirm whether that would be an accurate review of the information that he has provided? Thank you.

Thank you, Mr. Roland. Mr. Miltenberger.

Thank you, Mr. Chairman. When we talk of forced growth, we use the standard definition used by government. In the case of the money referenced by my colleague, there was work done with the authorities on all their budgets, recognizing that the budgets in the past may not have been historically accurate. There was re-basing done to all the budgets, which consumed a significant portion of the $8.1 million. Thank you.

Thank you, Mr. Miltenberger. The Chair will recognize Mr. Bell.

Thank you, Mr. Chairman. I do have some general comments about funding to the Department of Health and Social Services, and specifically to our health care system. Obviously, I think nationally we are engaged in a debate, as was referenced earlier, about the ever-increasing amount of money being spent on health care. In fact, health care costs seem to be spiraling out of control and people around the country are wondering when we will be able to get a handle on this because we can see that the future may, if we go the way we are going now, consist of provincial budgets that are just primarily health care spending, and then whatever is left over.

I would like to reference specifically a report released by the Canadian Institute for Health Information that does confirm that health care is steadily gobbling up a larger proportion of provincial budgets. I know this year our Health and Social Services budget is around $200 million, and this seems to be growing from the last few years. Can the Minister indicate how he proposes to deal with this problem of health care costs ever increasing? Thank you.

Thank you, Mr. Bell. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I think this issue is key to the debate on health and social services, not only in the Northwest Territories but in Canada. I would like to acknowledge as well that it is one that Mr. Dent has raised repeatedly. The whole intent of the action plan is to try to deal with that issue in one capacity of how we are doing business right now, the structures, the processes, the efficiencies that are there and looking at how do we restructure ourselves to make better use of a lot of services so that we are not tied up because we are not doing things efficiently. There is a lot of friction within the system and the way processes and procedures are set up is not effective. That clearly is one focus of the action plan.

We also recognize that, and things like a comprehensive human resource strategy and coming out with a service model that we can use and accountability frameworks that are clear so that we can see and monitor how effective the programs are that we are putting into place, and if they are not effective, how do we fix them?

We recognize that there are significant pressures and ongoing pressures in terms of things like salaries for allied health professionals, for doctors and for nurses. There is a constant growth of not the sophistication of disease detection, but there is also the cost of technology and medical services. We have to look through our core services as to what are the critical things we are going to do. The fundamental sustainability issue to my mind was referenced as well in the committee report. Until we deal with the front end of the process, until we get people to make the right decisions in terms of, for example, pregnant mothers not drinking when they are pregnant, smoking issues, the diet issues, all of the problems that result from alcohol abuse, the majority of which are initially personal decisions -- if we do not deal with that issue at the front end then we will never have enough money.

That is, in my opinion, a very sad but true reality. We can have the best technologies. We can have the best group homes. We can have the best support systems for children with FAS and FAE and adults with FAS and FAE, for example, but the goal has to be to have children born healthy. That has to be our fundamental goal as a government. As a department, that is an issue for us because we are constantly faced with the unending tide of demand far exceeding the revenue and resources we have available.

We have a number of areas where we are trying to deal with this issue. It is an issue that is going to require debate, as Mr. Dent has pointed out repeatedly. It is a debate that requires possibly hard decisions, but it is one that we have to engage in. We have an action plan that is going to start putting some pieces in place, but the action plan is not an end in itself. It is not an event. It is part of a process and we should be doing this on an ongoing basis. It is going to require the involvement of not only the department and the authorities, but very clearly the wise advice of Members of this Legislature and the help of the committee to put the best possible order and sense to this very complex issue. Thank you.

Thank you, Mr. Miltenberger. Mr. Bell.

Thank you, Mr. Chairman. Our committee did receive some information from the department, which breaks out the percentage of the Health and Social Services' budget by health costs and social services costs. I was quite surprised to see that a full $138 million of the $199 million budget will be spent in the area of health costs. I would like to ask the Minister if he sees this as, I guess not surprising, but would he not indicate that this is quite a lot of money to be spending on health costs?

Thank you, Mr. Bell. Mr. Miltenberger.

Thank you, Mr. Chairman. On a comparative basis, if you look at some other jurisdictions, I would suggest that we are more in the middle or bottom half of the spectrum in terms of the amount of money for 42,000 people. Yes, it is a lot of money. Absolutely. Is it something we have to look at and constantly monitor? Yes, it is.

Thank you, Mr. Miltenberger. Mr. Bell.

Thank you. I am not so sure we are in the middle to the bottom half. I would say we are, from the information that I see from the CIHI report, almost if not totally dead last. We are spending 16 percent of our territorial budget on health care costs. Ontario spends 43.9 percent of its budget on health care. Nova Scotia and Manitoba spend 39 percent. You go right down until you come to the lowest of provinces. PEI spends 30 percent of its entire budget on health care. We spend 16, Mr. Chairman.

You wonder, when we live in a Territory that, unfortunately, probably leads the country in preventable injury rates, suicides, teenage pregnancies, sexual assault, drug and alcohol abuse, STDs...you know, these are very unfortunate categories to be leading the country in. Then I ask, as a government, why would we only bother to address these profound issues with 16 percent of our total available budget? Thank you.

Thank you, Mr. Bell. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I do not want to engage in a debate over percentages. I am not sure, and that is the issue that comes up when you look at percentages and big numbers and other jurisdictions. We include health and social services. Some other jurisdictions split things out differently. I would suggest the numbers are somewhat higher than 16 percent.

The issue is, though, are we spending enough and should we spend more and can we afford to spend more? Very clearly as the Minister for this department, as we come forward with requests for supplementary appropriations, we are going to be indicating that the $200 million that we now have is not adequate. I think that is the point the Member is making and I think that is the point we are going to have to deal with as a Legislature. Thank you.