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

Thank you, Mr. Chairman. Mr. Chairman, there are a couple of aspects of the Department of Health and Social Services that I think could be brought up now, and perhaps in a bit more detail when we get on with the report. But the area of governance, Mr. Chairman, is something that interests and concerns all of us and it relates to many different government departments, not just health and social services. Unfortunately, we went through a fairly spectacular situation in our last sitting, Mr. Chairman, something I don't think any of us really cares to recall in great detail, but the decision was made to dispense with the Stanton hospital board and replace it with a public administrator, which I believe is still the situation there.

So the situation at Stanton still seems to be in some flux. We still have the authorities in existence in other parts of the territory and the Minister has taken the initiative to set up various joint councils to carry through with that. I guess in relation to the main estimates and the budget and the business year ahead, I wanted to ask the Minister his opinion or his status report on how the situation is working these days with the boards. Are there mandates that have been problematic from perhaps our viewpoint here in the Legislature, Mr. Chairman, where we have tried to sort out whose job is what and where accountabilities start and stop between the department, between the Minister and between his authorities. So, perhaps I will just stop there, Mr. Chairman, and see if the Minister can give us a snapshot of how governance in our health system is working. Thank you.

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, in my opinion as the Minister, the governance situation has evolved in the direction that I think it is working that we would not have, in my opinion, been able to achieve the amount of progress we have made in the last 14 months or so without having dealt earlier on with the relationship between the department, the Minister and the authorities. We have taken some steps to rationalize the system. We have put through Joint Leadership Council and through the Joint Senior Management Committee, and we have given copies to the Social Programs committee, an accountability framework that has been agreed to. We are working on finalizing the training for trustees, as well as we have worked through accepted roles and responsibilities of the trustees and we have put that in writing. We are working on a standardized selection process.

In regards to Stanton Territorial Health Authority itself, we have adjusted the relationship so that, for the time being, the CEO will report to the Joint Leadership Council. This is basically a committee that will be chaired for that particular issue overseen by the deputy minister and they will provide the oversight as the board chair and the department on the broad direction of Stanton Territorial Health Authority. That is the process that has been taken in that regard and we are going to continue to finalize the training component of the training for trustees. Thank you.

Thank you, Mr. Miltenberger. Mr. Braden.

Okay. Thank you. Some of these aspects here of how we are managing governance, I am pleased to hear. For instance, that you are undertaking a training program for trustees. I think that is something that is long overdue and we should probably be looking at doing this in other areas. We, through the authorities and responsibilities that we want to put at the community and the regional level comes the need for training and for familiarity. It is not a quick process of handing these over, so I am pleased to see that happening.

I guess in relation to the Stanton Territorial Health Authority situation, and if I understand the Minister correctly, we have the CEO of Stanton Territorial Health Authority reporting to the Joint Leadership Committee, which is overseen by the deputy minister. I guess what I wanted to ask there is what aspects of operational authority or accountability are invested in the Joint Leadership Committee and what are invested in the deputy minister? I would like some sense of whose job is whose here. Thank you.

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I apologize if I was not clear enough. The deputy minister is continuing to have a role as a public administrator, but the agreement to provide that broad governance oversight was deemed to be most appropriately served and provided by the Joint Leadership Council which already exists and which meets regularly enough to provide that kind of general direction and feedback to the deputy minister. When that happens, I will step aside and the deputy and the Chair will provide that function and give their feedback and input that is required. Thank you.

Thank you, Mr. Miltenberger. Mr. Braden.

Thank you. I would like to go on to a different area. It covers the injection of new money specifically into the recruiting of health care professionals. I think we saw some money early in the last session, in the September session, and another $8.3 million that was put in just before the end of the year. My question or comment, Mr. Chairman, relates to something that I heard repeatedly from Mr. Romanow, the commissioner for the federal inquiry into the national commission into the health care system. He said that while more money is needed for a system, what he really hopes will not happen, should not happen, is that as more money is put into it, it simply becomes higher and higher and higher salaries for health care professionals or administrators or everyone else. This was not something that he envisioned as a solution was that money just keeps going into almost a never ending spiral of one jurisdiction in Canada chasing another with higher pay packages as a way of attracting people.

In the Northwest Territories, Mr. Chairman, are we going to be able to solve or begin to solve our shortage of health care workers in other ways than simply, as I say, this revolving spiral of salary increase? Thank you, Mr. Chairman.

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I share the concern of Mr. Braden and in many cases it is a basic economic issue of supply and demand. We are in a situation of having to compete with all other jurisdictions in Canada, North America and probably the world for that matter because there is, specifically with doctors, a significant shortage. There has been a tremendous ramping up of training for doctors and nurses and they are trying to, I believe, do that with all allied health professions. So, we recognize that we have to remain competitive and that is a hard fiscal reality, but we also recognize that we have to look at retention issues, we have to look at some of the program areas that we have identified that we want to improve services. We have made an effort on the primary health care integrated service delivery to try to link services. We want to deal with birthing services. We want to deal with trying to evolve and develop nurse practitioners. We want to better recognize and be able to work and integrate the alcohol and drug workers who are going to become prevention workers. We are going to put some mental health workers in, some clinical supervisors to work as well with the social workers that we have added at the community level.

We have recognized that we have to do a better job and we need to do some training with community health representatives and get some more training for those folks. We want to make investments in the development of licensed practical nurses, helping them move from to become a more relevant and integral part of that whole integrated service delivery model.

So, we are trying to balance all these competing priorities, but there are significant economic pressures on us to make sure we are very competitive as it comes to health professionals. Thank you.

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

Thank you, Mr. Nitah. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, as the Member is aware, this is a complex issue. There are clearly more children that would be identified by social workers and child protection workers as being in need of care or in need of protection where there is not an appropriate care giver available, if there is alcohol involved, if children have been left unattended. But one of the things, as well, with the legislation we do have, we have more opportunity to work with parents where you can have initial contact with children, but you have capacity to be able to do work with families, where you have joint agreements on getting services into families and children. But the sad reality is that there is still far too high a need of children that are deemed to require the protection of the state. I will put that out there as an opening response to the Member's question. Thank you.

Thank you, Mr. Miltenberger. Mr. Nitah.

Thank you, Mr. Nitah. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, clearly, as the Member has articulated, the history of child welfare in the North and in many jurisdictions has not been one that could be looked upon as a shining success. I would like to think that we have learned from some of the significant mistakes made in terms of changing our legislation. In terms of recognizing the need to involve the communities with plan of care committees and hopefully family and children services committees at the community level. Of a commitment to hiring more social workers northern trained, hopefully as many as possible aboriginal social workers.

But the Member is right. The statistics are clear. They are stark. The majority of children in care tends to be aboriginal in the Northwest Territories. We have no clear link in our systems, for example, between child welfare information systems and the justice system where you could cross-reference to see if there is a link or with income support or with SFA to see which children have gone on to higher education. Would it be possible to do that kind of cross-referencing? It probably would with some effort, but the anecdotal information and for those of us that have been around the system long enough, we would not argue with the anecdotal assumption that a far too high percentage of children, that specifically there are permanent wards, end up graduating into the adult system where they are in need of supported living arrangements or they get into the justice system. That is a significant shortcoming that is yet to be addressed.

Mr. Chairman, the fundamental issue though is, children are deemed to be in need of protection and we have to come up with a way to work with communities and families to make sure that children do not require protection. Those parents and their families recognize that the risk they take if, in fact, they do not provide the care and protection of their children. That is the fundamental issue that we have to try to deal with as opposed to trying to keep fixing things after they are broken, which is very difficult. Thank you.

Thank you, Mr. Miltenberger. Mr. Nitah.

Thank you, Mr. Chairman. Mr. Chairman, as a person who has had almost 20 years with Health and Social Services, mainly with social services, I can tell you that there have been improvements. We have a long ways to go, but I can just give you some numbers as an example. In 1998 as of March 31st, of all the children in care, only about 3.5 percent were living at home. On March 31, 2002, that is up to 28 percent. We significantly rewrote in the last Assembly the child welfare legislation to build in the specific checks and balances that my colleague referenced. They need to involve family in the community to recognize where children are from, to avoid any further situations where children were taken into the system and disappeared, only to reappear 18 years later. Some were totally unsure of who they are and where they are from.

I know that that has happened. I know people who it has happened to. We've tried to learn from those mistakes. As the letter I wrote to Mr. Nitah points out, our systems still aren't as tight as they should be in terms of the numbers of children that are classified as unknown. But we've made a significant effort in trying to train and hire northern social workers. We're making efforts across the board with alcohol and drug workers and mental health workers. They start dealing with communities and families more effectively so we can, most fundamentally of all, try to avoid having to take children into care. When we do -- I agree with the Member -- we have to be very capable of making sure we have good plan and care that involves the communities and the families, that our systems allow us to know where the children are and if, in fact, we're being successful. Thank you.