Sergeant-at-Arms, could you escort the witness in, please?

Mr. Miltenberger, for the record, could you introduce your witness, please?

Thank you, Mr. Chairman. With me, I have Mr. Dave Murray, the deputy minister of Health and Social Services, and Warren St. Germaine, the director of finance. Thank you.

Thank you, Mr. Miltenberger. I will open the floor to general comments. Mr. McLeod.

Thank you, Mr. Chairman. Just a couple of things under general comments I would like to raise. I can appreciate the amount of work the Minister has been doing over the last while and the extra dollars he's been able to commit to his department. While it's gone to a territorial facility that services all communities in the North, I want to take at this time an opportunity to remind the Minister that there are other communities out there that need facilities, that need services. In communities I represent, I only have one nursing station and I represent four communities. Although all the communities that don't have the facilities in my riding are on the road system, it's still very difficult. Like if you wanted to go to a clinic, you couldn't just get up in the morning and just walk down the street. If you don't have a vehicle, you will have to find a ride or arrange for transportation. Even then, you have to find the appropriate people to contact to file for a travel claim or for any type of assistance you qualify for.

On the reserve, the population has been growing for the last number of years, yet we are not seeing an increase in our staff positions or to our facilities. Right now, it's quite difficult for a lot of the Members. It's been brought to our attention on a number of occasions that we need a type of facility, at least a place where we can have the nurse or the social worker, for that matter, coming to the community or the income support worker. We have no facility at all in that community. The band office is really the only place people can access, for the most part, and that is overflowing. We need to have something in place. It's difficult to have people travel back and forth. There are some travel arrangements made, but that hasn't improved in the 20- year forecast or the 20-year capital planning system. There are some dollars and I hope the Minister will start taking the time to address that issue to start doing the groundwork and necessary research to justify that facility comes into that community. We also, in Fort Providence and for many, many years now, have requested an increased level of care for our seniors. Right now, our seniors either have to travel to Fort Simpson or Hay River and that is difficult for the family members and a lot of the seniors have a hard time because they are away from their families. Not to discredit those facilities. I think the care is excellent in both the communities of Fort Simpson and Hay River, but it's very difficult for family members and for the elders themselves. I am not totally satisfied with the process and the hoops to try to request extended care. The Minister, on several occasions I have talked to him and I have also written him a letter. Health states that they don't build facilities for extended care or for seniors and the Minister responsible for the Housing Corporation also states they don't provide funding for extended care, so it's kind of a hot potato. We get pushed and tossed from one department to another, but no real clear process. We should have that. If that program falls under the jurisdiction of two departments, there has to be a better process put in place so that we can have easier access.

Also, I am also quite concerned that there have been statements alluding to the replacement of alcohol and drug workers. These workers, for the most part, are all long-term workers. Many people have committed a good part of their lives to working with alcohol and drugs and other addictions in communities. We've asked many times on many occasions to see some funding increases, so we can get better wages, better compensation for them. They dedicate a lot of time and effort to the communities. We also stated that they should be certified. We are not seeing that now. I have been told they are going to be replaced by mental health workers. I don't know what that means. Where are these people going to come from? What is classified as a mental health worker? What effects does that have on the different facilities in the North?

So there are many concerns in the area of health, Mr. Chairman. We have to ensure that whether you are living in a small community like Kakisa or Yellowknife, that we have equal access and equal treatment and that we deserve the same quality of service. In some of the communities, especially Kakisa, we have been trying to address how we medevac somebody out of that community. How do we get quick access and ability to get everybody out of that community?

So those kinds of things are of great concern to me, Mr. Chairman. I think the Minister has to take some time, now that he's been able to deal with the crisis at Stanton and start looking at the long-term planning for the smaller communities. I certainly welcome him into any of the communities that I represent. Thank you, Mr. Chairman.

Thank you, Mr. McLeod. I didn't hear any specific questions there. Mr. Miltenberger, would you like to respond to the Member? Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I thank the Member for reminding us that we keep a 360-degree focus in this portfolio and all communities on the radar screen.

With regard to the reserve, I have committed to the Member to work with him to go into the reserve and to sit down and discuss the issues that he has touched on. As well, planning to bring in members from the Deh Cho Health and Social Services Authority plus sit down with the people from Hay River that currently provide some service. There is money, as the Member indicated, in the capital plan to provide some infrastructure on the reserve, as the Member indicated.

We have also been trying to increase the support to seniors across the board. Basically there are three streams, Mr. Chairman. There is the facility living stream; the supported home living; and, we have been trying, as well, to improve our home care. This, as well, is an issue of priority for the federal government, so we are hoping that we may get some relief or additional resources to help us provide the services we are currently trying to provide but don't have sufficient funds.

With regard to the alcohol and drug workers, I would like to reassure my colleague that the intention is not to replace alcohol and drug workers with mental health workers. The intention is to convert alcohol and drug workers to a different focus. They would be called prevention workers. One of their functions would continue to be alcohol and drugs, but they would also be expanded to deal with some of the other presenting problems that are brought into the office when a person comes in with alcohol and drug problems.

In this budget, there is funding to give the alcohol and drug workers, soon to be called prevention workers, an increase in pay. Also, with some, for the first time, some benefits. So we want to develop a curriculum of training and certification for workers and we want to make sure that we recognize that among the alcohol and drug workers that are currently there, many have dedicated a significant portion of their working lives to an area because of their commitment to improve the lot in their communities at a very low pay with almost no benefits. So our intention is to work with all the incumbents to ensure that they are given every opportunity to make a transition with support and with training into the new job. It will be there that we'll put some of their skills to work and hopefully be able to supplement them with further training. Thank you.

Thank you, Mr. Minister. Mr. Roland.

Thank you, Mr. Chairman. Mr. Chairman, in the area of health and social services, we know it's a critical service in the Northwest Territories, especially in communities that don't have access to hospitals and doctors on a daily basis. Coming from a larger community, I have had to deal with individuals who have had to travel south and have some medical attention while they were south and I have heard some positive comments on the service that they can get here in the NWT compared to in the south when it comes to waiting for procedures and things of that nature. So it's been positive on that side of it, but we must recognize the efforts of the long-term nurses and doctors that we have in the system that have remained and stayed committed to the NWT. It's difficult and there are many options for them. As an example, Mr. Chairman, I went home for the weekend and heard that one of the nurses had taken a job in another country and is travelling to warmer climates and moving on. That's unfortunate because that means we are going to have to try to find somebody else to fill that position. On that specific area, Mr. Chairman, I would like to know from the Minister, as we go through this budget process and his department, in the area of recruitment and retention, that's an area that we've put a fair bit of money into over the years and I would like to know from the Minister how successful has that section been in bringing people to the North? Can he show and provide information on the number of new recruits that this section has helped bring to the NWT to the many health centres and hospitals that he has to provide services in? How have they worked with the boards in the regions to help with their needs?

It's very difficult, Mr. Chairman, when you talk to some of the nurses who are long-time committed in the communities and raised their families there. When they have to work beside a nurse who comes up on contract and spends either a month or two in the community and then travels back to their home in Alberta or wherever they come from to find out they are making, if it's not more, it's equal to the amount that the nurses are making here in the territories. Also, their housing seems to be taken care of, they get a couple of other allowances while they are up in our communities and that is the part that some of our long-time nurses have difficulty in dealing with. They are of the same profession, the same training level, but when these contract nurses come in, it seems to be a different standard that they have when it comes to being paid and what kind of benefits are available. How is the Minister's recruitment and retention section working? What is the total amount being spent in that section now and can he provide numbers as to the amount of recruits they have helped bring into the Territories? Thank you.

Thank you, Mr. Roland. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, the issue raised by my colleague about recognizing the contributions of his existing staff is a very important one and one where we have invested a considerable amount of time and money as of late, regarding both doctors and nurses, but we've tried to expand it to all allied health professionals, as well as social workers. We've put more money into long-term care. We are putting money into alcohol and drugs. We've committed to doing the review, which is underway right now, of the classifications of nurses to make sure they are adequately classified and that their skills, especially of some of the higher trained nurses, are recognized in OR and ICU and those types of things.

The recruitment and retention unit that has been in place has been somewhat controversial. There have been a lot of questions about how it's structured and how effective it has been. Recruitment and retention, when I became Minister, was identified as the number one issue by all the health authorities. What we have underway right now, as part of our comprehensive human resource strategy development, is a review both of the human resource services currently provided at the authority level and as well the structure of the current recruitment and retention unit. There is a clear sense among the members of the Joint Leadership Council that the current structure that we have had in place for the last number of years is not as effective as it should be. That there is possibly an over-concentration of resources at the headquarters level that might be better used if they were redeployed to authorities.

One of the problems we have come across as we have looked at this carefully is that there are about seven different levels of services that are currently provided in the human resource sections and divisions of the authorities. There is no clear rationale as to why or how the particular human resource services were developed as they were. So as we look at possibly realigning resources, we are also trying to come to grips with what would be a standard level of service that should be provided in the human resource sections of the authorities, so there is some consistency. So we are looking at that particular area. With all the most recent changes in adding money for training, as well as some of the other initiatives that we have undertaken in job reclassification, looking at making job offers to all the student nurses coming out of Aurora College, we have taken what we think are significant steps to start addressing this issue more effectively. We can, as the Member requested, get him numbers, but I can tell him that we have made job offers to all, I think it's 23 nursing graduates, that have come out of the college this year and we intend to keep making those job offers. We have set up increased mentoring. We have set up new nursing positions. We have tried to expand the number of nursing entry level positions, both at Stanton, as well as at the authorities in Inuvik, Hay River, Fort Smith and Simpson. We have found a home for the nurse practitioners. We are trying to adjust that program right now as well so that by this coming fall, we are ready to advertise for a second intake of nurse practitioners, which are a key component of the collaborative practices and integrative service delivery model that we are trying to work towards as a system.

So I take my colleague's concern about the recruitment and retention unit and how it was structured and we have been moving to make that whole process much more effective and much more collaborative with the authorities and the department. Thank you.

Thank you, Mr. Miltenberger. Mr. Roland.

Thank you, Mr. Chairman. Mr. Chairman, it's good to hear they are going to be looking at doing some restructuring. Hopefully it will be more successful in encouraging nurses and doctors to come work here in the NWT. I would like to know from the Minister when this work might be concluded. Thank you.

Thank you, Mr. Roland. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, this work is underway as we speak and we expect to be able to come back to the Joint Leadership Council and onto the committee or onto Cabinet by June. The work is going to be started and hopefully completed by then and pieces will be done in the interim, but we hope to have a final human resource strategy ready to put on the table here by June. Thank you.

Thank you, Mr. Miltenberger. I recognize Mr. Dent.

Thank you, Mr. Chairman. Mr. Chairman, in the spring 2000 session, a report called It Takes A Community was tabled in the Assembly. That was prepared by the Child Welfare League. There were some 58 recommendations contained in that report, along with the message to this government to increase the numbers of social workers. That report found that the caseloads for supervisors were some 80 percent over what was considered an acceptable standard. They found also that the caseloads for social workers were more than 40 percent higher than what they should be. So they recommended that this government hire close to 30 new social workers, at a minimum, to deal with the situation across the Territories. The department's response to that report was called A Children's Services Action Plan. They proposed in that report to increase the numbers of social workers by about 30 over three years. A year ago this month, I asked Minister Miltenberger about the plan and he responded at that time, we were in year two out of a three-year plan and that another 11 PYs are scheduled for 2003-04. Yet, Mr. Chairman, when I look through the budget, I don't see the funding for that critical increase in staff. So that means that four years after this important review, we still have social workers with caseloads too high and too few supervisors. I understand that the supervisors are still, for the most part, carrying extensive caseloads, so they don't have adequate time for proper supervision and training that you might want to see with staff.

So I know we've managed to increase the numbers of social workers in the Territories over the past two years, but in many cases, we are probably hiring young people who are recent graduates and who may not have a lot of experience. If the supervisors are carrying great big caseloads as well, they can't provide the mentoring and leadership that you obviously would like to have with new people in the job.

I also had understood that in year three of this plan, that we are going to see an increase, particularly in supervisors. The first two years were concentrated on getting frontline staff and then we were going to concentrate on getting supervisory staff in place. If we really are serious about trying to keep families together, why has the Minister chosen this year not to proceed with the final 11 PYs that he had committed to as part of the three-year plan?

Thank you, Mr. Dent. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I would like to make a two-phased approach to this, if I might. One would be somewhat broader and then I will narrow it down. This particular initiative has been deferred for a year. It was considered a new initiative for the third year and given the constraints, fiscal constraints we were under, new initiatives weren't considered. Forced growth had priority, so we intend to resubmit under the upcoming business plan process. I would also like to point out though, Mr. Chairman, that social workers and child protection workers don't work in isolation and as a system, we have put in about $26 million. We are adding money to long-term care. We are adding six new mental health workers. We are putting in six clinical supervisors to work with the mental health workers, the alcohol and drug workers. As we move towards an integrated service delivery model, the plan and assumption is that, although services at the community level will be working more closely and effectively together, we've attempted to supplement and bolster the services we have in a broad spectrum of areas. So I appreciate the Member's concern. It is still on our list. Unfortunately, the fiscal realities being what they are, preclude us from being able to go ahead with it at this point. Thank you.

Thank you, Minister Miltenberger. Mr. Dent.

Thank you, Mr. Chairman. Mr. Chairman, I am disappointed to hear that these 11 positions, as the Minister says, have been put on hold for a year. Of course, since last year he told us they were going to be in place for 2003-04, there is no guarantee obviously that we are going to see them come back in 2004-2005. So that causes me a lot of concern. I recognize that we have been expanding the services in mental health workers and alcohol and drug workers, as the Minister has spoken about. I think it's important that we take a look at what's happening with social workers. The caseload tends to be so high that I am not sure that social workers have the opportunity to do the job, in many cases, that they should or would like to do.

I take a look at statistics for child apprehensions in the Northwest Territories and compare that to the statistics in other jurisdictions. I have to say that it looks pretty alarming to see how many kids we are apprehending right now. If we had an adequate number of social workers, I would suspect that we would be able to get more help to families and probably wind up needing to apprehend fewer children. I suspect that if you take the cost of keeping a child in care, it wouldn't take too many successes at keeping families together to pay for the salaries of social workers. So I am afraid that the approach we are taking here is one much like justice and incarceration. We are dealing with after effects instead of being proactively involved at trying to solve the problem within the family. Has the Minister had some work done to examine whether or not we could defray the cost of adding social workers through reductions in the cost of child apprehensions?

Thank you, Mr. Dent. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I appreciate the concern of the Member. It's a debate and a question of choices. For example, I would submit that by finally recognizing and putting some funding into the alcohol and drug mental health section of the system and giving them a broader, more comprehensive job description and a decent level of pay and some benefits, that if we can, in fact, work more effectively with families and individuals at the community level and help them avoid starting drinking or dealing with the drinking before it gets out of control resulting in many cases in children being neglected and having to be apprehended, then we are in fact working towards the same end.

Yes, we do plan to put more social workers into the business plan, but once again it was a question of choices. I share the concern about increased apprehension rates. Ideally, we should be able to work with families and we are doing that more and more, working with families and children, and making sure that it doesn't become any kind of ongoing court, custodial kind of arrangement. Thank you.

Thank you, Mr. Miltenberger. Mr. Dent.

I am aware that in a number of other jurisdictions, the approach has been one of making sure that they have social workers available to spend time in the home with the family assisting the family to work better together. While alcohol and drug workers are essential parts of the mix, that's only really one small segment of what sometimes needs to be addressed in a dysfunctional family. I think social workers are still keen to do a lot of the healing and recovery that we need to see take place in the Northwest Territories. What's considered to be best practice now is one that sees much more direct intervention and has the social worker spending more time right within the home with the family. Unless we are able to invest in more social workers though, we are not going to see that kind of approach taken as broadly as it should be. So I would like to, again, encourage the Minister to examine what we could do with savings if we were to cut down on the numbers of apprehensions, if we were to cut down on the numbers of families in crisis, by getting first involved with the family and to do that, we would have to have more social workers. I think if the Minister takes a look at that, there may be a way to approach the FMB and say you have found a way to offset the cost of those social workers. I hope the Minister will take a look at that.