Thank you, Madam Chair. The Standing Committee on Social Programs met with the Minister of Health and Social Services and his officials on Friday, February 20, 2004, to review the draft main estimates for the department.
The committee noted the department is estimating it will spend $246,978,000 in operations expenses and $9,929,000 contained in the department's infrastructure acquisition plan for the fiscal year 2004-2005.
The Members made note of the following issues during their review of the draft main estimates for the Department of Health and Social Services.
Federal Government's Failure To Meet Its Responsibility
The committee noted that the federal Department of Health and the Department of Indian and Northern Affairs are disputing more than $30 million in charges relating to the delivery of health services and programs to aboriginal people in the Northwest Territories since 1999. The committee commends the Department of Health and Social Services' commitment to delivering a quality healthcare program to all northerners, regardless of ethnicity. The committee agrees with the department there is no option but to pay for these services as the evolution of a two-tier health care system is unacceptable.
To date, the government's efforts at the officials and ministerial tables have been cordial but ineffective. The $30 million this government is carrying on its books, as a receivable from the Government of Canada is money that this government could be putting towards delivering programs and services to all residents of the Northwest Territories.
With this thought in mind the committee believes it is time to aggressively involve our aboriginal partners in our dispute with Ottawa and has forwarded the following recommendation to the Standing Committee on Accountability and Oversight for their consideration.
The Standing Committee on Social Programs recommends the Government of the Northwest Territories place the issue of the Federal Government failing to meet their healthcare responsibility to aboriginal residents of the Northwest Territories on the agenda for the Northern Leaders Meeting with a view to arriving at a consensus on a joint plan of action to recover this debt.
Dementia And Long Term Care Facilities
The committee supports the department's efforts thus far in assisting the Yellowknife Association of Concerned Citizens for Seniors in planning a dedicated dementia facility in Yellowknife.
Committee Members believe there is a real need for such a facility in the Northwest Territories. Such a facility would relieve strain on other long-term care facilities that are not designed or properly staffed to deal with the myriad of needs that caring for a dementia patient can entail.
It was noted by committee members that there was a need to balance territorial facilities like a dementia centre with that of the need for more long-term care facilities in the regions.
The Standing Committee on Social Programs looks forward to further discussions on the future of a dedicated dementia facility and regional long-term care facilities in the next business planning cycle.
Telehealth
The committee is very interested in ensuring the success of the telehealth program. Members noted with disappointment the scaling back of the equipment purchases when compared to numbers contained in last year's infrastructure acquisition plan.
In the subsequent discussions, Members did point out that the use of telehealth does not always translate into cost-savings for the Department of Health and Social Services. In some cases, it would result in increased costs as a doctor may order someone medevaced in advance of the doctor's regularly scheduled visit to a community, based on observations made through the use of telehealth.
However, the committee does not view this as a major problem as several Members did point out that early diagnosis of a condition does increase the chance of a positive outcome for the patient and could possibly reduce the costs to government through the use of a less invasive or drastic treatment regimen.
The standing committee looks forward to further discussions on the future of the telehealth program in the Northwest Territories during the next business planning cycle.
Board/Authority Operations
It has become apparent to Members that the present board and authority structure for the Department of Health and Social Services and the Department of Education, Culture and Employment is no longer sustainable given the fiscal situation that this Territory finds itself in.
As the health and education authorities spend the bulk of government dollars in the Northwest Territories, it is appropriate that the government's initial effort in reviewing the board and authority regime in the Northwest Territories should begin with them. It is also necessary that a long-term vision be developed which clearly defines any new authority's role and function.
If the streamlining effort is done properly, committee members see an opportunity to increase local and regional involvement in the process. Members would point out there is a need to examine such issues as the present review of the Dogrib Community Services Board and a communications and participation strategy to ensure that communities understand the need for streamlining of the authorities and have the ability to let their concerns be known during any process.
If a decision is made to follow the community service board model there is an opportunity to improve service delivery at the community level and to make the system more accountable to the people it is supposed to serve.
The Minister has indicated he wants to work with the committee in examining this issue and Members look forward to these discussions.
Support For Prevention And Promotion Programs
The committee is convinced the department is losing ground on the prevention and promotion front at a time when there is a strong indication it is time to increase our efforts in health promotion and prevention. Members are very alarmed by the health-indicator statistics as presented by the chief medical officer. All trends are indicating an increase in preventable diseases and conditions. In the minds of committee members, this indicates a need to develop a course of action.
It seems the department is at cross-purposes with itself when it reduces funding to health promotion and prevention programs. We are not going to reduce costs down the road in providing healthcare to our residents unless we are prepared to make an investment right now in health promotion and prevention programs.
Committee members strongly support the efforts of the department in implementing tobacco awareness campaigns targeting young people before they become addicted to nicotine but would point out there is a need to put a similar effort into developing and delivering health promotion and prevention programs aimed at sexually-transmitted diseases, tuberculosis, diabetes and obesity.
Any health promotion and prevention program needs to be flexible enough to adapt to the needs identified in health indicator reports such as the recent report on cancer trends in the Northwest Territories. For example, it is apparent the department has addressed the issue of smoking in a dedicated health promotion and prevention strategy. What are not addressed are the other behaviour patterns that have contributed to the increase of other types of cancer like colorectal cancers. There is a clear need for a health promotion and prevention program aimed at the other primary causes of cancer in the population of the Northwest Territories.
The Standing Committee on Social Programs recommends that the Department of Health and Social Services develop an action plan to deal with the increase of incidences in sexually transmitted diseases, tuberculosis, diabetes and obesity.
The standing committee will be vigorously pursuing this issue during the next business planning cycle and wants to see evidence of an increased emphasis on health promotion and prevention programs at that time.
Territorial Treatment Centres
The Standing Committee on Social Programs is very concerned with the state of addictions treatment in the Northwest Territories. Many constituents have expressed frustration with their inability to access the programs and services they need to detoxify themselves and gain sobriety closer to the communities in which they live.
There is also concern about the lack of treatment programs available for young persons in the Northwest Territories.
This is an issue the committee hopes can be dealt with during the life of this Assembly. Members believe it would be possible to develop a system using residential and community-based treatment programs that meet the needs of territorial residents.
Insurance And Women's Shelters
Members of the standing committee were made aware that women's shelters in the Northwest Territories were having problems accessing affordable insurance for their facilities due to exorbitant increases over last year's insurance rates.
Further information supplied by the department indicated they were able to assist all shelters in the Northwest Territories in acquiring suitable insurance coverage for 2004/2005.
While pleased the issue of insurance coverage for the shelters was laid to rest for the next year, committee Members caution that this issue may come up again. If insurance premiums make it impossible for the non-government organizations to deliver these important programs it may become necessary for the department to take a more direct role.
At the very least, the committee would like to see the department following this issue closely and coming up with a plan of action.
Support For Aboriginal Liaison Person At Stanton
The committee appreciated the Minister's recognition there was a need to improve services for aboriginal patients at the Stanton Territorial Hospital by addressing translation and cross-cultural communication issues.
In particular, the committee noted the hospital has hired a discharge planner and coordinator to help people get back to their home communities and ensure that medical practitioners are ready for them when they arrive. This is a welcome first step but Members noted that it only addressed half of the equation. Those residents who arrive from our smallest communities are sometimes left to their own devices in accessing services at Stanton. This can be very overwhelming to someone with limited English skills and understanding of how hospitals operate.
During the next business planning cycle, the standing committee would like to see evidence of either a system or dedicated staff to deal with incoming aboriginal patients.
Madam Chair, that concludes our response to the review of the budget for the Department of Health and Social Services.