Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chair. Thanks for that response, Mr. Minister. I would just like to know what or if any plans are in the works for starting up a palliative care unit in Yellowknife or somewhere in the Northwest Territories. I know we don't have one currently and I think it's a glaring omission in our health department. I would like to know what his plans are to try to address that omission.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, what we are concerned about--and I have met with some of the people in Stanton, but is an issue in every community--is the end of life period of time with people who live in the communities. Sometimes they

require hospital care. Sometimes they can be looked at at home. We are working with the services we do have with the nurses and the home care people to try to ensure that we are very responsive and sensitive and trained as best we can to deal whenever possible with the end of life situations in the home community. In the health centres and hospitals like Stanton, Inuvik, Hay River and Fort Smith, the staff there are also trained. They use the acute care beds. The Member is correct; we don't have a separate palliative care unit or hospice, but we do try to accommodate that very critical final time in a very sensitive way. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chair. Thanks to the Minister for the response. This is something I feel quite strongly about and if we do land more money in the near future, I think this is something that definitely should be on the table for discussion, hopefully when that time comes. I know right now we are definitely under some financial constraints that might not allow us to do it right now, but it's something the Northwest Territories really needs. I am glad to hear him say that he recognizes that.

The next question I have, Madam Chair, is I have heard stories about the hospital in Fort Smith. I know we have a very significant staff complement at that facility, but we don't have any patients, from what I hear. I am just wondering if the Minister is aware that we are running a hospital in Fort Smith that is staffed to the hilt, but does not have the patients to warrant its operation on a full-time basis. Thank you, Mr. Chairman.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, we are currently engaged in a process to look at our acute care beds territory-wide that the average utilization rate, once you agree on the definition of acute care, is approximately 37 percent across the Northwest Territories. The average cost of an acute bed is about $300,000. So as we look at efficiencies, the Member is correct; we are looking at acute care bed requirements in Fort Smith, Hay River, in Yellowknife and in Inuvik. We intend to move ahead with a plan to rationalize the usage and look at what's the best use for that resource. The issue is sustainability, as was raised earlier in this House. The resources that are in the communities, there are pressures that we can't meet right now. So if in a community like Fort Smith, Yellowknife, Hay River or Inuvik, if there were an overabundance of acute care beds, then we have to reprofile resources to meet other needs and we will be moving to do that. That work will be brought back to Cabinet and brought back to the Social Programs committee as well. It's an issue that we are aware of that we are moving on, especially looking at the fiscal climate we are operating in. Thank you.

Thank you, Mr. Minister. Next on the list I have Mr. Hawkins.

Thank you, Madam Chair. I appreciate the opportunity here. I want to reference a quick comment with regard to long-term dementia care as I proceed into the recruitment and retention portion of my discussion. First of all, I am in full support of any long-term dementia care facility that the Minister can find a way to help support the evolution of a program that the Yellowknife seniors have brought forward where the Minister in the long term can find a way to work in the O and M portion of our budget. Although it's not noted here anywhere specific, I just wanted to make sure it was referenced with my support and my willingness to proceed in a deficit situation that could build support for something like that. That being said, I want to reference the recruitment and retention portion of our budget. Retention is probably one of my primary concerns, in a sense, because if we can't establish a long-term base of nursing staff, for example, at our territorial facilities, it does cause me a bit of duress. Could the Minister cite some of the primary difficulties that he sees in retention and recruitment in the health care industry? Thank you, Madam Chair.

Thank you, Mr. Hawkins. Mr. Minister.

Thank you, Madam Chair. I will just pick one component of the system that pertains to nurses and I will indicate some of the problems if I can use that as a starting point for the Member. Where we have community nurses in the past, given the shortage of nurses and in order to recruit them and to come up even on a short term, we created a system where we would bring in locum nurses, casual nurses, pay their travel in, cover their accommodation and their food and fly them out every three weeks, six weeks, three months, whatever the term was. What we've created, as we look at training northern nurses and we've done away with VTA, housing for long-term staff, we've made a bunch of changes and by attempting to deal with the immediate pressing problem of getting nurses into our communities, we've created a longer-term problem in terms of beginning able to get nurses to stay because now many nurses prefer to work on a three-month basis where they get flown back to BC, Alberta or wherever they may be hired from. So that's one issue. We've made significant gains in terms of training nurses, but we have to get them out into the communities.

Regarding doctors, we have a very, very competitive package but in some areas we still have trouble recruiting some of the specialists. They are very hard to find and that's a national/international issue and problem. We have some problem in the more specialized areas dealing with radiology and pharmacists, where there are not a lot of them, the lack of a pharmacist can shut down a hospital. The problem there is that we have businesses, drug stores and big chains coming in and I suppose they come in and recruit the pharmacists. They offer them whatever they are making, plus more. It's a significant incentive. We have to deal with that as well. So those are some of the areas that cause problems in terms of the longer-term recruitment.

Another issue in the communities is we have negotiated an agreement with the unions to be able to use agency nurses, but the problem with that is it's a very expensive remedy because we have to pay the agency $500 a day finder's fee, plus pay the nurse's salary and all her costs. So when we import a nurse from an agency, it's a very expensive short-term remedy, one that we spend the money on, but it's one of the other problem areas in terms of getting nurses into the communities. The nursing component in the larger centres is not as difficult, but the smaller communities struggle. Thank you.

Thank you, Mr. Miltenberger. Mr. Hawkins.

Thank you, Madam Chair. Referencing the last portion about the nursing agency, I wish to assure the Minister that I have had discussion with one person in this contest who left the North and they were picked up and now they are a temporary resident of the North filling this type of position. I won't say that I wish we could be doing more, but that's the primary concern. I can't assume the Minister is doing more, but what is the Minister doing to prevent that? I will wait for the Minister's comments before I provide my own in this particular case. If we are providing $500 a day plus the nursing fee, add that to the point that some local nurses have pointed out that they feel they are being overworked with the retention issue because they are working so much overtime, that money could be allotted somewhere else. What is the Minister doing on the retention side, so we don't have to go to agencies for the $500 plus a day, VTA, housing, et cetera, Madam Chair?

Thank you, Mr. Hawkins. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, the mid-term solution for us, not even mid-term, is training our own northern nurses and getting them trained to the point where they can work in the communities having a competitive pay and benefit package at the community level that will attract them to stay there, as well as enough support and things like training and professional development, that they will consider it a career.

We are also looking at an annual allowance for nurses in small communities that will give them compensation that recognizes the circumstances they work under, the isolation and pressure of being on call all the time and where they don't have a lot of support.

We are also taking steps to bring into play nurse practitioners, which will raise the level of professional capacity of the nurses. We would like to be able to not only train them, but also work with the nursing association to come up with the method to have nurses that have a lot of experience to take a refresher course and write a challenge exam so we can get nurse practitioners as well into the field. We've also had a relationship with northern Ontario where they are training nurse practitioners in lead communities to have nurses get experience in using some of the communities in the North as a practicum site for some of that particular training. So those are some of the things we are putting into place attempting to get a longer-term workforce in place. Thank you.

Thank you, Mr. Miltenberger. Mr. Hawkins.

Thank you, Madam Chair. Madam Chair, would the Minister for my benefit, and maybe other Members, do we have nursing practitioner legislation in the Northwest Territories that enables this industry to move forward? Thank you, Madam Chair.

Thank you, Mr. Hawkins. Mr. Miltenberger.

Yes, we do, Madam Chair. It was put into place by this Legislature late in the 14th Assembly. Thank you.

Thank you, Mr. Miltenberger. Anything further, Mr. Hawkins?

Absolutely, Madam Chair, absolutely. I think you brought up earlier that each health authority has its own HR recruitment area. Is there any strategy noting our difficult fiscal times of consolidating some of these recruitment and retention centres? Is there any long-term strategy possibly migrating them to the eventual outcome of a human resources department with the Government of the Northwest Territories? Can you express on your cost-savings measures implemented to date in that area? Thank you, Madam Chair.

Thank you, Mr. Hawkins. Mr. Minister.

Thank you, Madam Chair. Madam Chair, we, as a Legislature, have identified the whole area of human resources and how to best coordinate within government, and that includes, as well, the authorities, So we are very interested in taking part in that exercise. There is, I believe, a clear benefit to be gained by greater coordination and collaboration of how human resources are delivered in the government and the possible consolidation at the regional levels to provide some of the services. We are also looking at that in the pay and benefits side. There is merit to that. We are also looking in Yellowknife specifically where there is a crucial mass of health facilities and possible amalgamations that make sense, integration of services between the Yellowknife health and social services and Stanton where there is a lot of overlap in the services that are provided in the pay and benefits side, the human resources side, the administration side and the finance side. So we think there is a potential capacity there to have some efficiencies, economies of scale. Thank you.