Thank you, Mr. Miltenberger. At this time, I will ask Ms. Lee, Chair of the Social Programs committee, to provide the committee's overview of the department's main estimates. Thank you.

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.

Thank you, Ms. Lee. At this time I'll ask the Minister if he would like to bring his officials into the Chamber.

Yes, I would, Madam Chair.

Thank you, Mr. Miltenberger. Does the committee agree?

Agreed. Thank you. I'll ask the Sergeant-at-Arms if she would escort the Minister's witnesses to the table. Thank you.

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

Thank you, Madam Chair. I have with me Dave Murray, deputy minister of Health and Social Services, and Warren St. Germaine, the acting assistant deputy minister of corporate services.

Thank you, Mr. Miltenberger. At this time I will ask the Members if they have any general comments on the Department of Health and Social Services. Ms. Lee.

Thank you, Madam Chair. I don't want to offer general comments, but I do have some questions about some of the issues being raised by the Minister in his opening statement. The first question is on page 6 and it has to do with the 1-800 call centre. Madam Chair, I understand that on the surface -- and the Minister has spoken about this in this House -- this is an initiative that would give access to residents who are not in major centres in particular who may want expertise and advice from medical professionals or health care professionals on any ailment or health conditions they may have. It is my understanding that this project has become much larger and much more complicated than what was initially anticipated. I'd like to know from the Minister what the original plan was for this project and what is anticipated as a budget now and what has been some of the problems in implementing this project. Thank you, Madam Chair.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, what is envisioned with this particular initiative is another level of service, another avenue of access to medical information for Northwest Territories residents that's available 24-hours a day by licensed health practitioners, nurses. It's done in other jurisdictions like Alberta and Ontario where they have 1-800 numbers and the calls go into centres where they're staffed 24 hours a day by health professionals that have all the information of our jurisdiction and will be able to respond to issues to give a concerned client some initial information on questions they may have in regards to any particular situation. It's intended to complement services that are at the community level and, as well, complement, for example, the book "Do I Have to See a doctor or Nurse?". It's to provide one more avenue of access for all northerners that's not dependent on medevacs or medical travel, but it's just dependent on being able to use a telephone. Thank you.

Thank you, Mr. Miltenberger. Ms. Lee.

Thank you, Madam Chair. I have a question for the Minister in another area and it is broad. I appreciate that we're going to be going into different areas, more specific programs and services that we will be reviewing the budgets on, but I'm wondering if I could ask the Minister about what he plans to do on the supplementary health benefits programs. In the last Assembly, the Minister had undertaken to do a massive review on it and at the end of the last Assembly he still had not presented the results of that review. Can I get an indication from the Minister as to when he expects to have the results of that and when would the Members of this House get a chance to have an input into that? Thank you, Madam Chair.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, the document was completed late in the last Assembly. It was given initial review by the Cabinet of the 14th Assembly. We were subsequently overtaken by election events and so what the intention is now is to have the study taken back to Cabinet, as well as into committee for review and discussion. There's a lot of information in there. There are some recommendations. It's a very complex area and one that's going to require a lot of consideration. So the intention is in the next few weeks to take the document back to Cabinet and then, as well, take it to committee for review and discussion and mapping out a plan of how best to proceed in this very important area. Thank you.

Thank you, Mr. Miltenberger. Ms. Lee.

Thank you, Madam Chair. That is the second issue that the Minister is working on. Earlier today in the House there were questions raised about the disability action plan which the Minister is taking into the Cabinet, and this latest answer that the Minister is giving suggests that the changes to supplementary health benefits have

not been concluded. Can the Minister give an indication as to why that is? Is that because of dollar implications that he's not able to advance this? Does that mean that it is probably more than likely that we're not going to see the result of that? I just want to get a realistic picture here. I want to get the goods on where we are on this and does he see any problem with concluding those two? Let me just stick to this issue. Does he see a major problem implementing that supplementary health benefits issue? Thank you.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, as I indicated, the work has been done for the initial document. This is a complex area and we as a legislature have not had a policy discussion about the type of health care system we have, what changes we may want to anticipate. Right now, on the supplementary health side, we have a fragmented system of delivery that has evolved over the years with no clear linkages in many cases and it has become time to look at that. But it's going to require careful consideration because there are implications in a number of areas, not the least of which is the one in terms of the services we currently provide for the federal government in addition to the other supplementary health care programs we provide to our own residents that are not covered under those federal programs.

There are cost implications, to be sure, but depending on the direction that's chosen that's going to require some policy discussion. It's not just a case anymore of just putting more money into the current system. We have to look at how the system is now operating. Clearly, if the debate in this House over the last eight years is any indication, the system requires an overhaul, that particular program area for sure. The intent is to move that into Cabinet and the committees as soon as we can. The work is done, as is the work on the disability framework, which has just recently been signed off by the four deputies of the involved departments. We are now ready to take it into Cabinet and committee, as well. Thank you.

Thank you, Mr. Miltenberger. Ms. Lee.

Thank you, Madam Chair. My last question is on the item of the outstanding $30 million or approximately $30 million that we have a claim for against the federal government. I'm totally in support of the committee's position, obviously, and the argument that we, as the NWT legislature, have to work with our aboriginal partners in advancing this agenda and to make sure that we get paid every cent that we feel we are entitled to. But I do have a question on the details of that. The Minister has mentioned on many occasions in answering questions in this House that there are points of dispute between the GNWT and Government of Canada as to what services should be eligible for the federal government to pay. I guess my question is how much of this approximately $30 million in his mind, in his most objective analysis, is something that we should just give up expecting? It's such a contentious debate, I mean, if it's a case where the GNWT has decided to provide certain services and certain health care benefits because we feel on an objective policy basis that is something that we should be providing to our residents, but it is something that is not anywhere near based on any criteria that the federal government sets for themselves, I think there's a fine line between saying we're entitled to this from you because we provided it and you have to pay for it to saying this is something that we're willing to pay and that doesn't necessarily make it an accounts receivable on the part of another government. I don't know if the Minister understands, but I want to know what the realistic number is out of that $30 million that we can really be fighting for. Thank you.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. There are the two program areas. There's the program administered for DIAND for services to Indian and Inuit people for hospital and medical services and, as well, there's the non-insured health benefits. The DIAND programs are currently in arrears almost $23 million going back to 1999. We, as well, are negotiating with them on money that we are confident we're going to get, but is tied up into cash flow issues, which is about $19.2 million. Then we have about $4.7 million that we're currently negotiating with Health Canada on with non-insured health benefits. There are some very fundamental issues involved in this, as well. We signed an agreement under some duress. In 1988 we signed an agreement, there was a cap put on of two percent per year. We can demonstrate very clearly that our costs are growing at an average of about seven to nine percent a year. So you don't have to be a math wizard to realize very clearly that we're building up a debt. Last year alone it will be about $8.5 million that we've paid out over and above what we're funded. The one bit of good news is that Health Canada has agreed to increase the base for non-insured health benefits by about $2 million from $5.9 million to $7.9 million.

The problematic area for us is DIAND. I met with the Honourable Ethel Blondin-Andrew yesterday to talk to her about the situation. I know the Premier has raised this issue at the tables that he is at with the First Ministers, as has the Minister of Finance. Bureaucratically, we will be told on the DIAND program side that we're not going to get any of that money back, that we signed a deal and that's it, too bad. But like many things in our business, I don't think we can afford to just accept that answer. Not when we're $8.5 million out of pocket last year, a cumulative total of $22.9 million to date out of pocket. Clearly the intent of this program is not to beggar the Government of the Northwest Territories. We're working, supposed to be collaboratively with the federal government, to administer a program that should be cost neutral to us as a government and it isn't. So we can't afford at this point to give up any ground in the negotiations. Clearly, the two percent ceiling is not acceptable and it's an issue that is getting a lot of interest. I've met with Minister Pettigrew as well. The level of frustration is so high the Premier has gone public, as have I, that if at some point this is not resolved, we can't go broke delivering programs for the federal government. The federal government is going to have to look at stepping in.

So to make a long answer short, I don't think we can afford to give up on anything at this point. Thank you.