Thank you, Mr. Hawkins. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, the figure 17 is a target that we hold out in terms of what we consider to be an effective and doable number of patients in a day. That will vary over time depending on the patients coming through the door. It might be someone who just needs a simple prescription or a relatively minor fix with a Band-Aid or a consult. It may be someone who requires three-quarters of an hour. We look at things over time and we want to be

as efficient and effective as we can with the resources at hand. Thank you.

Thank you, Mr. Miltenberger. Mr. Hawkins.

Thank you, Mr. Chairman. My job here is to ensure that we have the health care professionals required on staff and those types of resources available when needed, except I go back to some of the concerns I raised in my Member's statement the other day. With the shortness of staff when it comes to doctor availability, doctors are seeing approximately 20 patients per day. I don't want to get into an agreement between 19 and 21, but if that's an approximate number to work with, let's work with that. We still have a shortage of net patients seen per day. How are we stepping in and filling that gap at present? Thank you.

Thank you, Mr. Hawkins. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, at present, we've added doctors over the years. Yes, we've changed from fee-for-service to contract salaries positions. We've negotiated a Collective Agreement, but we are also adding nurse practitioners. We are looking at the structural issues that we know are negatively impacting on efficiency of services in Yellowknife. We've talked about the clinic situation, the emergency situation. There is an administrative arrangement where the doctors work for Yellowknife Health and Social Services but many of them spend a majority of their time providing a service at Stanton. We are looking at the structure of how obstetrics are delivered. So there are a number of different areas we are looking at and the process or structural issues in addition to just the fact that we have a contract with doctors and there is a target in there in terms of the number of patients per day that are to be seen. There are other factors that are there as well. Thank you.

Thank you, Mr. Miltenberger. Mr. Hawkins.

Thank you, Mr. Chairman. I appreciate the Minister emphasizing that a majority of time was spent at Stanton. Would it not make sense to put the doctors we have in practice in the community in those clinics that we have and turn up the heat and get a few more locums at Stanton? The concern I am hearing out there is that doctors are spending more time at Stanton than they are treating their own patients. It's an exhausting period and I have heard it's an exhausting arrangement. Why are we not stepping up the locums? What is slowing us down about implementing the nurse practitioners potentially seeing those 17 patients per day?

Thank you, Mr. Hawkins. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I would just like to give a big figure here in my initial response. There are approximately 50 doctors in Yellowknife when you look at the specialists and the general practitioners and Stanton is a territorial hospital, the population in Yellowknife is about 17,000, so you on the very cursory face of it, on the ratio of one doctor per 1,000 in Yellowknife. You would think there is a lot of doctors, but the reality of it, the way services are structured between Stanton and the clinics, there are problems in terms of getting enough doctors to provide adequate clinic time because their services oftentimes are taken up elsewhere. So we are working on that, we are working on the nurse practitioners. We are moving relatively quickly. We've passed legislation. We've worked out the practice standards. We've agreed to the scope of practice. We've got the issue of the ability to do prescriptions straightened out. We are coming forward with a document that's going to lay out the number of nurse practitioners we see as needed in the different communities.

So we are moving on very many fronts trying to address some of the issues. We are doing that and are committed to doing that. Thank you.

Thank you, Mr. Miltenberger. Mr. Hawkins.

Thank you, Mr. Chairman. I think the Minister overlooked my concern where I had asked the question about what's slowing us down enacting these nurse practitioners to get 17 more patients each day seen by each nurse practitioner. That could potentially add up to quite a few patients. I think the Minister agreed the other day we are seeing approximately a net loss of 80 patient visits per day with the formula provided. I don't think it's appropriate, in my mind at this time, to compare the specialists to the general practitioners. The specialists are into a league of their own. I think one could say it's understood we are talking about the general practitioners at this time. Thank you, Mr. Chairman. So the answer on what's holding back the nurse practitioners. Maybe the Minister can tell me when we are going to see this document about the re-genesis of our health care system. Thank you.

Thank you, Mr. Hawkins. Mr. Miltenberger.

Thank you, Mr. Chairman. At present, we have three funded nurse practitioner positions in health and social services in the various authorities. There are two in Yellowknife and there is one in Hay River. There are some in training, but those are the funded positions that we have. It's a new category of nursing and it's in its relative infancy.

The document, as I indicated in an earlier discussion with one of the Members, is going to go to Cabinet within the next few weeks. From there, we are going to take it to the Social Programs committee for review. We will be sharing it with Members and we will be working on where we go from that point on after it's been through that process. Thank you.

Thank you, Mr. Miltenberger. Mr. Hawkins.

Thank you, Mr. Chairman. We squeaked under the wire. I guess I am a little concerned in the sense of how forthwith this document may be coming. Can we get a commitment from the Minister to emphasize a date when this document can be seen by Assembly Members? That being said, we had promises to see the Stanton master plan in the spring. Then we were told it was coming sometime in late summer. We've been assured by the Minister that it would come in the fall, late fall, and now we are into February and I don't think I

heard anytime in the last while as to when we should expect this master plan. So what is the master plan on the delivery of that master plan? Can I get a commitment today? I don't think it's asking anything unreasonable considering the ability of this Minister. We are not going to stop government and FMBS isn't going to call you as soon as you say what day, I assure you. Can the Minister say by March 1st we are going to get a copy of the Stanton master plan document, or April 1st? Wouldn't that be fitting; April Fool's?

It doesn't really matter. Can the Minister make a commitment today when Members of this Assembly will see both of these documents you have referred to? Thank you, Mr. Chairman.

Thank you, Mr. Hawkins. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, I made the commitment and I have indicated the process and sequence of events in terms of the document dealing with the facilities across the Territories. That's going to Cabinet in the next few weeks. We are working on the executive summary and the communication plan and those types of things. That has been done in full consultation, I just want to point out again, with the authorities, the senior staff, the board chairs, the board members of the various authorities have also been briefed and been involved in the work. So that is coming. The Stanton master plan will flow from this document. The Stanton master plan hasn't proceeded because we were reviewing the acute care usage, the doctors' mix, the emergency wards, the same as we are reviewing the occupancy and usage of other facilities. They are going to be further directed by Cabinet to look at the use of facilities with an occupancy of 30 percent or less. So once this facilities document is done, then the master planning will continue at Stanton, Hay River and Fort Smith where there is money in the budget in the capital plan to do the planning this year with construction to start the following year in all three facilities. Stanton is in the neighbourhood of $16 million over two years.

Thank you, Mr. Miltenberger. At this time, I am going to take a 15-minute break.

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Welcome back from the break here. Next I have Mrs. Groenewegen.

Thank you, Mr. Chairman. Mr. Chairman, I wanted to ask the Minister a little bit about what his assessment is of the viability of some of our hospitals operating here now. I don't know what kind of utilization rates when they're doing this review of infrastructure are being put together for the facilities, but it seems to me that -- I suppose I'm most familiar with the hospital in Hay River, so I'll use that as an example -- there's a lot more referring of patients who are ill to other medical facilities than there used to be. It seems like certainly the maternity aspect service of the hospitals is gone. That is partly I know due to the fact that a lot of general practitioners do not want to deliver babies now for whatever reason. It seems to me that in years past there were more serious illnesses that were just dealt with right there with the medical staff that they had. Then we went through the doctor shortage and the locums and it seemed like people got into more of a mindset of everybody going into survival mode; we'll do the best we can with what we've got. It didn't seem like after the doctor situation got addressed and we got staffed up again that we ever reverted to sort of a full service hospital, for lack of a better term.

So I don't really know why that is and I don't know if the numbers bear it out, but it seems like there's a lot more cases of assess and transfer, whether it's to Yellowknife or to Edmonton. I don't know if the Minister can help me quantify or qualify whether or not that is the truth, but that is what seems to be the case. It seems like people who have cancer and need chemo always go someplace else for it. It's not administered at a local level anymore where it certainly used to be. The hospital used to be full of patients and now it isn't. What's happened? Has the ability of medical doctors and nurses to treat patients with critical illness somehow diminished and we've become more reliant and think we have to refer everyone to a specialist now?

I think back to the days when I came to Hay River 30 years ago and they delivered babies, they did surgeries, they treated people with cancer, they did all kinds of things. But now it seems like there's a much higher incidence of referral. I have heard it also said that some days with the number of people going into Edmonton that they wonder if Stanton is open on that day. Now here's a centralization of all of the specialists and yet it still seems like there's a lot of referring. Is there any historical data to bear out what I'm saying or is this an incorrect perception? Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, the Member touches on an issue that is one of the key components of the document that we talked about where we looked at referral rates, acute care usage, the role of doctors, Stanton, the appropriate mix. The Member is correct. The facilities that were designed going back a number of decades now like Fort Smith, Hay River, the usages have changed, specifically on the acute care side. The occupancy rates are very low. How service is delivered has changed over time, too. The small hospitals that are full service are disappearing, if not an extinct kind of entity at this point. There has been a move to the larger centres where there's been a consolidation of services. The other issue that has gone on is there is greater and greater difficulty in recruiting GP family doctors, rural doctors. There has been a tremendous growth in the area of specialists. We have attempted to quantify that.

The Member is also correct that there has been a lot of services delivered centrally that at one time possibly were delivered in the communities. But we are making efforts and setting the stage to move things out. I can specifically speak to the issue of midwifery and the issue of dialysis where it was delivered in Yellowknife, but we've made the case and shown that it can be and should be delivered where there is a need close to the people, like in Fort Smith and we're working on that kind of service in Hay River. So those kinds of more outpatient services working in conjunction with Stanton and Edmonton is where there is a need. But very clearly, the facilities as they were designed initially, the usages have changed and that's going to be part of the renovations that are done at the various health centres and hospitals is to look at the

changed use and how do we put to use the space that is there in the best way possible. Thank you.

Thank you, Mr. Miltenberger. Mrs. Groenewegen.