Agreed. Thank you. I'd like to thank Minister McLeod, Ms. DeLancey and Ms. Bassi-Kellett for their attendance here this afternoon. Thank you very much. Perhaps we'll take a 15-minute break here while we switch gears. Thank you.

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I will call Committee of the Whole back to order. The next department is we have to consider under Bill 18 is the Department of Health and Social Services, and if the committee's agreed, I'll ask Minister Miltenberger if he would proceed with his opening comments. Agreed?

Agreed. Thank you. Mr. Miltenberger.

Thank you, Madam Chair. The Department of Health and Social Services is requesting a total of just over $265 million for the 2006-2007 fiscal year. This is an addition of about $18 million over last year's main estimates, an increase of approximately seven percent.

Investments in and changes to the health and social services system are being made to continue to implement the integrated service delivery mode, a team-based, client-focused approach to providing health and social services. The primary community care approach, a key element on which the ISDM is based, ensures that services are available as close to the client as possible. The primary community care teams, working closely and cooperative with regional and territorial caregivers, ensure a continuum of services for all residents of the Northwest Territories.

I would like to highlight a number of very important new initiatives in this budget in support of advancing the ISDM.

The 2006-2007 Main Estimates proposed establishing three new rehabilitation teams, to be located in Inuvik, Yellowknife and Hay River/Fort Smith, in addition to the existing territorial team located at Stanton Territorial Hospital. These regional teams will work with our community-based partners, schools and boards and will be made up of physiotherapists and their assistants, speech language pathologists and speech aids,

occupational therapists and assistants, as well as support staff. Through this significant investment, the teams will provide more consistent coverage of rehabilitation services and reduce patient wait times.

The main estimates includes over $4 million in new initiatives made possibly by the federal health care funding out of the 2004 First Ministers' Accord, including additional frontline nursing positions for small communities and the introduction of six new nurse practitioner positions.

In addition, while we continue to find efficiencies in as many areas as possible, we are investing additional resources to deal with the rising cost of doing business. We have made investments in the workforce, like salary increase for our physicians and specialists, the higher costs associated with foster care, medical supplies that must be purchased, and the expanding costs of our health benefit programs, including drugs and medical travel.

The main estimates request of just over $265 million will be distributed between five main areas of activity:

• • $26 million for program delivery support. This is the support and assistance needed throughout the system. This includes HR services such as recruitment and training, IT systems development and support, as well as the administration of our health services insurance programs and the authorities' operations.
• • $149 million for health services programs. These services are provided at our health centres, public health clinics, doctors' offices, hospitals and some facilities in southern Canada. It includes things like public health, chronic care clinics, inpatients and outpatient care, and physician services. The cost of delivering these programs is estimated to increase from last year's costs by approximately $15 million.
• • $17.6 million for supplementary health programs. This covers the additional benefits provided to eligible residents for programs like Metis health benefits, indigent health benefits, extended health benefits and medical travel.
• • $65 million for community health programs. These programs include the provision of child and family social services. This budget also supports programs that promote healthy lifestyles and community wellness, and include services for at-risk individuals and families.
• • $6 million for the directorate. This includes system-wide leadership and management, planning, policy and legislation development and administration support for the department.

We are continuing to make the necessary changes and improvements to the system to ensure access to services is as efficient and seamless as possible for clients. We are working to reduce wait times at Stanton's operating room and emergency room. We now have three registered midwives in the NWT. We are hiring northern graduates and training our staff for more advanced positions, including nurse practitioners. The toll-free nursing line provides 24-hour advice to people in their homes. NWT residents have used the toll-free health line over 5,000 times in 2005. For all these programs and services, the department and the authorities work collaboratively with many government and non-government partners.

However, there will never be enough money for health and social services if the primary focus is on treating illnesses. We need to continue to emphasize prevention: encouraging people to eat right and get enough exercise, to stop smoking and drinking, to immunize children against contagious diseases. Additional investments are being made, in cooperation with a number of other departments, on healthy living initiatives. Phase two of the very successful Butthead campaign, a challenge to our children and youth to be smoke free, is underway. We also have a responsibility as leaders to be role models and lead by example. I commend Members of this Legislative Assembly for successfully taking the challenge, along with our youth, to be smoke free. In the upcoming year, a healthy foods policy is being implemented in all health facilities in the NWT to promote healthy eating.

Madam Chair, I welcome the opportunity to answer the questions and listen to the comments of committee members. Thank you.

Thank you, Mr. Miltenberger. At this time, I'll ask Ms. Lee if she would like to provide the Standing Committee on Social Programs response to the Health and Social Services budget. Ms. Lee.

Introduction

Thank you, Madam Chair. Madam Chair, Members of the Standing Committee on Social Programs, as Members of the Accountability and Oversight committee, were involved in the new pre-budget consultation process with the people of the Northwest Territories in late August of 2005. Hearings were held north and south of the lake, and gave northerners and non-governmental organizations the opportunity to provide input to MLAs on the priorities that the budget should focus on.

The committee then met with the Minister and his officials on Friday, September 23, 2005, to review the draft business plan of the Department of Health and Social Services.

Members also received a briefing from the Minister of Finance on January 17, 2006, outlining the changes to the budget of the Department of Health and Social Services since the committee reviewed the business plan in September.

Committee members made note that the department is proposing to spend $265.186 million in operations expense and $9.301 million on capital projects in fiscal year 2006-2007.

Committee members offer the following comments on issues arising out of the review of the 2006-2007 Draft Main Estimates and budget planning cycle.

Pre-Budget Consultations

During the community visits, several common themes became apparent to committee members. People want to see health services delivered at a local or regional level.

There is a general recognition that existing addiction programs are not close enough to the community and require a holistic approach that involves the addict's family and reintegration into community life.

Many comments were also received on the need to support the non-governmental organizations that deliver health and social programs on behalf of the Department of Health and Social Services, with stable, multi-year funding agreements.

It was also noted that government departments build forced-growth funding into their budgets and yet expect NGOs to make do with the same amount of money, and deliver the same level of programming, year after year.

Finally, committee heard many comments on the need to support frontline workers at the community level. We heard that these workers are doing an excellent job, but are hampered in some cases by inadequate funding, large caseloads and micromanagement from the department and regional authorities.

Non-Governmental Organization Funding

During the business plan review and following feedback received from the pre-budget consultations and other concerned constituents, the committee recommended that the Department of Health and Social Services issue a directive to the health and social service authorities on the use and preference for multi-year funding agreements with non-governmental organizations with proven track records.

The department did not commit to a directive, but did commit to advising the health and social services authorities that they can use multi-year funding arrangements where it is determined such an agreement is in the best interest of the authority and the service provider. In addition, Minister Miltenberger encouraged NGOs to work with their health and social services authority to enter into multi-year funding arrangements during the October session. Whether this will translate into concrete action on the part of the department and its authorities remains to be seen.

Multi-year funding agreements may be inconvenient for the health and social services authorities to administer and track; however, it is important to remember that the reasons for multi-year funding agreements are to provide financial stability to the non-governmental organizations that deliver services to the residents of the NWT on our behalf.

Within the context of a proper reporting and accountability structure, we should, as a government, be trying to make things as administratively easy for NGOs as possible.

The committee will be tracking the use of multi-year funding arrangements during the business planning process and will be expecting an increase in the number of such arrangements by September 2006.

Madam Chair, at this time I would like to ask that Mr. Bill Braden, Member for Great Slave, continue on with the report. Thank you.

Thank you, Ms. Lee. Mr. Braden.

Treatment Centres For Troubled Youth

Thank you, Madam Chair. Under the area of treatment centres for troubled youth. During the business plan review the committee made a recommendation that the department examine any and all possibilities to increase capacity in the NWT to deal with those children and adolescents with addictions and emotional and mental problems.

This recommendation was made because of the significant amount of money, Madam Chair, presently spent on southern placements and the infrastructure that is in place in Yellowknife that will be underutilized once the Territorial Treatment Centre is transferred to Hay River in 2007-2008.

The department's response indicates that, given the amount of money being spent on southern placements, it is economically viable to deliver these types of services in the NWT. The department is in the process of examining its options, and although they have not provided committee with any firm timelines, the committee will follow up during the review of the 2007-2008 Business Plans in September of 2006.

Rehabilitations Teams

The Standing Committee on Social Programs is very excited, Madam Chair, about the concept behind the rollout of the rehabilitation teams. Getting important services closer to the people they are intended to serve is the hallmark of a responsive health care system and responds to many of the concerns that we heard during our pre-budget consultations.

Members strongly encourage the department to be aggressive in staffing these positions. Recent media reports seem to indicate that audiologists are in high demand and that the NWT's pay scale may no longer be realistic or a sufficient incentive to attract experienced and qualified candidates. The department, within the context of the Collective Agreement, will have to look for solutions to this dilemma.

Once the teams are in place, it is expected that wait times for rehabilitation services should be dramatically reduced and that services to children in the school system will improve. It is extremely important that the rehabilitation teams establish a close working relationship with schools, educators and child psychologists.

Madam Chair, the one area of concern for the committee was the workload that the Yellowknife-based team would have in meeting the needs of the residents of the Tlicho, Sahtu and Deh Cho regions. Some members of the committee believe there should be regularly scheduled visits to each community within these regions, while others would prefer the workload to determine the service patterns. The department is encouraged to monitor the workload of all the rehabilitation teams to ensure there is a proper distribution of resources and that extra help is provided to those teams that require it.

Addiction Services

Madam Chair, in the area of addictions services. During the community pre-budget consultations, it became apparent to committee that there is not a lot of buy-in at the local level for the Mental Health and Addictions Strategy. Anecdotally, Members have been told there is a real disconnect between residents and the primarily southern-hired mental health workers. Many people told committee that if the government would give them the money, they would be able to deliver addictions programming at the local level for much less than what the government is currently spending.

Members suspect that the answers and solutions lay somewhere in between the current model and involving communities and regions more directly in the delivery of addiction programming.

Committee also heard that the spectrum of addiction services is failing, not because there is a lack for funding or infrastructure, but because there is a lack of coordination between the department, authorities and non-governmental organizations that are delivering addictions programming on behalf of the GNWT.

There is clearly a need for a coordinated approach at the community and regional level between governments and NGOs. The department is encouraged to take the lead in fostering and maintaining such an approach, and it is hoped that the second Chalmers Report will provide the department with the strategic direction it needs to improve addictions services at the community level.

Members of the committee are also concerned that there does not seem to be an adequate focus on addictions in the school curriculum. Many people have told committee that the school system, in concert with parents and the community, has to do a better job of communicating the consequences of alcohol and drug abuse to our children.

Madam Chair, I would refer the balance of the report to my colleague, Mr. Robert McLeod. Thank you.

Thank you, Mr. Braden. Mr. McLeod.

Capital Planning And Health Infrastructure In The Smaller Communities

There is concern at the committee level that there is sometimes a leaning towards protecting government assets, such as health centres, in the larger communities, over ensuring that all NWT residents have access to the same level of health care at the community level.

It is noted there are several communities without adequate health centres and/or health care professionals.

The committee asks that the department be cognizant of this fact when determining their capital requirements for upcoming years.

Nurse Practitioners In The Northwest Territories

The standing committee would like to commend the department on their ambitious program to expand the use of nurse practitioners throughout the Northwest Territories.

Increased Funding For Dialysis And Cancer Treatments

The committee supports the repatriation of patients to the Northwest Territories from southern facilities and the provision of dialysis at a local or regional level wherever a sound business case can be made for offering such services.

Aboriginal Wellness Program At Stanton Territorial Hospital

The committee supports the department and Stanton in taking these first proactive steps in incorporating aboriginal traditional healing, values and beliefs into the health care system.

It is hoped that the physical component of this commitment will be seen once the committee has an opportunity to review the Stanton master plan.

Members would like to reiterate that they believe the community health representatives -- CHRs -- have an important role to play in the success of an Aboriginal Wellness Program, and the department and Stanton are encouraged to tap into this valuable human resource.

Dementia Facility And Other Territorial Long-Term Care Facilities

Members support the building of a dedicated territorial dementia facility in Yellowknife...

...as well as renovations to long-term care facilities in the communities. The committee believes it is important to keep patients in long-term care as close as possible to their families for as long as possible.

Funding For Foster Care

Over the last number of years there has been a marked increase in the number of children being taken into care and placed in foster homes. Increased uptake has meant an increase in required funding to deliver the program.

It is noted that this budget proposes to spend an additional $469,000 on foster care placements in 2006-2007. The committee is concerned this amount will not be enough and that more work needs to be done in addressing the root causes of why children are taken into care and placed in the foster care system. Thank you, Madam Chair.

Thank you, Mr. McLeod. At this time, I'll ask Mr. Miltenberger if he would like to bring witnesses into the chamber to join him.

Thank you, Madam Chair. Yes, I would.

Thank you. Is the committee agreed?

Thank you. I'll ask the Sergeant-at-Arms, then, if you would please escort the witnesses into the chamber.

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

Thank you, Madam Chair. I have with me Dave Murray, the deputy minister; and Warren St. Germaine, the director of finance and information services.

Thank you, Minister Miltenberger. General comments. Ms. Lee.

Thank you, Madam Chair. I'd like to begin the discussions on the Health and Social Services' budget by highlighting some of the points that were raised in the Standing Committee on Social Programs report, Madam Chair. The first issue that I want to highlight again is the possibility of multi-year funding to the NGOs. I have to tell you that I was quite disappointed that we couldn't be more enthusiastically supporting government's action in this regard so far, because I was under the impression definitely that the last time around, last fall or perhaps even in the summer session, that I had thought we made some progress in moving the government forward to be more receptive to this idea, and I don't think we've gone as far as we should be able to.

I think all the Members here understand the work that so many NGOs do in our communities. I can name tons in our city who have been around for many, many years. They provide services in all sorts of areas, whether it's about supporting women or supporting people with addiction issues. The list goes on and on. It's the kind of service the government does not want to take on. These are groups that have been around for a long time. They have a proven record and if they were an individual, no one would have any problem giving a great reference to them. I just do not understand why we can't see the government starting to get into some of these contracts. Give them three-year multi-year funding.

At the same time, I really want the government to look at the forced growth issue. Every year, the government budget goes up. It's hard for the government budget to stay the same. Just the forced growth items come and it's almost an automatic passage. When the government departments come to our committees and they tell you there are 100 positions in our government and we have an automatic increase of four to five percent, or three to four percent, whatever that might be. It's usually a very huge amount because of collective bargaining or just natural inflation costs. We just don't even have an argument about that. I think that same has to apply to school boards, NGO funding, because these are all the places that provide essential services and I am not saying the budget should go up by three or four percent every year. I am just saying what's fair for the public programs that we provide in government, it's a fair game for the NGOs, too. They have to put up with the same cost of living indexes. They have to compete to hire qualified people to provide the services that they do. Often they usually hire staff at a lower level of salary than what would normally be called for for the level of qualifications that people have. They aren't usually able to provide the benefit package that governments can. So already they are having to hire people and get resources in much more adverse circumstances than the government can.

So unless the government is looking at the future where they may have to take on some of these programs, I think it is in the interest of the government to look at those NGOs that are doing well, that have a proven track record, to build in a forced growth element and to consider seriously multi-year funding.

I would like to ask the Minister if he would take the lead. I think that question has been asked to the Minister of Finance or the Premier and the Minister of Health and Social Services in the past. I believe various commitments were made to look into it. It's just that no one has taken the next step of actually doing something about it. I would like to know if the Minister of Health and Social Services would take the leadership on that. Thank you, Madam Chair.