Thank you, Mr. Roland. Mr. Ramsay.

Thank you, Madam Chair. I guess following up on that question, the survey that is being conducted with the staff at Stanton, how will that be rolled out? Will the Standing Committee on Social Programs be privy to the information garnered from that survey, or will the department take it and decipher the information and then give something else to the standing committee? I just want the Standing Committee on Social Programs to get the real goods from the survey that is being conducted and I just want to know that that will happen. Thank you.

Thank you, Mr. Ramsay. Mr. Roland.

Thank you, Madam Chair. Madam Chair, we are going to continue to work with the Standing Committee on Social Programs through the process. Once we have got the results, we will be prepared to sit down to go over those results. The first phase of it is done by the Stats Bureau, and then there's a second phase that we are operating through an independent source to do that piece of it. As well, the draft set of questions, or the survey itself, we had shared with standing committee. Thank you.

Thank you, Mr. Roland. Mr. Ramsay.

Thank you, Madam Chair. One of the other issues I've brought up in the House previously is the issue of the privatization of certain services at that hospital. That happened a number of years ago; obviously, over the course of a few years. I'm talking about the privatization of the janitorial, the laundry and the kitchen, the food services there at Stanton. For me, it's really hard to put a price or to try to go the least expensive route when you're talking about the cleanliness of a hospital where care for the individual that's in the hospital and their family should be paramount, number one. I think if it's not that way, it's only a matter of time before we're faced with some type of outbreak or serious disease or something that's going to affect a number of people. I think the cleanliness should be, and continue to be, a top priority of the government.

Now, I certainly am in favour of privatization where it makes sense, but, believe me, I said this before and I will say this again today, I think the root cause of many of the difficulties at Stanton has been the privatization of those three major functions. I don't know how we, as a government, go back and reconstruct that so we repatriate those services back. I think we can't underestimate. I know people are out there trying to do the best they can to make a living, but if you are being paid a wage where you can't live, you have to have two or three jobs, all of a sudden that job does not become your number one priority. You have other priorities. I think we need certainly dedicated staff. There is a huge amount of turnover in all of those areas of that operation. There is no continuity. Also, there are language barriers too. I think that has to come into the equation as well. Some of the staff there don't have a very big command of the English language. There are language barriers. I think, as a government, we really have to examine that. What does it cost the government to have these contracts, to let these contracts? What does it cost to repatriate the services? Again, I am a fan of privatization where it matters and where it can make a difference, but in the area of health care, it is really hard to put a price tag on the health and well-being of our people. I think that is what the government in the past has done in an effort to cut corners, in an effort to save money, these services are privatized. In my estimation, repatriation would be the best thing that the government could do. Thank you, Madam Chair.

Thank you, Mr. Ramsay. Mr. Roland.

Thank you, Madam Chair. The issue of the services that are privatized in the Stanton facility, we have that as well in a number of our other facilities across the North that services have been privatized. The first initiative started back in 1994 as the government overall was facing a very serious shortage of revenues. The second phase kicked in at Stanton in 2001. Since then, one contractor, I think in 2003, has had both or all three of the services that are provided. Recently, it was re-let in November of 2006 and, at that point, we raised the issues of how the contractor was being provided, the services being provided, and had set up a process of ensuring that they are meeting the targets of that facility. Of course, in the health care field, we are concerned, as is every other jurisdiction, about the outbreaks that would happen within our own health care facilities. Thankfully, at this point, we are still the lowest or among one of the lower ones amongst other jurisdictions when you talk about the types of outbreaks that can happen. It doesn't stop us from being more vigilant. That is why we identified a process of monitoring how the contracts are being fulfilled. If the request is being made that we re-look at how these services are provided, that is something that we can undertake to do. We, of course, know that when you do a repatriation back into the government, there is going to be an additional cost of doing that. Thank you.

Thank you, Mr. Roland. Mr. Ramsay.

Thank you, Madam Chair. I would like to thank the Minister for that. I guess through our standing committee process, we could raise the issue with the standing committee in an attempt to at least get the numbers out there and see what we are dealing with in terms of what it would cost in addition to repatriate those services. I am not sure exactly how long the contract that was let in November of last year is for, so you would obviously have to work around that as well. I just wanted to thank the Minister for his open mind on that, Madam Chair, and for the work that he and his staff have done to date. It has been much appreciated. Mahsi.

Thank you, Mr. Ramsay. General comments. Next I have Mr. Pokiak.

Thank you, Madam Chair. I just have a few quick remarks in regard to the opening remarks by the Minister. It is good to see that there is more funding in regard to recruitment and retention of nurses and also, hopefully down the road, social workers. In Ulukhaktok, they are having a hard time to recruit a social worker. I think the department that we have should start looking at it.

The other comment, Madam Chair, is in regard to the homelessness. It is good to see that there is money for homelessness. Again, it is a broader picture where somewhere down the road we have to get this problem addressed in terms of not only in my riding but across the territory. This is becoming a problem. I think the department should work with the Minister of the Housing Corporation and ECE to really address this problem down the road.

The last comment I would like to make and maybe have a question for the Minister is with regard to the services for people. Back home in the smaller communities, we do have eye doctors, dental clinics and doctors that come down to the smaller communities outside of larger centres. One of the problems that they are encountering is that they are only there for two or three days. With the amount of clients that they have to see, they work 12 to 14 hour days and it doesn't give them enough time to actually go through the whole list of people that have to come down to see these people. Will the Minister direct the regional hospitals in terms of trying to find ways to address this problem regarding the amount of time these people will go to the small communities for medical reasons? Thank you.

Thank you, Mr. Pokiak. Mr. Roland.

Thank you, Madam Chair. The recruitment and retention issue is something that, yes, we have focussed on and will continue to focus on ensuring that we have the staffing levels up in all of our communities and facilities.

On the issue of homelessness, once the budget is approved, we will be prepared to go out with an RFP process to request submissions in that area. The area of delivery of services, working with departments, we are doing that through what is similar to the Social Programs committee side. We have a social envelope Ministers get-together on these initiatives to ensure that we are working together around that homelessness as well as a number of other areas. Doctor visits in the communities is something that we have heard about and need to look at on how we would provide services when doctors and other specialists go into communities. It is something we are looking at from within the department and working with health authorities on. Thank you.

Thank you, Mr. Minister. Mr. Pokiak.

Thank you, Mr. Chair.

Thank you, Mr. Pokiak. Next on the list, I have Mr. Miltenberger.

Thank you, Mr. Chair. I would first like to acknowledge the Health and Social Services budget is a particularly well put together piece of work, and I would like to commend all of the staff. They have done all the work necessary. I would also like to welcome the new director of finance to the table in this capacity for the first time.

I just have a couple of quick comments. The one comment is more in line with the Minister's other hat as Minister of Finance, but directly related to the issue of macroeconomic policy and the need, as I laid out in my reply to the budget address, to look at the expenditure side of our operation which means, in this capacity of course, that we spend over 60 cents of every dollar in the social envelope and 25 percent of every dollar goes to health and social services. We know that the majority of the ills that are caused are caused by some very basic issues of alcohol abuse, drug abuse, diet, exercise and smoking, and the need to stay focussed on the good work that is underway on the prevention side or else the Minister will never have enough money as the Finance Minister to continue to meet the needs of the people. That is one broad concern.

I know that we had targets where we want to spend at least 1 percent on prevention or move up to 1 percent, but I think that is going to have to be targeted for seriously across the government in terms of trying to control our costs as we found out with the butthead campaign. A good education campaign can work, especially when it is targeted to those that have a tremendous influence in our society, which is the young people who will buy into the need for what we are talking about and convince their parents as opposed to the other way around. The children have a tremendous influence on the behaviour of their parents. So that is the one caution that I want to encourage, but I guess is to just keep focussed. We have to provide on the future side all of the services we do and fixing the ills and the social problems, but our salvation will be in finally turning around some of the health indicators that we now know plague us in the North that are caused by personal choice. Thank you.

Thank you, Mr. Miltenberger. Mr. Minister.

Thank you, Mr. Chair. Mr. Chair, as the Member stated, as a government, we do have to look at the way we spend our dollars. We can quickly spend a lot of money and the millions on a daily basis and seemingly are unable to show where that money goes, because the system as large as it is and the demands for services are never being fully met in the eyes of many of the people we deal with. So it is something we do have to look at: how we spend those dollars, where we spend those dollars and are the programs we have in place today still relevant when we look at the initial drawdown of authority from the federal government. So it is something that we not only have to do within Health and Social Services, but government-wide at some point.

The issue of prevention is, of course, something that, as a government, when you look at the bulk of our expenditures, are in the acute care side or dealing with the aftermath of illness and accidents and self-inflicted wounds in some cases. It is something that we do have to look at. Although, when there is a need to provide a service, we are still going to have to meet that. As the Member stated, the prevention side of things, we are

targeting 1 percent of our expenditures to go towards prevention. The action plan that was put forward last fall is the majority of that action plan is dealing with health promotion and prevention. Thank you, Mr. Chair.

Thank you, Mr. Minister. Okay. We will now move to our next speaker on general comments. Mrs. Groenewegen.

Thank you, Mr. Chair. I have quite a number of issues that I want to touch on, not the least of which is something that I forgot to mention in the House earlier today. Mr. Ramsay raised the issue of the privatization of the three contracts at Stanton Territorial Hospital. I think the Minister by now has figured out that I am not too overly impressed with the services that are being delivered there. You hear from patients who are having...you talk about healthy food. Check this out and verify if this is true or not, but patients being served hotdogs and french fries under those covers that they deliver to the rooms, these are the kinds of things you hear. It doesn't sound too nutritious to me. I can't imagine if McDonald's can hardly keep the french fries hot, I don't know how you can get them from the cafeteria to a room and still have them taste edible for human consumption.

I think the Minister has the general idea. I appreciate his response that he will look at those privatized contracts at the hospital that deal with the issue of laundry services, cleanliness, housekeeping and food services. I think Stanton is obviously a beautiful facility. I remember the price tag on it not that many years ago. I see in the capital budget there is another $27 million slated to go in there. I don't think that there is a lot deficient about the actual facility itself, but what goes on inside it perhaps needs to be looked at. I want to be clear. I am speaking very specifically to those three areas. I am not talking about the issue of the care delivered by the front-line workers in terms of the health care professionals.

Mr. Chair, also noting Mr. Miltenberger's support for this particular budget for Health and Social Services and how well it was put together, I see that the Fort Smith Health Centre is right in there for...Hay River and Fort Smith were kind of on par at one time in terms of the timing for major renovations. I know there has been some discussion recently about whether or not Hay River would undergo a renovation or a replacement, so I want to ask the Minister when he gets the floor again to tell me if that discussion about which is the most appropriate route to go is what might have stood the Hay River facility back because the Minister recently kindly agreed to come to Hay River and had a tour of the facility. You could see that it is getting in pretty dire need of something, particularly in the old end of the hospital. The floors are sloping. There are some real function issues in there as well with the ambulance bay where it is and how far you have to go to get to the room where patients are assessed. They have to basically wheel half the length of the hospital past the waiting room and everything else. So there are some real functional issues with that hospital in Hay River and I think there are some ways that we could address them. I would just like to be informed on the timing. It wasn't that long ago that I thought that Fort Smith and Hay River were kind of on par in terms of timing, but it looks like Hay River has been pushed back a fair way.

When the Minister was in Hay River too, he saw some of the challenges that are there, say for example, in the outpatients' area. In health today, we put a lot of emphasis on the privacy of patients and their right to privacy, their records and things like that. The Minister saw firsthand in Hay River that, in fact, if you come in for an assessment as an outpatient in Hay River, there was a thin curtain separating you from the person in the next room where the patients are being assessed. In fact, you are privy to the entire conversation of what is wrong with the person in the next room, not room, just in the next little bay to where you are. I think that is a concern. It is a small town. Everybody knows everybody, but I know when I have gone there before, I don't really feel like discussing my medical issues with the whole town. That is something that I think needs to be addressed sooner than later. I don't think that can wait for hospital renovations.

The report on ambulance services is now out. Again, it is something that needs to be addressed in a fairly timely manner. We have been carrying on under the present system for quite some time now. I know the government needed time to work together with Health, MACA and Transportation to assess that, but all the while, the trucks and the vehicles are roaring up and down the roads. There are liability issues and there are concerns over these emergency response services being provided by a municipality through a volunteer organization and what would happen hypothetically, I guess, if there was ever an incident, litigation or some question about services that people had received. We need somebody to backstop us, I guess, as a community if those folks that are out there doing that are going to continue. Again, I think something very pressing, very urgent is the issue of the ambulance services report needs to be responded to and appropriate contracts and protocols put in place to deal with that.

The other thing I was going to mention is the issue of the physicians being on contract all working now. I don't believe there are any fee-for-service positions in the Northwest Territories anymore. Physicians are on contract. They work for the Government of the Northwest Territories. I made an interesting phone call the other day. I called the Great Slave Medical Clinic here in Yellowknife to make an appointment. The response that I got was we aren't taking any new patients. In a private clinic, I can see somebody saying that, but to say that in a clinic that is publicly funded and doctors work for the government, that is a bit of a strange response: we aren't taking any new patients. How do you know how often your patients are going to want an appointment with a doctor? Maybe they only go see the physician once a year or maybe once a month. Maybe they have chronic illnesses. I don't know, but I can see saying we don't have an opening available for three weeks or we will put you on a waiting list. When something comes available, we will give you an appointment. But to say we are not taking any new patients, and they are on our payroll, I have some questions and concerns about that. Those are our facilities. Those physicians are being paid by us, and I think that everybody is entitled to some kind of access. I don't think you have to have some status as a patient to...I mean I think we should all be eligible for service under that. I don't know if any other people in Yellowknife have had that situation. I've never had that response in Hay River, but I did get it here in Yellowknife the other day. So I'd like to ask the Minister about that.

Just one last thing that when we talk about barrier-free access to buildings and all the legislation and requirements over public buildings and people being able to get into them with wheelchairs, one of the strange anomalies in Hay River is the fact that there is no barrier-free wheelchair access to our medical clinic. There's just concrete steps and that's it. That money has never been spent. I know there has been talk about the medical clinic perhaps being incorporated in a new facility at some point in time and maybe they haven't wanted to invest the money, but for whatever it costs I think it would be extremely important to get a ramp, even if it's removable. It could be recycled and relocated someplace else in the future. To get something there so that people when they are accessing the medical clinic in Hay River could not be in a situation where a wheelchair could not get in that building whatsoever. Especially, I mean, it's bad enough in any building, but especially in a health care facility it's particularly difficult and unacceptable, I guess. I don't know what the status is of any capital to address that, but I think it needs to be dealt with.

I'm curious about the capital planning and certainly I think Hay River is due for either a renovation or a replacement of that facility. Thank you, Mr. Chairman.

Thank you, Mrs. Groenewegen. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, a number of issues raised by the Member and we are continuing to work on a lot of them. But specifically, for example, the food side of the thing, there was a ministerial directive issued last spring on healthy food being served in that facility and that's continuing to guide what type of foods are served in our facilities. As well, on the ambulance report, the report has been looked at. We've worked with Municipal and Community Affairs. We have now sent that back out to stakeholders, as well as to the Standing Committee on Social Programs, and we are putting in for the first phase of that initially to try to come up with some enhancement. It is recognized that throughout the territory we are all over the map, whereas we have municipalities providing the service, we have some health boards issuing contracts, so it is something that needs to be addressed. We have recognized that. It's a matter of what level of enhancement we can come forward or get approval on. So that is continuing to happen.

On the physician billing side of things, that has been an issue that has been raised from time to time on the level of service being provided now under our current system. We do in fact have three physicians who are still under the fee-for-service heading, is the way it used to be done. Not just on salary. That's something that as we go into any contract renegotiations with our physicians is something that could be raised at that point.

On the matter of clinics, that has been an issue. The message of not taking any more people into different clinics is something that is of concern in the sense that does the department have to look at that. We're working with the authority. In fact, I believe there has now been a one-phone-line contact system for anybody who requires services that they would contact the appropriate central line and then they would be directed to which facility or clinic had openings. So it's not a matter of absolutely no, it's now trying to better coordinate how people can seek those services or when they need to get into a clinic. That is something that is in place now.

Further to that, as you pointed out, in the capital plan the consolidated clinics process is going to be put forward and dealt with starting with this budget cycle that we're in to try and coordinate that and provide an improved service level.

As well, the issue of the Hay River facility itself, a number of factors came in there and, yes, I did tour that facility and saw that it is a well-maintained facility, but it is an older facility for sure and it is showing its signs of age. With that, we're going to look at providing some interim funding for a number of the initiatives that Mrs. Groenewegen has raised and trying to work with the health authority there on a particular number of initiatives that we feel need to be addressed before we can get to the construction of a new or renovated facility. On the facility itself, the discussion initially, most facilities we look at start off as a renovation and we work with the health authorities on coming up with an agreement on a master plan or that fits within the integrated services delivery model that we've adopted for the territory. Once we have agreement on that, then we are prepared to move ahead. Initially there was planning dollars in '06-07. There are still some dollars available that we're willing to proceed with some more planning, but we need to get agreement now with the health authority on, for example, bed count and those areas. Once we have that, we would then go through the next phase. It would still be designated as renovation, but once we have agreement on the facility, the bed count, the types of programs and delivery that would happen within that facility, then we would go out and the question would be asked can we do this within the existing facility. Is renovation an appropriate avenue or should we in fact upgrade to a replacement of that facility? Those would be the next stages we have, and the next cycle we have is the '09-10 business planning year that we have the next planning money going forward and that's where that discussion would happen; renovation or new. Thank you, Mr. Chairman.