Maybe the Minister didn’t hear the number $26 million. But the $26 million question is: where is it going to come from, and how is the authority going to pay that, or are we again going to take an eraser and just take $26 million? Money is not growing on trees around here lately. I haven’t seen any money trees growing out back. So I’m not sure where the Minister thinks we’re going to find $26 million. How is it going to happen? I’d like somebody to tell me.

I think the Members should be assured that we will not be asking the government to come up with $26 million. As I’ve stated over and over in the House, the outstanding payroll issue is not related to…. Well, I should restate that. The accumulated deficit that we are expecting to be at $11.5 million takes into consideration outstanding payroll. Stanton has the outstanding revenues as

well. They have receivables from Nunavut hospital that they’re making fairly good progress on.

When you’re looking at a cash flow, it is about a $100 million operation. It did have an accumulated deficit, starting from last year and the year before. The government has funded $1.3 million, I think two years ago, when the Stanton deficit hit a significant amount, relatively speaking, at about $2 million. So FMBS did authorize a $1.3 million infusion of cash.

There is a discussion that began between the Stanton Territorial Health Authority, FMBS and the department to find out what is causing the deficit situation. That discussion led to a zero-based review. The zero-based review preliminary report tells us about how much it should cost to run those 53 programs. Some of them are being underfunded, and some of them are actually not spending the money they have.

My thinking as the Minister was that we need a second layer of analysis to see. You like to think that an operation that runs at $100 million may have some flexibility to control their finances, but I don’t know that for sure. So I agree with the Member that the department and I as the Minister are accountable to the Legislature on the expenditure. I am working on getting my best information to the Member about the status of the operation of Stanton and about what led to the deficit situation. I would think it probably will be partly to do with underfunding, but I need to get specific information as to what parts of it are contributing to that and what portion of the $11.5 million is involved. Those are the questions I am working on.

The public administrator is looking at all aspects of this question, and I have confidence that he will give us the information we need to go forward.

I don’t know if I’m understanding this correctly: that Stanton Hospital hasn’t paid FMBS back for six and a half months. That’s $26 million. How could that $11.5 million of accrued deficit include all the payroll? That just doesn’t make any sense to me.

Again, from a budgeting perspective, where is that money going to come from? What are the outstanding accounts receivable at that hospital? Why don’t you tell us that? I could feel a little bit better about the fact that, yes, some money might be coming in. What is that amount?

One moment, please. I believe there are about $12 million of outstanding receivables that Stanton Hospital is working on, and the largest portion of that is from the Nunavut government. But there are other routine receivables they’re working on. They do provide services they could bill other third parties for. I don’t think WCB is one of them, but there are other health authorities

that they are to bill, and they do bill and they get money. I just want to emphasize that these are not extraordinary situations, in that it is a $100 million hospital. They do provide services to anybody who walks into operations. There is a lag in time between the time they bill and the time they collect.

Mr. Chairman, the math still doesn’t really work for me. I know the Minister has committed to getting back together with the Social Programs Committee to go over the situation at Stanton. I think the sooner that happens the better, so we can try to figure out what is happening there and what is going to be the course for the future.

I agree with my colleague, Mr. Abernethy: I don’t want to see people affected out there. I don’t want to see services reduced. I want to see us funding that hospital to the level where it’s supposed to be funded and finding out what that is.

Mr. Chairman, it’s kind of ironic that when the department went out and did the zero-based review and came back with its initial findings of that zero-based review, it’s shortly thereafter that we learned the hospital hasn’t paid its payroll in six and a half months. That’s $26 million. The last question I have for the Minister is: if they’re not paying the $2 million every two weeks — and that’s what the payroll is every two weeks at that hospital — what are they doing with the money? Where is that money going?

Mr. Chairman, I have to say I do appreciate the Member’s concerns and questions and the need to get into the information here. I’m providing him with everything I have, but I do have a little bit of a problem with his question, “What are they doing with the money?” They are spending the money to run the hospital. I don’t know what else they would be doing.

My understanding of how the authorities are funded is that we approve our budget here, but they don’t get the whole $90 million — or whatever they’re getting — in a lump sum. The FMBS keeps that, and they get instalments of money. With payroll, FMBS writes us a cheque for every employee within the governing system, including the authorities, every two weeks. The authorities or departments charge them back. So the money they’re not paying back to payroll, that’s $2 million out of the $90 million in instalments they’re working on. They pay for contractors. They run their hospital.

I don’t know if the Member could give me other questions to get to the answer he’s getting to, but I’m not sure what to say when I get asked, “Well what are they doing with the money?” I have no evidence to think they’re doing anything with the money other than running the hospital. They’re working really hard to get their receivables updated.

They’ve been working really hard fully participating in the zero-based review, because they understand that will get them some of the answers they need and that it has implications for other authorities as well. So it’s a very complex file we’re working on step by step. I’ve already said many times that I’ll be looking forward to going to the committee and presenting all the information we have, and we can make decisions together.

Thank you, Ms. Lee. We’re getting quite a list here, so I think we’ll move on. May I call next on Ms. Bisaro.

Thank you, Mr. Chair. My question is in reference to the funding for the health authorities as well.

I appreciate that the department has capped their growth at 3 per cent. But when I look at the figures that are presented to us in the budget, I see that funding for hospitals is actually going down from the Revised Estimates last year to this year. My concern is that if the total amount of money that health authorities and hospitals — and health centres, I guess I should say — are going to be receiving is going down — although health centres are going up a bit.... But if money is going down for hospitals, how has forced-growth costs been considered in the grants to the various hospitals and health centres?

We’ve acknowledged many times in our discussions, in regard to every department’s budget, that fuel costs, for instance, are going to be a huge impact on forced growth in every department. There’s been some forced growth worked into many department budgets, but we know that fuel prices are going to be going up over the next year, farther than they already have.

I find it really difficult to understand that a hospital or a health centre’s been given a 3 per cent increase to their funding, but the total amount they’re receiving is going down. I’d like an explanation, if I could get one.

Thank you, Ms. Bisaro. If I can call on Mr. Elkin.

Thank you for that explanation. I guess my understanding of the way the ’08–09

Main Estimates were developed was that forced-growth costs, which should have included all the costs from sub-funding from ’07–08, were included, were added to the base for ’07–08, and that the numbers for ’08–09 included the base from last year plus all the forced-growth funding they’d received through supps over last year.

If that’s not the case in this situation, I guess I would like to hear that explanation. Again, I’m confused. Sure, our budget’s gone up from the Main Estimates of last year. But there’s some $6 or $7 million between the Mains of last year and the Revised Mains. And if that money’s been spent — which I’m sure it has, because it’s health centres and hospitals — how do we expect our health centres and hospitals to operate with less money than they used in their Revised Estimates from last year?

I’m not sure if I’m clear, because I’m kind of getting myself confused. But I really don’t understand these numbers.

Thank you for the explanation, Mr. Elkin. That makes it a little more clear. But it doesn’t help me with my concern.

We’re dealing with prior-year funding deficits or overspending — whatever you want to call it. To me that indicates these particular hospitals are not receiving enough money in funding. If it’s $1.6 million we gave them in a one-time grant, or whatever you want to call it, to cover their prior years’ expenses, they still have that expense on their books. They are still going to have it this year. It is still, to me, in effect, a cut. Again, I just have to express my concern that we’re putting these hospitals and these health centres into a situation where they can’t possibly win.

I appreciate that Stanton, for instance, is undergoing a review, but I think our premise is incorrect and we’re not giving them enough funding at the beginning of the year. We are going to put them.... Even if we take the eraser, as Mr. Ramsay says, and wipe off the current accumulated deficit, we are putting them in a situation where they’re not going to be able to succeed; we are going to put them back into a deficit at the end of this ’08–09

year. There’s no question there. I just wanted to make that comment.

Thank you for that comment, Ms. Bisaro. Moving on, next on my list is Mr. Abernethy.

Now I am ready. Thank you, Mr.

Chair. I just wanted to start by saying I

understand how difficult the Minister’s job is. Health is one of the most complicated departments there is. Certainly it’s one of the ones that costs the most money and is the hardest to deal with due to national and international shortages and wildly increasing costs in delivery of health care. I also absolutely respect everybody in the department. I have worked with a lot of them. I have seen a lot of them at work, and I know they are incredibly hard-working individuals and deserve a real pat on the back, as do all the people in each of the health authorities: all the nurses, all the doctors. Without them, we’d have nothing.

But there are still challenges. I mean, I guess the fiscal reality is in what’s going on out there. There are places that are obviously working a lot better than others, and I’ll give you an example. The Sahtu Health and Social Services Authority has gone from being in rough shape several years ago: no nurses, couldn’t find staff, running deficits — pretty bleak out there — to the point now where they are pretty near fully staffed on a regular basis. They’ve got a lot more permanent nurses in the community health centres than they have had in a really, really long time. Things seem to be going pretty good out there. They’ve gone from being the authority that used agency nurses more than any other agency to being one that hardly uses agency nurses at all. So of all the authorities right now, they really deserve a nice little clap on the back.

The reason I’m bringing that up is because I know a lot’s being done out at Stanton right now trying to find some streamlines, to try to find some efficiencies without reducing the quality of the services that are being provided. I’d like to take this opportunity to encourage the Minister and hopefully get her to commit to working through her public administrator at how some of the other authorities are running and to go out to places like Sahtu. I understand it is a completely different business given they are community health as opposed to a hospital, but there are efficiencies they are finding out there.

I think it is time that Stanton looked at some other alternatives, some other ways to deliver their services in efficient ways to gain those efficiencies and ensure that services continue to be delivered in an efficient and effective way.

One way I would also encourage the Minister to consider — and there seems to be resistance to

this one, which I don’t always understand — is the value in creating some redundancy within the hospital itself. We hear a lot about the payroll. We hear a lot about the cost escalations in payroll and whatnot, but there would be some real advantages to at least pursuing and seriously considering, with an open mind, the concept of creating some redundancy in there. By that I mean creating some additional positions in Stanton, some additional nursing positions that would be on duty on a regular basis, that could be used to cover factors such as when nurses either call in sick or are away on annual or are away for any other variety of reasons, including training and development. Redundancy would cost you less than overtime and save the authority money over time.

I guess what I am asking is for the Minister to commit to exploring these options with an open mind, not being closed off to them right off the top, and working with your public administrator — who I respect very much and I think was a very solid choice — to look at some of these options, including what’s being done in other authorities such as the Sahtu Health and Social Services Authority.

Minister Lee.

I agree with the Member’s observation about Sahtu. It is a success story; the little train that could.

I want to assure the Member that through the Joint Senior Management Committee — which is made up of all the CEOs and which the deputy minister oversees — we are in constant touch with all the CEOs, talking to each other, looking at best practices, looking at ideas. I also have the form of JLC. So the authorities and the department are in constant conversation. I think we should be mindful of the fact that each of those eight authorities is quite different in its characteristic and its operation too.

Lastly, on the point about a float pool of nurses and increasing the number, I did say yesterday that Stanton has nine float-pool nurses. There is a proposal being made by one of the nurses that has been circulated to all the Members. It says we should go to 15. I did indicate that we are doing a cost-benefit analysis on that and that Stanton is looking at the possibility of doing a pilot project of 12 nurses, keeping in mind all of the details that have to go with that. We are not discarding that idea. It’s one idea that’s under consideration.

Just as a note, I did indicate that I realize the authorities are radically different and their businesses are quite different.

That’s great. I am glad to hear that you are open to the idea of increasing the float pool. My concept was slightly different, in that I was thinking it might

actually be beneficial to extend the wards and units. For example, if you were to increase, say, surgery by a couple of positions, you’d be creating some redundancy within surgery itself, which could conceivably eliminate the need for overtime when people call in sick, because you would actually be slightly overstaffed. And those people.... Given the job descriptions that currently exist, and taking Stanton as an example, the job descriptions currently say that a nurse may be taken off one area and put in another area should demand be there. If you had some redundancy built into actual lines, into individual units, you would be able to use those people in other areas should the need arise, but they’d also be available in that unit should someone call in sick or someone be away on annual. It would just give you a little bit more freedom to help you reduce some of your overtime costs.

In addition to the good work you are doing with respect to the float pool, would you consider other options and explore other avenues to help you reduce your overtime rates at Stanton, thus saving you money in the long run?

I believe we are looking at all options.

Thank you.

Mr. Abernethy? Moving on, Mr. Krutko.

Thank you, Mr. Chair. My question is in regard to the area of health services, especially in communities. I think the mess you have to face, the dilemma you are having, is to not have the access to your health centre because it’s under reduced core services because there’s not enough nurses. Because of that, you can only phone in for emergency cases or call the Inuvik emergency department. Or the other suggestion is that they call Telehealth, Tele-care, in regard to that service.

I think that when people see letters posted in communities saying these are the only services they will allow because they won’t schedule any appointments or clinics due to the shortage of nurses, it does have an effect on the well-being of the communities. Yet one of the priorities of the government is to provide services to people. When you don’t have those services, I think you really appreciate whatever little services you do have. When people talk about amalgamating clinics and walk-in clinics and all these care facilities people are taking for granted, they’ve got to realize that there are people out there, especially in our communities, who aren’t getting the fundamental services that most people take for granted.

As a government, we have to do a better job and use locums or whatever else. At the end of the day, there are some parts of the Territories where they have a very high turnover rate by way of trying for

recruitment, retention. I know Ms.

Lee said in

McPherson the community has a pretty stable workplace where the head nurse has been there for three years. They are considering at some point moving on. But also through our community health nurse program, where we are training our own local nurses and they’re going back to the communities, that’s the goal we should be meeting.

But again, half an hour down the road, at Tsiigehtchic, they haven’t had a permanent nurse there for a number of years. They have a nurse who goes there every other Thursday, and that’s the service they get. Yet we have a very large aging population, especially in that small community. A lot of people have to fend for themselves by either going and finding their way to Inuvik.... Something’s got to be done to improve that service in the outlying community considering that the level of service is what we get in some cases — there is no service.

I think as a government, again, we’re spending some $27 million on health care centres in communities. We have to realize that sure, we have some challenges, but the fundamental bottom line is everyone should have some basic level of health care. When you don’t have any health care services by way of the doctor.... If the doctors are short in Inuvik, you ain’t gonna get a doctor’s visit to your community; they just can’t leave Inuvik. That’s the problem I see in the Inuvik region. This issue hasn’t got any better since the vision; if anything, it’s gotten worse. Every year the Inuvik health board has been running a deficit, year after year after year, and yet we continue to see fewer and fewer services to our communities. I’d like to know where all this money is going if there are no services in communities? Who is spending those dollars that were earmarked for community health care providers — nurses, alcohol and drug, mental health nurses, doctors and whatnot?

The bottom line to me, in this day and age, is that we have a situation where people have to deal with it or file lawsuits against the government by way of health care, or lawsuits against the regional health authorities because of the service we’re getting. It seems like it’s coming to the point where we’re out of talking; we have to basically have something change for the better so that those residents, at least, have some means of health care.

I know you talk about dementia centres and more clinics and everything else coming to smaller communities. But for us, that’s dreaming in technicolour. They’re great for you, but for us, if you can’t get an appointment at the health centre because they’re short of nurses, you can’t get in unless you’re almost dying or half dead before you get there. Then they might take a look at you and medevac you out.

I’d like to know exactly what you are going to do differently from what you’ve been doing previously, which is a major cost? We’re running deficits with these health boards, but the services have been declining. I’d just like to know why it is that we’re spending more money in these authorities, and yet there are no services in our communities.

Minister Lee.

I’m not sure that there are no services in communities, but I guess when it comes to health care every citizen in Canada and the Territories always is hoping for more. I think the basic principle we work on is that our residents have access to services, but those services may not necessarily be located in those communities.

We do allocate a large amount of our money to make sure there are nursing services in communities. Even if you don’t have a nurse residing there, we do have nursing services in communities, and we will continue to do that. If the Member would like more information on exactly where all the funds are allocated within Beaufort-Delta Health Authority, I’d be happy to get that for the Member.

Well, I find that pretty alarming, if that’s the position of this government: that you basically have access to services but it means you have to get it from Inuvik or you have to get it from Yellowknife.

My view is: why is the federal government paying this government all this money to provide services to the residents of the Northwest Territories if you have a Cadillac model in the regional centres but you no health care services in communities, and you have to hitchhike to those centres so you can get services? That’s the wrong attitude to have, especially coming from the Minister. You have to have access to services but you have to go to Inuvik to get your services? I think we’re going backwards, if that’s the case.

I’d just like to ask the Minister exactly what has happened to this government in regard to community empowerment, community initiatives, giving the communities the resources to find their own nurses? Why couldn’t a community basically find its own locum services? Give them the money; let them run the services, because they couldn’t do any worse a job than what’s going on here today.

I’d just like to really take on the Minister’s comments about access to services. Meanwhile, there are no services in communities, but as long as you’ve got access to go to a regional centre, that’s the process of dealing with health care?