As I

stated earlier, the

authorities are expected to submit a balanced budget every year. They are to submit a deficit recovery plan the following year if they are experiencing a deficit.

Wouldn’t the simple answer be the expectation of that strategy is to work themselves out of a deficit?

I think we’re saying the same thing.

Okay. Then we’re saying the same thing. That’s fine. What do you do when they don’t work themselves out of that expected deficit plan?

We have on occasion given extra cash, or we have had lots of authorities who have submitted a deficit recovery plan to the Minister. The Minister approves them, and they work their way out of the deficit and they sometimes incur surplus.

Mr.

Chairman, wouldn’t that be

perceived as rewarding bad management? If an authority has a deficit, can’t seem to get their way out of it by second year and is required to therefore come up with a plan — and we now clearly have, for the record, the expectation is to get out of the debt.... Therefore, if they’re not achieving that and the department comes in and pays off the debt, wouldn’t that be seen as rewarding bad management?

Only if you assume that deficit is caused by bad management, which I don’t think is the case. I don’t know of any situations. If the authorities could…. They have explanations as to why the deficit is caused, and then they have a plan as to what they can do. We have professional managers operating these hospitals, health centres and authorities. If a deputy minister of any department projects that there would be a deficit, they have a means of balancing that book, whether you’re keeping the vacancies open, not following up on a contract or buying something new, or whatever.

I said earlier a hospital the size of Stanton — where they have 53 programs and almost a $90-million-

plus budget — does have some flexibility on how to manage those deficits. We do understand, with Stanton, that there has been a significant accumulated deficit that they will not be able to recover in that way.

Thank you very much, Ms. Lee. We’ve all been working very hard here. I

think a little sustenance might benefit the

discussion, so I’m going to call a short break so we can service that need.

The Committee of the Whole took a short

recess.

Thank you,

committee. We’ll be reconvening. We’re on page 6-25, Activity Summary, Health and Services Programs, Operations Expenditure Summary: $175.476 million. Are there any questions? Mr. Krutko.

Thank you, Mr. Chair. In regard to access to services, I’d like to ask the Minister: do you have a number — I might as well use my constituency, the Mackenzie Delta communities: Aklavik, Tsiigehtchic and Fort McPherson — for those who have had to access services from outside the community or had to go to Inuvik for those services? Do you have those numbers?

Thank you,

Mr. Krutko. Minister Lee.

Thank you, Mr. Chairman. I don’t believe I have that information handy. Beaufort-Delta is responsible for providing services to all eight communities. I’m not even sure if they would keep track of where all the clients are coming from within their region, but I can undertake to look into that.

In regard to the number of days the health centre is open or being closed because you’re short of nurses and whatnot, do you track that information?

I don’t have that handy, but I will undertake to get that.

I think we should make every attempt to find the reasons these health centres are closed, why people can’t access services at their local health clinics or health centres and have to make their own way to Inuvik to see a doctor or get medical attention on their own. I think if that’s the trend we’re seeing, we should have a system in place and make it clear that people will establish clinics in Inuvik so the outlying communities can come in, go to those clinics and receive the service and attention they should.

Since the Minister made a reference that access to service isn’t guaranteed in every community as long

as you make the attempt to provide that service, I’m trying to build on that comment. I’d like to ask the Minister if we can statistically show that more people are going to the regional centres for those services because those services aren’t being provided in their communities.

I should correct that. If the Member thinks I might have said that access to communities is not guaranteed, that’s not what I said. What I meant to say, and I believe what I said, is we have an obligation to provide access to services to everyone in the Territories. That’s our legislative requirement. So services are available in communities; it’s just that the health care professionals may not be in a community. Also, I do accept the Member’s statement that Beaufort-Delta has had significant shortages of doctors and nurses of late, and we’ve been getting notices about limitations to services in some of these clinics. But there’s always information about how to access services. No health centre has been closed.

Just going back to the issue in regard to the deficit recovery plans that are in place from time to time for health authorities that are running a deficit or having problems with their finances, I'd like to know in regard to the Inuvik health authority — where they have been running deficits year after year after year — in regard to their deficit recovery act.... As part of these positions not being filled in communities, is that a cost driver from the deficit, or is that a cost savings to the department? You don't have positions in communities — they're vacant — so those dollars go back to offset the deficit at the headquarters or regional level? Is that driving toward the deficit, or is it assisting to bring down the cost of this deficit because you’re not filling those positions?

Not being able to fill the nurses or doctors in these authorities contributes. They’re drivers that cause a deficit, because locum doctors or locum nurses are always more expensive than having resident doctors or any other health care professionals.

Just on that, I think that’s why it’s so important we do everything we can to find ways to recruit but also try to have a stable workforce in those communities, especially health nurses. Again, in Tsiigehtchic, yes; they have a health centre, but the only person working out of there is the community individual, who basically works out of there. But there is no profession, per se, by way of mental health or nurses or doctors who operate out of that centre, where they come in maybe once a week or once a month.

I’m just wondering: what are you doing to ensure those services are being provided, that people’s health and their well-being is not being jeopardized by the financial situation in Inuvik Hospital?

I was in the community of Tsiigehtchic in January, and the Member and I had a meeting with the community leadership there. I know that the community would like to see increased nursing services there. I have made a commitment to the Member to look into that. And as I had indicated earlier, I am looking to see how we could better use the health care resources we have and find ways to increase those services.

Just a question in regard to the deficit recovery plan that was put in place by the Inuvik authority. Have they been able to live up to that plan by way of their plans submitted to yourself as Minister, as I heard you mention earlier? I’d just like to know, if they are, why are they running deficits year after year after year?

As I said earlier, not being able to fill their doctors’ positions or having had a hard time finding nurses to staff all the vacant positions we have — those do cost money. Those are major drivers of health care and social service expenditures. We have not had, I don’t think, a deficit recovery plan at the authority, because they are taxed in their resources to provide the services they do. We don’t want to have to face the situation of reducing services.

Can the Minister get a breakdown exactly in those areas where there’s forced-growth issues or in regard to these high costs to operate because of shortages of nurses, locums? Can you get a breakdown of exactly why they are running these deficits and what areas these deficits are coming from?

I could undertake to get that information for the Member.