I’d like to call the Committee of the Whole back to order. We’re dealing with the Department of Health and Social Services. At this time I’d like to ask the Minister responsible for Health and Social Services if she’ll be bringing any witnesses. Ms. Lee.

Yes, Mr. Chairman.

Does the committee agree that the Minister bring in her witnesses?

Sergeant-at-Arms, escort the witnesses in. Minister Lee, could you introduce your witnesses for the record?

Thank you, Mr. Chairman. To my left is Deputy Minister of Health and Social Services Mr. Gregory Cummings, and to my right is director of finance Mr. Derek Elkin.

Thank you, Minister. Welcome, witnesses. General comments, Mr. Abernethy.

Thank you, Mr. Chair. I have a number of opening comments I’d like to make. Then I’ve got a lot of questions I’d like to ask, once we get into the line-by-line.

One of the first barriers I want to start off talking about is recruitment and retention. In the Premier’s opening statements, or Budget Address, he talks a little bit about expanding nurse practitioner training and expanding the Community Health Nurse Development Program. Yet I was under the impression when we reviewed the budget that there are actually reductions in those areas. I believe the Community Health Nurse Development Program is being reduced by four positions. I also believe that the Nurse Practitioner Education Leave Bursary has been eliminated completely. There are also, I believe, reductions to the number of individuals that we’re going to support through things like the Advanced Nurse Mentorship Program.

In the statement he does talk about $1.8 million going to investment in these areas. The Minister’s comments also talk about $1.8 million going into these areas, which I have trouble reconciling, given that there are cuts in these same areas. I believe programs like the Community Health Nurse Development Program are valuable programs that are going to help northern nurses transition from a hospital setting into a community health setting, where we as Northerners are experiencing a significant number of problems finding people and training people and getting them into there. I’m having trouble reconciling the message that we’re getting now as compared to some of the information that we had discussed previously. So when we get into that area, I’m going to have some

specific questions on how you can be reducing yet expanding and enhancing. They don’t seem to work for me.

Another area — and it was mentioned in the Social Programs report — is Telehealth. We hear a lot about changing the way we do business. We also hear a lot about finding ways to increase efficiencies and reduce costs. Our medical travel costs are really going through the roof, yet here we are, cutting one of the programs — or reducing our ability to enhance and deliver a program — that can clearly, if utilized appropriately, reduce some of our costs.

So I am disturbed that we are reducing one of the Telehealth coordinators in Stanton. I’m happy that we’re putting the one back in Inuvik, but I think that doesn’t solve the problem. The Telehealth positions provide an education and a clinical function to help with mental health consults, to help with physiotherapy consults. They help with discharge planning. If someone is being discharged from Stanton before going back to the community, Telehealth has a great opportunity to coordinate a conversation to help with the discharge planning. I really feel that in getting rid of the Telehealth coordinators, we’d be taking away one of our champions.

I hear things; people say things like, you know, we’ll be able to continue to deliver Telehealth; we’ll get the nurses to do it; we’ll get these other people to do it. It takes time and it needs a champion: someone who can get out there and actually provide the education. It’s not as simple as just doing the bookings or managing the equipment when we’re doing a consult. It takes education. It takes someone to get out there and provide training and education to all of those people out there to help them understand the importance and the value of such a program and such a tool.

If it’s being underutilized, I’m suggesting that it’s because we don’t have those champions in place. I’m under the impression that they just hired a consultant or a coordinator in Stanton, and three weeks after she arrived, she got her letter of affected status. It doesn’t make any sense. You can’t say it’s not working when you don’t have anybody in it. Get somebody in there and make them demonstrate how valuable this program and this service can be. I’m going to ask a lot of questions on Telehealth when we get to that section.

It’s been difficult to get a clear picture of the position cuts that the department is talking about. When you get in there, I’m going to be interested in getting from you, the Minister, a copy or a list of all the positions that have been identified for elimination, as well as which positions were filled and which positions were vacant, so we can get a

real sense of the impact on the departments and also the provision of health and social services.

Another area that I’d like to talk about it is that I understand each authority has been given an amount of money, and they’ve been told to live within their means. Given the amount being provided is not necessarily equivalent to the growth that has happened in the last number of years, I’m worried that telling them to live within their means, when you’ve given them meagre growth, is going to result in job cuts. I’ve had individuals from Stanton indicate that they’ve already received affected letter notices. We’ve received no information from the department and from the Minister outlining what the impacts of telling the authorities to live within their means are. I’m worried that it’s going to result in major cuts in the authorities and therefore result in a limitation or a degrading of the quality of services these authorities provide. These authorities are an incredibly important part of our health system, and laying off nurses — laying off any other health care provider — is detrimental to the provision of services.

I understand costs are ballooning in the health system rapidly, but it’s time to actually rethink how we do business. This is something the Premier said right in the beginning: a lot of this exercise we’re going through now is about redefining how we do business, changing direction, and finding better ways to do things and better use of our own money. There are lots of things and lots of opportunities that may exist that will help us spend our money wisely, but they seem to be completely ignored or not even considered.

I’ve had a lot of conversations with a lot of different individuals who have talked about Stanton as an example where our overtime rates resulting from things such as sick leave and annual leave and all of those types of things are ballooning. Every time someone is sick or on annual or away, they have to have somebody come in and do overtime to backfill for them. When they’re gone, because they’re taking lieu time or whatnot for the time that they’ve put in, two more people have had to cover for them. As a result, one sick leave or one lieu time or one annual day actually costs us way more than a simple one-person replacement.

I’ve had individuals talk to me about the fact that it may seem radical, but if we’re actually to increase the number of nurse positions at Stanton so that we build in a redundancy, we would be able to reduce the number of overtime hours being put in. If we reduce the number of overtime rates, we’re actually saving money in the long run. We can actually reduce our costs through redundancy, if we actually create some redundancy and eliminate our use of overtime. Yet when we talk to the department, we get very little response on that, or Stanton gets very little response on that. I think that is seriously

something that is worth consideration. I think that is something that is worth investigation, and I would encourage the department and Stanton to look into that very closely and see if, in fact, they can realize some savings in that way.

I know health care is difficult. I know that it has challenges due to international and national shortages of all levels of health care providers. This suggests to me to that it’s really time. If in no other area, this is definitely one area where we seriously, seriously have to reconsider how we do business. Sticking with the same old way of doing business is not working. The costs are ballooning out of control. We’re frustrating our health care professionals, who are our most valuable asset in the world of health care.

I’ve talked to individuals who have said they’ve applied for nursing jobs at Stanton, and they’re told, “Oh, we’re not looking for anybody, because we’re fully staffed.” Yet they’re still paying out huge quantities of overtime, and it’s costing them more and more and more. Then they stand back and say, “We’re broke. We need $11 million in a supp appropriation so that we can pay our payroll.” Yet they keep paying overtime: more overtime, more overtime, more overtime.

Once again it’s time to seriously look at how we do business. Consider some of these radical approaches, such as built-in redundancy. You will likely find some cost savings and not have to end up laying off staff at Stanton, shutting down the OR at Stanton and telling nurses in the OR, “Your job’s gone; you’re an affected employee” — things that I think we should all be concerned about.

I’m going to end there and let somebody else talk. I’ll have a lot of questions for you as we start going line by line. Thank you very much.

Thank you, Mr.

Abernethy. Next on my list I have

Mr.

Menicoche, Mr.

Hawkins and Ms.

Bisaro.

Mr. Menicoche.

Thank you very much, Mr. Chair. Health and Social Service issues are another one of the high-demand concerns in all the communities in my riding. I’ve got six small communities.

Maybe at this time I’d just like to say thanks to the Minister, as well. We conducted a tour of all the communities in early May of this year. The tour went really well. We went to all the communities. I just want to touch on many, many of the issues that we talked about when we visited the communities.

I’ll just begin with the one that I’ve been pursuing for some time now: the nursing position in Wrigley. The Minister was with me in the community of Wrigley and saw the need and urgency of having that professional service there. As well, with the

corresponding policing issues that the community has been requesting for some time, it’s still an urgent need. I say again to the Minister that I continue to advocate on behalf of Wrigley, that this nursing position is important and that we must seek to fill it. In fact, we should start to spend as much time as we can with the positions that we have in Fort Simpson, getting them into Wrigley on a more regular service.

I know that in the last couple of months we had one individual in Wrigley. She was there for about two weeks, and the community was very happy that there was some stability. They’re developing a good working relationship with that nurse. It goes a long way with making the community feel that they’re safe, that there’s good health care in the community, that there’s a good provider in the community. That’s all the people ask for, Mr. Chair. When we talk about improving the lives of our people, this is one simple aspect of it. That simple act of having a nurse present goes a long, long way in providing that necessity.

One of the things that we heard as we travelled around my riding was the need to use the telephone to contact the regional centre, which is in Fort Simpson. There are lots of Tele-Care health issues. People are aware of it, and they have been using it. But they need to get in contact with the Fort Simpson district office, because there are appointments that have to happen. There are specialists that travel to Fort Simpson, and sometimes they require people in the outlying communities to travel into Fort Simpson. The issue here is that people have to pay for their own phone charges to get hold of the health centre, and it’s often difficult in small communities. The phone is often strapped, and they’re using calling cards and they’re running out of minutes, et cetera. So it’s very difficult for them to call to the outside, even to Fort Simpson. One of the requests that came out of several communities to the Minister’s office is: is there a 1-800 number even for a district like Fort Simpson? How can we call the Fort Simpson office to talk about these needs of ours?

As well, I do have to commend, of course, Health and Social Services for the improvement in training for our CHRs in all the communities. Once again, I would advocate and support the continued training and improve the skill level. These people are home-grown people in our communities, and the improved service benefits our small communities and our people.

Another thing that was prevalent in the smaller communities is that the people are saying, “Well, you know, the doctors and nurses come here, but they’re only staying a couple of hours, and they’re missing some people.” When that happens, people with needs often have to wait an additional month. Sometimes, if they didn’t make the visit — if they

get weathered out — then often you’re talking like two months with no health professionals in the smaller communities. So more effort has to be shown to the communities that we want to go there, that if there’s a missed visit or circumstances beyond anybody’s control, like weather, then we’ll continue the following week to make that effort to get back in there. And when they are there, longer visits — even an overnight visit — is all they ask for. That will improve the service once again. Even that little overnight visit stimulates that small community — even like Jean Marie. You’re paying a room for one night, and it goes a long way in the small communities to stimulating the economy with that one little act, again.

Some of the other things that we heard, particularly in Fort Liard…. They are saying that there has to be more resources in Health and Social Services to ensure a healthy workforce. They’re running into addiction problems and alcohol problems in Liard. If there are more resources available, more mental health workers and more visits by them, we should be able to intercede and stop some of this…. Well, actually be there for the people when they want to heal themselves. Particularly Fort Liard is a resource-based economy, and the people are the backbone of that economy. Because they’re struggling with their addictions issues, we should be there for them and provide as many resources as we can.

Some of the ways are not always department-oriented. The bands and local groups do have their own ground-based proposals that they would like support on. It goes back to some of the fundamental issues that many, many MLAs speak about. Even with some of the existing supported programs, there are no increments for cost-of-living increases to existing staff, and that’s something that we have to continually be aware of. People are doing good work, but if they’re not paid accordingly or are trying to keep up to the increased cost-of-living pressures, we must help them meet those to keep those people there.

As well, in Fort Liard they spoke quite heartily about using B.C. facilities to help ease some of the costs of travel for them. Often they are travelling to Fort Simpson and then getting on a plane and coming to Yellowknife. Then the doctors here are telling them, “Yes, you’ve got a bad knee, and we’ll set up another appointment.” Then they have to go all the way back to Liard. That’s three days’ travel. They’re saying, “Look, Kevin, we go to Nelson every couple of days. Couldn’t we see the doctor there, get an assessment, get diagnosed? Then we’ve got no problem going to Yellowknife for the treatment.” But to come all the way here to get diagnosed, to them it seems fruitless, like “What’s the point?” Because that’s a long, long way to travel for them.

Often, too, Fort Liard is a largely aboriginal community, and a lot of them look to translation — people travelling with them for translation services — and sometimes they don’t get that.

Just with regard to translation services, Mr. Chair, I spoke quite a bit in the 15th Assembly about cross-

cultural training. I believe that Health and Social Services has to look at it again. One of the reasons is that people are telling me that they’re still going to the health centre — our elder population is going there — and they’re still not being adequately served because they’ve got broken English. I always say there’s a lot of head movement in our elders. They go “uh-huh” lots, like in the affirmative. But when the doctor or nurse is talking to them — “Are you okay?” — they’ll go, “Uh-huh,” and all this time they’re very sick with pneumonia.

There are some bad cases out there in not only my region, but people get misdiagnosed, and it’s only because they’re not understanding some of the cultural things. That’s just one of them that they must understand: that a lot of the elders do tend to say yes a lot. They really don’t understand what’s going on, and they keep saying yes, and the doctors or nurses are saying, “Well, this person is obviously fine. Here, go home.”

But I think that cross-cultural training has to be…. I don’t know what happened to it. It’s got to be reinstituted. It will be a benefit not only to our health care professionals but also the community.

One other issue I’m going to speak about now is midwifery in Nahendeh. There was a Member’s statement about it earlier today. It’s something my region has been asking about, as well, for some time now, and hopefully we’ll work towards it. I know that it’s a success in some other regions, and only because people get to stay home. That’s the key thing. Right now, for safety reasons, everybody’s got to go to Yellowknife. Someone who’s had a couple of children already is saying, “Well, what’s the point? Why am I going there?” Anyway, midwifery is an important concern that was raised in a couple of communities.

With that, Mr. Chair, I’ll just note the time and allow some other Members to speak, but I do have some more opening remarks to speak to. Thank you.

Thank you, Mr. Menicoche. I’d like to ask the Minister if she’d like to respond to those comments. Ms. Lee.

Thank you, Mr.

Chairman.

Perhaps I should start with some of the comments that the Member for Nahendeh raised. I want to also thank the Member for inviting me to his communities. It was a very busy trip, but it was a really great opportunity for me to visit some of the smaller communities as Minister.

Increasing nursing positions in communities obviously is something that everyone wants, and our communities want doctors in the communities too, but it is not something that we could afford in all places. I have committed to the Member for Nahendeh, and other places, that I will make my best effort to see how we could increase the access to services for small communities wherever we can, even if we can’t have permanent staff live there.

As we move forward and in order for us to face head-on the challenges of the health care costs, we do have to look at innovative ways of how we deliver our services, our staffing model. I think the recommendation by the Standing Committee on Social Programs…. We looked at reorganizing the board structures so that we could have a better, comprehensive implementation plan on all health care professionals. It’s something that gives us a really good basis to work on.

I really look forward to taking some time with my officials when the budget is over and coming up with something for the next business plan cycle where we, as a Legislature, could look at some more details about where we can just increase the physician services, nursing services, midwifery services. Under the limited resources we have — although Health and Social Services has a huge budget — we need to use every cent wisely. Increasing services would require some innovative and transformational changes, and I look forward to having more discussions on that.

With respect to the telephone trouble in Fort Simpson — maybe the deputy minister could give more information — I think that was a very particular issue with NorthwesTel. It wasn’t to do with a 1-800 number. So I’d be happy to follow up on that, or maybe the DM could add to that.

In a lot of communities we were at, cross-cultural training and such…. I think we’re lucky to have the CEO we have in Deh Cho, Kathy Tetso, who has been there for a very long time. She knows, I think, most of the residents and the staff that she has. I know that she has inside knowledge of the people, the communities, the issues, and she was constantly sharing them with me when I was travelling with her. So I’m sure that she makes that a priority with any of the new staff that come on board.

Another thing I had a chance to look at: in visiting communities where the interest and the enthusiasm on the part of the community members to do a lot of things themselves in the communities…. They wanted some information on chronic disease management. They want to know more about how to take care of diabetes situations, or they wanted to work on community wellness. They wanted to work on youth issues, senior issues. I talked to the CEO and the Chair. I asked them to come up with

some of the proposals that we could work on. That’s not grand and it’s not huge, but it’s something that could work on small communities. So I look forward to looking at more of that.

Moving on to Mr. Abernethy’s questions, I’m also going to ask the deputy minister to give you detailed information on the investment of $1.8

million under CHNDP program. We are

definitely committed to increasing and expanding the NP practice in the North. It does take a lot of work in a very multilateral kind of way. Not only do we need to train the NPs, but we need to make sure that they’re placed in the right places, and we also have commitment from all the authorities that they will do everything they can to accommodate the NPs that we train. So I’m going to ask him to do a little bit of detail on the difference between the $1.8 million investment versus some of the reductions we’re making.

On the issue of Telehealth that the Member…. I understand that he’s going to ask more detailed questions on that. I just need to say here that the Department of Health and Social Services…. We have about 130 people in headquarters and about 1,200 people in regions in eight authorities. Most of the position reductions came out of headquarters, and it is up to 12.5 per cent. I think the Members may not have noticed, but it reflects the priority I had as the Minister, and the department, when we were given…. We’re a part of this realignment exercise, and when we went to work on it, I wanted to make sure that if it’s at all possible, we do not affect employees in the front line. And this is the reason why almost all of the positions, except for two, came from headquarters. That’s not to say that we have a lot of fat in headquarters, but it is showing the commitment on the part of myself, as the Minister, to make sure that if at all possible we try to do it to be more effective and efficient and minimize the impact of the reduction exercise in the front line.

So perhaps Mr. Elkin or…. Let me go down the line. We could give you detailed information, without interfering with privacy issues, on the details of which positions are affected.

I just want to comment a little bit on the balanced budget issue. I think if you look at the opening comments, there was a statement that in the past we have had authorities go through their expenditures or come back for supplementary funding later on. This budget introduces a very different way of doing that. I think it’s a good way of doing that. We’re letting the authorities know, up front, what their budget limitations are, and we work from the beginning, starting when this budget is approved, so that we have better control and better ideas about how the expenditures are being made in each authority.

It is a different way of doing that, although officially the authorities have always been required to submit balanced budgets. It’s just that there was a little bit of a practice or a convention that if the cost of expenditure goes above their budget, they could always come back for supplementary funding as long as it’s justified. Whereas in this budget we’re increasing their budget in the base, but there is more understanding and expectation that we will work every day, every month to make sure that our expenditures are in line with our budget.

With respect to affected positions at Stanton that Mr. Abernethy mentioned, I have to tell you once again that there were no other positions affected under this budget reduction exercise other than the Telehealth positions in Stanton and Yellowknife and Inuvik. We have accepted the recommendation, part of the recommendation, of the Standing Committee on Social Programs, and reinstated the Inuvik Telehealth position. But we believe that we have to do our part.

Health and Social Services is the biggest part of the expenditure of the.... Not biggest, but one of the larger ones. If we keep increasing and we don’t do our part in keeping our costs down, that means other departments will have to do more reduction.

With respect to Telehealth positions, we believe firmly now that with the reinstatement of the Inuvik Telehealth position — we do have a headquarters position in Yellowknife — we can still continue to deliver the programs. There are lots of communities in the Territories without a Telehealth coordinator, but both services are still being prepared.

I just want to make an initial comment on that, and I’m sure that as we go forward line by line, we could have more detail back and forth.

The affected position at the OR Room: Mr. Abernethy mentioned earlier that there is a nurse being laid off in OR, and that is not entirely correct. I don’t want to talk specifically to one person, because I want to respect the privacy rights, but I want to just advise the Members that we have done everything we can and the department has done enormous work and put in a Herculean effort to do the realignment exercise and the budgeting exercise without impacting front-line workers in this realignment exercise.

As a balanced-budget issue, we are in the process of working that out. I don’t have all the details on that, but I’m applying similar principles: if at all possible we need to look at structural and transformational changes to the way we are delivering our health and social services so that we minimize the possibility of affecting front-line health and social services workers.

We have not finalized that budget plan yet. The Cabinet will be looking at options, and the Standing

Committee on Social Programs will, I’m sure. I’d be happy to share some of that information with the committee.

I’ll leave it at that. I’m sorry to take so long, but there was a lot to add there. I wonder if the deputy minister could just give a little bit of detail on some of the issues raised.

Maybejust for the case of proceeding, I think we’ll allow each Member to make general comments, and at the end of the general comments we can allow you as much time as you need to answer those general comments.

So with that, I have Mr.

Hawkins, Ms.

Bisaro,

Mr. Ramsey, Mr. Bromley for general comments. Mr. Hawkins.

Thank you, Mr. Chairman. I’m glad to see answers are free-flowing tonight. I thank the Department of Health for coming before us, and I’m going to keep my opening comments specific to the Minister’s comments.

That said, I’m pleased to see the infrastructure, not just here in Yellowknife but throughout the Territories. I know this investment will go a long way. I’m very happy that Yellowknife will be receiving a primary downtown clinic. I’ve heard from a number of people. Most recently, a couple of weekends ago, I was at Canadian Tire, and someone was telling me how difficult it is to get in to see a regular doctor nowadays. At the doctor’s they have to book weeks in advance just to get a spot, so they take either themselves or their kids to emergency, where they have to wait hours just to see a basic doctor over something simple. They certainly wish there was a more streamlined approach.

I’ve heard a number of concerns — I would describe it as no fault of the staff — in the context of the triage approach. It’s the approach that exists and works, but the fact is, it is slow for people with everyday concerns who just need a little help, as opposed to the emergency ones, which it’s designed for.

So I’m really pleased to see that the primary care clinic is being moved forward, finally. This is an initiative.... I couldn’t tell you exactly when it first came to light, but I’m sure it must be in the range of seven or eight years ago. Someone came up with this idea of consolidating all the clinics and putting a primary clinic downtown. That way, we could take some stress off Stanton. It’s phenomenal.

I’m always impressed when government moves at the speed of government. So much goes on by, long before anything gets done. This is a fantastic example of this. But the fact is, maybe it’s this project’s turn, and I’m kind of glad to see it’s on the books.

Mr. Chair, I’m quite curious as to where it will show up — the acquisition of what land or what spot or what facility will be turning into this. I certainly hope that the government, as I’ve said on a number of occasions, does not purchase a lease for life. I often find it quite concerning when there’s no end in sight for these things, or no option to buy after a certain number of cycles. This would be a horrible prospect to invest in unless the government was the end benefactor of owning a building or some type of capital investment.

Mr. Chair, another project I’m quite pleased about — and I know a number of members here are — is the territorial dementia facility. It’s a significant piece of infrastructure in this community, because it will finally deal properly, in an appropriate and respectful manner, with people who are suffering from dementia and Alzheimer’s. I know that YACCS, the Yellowknife Association of Concerned Citizens, has worked tirelessly with a number of members there to bring this project to life. They’ve struggled for many years. This is quite a credit to their lobbying and pushing, and the pursuit of a number of MLAs to keep this project on the books for many years or, I should say, at least on the radar of government for a number of years. Moving forward with it, with the launch a month or so ago, was certainly a significant movement. Without the partnership from groups like Diavik, I don’t think the project would be built. I’m very grateful for their contribution, because this infrastructure is, of course, needed, as many other pieces here are needed throughout the North. My only fear is, of course, that this is tied to the budget, and the project’s success or failure will be tied to the budget. I will have questions for the Minister, at this time, to find out whether, if this budget doesn’t proceed in this forum, they will be lost in this potential capital investment.

Mr. Chairman, I look forward to seeing the outcome of.... Again, speaking of the Minister’s opening remarks, I look forward to seeing the evolution of this $150,000 to collaborate with MACA on developing a framework for ground ambulance and highway rescue. I know when I was on city council with Mr. Ramsay and Ms. Bisaro, that was always an issue — that the Yellowknife fire department was responding to emergencies. There was always, of course, the fairness of compensation as well as a number of other issues. So it’s finally nice to see it again — fine work from government moving at the speed of government. The fact is, this is finally another initiative moving forward, and I’m glad to see it. I’m sure the city will be quite pleased, as well as other areas such as, probably, Hay River and maybe even larger centres that have their own ambulance service.

Mr. Chairman, although this moment’s probably not the time, I’m certainly curious as to the description of where these 17 positions are being reduced.

I would like the information on a line-by-line basis. If it can’t be read aloud, I’d certainly like it on a piece of paper for myself.

The issue, really, is the 17 positions in Yellowknife. The fear is…. We’ve heard from a number of sources, whether they’re in ORs maybe mentioned, or in other areas. I’ve heard a diabetic nurse has been let go; what happened, more accurately, was that someone left and they decided not to re-staff. That’s having an impact. That’s affecting constituents of mine who are having those types of problems. I just want to make sure we find out what and where spots have been chosen to be eliminated. Again, I say that it’s a public document. I’m sure I’m not the only one here who would like to see the detail of exactly where they — supposedly strategically — let someone go.

Just on that note, the fact is…. Fundamentally, I’m a little cautious on agreeing that strategic analysis has been done on a lot of these positions. I don’t reserve that comment strictly for the Department of Health; that’s probably for most departments. I

wonder what motivated them to choose one

person or one position over another. On that point alone, I wish, as a Regular Member, we had more input on that. I know there are a number of positions in sectors of government that, I feel, probably do little to nothing and could have gone first before some of the things that have been chosen.

On the federal wait-time money, I certainly hope the Minister will highlight a little further on what we will realize and see what’s happening out there. She highlights, here, $1.8 million for patient wait-time guarantees. Whether that’s here in Yellowknife at Stanton or at the Yellowknife Health Authority or throughout the communities or the territory, I’d certainly like to see where that is highlighted directly on the ground. The principle of that is, I want to make sure people are served up front and by the front-line workers. That’s really where they have the biggest impact.

On that note, I’ve heard from a number of constituents about their concern — and this goes back to the 17 positions. The fear is that the front line has often been attacked, whereas the management line has been cushioned, and the senior management has been covered with high honours to ensure they were protected. Oddly enough, they are the ones who have the highest salaries and whatnot.

These are just opening comments. I just want to leave it with one final area. It was mentioned earlier, and I’m sure it will be mentioned a few more times, about the locum nurses. I’d like to repeat some of the comments made by, I think, Mr. Abernethy. At a constituent meeting of mine

I heard from a number of nurses about the fact that overtime is at its max.

To that detail, I’m going to ask what the cost of that is and what the cost of it is in the sense of affecting our hospital and our bottom line. I wouldn’t be surprised if that was related to that $11 million problem that Stanton has. All these things are cumulative in how this place is being operated. The nurses were telling me a little more about when it gets to be late at night and their phone rings; they know who’s calling, because no one wants to work and there’s a shortage of staff.

Again, I’m highlighting comments already said, but I’ve heard them myself. I’ve had the pleasure of recently being in the emergency ward. I could see how busy they were, serving people and trying to do their best. I watched people come in and said, “Well, they got the phone call. They were really short and they had to be there.”

The fact is, it causes me to wonder…. The point was made earlier: if we hired a few more people and built in that redundancy factor, that probably could make a big difference and go a long way in balancing out the stress. The burnout factor is high. Sure, if you’re young, it’s always exciting to get a lot of extra overtime and whatnot; the older people like lieu time and whatnot. But you reach a point in your career where you just don’t want that stuff anymore. You want to do your job and go home at the end of the day, be with your family or whatever is important to you. This so-called stuff of overtime and lieu time, I think, burns out the experienced person. They really like to focus their energies and time elsewhere. That said, it really comes down to the principle of reasonable and fair and responsible management.

Mr. Chairman, I’m going to thank you for this time. I shall be listening eagerly to the other Members as they bring forward some observations and comments on the Minister’s opening statement.

Thank you, Mr. Hawkins. Next on the list I have Ms. Bisaro.

Thank you, Mr. Chairman. I have a number of comments. I will have questions when we come to the various sections within the document. These aren’t in any particular order, but just as we’ve gone through the document, a number of things have struck me.

I am pretty much amazed at the amount of money we spend on medical travel. I feel there has to be some method of reducing the amount of money we spend on medical travel. This is an area I think the department needs to seriously look at.

The other area — and these are sort of tied in, for me…. I’m disappointed that the Stanton Telehealth coordinator position was not reinstated. I accept the

explanation from the department, but I don’t agree with it. We can agree to disagree, I guess. I feel really strongly that if we can expand our Telehealth services within hospitals and health centres — basically, all over — it’s going to assist us in reducing some of our medical travel costs. I think there’s an awful lot of instances where a Telehealth visit could replace an actual airplane or drive or whatever to the larger centre to see a medical specialist.

I am concerned with some of the ways the funds have been saved — some of the reductions within the budget. I think there are about six or seven reductions to professional development for, mostly, nurses. The doctors seem to have managed to retain theirs. I’m somewhat concerned that if we don’t provide incentives for professional development and we don’t provide options for nurses to take advantage of training and re-profile themselves and so on, then that’s going to have an effect on keeping our employees long term.

It was mentioned in the standing committee’s report about multi-year funding for non-government organizations. I don’t remember if the Minister mentioned it or if it’s elsewhere, but I understand there is some move toward providing multi-year funding for NGOs. I think that’s a great thing. I want to make sure the department does go forward with that.

I am more concerned about the fact that I don’t see any evidence in this budget of increases to account for forced growth for NGOs. Once we get there, maybe I’ll get an explanation for it. But to me, that’s a huge concern. It’s one thing to give an NGO a three-year contract. If there’s no avenue for them to get extra funds for forced growth, then it really doesn’t do them any good to have a multi-year funding agreement.

Affected positions. And, unlike some other Members, I do have a copy of the 17 positions; we did get it. I don’t know if it’s the same one that you guys are going to give us, but the committee did receive it from the department. I do have a question, though. The data that we have indicates 15 positions. Yet when we got the extra information from the department, it’s got 17 positions and two of them say “TBD.” So when we get there, I’m certainly going to want a little explanation as to why we have two positions identified and we don’t know what they are. Or you can tell me that it’s 15 and not 17.

Another issue that comes to mind for me — and perhaps the information is there and I can’t find it — is that there doesn’t seem to be any sort of reference or indication that there’s money provided for addictions treatment and services. Again, it might be there, but I don’t see it itemized. I feel very strongly that we do need to provide those services

to our residents. We’ve had this conversation before. In Yellowknife I think we need a centre to provide that sort of service. Perhaps the consolidated clinic will do that for us. I don’t think the hospital is the right setting for addictions treatment.

Funding for Indian and Inuit health services is a huge problem, as the Minister’s well aware. I just have to say out loud that this agreement needs to be renegotiated, and it should have been done two years ago, I think. So whatever needs to be done to get that done, do it.

It was mentioned earlier that the money has been earmarked for highway emergency services and that this is a shared project with MACA. That’s great. There is a need for that particular service and for it to be provided, and the communities shouldn’t have to fund that on their own. I’m curious to know how the departments will work together and to know how much money MACA has budgeted. I see $150,000 here, but I don’t know how much money there is in total.

As to the Stanton issue and staffing at Stanton and so on, I recognize that the Minister really can’t answer those questions because it’s not within the purview of the department. However, the Minister is responsible for the authorities from a monitoring point, and I’m concerned that Stanton needs to develop a master plan. I know she’s working on it. It’s mentioned in the standing committee’s report as well — that the committee’s not going to support throwing money at Stanton unless there’s evidence of a master plan, and a good master plan. I encourage the department to make sure that gets done sooner rather than later.

I have to mention the locum nurses problem and the overtime problem at Stanton and so on. Again, it’s not really something the Minister can speak to, so I’ll just leave it at that.

Lastly, I haven’t noticed in the document where health authorities have received any kind of an increase in funding for their own forced growth. It could be there, but I’m going ask some questions when we get there to try to understand that the authorities have been given an increase, certainly for this year. They’ve been told to live within their means, but we have to make sure they at least have a reasonable figure to live within.

The only other thing I have is the nurse practitioner positions within Yellowknife. There were two positions that were going to be lost. I thank the Minister for the work she did and the department did in providing a six-month solution. That’s great. Those two individuals are particularly happy. However, we need to have a longer-term solution than just one that’s going to last six months. I anticipate hearing something, I would hope, prior

to this six-month period being up, that we’ve got a longer term solution for the nurse practitioner positions within our health services.

That’s all I have, Mr. Chair.

Thank you, Ms. Bisaro. Next on the list I have Mr. Ramsay.

Thank you, Mr. Chairman. I’d like to thank the Minister and her staff for being here with us at this late hour in the day. I appreciate their time.

I wanted to start off by thanking the Minister for her hard work on the dementia facility here in Yellowknife. As well, some thanks have to go out to the former Minister of Health and Social Services, Mr. Roland, and Mr. Miltenberger, who played a role in getting the project where it is today.

Applause.

It’s high time the Northwest Territories had a service here in the NWT that will cater to those elders with Alzheimer’s and dementia. I think it’s long overdue. Again, thanks.

I also wanted to thank — I know Ms.

Bisaro

mentioned it — the Minister as well for listening when it came to the nurse practitioner positions here in Yellowknife. I know it’s a short-term fix, but thank you for your flexibility and your ability to listen to our concerns. We appreciate that.

I thank the Minister. She is in a very unenviable position, being the Minister of Health and Social Services. Our jurisdiction, obviously, is not alone with the rising costs of health care. In fact, we probably see it a little bit more than other jurisdictions, given our geographic location in northern Canada. We always have to, as Mr.

Abernethy said, find new ways of doing

business and make sure that every dollar we’re spending is spent effectively. That’s why I sometimes come across as maybe giving the Minister a bit of a hard time on the accountability side of things and what’s happening at Stanton. I don’t want to see us wasting or losing out on opportunities to spend money more effectively and more wisely. That’s the reason I raise so many concerns about Stanton and its operation. I don’t want to see any more ward closures there. I don’t want to see any more positions lost at that hospital.

The Telehealth coordinator: arguably, that position is going to save us money, so why the department would look at cutting there…. I’m not quite sure, again, that I understand the rationale for cutting a position that, like I said, arguably is going to save us money. There was talk earlier, too, of the nurse in the OR. There are rumblings that there might be more layoffs or affected employees at Stanton. Again, I don’t know if we need to be looking at that.

I mentioned earlier in this session that nurses out at that hospital are working alongside the locum nurses, and I think there still is too much of a reliance on locum nurses. I think HR should be involved, too, in trying to open up positions. I think we should be increasing the indeterminate float pool at that hospital so that we do have the ability to hire more nurses that are living here.

We let our nurses go, and then we hire them back and we fly them back. To me, that’s taking a step backward. We want to ensure that our nurses are living here and they’re happy. I don’t know if that’s necessarily the case out at Stanton today.

Ms. Bisaro also talked about the Stanton master plan, and I’m not sure how we would, or why we would, embark on spending millions and millions of capital dollars at that facility without a master plan. To me, it’s ludicrous. We shouldn’t even be thinking about that. That master plan should be the blueprint by which we go forward and we get a plan for how the hospital is going to be run.

I’ve had lots of issues with how it’s been turned into an office building, and we’re putting too much administration in there. That’s very expensive office space. I think, when we’re looking at the master plan, we have to ensure that it is exactly what it was designed to be, and that’s a hospital, not a glorified office building.

I disagree with Ms. Bisaro a little bit on some of her comments, because I believe we have to use the Minister: she’s our conduit to Stanton. I mean, we’ve got no other avenue. We have to go through the Minister. She’s accountable to us. The questions are going to come, and somebody has to answer the bell when it comes to money and accountability issues at that hospital.

We’ve had many discussions about the management there. I won’t waste any more time here, talking about the management there, but I do think there needs to be changes.

Again, I know the Minister, and again, she was on this side of the House not too long ago, raising the same issues, talking about the same things. I’m glad to see that she’s in her position, and I have a lot of faith in your ability, Ms. Minister, to deliver on running a first-rate health care system here in the Northwest Territories.

I’m glad to see Mr. Cummings is there as well. I

know he’s got a tremendous amount of

background experience in the area too, so I’m happy to see him there.

You know, for the first time in a long time, I think there is a light at the end of the tunnel, and I think we can get there if we work together and share information and come up with a way to do business better.

That’s about it, Mr. Chairman, for me. Again, I’ve got a number of questions as we go through the detail, as well, but I wanted to thank the Minister and her staff again for being with us tonight. Thank you.

Thank you, Mr. Ramsay. Next on the list I have Mr. Beaulieu. Oh, sorry. Mr.

Bromley, Mr.

Beaulieu, and Mr.

Jacobson.

Mr. Bromley.

Thank you, Mr. Chair. I’m going to try not to repeat too many of the things we’ve heard already. I have many of the same issues, and there’s general agreement there.

I also want to thank the Minister and her staff for being here in support of Health and Social Services and their authorities.

I think, first of all — and here I am, repeating already — I

have to stress support for non-

government organizations. You know, the people across the Northwest Territories that are self-motivated and generous with their time and skills all represent opportunities as well as amazing assets that we have in the North. I think working with them and supporting them is a respectful and also a very wise way to go.

I was encouraged to hear about the interest in the multi-year funding, and maybe there’s been a little start on that already.

I wanted to mention in this area that I’ve talked about YACCS already today: the Yellowknife Association of Concerned Citizens for Seniors. There’s the Centre for Northern Families and the YWCA. There’s also a number of organizations involved in working with the homeless, and many others.

Particularly with wages and what that can mean to retaining qualified staff in these organizations that are obviously competing with government and industry in the roaring economy that we have today…. The predictability that multi-year funding brings can help somewhat with that, but obviously, the wages issue needs to be addressed directly and looked at from year to year.

Finally, of course, the cost of living, and I think Ms. Bisaro mentioned that specifically. Obviously, facility maintenance, utilities, fuel, food and so on are rising steeply.

I wanted to mention emergency room services as an area that I hear about. These are obviously the very front-line services where our facilities exist. And particularly, I understand, we’re down on our admitting clerks, even to the point where nurses and — rarely, I suppose — doctors are having to be taken away from care services to do the

administration of admission and so on, particularly in the evenings.

Somewhat associated with that is the whole idea of security issues in our hospitals. This has been raised very strongly: issues of both theft and safety, and safety of both young and elderly patients as well as the medical staff themselves. There have been a number of horror stories that have come out, and the potential for very serious consequences is high. We are trying to get by with fewer security staff and less-trained staff for those that remain.

The need for more effective plans and their implementation for a number of areas that probably have been mentioned: making good use of nurse practitioners; long-term vacant positions for nurses in small communities, and these vacancies have downstream impacts on other people and facilities; and of course, the locums that have been mentioned. I

think there’s been some tune-ups

there, and we’re already enjoying some significant savings, but again, there’s probably more room for progress there.

Something that’s been highlighted in my riding is translation services and how extremely important that can be, especially with our elders when they need health services, and especially on an emergency basis. I’m not knowledgeable about what services are provided. I’m highlighting the importance of it and, if they are vacant, making sure they’re filled as quickly as possible.

The Health and Social Services authorities have been brought up as opportunities for efficiencies; working with them to stay within budgets. Some clear tune-ups are needed there, and I’m looking forward to working with the Minister and her staff on these as we get into a lot of things that we’ve already had mentioned.

On the positive side I also wanted to mention the territorial dementia facility. It deserves a repeat.

I’ll mention respite services. Our amazing volunteers and family members who are extending their services, sometimes at considerable cost, deserve our respect and our recognition, and I really appreciate the increase of respite services. I hope that extends to aftercare in the communities for addictions clients that are returning to communities.

I’m going to leave it there, at that spot. Thank you very much, Mr. Chair.

Thank you, Mr. Bromley. Mr. Beaulieu.

Thank you, Mr. Chair. I have very few comments. From the perspective of my communities of Tu Nedhe, Fort Resolution and

Lutselk’e, I think one of the key issues is for the department to work on prevention.

There are many ways to prevent some of the chronic diseases that are in the small communities, even starting with diabetes, where there needs to be something done. There’s a high rate of diabetes. I’m not sure of the rate. I just know a lot of people that have diabetes, at least in my hometown of Fort Resolution. I

think the department should be

working on the prevention of the various diseases, starting with diabetes. I think preventing that would be, of course, a lot more economical than treating diabetes, so I think that a lot more effort should be put into prevention.

I think that community wellness is an area that is very important. I

think that A&D workers in

communities need to have proper quarters for counselling individuals. I know that in my communities, the alcohol and drug workers are part of other office workers, and they’re all in there together. Sometimes when individuals go for counselling, whether it be for drug or alcohol or one of their addictions, then they’re walking through a bunch of other people who are standing around or working at the office and visiting around there, because it’s become quite a centre for individuals to drop by and visit with people there, or do some business with them or whatnot in the office building.

So I think that community wellness should be a priority. Again, working in the area of prevention in both of these areas — drugs and alcohol —prevention is also something that would go a long ways. It’s a lot more economical to prevent people from getting into addiction problems, as opposed to treating the addiction problems.

I spoke earlier, in my Member’s statement and previously, on counselling and so on. I believe that the department’s headed in the right direction with the social workers that are being brought into our communities. But there’s always a natural turnover when you have employees that are not specifically from the community, so I feel that the department has to do something to maybe change the standards that are required in order to become a social worker.

And very importantly — for something that’s operated out of headquarters here in Yellowknife but it affects all of the communities — is policy development. I’m not sure if policy has to be written a certain way because some of the various acts that the department works under have to be applied a certain way. I’m not 100 per cent sure on the detail; I’m not sure of the detail at all, actually. However, I do see the results, and the results are that the policies don’t fit the smaller communities that well. Individual social workers are doing their jobs, and they’re doing a good job of carrying out their mandate according to the policies and

procedures laid out by the department. It conflicts with the way people view things.

Just one area that I’ve looked at a little bit recently has been the whole issue of child-care work and child apprehension and so on, although I guess it’s not a really major issue in these two communities. However, some of the other people from those communities that are located, for example, in here or Hay River and so on are also people that are my constituents that have had their children apprehended.

From the outside just looking in, from a layman’s perspective, it would seem like such a natural thing to be able to keep the kids with other family members in that family or that circle that would be more than capable of taking care of the kids, but the reality is it continues in one direction. It’s a very hard thing to change, and once it gets rolling, I think that…. Once it happens, it’s very difficult to reverse. Once these policies are applied, it’s very difficult to reverse. They’re almost irreversible until you get way up the ladder — maybe to the ministerial level or maybe the deputy minister level before things can be reversed.

It’s got to be a situation where individual social workers coming into a community have to have a good understanding of what they’re dealing with. I think that’s part of the issue: sometimes people don’t take responsibility for their past actions, but not taking responsibility shouldn’t be punished by losing your kids for the rest of your life. There’s got to be a balance somewhere, and I’m hoping that the department’s able to do some work in the policy development area that could be more sensitive to what happens in the smaller aboriginal communities.

Another area I’d like to just touch on is home care in the small communities. These are small programs compared to some of the huge programs and huge projects that are all over the North. In small communities there’s very little there, but what is there should be supported by the department.

In both communities, I’ve heard, there are concerns with the home care workers, whether there is too much work, not enough support, or other things that could be a problem.

I know that in Lutselk’e the issue is very clear: they just need more home care workers for the community, considering all the elders’ households that do exist.

Along with other departments home care is another good program that prevents elders from having to be forced into a care type of facility. I

think

everybody knows that an elder living at home, getting a little bit of home care, making sure that the unit’s in pretty decent shape, is going to cost the government a lot less than if that individual were to

be relocated to a care facility of some sort, whether it be a level 1, 2 or 3. I don’t really know the difference; I just know the words. I know that there are different levels of care: that one requires up to a nurse, and the others probably require a lot less. I think some of those home care workers could help elders remain in the community.

Once an elder does go beyond the ability to take care of themselves 24/7, and with a little bit of support from local home care workers and so on, then the elders should also remain in the communities for their last days too. I don’t think that’s something that the department has taken a really close look at. I know it’s really difficult to do, and it may be costly, but it’s also very important. It’s very important to the people of the community; it’s very important to the elders; it’s very important to the families. So sometimes, when you have things that are paramount to the people in the small communities, the importance of them having their elders remain in the community for their last days is something that I think the government should pay for, if need be. Thank you.

Thank you, Mr. Beaulieu. Mr. Jacobson.

Thank you, Mr. Chair. It’s good timing today, because I was speaking on this today in regard to doctor shortages in my riding of Nunakput in the Beaufort-Delta.

To serve my people of Nunakput, doctor shortages need to really be looked at with the Minister and her staff, to try to utilize the doctors out of Yellowknife to come up north for short stints, and to assist the nursing staff in the smaller communities — the locum nurses who come into the community who don’t really know the community people. They’re only there for two or three weeks at a time, and there’s high turnover.

I can see where the turnover is coming from. In my riding the nursing station in our units has four apartments above the health centre. I went on a tour a couple of times. The furniture, kitchen utensils, no TV, blankets and stuff — I could see why they want to leave.

The biggest concern for me in health is my elders in my communities not seeing doctors for as long as six months. Today I got a call from Ulukhaktok, and still no doctor.

Our elders won’t complain about pain or the way they’re feeling until a family member tells them they have to come to the health centre. The next thing you know, the elder is being medevaced out of the community and brought into a larger centre. This has to be looked at. It’s a real serious situation I have in my riding with the doctor shortages.

My colleague Mr. Beaulieu brought up a lot of my concerns with Health and Social Services. He touched on that for me.

The last one I’d really like to speak on…. I’d like to thank Dr. De Clerc and his staff up in Inuvik in the Beaufort-Delta for providing the service for the Beaufort-Delta area, and also the staff at Stanton Hospital. I used the emergency last week, and they’re really good at what they do. So I commend them and all the hard work they’re doing for both Stanton Territorial Hospital and the Inuvik Regional, and all the good work they’re doing with all their staff.

Again, the Minister knows the issues I have with the doctor shortages and the problems I have in my riding.