Thank you, Mr. Chairman. To the motion. I’m obviously going to support the motion. I think, for me, it’s about being consistent, and it’s about the issues surrounding the process that the budget has followed to date. We’re simply just setting it aside — that’s all we’re doing — and we’re going to be consistent until we get some positive responses from the government.

Thank you, Mr.

Ramsay. Again to the motion.

Mrs. Groenewegen.

Thank you, Mr. Chairman. I

appreciate the Premier’s comments. Granted,

there is no outstanding information per se, but there are some outstanding motions. If this is the wish of the majority of the House, so be it. I’d request a recorded vote, please.

Thank you, Mrs.

Groenewegen. The Chair recognizes a

request for a recorded vote. Anything further to the motion?

Question has been called. All those in favour, please stand.

All those opposed, please stand. All those abstaining, please stand.

Thank you. The results of the recorded vote on the motion: ten in favour, zero opposed, seven abstained. The motion is carried.

Motion carried.

That concludes our current review of the Northwest Territories Housing Corporation. I’d like to thank the Minister and witnesses, and you are excused at this time.

And as per our original decisions, we will continue on now with the Department of Health and Social Services.

Does the Minister have some general comments?

Yes, Mr. Chairman. I’m pleased to present the Department of Health and Social Services Main Estimates for fiscal year 2008–2009. The department’s mission is to promote, protect and provide for the health and well-being of the people of the Northwest Territories. To achieve the mission, the department has the following goals:

•

to promote healthy choices and responsible

self-care;

•

to protect public health and prevent illness and disease;

•

to protect children and vulnerable individuals from abuse, neglect and distress; and

•

to provide integrated, responsive and effective health services and social programs for those who need them.

The department is requesting an appropriation of $309

million, an increase of approximately

$33 million over last year, which is an 11.7 per cent increase.

The proposed budget is allocated to five main areas of activity:

•

$175 million for health services programs that include public health, chronic care clinics, in-

patient and out-patient care, and physician services;

•

$75 million for community health and social

programs that promote healthy lifestyles and community wellness and services for at-risk individuals and families;

•

$31

million for program delivery support,

including $12.5

million for authority

administration and $7.2

million for specific

recruitment and retention and training initiatives system-wide;

•

$21 million for supplementary health programs, including medical travel and extended health benefits; and

•

$6.7 million for system-wide support.

The department is proposing critical capital and information technology investment of $34 million, including:

•

a consolidated primary care clinic in

Yellowknife;

•

the addition of seven beds to the Northern

Lights Special Care Home in Fort Smith;

•

the completion of the new adult supported-

living facility in Hay River;

•

a new territorial dementia facility in Yellowknife;

•

a major renovation to the Fort Smith Health Centre;

•

minor code upgrades to existing infrastructure, including the Territorial Treatment Centre, Woodland Manor Long-Term Care Facility in Hay River;

•

evergreening of major medical equipment; and

•

investments in electronic health records

management and imaging archive technology to improve health service delivery, in partnership with Canada Health Infoway.

Mr. Chairman, the 2008–2009 budget for Health and Social Services continues to follow the direction outlined in the department’s strategic action plan. We’re proposing to focus our resources to continue to improve services to people, support to staff and trustees, system-wide management accountability, and development of the integrated service delivery model.

This budget proposes an increase in spending for Health and Social Services to reflect the cost of delivering these critical and valued services to residents of the NWT.

The $33 million increase is comprised of:

1) strategic

investments

;

2) forced growth for services provided within the

NWT;

3) new federal funding for specific health and

social services initiatives; and

4) increased cost of services provided to NWT

residents in the south.

Strategic Investments

As a first step in re-evaluating how we deliver health and social services, a number of initial investments are being proposed, including:

•

$571,000 for the new supported-living facility in Hay River; the total cost of the facility operation will be offset by repatriating eight clients currently in the south;

•

$224,000 for respite services for families with special needs, to establish three regional programs outside of Yellowknife;

•

$800,000 to collaborate with Education,

Culture and Employment to support existing shelters and enhance community services;

•

$150,000 to collaborate with Municipal and

Community Affairs to develop legislation and a framework for ground ambulance and highway rescue services;

•

$100,000 to collaborate with MACA on the

Healthy Choices Framework to promote healthy living; and

•

$1 million for the standardization of foster care rates.

Reductions

To be able to reinvest in transformational changes of the Health and Social Services system, the department examined the programs and services it is currently delivering to determine how to change the way services are currently provided and to identify efficiencies that could be realized.

For 2008 and 2009 these include:

•

reducing Tele-Care promotion costs, now that it has been implemented;

•

changes to delivery of Telehealth services,

while pursuing partnerships with Canada Health Infoway for enhanced services in the future; and

•

reduction of Health and Social Services

recruitment and retention initiatives to match current spending levels.

Earlier this year the department underwent a functional realignment to better support the Health and Social Services system as a whole. In support of this process, a number of positions are being proposed to be eliminated, to reflect the refocused role and function of the department. As part of the government-wide realignment initiative, the department has identified 17

positions in

Yellowknife to be eliminated. This represents a 12.7

per

cent reduction to the current

133

department positions: 118 located in

Yellowknife, and 15 located in Inuvik. This will result in ongoing savings of $1.6 million starting in 2009–2010. Due to the timing of the reductions, this will result in savings of approximately $400,000 in 2008–2009.

Forced Growth

As a front-line service delivery department, a majority of the Health and Social Services budget is for personnel costs. As a result, much of the annual forced growth is for compensation-related costs. The forced growth for the delivery of services within the NWT includes:

•

$7.8 million for increases in fixed costs related to compensation, including collective agreement increases, position re-evaluations, pension liability and relief staffing in hospitals;

•

$1 million for supplementary health benefits for forecasted cost increases in 2008–2009;

•

$4.7 million to support costs related to the

delivery of front-line services at the community level, such as fuel costs; non-governmental organizations; electronic health records and electronic medical records systems’ operating costs; physician services; purchased services contracts to provide support services in our hospitals and at the community level, such as dietary, laundry, leases, laboratory services, et cetera.

Federal Funding

The budget also includes drawdowns of short-term federal funding for specific initiatives:

•

$1.8 million for Patient Wait Times Guarantee, to support community health nurse training, nurse practitioners, and EHR/EMR legislation development;

•

$3.1 million for year three of five of the

Territorial Health Access Fund, for long-term reform to invest in front-line services such as nursing resources in small communities, midwifery, dialysis, physician support and training, and home and community care.

Mr. Chairman, the Department of Health and Social Services has historically been the recipient of time-

limited targeted third-party funding, primarily from the federal government. These often result in public expectations for ongoing programs once the funding sunsets. The department is acutely aware of the implications associated with this type of funding. Examples include:

•

The Territorial Health Access Fund (THAF) for long-term reform is scheduled to sunset on March

31, 2010, resulting in an annual

reduction of $4.3 million.

•

The Patient Wait Times Reduction Guarantee Trust, totalling $4.6 million over three years, also sunsets on March 31, 2010.

The department, in collaboration with the governments of Nunavut and Yukon, is developing an evaluation framework for THAF, along with the federal government, to attempt to extend this funding beyond 2010. However, as with other funds there is no guarantee that additional funding will be provided, so the GNWT must incorporate the sunsetting of these funds into its planning framework.

Southern Referrals

NWT residents are referred to southern Canada, primarily Alberta, for a number of acute and specialty services not available in the NWT. These costs are driven both by the volume of NWT residents requiring referrals, and the price of services in the south.

Due to the variable and unpredictable nature of these demand-driven costs, the department has historically been required to return for supplementary funding near the end of the year, once the full costs are known.

In the past two years the supplementary funding received for these services has been $7.7 million and $5.6 million.

For 2008 and 2009 the proposed budget has included this funding up front in the Main Estimates to minimize the need to return later in the year for a supplementary funding request, including:

•

$5.1 million forced growth for out-of-Territories hospital and physician services and southern residential care.

•

An additional $4.7 million for out-of-Territories hospitals, reflecting a dramatic increase in national in-patient and outpatient rates. Effective April 1, 2008, the interprovincial per diem rate across Canada increased approximately 30 per cent.

•

$2.1 million for increased costs related to air medevac services to transport NWT residents

as a result of the current market conditions and increased fuel costs.

That concludes my opening remarks, Mr. Chairman. I would be pleased to answer any questions Members have. Thank you.

Thank you, Minister Lee. I will now ask the Chair of the Standing Committee on Social Programs to provide opening comments. Mr. Robert McLeod.

Thank you, Mr. Chair, and I hope you’re enjoying your supper.

Laughter.

The committee met with the Minister and her officials on Wednesday, April 2, 2008, and Thursday, April 3, 2008, to review the Draft Main Estimates for the Department of Health and Social Services.

Committee members made note that the department is proposing to spend $309.822 million in operations expenses and $32.414 million on capital projects in the fiscal year 2008–2009. We would like to thank the Minister and her officials for appearing before the committee and responding to the committee’s questions and concerns.

Committee members offer the following comments on issues arising out of the review of the 2008–2009 Main Estimates.

Nurse Practitioners

Members of the committee are very concerned with how nurse practitioners are being utilized in NWT hospitals and how they are being integrated into the NWT health care system.

It is understood that all nurse practitioners who have had their education, or upgrading, paid for or subsidized by the department could be employed in front-line positions at community health centres. There are a number of nurse practitioner positions that have been funded on an ad hoc basis and utilized one-time federal funding pots. These positions have been acknowledged to reduce hospital stays and associated costs and to improve patient outcomes. The department and health authorities should be using nurse practitioners to improve patient outcomes throughout the NWT health care system and make the necessary program and funding decisions to best utilize our nursing resources. It may also be necessary to re-profile existing vacant nursing positions to accomplish this goal.

Committee members were aware that considerable expense was incurred between the cost of training and the development of enabling legislation and an implementation plan. It is time to follow through. We expect to discuss the use of nurse practitioners and

review a definite implementation plan during the review of the 2009–2012 business plans in September 2008.

Telehealth and Medical Travel Policy

It is noted from examining forced-growth figures in previous Main Estimates and supplementary appropriations that medical travel costs are increasing at an alarming rate. Some of these costs — like increases in airfare and charter costs because of the rising price of aircraft fuel — are outside of the control of the Department of Health and Social Services. The areas where the department can control costs are related to the number of patients using medical travel and the frequency of that travel. Members of the committee believe that wherever possible, the use of Telehealth to consult with other health care professionals is preferable and more cost-efficient than sending patients on medical travel.

In order for this to occur, it is important that Telehealth programs in the two territorial hospitals be delivered in a coordinated and focused manor. For this reason, the committee recommended that the two Telehealth coordinator positions —one at Stanton and one at the Inuvik hospital — be retained.

The committee was pleased that the department reinstated the Telehealth coordinator in Inuvik; however, committee members remain concerned that even though there may be qualified persons to operate the Telehealth equipment at the Stanton Territorial Hospital, without a person and a coordination role the equipment may not be utilized to its full potential. Committee members will be tracking the usage of Telehealth through the business-planning and results-reporting processes.

Mr. Chair, I’d like to hand it over to my colleague Ms. Bisaro to continue with the report.

Thank you, Mr. McLeod. Ms. Bisaro.

Thank you, Mr. Chair.

Stanton Master Plan

It is noted that there is no long-term planning in place related to the future of the North’s flagship health care facility, Stanton Territorial Hospital. At this time, committee members are being asked to approve piecemeal capital projects without any inkling of how these projects interrelate to a master development plan for Stanton.

Members of the committee are aware that some wards are overcrowded and that patient privacy is slowly being eroded. We also hear that medical and administrative staff at Stanton is being asked to work in less-than-ideal conditions.

The Minister has committed to following through on the development and finalization of the Stanton master development plan

and has made it one of

the priorities of the newly appointed public administrator for Stanton. The committee wants to make it very clear that we will have great difficulty in recommending future approvals of capital projects for Stanton in the absence of the master development plan.

Support for Home Care and Respite Services

The committee supports the home care programs offered through the authorities and their partners. These programs are instrumental in keeping people in their own homes for as long as possible and keeping health care costs under control.

The committee is also very pleased to support the expansion of respite care services to communities outside of Yellowknife in the 2008–2009 fiscal year. Many families do a fantastic job in addressing the medical and care needs of their loved ones, but these same people need a break every once in a while.

On a related matter, it is noted that policies under the Income Support programs, administered by the Department of Education, Culture and Employment, do not allow employed persons to stay with family members renting public housing, when those family members may require some assistance in maintaining their independence, without using the employed person’s income in calculating the rental rate.

It is known that seniors living in their own homes utilizing home care and assistance from family members to maintain their independence are less of a cost to government than those who move into government-run long-term care facilities.

The committee will be making a recommendation to the Department of Education, Culture and Employment to change Income Support policies so that with appropriate approvals from medical professionals, persons who move in to provide assistance to family members in social housing will not impact unit rental rates.

Electronic Medical Records and Interoperable Electronic Health Records

The committee notes that the Department of Health and Social Services is solely responsible for the costs associated with the development of the electronic medical records, and that Canada Health Infoway is paying the bulk of the costs associated with the development of the interoperable electronic health records. It’s hoped that the eventual rollout of these two systems will help the medical community in accessing information and improve patients’ medical outcomes and, at the same time,

reduce the administrative costs and burdens for the department and health authorities.

It’s hoped that the committee will be able to see the implementation of these new systems during the life of the 16th Assembly.

Mr. Chair, I would like to pass the reading of the report on to my colleague Mr. Abernethy.

Thank you, Ms. Bisaro. Mr. Abernethy.

Thank you, Mr. Chair.

The Future of Health and Social Service Authorities

It is apparent to members of the committee that our current method of administering health and social services by using regional authorities is unsustainable, going forward. A health authority with 42,000 residents in southern Canada would be a very small health authority. In recent years in most provincial jurisdictions, it is likely a health authority of that size would have been rolled into a larger authority. The fact that the GNWT has seven health authorities means that many administrative functions are duplicated and that some economies of scale by such things as centralized purchasing are not being realized.

In addition, it is understood that having seven different employers of health care workers has made it difficult for workers to temporarily work in other communities if the same health authority does not employ them. It is proposed that a single employer of health care professionals would make the system more flexible in responding to emergencies and staffing shortages. Members also believe that a centralized single employer would result in a better outcome for the funding that is currently spent on recruitment and retention by allowing for greater mobility for our health care professionals.

The original intent behind the regional health authorities was to build regional governance capacity. Members believe that between the development of the institutions of the territorial government, the non-government organization and the various aboriginal governments and development corporations, this capacity now exists and that a strong case can be made for consolidating operations in a single board representing all regions of the NWT.

It should be clear to all residents of the NWT that if Members of the Legislative Assembly are faced with a choice of cutting Health and Social Service programs or changing governance systems to save money, Members will choose to save programming for the residents.

Phase II of Family Violence Strategy

The committee was pleased to see the family violence action plan is moved from being coordinated by the Department of the Executive during its development and implementation to being delivered by the department and its authorities.

The department will spend nearly $1 million to enhance emergency services in regions with no services and to increase funding for existing shelters and programs. This is an important step in ensuring the safety and welfare of northern families. The committee looks forward to reviewing results of our increased investment in future years.

Recruitment and Retention Issues

The standing committee has reviewed information provided by the department on bursaries and paying for seats in medical schools for doctors. It is not apparent that the people of the Northwest Territories are receiving value for money in sponsoring these medical seats, as past experience indicates that very few of these doctors are returning north, even with a Return of Service Agreement in place. The reality is that other jurisdictions are so desperate for doctors that they are more than willing to foot the bill to pay out a Return of Service Agreement.

Although the original intent made sense, given the problems in recruiting doctors, the situation has evolved into one where the Department of Health and Social Services is paying to train doctors for other jurisdictions. NWT students are being accepted into medical school on their own merits, regardless of whether the Department of Health and Social Services is paying to reserve seats for NWT medical students. For this reason, the committee recommended that the Department of Health and Social Services examine eliminating paying for the seats at medical schools. The department agreed with this recommendation and will be phasing out paying for seats at medical schools as current students graduate.

Mr. Chair, I’d like to now pass off the reading of the report to Mr. Beaulieu.

Thank you, Mr. Abernethy. Mr. Beaulieu.

Thank you, Mr. Chair.

Federal Fiduciary Responsibility for Indian and Inuit Health Care Costs

It is noticed that the federal government has capped forced growth for health care for Indians and Inuit at 2 per cent per annum. With increases to health care costs averaging 6 to 7 per cent annually, the amount the territorial government is responsible for is increasing at an alarming rate.

Information provided by the Minister of Health and Social Services estimates the amount in dispute is approaching $95 million. This money could be used to enhance existing health care services or to develop new programs or infrastructure.

It is obvious to members that it would be reprehensible as a government to restrict the services available to eligible Indians and Inuit to correlate to the available funding from the federal government. The Minister and the Premier are encouraged to work with their territorial and provincial counterparts to lobby the federal government to live up to their fiduciary and treaty obligations to provide health care to aboriginal Canadians and to develop a long-term funding solution that recognizes the increased costs in delivering health care.

Support for Non-Government Organizations

Non-government organizations deliver many programs and services on behalf of the Department of Health and Social Services and their authorities. Subsequent to our discussions with the Minister, she provided committee with a list of NGOs that have entered into multi-year funding agreements with the Department of Health and Social Services. It was noted by committee members that these multi-year agreements are for organizations that are territorial in nature, have an advocacy role and require core funding to fulfill their obligations to identified classes of people, such as seniors or disabled.

Committee members are more concerned with NGOs that enter into a funding agreement with Health and Social Services authorities to provide programs and services to community residents. Members have heard that these NGOs are facing difficulty in retaining qualified staff because of uncertainty over year-to-year funding, and that too many of their resources are being utilized in preparing yearly reports and funding proposals to justify or request program spending or funding.

It is felt by committee members that where practical, three-year funding agreements would provide enough certainty to NGOs for them to recruit and retain qualified program-delivery staff and reduce the administration burden on the NGOs. Health and Social Services authorities need to be more proactive in dealing with the NGOs that deliver programming and services on their behalf to the residents of the Northwest Territories. The administrative burden placed on NGOs to report on activities and prepare annual funding proposals can be unrealistic and detract from the NGOs’ ability to actually deliver the services for which they have been contracted.

Committee members are aware that work is underway by the Cabinet committee to examine

ways to support NGOs while ensuring that the government gets value for money. As well, the examination on the future role and need for a regional Health and Social Services authority may provide an opportunity for improving relationships with NGOs. The committee looks forward to measurable progress during the life of the 16th Assembly.

Mr. Chair, I would like to now turn it back over to my colleague Wendy Bisaro.

Thank you, Mr. Beaulieu. Ms. Bisaro.

Thank you, Mr. Chair.

Support for Territorial Dementia Facility

Members of the committee look forward to the opening of the territorial dementia facility in Yellowknife. This is a welcome addition to the spectrum of services available in the North, and will keep families closer to their loved ones in a safe, caring environment.

Assisted-Living Facility in Hay River

There are many Northerners in southern Canada living in assisted-living situations far from their families and home communities. The Department of Health and Social Services spends a significant amount every year in meeting the needs of these residents. It’s important to note that these costs are increasing yearly, and that the point has been reached where it makes economic sense to deliver more of this programming in the North.

While it still may be marginally cheaper to contract with southern operators of assisted-living facilities, the fact is that once this money is paid out to these contractors, no net benefit to the NWT economy occurs. By basing these services in the NWT, the wages paid to employees and the money spent on obtaining local services and products will at least contribute to the economy of Hay River.

As a committee, we look forward to the opening of this new facility and hope that it may serve as a template for the development of facilities and services for northern residents who may require assistance in meeting their day-to-day living arrangements. Members also look forward to families being able to reintegrate themselves into the lives of family members who will be repatriated from southern Canada. That’s the end of opening comments.