Thank you, Mr. Beaulieu. Minister Lee.

I’m sorry, Mr. Chairman, are we still on 8-17?

That’s correct; page 8-17. Is that correct, Mr. Beaulieu?

That’s correct, sir.

Thank you. Minister Lee.

Mr. Chairman, the home care service, the money is provided to each authority under our primary care. Thank you.

Thank you, Minister Lee. Anything further, Mr. Beaulieu?

No, no more questions. Thank you.

Thank you, Mr. Beaulieu, and I’d like to turn now to Mr. Krutko.

Thank you, Mr. Chair. In regard to the area of community health nursing, I know you’ve heard me many, many times talk about the nursing situation in Tsiigehtchic and I think that there’s motions passed, like I said, in the Gwich’in assemblies, passed in the Dene assemblies and this issue has always been an issue in regards to the health and the well-being of the community.

Like I stated earlier, if you look at the budgets going back to 1998-99, prior to division, if you look at all the smaller communities, you can see the amounts of dollars that were spent in regard to the different care, from nursing care to social programs. The majority of the smaller communities, in which their population is under 200, had all those services being provided and being expended to those communities based on the funding allocations. I think since then there’s been a real decline in regard to actual dollars being expended from physical bodies, service providers since that.

So I’d just like to ask the Minister, I know that there has been an issue about nursing care. I’ve spoken to the Minister several times on this matter and I was hoping that February 1st there was going to be

a nurse in Tsiigehtchic, because that was my understanding. I’ve raised that issue with the chief and the community and mentioned to them there was going to be nursing care in the community effective February 1st . So I’d like to ask the Minister

how soon are you expecting to have a nurse full-time in Tsiigehtchic?

Thank you, Mr. Krutko. Minister Lee.

Thank you, Mr. Chairman. There are a couple of issues that the Member raised. The first one about how services were better back in the ‘80s, I do not have information to either accept that or dispute that. I believe, by and large, this government is able to keep records from basically ‘99-2000, because it’s just hard to make comparisons when we’re talking about information prior to division. Anecdotally, I used to work as an executive assistant of the Minister of Health and Social Services for the entire NWT and I think there were as many issues back then as there are now.

On the issue of nursing coverage in Tsiigehtchic, Mr. Chairman, I need to say once again that it is not accurate to say that there is no nurse service in

Tsiigehtchic. I understand that the Member is passionate about seeing a permanent nurse there. I have given him the information about the nurse coverage that the Beaufort-Delta Health and Social Services Authority is providing. For the community of 170 people, last year Tsiigehtchic had 14 weeks between the breakup and freeze-up and another 20 weeks of service I believe. So that’s 34 weeks of service, which is a little over half a year. That is what the authority is able to do within the current regime that we have and the Foundation for Change action plan, and some of the strategic work that we are doing is looking at the entire service delivery model as well as the governance and we will be putting focus on concentrating on small communities and how to better work out a team of care providers that MLA Yakeleya has mentioned earlier. So that is the plan and that is the work that we are trying to do.

However, I need to state, once again, that Tsiigehtchic does have nursing services. We service that community in the way the RCMP services are provided in Tsiigehtchic, which is what the MLA had asked me to do. I had committed to do that last February in the spring and summer sessions last year and I am committed to continue to work on that. Thank you.

The community of Tsiigehtchic appreciates what the Minister is providing. The community is requesting a full-time nurse in the community. That’s what they are requesting: full-time. Not six months, full-time. So that’s where I am coming from in regards to providing those services full-time in those communities.

Like I said, the community has done everything they can. They’ve purchased a housing unit so that they can’t use the excuse we don’t have housing for nurses in the community. They did that on their own. They’ve done that through their charter community. They are working to try to find ways to get policing in their communities by allowing them usage of facilities they have in the community which can accommodate the RCMP to stay overnight. The community is trying to do everything they can to attract everything to their communities, but what we need from this government is a commitment that those people that they do get there, they are going to have a care provider that is constant. That you work out that relationship between yourself and the provider, so you know who the elders are, you know who George Naditchie is or you know who these different elders in our communities are.

Again, I request from the Minister, is it possible to have a full-time nurse in Tsiigehtchic in a short time frame, knowing spring is coming forward? We know there will be a nurse there during breakup and freeze-up. I am requesting if that is possible to have a full-time nurse in the community in the immediate future.

Thank you, Mr. Chairman. The way our system is set up, the authorities get the funding to provide services to the communities. They work as one entity and they distribute their resources in the best way possible. I understand and I have heard, and I have met with the community about the desire of the community to have a permanent nurse physically there all year round. The issues are the Beaufort-Delta Health Authority is stretched, not only in terms of dollars, but in terms of available nurses. They have the obligation for all of the Beaufort-Delta communities to spread their nursing resources around.

The second thing is our labour law requires that there needs to be at least two nurses and it would be difficult to have two nurses in a community of 170 people. I’m not talking financially, but just it would not be enough work for two nurses for 170 people unless the 170 people went to the health centre every second day.

I understand health care is very important. Health care includes doctor’s service, nursing service, community health rep, wellness worker, people who can take care of the elders, including home care workers, including people who talk to people about how to prevent diabetes, take care of diabetes, see if they have it, cancer prevention. There is a whole basket of health care services that our communities expect. Health care doesn’t mean having a physical health care professional necessarily sitting there because we feel healthy if we see a doctor sitting in our office or nurse. Maybe that’s how some people feel, but that’s not how we can continue to deliver health care services.

Just like the RCMP, we don’t have two RCMP stationed in Tsiigehtchic, but the government has made the move to hire extra resources in McPherson so they can increase patrols in Tsiigehtchic, which is a great advance. That’s what we are trying to do for the nursing coverage until such time as we have different ways to address that. I don’t know how else I can put into this, because nurses need to keep up with their skills as well. They need to be able to do the work that is necessary to do and all of the practice guidelines will say being a full-time nurse in a community of 170 people may not give them the kind of work that’s required to keep up with their credentials.

I just want to state again that I am committed to working to enhance health care services in our communities, but they come in different shapes and sizes. Thank you.

Thank you, Minister Lee. Mr. Beaulieu.

Thank you, Mr. Chairman. Mr. Chairman, just a follow-up on my last question again. I had asked about the money for home care and the Minister indicated that was under primary care. There’s, like, half a million dollar there to do

all the functions under primary care. I just wanted to confirm that home care, along with all those things listed, come out of primary care.

Thank you, Mr. Beaulieu. Minister Lee.

Thank

you,

Mr.

Chairman. Later on, under tab 8-30, there is a provision there for home care services. For now, the Member asked what we fund out of the primary care and I’d like to ask the director of finance to identify the details. Thank you.

Thank you, Minister Lee. Mr. Elkin.

Thank you, Mr. Elkin. Mr. Beaulieu. Back to Mr. Krutko.

Thank you, Mr. Chair. Mr. Chair, this government has tried to take strides in accommodating small communities by implementing health care providers in different areas; mental health position, alcohol and drug position, social worker. Nowhere does it say that you can have people in a community working in similar areas, so that you do have more than one person in the community. That doesn’t say you have to have two nurses. You could have a nurse and a mental health worker, a nurse and a social worker working out of the same office or same operation. But I think if you use the argument the Minister is providing, it’s just another excuse to do nothing. I think we’ve tried to find ways of accommodating communities with policing, by trying to find police for 10 communities that don’t have it.

A similar arrangement applies to the small communities. Maybe I will just read out for the Minister... This is prior to division. I will just use Tsiigehtchic for an example. It’s tracking expenditures that were done back in 1988-89. The Territorial Health Insured Services, $284,000 was spent in Tsiigehtchic; social assistance, $205,000 in Tsiigehtchic. It goes on with regard to hospital services outside the Northwest Territories, $110,000 for Tsiigehtchic. If you just look at those numbers alone, they were spending over $500,000 in Tsiigehtchic. From the last numbers I got from the Minister, it was $147,000. So if you tell me that services have gone down since division, I think that because we had a lot of small communities, we were part of Nunavut, there were 51 communities we were serving. We were able to accommodate 51 communities with regard to health care services before division, but it seems like after division, we’re at a situation where basically the so-called dollars expended to small communities has

depreciated to a point where that’s why you don’t have services, because it’s being spent in the larger centres to provide at those new hospitals or dementia centres or walk-in clinics or whatever you want to call them Those things are taking up dollars that should be expended in those small communities.

Mr. Chairman, I will give the Minister a copy of this. Maybe she can get her department to look at the cost breakdown of what we had prior to division and the expenditures we have today, so she can see for herself. I’ll give copies to several Members of small communities so we can see how exactly our services have depreciated to the point that they are not expending the same money as they were prior to division.

Thank you, Mr. Krutko. I did not hear a question there but, Minister Lee.

Thank you, Mr. Chairman. I’ll take the Member’s point, but I think it is really hard to get an accurate comparison to take one part out of the government’s budget, say from 1986 or something, and compare it to ours unless we used the same indicators. So I just want to say, modern medicine and health care have changed so we need to know what is included there. People in Tsiigehtchic, they are connected to roads which is different than some of the other communities in the Territories who are not connected by the road and they still get fly-in nursing service.

Mr. Chairman, I understand his objective, which is to enhance nursing coverage and other health care coverage, and actually services to a small community like Tsiigehtchic. I understand that. I want to tell him that I am committed to work with him to do that. I am glad that he said that a nursing service doesn’t have to be 100 percent nurses, because you understand that a community could need a lot of things. They need a wellness worker, they need a mental health and addictions person, maybe they need a community organizer. We understand that we can’t have six, seven, eight, nine, 10, perhaps, people doing all of it separately in a small town, but that is exactly what Foundation for Change is trying to do. We are trying to find efficiencies as a system, because we believe there is a better way to address, a better way in which we spend our health care and social services dollars, so that we could refocus on the communities and do community wellness work and say, okay, what does a community like Fort McPherson or Tsiigehtchic need, and have a dialogue with the community.

If you look at the Foundation for Change plan, that is part of our plan, because we understand more and more that we are going to have less nurses and doctors and other people there to recruit, but that doesn’t mean that our people don’t need that

service. So we need to find ways to see how we can serve our communities better. That is part of our plan and, in the meantime, we are continuing to work on how to enhance nursing coverage and try to create a team of providers in a community like Tsiigehtchic, and that is our plan. Thank you.