Agreed. Sergeant-at-Arms, escort the witnesses in.

For the record, Ms. Lee, would you introduce your witnesses?

Thank you, Mr. Chairman. To my left is deputy minister of Health and Social Services, Paddy Meade; and to my right is director of finance, Mr. Derek Elkin.

Welcome, witnesses, Minister. General comments. Mr. Beaulieu.

Thank you, Mr. Chairman. Mr. Chairman, I guess just a few very general comments I’d like to make. In my travel to my constituency, I had an opportunity to ask health professionals what they felt was the number one cause of the high cost of health care in the NWT, and from the nurses’ perspective, from what I’m told, the number one cause of the high cost of health care in the NWT is alcohol.

I know that a few years back, there was some sort of health reform that was presented by this government, by the GNWT, I should say. It wasn’t this government, but there was some sort of health reform where they got away from drug and alcohol treatment and tried to move more towards the outpatient type of treatment for drugs and alcohol and provide the communities with the money to be able to address the issues in that fashion with just one treatment centre remaining within the Northwest Territories. From what I understand, however, the budget at that time, at the beginning of that reform, 14 percent of the Health and Social Services budget was being spent on alcohol and drugs or addictions and wellness, the whole area of treatment and perhaps even the prevention of addictions. After that reform, the budget that addresses that portion dropped to 3 percent.

So I guess I’m more or less just looking at the budget overall. It’s hard for me to kind of extract out of the budget exactly what is there to address, targeted specifically to address what the health professionals in the smaller communities consider to be the number one cost driver in health and that being alcohol addiction. Of course, there are other addictions that are slowly becoming a major issue in the Territories, but I’m wondering right now, our health care seems to just continue to grow and I

think that’s because we are addressing the health issues. Almost like managing in a crisis, you know, a reactionary type of management. I’m not really saying that that’s the philosophy of the department, it just appears that there is not really a whole lot else that can be done. I think what can be done is to start paying more attention to the prevention side and the treatment side of things. An example, I guess, is that if we had absolutely no alcohol consumption in a particular small town where it would be an issue, according to local health professionals, the cost of health in that community would drop to almost zero. It causes all kinds of other sicknesses and other things that are related to heavy consumption of alcohol.

Cigarettes, I know that there’s some work being done with the kids and cigarette smoking and so on, but I guess I was just hoping that there would be more attention paid to that area in the small communities. I know that in my communities, at least one of the communities, the addictions counsellors are right in the main building of the community, so it’s very difficult for people to go there and receive counselling for whatever addictions that they have and so on. You know, like money to maybe build something that’s more private for the community to take advantage of perhaps will bring more people into the program and more people participate in trying to do what they can for their addictions, especially addictions in alcohol and drugs. I guess as we go through the budget page by page, at the appropriate places I’ll be asking the Minister on what the plan is to address those issues that seem to be hindering the small communities and driving the cost of health in small communities through the roof. Thank you, Mr. Chairman.

Thank you. Next on the list I have Mr. Hawkins.

Thank you, Mr. Chairman. Mr. Chairman, with the budget before us some things sort of pop out and I’m certainly pleased to see the evolution of our downtown clinic. Through this budget it will help support that. Our budget also supports the soon to be opening dementia centre, which is excellent news and I think it is a step forward in the treatment of people with this chronic ailment. It’s certainly a good thing to see that we have a facility that’s up to date with an appropriate way of helping people through this problem. The day shelter, there will be funding for the day shelter or drop-in centre. It was a primary issue I had been raising for some time about public access or public washrooms for the general public that is specifically, obviously, the homeless or street people. It’s been my understanding from speaking to people who have been running the shelter, to speaking to staff, to speaking to different people at the hospital to hear that since that facility is now open, it has had a significant and hugely positive

impact on this community. People have recognized it from the malls to see less people loitering, causing problems, demands on their facilities. And, of course, conversely, the pressure being put back on the homeless, I always thought was significantly unfair because, I mean, they have rights too. It’s very fortunate that we’ve been able to find a way to balance that out and, of course, through the partnership it wouldn’t work.

Treatment centres, in my view, still need to grow. I know the department continues to argue that, for example, the treatment process offered through the Salvation Army or the Tree of Peace is significant enough, but in my view, the department needs to refocus its issues for the severe drug problems and alcohol problems such as a detoxification centre here in the North. Speaking as a Yellowknife MLA, I don’t necessarily think this type of service centre needs to just be here in Yellowknife. I think in any community a detoxification centre could exist, and I would welcome to see it put into an area that could use some territorial stimulus money, if I may define it that way, because I think this is a type of service that could go anywhere, and, if anything, it’s probably best that we put it out into an area that could bolster the local economy as well as make it difficult for the person to just get up and go.

Member Jacobson today was talking basically about follow-up treatment for those in a treatment program. I spoke to this issue a year and a half ago, and I think he’s on the right track. The Department of Health and Social Services doesn’t offer a follow-up treatment program that I’m aware of, unless it’s an individual group that chooses to follow up with someone. The example that I provided at the time was Poundmakers out of Edmonton, which if a person travels down there for treatment, they endeavour to follow up your progress after you leave the centre. I think that’s a significant portion of your treatment. I mean, it’s great that you go down to get the million dollar therapy immediately, but then you’re left to your own devices. In many cases -- and I think the counsellors are right -- we end up putting people right back in the exact same circumstances and circles that they were in prior to the beginning of treatment. So in other words, we put them back into maybe the circle of influence of where their problems were. I often believe that the follow-up treatment and support programs need to be a critical, fundamental element of anyone’s treatment at all, because without that follow-up, I believe quite strongly that a person doesn’t have the same type of strength on many occasions to go through it alone. This gives them the extra ability to have contact with someone regular who will help support them, whether they just need to talk or it becomes a crisis that they have an emergency.

Mr. Chairman, I am curious what the Minister will have to say on this year’s theoretical budget, if I may define it that way, on medical travel. A lot of calls and e-mails are coming into my office in the last little while regarding denials for medical travel and people have no way of receiving, whether it is back pain services in Edmonton or whether it is specialized treatment in other areas where they have been going to private clinics in the past in Edmonton. It is not just this is the first time. This is happening with a number of people. People who have gone out for specialized weight loss clinic programs are now being denied. I fear that the medical travel system, perhaps rightly so is evaluating what it is paying for and perhaps it is a wise decision to evaluate what programs we are going to pay for as well. But yet it seems as if it has decided to cut people off cold turkey without either announcing to MLAs to spell it out as simple as these are the programs we are going to start trimming back and create a transition program at the same time. It seems to be as if a bucket of cold water dropped on people. The shock starts to set in and then people are wondering what they could do next. Told that diabetic services as one example is coming provides little warmth for those people who had been attending another program or it had furthermore looked forward to attending a particular program that was offered in perhaps Edmonton or elsewhere. Really, what we are talking about is services that are recommended by specific doctors saying that these clients need these types of health services and now pulling the carpet from underneath them provides a bit of a moral setback and emotional setback for these people but really we are counting on these things to move forward on their treatment.

Mr. Chairman, although I don’t see specifically in the budget on my perusal, but I certainly would like to hear a little bit about what is today’s Stanton deficit. I would like to hear on perhaps how, if there still exists one, what is the updated figure and I would certainly like a copy of the plan as to how they plan to get out of a particular deficit. What is missing in this particular budget that I am not seeing and I think it is probably critical to emphasize is the NIHB money that is owed to this government where we provide health services to First Nation folks and the federal government still owes us a responsibility. It needs to be an item written in red ink here that emphasizes where our government is covering an obligation that should be out there by the federal government.

Finally, Mr. Chairman, in the area of extended health benefits or self-health benefits, depending on what day of the week we want to call them, continues to be a significant concern in my constituency. I know proposers suggest I have the most seniors in my community, but I can tell you I have a significant amount of seniors in my

community. They are very concerned about what the government may or may not be doing on their behalf. That also scares them that the government is re-evaluating these programs on their behalf. There seems to be little communication as to what is actually happening. Furthermore, it has created a fair amount of destruction and discomfort in knowing that the government is acting on their behalf without them having sort of a guiding principle being sent out to them.

Many issues have come into the forefront as to areas of protection. As I have said on a number of occasions, I think that what the department has intended to fix a year ago or two years ago, I think there was little understanding as to what was actually being fixed without identifying the actual number that the department needed to find. I think that challenges are recognizable, that there is a situation where we will define a group of individuals, whether they are families or individuals, that are not covered by health services. I think incumbent upon presenting this government, this House, this Legislative Assembly, individual Members the detail as to what these actual costs can be and I am very confident we will find a way to work our way through it. It means that we have to give up an individual program one particular year because, and I apply this example not to a specific project, but, I mean, we need to ask ourselves is chipsealing as important as someone’s pain medication. I would certainly think that all of us would choose pain medication.

I am not picking on a particular project. I am just emphasizing the fact that we could make those types of choices to say we will put health care before a particular project that really has the label of convenience on it as opposed to a label of necessity.

Mr. Chairman, at this time, I will leave that as my opening comments. I certainly look forward to the detailed answers to the issues I have raised. Furthermore, if the Minister is unable to provide them today, I will certainly accept them in a timely way forwarded to me through a letter, of course, and I will deal with them individually at that period. Thank you, Mr. Chairman.

General comments. I am not seeing anyone. I would like to give the Minister an opportunity to respond to the general comments that were raised yesterday and today. Madam Minister.

Thank you, Mr. Chairman. There were a lot of good comments made by the Members yesterday and today. I do appreciate that as we go line by line that there will be more specific questions which I would be happy to answer too.

First, something that I want to mention is the Foundation for Change Action Plan, because it is something that I have been speaking about often

and other Members have mentioned. I agree with MLA Groenewegen that we should have a healthier version to having consultant studies and fancy books. I just want to reiterate that this is a working document. It is a to-do list. It is about how our health and social services system will go through a transformational change over the next three years. It is a three-year action plan. It was not prepared by a consultant but by the department staff. I guess one of the biggest reasons we need to have this is we have a lot of stakeholders in the health and social services system. Not only the clients that we serve and the residents we serve but also the MLAs in the House, the health authorities, medical professionals, allied health care professionals, they all need to know in writing what it is that the system is trying to do. That is where it is.

Member Bisaro and others have stated that they gave us preliminary support but they would like to see more update on that, and on that I agree. We have committed to give regular updates and seek input from the Standing Committee on Social Programs, so we are scheduled to appear before the committee at a neutrally convenient time to do that.

There were lots of issues about services and especially in small communities as well as what MLA Beaulieu mentioned today about the cost of health care. I think obviously the Member is… We couldn’t disagree with what the Member said, and that is alcohol use and misuse contributes to general health negative indicators, but also added to that is tobacco and poor eating habits and lack of exercise. This morning, Dr. Hendricks, who is an intern, was on CBC and she talked about the fact that there is a response for economic projects and everything else. That just places more importance on the fact that we need to make sure that we do everything we can while we can control it. I believe that in the NWT we could still do this by making transformational changes, making sure that we use our health care resources as efficiently as possible. That requires all of the authorities working together. That requires investment in technology. That requires lots of thinking together to make sure that we keep what we have and we continue to enhance what we have, if possible.

Just going back to demographics, Mr. Chairman, it is the alcohol use and all the other personal habits. But just demographically speaking, in the last 10 years the NWT’s population grew by about 4 percent. Our health care budget almost doubled. Our seniors population grew by half, so our senior population grew by 50 percent. I am not going to suggest that the seniors are responsible for our health care costs. That is not what I am saying at all. I have a mom who is a senior who is quite healthy. She does everything right but she still goes to doctors more than me. Your body is used more and there are more costs involved in that. Looking

forward, we are looking at demographics that suggests to us that our health care costs will continue to rise. So demographic challenges are not just the clients, it’s the service providers. It’s the great tsunami that everyone is talking about that we are going to have less and less care providers to share and so that just puts more onus on the government to make sure that we look at what we are doing constantly and try to change the system so that we are better equipped to handle the demand and expectations that our residents have of us, that we provide the services that they’re looking for. Things like medical travel, treatment services, cancer treatment, chronic management, chronic disease management, prevention and treatment. All that is listed on Foundation for Change as to how we suggest that we can go forward for the next three years.

MLA Beaulieu mentioned an interesting point about the fact that way back when, 14 percent of the budget was on alcohol and drug treatment. I don’t have information on that, because 14 percent of our budget would be over $100 million on alcohol and drug treatment. I can tell you right now, we’re not... No, that’s not it. My math is bad. Okay, 10 percent of $320 million is $3.2 million...$32 million. Okay, so about $40 million we would have to spend on alcohol and drugs. I think we’re somewhere near $10 million, so we are spending a lot less.

The same with prevention. The ideal situation for any government is to spend 4 to 5 percent of their budget on prevention. I have to tell you most governments are not able to do that because we spend most of our energy and time treating the sick and the people that show up after they have developed something.

So my dream, and I think the dream of all Ministers of Health, and we talk about that often, is to work on prevention and promotion, but we are constantly having to address the after effects of natural causes and induced effects of health indicators.

Anyway, I want to start with that opening statement and I would be happy to go page by page and provide any detailed information that the Members might require. Thank you.

General comments. Mr. Yakeleya.

Mr. Chair, I want to say a few comments and maybe get a response from the Minister. She’s talked about a document called Foundation for Change. Again, I want to say to the Minister regarding health care services in our small communities, the standard of health care services in our small communities, we really need to ensure that when they walk into the health care centre, you know you’re going to get a satisfactory level of care from our nurses or when you live in a small community with no access to a hospital in a matter of minutes or hours, that the health care would do

its utmost to help the people and the services of the hospital has to be striking, I guess, in terms of how we take care of our people.

Something I look forward to this Minister doing in terms of strengthening the standards of health care. Some of our small communities on weekends, there’s a lot of... Just listen to Ms. Minister’s response to the issue of the use of alcohol. Sometimes our patients in our communities use alcohol and sometimes the nurses, on their discretion, will see or not see a patient. That is unacceptable, especially when there’s a serious injury. The nurses usually say bring them in while they are sobering up; you can’t bring them in while they’re drunk.

I know there is a safety issue there. I have seen a few myself in my own community. I have brought people in who are pretty high, but they had some pretty serious damages on them and they had to bring them in, some of the members in the community.

So I want to look at this in terms of ensuring that all our health centres, especially with the nurses that do come in, who are there for six weeks, who are there for two weeks, who are there for one week, know that these are the types of standards we expect in our community in terms of services.

There is also a safety issue and I think it needs to be worked out with the health boards in terms of what we expect from the health centres. I want to let the Minister know that this needs to be looked at. We need to ensure that these nurses there are signed on to do a job and sometimes that job means being on call or responding to a situation at any time of the day and they’re there to serve the people. I have personally witnessed a call to a nurse, an elder who fell down, and the nurse -- this was a little after 11:00 -- said bring her in after I take a shower. That type of attitude is unacceptable.

So I ask the Minister through her leadership and working with the board chairs, that nurses who go in, they understand the expectations of health care into our communities. I just wanted to make comment to that right now as we’re looking at the budget, especially the operations and maintenance budget of the Health department. They are there to run the program and do the best they can. At the same time, these nurses are under extreme pressure in terms of the work that they do. This is not to say that they are doing a poor job. There are people in the community who look forward to having a nurse, but also to having a nurse look after an injury when it’s needed and not to be told come later on.

I just want to tell the Minister that we need to continue working on how to improve our health care in the small communities. It’s something that she’s already said that to the leadership in the Sahtu and

we’ll continue to do that. I look forward to seeing the responses through the different parts of her budget. Mahsi.

Thank you, Mr. Yakeleya. With that, I would like to ask the Minister if she’d like to respond to Mr. Yakeleya’s general comments.

Thank you, Mr. Chairman. Yes, I would like to give my commitment to the Member again that I will continue to work with him and the Sahtu Health and Social Services Authority to continue to work on our communication. We understand that our health care staff, whether they be physicians or nurses or anything else, have their professional guidelines and rules and regulations that they follow in their practices. We can’t comment, really, on individual situations obviously, but I do appreciate that there is some room; there’s lots of room, actually, to work on for the providers as well as our residents on how we build relationships. I understand the health care professionals are near and dear to our hearts, that people expect a lot of our health care professionals. At the same time, they are under lots of stress as well and they are a really valuable resource. So it’s really important that we work together and I’ve said that to the community leadership in every community.

I think our people, I’d like to advocate more on owning our own health care and not only what we do individually, but being able to advocate for ourselves and communicate what we are expecting. How do we develop mutually respectful relationships between the providers and the clients so that we get the services we need from the professionals? They know what our clients are, what our cultural and other community expectations are, and it’s something that needs work on an ongoing basis and I would commit to the Member that that is something I’ll be interested in working on further. Thank you.

General comments. What is the wish of the committee? Detail. Okay, if we can turn to page 8-8, or page 8-7, we will defer that to deal with page 8. So with that we’ll defer page 8-7 and then once we conclude the department, then we’ll come back to conclude department summary. Is the committee agreed?

Page 8-8, information item, infrastructure investment summary, information item. Mr. Yakeleya.

Thank you. Under the infrastructure investment, the item information technology projects, $2.4 million, Mr. Chair, can I just ask for a brief explanation in terms of that line item?

Minister of Health.

Thank you, Mr. Chairman. I would like to ask Mr. Elkin to provide the details. Thank you, Mr. Chairman.

Mr. Elkin.

Mr. Yakeleya.

Thank you, Mr. Chair. The TeleSpeech project, are communities already selected for that project? I’m not too sure if that is being done as going through the committee or if there was assessments done on it, because we’d certainly like to see another project to all the telehealth projects being up and running. So can I see a little more information on this specific item here.

Minister of Health.

Thank you, Mr. Chairman. We expect that the TeleSpeech project will be available in every community, but it’s going in in a phased-in approach. I believe Sahtu is one of the first ones, because in our tour, we saw the TeleSpeech machines in all facilities. I believe the full implementation of that was delayed a little bit because we were concentrating on the H1N1 effort.

TeleSpeech will be used to give speech language therapy first of all to students who need them. We have some of those stations in schools and we work with the Department of Education, Culture and Employment on that. Also, I know that the Department of Health has been working with Justice in providing that program to do with parents who are separating. So by that one that Justice started and there is certainly a lot more room to grow with this equipment, but obviously there is training and program support needed to expend those.