Thank you, Mr. Chairman. If I may, I would like to ask the deputy minister to give some information on where we are with physician recruitment in our authorities, especially in light of the new Collective Agreement and as well as the work that the deputy minister has been doing with the medical forum on this issue. Thank you.

Thank you, Minister Lee. Deputy Minister Meade.

Thank you, Ms. Meade. Mr. Yakeleya.

Thank you, Mr. Chair. The comment from the deputy minister on looking at the delivery system in the Northwest Territories, because of this issue that we are facing here, would I dare say that are you looking at an overhaul in terms of how we deliver our health care in our communities or our regions in terms of coming to a centralized system of health care delivery as to what the regions and the communities want to see more health care delivery in their communities. I know there are some specialists that come in the regions on a rotation basis, doctors do come in on a certain rotation basis, and we would like to continue with that. However, I’m going to make the speculation that I don’t know what to expect from the health care delivery system in the Northwest Territories. I’m not too sure if that’s a fair question to ask of the deputy minister in terms of what does she mean by that.

Thank you. I certainly look forward to the day where I could see what the deputy minister is saying in terms of improved health care services in the communities.

In the description here it talks about recruitment and retention programs specifically related to health and social service professionals. I want to ask, in terms of the recruitment of the aboriginal wellness workers, aboriginal health care providers such as the community health representatives, you know, people in the communities that have been working in this field but they’re not recognized; some of the elders that we use or we go to for various reasons that could be deemed health issues or social services issues that recruitment of relying on our own people and not always relying on the outside. There are specific times when we need a medical doctor to come in, but there’s also recognition of the aboriginal medical, if you could call it that, wellness model, so that we can utilize the traditional knowledge of the elders in our communities.

I think, Mr. Chair, that the Minister, prior to this chapter, did make some mention of the Foundation for Change. I’ve been looking at this. So that’s what I wish to see. That’s my vision, that our own people could be at the health centres or they can be going into the different houses in the communities to talk about prevention, to talk about the use of the traditional medicines from the land, medicine they have from the animals, medicine that could be used. People have a choice in terms of their well-being and the prevention of diabetes, prevention of heart disease, prevention of a lot of other things that we haven’t yet given prudence to the aboriginal view on how we can work on this. A lot of it we rely on the model of the western concept of illness, and that is something that’s good for some reasons but not for everything. So I hope, through the recruitment and on the whole health and social services, that this here looks at a balanced view of how health could be looked at in our communities and regions. Those are more comments to the department here and that’s my wish, I guess, to see

how this program should be, could be, and hope to be implemented in this department. Mahsi.

Thank you, Mr. Yakeleya. If I had a billion dollars... Minister Lee.

Thank you, Mr. Chairman. I just want to advise the Member that much of what he’s saying is something that we have been discussing and working with and it’s part of the Foundation for Change plan in that we understand that we need to work on the larger framework, like the governance and delivery models but the focus in delivery needs to still be at the community level.

As mentioned earlier by the deputy minister, the recruitment and retention of physicians, registered nurses, nurse practitioners, for example, we have 68-plus positions and we have about 20 vacancies. While we are trying to recruit and retain, we understand that will continue to be a challenge because of the fact that not only are the residents and clients aging, but our health care professionals, by and large, are aging as well. So we are going to see increased demand for service but decreased number of people who could do the job.

This is why, under the Foundation for Change, we need to look at the overall system and do much of what MLA Yakeleya is saying, that is, to look in each community and see what is the team of care providers that we can establish in each community and region. They may not be the conventional health care people. We go to doctors when we need doctors here. We go to nurses and those people when we need them, but there are a lot we can do on prevention, promotion, as well as working with people as they go through their illness or their questions about their health issues or managing their cancer care afterward, because we know that lots of people can live a pretty good life afterwards from cancer treatment as long as they are looked after. So that is short. I will conclude there.

Much of what he is saying is part of our Foundation for Change action plan, understanding, though, it will take a long time for us to go to every community and work it out. So we are looking at first regional dialogue and we are looking, as the fund permits, to bring people together and have a dialogue about how do we take ownership of our own health care and what can we do from the ground up to make this work for us. That is part of the plan. Thank you.

Thank you, Minister Lee. Next on my list I have Ms. Bisaro.

Thank you, Mr. Chairman. I want to follow up on a question I asked yesterday. It doesn’t technically belong in this section. I think it does apply, because I am talking about the provision of physician and clinical services and so on. I asked yesterday about reciprocal billing and what we receive from Nunavut for the services that we

provide to people in Nunavut communities. I understood the answer, but Ms. Meade stated that the agreements and the contract in place are in place verbally and that they are finalizing the language. I am considering it a second time. I thought, oh, my. That is a little alarming that we have a verbal agreement. I am reading it again. I am pleased to hear that we are finalizing the contract, but my issue goes more to what is included in that contract. I wondered if I could get a bit more of an explanation.

When, for instance, we send Nunavut patients out to Edmonton for treatment, they use the services of Larga House, I believe, in Edmonton. They are assisted with their travel. They are assisted to get to their appointments and so on.

Another example is that we have a doctor in the ER generally who is on call and will take calls from nurses in Nunavut communities.

Another example is I gather that we send travelling clinics which go to Nunavut communities, the eye clinic for instance who is one and there are other ones as well who go into communities and do clinic work there.

Those are three examples of things which I don’t imagine are covered in our reciprocal billing. Are those sorts of things covered in this contract which is currently verbal and which language is being finalized into a firm contract? Are those sorts of things considered in this contract? Are they in there or are we getting repaid for those kinds of services which are kind of under the radar and somewhat minor but it all adds up in the end? Thank you, Mr. Chairman.

Thank you, Ms. Bisaro. I will turn to deputy minister Meade for that response.

Mr. Chairman, thank you to the deputy minister for that explanation. I guess I am glad to hear that this is an issue that is going to be looked at in further detail. To me it sounds as though this is a logical approach to look at the big picture, figure out what we should be doing and what we shouldn’t be doing and then go after the funding for those things that we are doing that aren’t now covered. Is it possible for the deputy minister or the Minister to give us some indication of timing on sort of when this work might be completed, when we might be amending the agreement to sort of be able to say we are capturing all of the expenditures that we are incurring on behalf of Nunavut communities and citizens? Thank you.

Thank you, Ms. Bisaro. Minister Lee.

Mr. Chairman, the agreement that has been agreed to has been worked on for quite a while. That contract is closed, basically. The negotiation has been going on and that is done. As the deputy minister had indicated, there are some other things that we want to be able to prove, but that would involve larger discussions between not only the DMs but myself with the Nunavut government. This contract that we are finishing off is basically dealing with a situation where there had not been any solid agreement before and we are closing that part of our relationship with Nunavut. So we will have to engage in a bigger conversation with Nunavut. That could take a while to get there. We are more interested in getting this part done and then to build on the next phase. Thank you.

Mr. Chairman, to the Minister, I understand that the one contract, the current contract, is basically finalized. I know a long time is what she has mentioned, but I am talking about the things that are not being captured now. How long do we think it is going to take to get some sort of agreement in place so that we can capture those

things? I appreciate that it is a long process, but what does “a long time” mean? Thank you.

Mr. Chairman, I could tell you that this is something that is of interest to us. It does take two parties to negotiate. We will continue to encourage Nunavut to come to the table on this issue. I will be talking to Minister Curley on this issue as the DMs have been working on it for the last while. Thank you.

Thank you, Mr. Chair. I guess without having any kind of a time frame I need to ask a general question. If we are not currently capturing the costs of providing services, some services to Nunavut patients, communities, et cetera, what sort of liability does that put out there for us? How vulnerable are we to spending money that we’re not going to recoup? Is this going to create a situation where we are going to be basically in debt because we’re providing services for which we’re not being paid? I guess I would like to know how much. But if the Minister can’t tell me when we’re going to be negotiating a new agreement, that’s probably not forthcoming, but to the question of vulnerability and what sorts of costs we are liable to incur. Thank you.

Thank you, Ms. Bisaro. Deputy Minister Meade.

Thank you, Ms. Meade. Minister Lee.

Thank you. Beyond that I would just like to add that we have had a situation of not having a written contract between Stanton and Nunavut and it was important for us to make sure that we conclude that so that we settle the outstanding receivables and we have made some gains on that. So that’s why it was important that we conclude this and any newer issues that we need to be bringing to this we will deal with that in the next phase.

Also, I think it’s important to note that while Stanton has been experiencing a deficit, it is not correct to think that this is contributing to the deficit to the extent that it might suggest. That was just one part of that. We are doing lots of other work through the Foundation for Change and such, to address that issue.

I think it should also be noted that Stanton has been having capacity issues in their finance section and this budget includes some investment in that area, because it’s not clear cut we collecting everything that we need to do with Nunavut. Of course we will do that and we would not be wanting to provide services where we’re not getting paid for it, but there are lots of other issues where we needed to put some resources in there so that we catch up on what was falling behind and we are doing that through this budget. Thank you.

Thank you, Minister Lee. I’d like now to call on Mr. Beaulieu.