So there has been a zero-based review done of Stanton, but what happens is it doesn’t show you where the change has to be, it just shows you where the money is going to go. So the drill-down in both, Stanton is ahead of this, has been where is the actual money being spent, where do we see the system offloading and creating that deficit, because the money actually hasn’t been realigned since 1998 and the way we are delivering health care in the Northwest Territories has changed and the movement of patients.

So some of the things we have done, a specialists review, we started that with Stanton but we found out that specialists are being used by some of the other authorities, and some of the use of those specialists might be avoided if we look at how we better utilize the specialists at Stanton, so that is both what are the real services we must and need to apply here.

There has not been a business case come forward, so again the specialists have, I think there are at least 10 specialists that have been added to over time without the funding, because the business case wasn’t made. Those specialties are not nice to have, they are actually must haves to run the kind of acute system we have. The specialist review is now looking at so what about the other specialists. For example, we have used a specialists model at Beaufort-Delta and we may be able to save costs and efficiency by marrying that better with Stanton and looking at a general practitioner model where they have the ticket and that is done in many rural and remote areas. So it is not just what is the actual funding required but what is the funding and how do we find that internally by better use of resources.

The same thing with the physician model. If you see the physician resources and a territorial resource as opposed to authority by authority, you can actually expand the use of nurse practitioners. This is where the Territorial Support Network and the use of electronics to maximize that use is coming in. When you are in the health system, you have to have the key decision-makers and providers lined up, and a lot of the work was rejigging and realigning the medical directors forum and getting them back into the leadership piece. The other professions have to follow suit, but that was a major piece of it because the medical leaders have to take leadership around the number of labs, the number of tests, the kinds of things that both the locums and general practitioners are doing. So they have looked at

standardization of referrals, clinical screening guidelines, all of which brings efficiency and patient safety and quality into it. Some of the other things have been what is a better way of covering off, how do you manage your ORs. You have greater efficiency in large hospitals, but even looking at the amount of time to turn over an OR and is there a way of increasing that. So we’ve looked. Hay River can turn it around fast. How can we bring that over into Stanton and Beaufort-Delta? Some of it is equipment sterilization. Some of it is manpower and how we better utilize them. So your efficiencies are less about deficit but they’ve hit that cost curve on deficit because of the ongoing increase in need. So it’s everything from staffing mix, how are we using our specialists, what kind of programs are in each authority, and can we do that as a system better. Quite frankly, over time there have been a lot of services that are managed by those authorities currently in deficit or close to -- I would throw Yellowknife Health and Social Services into that -- and how do you align where you have a surplus. Part of that has been that those services can’t be and won’t be provided in those authorities so how do you have the dollars basically flow with the patient?

It’s quite a massive undertaking. Every time you peel this one it gets more interesting. I do think that there are efficiencies for scale, less so at Beaufort-Delta just because of size, but certainly as a system there are efficiencies. So when you’re talking about what are we doing, we’re trying to address that cost curve and live within the growth that’s been given to us but also to make a business case of where money has to move or where we have to reprioritize within the system. That’s just a highlight.