Mahsi cho, Mr. Speaker. I’m sure we will be covering a lot of these issues as we go through the detail of the business plan, but I will touch on some of the comments.
Midwifery was brought up fairly consistently. We are rolling out a plan. We have midwifery, yes, and we’ve had midwifery, yes, for quite a while, but we have a community midwifery program. We are trying to expand that into a regional midwifery program and ultimately a territorial midwifery program. We see quite a difference between a community midwifery program which is successful and a regional and then ultimately a territorial midwifery program. We don’t see that as just taking the current successful Fort Smith model and plopping it in Yellowknife and calling it a territorial midwifery program. There is more to it than that. An example was brought here with the midwives going out to the communities. That is a regional midwifery program. That is not what we have in place now. We need to develop this program so that, even if it takes us the extra year to develop, we want to develop a good program; not a fast program, a good program. That’s what we’re trying to do here. We are trying to put a program in that will see long-term success, not a program that needs to be rushed in because we’re being pressured by some people to say we need to have a program, we need to have people in the communities ASAP.
Lots of discussion about addictions, and many other items that were brought up by the MLAs relate to that. We don’t necessarily have a specific program that would say we are going to do this, this and this in family violence. However, we do have programs in place. We do work with NGOs. We are also trying to address the main cause of family violence and that’s alcohol. We have to be able to see the link.
If we are addressing the main issue of people being in jail, if we are addressing the main issue of people being in the hospital, if we are addressing the main issues of chronic disease, then I don’t think we have to draw out programs that are put in place necessarily to combat those specific issues. We are trying to move towards prevention, as the MLAs have clearly indicated to us over the last couple of years. What we are doing is we are saying let’s work on the cause. The cause will then… Then everything else kind of falls into place afterwards.
An example that I like to draw upon is, if we had no alcohol, we would have very few people in the correction centres. At $90,000 per person per year, that is a substantial savings to the government. We would have many people that would have jobs. We could put a major dent into income support. People would be ready to go to work. There are all kinds of factors that this type of thing impacts.
When we came to work to do this job that’s the first thing we asked. What’s causing all of the problems? The answer was clearly from the communities: addictions. But we can’t continue to pick at programs that are caused by the addictions. We want to address the addictions issue. Of course, we’ve done other things that are not social services, although they are social determinants and they impact on other things like governance. Sometimes governance prevents us from moving quickly through the process.
Right now we have a system where each authority has responsibility for physicians. Each authority has responsibility for nurses. Each authority has responsibility for bringing social workers into the mix and mental health workers. Yes, we need to develop the social Integrated Service Delivery Model. We recognize that. We are clearly behind in the improvement of the integrated or the revision of the Integrated Service Delivery Model, there is no question about it, but that’s because we have a lot of other pressures.
You notice in the House or in our business, there are always demands for us to do this thing or that thing. So a lot of times we are putting out fires, so we don’t get the opportunity to take our people that are there currently doing the firefighting to take them off of that job and put them on the redevelopment of an Integrated Service Delivery Model. As an example, which is essential to our system, this is an essential tool to our entire health and social services system. Once we develop that, we’ll know what’s needed in the communities.
We know what is needed as far as nursing goes in the smallest community to what’s needed in Yellowknife, our largest community. This is the delivery model that is going to tell us that. But we have to do that. We have to get to it.
We have talked about medical travel. We see the efficiency of medical travel will increase overall efficiencies. So what we are doing is, because we are not given a full opportunity to work on the medical travel and to revise medical travel, we are doing other things that we think are going to help reduce the cost to medical travel, and that is things like the electronic medical records.
In as far as the funding that is causing the Stanton Territorial Hospital from being in a deficit, it is true. The MLAs know that medical travel is over $3 million. Physician funding. Yes, physicians sometimes are providing support to other authorities and are being paid through Stanton and it is causing a bit of a deficit there. However, we are going again to look at medical travel, making a decision on whether or not medical travel should continue to be housed in Stanton. Maybe pulling medical travel as a departmental program then would no longer would have this deficit effect on Stanton.
The MLAs talked a bit about prevention versus treatment. It is difficult to move fully into prevention because we do have to maintain the health of people that are currently sick. There is some treatment that has to continue, but we clearly see that the more prevention we do down the road, and I use the term upstream work for downstream positive impacts. We recognize that prevention is exactly that. It is good upstream work done so that we have positive results downstream. We are introducing things that, although I don’t want to get into the very specifics of it, we are looking at developing legislation that will allow for us to have second opinions. We see that as a fairly critical piece of the puzzle, too, that if somebody thinks that they are being misdiagnosed, then they can get a second opinion and we are able to pick up the correct diagnosis as a result. Then we could save money in the system.
We see that Stanton Territorial Hospital upgrade is a capital item. It is briefly discussed here. We can see that as a capital item. We will have an opportunity to discuss that when we discuss the capital item, but it’s going into the system, we’re looking at it. I do believe we’re doing the planning study now. So we will have a pretty good idea of what’s going to happen with the hospital. I think it’s fairly clear that we need to do something, but exactly what, we’ll decide once the planning study is done.
There is some discussion on long-term care and how we are hoping to address that issue. We do recognize that long-term care is a costly thing in that our people are aging. I use the number 25 percent more. I think I may have said, in the next 10 years there will be 25 percent more people over the age of 65 in the Northwest Territories. We have to prepare for that, and part of preparing for that, I think, is trying to develop a system where we’re trying to provide a continuum of care for seniors.
We don’t see any other alternative. We cannot afford this system, or no system in this country, actually, can afford to take people and put them into residential long-term care facilities. In our system it’s costing us $110,000 per senior. So we have a couple in there who could be in their own home, potentially, but we haven’t made that shift yet. It’s costing the system maybe $220,000 for one family to be in there for one year.
What we want to do is look at all of that. We started work with the NWT Housing Corporation, the Housing Corporation is expanding their assisted living facilities into four communities. We want to work with them. They’re putting a common area in their facilities, so Health has an opportunity to put programs into those facilities. That’s a collaboration amongst a few other things that we’re collaborating on.
We’re collaborating with, I think MLA Bisaro said it was good to see some collaboration in early childhood development. The department is collaborating with DOJ, Department of Justice, and specialized courts. We’re partnering with Education in developing school curriculum for mental health. We see that as important, the whole development of that. As we lay it out in our action plan, we see how to open the door to get the discussion going and to talk about mental health and the issues that surround that, and that mental health doesn’t have to be something that… It should be something that is addressed. If you hide it, you don’t address it.
We work with ECE on early childhood development. A few MLAs talked about that. We work with ECE, DOJ and NWTHC and ITI on the Anti-Poverty Strategy. We worked with MACA, DOJ and DOT on ground ambulance, and the NWT Housing Corporation, again, in providing continuing care for adults. Also, we’re working on a Healthy Choices Framework with ECE.
Mr. Chairman, I’m just going through the list. We’re going to have discussions with BC Health, the community of Fort Liard, and seeing what type of arrangement we can make that would be similar to the arrangement we have with Alberta Health. We see that geographically it may be a good idea. If we fully develop the ground ambulance in our legislation, as we talked about in committee on emergency medical service providers, then we develop that legislation. Once the umbrella legislation is developed, then one of the professions that we look at under there would be the emergency medical service providers. If we’re able to develop regulations in there, we should be able to continue working with MACA and DOT on full implementation of providing ground ambulance service.
Community wellness. We do receive a fair amount of money for community wellness through the federal government. We are working actively within the department to make sure that we develop community wellness plans for all the communities.
The funding that was referred to, I think we do have to sort that out. Mainly we want to develop wellness plans in every community that lay out what’s needed and where we’re headed. We want to know, community by community, how we’re going to make the communities well, how we’re going to move towards that. Again, that all goes back to, essentially, prevention in the business that we are in.
Nurses in small communities, again Integrated Service Delivery Model is going to determine our needs in the small communities. We may be able to do it in the communities as we work our way through the system with the nurses if we have, like I think was specifically mentioned, licenced practical nurses in the small communities. We need to develop some sort of system that allows them to be in there, because they have to be supervised by a registered nurse nearby. Then maybe there’s other work they can take on; for example, in home care, developing some work with foot care and so on. These are all things that we need to work on and continue to do so.
The funding for the flexibility built into the position funding, I indicated in the House that we will have a proposal, whether it’s a business case that’s developed by the authorities. We’re hoping to have their input, the request coming from the authorities. To provide that flexibility, we want their input. One way of another we’re going to present a business case as an interim measure, likely, to Financial Management Board by April 30th. If it’s not a problem, then that flexibility may allow the authorities to hire nurse practitioners where they’re having difficulty getting doctors.
We also have a plan to bring doctors in. We’re working with the NWT Medical Association and we want to bring doctors into areas where we usually have doctors, and that is Hay River, where there’s seven doctor positions. When we look at that Integrated Service Delivery Model, then it might be more than seven doctors. If the new health centre is a good place to provide a service to Fort Resolution, Fort Providence, Kakisa and the Hay River Reserve – they probably provide service there already – and Enterprise, then there might be more doctors than that.
I’ve asked the authorities to give me a model of how they’re going to or plan on bringing physicians into the authorities. We’re doing it. There are two physicians in Smith that weren’t there last year. There are five in Inuvik and we’re working to bring the physicians into Hay River. Like I said to the Members from Hay River, plan A is to have doctors living in Hay River, plan B is to have the same doctors that will provide the service in Hay River living in Yellowknife. So those doctors will be the same doctors that are going down there every week to provide a service, and they have their caseload, and they’ll have their patients and if there’s any need for the patients that come to Yellowknife to see the same doctor. So, ultimately, we’re trying to achieve the same objective, and that mainly is to have doctors north of 60 living here and practicing here and providing a service.
We talk about all the technology that we’re trying to employ. I think the young doctors recognize that’s a really good tool for them and it’s a really attractive place to come to work. Hay River is going to have a modern health centre and Norman Wells is going to have a modern health centre. Fort Simpson is going to have a modern health centre. Stanton is going to be upgraded – although we don’t have trouble attracting doctors to Yellowknife – and Inuvik is attracting doctors. So if we look at the whole system, we’re putting technology, proper infrastructure in place so that it’s attractive so that we bring the physicians here.
Aside from providing excellent service to the people of the Northwest Territories, as far as physician services go, it also should reduce costs. It should reduce costs in medical travel and also reduce costs of having to bring doctors in from other parts of the country.
We do plan on doing something with the report from the Addictions Forum, quickly. I think there was a recommendation here that something has to happen by the fall. I hope that we’re able to put some of the work in play by the fall, but the first thing we have to do is we have to look at the report, to examine the report and see what type of things we’re going to need to do.
Surprisingly, some of the initial discussions that they’re having were related to parenting. I think an MLA here mentioned that today. It’s very important that they have good parenting at the community level. Good parenting everywhere is essential to our whole system. We have the school curriculum, like I indicated, that’s again targeted to youth, and anything right now that’s being paid by the federal government through THSSI will be paid by the GNWT if that THSSI funding is pulled.
We can’t just eliminate that funding and say, well, we’ll reduce our medical travel by that amount; we’re going to not have the physician funding that comes from THSSI or we’re going to lay off six nurse practitioners in our system. We will not be able to do that. But it’s my mandate as a Health Minister to try to sign another agreement with Health Canada on THSSI. Most of our other agreements are now long term. I mean, the Premiers themselves negotiated the Health Transfer Agreement and other agreements are long term.
I recognize the child and family services review is something that needs attention, and one of the key elements of change would be to make sure that we have committees in the communities. It’s very difficult to do. It’s a more difficult task than I anticipated, that’s for sure, but it could be a couple of reasons. One is the sustained pressure on the staff and, ultimately, on the communities to try to put these committees together may not be there. That may be lacking in our system and it’s something that I want to get back to. When I started a year ago, it felt like such a huge priority, and then essentially just get engulfed with all kinds of other priorities in the health and social services system. But we’re going to step back from this again and say we need to provide a sustained pressure on to the system and on to the communities in order to make sure at least those committees are in place.
Some aspects of the report we’re doing. We recognize that one of the key things is healthy families. We’re expanding Healthy Families, we’re continuing to expand Healthy Families throughout the system, and Healthy Families is something that we’re hoping to have in either a satellite operation or a person working in the community in all the communities where we have births. Where all the kids are born from, I should say, because we don’t have births in the actual communities, but that’s what we would like to have, Healthy Families to support young, pregnant moms, and then on to early childhood development and then working again with Education to try to make sure that we are producing healthy children that are ready for kindergarten when they’re five years old. At five years old we’re doing that measurement as a government. Through the Department of Education, Culture and Employment, we’re using the early development instrument, and in February of their kindergarten year, all kids are evaluated. We’re going to see a progress every year. So that will be a real, real good measuring tool and, theoretically, I’m seeing these numbers go down where we have children that are not right up to par at that grade and in kindergarten. That number should continue to go down every year, should. If we’re putting money in where we think it’s going to have an impact for us, Healthy Families is really where we need to go.
We need to look at the working poor, like Ms. Bisaro talked about. We recognize that. They’re not the indigent health benefits, they’re not the extended health benefits, they’re not the Metis health benefits, but they’re the health benefits that don’t exist to this certain group that make too much money to be indigent but not enough money to pay for the medicines that they need to remain healthy. So I know that the House wants to look at that, but that’s more money into the system. So we see that as a gap also, but we don’t have a program to cover it at this time.
Social determinants. We strongly agree with the Member who talked about the social determinants of health. We see that, we recognize that. If we’re able to address early childhood development, education, job-ready people, food security, health services, income. Right there, there’s the plan. We’re able to address those issues. If we’re able to make progress in those issues, we’ll make progress in the health system, no question about that.
Chronic disease management. Chronic disease management is a serious thing. We have the three pilot programs that we’re going to report on this coming spring, and we’re going to develop from those three pilot programs a chronic disease management for the Northwest Territories. We consider that, again, to be one huge essential part of the health system.
The Member for Sahtu talks about sort of how I view a continuum of wellness. This is what we are trying to develop. This is what we’re hoping the Addictions Forum can provide the key elements to what we need to develop this continuum of wellness in the system. Very important. We’ve never really looked at residential treatment as a piece of the puzzle where people are going there to get educated in addictions, but we need to look at that as a piece of the puzzle, where people are going there to get educated in addictions. Then that’s the very beginning of the step towards wellness. As they move through the system, the last step is a personal responsibility. The person who is afflicted with addictions, has to take personal responsibility for their addictions. If their addiction is costing them job, health, family, then they have a personal responsibility to address that issue.
As a government we have a responsibility to provide them with some of the tools necessary to achieve that, and for us that’s very clear, that we bring this down to that level. We have a responsibility in this whole addictions field and so do the people who are afflicted with addictions. We have a shared responsibility. We don’t have all the responsibility. I can’t cure or the Department of Health can’t cure someone from addictions, but we can help. We can provide a place for him to get educated in it. We have provided a place for him to go to where he’s comfortable and he’s talking to people who are experts in the field. We can provide things to the youth and we can provide education in the schools. We can do all of those, but at the end of the day it’s a personal responsibility and a personal choice. If it’s affecting your life negatively, then you have a responsibility to address that issue. Depression and all of those things that come with addictions, and other things, but some come with addictions.
We have a health status report that looks at the physical health of people. We have that. That’s available. We don’t have a health status report on the mental wellness of people. It’s interesting, because as I’m sitting here listening to the comments from the Members, that’s something I see as a gap in the system. But, again, it’s very difficult to do. The Mental Health and Addictions Action Plan lays out how we can do that. The very first step is just to talk about it, and recognize it, and don’t hide it. That will be the steps that we need to take, initially, to be able to do a mental health or wellness status report. When the Member brings up how do you guys determine the report card of health, we can say, well, we have the health status report. If they ask us, how about mental health. We’re just beginning that process.