Thank you, Mr. Ramsay. Final, short supplementary, Mr. Hawkins.

Mr. Speaker, I’m not the problem. The reality is the mine isn’t meeting its commitment. It barely meets 50 percent of northern Aboriginal workforce, just barely over 50 percent northern workforce, 64 percent of our workforce in total is coming from the South. You know, those tourists, just visiting, working here.

I have not heard anything on what concrete actions can he take to get Northerners working at this mine, because the way the commitments are written in the socio-economic agreement they’re not fulfilled, Section 10 is ignored, Section 9 is ignored, Section 8 is ignored. Who is responsible and who is taking responsibility for this? Thank you.

---Applause

Sorry, Mr. Ramsay. Let’s have a little bit of decorum in here, a little bit of respect for Members’ replies and questions here. Mr. Ramsay.

Thank you, Mr. Speaker. It’s in both industry and the Government of the Northwest Territories’ best interest to have employees living here in the Northwest Territories. Again, ITI was responsible for the negotiation and completion of the socio-economic agreements and the training requirement is the responsibility of the Department of Education, Culture and Employment. As I mentioned earlier, we work closely with Minister Lafferty and his staff, we are currently trying to put together a pan-territorial approach to mine training that would look at providing the funding for both the Nunavut Territory, the Yukon Territory and ourselves for years to come because of the mining activity taking place in the three northern territories. We’re hopeful that we can get some success on trying to find some funding from the federal government on that initiative and there will be some good news coming soon. Thank you.

Thank you, Mr. Ramsay. Item 9, written questions. Item 10, returns to written questions. Item 11, replies to opening address. Item 12, petitions. Item 13, reports of committees on the review of bills. Item 14, tabling of documents. Item 15, notices of motion. Item 16, notices of motion for first reading of bills. Item 17, motions. Item 18, first reading of bills. Item 19, second reading of bills. Mr. Ramsay.

Thank you, Mr. Speaker. I seek unanimous consent to go back to item 14 on the Order Paper. Thank you.

---Unanimous consent granted

Thank you, Mr. Ramsay. Mrs. Groenewegen.

Thank you, Mr. Speaker. I seek unanimous consent to go back to item 3 on the Order Paper, Members’ statements.

---Unanimous consent granted

Thank you, Mr. Speaker. Thank you, colleagues. I didn’t get a chance to do my Member’s statement earlier but I wanted to speak a little bit today about the process that we’re in here right now. This is what we call the budget session. It’s the longest session and it’s the longest sitting of the Legislature. We go through the normal orders of the day, but one thing that makes this session very unique is that in Committee of the Whole, we go department by department and consider the budget. We approve the main estimates during this process we call the budget session. I’m sure that the people out there in the Northwest Territories are hanging on every word we say and they’re really enjoying this, but I have some issues with our process and how we do this.

In the 18 years that I have been an MLA, I have never seen the Caucus, the full Assembly ever come together and question the process and protocols of how we pass this budget. I think anybody watching this can pretty well conclude that most of the dialogue, debate and work that goes into the budget has gone into it behind closed doors before it ever gets to the floor of this House. When it gets to the floor of the House, there is no opportunity to add anything to the budget. We can delete things but we cannot add a thing. The people should know that. There are things we can do: we can hold up the passage of a department, we can make recommendations to the government, but by the time it gets here in the budget session, the budget is set except for the potential for deletions, which does not happen very often. We cannot add anything to the budget. So we spend an extraordinary amount of time, hours and hours and hours, sitting in Committee of the Whole going over the budget.

Myself, for one, I do not have a huge appetite for micro-examining every line in our budget. I am here, I hope, to make a difference and I would like to think that, as legislators, we are here to set broad policy direction and vision for our government. I have no interest in being an extension of the bureaucracy. I am not a bureaucrat. I am not a technocrat. I do think I have a vision and I am here in this Legislature because I want to see good things happen. I want to see change. I want to see progressive change.

I want to say today that I seriously question why we do not have more processes in place that would allow our public – because that’s what this is all about, it’s what the public sees – to see creative, spontaneous and lively, real debate in this House. Our processes do not allow for that and that is a sad thing. I’d like to see it changed.

Thank you, Mrs. Groenewegen. Item 20, consideration in Committee of the Whole of bills and other matters: Tabled Document 9-17(4), NWT Main Estimates, 2013-2014, and Bill 1, Tlicho Statutes Amendment Act, with Mrs. Groenewegen in the chair.

Okay, I’d like to call Committee of the Whole to order. The Speaker has indicated what is before us today. What is the wish of the committee? Mr. Menicoche.

Thank you very much, Madam Chair. The committee wishes to consider Tabled Document 9-17(4), NWT Main Estimates, 2013-2014, with a deliberation of Health and Social Services.

Thank you, Mr. Menicoche. We will proceed with that after a brief break. Oh, does the committee agree? Sorry. Does committee agree?

Thank you. We’ll commence with that after a brief recess.

---SHORT RECESS

I’ll call the committee to order. The next department we have is the Department of Health and Social Services. I’d like to ask Minister Beaulieu if he has any opening remarks for his department.

Yes, I do, Madam Chair. I am pleased to present the Department of Health and Social Services’ main estimates. The proposed operating budget for 2013-2014 is $363.856 million which represents a 4 percent increase from the current fiscal year.

This budget includes $9.1 million in forced growth and $4.6 million in new initiatives. Like other provinces and territories, we are facing cost increases in areas such as staff compensation and investments in new technology. The budget also includes forced growth to address compensation and other inflationary pressures.

I would like to report our budget includes $4.6 million in new spending to address the priorities of this Legislative Assembly.

The department clearly sees the link between investing in prevention and promotion, and containing future health care costs. New investments approved for the 2012-2013 budget, when combined with the proposed new initiatives in the main estimates, will result in 3.4 percent of the department’s budget being dedicated to direct prevention and promotion activities.

But in reality, the proportion is higher. It’s difficult to carve out prevention and promotion-related work from our broader mandate – there is so much overlap between this area and other priorities. Much of what we do in health and social services is directly related to promoting healthy lifestyle choices, investing in broad public health initiatives and preventing disease in the population. For example, when I speak of new resources to advance the department’s Mental Health and Addictions Action Plan, $370,000 of that funding will support working with youth and community members on prevention and promotion activities. When I talk about rolling out a territorial midwifery program, we know that improving prenatal care and supporting families and children during the first months of life is an important investment in early childhood development. Most of our chronic disease management initiatives include prevention and promotion elements.

The budget includes an investment of $142,000 to ensure that our children are receiving the most up-to-date vaccinations during their early years. The completion of the Revitalized Early Childhood Development Framework will help identify future investment or reallocation priorities.

This budget responds to the priorities of this Legislative Assembly by including $1.1 million in new funding to address gaps in services for mental health and addictions, as identified in the department’s Mental Health and Addictions Action Plan. In addition to funding for school curriculum development and working with youth, this new funding will support implementation of new and expanded on-the-land treatment programs, final development of a territorial Youth Addictions Treatment Program, and development of a territorial detox model and implementation plan. Ensuring that we have an effective range of community-based and medical responses to mental health and addictions issues is a foundational piece to many other priorities of this government, including the successful development of a specialized courts program.

It is widely recognized that by promoting healthy lifestyles, and by doing a better job of diagnosing and managing chronic diseases, we can improve quality of life for our residents and also help to control health care costs. Forty percent of admissions to NWT hospitals are linked to chronic diseases, including diabetes, heart disease, mental health and addictions issues, and cancer.

We have skilled and dedicated people working in our system, providing excellent care. But we also have a system where we rely on locum physicians and nurses, which makes it difficult to ensure continuity of care. Because of our governance structure, health and social service authorities have adopted different standards of care across the NWT.

This is why the chief executive officers of health and social services authorities, medical directors and board chairs asked the department to put in place system-wide leadership to ensure that every resident receives the best care possible.

This budget includes $1.2 million to ensure that consistent standards of practice are in place throughout the Northwest Territories, and that every person diagnosed with a chronic disease receives the best support and treatment available within our resources. A chief physician advisor will lead the development of clinical practice guidelines, and the department will have the capacity to monitor implementation and outcomes.

An exciting initiative in the budget is funding to support the rollout of an electronic medical record for the territory. The Northwest Territories is the first jurisdiction in Canada that is poised to implement an Electronic Medical Record system, or EMR, on a system-wide basis, with assistance from Canada Health Infoway and GNWT capital funding. The budget includes funding to support practitioners, to provide training and to maintain the system.

One of the many advantages of an EMR is that it is an excellent tool for chronic disease management. Health practitioners can use it to research current standards and enter reminders for follow-up treatments. Electronic medical records help to ensure that once a chronic disease is diagnosed, every patient receives the appropriate ongoing treatment. The system-wide EMR will enhance patient care, and we are told that it will serve as a recruitment tool for new physicians. Today’s doctors are educated using modern technology and are eager to practice where they can utilize the latest advancements.

In addition to these investments, the department is working in close collaboration with other organizations, such as the Canadian Partnership Against Cancer and the Canadian Foundation for Healthcare Improvement, to adapt best practices for our communities. Through pilot projects that will wrap up later this spring, we have documented ways to improve care for patients with mental health issues, diabetes and kidney disease. These improvements will become standards in our system after the pilots are evaluated.

New funding in the 2012-2013 budget allowed us to begin the development of a Cancer Awareness and Response Strategy. Workshops have been held in two communities, and these workshops have helped to define the actions we need to take. We need to improve access to screening, help people understand what they can do to help prevent cancer, and provide better support to cancer patients and their families. This important work will continue.

While still relatively low compared to the rest of Canada, we know that the incidence of diabetes in our population is increasing. To ensure we can maintain our current level of treatment for diabetes-related disease such as kidney disease, the budget includes funding to support existing dialysis and renal disease management programs on an ongoing basis.

Members of this Assembly have been unwavering in their support for the establishment of a territorial midwifery program. The existing midwifery service in the Fort Smith HSSA is an example of how this important service can improve the health of mothers and babies throughout pregnancy, delivery and the early months of life. For years we have supported the Fort Smith program with time-limited federal funding. This budget includes base funding so that the program is sustainable over the long term.

I am also pleased that the budget includes additional resources so that we can begin to expand midwifery to other regions. Beginning in Hay River in the 2013-2014 fiscal year, our vision is to expand midwifery services to Hay River and the Beaufort-Delta. Ongoing evaluation and monitoring of program outcomes will help inform future expansion. Eventually, we hope to offer a territorial midwifery service in Yellowknife as well.

The population of the NWT is aging. Over the next five years, the proportion of NWT residents over the age of 65 will increase by 25 percent. As people live longer, there is a greater chance that they will need long-term care. Our long-term care facilities are under pressure, with a greater number of residents, and a higher level of care needs. This budget includes $1.1 million to enhance staff levels at three long-term care facilities: Northern Lights in Fort Smith, Aven Manor in Yellowknife and Fort Simpson. This will improve security and safety so that our elders will receive appropriate care and support.

Over the next year the department will work on a strategic plan for the continuum of care for elders, with a goal of keeping seniors in their own homes and their own communities as long as possible.

Medical travel plays a major role in our health and social services system, and has done so for many years. Not only is it a cost-driver, but it can be a burden to patients and families. Advances in communications and medical technology have already allowed us to avoid unnecessary travel; for example, by sending digital X-rays of potential bone fractures for review by specialists in Yellowknife or Edmonton. We have the potential to do so much more, not just in emergencies, but also for routine care.

In Newfoundland and Labrador, Rosie the Robot provides a connection between patients in remote communities and physicians in St. Johns. In Halifax, obstetricians use a “Doctor in a Box” to monitor pregnant moms in Bolivian mountain communities. We will follow their lead, and use the full functionality of modern technology to bring services to our residents in as many ways as possible.

This budget includes $472,000 to take the first steps towards establishing a virtual call centre that will provide 24-hour consultation and care to health practitioners across the NWT, using a wide range of technology including phones, digital imagery, webcams, and e-consults over the EMR system. A similar long-distance critical care centre in South Dakota reports an 18 percent decrease in patient transfers, and savings of over $6 million. Containing costs is important, but more important is to improve our residents’ access to quality care in their home communities. The installation of a fibre optic link down the Mackenzie Valley will support the increased use of electronic health technology, enhancing the potential to expand these services.

This concludes my opening remarks. I am happy to answer any questions. Mahsi.

Thank you, Minister Beaulieu. Before we proceed to general comments, I’d like to ask the Minister if he’d like to bring witnesses into the Chamber.

Yes I would, Madam Chair.

Thank you, is the committee agreed?

Agreed. Thank you. I’ll ask the Sergeant-at-Arms to please escort the witnesses to the table.

Minister Beaulieu, for the record could you please introduce your witnesses.

Yes, Madam Chair. To my right I have Debbie DeLancey, deputy minister of Health and Social Services. To my right I have Jeannie Mathison, director of finance, Health and Social Services.