Thank you, Mr. Moses. Motion is on the floor. To the motion.

Question has been called. The motion has been carried.

---Carried

Item 18, first reading of bills. Mr. Miltenberger.

Mr. Speaker, I move, seconded by the honourable Member for Inuvik Twin Lakes, that Bill 8, Write-off of Debts Act, 2013-2014, be read for the first time.

Bill 8, Write-off of Debts Act, 2013-2014, has had first reading.

---Carried

Mr. Miltenberger.

Bill 9, Forgiveness of Debts Act, 2013-2014, has had first reading.

---Carried

Item 19, second reading of bills. Item 20, consideration in Committee of the Whole of bills and other matters, with Mrs. Groenewegen in the chair.

I’d like to call Committee of the Whole to order. There are a number of items before us today in Committee of the Whole. What is the wish of the committee? Ms. Bisaro.

Thank you, Madam Chair. Committee would like to consider Tabled Document 22-17(5), 2014-2015 Main Estimates, and we’d like to continue with the Department of Health and Social Services.

Thank you, Ms. Bisaro. Does committee agree?

We will resume after a short break. I might remind Members that we are going to a reception in the Great Hall. Thank you.

---SHORT RECESS

Thank you, committee. We left off with the Department of Health. Minister, do you have witnesses to bring into the House?

I do, Mr. Chair.

Thank you, Minister Abernethy. Does committee agree?

Thank you. I’ll ask the Sergeant-at-Arms to escort the witnesses into the Chamber.

Thank you, Minister Abernethy. I’ll ask you to introduce your witnesses, please.

Thank you, Mr. Chair. With me today are Debbie DeLancey, the deputy minister of Health and Social Services; and Jeannie Mathieson, director of Finance.

Thank you, Minister. I’ll now open the floor to general comments on the Department of Health. General comments. Mr. Dolynny.

Thank you, Mr. Chair. I’d like to welcome the Department of Health and Social Services here today. We’ve got a fairly daunting task before us here in the next day or two. I’m hoping to try to evaluate the current budget here for the Department of Health and Social Services. I did have a chance to read the Minister’s opening remarks again, and obviously, I had a chance to

read one of his statements earlier today on the health and social services system. So I’ll try to amalgamate both here today in kind of a general overview at a high level here.

I think we are in a ripe position to reposition the department where it is today. I want to make sure that the message is loud and clear that just by changing the leadership as we did here a couple of months ago, in my humble opinion, isn’t going to fix all of our problems. It’s just one of the many solutions that we have before us. We are encouraged by some of the recent actions by the Minister and have seen some great strides in a short period of time.

That said, there is definitely still room for improvement and I think the Minister and the department would probably agree with that. I believe the system in itself is doing a relatively good job and I think our territory is recognized to being comparable to across Canada.

We are definitely falling short in some key areas and some of the real disparities still to this day are the levels of care between Aboriginal and non-Aboriginal. I think I’d like to hear more about narrowing that gap of disparities as we move forward and for the remainder of the 17th Assembly.

We know that we’ve got the highest rates in Canada for alcohol consumption, binge drinking, smoking and suicide and yet some of the programs we have aren’t really hitting those numbers and bringing them down. We’re seeing some decrease, but quite frankly, we’ve got such a large margin to improve upon that I think we need to take a better look at a larger number of bringing those numbers down.

We have a very high hospital admission rate which is still concerning, given the ratio of population base. I believe our injury rates vis-à-vis the rest of Canada are 10 times higher than the national average. So, we’re dealing with some pretty daunting statistics and we’re facing a lot of challenges in the Northwest Territories in meeting the high quality of health and social services deliveries.

Of course, we have a lot of things that are still plaguing a lot of our areas in our health authorities. We’re still having issues in recruiting the right calibre of professional staff. We still have a lot of technology that’s missing in our communities to allow that emerging technology to reduce wait times, better outcomes and everything else. I know there are lots of variables that are coming to light. The fibre optic line that should be operational in 2016 will definitely be a benefit.

One of the areas that I find the budget is not addressing enough of, and we’ve heard a little bit here today and in the last couple of days, is our aging population. Again, it would be nice to get more of a positioning statement from the

department where the aging population fits in the health care sector.

The Minister has been showing strong leadership and championing a bit of a reform, if you like, in terms of how the overall structure of our health system is currently being handled and ways of improving. It’s enlightening to hear that we’re actually moving and making headway on that. I didn’t capture a lot of that in the opening comments, but I think 2014 will be one of those years of change. I’m looking forward to working with the department, working with the Minister and working with all the stakeholders, including the Joint Leadership Council, with Regular Members and committee to create a more cohesive and stronger health care system delivery.

However, there is still the issue of quality of care. That quality of care, I find, is not the same standard across the Northwest Territories. We have, in many cases in today’s environment, many of the authorities not delivering the programs consistent to the standard of care that many of us take for granted, and I think that’s something that needs to be highly emphasized more than what we’re hearing today. I think there is still a feeling out there that many patients are falling through the cracks, and the follow-up process that we deal with a lot of our patients, once they receive primary care in our hospitals, are finding that they’re not getting that follow-up care in their respective communities on their return home. I think that’s something we still need to look at.

When it comes to tracking our key indicators and how we’re doing as a system, again in referencing even in today’s delivery from the Minister here, we’ve got a number of reports – Health Status Report, physician services utilization report, addictions and substance use report – and a lot of these reports are great. Unfortunately, they’re so sporadic, some of them are five years in length, some of them are three years in length, and we may literally only see one of these reports in the life of this Assembly, which is very hard to try to gauge and create those compass points in terms of how effective some of these changes might be occurring. I know there are costs involved for providing these accounting and key indicators, but without key indicators, without any type of gauge really, how do you evaluate your performance? This is something that I’d like to work with the department, I’d like to work with the Minister to try to see if we could tighten up some of the lapsed time between some of these major reports, maybe looking at a more cohesive look at key indicators and have a bit more of a dashboard, ongoing, real-time dashboard monthly on key issues that affect the Northwest Territories as a whole. These are opportunities, these are barriers that have been overcome in other provinces and in many areas in the United States where they’ve actually been able

to overcome that. I think there’s opportunity here. I’d like to hear it from the department as well.

When it also comes to accountability, I’d have to say although I believe most authorities are doing well when it comes to spending their budgets appropriately, still to this day – and I’m echoing the same words of the Auditor General report – we have contribution agreements in place but we don’t have all performance in place, to my knowledge. If that’s the case, we still have authorities with surpluses and deficits, and sometimes the same authorities that have those in tow, which again should raise alarm bells. If you haven’t spent all your money, have you delivered all the programs? Again, it goes back to my first question, how do you evaluate that in a real time setting, and I think, again, I feel that there is opportunity there. Also, I find that when you do travel from authority to authority, I’m not sure if that standard of care is all there in relationship to possibly what you may get in an urban setting. What I mean by that is that a lot of them will have their own strategic plans, some of their own visions and goals and measured goals and outcomes, and it would be nice to see us, with time, having a standard level of care. Again, going back to my earlier comment, minimizing the gap between Aboriginal and non-Aboriginal, I believe there is definitely opportunity as we move forward.

I guess last, but not least, and again in no particular order, I think it is very, very important because language really is the conduit of understanding our health care. We still struggle in a lot of our communities in having that service provided in that first language of choice. We hear this not only in health. We’re hearing that in justice. We’re hearing that in other types of services. I don’t want to be oblivious to the fact that I know you’ve got to find translators, there are costs involved, but if we can’t communicate, how do you deliver a service? It’s almost counterintuitive. I think we need to look at language as being the conduit of the transition of care for all communities, even to the smallest ones in the remote areas. I just don’t think it’s quite there yet. I want to hear that. I want to hear the Minister, I want to hear the deputy minister, I want to hear the Department of Health and Social Services shout this out more and more. I’m giving it more emphasis at the end of my opening comments because that’s probably one of the big areas, I think, of opportunity.

I appreciate the committee’s indulgence for allowing me almost a full 10 minutes here, but again, generally we’re seeing some good things here, but there are some huge opportunities as we move forward and looking forward to working with the new Minister for the remaining life of the 17th Assembly.

Thank you, Mr. Dolynny. Committee, I’ll just remind you, we’re

going to go through all the general comments and then have the Minister speak. Next on my list I have Mr. Menicoche.

Thank you very much, Mr. Chair. I just wanted to begin with some caution, I guess. I know the Minister is trying to streamline and provide quality service by having standardized levels of servicing in all our regions. I guess the concern that he heard when he traveled with me to Fort Simpson was there is still a need for some type of regional autonomy, community councils, along with some type of appointed members do want to still have their concerns at some board type level. I will just mention that to him again.

Recently, of course, I just spoke in the House about an elder being misdiagnosed, and just reviewing my notes, it has happened before. There were actually two incidents in Wrigley, two young girls in 2005 had their legs broken and weren’t diagnosed until about four days later. These types of things are continuing. I’ll ask the Minister in the House, I know that he just tabled a 25-year report. I haven’t had a chance to look at it, but it’s just about how do we track our clients being misdiagnosed and is one region higher than the other. That kind of approach will help our system keep track of how things are done, because, actually, when there’s a follow-up incident or follow-up investigation, we all should learn from it, much like I guess the coroner’s office does. How do we learn from this incident? How do we make it better for everybody else. Most recently, the elder that had cracked her hip in Fort Simpson, she spent four days at home before she was diagnosed with a broken hip and was medevaced to Yellowknife to receive the proper care and attention that she deserved. But it’s about examining that. In fact, the family told me that to raise it in the House only so that it doesn’t happen to somebody else again. It’s very stressing. Her children had to work and take time off from work to take care of her and that kind of stuff. If we had the proper procedures, I believe that she could have received her attention sooner.

On a similar note, it’s the care and attention that Wrigley residents want as well. They want consistent care and attention, that’s why they’re consistently asking for full-time nursing services in Wrigley. I spoke about two young girls that broke their legs in 2005, only because there wasn’t a certified nurse on site to make the call at that time. In fact, it was almost the fifth day by the time the nurse got there because there was a one day delay by fog. There’s an incident there. Then in 2009 in the community of Wrigley, out of 175 residents, 100 of them suffered from flu-like symptoms and with nursing in the community, that kind of stuff could have been monitored, picked up early enough. In fact, that lasted a week long. The Minister assures me, I think he said the nurse goes in there weekly, but for whatever reason the nurse didn’t go in there.

The only reason we sent medical staff in there was the chief and council had to get hold of Indian Affairs at that time, their health department, and they contacted us to send in medical staff to see what’s going on with these 100 residents that had flu-like symptoms. It was pretty scary. It was right in the midst of the bird flu scare at that time, as well, so nobody knew what was going on. It was only because we didn’t have staff on the ground.

We’ve been making progress towards that. We’ve got full-time dedicated RCMP services up there. I do know that Fort Simpson has dedicated staff that go into Wrigley as well. I’m hoping that we can arrange things so that these full-time paid positions can eventually relocate to Wrigley. I’ve been pressing the case that increased development in the Sahtu is increasing the pressures of the community as well. I think that was the same in about 1973 when the first Mackenzie Valley gas pipeline was planned. There was a highway going into Wrigley so everybody knew the increased pressures of modernization, as it were, I guess, so there was nursing in Wrigley and there was actually a staff RCMP housing plus a small jail there in Wrigley at that time. But over the years the pipeline didn’t go and so those services were withdrawn.

But having professional services there at that time made it a vibrant and healthy community, and now that those professional services are gone, the policing services, the community is really, really struggling at this point. The Minister spoke about the community wellness plan. With great effort they do have a community wellness plan, but I feel that without policing or nursing there that the wellness plan is not going to have a good chance of succeeding. At any rate, I’m pressing the case there that with increased development that we should restore their services to the community because it’s only going to get worse in the long term because with the development of the Sahtu it’s not only the winter roads now. They’re talking about increasing the pipeline, the oil rigs, or the Sahtu connecting to the existing Enbridge pipeline. There might even be two pipelines. It’s going to have a huge impact on the community.

With that, those are my opening comments. Thank you.

Thank you, Mr. Menicoche. Next on my list I have Mr. Moses.

Thank you, Mr. Chair. Welcome to the Minister and his staff to the House here. This is kind of our third kick at the can with the operations budget and it’s been an educational one, I think, for both the department as well as for Members of the House in terms of how we look at doing things differently or looking at things more efficiently and looking at where we can improve within the department itself.

With that said, I know this is the biggest budget in the government, but it is also one of the departments that has some of the more unique challenges that we don’t see in other departments. It is really hard to address and I commend the hardworking staff on the work that they do with the amount of dollars that we have and, as I mentioned, the challenges that we have.

With that said, before I get into some of the ongoing concerns and questions in areas that I would like to highlight moving forward, I know in the federal budget it was announced last week that all three territories are going to get a three-year funding of $70 million, so just moving forward, I want to make kind of a general comment on how those dollars will be allocated, or will something come before committee? Will committee have some type of input on looking at some of the priorities of this Legislative Assembly as a whole but also some of the initiatives that came out of standing committee moving forward?

It is always a concern for me, and something that I have tried to address and continue to address, I’m glad to see that the Mental Health Act is on the legislative list to be amended moving forward. Some concerns that I do have is that we have a lot of counsellors, 65 counsellors, but only in 19 communities. That is something that continues to stick with me, because in my discussions with the chief coroner as well as other constituents and people in the small communities, we need to address mental health issues. It is not always readily available. I appreciate the update that the Minister gave in the House yesterday on the NWT Helpline, that on March 1st it is moving to 24 hours

and staffed 24/7, so that is good news.

Something that I have kind of done on my own, working with my constituents back home that have gone to treatment, is having something in place within the government, possibly, that we have that ongoing support, ongoing treatment from the North with the individuals who are out of jurisdiction because, I guess dealing with a couple of cases here, individuals who do need treatment, sometimes they are left on their own and get stranded down south or have incidents where they have to try to find their own way back into their communities.

I am just going to stay on topic here with some of my Member’s statement today in the House in regards to oral health care. I know that we have had some money that sunsetted this year, I think $438,000 or something in that area, and with that money that is coming back, I know there was some references in other back and forth communities with the high rates of incidents of early childhood kids that are dealing with dental issues before the age of five, so we have the stats, they are known, so we just need that action plan to come forth. I think that

is a big one, because when I did more research on it, I saw that gum disease, tooth decay, can actually lead to more serious issues with the heart and other major organs.

With seniors, that issue I was dealing with in Inuvik just recently, so I looked at some of the things that we do here within our government and when I was looking on the website, I saw that we have a Seniors’ Action Plan from 2003. I think that needs to be looked at and possibly revised. Some policies that deal with seniors, whether it is with income assistance, income support or housing, or people living with disabilities, there is an opportunity to modernize that a little bit more with things that we are dealing with in today’s society, especially with the seniors population increasing.

Next month, the Minister does know, and staff probably know, that we are going to get a report back from the Office of the Auditor General in regards to child and family services recommendations that were brought forth and that is going to be interesting to see the results of that. I am not sure if I will be seeing any big dollars in the budget for that. How do they adjust those recommendations moving forward? I think there will be some action items that are going to need to be taken to task. That is why we are going through the process of possibly looking at trying to change the budgets and how to reallocate more funding dollars toward the Child and Family Services Act, especially when the Auditor General’s report comes out next month.

Something that was brought to my attention, and I know they do it here at Stanton Hospital and in some cases at the long-term care ward in Inuvik, is to deal with traditional foods. I do visits to the hospital and chat with some of the elders, but also some of the patients, and sometimes they don’t even eat because the food isn’t always up to par. That needs to be addressed and I think there has to be a better way to get some of the traditional foods in our communities, especially when we get residents from the small communities going into, say, regional centres or even here in Yellowknife, when they might not know a lot of people in the community that might be able to help and assist them.

One occurring thing that I have noticed up in the Beaufort-Delta is that there is a constant challenge with overtime and call-backs as well as authorities working in deficits every year. I know Inuvik, the Minister was up there and listened to some of the cost-saving practices that they did – and I think that this is something that needs to be adopted right across the Territories – ways that we can better improve our staffing in some of the department divisions and to deal with some of these call-backs and overtime, but some of the costs that are associated with it.

One thing that I am not sure is really taken into account here is the high cost of travel, specifically in the Beaufort-Delta in getting to the coastal communities is quite challenging at best. Even just dealing with the weather, but there is also an added cost to that moving forward.

They are all concerns, but as some of my colleagues have stated, there has been a lot of good work that has been done with the department and committee. I know the department has come before committee on numerous occasions where we have had really good debate and good discussion on a lot of issues, how do we deal with them and address them. I look forward to continuing those debates and discussions, those discussions with their partners, to come up with the best solutions for residents of the Northwest Territories.

One last thing, and colleagues have been bringing it up in the House on numerous occasions, and that is nurses in the small communities. I think we need to find a legislation that is going to work with that. I know it does deal with police presence and the RCMP presence in the small communities, but I think there is a way we need to try to adjust that, because there are mental health issues, there are a lot of health issues in the small communities that need to be addressed sooner than later.

I appreciate that there is midwifery dollars in this one. The Anti-Poverty Strategy, moving forward on that, that is really great news as well. Something that is also being reviewed, and I am glad that it is being reviewed, is the Medical Travel Policy. I know that one is always a tough one to deal with. I think we have to get something in place that is really strong and we can refer to whenever we send our residents south or even to regional centres like Yellowknife.

I guess to finish up with just translators. I know that is something that we have mentioned numerous times, possibly at every budget session, is getting proper translators for our elderly residents or our patients that only speak their own Aboriginal language. That needs to be addressed when they come in, and we have to look at the terminology. Obviously that is going to be a big, big project moving forward and I just want to bring that to the department’s attention as well.

I look forward to going through this budget and continuing the work that we have had with the department. Thank you, Mr. Chair.