Thank you, Madam Chair. I just want to touch on a few subjects, a little bit of repeat from my other colleagues, but I do think it’s important to further lend strength and emphasize in certain areas. I’ll certainly bounce around here on a few subjects.

One of the issues I’ve raised repeatedly over the years is a seniors charter. I have yet to see any development of it. I had the former Minister express an interest in it, and I certainly hope the department eventually finds time in something like this. We always seem to talk the talk about how important our seniors are, and many of our health benefits are geared towards ensuring they’re targeted to a quality of life for our seniors in their golden years. I would certainly stand with anyone and certainly stand against any decriers of saying that the Northwest Territories doesn’t offer some of the best benefits, but I would say that the problem with offering good benefits is somebody always wants more, and the challenge, of course, of meeting those needs is always high. We conversely know that we put such a high priority on our seniors’ care, physical and mental well-being that it is an important value. What we offer today I think needs to not only be matched but superseded because we do care and we’re the type of jurisdiction that puts it as the highest priority.

I, like my other colleagues, wanted to sort of emphasize a little further on the options for treatment programs here in the Northwest Territories. I look forward to the day of hearing that we’re going to find a residential treatment program up and running. I’ve watched people, even as of recently, deal with their struggles and knowing that their options of fighting for weeks on end, months on end of trying to be stable enough so they can be sent out and wait for that opportunity. It’s really disheartening in watching this. I know there is no magic wand. If there was, it would be certainly worth a fortune by all means. It would certainly change the face of addictions the way it is. I know it’s a real struggle, watching people with these things. It’s just day in and day out. I have yet to meet a single person who ever said they wanted this. It’s such a terrible burden of these addictions where it is what keeps people down and moving

forward. I don’t necessarily feel that the government pays enough attention to it. On the street you would ask people to talk on three or four issues in the Northwest Territories and it’s always up there as one of the most important issues of the day, yet I know things happen behind the scenes. I’ll be clear about that. I do know that, but it is still one of the absolute most important problems in the North, and yet, as I said, we don’t have a residential treatment program for addictions. I think that that’s something that we have to strive towards.

During the letting of the most recent medevac contract just prior to officially becoming implemented, I would say that one of the issues I was trying to raise about is the programming that they now offer in the new contract which is called CAMTS. It has really added financially, this particular program. I really wish the MLAs could have been in the early stages of the discussion with it. Even the director of the medical care at the Edmonton medevac facility felt it was asking a little much. It was very difficult for them at their location, which houses STARS air ambulance and is the receiver of all these medevacs to the Edmonton area. They felt it was an impossible challenge even for them to keep the credentials on a day in and day out basis. Our jurisdiction, which really I think mathematically, if I may define it this way, has approximately a medevac a day. I know it’s not exactly like that, but to illustrate the purpose, they felt that it was very small in comparison to the need of it and would add significantly to the costs to the medevac contract.

It’s easy to say we want the best care for all of our loved ones, and of course, when it’s your loved one, we always want the absolute best care. But we always have to say that if this is where we’re going, what next? We should be flying full C-130s fully loaded with doctors and nurses and medical equipment? I mean, where does it end? That’s the problem. I just worry that it’s a little sort of the old proverbial horse has left the barn situation here. To my knowledge, there was no early discussion before the contract went out for RFP. The only time we could raise it was during it, which the Minister didn’t want to talk about it, and I understand why he didn’t. I understand I’m not fooled by the engagement of the Fairness Commissioner. I’m prepared or don’t want to waste his time by saying I know what you’re going to say by saying you didn’t do it, couldn’t talk about. But I do say that it does add a fair bit of expense to the larger portion of the program.

Now, Mr. Chair, I see we’ve done some seat shuffling. We talk about how important the Mental Health Act is. It’s not to be treated as criticism that people are to be offended by, but it’s funny how much time we all keep saying that it’s so important. If it’s that important, why aren’t the resources being put towards it? I hear from almost every single

Member how important the Mental Health Act is. I hear it in the public. I was in Fort Smith talking to somebody; I was in Hay River talking to somebody not that long ago; I talked to somebody in one of the other communities about it. Everyone seems to know how important this act is and the update. I’ve worked with, sort of, in some ways or in other various ways, some families presently going through the challenges through these problems associated with the lack of power, lack of direction, lack of innovation in the current act. I think the staff at Stanton Hospital has done an incredible job on working with what they’ve got, but the challenges before them of working with the current act is that it lacks the ability to do the things we need to do. The problem that really becomes extremely frustrating is that everybody seems to know what the problems are, and I just wish we wouldn’t talk about how big the act is or how many few days left we have in the Assembly or, oh, it will be the next transition document. It’s these types of things that really define a legacy of work done or work not done. As I said in the beginning, it’s not to be treated as a criticism, but I really wish the resources were asked for. I don’t see anyone stopping any of those dollars being forwarded or supported in any way. Is it a matter of hiring another writer? Is it a legislative writer or those types of things? I don’t know anybody who wouldn’t support that. If somebody just spent 10 minutes with one of these families, and I have, to talk about the challenges these families have with the current act, you’d be certainly hard pressed not to feel terrible about the way the situation presently is.

To add insult to injury, if that wasn’t enough, I wish we had stabilized psychiatric care at our hospital, I wish we had more care, I wish we didn’t have to use locums, I wish we could find a way. I’m not sure what the right way is. I can tell you what I think needs to be done, but often we hear we can’t hire anyone so we have to hire locums that come in and out and learn about the patient every time they come in, then the new doctor comes in and adjusts the medication, modifies it and then it’s back to re-introducing the problem, getting to know folks, trusting folks. It’s a real stress point for the families and I really do try to imagine for the person who needs the help.

I am reminded of a recent case of a particular family and the RCMP picked up this family member because of an incident. I was very thankful, certainly the family was very thankful, the fact that the RCMP recognized that this person’s issue had more to do with mental health and ability than it was a legal problem and they should be dropped off at the RCMP station, press charges, et cetera, and how the story goes. I would say to the RCMP, I appreciate that we do have members out there recognizing that, but the system itself is bound by certain problems.

I see my time is grinding away very fast. It’s funny how fast it goes when you’re on the clock and how slow it goes when you are listening to somebody else. I am going to use every second of it up. No time unused.

I would certainly like to go back and point out that I have often heard about on-the-land programs. I have yet to see the details of how those work in a positive way. It’s really designed, certainly in talking to people about spiritual health and mental wellness, but it’s really not for folks with addictions.

I will end with that and by just saying I don’t think we can do enough with addictions, enough in the sense of enough resources. I would certainly support more work towards the Mental Health Act and any way to get that done. Mr. Chairman, my time is up but I just wanted to emphasize how important those two particular subjects are to me. Thank you.

Thank you, Mr. Hawkins. Minister Abernethy.

Thanks, Mr. Chair. Thank you to the Member for his comments. I have to say I’m not exactly sure what the Member is talking about when he refers to a seniors charter. Maybe after sitting today we could get together and he can explain to me what specifically he is referring to. I remember a lot, but clearly I can’t remember everything so I’m not 100 percent sure what he’s talking about.

I do agree with the Member that there’s a lot of good work being done around elders and seniors and I do agree that more needs to be done, as well, which is why we are working on a number of those strategies that I articulated previously and we are going to continue to do that work.

We have a really good relationship right now with the NWT Seniors’ Society and the other NWT-based seniors’ societies. We are meeting with them on a regular basis, or as much as we can to make sure they are included and involved in any of the work we are doing and offering insight from their perspective, which I think is critical.

The Member talked about the frustration that individuals are having around long delays in getting them into residential care for addictions. I’m sure it’s true, but I do find that rather frustrating because we have gone to a 24-hour referral process and we can actually get individuals referred into treatment within 24 hours. So I would strongly encourage the Member if he knows people who are having some real problems there, we can refer them to the system navigator. They can go to you or a health practitioner. If they go to a health practitioner, that health care practitioner can make a referral to the territorial director and we can have a turnaround time in 24 hours. We have seen some fantastic success in this and I will acknowledge that not

everybody seems to be aware that we have made that change. We have tried to tell people and tried to get that information out there. I am going to continue to say it, and I strongly encourage all of you to say it to your constituents and residents, so that we can get rid of this delay that individuals are experiencing and get them where they need to be. Right now we have contracts with four residential treatment programs that have a huge range and variety of programs within each of them that are really giving quality results to our residents of the Northwest Territories. So, please, let’s all work together to make sure that our residents know about this referral process. If they are having difficulties, let’s get them referred to the system navigator who can help them work through the system.

The medevac program, CAMTS, it stands for Commission on Accreditation on Medical Transport Systems. Although there was a significant cost to the air ambulance services, we are confident that the CAMTS is actually in minor financial impact on the overall contract. CAMTS itself did not result in a significant cost increase.

I will say, and I met with the individuals in Edmonton who are running the facility at the Edmonton International Airport. I did have a conversation with them around CAMTS. They did indicate that they don’t use CAMTS, but they did say that for a jurisdiction like us that is smaller, it is a reasonable, accredited national program that would be appropriate for a government our size. In fact, Alberta was part of our screening and evaluation committee and they strongly recommended CAMTS. As part of the assessment team, we did have a lot of confidence in their history, in their knowledge and their ability to direct us, a small jurisdiction, to an accreditation program that ensured the safety of our residents who happen to be using air ambulance services. So, we’re comfortable with CAMTS. We believe that it’s given us some certainty around the services being provided, and the successful proponent was able to meet those conditions.

The Mental Health Act, I agree. I sure would have loved to have seen this act done in the life of this government, but it is a huge amount of work. I know the Member doesn’t want me to say it again, but it is a huge amount of work. It’s essentially a new act. The old act was so outdated and so no longer effective, it is not effective.

We had extensive feedback from the consultation process, and we also received a significant amount of input from the Standing Committee on Social Programs that clearly has a strong passion for this piece of legislation and also wants to see it. We have a team on this constantly, trying to ensure that every piece of input that was provided to us is analyzed and considered fully. But recognizing that

it is essentially a new act and that we do have a set number of days, we have to have the legislation done in time so it can go through a 120-day process. In order to do it right, to make sure that we get the legislation that truly will benefit the residents of the Northwest Territories, we don’t feel we’re going to be able to have it done in the May/June session, which is why I intend to table it in the fall session so that at least it’s out there – because it will be done long before then – so that residents of the Northwest Territories can begin looking at it and discussing it, which will only help enhance that piece of legislation moving into the life of the 18th Assembly. I’m optimistic that we’ll continue to get strong feedback. But I, like the Member, want to see this done and it needs to be done, and the sooner we can get it done, the better. But recognizing the realities of time and the amount of input that was provided, we’re not going to have it done for May/June.

I totally agree with the Member on stabilized psychiatric care. Absolutely, we struggle. We know that there are pressures and we’re constantly looking for ways to recruit and retain in that area and continue to enhance those services. But we continue to have relatively high turnover. We’re always looking for some thoughts and advice on how to improve this area, and we’re open to any opportunity within our fiscal reality.

On-the-land programs, the Member talked about evidence. A lot of the on-the-land programs are based on community wisdom. There’s a lot of Canadian literature that supports these types of on-the-land programs for improved mental health. For example, Australian literature supports improved physical as well as mental health through the use of on-the-land programs.

To answer the Member’s long-term question about are we getting benefit, we are actually developing evaluation programs for these on-the-land programs to make sure that we can monitor them and evaluate them and have long-term data that can come to this House to help us make informed decisions on how to continue to evolve and improve on-the-land programs in the future. Thank you, Mr. Chairman.

Thank you, Minister Abernethy. Mr. Hawkins.

Thanks, Mr. Chairman. I won’t spend more than, say, two minutes. I just wanted to make sure I mentioned something about naturopaths and I would certainly like to see further development of that. Maybe the Minister can speak to that.

The other two subjects are midwifery. I’m glad to see it’s expanding through the Northwest Territories and I will certainly agree that any support that could happen and we can be part of, I’d like to see that. But I also think there’s a glaring gap in the capital

region on the need of that particular program, and I certainly wouldn’t mind just hearing a quick snapshot of where that path will go.

The last area I just wanted to make sure I got on the record, I guess I probably won’t do the page-by-page on these particular questions, is that children with disabilities, often diagnosing some of the disabilities usually has to wait. In some cases parents will tell me it’s through the school and education system. They get the school to help identify it and send to through the right path or coordinator to help identify these things. Everybody will say – and they’re right – that early diagnosis can help to good stabilization, growing correct pathways and helping people. A good example of that is early diagnosis of autism, for example, and to better treatment. There is speech and language and other opportunities. I mean, it just goes on and on, early diagnosis.

Like I said, I just wanted to get those three areas on the record quickly, but if the Minister could speak to those three particular areas of concern and interest that I have, I would appreciate it very much. Thank you.

Thank you, Mr. Hawkins. Minister Abernethy.

Thank you, Mr. Chair. It’s already had its second reading and it’s in front of committee, is the Health Professions Act. The Health Professions Act will give us the ability to create regulations to basically licence health professionals like naturopaths in the Northwest Territories. We have four priorities in that area. Recognizing how increasingly popular naturopaths are, naturopaths are actually fourth on the list. I put on the list for something to be done with the other three immediately after the legislation passes.

It will take a while once the legislation passes and is concluded, but we have been talking to the naturopaths and they are aware that the work is being done, and we will certainly be engaging them as we create regulation around that.

Midwives, there are two midwife positions in Fort Smith, two midwife positions in Hay River. We’re excited because there will actually be some births in Hay River as a result of a midwifery support program. The current budget calls for a Midwifery Program to begin rolling out in Beaufort-Delta in ’15-16, but I’ve written a letter to committee, seeking some advice and guidance and possibly going to a territorial program first, rather than going with Inuvik. Realities on the needs from midwives in Beaufort-Delta has changed since we originally came up with the plan to go there, so we’re looking at a territorial program possibly based out of Yellowknife but would also provide midwifery services in Yellowknife. We want to do that planning in ’15-16.

The children with disabilities, I agree with the Member, obviously, with any condition, not just disabilities. But early diagnosis is always going to give us better results. So, we’re constantly working with different professionals to create opportunities or create tools that will help do early diagnosis. We do have to rely an awful lot on some of the work that’s being done in southern jurisdictions where they have more money and more expertise that we can rely on, so we tend to work with a number of southern jurisdictions on those.

Thank you, Mr. Abernethy. I have nobody else on the list. Is it agreed to go to detail?

We’ll defer the department summary on page 183. Page 184, Department of Health and Social Services, revenue summary. Questions? Mr. Dolynny.

Thank you, Mr. Chair. Just a couple quick questions on this activity on the revenue. As the Minister is aware, we’re currently doing the Health and Social Services Professions Act. This act is currently in committee and I’m sure will be coming back to the House. That said, with the potential regulation of a number of new professions that will be affected in this fiscal year, I’m surprised to see that the amount of professional licensing fees has remained the same from the revised of last year to this year.

Does the department not consider the fact that there will be a lift in registration fees when that act passes? Thank you.

Thank you, Mr. Dolynny. Minister Abernethy.

Thank you, Mr. Chair. When and if the legislation passes, we’ll begin the process of actually creating the regulations which will allow us to license those professions. The numbers of professions, actually, individuals who fall into these professions is quite low, so there may be an increase but there won’t be a significant increase in the 2015-2016 fiscal year. We might start to see slightly larger numbers in years after that, once it’s actually been in place for an entire year. There may be a small increase, but the licensing fees are not huge either. There may be a slight increase and there’s room for adjustment once we have a better take on what those might be.

I would agree; the numbers in question are not huge. We’re talking about $180,000, but it’s the principle behind it. The fact that even when the act, hopefully, that will pass in the House and the regulations to follow soon after, they will probably – and again, I don’t have the numbers in front of me – be at least 50 to 70 health professionals that are affected by that legislation to which it will have a fee anywhere from $200 to

$500. Again, it would happen, I would assume, during this calendar year. I’ll refrain from beating that one down a little bit more and I’ll definitely ask those questions later on when we review the budget cycle again.

With respect to the reciprocal billing, the two line entries that we have on this activity, both of them are for medical services for both hospital services and specialist physician services for Nunavut. There are about, collectively, it looks like about $12.8 million. If memory serves me right, they’re in the public accounts. There was a bit of an issue with respect to this amount of money always being in escrow, which means that we’re always waiting for the Government of Nunavut to pay its bill. What has the department done to bring the payment program in line so that this government here is not carrying services, paying for services, and then we’re waiting for 60, 90 days, 180 days for money? What is the department doing to mitigate that?

I remember in the 16th Assembly there were a lot of questions around this, and at that time we didn’t have solid agreements with Nunavut on what the actual costs are being, but we do have solid reciprocal billing agreements with Nunavut which clearly articulate the cost of the services and which services there are costs associated with, and we do collect the money. There are some delays. For instance, Stanton is behind about five months at this time on billings, and this is often as a result of capacity within Stanton. Receivables at year end are for services in that year to Nunavut and some of which are not invoiced to the end of the year, so there are some times where it’s a little late because we bill right to the end of the year and then we have to send invoices which are usually after the end of the year. There are a few delays, but we do collect the dollars that are owed to us. Some of the situations where money was outstanding, that was a number of years ago before these reciprocal billing agreements were really hard and fast and we had worked out some of these issues with Nunavut, but we do get the money.

We do get the money. That’s a clearly broad response to a question which I believe needs some due consideration. If we’ve just heard correctly, if we’re five months behind in billing on a rolling average of money, again, I’m not going to do all the math here, but I know if it is around $7 million and if that rolling average is five months, I would venture to say that the amount of interest that we’re being held accountable with the taxpayers having to leverage, would be around $350,000. It becomes a significant amount of money over the course of the year if the taxpayer of the NWT is required to finance reciprocal billing that’s that far in arrears.

Again, to the question, what is the average billing time? Is it five months now or are we making headway of maybe collecting these monies within a 30 or 60 day period?

We have a year to actually bill. We don’t actually have to send the bills until a year has expired, but they have to go within that year. As far as the amount of times, 30, 60, 90 days it’s taking Nunavut to pay us, I can get the department to look into that and get that answer back to you.

I’d appreciate if we can get that level of detail. Again, interest compounded daily, monthly, yearly adds up, especially when you’re dealing with potentially over $11 million, $12 million. Again, public accounts has shown us that that rolling average went down for a couple years and now it’s back up there. Again, I think it was around $7 million. I encourage the department to keep a handle on that because that’s a cost. It’s a cost we don’t talk about. It’s a cost that’s a burden to the taxpayer.

To the question, though, in terms of zero-based budgeting and looking at forecasting for the 2015-16 Main Estimates, I notice that for all reciprocal billings except for the specialist physicians in Nunavut have remained the same. It’s the same as the revised estimates of 2014. More importantly, they’re all zeros. They’re all averaged up to a whole number, which I find that odd if we’re doing a budget purpose that we wouldn’t have the actual revised estimates as a whole number like that. Can we get some explanation why we’re just seeing literally, really, a rounded up number when really we should be, especially for revised estimates, we should be seeing some decimal points, some dollars and cents there rather than a very wholesome number.

Thank you, Mr. Dolynny. I’ll go to Ms. Mathison.

That’s fair. I needed to ask that question because it does stand out a little bit more bluntly than some of the other numbers that we have in this budget. With that, no further questions.

Thank you, Mr. Dolynny. Committee, we’re on page 184, revenue summary, information item. Questions?

Page 185, active position summary. Questions?