Thank you, Mr. Speaker, and thank you, Mr. Moses.

Minister’s Powers

Bill 44 in its original form proposed to give substantial new powers to the Minister. T

he

committee introduced two motions to amend the bill to narrow the Minister’s powers. The first amendment will ensure that the Minister can only disregard this act or another enactment for

reasons

of public safety or to address a pressing gap in service delivery. The second amendment places a restriction on

the provision under the regulation-

making authority. The original provision would have authorized an exemption through regulations from “any provision of this act.” However, the committee felt strongly that a subordinate form of legislation—a set of regulations—should not circumvent the wish of the Legislative Assembly as expressed in a statute. The Minister agreed to both of these

motions at the clause-by-clause review.

Transitional Provisions for Hay River Employees

The Union of Northern Workers presented a convincing case that Bill 44 in its original form violates workers’ rights to engage in collective bargaining. This right, the UNW argued, is enshrined under Section 2(d) of the Charter of Rights and Freedoms. The UNW specifically took

issue with the proposed subsection 17(2), which releases the government of any contractual obligations or liabilities pertaining to the Hay River Health and Social Services Authority except to the extent that it expressly agrees to assume them.

The committee agreed with the UNW’s analysis on this matter, including its claim that three recent cases have significantly altered the Canadian landscape with respect to workers’ rights to engage in collective bargaining. Each case hinges on Section 2(d) of the Charter and protects workers’ rights to advance workplace goals through collective bargaining. The committee further agreed that Bill 44 in its original form would leave the government vulnerable to a legal challenge and subsequently sought to ensure that the entitlements of employees belonging to UNW Local 21 would be handled through a clearly legislated succession of those entitlements.

It is worth nothing that, in the midst of the review, the committee asked the Minister if he would concur with an amendment to provide for mediation wherever the GNWT and Hay River employees were unable to reach agreement. The committee also asked about the status of negotiations between the GNWT and the union representing the Hay River employees and what assurance could be provided that Hay River employees will not lose seniority or pension benefits. Regrettably, there was no formal reply. In the absence of clear information, the committee prepared an amendment that would simultaneously align with the spirit of the bill and give peace of mind to Hay River employees. Specifically, this motion to amend Bill 44 ensures that the transitional provisions will not be brought into force until a contract negotiated through collective bargaining has come into force.

Other issues were raised by the UNW, including the matter of pension entitlements for employees transitioning from the Hay River Health and Social Services Authority to the GNWT. The committee concluded that this matter is outside the scope of the bill but is urging the government to give it careful consideration.

The UNW also expressed fear over the loss of regional positions, arguing that amalgamation will create economies of scale in procurement, records management and diagnostics, and may in turn create redundancies. The committee supports the UNW’s request for assurance that the government will provide retraining for any affected employees.

Critical Incidents

The committee commends the Minister for introducing provisions pertaining to critical incidents. However, the committee noted a number of concerns. First, the committee sought to clarify who will be eligible to report a critical incident, and prepared a motion to amend which would allow any patient or client, or any relative of a patient or client,

or any staff member to report a critical incident. The motion was modeled on provisions in Manitoba’s Regional Health Authorities Act. The Minister concurred with this motion at the clause-by-clause review.

Second, the committee prepared a motion to amend which would compel the Minister to conduct a critical-incident investigation based on a motion of the Legislative Assembly. The Minister also concurred with this motion.

Third,

the committee inquired about the proposed

Section 25.2 which does not expressly stipulate

that

a legal guardian or substitute decision-maker must be notified in the case of a critical incident. The committee subsequently determined that provisions in the Health Information Act will apply, establishing a clear protocol for the sharing of medical information pertaining to a child or a person with diminished mental capacities.

Fourth,

the committee expressed concern about

how critical-incident investigations will be handled and whether the results of investigations will be communicated in a culturally sensitive manner.

Fifth, the UNW noted that clause 9 of Bill 44 would impose a duty on employees to cooperate in any investigation and, further, that investigations could result in disciplinary action or discharge on account of employee misconduct. The UNW sought an amendment to provide for union representation for employees during any investigation, inspection or audit. The committee determined that collective agreements already provide adequate provisions and protections.

Sixth, the Information and Privacy Commissioner noted some privacy implications pertaining to critical-incident investigations, inspections and reporting. She recommended including a general provision stating that personal health information should be protected to the greatest extent possible. However, the committee concluded that the new Health Information Act will establish adequate safeguards pertaining to the use, collection and disclosure of information. In addition, Members noted that reports will have limited circulation.

Privacy Concerns

The Information and Privacy Commissioner raised several privacy concerns. First, a general concern was raised about the combined effect of the proposed amalgamation and the new Health Information Act. The Commissioner noted that these changes will significantly expand the “circle” within which personal health information can be shared without the patient’s express consent. The Commissioner recommended that the Department of Health and Social Services undertake a privacy impact assessment for the proposed amalgamation. The committee agrees with this recommendation.

Second, the Commissioner’s submission alerted the committee to a pair of provisions that would permit a board of management to close a meeting, or a portion of a meeting, if privacy issues warrant it. The Commissioner noted that any meeting should be closed to the public if personal health information is being discussed. Upon reviewing this concern, the Minister agreed and two motions to amend the bill were passed at the clause-by-clause review.

Third, the Commissioner noted that Bill 44 does include a duty to inform a patient if their personal health information is used in the course of an investigation, inspection or audit. The committee determined that the Health Information Act will place appropriate limits in such circumstances. While the use of information for an investigation, inspection or inquiry is a permitted use under the Health Information Act, there are limits and obligations placed on anyone who receives the information. Moreover, the disclosure of information must be recorded by the person disclosing it.

Regional Considerations

With respect to regional involvement in the new system, some concerns were raised. A handful of stakeholders indicated that regional influence may be unduly diminished under the new system. This viewpoint was also expressed by the public administrator of the Dehcho Health and Social Services Authority, who spoke on behalf of a number of Deh Cho residents.

As well, because Bill 44 is silent on the role envisioned for the Tlicho Community Services Agency under the new system, Members are seeking clarity about how this board of management, or any others which might come into existence as a result of self-government agreements, will be accommodated. For their part, the Tlicho Community Services Agency expects things to be business as usual under the new system, although in some areas they intend to seek greater autonomy from the GNWT. One example is housing. The GNWT does not currently permit the Tlicho Community Services Agency to guarantee its staff long-term security of tenure which has a negative impact on staff retention.

K'atlodeeche First Nation is looking for greater clarity with respect to how its unique interests will be represented under the new system. Similarly, Hay River employees seek clarity as to how their needs and interests will be represented on the Territorial Health and Social Services Authority in the absence of an agreement with the GNWT. Once again, the committee invited the Minister to reply to these queries but no reply was given.

Recommended Actions

The Standing Committee on Social Programs recommends the following courses of action:

1) that the Department of Health and Social

Services conduct a privacy impact assessment pertaining to the proposed amalgamation and the new Health Information Act;

2)

that the Government of the Northwest Territories move swiftly to complete negotiations for a new contract with UNW Local 21;

3) that the Department of Health and Social

Services give careful consideration to

the

matter of pension entitlements for employees of UNW Local 21;

4)

that the Department of Health and Social Services take reasonable steps to retrain employees if regional positions are lost or threatened as a result of system transformation;

5) that the Department of Health and Social

Services

ensure that inspections, investigations

and reporting pertaining to critical incidents be conducted in careful adherence to privacy legislation;

6) that the Department of Health and Social

Services ensure that critical incident investigations, and the communication of their results, get handled in a culturally-sensitive manner;

7) that the Department of Health and Social

Services establish rules in the regulations around the taking of samples for the purposes of an investigation;

8) that the Department of Health and Social

Services

ensure that clear terms of reference

are in place for each regional council;

9) that the Minister of Health and Social Services

ensure that the chairs of regional councils have a sound base of experience in the delivery of health and social services;

10)

that the Department of Health and Social Services give due care to information shared between the Territorial Health and Social Services Authority and charitable foundations; and

11)

that the Department of Health and Social Services communicate effectively with stakeholders regarding its change-management plan.

Recommendations

Recommendation 1

That the Government of the Northwest Territories provide a comprehensive response to this report within 120 days.

Mr. Speaker, I now turn the report over to Mr. Moses.