Thanks, Mr. Chair. This is where I get to go back on the train. Earlier, the discussion about the budget, I was asking questions about midwifery and was referred to this page. The last question I think I have on this is there are a number of midwives in Yellowknife. They would like to be able to practice midwifery. Are there any obstacles to them doing that professionally? Thanks, Mr. Chair.

Thank you, Mr. O'Reilly. Minister Abernethy.

Thank you. Thank you, Mr. Chair. Mr. Chair, the Midwifery Profession Act has allowed for the licensing of registered midwives since 2005 in the Northwest Territories. The Act establishes a licensing and complaints discipline regulatory framework. The Act does not prohibit private practice.

Currently, registered midwives in the NWT work within the Health and Social Services system as employees, so their services are covered by the NWT health care plan as a core program. This is similar to a number of services such as vision exams, physiotherapy, occupational therapy. These services are not covered if they are provided in a private clinic, and that's true for physiotherapy and occupational therapy and those services as well.

If a registered midwife was willing to assume the costs of private practice such as insurance, overhead, staffing, those types of things, they are free to do so in the Northwest Territories, but a registered midwife would have to bill their clients directly, and their services would not be covered by the Act. Thank you Mr. Chair.

Thank you, Minister. Mr. O'Reilly.

Thanks, Mr. Chair. So I take it from the note that the Minister was reading that there's no support provided through Stanton for midwives to actually practice; that they would have to do it on their own; get their own insurance, their own office or whatever. So there's no support through the existing system for midwifery in Yellowknife? Thanks, Mr. Chair.

Thank you, Mr. O'Reilly. Mr. Minister.

Thank you, Mr. Chair. Mr. Chair, if a midwife wanted to have a private practice here in the Northwest Territories or in Yellowknife in particular they could seek privileges at Stanton; that's something we'd certainly be willing to have a conversation about. If they wanted to start a private business they would have to have their own insurances and whatnot. Having said that, and I've said it before and I'll say it again, we are looking at developing a territorial midwifery model based out of Yellowknife. We have the one and a half positions, finally able to fill them as of last February; we're moving forward with the design. We have to build a business case so that we can bring it through our business planning process, through our financial process, to see if we can get the money, but we have to have a plan before we do that. That's the work that we're doing today. Thank you, Mr. Chair.

Thank you, Minister. Mr. O'Reilly.

Thanks, Mr. Chair, and I appreciate the response from the Minister. This is just more of a comment, but there's a number of people in Yellowknife that are quite frustrated at the lack of services when it comes to midwifery. I mentioned the other day how one family actually had to go to Hay River at their own expense for a couple of weeks to avail themselves of the service. I appreciate the response from the Minister but I look forward to seeing that business plan as soon as possible. Thanks, Mr. Chair.

Thank you, Mr. O'Reilly. Would the Minister like to respond?

Thank you, Mr. Chair. Mr. Chair, we are committed to developing the plan. We're committed to expanding the midwifery services that we have here in the Northwest Territories. We've been committed to this for a while. The expansion has been slow but we've gone from providing about $775,000 worth of midwifery services in 2013-14 to $1.5 million, so it's not that we haven't been doing anything.

We had a plan in the Beaufort Delta which was modified. We have midwives in Fort Smith and Hay River and we are looking at a territorial model. At the same time, and as I said yesterday, as we build our facilities, our larger regional facilities, we actually planned space for midwifery services. If you look at the health centre we're building in Norman Wells there's a dedicated room properly plumbed to be a midwife's room with birthing tubs. We're planning ahead even though we haven't done all the work for the final design of a territorial plan, but we are doing the work that is necessary to build appropriate plans.

Thank you, Minister. Mr. O'Reilly, nothing further? Next on my list I have Mr. Vanthuyne.

Thank you, Mr. Chairman. Not to belabour this particular point, but I would like to ask the Minister then as it relates to the roll out of the territorial model, is there the ability to put some type of, I don't want to refer to it as a preference, but kind of immediate attention to maybe what we would call the Yellowknife component of the territorial model and be able to prioritize that portion of the model and maybe even possibly start midwifery programming based on getting that model done sooner rather than later?

I mean, it just seems to me that the reason why Members continue to raise this point over and over and over again is because they're struggling with the difference between why a territorial model versus why not just start midwifery services in Yellowknife. So I guess if there's a question in there it's can we prioritize the Yellowknife component of the territorial model sooner rather than later and actually look to roll out Yellowknife midwifery services? Thank you, Mr. Chair.

Thank you, Mr. Vanthuyne. Mr. Minister.

Thank you, Mr. Chair. Mr. Chair, as we move forward with the territorial model it will be based out of Yellowknife, located in Yellowknife, and will be able to provide midwifery services to residents of Yellowknife. But as with anything that we do we have to be able to show cost effectiveness. Currently, although it's not midwifery services we have high quality obstetric services available to the residents of Yellowknife. In the meantime, we don't have complete obstetrical services to individuals outside of Yellowknife in some of our regional centres and our communities. As a result, all those people do have to travel into Yellowknife for birthing purposes.

There's been a suggestion that midwifery is going to save us a whole significant amount of money, but for the individuals in Yellowknife they don't have to travel out now; the people from outside from Yellowknife do have to travel in. We aren't going to be able to downgrade or limit the number of physicians we have in the Northwest Territories by bringing in midwifery services so we're not going to save any money on physician costs.

I understand there's a significant amount of challenges around understanding some of the financials and we've got some analysis, but what I'll commit to do is retaining an external health economics expert to do an update on our analysis of whether it would actually be cost neutral to-- or achieve efficiencies to bring midwifery services into Yellowknife. Ultimately, we want to do this but we have to make sure we build a proper business case and that way we can demonstrate value for money in doing so. So I'll commit to retaining an external health economics expert to update our analysis and provide us with some more clarity on cost-saving measures if there are in fact any. Thank you, Mr. Chair.

Thank you, Minister. Mr. Vanthuyne.

Thank you, Mr. Chairman. Ultimately, Yellowknifers are actually having to leave Yellowknife to have this service provided, and so now all of a sudden dollars seem to matter to the Minister. That didn't seem to be the case earlier; it was prioritizing healthcare. Anyway, I won't belabour this point any more. I'm looking under line item "medical and surgical nursing," it seems to have nearly a $2 million increase. Can the department maybe just provide us an explanation as to why there's a-- every other line item there seems to be relatively status quo and this one seems to have a significant increase. I wonder if there's some clarification on why the jump. Thank you, Mr. Chair.

Thank you, Mr. Vanthuyne. Mr. Minister?

Thank you. Thank you, Mr. Chair, and I appreciate the Member's comments. I will point out that, you know, we do have to be conscious and aware of the bottom line and we have to ensure that we're spending money wisely.

We are committed to moving forward with the midwifery services but we have to make sure that it makes sense and that we cost it appropriately. For individuals who choose to go outside of their home community for midwifery services because they aren't here, that is a choice people can make. At the end of the day, we do have high caliber professional obstetrical services in this community and birthing could have been facilitated, granted not with a midwife. The increase the Member is asking about is actually directly related to Hay River and the opening of the new H.H. Williams and the increase in staff to fund that building appropriately. Thank you, Mr. Chair.

Thank you, Minister. Mr. Vanthuyne.

Thank you, Mr. Chair, nothing further at this time on this page. Thank you.

Thank you, Mr. Vanthuyne. Next I have Mr. Testart.

Thank you, Mr. Chair. Under "Mental health and addictions nursing" the description of the expenditure mentions beds that are designated for services for adults with psychiatric/psychological disorders. I'm wondering if the Minister can let us know if any of those beds are designated for youths or youth, alongside the adults, and how many of those beds are available if so. Thank you, Mr. Chair.

Thank you, Mr. Testart. Minister Abernethy.