Thank you, Mr. O'Reilly. Next, I have Mr. Testart.

Thank you, Mr. Chair. I want to thank my honourable friend for his comments. I think he has done an excellent job of summarizing the concerns many of us have with the budget and areas that need improvement. I will just repeat a few of those.

The Regular Members have asked for $500,000 for youth-in-crisis funding and to support a mobile crisis intervention team to address our atrocious rates of suicide, and especially suicide affecting young people in our communities; another $500,000 in anti-poverty funding to support our NGOs in delivering what I would say are essential services to our communities in supporting the objectives of reducing and ultimately eliminating poverty in the Northwest Territories; and, of course, perhaps the most important aspect this government needs to focus on, $1.5 million for homecare funding. This would be a way to roll out more homecare workers into each of our communities and to support transportation services for seniors and elders who have mobility issues and need to access these services. It is no secret that our population is aging and aging at a rapid pace that our healthcare system can't keep up with. We need to invest in sustainable solutions, which start with prevention.

I think there are good things in this budget. The work done to date on homelessness, and especially homelessness affecting Yellowknife, which is where my riding sits, is commendable and is a really good start. The sobering centre is a foundational project that can lead to other initiatives like a managed alcohol program and other services like that that currently have no home. I am looking forward to the success of these projects. With that being said, we still need to do work on those other areas.

Mental health is becoming increasingly important. Having quality and effective mental health supports will allow us to reduce the rates of addiction, the rates of suicide, increase productivity and employability. It all stems from properly supporting mental health, and I think we are still coming to grips with it.

We see a lot of action plans, a lot of strategies, and the department does not appear to be in a position to really move in an impactful way apart from those action plans and strategies. We need to do more, and we certainly are in a position, as we've discussed as a committee, to start funding some of these initiatives now. Hopefully, the department will be in a position to take that funding and do something with it sooner than later. In particular, our young people are in crisis and they need the support that they can't find at home. We need to offer a helping hand and ensure that they have healthy, safe communities. I look forward to further discussion of this budget and the long-term goals of the Department of Health and Social Services. Thank you.

Thank you, Mr. Testart. Next, Mr. Beaulieu.

Thank you, Mr. Chairman. Mr. Chairman, I think there are a lot of good items and a lot of money well-spent or planned to be well-spent in this budget. I just want to touch on, in no particular priority, some of the items that I will be exploring as we go through the budget with Health and Social Services.

Long-term care, I think, is something that the department is heading in the right direction. I am very pleased with the fact that we are able to provide long-term care regionally, the fact that people from Fort Smith can go into long-term care in their own community, Hay River. Hay River encompasses my community of Fort Resolution. Yellowknife long-term care encompasses the other three communities in my riding of Detah, Ndilo, and Lutselk’e.

I was very pleased to see that Behchoko is increased, doubled in size, for long-term care, and then recently the discussion about providing some continued extended care in Stanton Hospital, I thought that was good. I think complementing long-term care is homecare services. I think that we do need long-term care, and, ultimately, the department and the Minister know that we will need increased long-term care. Homecare services, our position as Regular Members is homecare service is going to slow the need for long-term care, so we certainly want to see increased work in the homecare services area.

NIHB is also something that I am interested in hearing about. It is the Treaty Indian people like myself, eligible for NIHB. We have that group of individuals, some Treaty people are covered with Non-Insured Health Benefits; Metis have coverage extended. There are seniors that have coverage. Individuals that are indigent have coverage and then there is that group that have to buy their own private insurance. Maybe looking at that as a possibility for trying to cover everyone in the NWT one way or another is something that we should look to.

I am also interested in hospital stays. There has always been something that I thought we should look at targeting, and that is who is using the hospitals and at what cost and why. Why are they using the hospital? If someone is just old, I understand that, but are there other groups that are using the hospitals more than they should be? Maybe looking at that.

I have always felt that prevention was a really big item for this department. If they are looking and starting to concentrate on which groups are smoking, which groups are drinking more, and which groups don't have access to healthy foods, and which groups are not exercising, for that matter. I think that type of knowledge by the department, and they probably do have -- of course they have all that information, but to employ it in a big way, I think, is very important. Language services, Aboriginal food at the hospital I think is something that we should continue and maybe increase in some fashion.

Of course, a very exciting part of the department is the health transformation, especially the territorial doctors. If we could get all our doctors living in the NWT, it is good for many things. It is good for the economy. You start to employ all the doctors right in the Northwest Territories, whether they are living in Yellowknife, Hay River, Inuvik, Norman Wells, Fort Simpson, Behchoko, it is still one way or another. If they can't live in Behchoko, then they could live in Yellowknife. It is better than them living in Nova Scotia. I think that is something that the department is making headway into, that area as part of the health transformation. I am pleased with that.

We have to increase the amount of work that we are doing in mental health and addictions. Mental health and addictions is a huge cost driver for this department. I have talked to a lot of the community nurses, and it is the same thing in the small communities. I think it is very similar in the city and similar in the regional centres that mental health and addictions is probably the biggest cost driver that we have in the whole health system in the NWT. I think some of the work that is being done in early childhood development, prenatal, healthy families, healing on the land are all initiatives that this department should be behind 100 per cent. If there is money needed in those areas, those are huge returns on investment, especially early childhood development, prenatal. The returns on those investments are huge.

At the other end of the spectrum, of course, are seniors, supporting the seniors. Seniors who are living healthy are also important. I know this department supports seniors, supports persons with disabilities, and of course I encourage that.

I think we need to look at Child and Family Services and how we manage that whole portfolio. I think that it is important. I know that there has been quite a shift in this department from working with children in care in their own homes. I think that is important. We still have children who are being apprehended. We still have the high need for foster care in the communities and in the regional centres and in Yellowknife. I think that is something that maybe we should really, really look into why. Why do we have that? We hear national numbers saying that Child and Family Services have more children in foster care right now across the country than they have had at the height of residential schools. More children than in residential schools. That is a huge number.

When we hear lots of stories about kids going into hotels and things like that and the tragedies of some of that down south, we haven't done that here, I don't believe. I think that we have a system here that works well. Of course, my belief is that we have social workers from the NWT. I think that will improve the system.

Medical travel, again, is something that keeps going up all the time. This department has invested into some sort of tele-health. I know I have seen it at the emergency, where it works very well with the system, with nurses in the small communities having a direct dialogue with the doctors at Stanton or the emergency. I know the name of that has changed, and I forget what the name of that is now, but I know it is a very good initiative.

The last thing I want to touch on is chronic diseases. It is something, I think, during the deliberation of this budget for health and social services I will be talking a bit about how we are dealing with chronic diseases as well. Thank you, Mr. Chairman.

Thank you, Mr. Beaulieu. Do we have any other general comments? Mr. Nadli.

Thank you, Mr. Chair. I wanted to take the opportunity to highlight some thoughts in terms of going into the section of the business plan and programs, maybe highlighting my language at a later point in terms of just some of the key issues affecting my riding. For the most part, the Department of Health and Social Services is the biggest department, at $415 million.

The big thing that I have been aware of, and monitoring, is just the whole transformation initiative in terms of coming to one single authority. What do we keep? As my colleagues have outlined, there are generally some positive initiatives that are being led by this department. A few of them, maybe, I can mention are on-the-land programs. I know there have been efforts to try to expand upon it, but the concept behind that is to ensure that, not only in the urban setting or the community setting, that you can bring wellness and mental health initiatives for individuals, or for families for that matter, but you can actually bring them out into the environment of nature. That is the strength of First Nations people, being out on the land. To try to at least be out there relative to nature, to try to derive some strength, whether it is spiritual or physical, but at the same time emotional, and also the mental capacity, ensuring that you feel at peace out there and that those things that you can build upon as strength. For me, that is a positive. I look forward to more advances in that area.

Of course, I can't help but feel concerned in terms of the things that directly affect my constituents that periodically I hear of. The culturally appropriate care in terms of one example is translation, having that available, especially for elders when they go into the health centres. There are issues in terms of medical escorts. There are concerns in terms of Child and Family Services in terms of how the changes that came about from the Auditor General's Report and how it's being tackled in terms of bringing some very substantive changes in terms of some of the systemic problems that we've come across, and I look forward to the ongoing initiatives in terms of trying to complete that whole exercise.

For the most part, in terms of the transformation changes in terms of moving to a single authority, just recently I was in my home community of Fort Providence and I was made aware that the first, more likely inaugural meeting of the Dehcho Regional Wellness Council was being held in Fort Providence. So I had an opportunity to be there and witness the members of the communities have their first meeting and it was interesting. I look forward to their renewed vigour to ensure that communities do have input in the effectiveness of the healthcare system in the NWT and particularly for the Deh Cho riding.

The question that I asked in the House was, how is it that's going to change in terms of, whereas before we had health boards, now we have regional wellness councils. How is that going to play a part in terms of protocols? Do I, as an MLA, work along with the regional councils, or is it another conduit in terms of addressing the community, concerns of constituents? I was trying to figure that out, and it's ongoing.

At the same time, there are some concerns in terms of the involvement of -- you know, we have within my riding, Hay River Health Authority and, of course, the Dehcho Regional Wellness Council, and we have two administrative bodies. It could be good, it could be advantageous, because we have a brand new hospital in Hay River and at the same time another one coming up in Yellowknife, and, of course, access to Fort Simpson. So there's always, in terms how do we fit in as a community, questions like that. Sometimes leaders ponder: how do we fit in in terms of ensuring that our concerns are being addressed? I understand there might be some growing issues in terms of whether it's the Hay River Health Authority that could address matters from the Hay River Reserve or is it maybe through the Dehcho Regional Wellness Council. So questions like that will probably come up once in a while.

The other matter is just in terms of ensuring that when we do have health centres. In Fort Providence we have, of course, with the communities of Kakisa, being on the road system. There's Fort Simpson, too, as well. Kakisa and Enterprise, we don't have any building or structure to house nurses or visiting doctors. So when people need to go see a health practitioner or a doctor they have to travel either to Fort Providence or Hay River. So there's always the desire for those communities to try and get more access to the programs and services of the department, particularly for healthcare, so I just wanted to mention that.

There have been some advances in terms of the Hay River Reserve. Recently it was noted that we did establish the Judith Fabian Wellness Centre there, and just recently there was an effort to try to bring health services to the people on the reserve. So I think that's been a good gesture, a good step forward, and I'd like the department to try to build on that; of having more healthcare services for people on the reserve.

In terms of some of the other matters that I wanted to highlight, too, is there are ongoing matters in terms of the treaty rights and the federal government in terms of how it is that they're involved with the delivery of healthcare in the NWT. More so for the reserves in terms of how it is that there's an obligation that needs to be upheld by the GNWT plus the federal government in terms of their involvement in bringing more programs and services to the reserve. I think that needs to be highlighted. That's a matter that has been brought to my attention by the local leadership of the K'atlodeeche First Nations.

At the same time my belief is that I think more could be done in terms of wellness and healing, especially in the communities, and that perhaps it could be this department that is the lead agency in terms of engaging the federal government in terms of bringing more resources so that there's adequate counselling services for individuals, for families that need help, who want to lead a better life in their communities and a better future for the well-being of, not only our communities but for the whole entire North. My belief is that this department could perhaps maybe be the lead agency in terms of bringing some discussions at that level.

The other matter that I wanted to just maybe raise in terms of reminding this department is that we still have a treatment centre on the Hay River Reserve and the fate of that treatment centre on the reserve hasn't been decided upon. I know there's been some dialogue between the GNWT through this department and the K'atlodeeche First Nation, and I don't know where that's at. There's still an interest to see how it is that facility could be used.

A point was made that most alcohol and drug treatment centres that exist in most provinces are run by First Nations people. The point is that, unfortunately, the statistics is that what plagues our communities is alcohol and drugs, and unfortunately, statistically speaking it is First Nations that have issues and challenges with this. So the point was made, well, perhaps it should be our First Nations people that provide those counselling services because they have an understanding of the culture and the issues and maybe they can provide that expertise of trying to share their experiences in terms of trying to be successful in terms of managing that problem.

I just wanted to highlight maybe just in my language, too, in terms of the need for homecare services. It can be said, you know, as an example in Fort Providence we have an aging senior population. Generally in the NWT that's what we're facing and there's a need for homecare services and we've been trying to build upon that, and I can't emphasize more that we're expecting a burgeoning population 10 years, 15 years down the road. Not only should we look at senior care facilities, but expanding upon the homecare services in terms of bringing services into the communities. Elders who make a conscious choice to stay at home for as long as they can, and sometimes they're not mobile and those services have to be brought to their home. Mahsi, Mr. Chair.

Thank you, Mr. Nadli. Do we have any further general comments? Seeing none. I will allow the Minister to respond. Minister, you have 10 minutes to respond, keeping in mind that there will be time as we go through the main estimates to respond to each issue as they're brought up. So, Mr. Minister.

Ten minutes?

Only 10 minutes.

Is that a new rule?

Minister, there are 10 minutes. Each Member gets 10 minutes to make a statement, then you have 10 minutes to respond. So please continue. I'll reset the clock for you.

---Laughter

I'm pretty sure that's a new rule, Mr. Chair, but I'll do my best. Thank you. Thank you, Mr. Chair.

Mr. Chair, I hear the Members loud and clear, and there are definitely a couple of recurrent themes in there. Earlier this year the Minister of Finance and I had an opportunity to meet with the Member from Kam Lake and the Member from Tu Nedhe-Wiilideh to discuss budgets and try to negotiate our way forward. At that time we clearly articulated that we agree with committee 100 per cent. The areas of homecare, mental health and addictions, and poverty are areas that we want to invest in. We believe that, with this budget that's in front of you today, it positions us very strongly to make those investments starting in the 2018-19 fiscal year.

I hear you clearly indicating that there's a desire to move on some of those things today, and I would love to, as well. The problem is, in some of those areas, we haven't quite finished the work that is necessary to even help us quantify what some of those dollars are, but we are diligently working to find ways to improve homecare services here in the Northwest Territories. We are working diligently to make significant progress in our responses to mental health and addictions.

With respect to homecare, we are currently finalizing the NWT Care Services Action Plan. This is scheduled to be done this spring; by March 31st, we're hoping. This will clearly identify priorities for next steps; things we need to do.

There are a couple of things, and we already know this based on the work that we've done, is we really need to understand what services are necessary to residents in the Northwest Territories. There is zero consistency across this territory as a result of having multiple authorities. We are really a fragmented system across the Northwest Territories. So we basically have to define where we need to be. What are the services that are required by communities?

The next thing that we'll need to do is we'll need to assess the gaps, recognizing as I said, every authority had their own take on what level of coverage of services they want to provide. So we need to go out there and really compare to where we need to be. We need to figure out where we are, so we need to assess the gap. At that point, we'll be in a solid position to quantify what resources we need to fill that gap. We're obviously trying to get that work done as quickly as we can, but it is a fairly significant amount of work, and we will be moving forward as soon as we table that action plan or bring that action plan to committee at the end of March.

Beginning in a new fiscal year, we plan to actually start some of that work that I've just talked about, a comprehensive review of what services are out there compared to, you know, what it is that we think we need. There is some federal investment coming; we don’t know the full amount. We don’t know the parameters under which they want to release it, but you know there's some things we think we can do to actually help us in that planning process so we can actually have a meaningful discussion in business planning for 2018-2019.

We want to explore how we can better integrate homecare services with our primary care services. There are successful models across the country that we want to examine. This will help us develop the new model for home and community care, but it might involve new scopes of practice, and in some of our side conversations, I've heard some really great ideas. You know, looking at paying family caregivers to support elderly or disabled family members to help live in their homes longer, possibly developing a paid community caregiver position, somebody who could help with some of the activities of daily living, shovelling sidewalks, shovelling driveways, helping with some cooking in the home, helping with some cleaning in the home, those types of things.

This model could really free up some homecare nurses to provide the services that homecare nurses need to be providing, which might include wound control or some of the other things that they need to do. We could really make some definite plans for allocating some of the new federal resources that are available. Some of the other things we can use, I mean, once we figured out what parameters or what areas we could spend that federal money is to document some of the best practices that might work in our jurisdictions, develop a model for care, i.e. the paid community caregiver, which I think there's some real opportunity there.

The big gap in our system right now is the lack of assessment tools for our community health nurses to use when trying to figure out what level of services a resident needs. We need to do that work. Until that work is done, we won't really be able to accurately quantify, you know, exactly how many positions we need. So we need to get that work done.

There's some desire, you know, to put some money in to get some feet on the street. We need to understand and we need to make sure that we get the right feet on the street. We need to make sure we do this work upfront. Now, there is a lot of work that I've outlined with respect to homecare, and it's our plan to have all that work done in time for the 2018-2019 business planning so that we can bring that information to committees, have the discussions on where we set our priorities, and as the Minister has committed to the two Members previously that's going to help them form how we set priorities. These are priorities; they're mandate priorities, and the government is willing to commit to these areas, the areas that have been identified.

We just feel that we need to be ready so that we can make informed decisions as opposed to putting in maybe the wrong positions upfront or getting tied to positions that don’t have long-term benefits. However, as we move to 2018-19, if we get to a point where we think we can move sooner on some of these things, we're prepared to come forward with a sup and present a sup to FMB for the possibility of supplementary funding. I can't guarantee that we'll even get to that point, but we're certainly open to doing that if we get there.

With respect to mental health and addictions, I was asked some questions today, and I think the Member from Tu Nedhe-Wiilideh had some really solid comments when he was doing his Member's statement. We're moving forward on the development of those action plans, so those action plans in and of themselves will help quantify and help form discussions between ourselves and committee when we're setting priorities and setting fiscal resources towards these initiatives for the 2018-19 fiscal year.

That plan, the first action plan, will be done this summer, so we'll have lots of time to share and discuss and talk before we get to business planning and work together to set the priorities where we're going to allocate resources in the future. In the meantime, we're continuing to seek other opportunities to get money from outside agencies, outside parties who might be able to help us do some of those things upfront.

Anti-poverty, obviously this is an area that I'm incredibly interested in. I've been working to help address poverty in the Northwest Territories for years. A couple of Members talked about it. I think the Members are exactly right. There are a couple things we need to do. We really need to come up with an evaluation framework. I talked about this the other day. In order to get an evaluation framework, I think we finally have to break that impasse and come up with a definition that everybody could agree to, and we've struggled with that between ourselves, NGOs, and our partners.

At this time, we don’t have those resources to put into anti-poverty, but at the same time we did increase money available through income support to individuals who help individuals who are on low income get food, get groceries, feed kids, live healthy lives. We did, through solid discussion and input from Regular Members, we have fully come to fund JK, which is going to put up to $12,000 in the pockets of many individuals in the Northwest Territories, certainly those with four-year-olds. We need to do some work around anti-poverty. There's no question. We continue to invest in housing.

In Health and Social Services, as we move forward with Building Stronger Families, one of the opportunities we have is when families are struggling they can now come to us for voluntary support, and in some of those situations we can provide funding. We are providing a pilot project in Behchoko right now where individuals who are struggling and unable to pay their rent, they can come to us in Building Strong Families, and we actually have been able to help a couple people pay rent so they don’t lose their homes and the children don’t end up in a neglect situation.

So we're moving on a number of these things trying to move forward. So that goes to sort of the main priority areas. We're with committee; we agree with committee. These are areas that need investment. We're prepared to do it, but I'm simply asking for time to finish the work. If we get the work done in time and we feel comfortable with all stakeholders, including yourselves, that we can move forward on some of these areas, we're absolutely prepared to discuss possibility of sups with the Minister of Finance and certainly prepared to financing into these areas in the future.

I don’t have a clock.

One minute.

I don’t even know where to go now. There are so many questions. I'll stop. I've addressed, I think, the three big ones. I know I'll be asked more questions on those, but just in closing before we go to line by line, there's no question that Cabinet agrees with committee. There's zero. These are mandate items. We're 100 per cent in, we're going to move forward with this work, we're going to work with committee, we're going to get it done, and we'll be able to have informed discussions about how to set our financial priorities in the best interests of the people, but without that work being done it's a shot in the dark. Let's get it done and let's get it done right. Thank you, Mr. Chair.

Thank you, Minister. Does committee agree we proceed to the detail in the tabled document? Committee agrees. As has become custom, we will defer consideration of the departmental total until after we consider the activity summaries. The first activity summary begins on page 159, Health and Social Services, Administrative and Support Services, and continues up until page 162. Are there any comments or questions on page 159? Mr. Nadli.

Thank you, Mr. Chair. I just wanted to ask a question in terms of the reporting relationship in light of the changes to the one authority through the transformation initiative in terms of trying to streamline reporting. Could maybe the Minister highlight, just maybe outline in general, the relationship between his office and the district offices and the health centres at the community level in terms of raising some significant points in terms of decision-making and perhaps information sharing on patients, things of that nature? If he could maybe just highlight how that's going to work as the move to a single authority has almost been implemented? Mahsi.

Thank you, Mr. Nadli. Minister.

Thank you, Mr. Chair. Mr. Chair, much of that is actually legislated. One of the differences between the old system and the new system is, there are actually some lines of clear accountability that never really existed in the old system. In this system, the Minister is ultimately responsible. The Minister is responsible for selecting a chair and board members of the Territorial Authority who are providing some management direction to the operation of the healthcare system, the delivery system.

In the delivery system, there is a COO, or a CEO at the top of the authority who is the supervisor of the regional COOs. They also have a secondary responsibility to work with the chairs of the individual wellness councils, helping them tailor information at a local and regional level, but ultimately, their reporting relationship is to the CEO.

The deputy minister reports to the Minister and is responsible for the ministerial functions of Health and Social Services, where the CEO is responsible for the delivery mechanisms. Not all those functions have been fully transferred yet. We're still in a transformation phase.

When an individual has an issue, a patient or resident, we're strongly encouraging them to engage with quality assurance so that their issues can be reviewed, examined, and dealt with, keeping in mind at all times our obligations under the Health Information Act, which is to ensure that privacy is maintained.

As for communication with MLAs, as an example, when an individual raises an issue with an MLA, we require that MLA to get a consent form so that I and my staff can look into their issues because I, even as Minister, cannot look at somebody's personal information or health-related information without their consent.

All this is articulated within the legislation on how that whole structure works as far as who is accountable to whom. I'm not 100 per cent sure I got the Member's question exactly right. I hope I'm on track.

Thank you, Minister. Mr. Nadli.

No further questions.

Thank you, Mr. Nadli. We'll move to information items on pages 161 and 162. Do we have any comments on pages 161 and 162 before we move to the activity total? Mr. Beaulieu.

Thank you, Mr. Chair. Mr. Chairman, I was wondering if the Minister could give us an update on the status of the employees working for the Hay River Health and Social Services Authority?

Thank you, Mr. Beaulieu. Minister.

Thank you, Mr. Chair. Mr. Chair, I am assuming the Member is asking where we are as far as bringing them into the public service. We are in the same place we were last year. We have not moved forward at this point. We still want to bring them in, but as I said in the previous government and early in this government, there are a number of things that have to happen first. We're kind of waiting to see what the lay of the land is, waiting for a number of collective agreements to be completed so we know what the lay of the land is. They are still ongoing. It has been quite longer than I think any of us anticipated. Once we know what the lay of the land is, we will be able to dig in a little bit more, figure out what the costs are, pension transfers, et cetera. We continue to quantify what some of those costs are going to be so that we are ready when the time comes. We believe that transfer of Hay River employees into public service could be anywhere from $18 to $23 million. Those numbers fluctuate from time to time. I have heard quite a range.