Marsi cho, Madam Chair. Committee wishes to consider Tabled Document 30-19(2), Main Estimates 2020-2021.

Thank you, Mr. Norn. We will resume after a short break.

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Good afternoon, Members. Today, we are going to continue our review of the Department of Health and Social Services budget. When we left off yesterday, we were talking about the section on out of territory services. Are there any additional questions on out of territory services in the Health and Social Services budget? I think that's beginning about page 175 of your document. Are there any additional questions on out of territory services? Sergeant-at-Arms, could you please escort in the witnesses. Will the Minister of Health to again introduce her witnesses, please.

Thank you, Madam Chair. Today, I have with me Deputy Minister Bruce Cooper and Ms. Mathison. Thank you.

Thank you, Madam Minister. I have on the speaker's list the Member for Monfwi. Please go ahead.

Masi, Madam Chair. [Translation] Thank you, Madam Chair. Page 180, that's what I'm referring to, about the English term, when we say addiction treatment centres, meaning that, for the treatment, they would be able to be sent to Edmonton, but last year, according to the record, there were 191 sent for treatment, and that spent well over $200,000 on residential, school, and medical services, all together included, but because I don't know if it would be in the same department, I would like to ask about that one. Sending people for treatment out of the territory, is it under Health and Social Services? Would they be able to look into it again? Regarding the 191 people who were sent out of the territory, is it possible that they could be treated or going for treatment here in the territory, because there is on-the-land funding?

We have a lot of elders today who would be able to treat. Our leaders, our teachers, would know how to help with the treatment, but people referring to working on themselves, we are always sending them out of the territory. Let's not do it anymore. Let's have an addictions program here in the territory and have elders working with them. Put them in place. We know they are strong, respecting our elders, and also have an aftercare program, as well, with it. Right now, I would like to ask the Minister: was there ever an issue, topic of discussion, about this kind of treatment being put in the territory? We know how many were sent. That's money that could be spent in the territory. Can the Minister respond to that? [Translation ends]

[Microphone turned off] ...Minister of Health and Social Services.

[Translation] Madam Chair, addiction treatment centre [English translation not available] [Translation ends] I hear where the Member is coming from in terms of looking at doing something closer to home, including our elders, including our residents. Right now, within the department, we provide funding to all the Indigenous groups to have an on-the-land fund. In terms of the addictions, have we thought about that in the past? I am going to ask Mr. Cooper if we have thought about that previously.

Thank you, Minister. Deputy Minister.

Thank you, Deputy Minister. Follow-up question, Member for Monfwi.

[Translation] Thank you, Madam Chair. About the treatment, when we speak of treatment, sending people out to Edmonton, it has been seven years now in the Northwest Territories. There is no addiction treatment centre with us right now, but we know we have an agreement with Edmonton or Alberta for the treatment of our people. When can we have our own program, an agreement, on-the-land program within our region? We all need the treatment. We want it very strong so that we get very strong elders. We know; we lived here; we grew up with elders and how we respect our elders when they speak to us. However, what we are going through in addictions of all sorts, alcohol, drugs. If we put it all on the side, we are strong enough. We would be able to take their words and go with this after-treatment program.

When we speak of it, I am not really in favour of sending people out. They come back; there is no aftercare program. I have to say that again for our young man that we have lost recently. What happened to him? When I look at it today, it's a very heavy issue. It's very important that we share it. How come we don't have treatment on our land in our home community? We lose a lot of people to addiction. It's not very healthy one way. I would like to see programs within our regions. On-the-land programs are very important. If it's under them, it would be very powerful.

When we send them away, out of the territory, for treatment, when they come back, what do we see? We don't have an aftercare program. We also spend a lot of money going out that way, but if we have it within our homeland, we would have the control of being funded. Right now, if it's out of control, we would be able to control it from here. When they are out there, we don't know what's going on. We don't really know what they are doing with them. Again, I have to say, we don't know. When they come back, they are back to square one with their addiction. We see that.

This is why I am repeating this, especially in my home community, my region. How many weeks now that we have lost all sorts of people, young and old? I have to continue. I have to be very strong and do whatever I can for my people. It has to be fixed. It has to happen. Right now, I would prefer to have a motion. Justice Department, ECE, they have to be able to be working together. This is why. Are the Ministers able to work together and have a proposal together and say this is what they can do for our homeland so it can be done? Is it possible that would happen? I know it's not going to happen right now, but when we leave now, when we come back to the table in the fall, we would have something in place. It would be the beginning of having a discussion and very strong to have this treatment for our people. Thank you, Madam Chair. [Translation ends]

Thank you, Member for Monfwi. Our condolences to the families of those who have died in your region as a result of their addictions. I am going to turn to the Minister now for her response.

Thank you, Madam Chair. Again, I apologize, too, for what the Member's family has gone through as a result of mental health and addiction. Right now, in the territories, we have the Mental Wellness and Recovery Action Plan, which supports the 19^th Assembly's priorities, which is increasing the number of culturally respected, community-based mental health and addictions programs, including aftercare. Some of the key activities in this action plan include reducing wait times and increasing access to counselling services by establishing access to e-mental health options, enhancing supports and aftercare options for individuals who are recovering from addictions, as well as developing a GNWT problematic substance abuse task force, which includes developing a territorial plan on alcohol. Thank you, Madam Chair.

Thank you, Minister. Any further comments, Member for Monfwi.

[Translation] Masi, Madam Chair. Just a short form. I would like to just say to the Minister what is written in front of her, she is reading, but most of the time there's no follow-up. I'll have to say what happened to my home or my region. If we had actions about what we have, it would be good. Right now, I'm asking the Minister if she would be able to say: let's have a strong after-care program proposal. It's not only for communities, because I know, I hear, in other regions, they have all these issues, this problem like the Tlicho community, see if she would also work with them. In the short form, I'd like to have her to work with PSEA so that this after-care program would be strong. Thank you. [End of translation]

Minister.

Thank you, Madam Chair. I hear the Member asking our department to work with the Tlicho government and the residents in terms of how we come up with solutions to better enhance some of our programs so that we can deal with mental health and addictions. That is something our department will look into. Thank you, Madam Chair.

Thank you, Minister. Next on my list, I have the Member for Thebacha.

Thank you, Madam Chair. I just want to make some clarifications with regard to addictions. I, too, in my region, have a lot of mental health issues, and I had deaths in our region due to addictions. I respect the Member from the Tlicho. He is asking for more monies put into on-the-land, but I want to make sure that the option is still there for members to have the proper addiction facilities available for treatment, because the addictions facilities that are being offered in southern jurisdictions, especially Poundmaker's, is very much on the theme of Indigenous people, when they go to addictions. I'm quite familiar with all of these, because I've had Poundmaker's do complete addiction courses and whole things at Salt River, on reserve. They were six weeks long, and a whole team is included, psychiatry, psychologists, and these were all Aboriginal people.

To me, addictions also includes getting into what happens, why they are in this situation, and on-the-land is part of that for the after-care, and I respect the Tlicho Member's statement. I think that on-the-land doesn't have enough monies allocated to it, and I think that's something that should be looked into in future, but in treatment centres, most of the time, most treatment centres have addiction doctors who go there, and they balance the whole thing even with the pills and what is needed to offset some of these addictions. You know, these are big costs and, for the amount of money we spent, I was surprised at how little it was, for 191 people who went, because that would have cost us much more in the long run.

I'm just pointing those out, because I'm always about getting the best for the members of the Northwest Territories, and I want to make sure that the after-care is also in place. I mentioned that yesterday. I'd like to see you think about that, Madam Minister. We had a great discussion on this in past times with all the Aboriginal groups about addictions. We spent a whole day on it one time with all the leaders. It was very informative for me because, like I said earlier in my comments, almost every household, no matter if it's Indigenous or non-Indigenous, no matter of race, no matter of colour, no matter of religion, there is always a problem in almost every family, and it's something that each and every one of us has to face. Anonymity is very important, also. We live in a small territory. Anonymity and privacy are some of the things that we discussed in the last couple of days, and I think that anonymity is extremely important when we make some of these big decisions. Thank you, Madam Chair.

Thank you, Member for Thebacha. Minister.

Thank you, Madam Chair. I hear the Member's concern about being anonymous. I mean, right now, there is so much stigma attached to mental health. When people hear about going to treatment and going to get some help, there is that stigma attached. We need to get away from that. We need to start thinking about: how do we rename or how do we get away from people thinking it's wrong to go to treatment? It's not. You're going there for help, and I think that's important. I hear what you're saying. Sorry, Madam Chair. I hear what the Member is saying, and I totally agree.

On-the-land programs are important; they are key. Right now, our department spends $1.8 million with partnerships with Indigenous groups so that they can start to deliver on-the-land programs, and I think that's important. I mean, every Indigenous group in the territory is diverse. We have First Nations, Metis, Inuit, and it's all culturally relevant. They deliver programs based on how they want to heal their residents and their people. Thank you.

Thank you, Minister. Do you have a follow-up question, Member for Thebacha?

No, Madam Chair.

Thank you. Are there any other comments or questions on this section? Mr. Jacobson.

Thank you, Madam Chair. Just on work on behalf of others. Bringing up what my colleague from Monfwi brought up in regard to the healing centres, I know Fort McPherson had Tl'oondih. Inuvik and the Gwich'in, there are two places that we could send people to get help, get healing, and I guess working with that. I've seen so many people, same as him, fall through the cracks in regard to sending them out for treatment. When they come back home, there is nowhere to go. It's a vicious cycle, but it's a cycle of peer pressure and that they make by choice. I think those should be really looked at in regard to trying to help our own people up there, because nothing has been done. Nothing is being done. We could help more people if it's more centralized, say, in the Inuvik area, bring people in from the communities. That's just one of the concerns that I have.

These past few months, with the First Nations and the cancer strategy across our territory, I think what we should be really looking at is: so many people are telling me that they are getting misdiagnosed with cancer. They've been going to the health centre for a year, a year and a half, and they get sent out. They go out to Edmonton, come back, and when they do come back to the community, it's stage 4 cancer. You can't do anything. It's too late. Some of them get stage 2, they did catch it in time, but I'm dealing with a couple of constituents like that. The misdiagnosis is happing too much. I just want to make sure that the Minister is making sure, on behalf of all of our constituents who we serve, and the department, I guess out of Inuvik it would be myself, that the following up of the heading to the Cross Cancer Institute, making sure their appointments are made, especially with this COVID-19 stuff that we have going on, just to follow through. Just a couple of weeks ago, we had one with kidney failure with a misdiagnosis again. It's really tough in our communities, because our health centres do the best that they can to provide the service. We have to rally around that in terms of trying to work together for our constituents to getting them served. Thank you, Madam Chair.

Thank you, Member for Nunakput. That takes us back a few pages, but I am wondering if you would like to respond to that question, Minister.

Thank you, Madam Chair. I hear the Member's concern, and it is very important. Right now, we have a relationship with Alberta as they take a lot of our patients. It is a combination of making sure, when we catch anybody at a certain stage in cancer, that we do our best. That has been our department's approach, to make sure that they get to their appointment as quick as possible. The relationship that we have with Alberta has been doing great. We are trying to make sure that our patients in the Northwest Territories are just as important as the patients in Alberta, and we have that relationship. Thank you.

Thank you, Minister. Do you have a follow-up question, Member for Nunakput?

Thank you, Madam Chair. I just wanted to see, on my first comments in regard to the treatment, if being able to bring it up North, working with the Gwich'in, working with the Inuvialuit, working with communities who want to try to help our own people, is it possible to see if there are any avenues that we could work together, going down that road together? Thank you, Madam Chair.

Thank you, Member for Nunakput. Minister.

Thank you, Madam Chair. I know, in the past, that we have had a lot of treatment programs in our communities. I don't know why they have shut down. That's prior to my time. It is something that we could look at. I do want to say that we provide funding to the Indigenous groups, but we don't tell them how to spend it. When we provide a contribution agreement with them, that's them coming up with their own plan and resources. Most times, they match a lot of our dollars, and they are able to deliver programs that are relevant to them and their culture. We do provide funding; we just don't tell them how to spend it. Thank you, Madam Chair.

Thank you, Minister. Anything further, Member for Nunakput?

Thank you, Madam Chair. No, I think it's time that we do start telling them in regards to how to get treatment, because they're not doing it. It's too much overhead, the costs. The start-up cost is the biggest thing. Like I said, we have two camps up there, three camps, potentially, that closed down due to everything being sent down to Alberta. I am thankful that our territorial government has a good working relationship with Alberta. I am happy for that, that people are being served on a timely basis, but I think it's time that we start taking a look at ourselves within to try to start taking care of ourselves and working together; not just giving them the money and pushing it to the side, thinking it's going to get done, but actually seeing boots on the ground trying to do these programs as a starting point. Thank you, Madam Chair.

Thank you, Member for Nunakput. That's more a comment than a question. Did you want to respond, Minister?

I hear the Member's comment, and I take that as a comment. Thank you.

Thank you, Minister. Any further questions on this section? Member for Hay River South.

Thank you, Madam Chair. I'm on page 180. Hopefully, I'm on the right page.

You are.

Thank you. This may have been answered yesterday; I had to leave a little bit early. I just want to know: how many people do we have in the South under residential care right now? Thank you, Madam Chair.

Thank you, Member for Hay River South. Let's see if we get the same numbers today.

[Microphone turned off] ...Deputy Minister Cooper. It's 119.

Deputy Minister, please.

That is consistent with yesterday's answer. Good. Further questions, Member for Hay River South?

Thank you, Madam Chair. I had a question from a constituent there a few weeks ago. She has a sister who has been down there for quite a number of years, and whether she's forgotten or whether the government has forgotten about her or not, I'm not sure. Are there any plans to repatriate the people under residential care back to the territories in the South? Thank you, Madam Chair.

Thank you, Member for Hay River South. Minister.

Thank you, Madam Chair. This is something that our department is looking into. Right now, we have residential care services for those with difficult needs. They have developmental delays. There are complex care needs. We would like to bring them closer to home. Sometimes, the services that we offer are not suitable for them and, therefore, the reason why they are not able to be at home. Thank you.

Thank you, Minister. Member for Hay River South.

Thank you, Madam Chair. Just to continue on with that, then, if we can't provide the services here, I'm just wondering: we keep sending people down there. How many people have we brought back because we actually implemented something here in the territories to allow them to come back? How much of that work has been done? Thank you, Madam Chair.

Thank you, Member for Hay River South. Minister.

Thank you, Madam Chair. I just remembered something prior to the question. We are doing a supported living review so that we can be able to determine all of our patients who are having to have services outside of the territory, to do a review so that we can repatriate them eventually.

In terms of the past, sorry, Madam Chair, I'm just going to ask Deputy Minister Cooper. I don't have the numbers in front of me to be able to offhand say how many people we have actually brought back in the prior years. Thank you, Madam Chair.

Thank you, Minister. Deputy Minister, please.

Thank you, Deputy Minister. We will take that as a commitment to return. Member for Hay River South.

Thank you, Madam Chair. What is the average cost, I guess, per person per year to house them down South? Thank you, Madam Chair.

Thank you, Member for Hay River South. Minister.

Thank you, Madam Chair. In front of me, I don't have that number, but we have to recognize that it would all depend on their level of care. The patients that we have outside of the territories, whatever services they are providing, it all would depend. I don't believe we have numbers at this time. Thank you, Madam Chair.

Thank you, Member for Hay River South.

Thank you, Madam Chair. It sounds like it's about $200,000 per person. It just seems to be a fairly hefty number. It would be nice to see, start to look at ways to bring people back here. In saying that, you mentioned a variety of issues that people have, and I am not sure if there is kind of a theme to that, if there are more in one area or not. What is it that we are short of here in the NWT that we have to send these people South? What are we short on the ground? Thank you, Madam Chair.

Thank you, Member for Hay River South. Minister.

Thank you, Madam Chair. I'm not aware of the specifics, and I will ask Deputy Minister Cooper to be able to dig deeper into specific care needs and costs. Thank you.

Thank you, Minister. Deputy Minister.

Thank you, Deputy Minister. Member for Hay River South.

Thank you, Madam Chair. I guess the next question is: you said that there are some people that have been down there for quite a number of years. How many of those people have we lost to the Alberta healthcare system, if any? Thank you, Madam Chair.

Thank you, Member for Hay River South. Minister.

Thank you, Madam Chair. I don't know that level of detail. However, I can look to Mr. Cooper to be able to see if he's got specific numbers on how many we have lost as a result of them going to Alberta. Thank you.

Thank you, Minister. Deputy Minister, please.

Thank you, Deputy Minister. Member for Hay River South.

Thank you, Madam Chair. My understanding, as well, with dementia, we have facilities here in Yellowknife to place people, but we don't really have any facilities outside Yellowknife with the proper care, and we send people to Alberta. Can you give me an indication if this government's looking to expand that type of care outside Yellowknife? An example would be Hay River. We have a building that's going to be available, and I just want to get an indication if that is something that this government would be looking at. Thank you, Madam Chair.

Thank you, Member for Hay River South. Minister.

Thank you, Minister. Anything further? Last question, Member for Hay River South?

Nothing further. Thank you.

Thank you, Member for Hay River South. Are there any other comments on page 180, out of territory services? If there are no further questions, then, on page 180, I'm going to call the page. Out of territory services, operations expenditure summary, 2020-2021 Main Estimates, $73,528. Does the committee agree?

Thank you, committee. Next, we are going to look at funding allocated to health and social services authorities beginning on page 185. Are there questions on this page? Sorry, Members. I didn't realize these were double-sided pages. We are now going to consider supplementary health benefits beginning on page 182. Are there any questions on this page for the Minister? Go ahead, Member for Inuvik Twin Lakes.

Yes. Looking on page 183, the extended health benefits, can the Minister explain how, this year, they expect it to be less than previous years? Thank you, Madam Chair.

Thank you, Member for Inuvik Twin Lakes. Minister.

Thank you, Madam Chair. In the previous years, the budget was $13 million, and this year, it is $11 million and change. The reason for the decrease is we got one-time funding in the prior year. Given that one-time funding was for us to do a supplementary benefits program review, so that's what our department is working on right now. In prior years, it was $13 million, and now, we're back down to $11 million as we're doing our review. Thank you.

Thank you, Minister. Member for Inuvik Twin Lakes.

Thank you, Madam Chair. Just to clarify, in 2018-2019, we had $13 million, and 2019-2020, we had $13.1 million, almost $13.2 million, and now, we're going down $2 million almost. It was $2 million a year for a review? Thank you, Madam Chair.

Thank you, Member for Inuvik Twin Lakes. Minister.

Thank you, Madam Chair. In the prior years, we were able to do supplementary appropriations to be able to address any growth. That's why it's been $13 million, and then $13 million, but this year, we're not given the extra funding. If we do, it would be through a supplementary.

Thank you, Minister. Member for Inuvik Twin Lakes.

Yes, thank you, Madam Chair. I'm just kind of confused, just knowing my process now. The main estimates in 2019-2020 were the same as the revised estimates, so there was no supplementary appropriation in that section to my knowledge. I'm trying to figure out what exactly did we spend, or what are we not spending, or where did we cut $2 million out of this budget? Thank you, Madam Chair.

Thank you, Member for Inuvik Twin Lakes. Minister.

I'm going to ask Ms. Mathison to help me out here. Thank you.

Thank you, Minister. Director of finance.

Thank you. Member for Inuvik Twin Lakes.

Thank you for that answer. With that answer, with us sitting there with $11.4 million and we don't have the extra funding this year, what was given to me with 2018-2019 was $18 million. Is this budget we're looking at, probably a $6 to $7 million difference? That's what we need to be looking at for this next year? It's not actual? Thank you, Madam Chair.

Thank you, Member for Inuvik Twin Lakes. Minister.

Thank you, Madam Chair. The program is demand-based, as well, the actuals will fluctuate from year-to-year based on the benefits that we provide to clients. Thank you, Madam Chair.

Thank you, Minister. Member for Inuvik Twin Lakes.

I'll move on to the next section. The medical travel benefits, we've got $19 million and then $15 million and $15 million. The $15 million for medical travel benefits, is this just for non-government travel, medical travel benefits? Thank you.

Thank you, Member for Inuvik Twin Lakes. Minister.

Thank you, Madam Chair. The medical travel program is complex. Right now, if a patient in the Northwest Territories does not have any insurance or any way to cover their medical transportation, this is something that our department covers. However, if you are an employee of the GNWT and you require some medical travel, then the benefits will come through human resources. Thank you, Madam Chair.

Thank you, Minister. Member for Inuvik Twin Lakes.

Thank you. Under this medical travel benefit, I know that we have contracts. Does that fall under this budget? Just to clarify, for Larga and for Vital Abel and for the different homes, does that fall under this chunk of money? Thank you.

Thank you, Member for Inuvik Twin Lakes. Minister.

Thank you, Madam Chair. I'm looking to my colleagues. They are nodding "yes," so it does include that. Thank you.

Thank you, Minister. Member for Inuvik Twin Lakes.

Thank you. Just to touch on here, I would like to know, since it falls under here and now that we're sitting under this, there have been a lot of concerns raised with medical travel and some of the places where they have to stay where there is not enough food for some of the residents who I've gotten complaints from, so how do we assess that? Is there an assessment over these places or questionnaires that go out to people so that we know that we are providing enough funding so that, when people are travelling for medical travel, they are meeting the needs of the clients when they are travelling out? Thank you.

Thank you, Member for Inuvik Twin Lakes. Minister.

Thank you, Madam Chair. I hear the Member's concern. When we send our patients out, we're sending them to the facilities outside the territories; even within the territories, we have a number of places we use. The Northwest Territories health and social services authorities, they have regular reviews to ensure that the locations or the facilities are meeting the requirements, so we do have the review done. Thank you.

Thank you, Minister. Member for Inuvik Twin Lakes.

No, that's all I have. Thank you.

Are there any additional questions for page 182, supplementary health benefits? Member for Kam Lake.

Thank you very much, Madam Chair. I just have a couple of questions in regard to supplementary health benefits, and I'm just wondering: is there an anticipated review of supplementary health benefits coming in the near future? Thank you.

Thank you, Member for Kam Lake. Minister.

Thank you, Madam Chair. Yes. Right now, we are looking, and we talked about the reduction in main estimates from prior years because that was one of the recommendations, that we put together a review, so we're doing that now. We have our committee on child and family services, and we are looking at that. That is something that we will bring forward to AOC, and we're planning a time to review that. Thank you.

Thank you, Minister. Member for Kam Lake.