Thank you, Member. Minister of Health and Social Services.

Thank you, Madam Speaker. Madam Speaker, I welcome the opportunity to answer this question.

In this House this week, I've been asked for nursing student bursaries, fertility treatments, suicide prevention money. I've also been asked for HIV PREP, which is a preventative medication, and free contraception. That's the problem, Madam Speaker. The expectations of the health system are not commensurate with the amount of money that is provided to it.

What I want to say about the deficit is that it is top of mind for NTHSSA and for me as the Minister. We created the NWT health and social services system, as the Member said, in 2016 and inherited a deficit at that time, and it has grown since. We report twice annually, and we report this to the Regular Members as well as to Cabinet, about the work that's being done by the sustainability office. I want to say that where they are at right now is with cost containment. So I'm not expecting a report that says that money has been saved but rather that the deficit is going to not grow as quickly as it has been. Thank you.

Thank you very much, Madam Speaker. Madam Speaker, absolutely that residents have asked for all of that. I guess it comes down to choices because I've also seen some things that I would think that are not necessary expenses for the Department of Health and Social Services, which I won't get into. But I do think it comes down to choices, and I think that there are ways that we can spend money smarter. So my next question is how is NTHSSA working with regional health authorities to reduce the trend in this growing deficit? Thank you.

Thank you, Madam Speaker. Madam Speaker, it's easy to second-guess spending by a big department by Health and Social Services. And if the Member has ideas, then certainly we're open to hearing from them.

NTHSSA is now one entity. So it's a whole system approach to understanding what the cost drivers are and what to do about them. So examples of initiatives underway now are

• Improvements to inventory controls and purchasing;
• Process improvements to improve billing and collection of accounts receivable for chargeable services;
• Improvements to processes used for managing facilities and fleet;
• Processes to ensure NTHSSA recovers all costs for services it performs for other departments and jurisdictions;
• Improvements to budgeting processes; and,
• Establishment of a quality improvement framework.

So I want to convey that this is an issue that we are taking very seriously, and the sustainability office is working diligently to find ways to control spending. Thank you.

Thank you very much, Madam Speaker. Madam Speaker, I always love sharing ideas. I've shared one this week that will tackle two of the five major items that run over in the health budget, which is trading education for service in the public service. Thank you.

My next question for the Minister is has there been an evaluation of health authority programs to determine where specifically there can be cost savings to the government in this fiscal year? Thank you.

Yes, thank you. So this is a three-tier process. We are currently in tier one, which looks at internal controls and cost containment initiatives. Some of the things that we've done relate to the supplementary health benefits that I mentioned yesterday, so that's offering generics instead of biologic drugs, changing the dispensing fee regimen so that meds are dispensed 100 days at a time rather than every 30 days. And those are some specific examples of things that we're trying to do to contain costs. But at the end of the day, we are underfunded and the demand for additional services is relentless. And so until there is some acknowledgement, starting by the Members in this House, of the fact that we can't afford to do everything for everyone, we're going to continue facing this issue. Thank you.

Thank you very much, Madam Speaker. Madam Speaker, I do hear the Minister, and that's why I started with the question of whether or not healthcare in this territory is chronically underfunded. There are certain things that residents of this territory are going to expect to be able to have access to and equitable access to across the territory. Health demands are much different, say, in Fort Smith or in Yellowknife as they might be in Nunakput and the costs of each of those. And so my question to the Minister then is what conversations is the GNWT having to ensure that health systems in the territory are adequately funded? Thank you.

Having a little private laugh about a meeting this morning. Yes, what we need is we need to do several things. One is that we need an increase to the Canada health transfer, and that's something that the Premier is working on at the Council of the Federation table. And you may have seen the ads reinforcing those messages that have appeared recently.

We are also negotiating with the federal government to continue to fund and, in fact, augment the Territorial Health Innovation Fund which is -- it's a fund that acknowledges that costs in the NWT, and this fund is available in Nunavut and Yukon too, but costs in these remote places are more expensive.

The Department of Health and Social Services has submissions in with the Financial Management Board which point out areas in which we are underfunded and in which we need more funding. The thing about it is that health is expensive to deliver. It is getting more expensive. The population is aging. They're sicker than they ever have been. We're a great distance from specialists' care. So there are cost drivers that I don't think we are going to be able to overcome without a big injection of cash from the federal government.

The other thing we have to do, which we've started with the supplementary health benefits, is we need to ask people who can afford to pay to pay for things that we're currently giving away. So that is, for example, not having any rational reason to pay all the drugs for somebody who has cystic fibrosis and none for ALS. That is a system that doesn't make any sense and a system that we're trying to fix so that it is both equitable and that people who can afford to pay do pay. Thank you.

Thank you, Minister. Oral questions. Member for Thebacha.