Thank you, Mr. Chair. Mr. Chair, for this one, there certainly are some shortfalls being projected. Mr. Chair, let me direct that one over to the deputy minister and see if he can get that level of detail. Thank you.

Thank you. I'll go to the deputy minister.

Thank you, Mr. Chair. So there are a number of factors that are for all three territorial health and social services authorities that are requiring more money to be spent on child and family supports. It's just that the Tlicho region was unable to offset those costs from other areas so they require a supplementary appropriation for this purpose. Thank you.

Thank you. I'll go to the Member from Yellowknife North.

Thank you. Does the Minister know, does this reflect a sudden spike in, for example, children being apprehended or taken into care or something different that has happened, or these are just sort of run-of-the-mill incremental sort of forced growth costs? And if she is not aware, I can follow up later with the health and social services Minister. Thank you, Mr. Chair.

Thank you. I'm going to go to the Minister.

Yes, Mr. Chair, I was going to suggest that that -- what may or may not be happening on a broader and systemic scale is probably best directed to the Minister of Health and Social Services but if that's not necessarily required for this moment, then I'll not redirect it over there. Thank you, Mr. Chair.

Thank you. I'm going to go to the Member from Yellowknife North.

Thank you, Mr. Chair. Okay, so my next question, following up on the Member from Range Lake's questions about cost associated with agency and contract staffing, can the Minister confirm whether costs of locums -- so that's either locum nurses or locum doctors -- would that be included in that line item? Thank you, Mr. Chair.

Thank you. I'll go to the Minister.

Thank you, Mr. Chair. Not locum physicians if that's what you're seeking. Thank you.

Thank you. I'm going to go to the Member from Yellowknife North.

Thank you, Mr. Chair. So, I mean, one particular concern that I've heard related to the way we budget for agency nurses is -- I think people on the front lines have a sense that there are strong attempts to limit the budget -- the regular budget for the NTHSSA so there's resistance to, for example, you know, adequate levels of staffing or putting new staffing positions in place because that would increase the budget that, you know, we're trying to keep under control and yet by not recognizing what is needed to keep the system sustainable, those costs are actually inevitable and they keep popping up in these sups which, you know, we have a very hard time refusing certainly, especially, you know, after the fact once it's been spent, but that way of budgeting creates these sort of perverse incentives to keep sort of overly squeezing our staffing models at the front end and incentivising health authorities to just sort of hire agency nurses when they realize that they need more people, which could be involved by a more sort of wholistic and sustainable staffing models that, you know, we plan ahead for and include in the main health authority budget.

So I'm wondering if -- a question to the Minister here. If these costs of agency nurses that come through the sups end up being fed back into the considerations when it comes to overall health authority budgeting that they get sort of counted so to speak, not as just sort of extra unexpected costs but as actually as fundamental costs necessary to running of the system and that that might lead to better staffing models in the first place, that would avoid us having to pay for these things after the fact. I know that's a convoluted question, but the question is is there a feedback loop given these millions of dollars of extra costs that are coming after the fact that will allow us to plan better staffing that would prevent these costs from happening in the future? Thank you, Mr. Chair.

Thank you. I'm going to go to the Minister to the question.

Thank you, Mr. Chair. Mr. Chair, I guess I'm not sure that my observations are necessarily the same in that the Department of Health and Social Services has seen a rather exponential growth in its budget over the last sort of five years, if you will, at a growth rate or more in excess and significant than that of other departments. And largely that is driven by, well, the cost of services going up significantly but also the number of health care work staff, labour force, physicians, nurses, as well as others, for example to support the nurses that are there. So we right now, for example, I think -- or at least last week, last time I had heard, we had exactly one agency nurse in the Northwest Territories. So I don't know that -- yes, I don't know that keeping a line item when we many times will have only one is necessarily the right response. The desire to see less use and less reliance on agency nurses is shared, I suggest, across the territory and including -- and certainly across this -- within this House, but keeping the ability to do so for emergency needs at the same time is still one that is important for services. So the number does fluctuate but, again, it was certainly at a one not long ago and may well be at or near a one right now. I mean, the bigger challenges, of course, is to determine the appropriate level of total budget for an appropriate level of services, which is a much more complicated thing than I can answer right now, but is, indeed, the work that is underway both by the health sustainability unit as well as by the health administrator and then to put those pieces together, I think that -- those questions were already answered by the health Minister today. Thank you.

Thank you. I'm going to go to go back to the Member from Yellowknife North.

Thank you, Mr. Chair. I can appreciate that answer, and certainly I'm not suggesting that we should sort of ban agency nurses as they might be needed in emergency situations or to fill in urgent gaps. However, my concern is if our system becomes designed to continually rely on them, and I do hope and I want to keep emphasizing that it is important work of both the health care system sustainability unit and the public administrator, to look at appropriate staffing models as part of their work, staffing levels and what kind of staff and the right numbers of staff that are needed.

I would just point out, I mean, we have heard a number of times from the health Minister and finance Minister that, you know, we only have one agency nurse in the territory but, I mean, $2 million worth of agency nurses is more than one nurse and, you know, it does add up over time. So at any given time, I understand that there are few but it's obviously added up to $2 million, so we are still -- there is a sizable enough reliance that it's worth looking at how we can better structure the system to avoid, when possible, needing them. So I'll leave it there. Thank you, Mr. Chair.

Thank you. I'm going to go to the next Member on my list, is the Member from Monfwi.

Thank you, Mr. Chair. We're talking about money that's already been spent. So you know and I know the majority of the people living in small communities are Indigenous people. And for some of the small communities, we know that without agency nurses or contract staffing for nurses, we will be without nurses. We're not going to have any services. We have a health centre but we're not going to have any staff, nobody to look after the small communities. So I do support some of -- because of that, you know, I do support where we do need -- and here we're crying, we're asking for more doctors, we want more nurses, but small communities -- and you said it before too, small communities do matter and we do need a better health care.

So with that in mind -- with that in mind, like, for the nurses in small communities -- and I know that you said locum and physicians are not in this -- it's not part of this budget here, that $2.4 million. So I just wanted to know and ask -- well, I know it's finance Minister, but I think I should be asking the health and social services Minister. I know it's hard and it's culture shock for newcomers to come in, but I just wanted to know -- and I know that there's a lot of colleges and universities in the south where it is Indigenous, most -- you know, there's a college of nurses in -- which is for Indigenous in Saskatchewan and in Alberta as well. So I just -- sometimes we do get lucky. We get a nurse that loves our community or that loves the region that stays for many years, you know, and they -- some of them stay until they retire or well beyond retirement, you know. But that's only few in between. It's not too often. So I just want to -- it would be nice if we can do something to recruit -- I know that in the North we don't have too many Indigenous nurses and doctors that were born and raised in the North. And if we do, then they go somewhere else in the south so I think we need to recruit more Indigenous nurses and doctors across from -- you know, like, from the south, from the colleges.

I don't know if it's -- could be part of this budget but I just wanted to know if there's any kind of a campaign that's happening between the GNWT, health and social services, or with the human resources to recruit other nationalities? Because I know if it's an Indigenous, hopefully they will want to stay because they come from -- many of them are from small communities, small -- like, from outside of a larger regional centre. So, and I know this is not -- this is old money that we're talking about; it's money already spent, but maybe for upcoming budget, if we can put something in there where -- because it's good for career too, a career opportunity for young people that are -- you know, that are within our region. So I just -- that's just -- it's more of a comment.

So maybe, A, we can keep that in mind for future reference, especially for small communities, for outside of Yellowknife, where it is hard to recruit. And we do need more nurses and sometimes it's the agency nurse that comes in, and we don't -- and I don't think any communities would like to see their health centre shut down because there's no nurses. And agency nurses do help in many of this -- in these areas.

So another one too is that here, to provide funding for the in-territory child and family services program with NTHSSA. But it's not just TCSA, but it's probably other region as well. So is this keeping to where -- keeping the kids in the North or in the regions? Is that -- this budget, is it part of that? Because I know that a lot of time before kids were -- when they were removed from the community, they were always sent to a larger regional centre, and there's a lot of voluntarily agreement that's being -- that's taking place. Does this budget reflect that? I'm not too sure. Thank you.

Thank you. I'm going to go to the Minister, to the question.

Thank you, Mr. Chair. And first of all, I do want to commit that the human resources -- or the health recruitment unit that does -- is a shared responsibility between health and finance. More than happy to have them follow up if there -- if we can identify the specific programs that the Member's suggesting, we'll make sure they're following up and even just generally, perhaps, take an opportunity to see that we recruiting -- we do tend to recruit almost all, if not all, graduates from Aurora College, but if there's specifically some Indigenous focused programs elsewhere, that would be very helpful. So, again, I will certainly follow up with the Member and with HRU on that.

With respect to the in-territory child and family services system, it is a function of there being an increase in need but also, again, as Members noting, the costs associated with trying to have systems or programs that can keep families together, so a higher cost for preventative programs but also that can then, you know, working with a family, there's different types and different levels of agreements, voluntary services plan of care agreements up the chain and so the more can be invested sometimes to try to fix some of the structural issues that does result with more clients and with more need, there's more costs, but that -- so, yes, you know, in some cases there still will be children who do not have a place but to the extent that they can be kept with their families or in foster care within the community, which sometimes also requires more costs, then that is -- that is resulting in increased costs. And, again, it's not just Tlicho. Just that was the only entity out of the three that didn't have the opportunity or didn't have other surplus money from elsewhere they could put toward a cost overrun. Thank you.

Thank you. I'll go to the Member from Monfwi.

Thank you. Yeah, thank you. It's more like a family preservation program too as well, yeah.

So another one too is that to provide funding to address the impact of costs associated with the tuberculosis outbreak, so it's probably mostly the Indigenous people here because the majority of the people that, you know, living in Yellowknife too, it's half/half but, you know, probably mostly -- I don't know. For that one, the funding, is it just only for -- was that money only assessed only Yellowknife or, like -- or was that, this cost association -- associated, was it only for Yellowknife only, or did some of this fund went to outside of Yellowknife as well?

Thank you. I'm going to go to the Minister.