Mr. Speaker, I rise today to say goodbye to you and my colleagues in this House. It has been a privilege to spend the last eight years in this Legislative Assembly representing the constituents of Yellowknife Centre and for the last three years serving all residents in the NWT as Minister of Health and Social Services, Minister responsible for Seniors, and Minister responsible for People with Disabilities. I would like to start with some acknowledgements.

My parents made the decision to immigrate to Canada when I was a child. It opened a world of opportunities in education and employment I don't think I'd had if I had stayed in England. I am so very grateful to them. My dad, Stan Green, instilled the social justice values that have shaped my life. He has been a fervent supporter of my political career and I count on his constant encouragement. Thank you, Dad.

Turning to the people in the gallery today, I would like to thank my partner, Janice McKenna, for her steadfast help and encouragement through our many years together but especially in the last eight. She has inspired and supported me through the many challenges of political life. Thank you, Janice, for your patience, love, and wisdom.

I also want to thank Catherine Pigott who persuaded me to give Yellowknife a try as a place to live and work. And my brother from another mother, Don Babey. As well as my friend and champion, Audrey Henderson. Thank you all for your friendship.

The early days of my political career were overwhelming, indeed like drinking from the proverbial firehose. There was so much to learn about the government, about how the Legislative Assembly works, and getting to know colleagues.

A former MLA gave me a valuable piece of advice early on. He said, If you are well informed, you can be very influential. I took that to heart and continued to read as much as possible.

Regular Members can also make a difference in other ways. The one I found most effective was motions. I put forward five motions in my first term, and they all gained some traction. The one I am most proud of is my motion on International Women's Day 2018, creating targets for increased numbers of women MLAs in this House. In the 18th Assembly there were just two women elected, myself and the Premier. And in the history of this legislature, there had never been more than three women here at one time.

The motion came to life with the creation of a special committee to increase the representation in the Legislative Assembly. Five of us toured ten communities in the NWT to learn about the barriers women faced running for office. We made recommendations to remove those barriers in the special committee's interim report. Women said they needed a family-friendly workplace, information and training on the role of MLA, and financial assistance to pay for campaigns. My colleagues adopted all these recommendations.

The final report dealt with the question of introducing quotas to ensure change happened. While most women told the committee they didn't want quotas, they did want to see more women in the House. In the end, we recommended that if voters didn't vote for women in the 2019 election, we would revisit the idea of quotas through a plebiscite. The point, of course, turned out to be moot when voters elected nine women to the House in that October, and an additional woman in a by-election, creating a majority of women Members in the House. A first in Canada.

The result exceeded my grandest expectations. I am proud of helping to bring so many women into politics. I believe that having women here in the legislature has made a difference. There has been an unprecedented focus on housing, child care, education and health. At the same time, women have shown they can lead on the economy, finance, and infrastructure. My hope is that women's representation is now the norm and voters will again vote for women's equality on November 14th.

As well as having more women in the House, the 19th Assembly couldn't have been more different than the 18th. The COVID-19 pandemic had a lot to do with that. We were just starting the winter budget session when fears about transmitting the virus put public life on hold. People went home, worried about being isolated from family and friends, trying to help children and youth to get on with school, and pivoting to keep their businesses open. Those stressful days became stressful months as the lockdown continued, not only for businesses but also for students whose education was disrupted, seniors who were isolated for their safety, and people who didn't have homes. It was also a time of great innovation: Working from home, online education, and expanded telehealth, to name a few.

At the end of that summer, I joined the executive council and became part of the government's response to COVID.

It's worth remembering that we had few cases in the NWT in 2020 thanks to a comprehensive and controversial lockdown by the chief public health officer. The federal government provided us excellent support with testing, PPE supplies, and prioritizing the North for early access to vaccines.

On New Year's Eve 2020, staff started vaccinating elders in long-term care. After seeing COVID kill thousands of seniors in the south, I think we all shared a sense of relief. But our real COVID test was still to come as new more infectious strains swept through the community and other communities in 2021 despite continued precautions. I mourn the people who died - elders who were knowledge-keepers in their communities and the unhoused population.

I want to thank all the staff from the department and the health and social services authorities who worked so hard to make each of the steps along the way work. Your dedication and personal sacrifice made a difference to all of us. Thank you.

Mr. Speaker, in the 18 months since the public health measures ended have required a massive effort to catch up on other priorities. I am proud of the work the staff of the health and social services system have done to complete the alcohol strategy, the seniors framework, the Baby Bundle Program, the Indigenous Patient Advocates, the Office of Client Experience, and reaching a draft agreement with the Inuvialuit Regional Corporation for them to take the lead in caring for their children and youth.

The initiative I am most proud of is the work to overhaul the Extended Health Benefits Policy. The ability to access benefits, such as drugs, medical appliances, dental and vision care, will no longer be tied to the diagnosis of a specific disease. These benefits will be available to all residents of the NWT. No one who has coverage under the old specified condition program will lose it. And 2,200 people who didn't have insurance before will soon have it. In short, we have developed a policy for universal coverage that includes everyone.

This new safety net requires income testing that considers family size and location in the NWT. If cost-sharing is required, it will have an upper limit based on income. These changes come into effect on April 1st next year, and staff are working hard to provide a seamless transition for clients of the old program.

I'd like to thank everyone who has had a hand in all these initiatives. I want to make special mention of deputy minister Jo-Anne Cecchetto and former deputy minister Bruce Cooper for their leadership, along with the rest of the team who give it their all every day. Thank you.

Mr. Speaker, now I want to talk about where we need to go from here with health and social services. Our biggest challenge is recruiting and retaining staff. NWTHSSA had a vacancy rate of 13 percent across all regions and departments as of this summer. We are especially short of nurse practitioners, midwives, registered nurses, and physicians in regional centers. While we haven't had to close any health centres, several of them have been, or are on, reduced services because of staff shortages. We have had good uptake from staff on the incentives that we've offered to strengthen retention, as well as hiring as many Aurora College nursing graduates as possible. But this national, even international, problem persists and challenges us to provide the level of care residents want and need.

Our second biggest challenge is the cost of delivering health care. It has escalated, along with everything else, in our lives. For example, the cost of a hospital stay in the NWT is almost twice the national average, and hospital stays are generally longer here. The health and social services budget is the largest in government at $610 million for this year. Even though federal funding for health care will increase this year, the amount is not a game changer. In fact, the Northwest Territories Health and Social Services Authority is forecasting that it will again add to its operating deficit, now at $245 million.

Staff compensation and benefits, along with unfunded contracts and medical travel, are the primary drivers of the deficit. Let me assure residents and taxpayers that staff are working hard to contain costs and seeking funding from a variety of sources for positions, services, and programs that are unfunded or underfunded but it's an uphill battle.

Mr. Speaker, our third primary challenge is to manage expectations of what health and social services can deliver. The demand for more services and programs is constant. There are lots of good ideas and the territory would benefit from them, but financing and staffing new initiatives is a real challenge. We simply can't offer all services in all centres given the money we have available and staff vacancy rates.

Outside of federal funding tied to specific initiatives, the GNWT has limited sources of revenue to direct to the system. We are not Alberta with multi-billion dollar surpluses. We are at a fork in the road. Either we stop offering services free of charge that are outside the NWT health care plan or we ask NWT residents to pay for those additional services according to their means. This is a big ask here in the NWT but not in most southern jurisdictions.

The idea of paying for things, like physiotherapy and eye exams, won't be popular but it is necessary for the system to maintain the focus on core services. There's no sugar coating this, Mr. Speaker. There are hard decisions ahead for the residents of the NWT to support the health system. At the same time, the next government will have to continue to lobby Ottawa to increase investment in health care to walk the talk of reconciliation with NWT residents.

The heartbreaking truth about the health and social services system, Mr. Speaker, is that despite all the money spent, health outcomes for many residents are poor. Life expectancy in the NWT is five years less than the national average. Deaths that are avoidable with better prevention and care are two-thirds higher. We also have higher rates of smoking, drinking, and obesity which drive chronic conditions. All these numbers come from the Canadian Institute for Health Information.

The underlying cause of poor health in the NWT is poverty. Unfortunately, our poverty indicators are depressing. The NWT Bureau of Statistics estimates that 15 percent of the population lived in poverty in 2021, using the Northern basket measure of goods and services representing a basic standard of living. That's 6,400 people who don't have enough money for the basics.

Drilling down further, 23 percent of the population reported they worried about food security all the time. The Salvation Army in Yellowknife recently reported food bank use has doubled since the evacuation. Our housing crisis continues to deepen with core housing need that includes housing that is unavailable, unsuitable, or inadequate is at 24 percent of NWT households as of 2019. Almost a thousand people are on the public housing waitlist across the territory. And while it's hard to gather reliable numbers of homeless people, we can all see it's a growing problem in Yellowknife and the communities across the NWT and involves younger residents than ever before.

What happens to people who are homeless, hungry, and suffering from chronic disease? Mr. Speaker, the answer won't surprise you: Their health outcomes are poor. This situation contributes to the avoidable deaths I just mentioned.

Clearly, we have an equity problem and I expect the disparity between have and have-nots to continue growing given the increased cost of living. But it doesn't have to be this way, Mr. Speaker. We can and should prioritize investments in these social determinants of health to improve health outcomes. Let's start with housing.

During the COVID lockdown, we came as close as we ever have to ensuring everyone had a place to live. Once the pandemic started, living in a congregant setting such as shelters wasn't a good idea because the virus was so infectious. Instead, people lived in hotels, with wraparound services. I'm not aware of research on the health outcomes of providing hotel rooms other than the intended and important benefit that they protected people from getting COVID. But almost as quickly as it started, the use of hotel rooms was scaled back and people returned to shelters. That was the similar situation that we recently saw during the evacuation, where the street population went from shelters to hotel rooms back to shelters.

We know about the health effects of not having stable housing. There is evidence that people who are homeless are more likely to be admitted, or re-admitted, to hospital and live only half as long as the rest of the population. In summary, to quote Dr. Andrew Boozary of the University of Toronto, "What rate of death and disease are we willing to accept by denying people access to housing?"

NWT Housing has been chipping away at this problem, buying property such as the Aspen Apartments in Yellowknife for example, to increase transitional housing options in Yellowknife. But we have a long way to go.

Mr. Speaker, we have some significant challenges ahead, but we also have some successes to celebrate as well. The department started down the path of establishing cultural safety and eliminating racism in health care ten years ago. The department has made a commitment to this work and to value and incorporate Indigenous knowledge. Today, there is a cultural safety division staffed by Indigenous people. They provide important training and advice to ensure the work we are doing is culturally safe and antiracist. We want to rebuild residents' trust in health and social services and we're willing to do the work to get there.

Mr. Speaker, we have made historic investments to improve child and family services and they are giving us good returns. We are working on a paradigm shift to support children and youth to stay with their families and in their communities. This year's annual report, which I will table later today, says 95 percent of children and youth who are receiving services do so in their home or in their home community.

Mental health issues have emerged front and centre even before the pandemic and are more significant today. The department has responded by increasing the number and variety of counselling and treatment options. Now the average wait time for a scheduled appointment is four days in the NWT compared with the national average of 22 days. Client satisfaction with counselling services is at 72 percent. Hospital stays for mental health and substance use are on par with the rest of Canada. That said, suicide rates are three times higher; a number that is obviously much too high. I hope to see the best practices learned, from a study trip to Iqaluit in June, become an action plan on suicide prevention early in the life of the next government.

Mental health, as we know, goes hand in hand with addictions. The Auditor General's report on addictions and aftercare has helped to identify priority areas to address. We need to continue strengthening addiction treatment in partnership with Indigenous governments. I continue to believe that one centre won't meet the needs of the whole territory. Many regions have started working on their own initiatives - the Gwich'in healing camp, the Tlicho healing path, and the Deh Cho healing camps. Please take note of the word "healing." We need continued collaboration to help move residents into a healthy and happy place in their lives.

Mr. Speaker, I want to close with some additional thanks. First, to the constituents of Yellowknife Centre. Thank you for electing me to represent your issues and ideas and to my constituency assistant Craig Yeo for his excellent service. Thanks to my staff, Elizabeth King and Ramie Wourms, who have gone the extra mile every day. I want to thank my colleagues on the executive council and the staff that support us. And, lastly, I want to wish the Members of the 20th Assembly wisdom, humility, patience, and kindness for the important work they will do for all of us in the Northwest Territories. Thank you, Mr. Speaker.

Thank you, Mr. Speaker. Mr. Speaker, work has started on creating midwifery regulations under the Health and social services Professions Act. And that work will produce a modernized framework, including looking at the scope of practice, which I know the Member spoke about in her statement, to align with the scope of practice in other Canadian jurisdictions.

There is now an advisory committee with representatives from the Midwives Association of the Northwest Territories who are meeting with the department to do this work. So drafting instructions are being developed now, and it's anticipated that the regulations will come into force in 2025. Thank you.

Thank you, Mr. Speaker. Mr. Speaker, as with other health professions, we don't have the capacity to evaluate international credentials to decide whether they meet the registration requirements in our jurisdiction. So what we count on is that internationally trained health care providers are licensed in another province and once that happens, they're eligible for registration in the NWT. So we depend on the greater capacity of the provinces to assess their credentials and then once they've been assessed and found to be adequate, then of course we would register them here in the NWT as well. The business about evaluating international credentials is something that the whole health and social services system across the country is looking at because it's a very uneven approach as things stand now. Thank you.

Thank you, Mr. Speaker. Mr. Speaker, the health and social services system doesn't have any formal relationships of the type that the Member is talking about. But I think there's room for us to be proactive there because we do, in fact, welcome students to do practicums in our health and social services system and that, of course, extends to midwifery as well. So I think that there's room for us to perhaps create a more solid relationship with one of the training facilities to make sure that we have a steady supply of students. Thank you.

Thank you, Mr. Speaker. Mr. Speaker, there is a shortage nationally and internationally of midwifery candidates which is hobbling our efforts to fully staff our program. That doesn't diminish our commitment, and we are still actively recruiting for midwives wherever the program exists. So to be more specific, the territorial manager position is vacant and currently open for competition. The midwifery specialist position is filled and will focus and support the territorial program. Fort Smith, one out of three positions are filled so the services are limited. Hay River, two out of 3.75 full-time equivalent positions are staffed. And this includes the services that -- that staff there includes the services provided to Fort Resolution with visits that occur every six weeks. Yellowknife, one out of four positions are filled. And this position has been redeployed to support stabilization of staffing in Fort Smith because there are alternatives to midwife use in Yellowknife. So in short we are very short staffed, but we continue to advertise to fill all the vacant positions. Thank you.

Thank you, Mr. Speaker. Mr. Speaker, today I'd like to start by introducing Darin Chocolate, who is sitting right there, and Kenzie Yakelaya, who I haven't seen, who are working for us as pages in this session. They are residents of Yellowknife Centre, and I want to thank them for all the work they've done for us in the last two weeks.

I'd also like to introduce Mr. Shawn Dean, a constituent of Yellowknife Yellowknife Centre, a former director of communications for the Legislative Assembly. I hope you're enjoying your retirement, Shawn.

And I'd also like to recognize my partner Janice McKenna, my brother from another mother Don Babey, and my friend Audrey Henderson. Thank you for coming.

Mr. Speaker, substance abuse continues to challenge residents, family, friends and communities in the Northwest Territories. The health and social services system has a range of options to help Northerners recover their health and well-being. I am going to summarize a few of those options that have taken shape in the 19th Assembly.

An approach called Stepped Care 2.0 has transformed the community counselling program by offering same-day or drop-in support, resulting in a 79 percent decrease in wait times. Community counsellors can also help residents gain access to more specialized services such as facility-based addictions treatment.

Mr. Speaker, we now have six facility-based addictions treatment programs. The department has recently contracted Sunrise Healing Lodge in Calgary to provide culturally-safe, recovery-oriented, and person and family-centered services. Sunrise Lodge responds to the request from residents for an Indigenous-led treatment option.

Even before individuals return from addictions treatment, the community counselling program offers aftercare planning and support. This is part of our response to the 2022 Auditor General's recommendations to improve addictions services.

Mr. Speaker, we understand that the availability of safe, sober, housing close to home is another important component of support to individuals in their recovery. The department is taking steps to establish community-based transitional housing options in four different communities. Work is progressing well in Inuvik and Yellowknife. The next step is to work program delivery costs into the next budget.

The department also continues to support the delivery of a managed alcohol program in Yellowknife. This program began during the pandemic as part of a comprehensive system of support for people living with addictions. This program takes a harm reduction approach by providing participants with a set dose of beverage alcohol in a safe setting, limiting intoxication levels and the consumption of non-beverage alcohol. The program is delivered in combination with housing, health care, counselling, and life skills.

Mr. Speaker, I recognize the leadership role Indigenous governments and community organizations have in delivering addictions recovery supports. Following a request from them, the department recently merged three existing funds into one. This combined fund will help reduce the administrative burden on Indigenous governments while providing them with more flexibility in determining the types of programs needed in their communities and how they will be funded.

I am pleased with the direction that our work is taking and the supports available to NWT residents, yet I recognize there is still more to do.

We are planning for a combined community counselling satisfaction and addictions recovery survey for early next year. This combined survey will seek feedback on people's experiences with all the available NWT addictions recovery supports and services, including the types of supports they used, any challenges or barriers they encountered, and what needs to be improved.

Mr. Speaker, I would like to conclude by discussing the ongoing dialogues initiated between myself, the department, and Indigenous governments. Our primary objective has been to enhance our collective efforts in addressing the addiction recovery requirements of NWT residents. I deeply appreciate these exchanges and their influence on shaping our course of action. Our shared goal is to help residents, and I firmly believe that the most effective solutions can be achieved through working together. Thank you, Mr. Speaker.

Thank you, Mr. Speaker. Mr. Speaker, my time as health Minister is drawing to a close so I'm unable to commit to any further examinations of the medical travel policy. But I encourage the next Assembly to continue its focus on improving those services. Thank you.

Thank you, Mr. Speaker, and thanks to the Member for that question. No one who turns up at the emergency department in Yellowknife is denied treatment, and people from anywhere in the Northwest Territories are welcomed to make appointments in Yellowknife when they think they're going to be here. So I'm not really clear what the barriers are that the Member is talking about. Thank you.