Debates of February 10, 2006 (day 27)

That is really good news. I am happy to have that on the record. That is all I can think of for right now. I do want to say that I recognize the challenges of the size of this department, the magnitude of the challenges and certainly the scope of the various issues this department deals with. I just want to commend the Minister for his attention to all of those. Thank you, Mr. Chair.

Thank you, Mrs. Groenewegen. We are moving on to Mr. Pokiak. Mr. Pokiak, general comments.

Thank you, Mr. Chair. I just have a quick question for the Minister in regard to page 4 of 5 of his opening remarks. I am just going to refer to the toll-free health line. In 2005, they indicated there were 5,000 calls. Can the Minister just quickly explain what the actual cost was for the toll-free line and give an example of what kind of nature of call it was? Was it just for a cold or something more serious? Thank you.

Thank you, Mr. Pokiak. Mr. Minister.

Thank you, Mr. Chair. We spent $850,000 for the line last year. The nature of the calls -- and we made a point of trying to publicize this as far and wide as we can -- are not for what would be seen as a medical emergency. It is for advice. It could range from a young mother calling because their baby has sniffles, to somebody that may have a question to do with a medication or a potential side effect that they think they may be suffering. There is a wide range, but the intent is to be able to give access to northerners to ask the questions that would not make it necessary for them to have to travel all the way down to their emergency ward or to the nursing station to get the answer when they can pick up the phone and be reassured, potentially, and be given the information they need to make the right decision. Thank you.

Thank you, Mr. Minister. Next on the list I have Ms. Lee.

Thank you, Mr. Chair. There are a lot of issues here. I do want to save most of them for detailed discussions, but I do want to raise one issue about homecare. I speak in favour of the program. I do appreciate that we are working on a whole spectrum of services to take care of those in need of varying degrees of intervention and care. I know that, in the city of Yellowknife, homecare is one that is very appreciated. It is oversubscribed. I think there is a bit of an issue with homecare when we know that homecare is supposed to be used to promote independent living. It is to care for those who could stay at home and have a reasonably independent living, if they get some help from homecare, rather than them spending their time at the hospital. People could need homecare for all sorts of different reasons, but that is different than assisted living which requires more intervention. The sense I get is that there is not enough distinction being made there so that these programs are delivered differently and people who need them are provided with that distinctive level of service. I think we still need more resources on homecare needs and respite care needs, which is the temporary and little break kind of idea, and then there is the assisted living facilities which I don’t think we have enough of, especially in terms of seniors.

The homecare issue I wanted to talk about that takes us outside of the city is, during our pre-budget consultation, we were visiting small communities. I learned from those visits that in communities the homecare workers are sometimes half-time positions and small towns, being what they are and especially if they do visits to seniors, I am sure that seniors want to talk to homecare about all sorts of issues, not just particularly about the issues that homecare workers are supposed to be responsible for. I felt a lot of sympathy to these half-time workers that are kind of the only game in town and all of the seniors come to her. I am just wondering if there is any way to make sure that we don’t have half-time workers. I could just see that, in order to attract good people, we need reasonable job security. Is it not possible when this department, or the government as a whole, provides so many different programs, is it not possible to work with other departments or other sections to combine two half-time positions and make them into one full-time position?

My point of raising this issue is to speak in favour of this program and it is one that I want to see strengthened. I want to see it refined so that it is provided to those who really need it. In communities, I think there is a lot more room to move in this one, especially where there is not more sophisticated care that can be given. I think homecare workers right there could help people like seniors and people with disabilities who need them. Could I ask the Minister where he sees this program going under his mandate? Thank you.

Thank you, Ms. Lee. Mr. Minister.

Thank you, Mr. Chair. We, at this point, between our own funding and available federal funding, invest in the neighbourhood of about $7 million for homecare. We see this as an area of continued investment that is identified across Canada as a service that has tremendous benefits that can keep people in their own homes and out of facilities that are very expensive to run. We are working to expand the support we can provide in the communities to work with the individuals, to help them stay in their own homes as long as possible to provide respite care services to adults. There is a whole range, but the homecare pieces need to be very critical. Thank you.

Thank you, Mr. Minister. Ms. Lee.

Thank you, Mr. Chair. Another issue I want to bring up is about some of the changes being done to clinics in Yellowknife. I know the Minister has mentioned it and this has been in the books for awhile. There is a consolidation and amalgamation of clinics going on in Yellowknife. I only go to one myself, obviously, so I don’t know what it is like in other places. I am assuming that the work is being done in a coordinated way. I see the changes being made at the Great Slave Clinic there. I think it is being used as a pilot model of sort. This is being done with some of the federal funding. There is a walk-in clinic at the YK Women’s Centre which, I think, is working really well. They are serving a lot more people for a lot less money. It is really filling the niche of needs there. I would like to see that expanded. Also, the Great Slave Clinic is testing a new electronic system. That is another initiative that the Minister started. I would like to just get a quick update on where we are with all that and how that fits in to the master plan for the Stanton. These are all linked with emergency responsiveness and such. Thank you.

Thank you, Ms. Lee. Mr. Minister.

Thank you, Mr. Chair. I attempted to lay out the packages that were in the component pieces yesterday where, before we can move on to Stanton, we wanted to do the facilities review that would help us look at rationalizing our over-capacity on acute care beds to make some clear decisions on the types of programs that are going to be available. Before we could do any further work on Stanton as well, we wanted…an emergency where there was $6 million in the budget, it became clear that studies tell us that over 50 percent of the people coming into emergency for care are non-emergent care patients, that they could get a service in another setting less expensive and less time consuming which gets us to the issue of clinics with better hours, capacity for services, testing ability, waiting rooms, reception, which got us to the case of before we do any of those, we should look at trying to consolidate the old, inefficiently-laid-out, expensive-to-run, fragmented service provided by the current clinics downtown.

We pulled together and we are still working on rationalizing a plan that would allow us to do that and bring that proposal forward. It is not currently on the capital plan, but it is a piece that came up as we did our assessment of how do we improve the services, and it all was initiating when we started looking at Stanton. So we are going to be moving on the clinic piece. We are going to look at doing some improvements to the emergency, but we are still committed to, now that we finished the facilities review, working and finalizing the master development plan for Stanton to allow us to do the improvements that are necessary there.

As well, we want to be able to do some adjusting to budgets to assist us to make the case for the consolidating clinic piece, things like if we can do land exchanges in Yellowknife that won’t necessitate us to spend $3 million on land, that will be a tremendous benefit to making a project viable. We are looking at all those different pieces. They are underway. The work in the Great Slave Clinic was under the primary health care transition fund going back almost three or four years now. That is giving us an idea of how we can actually demonstrate and work together on this integrated service delivery model with teams of people, of health professionals that work together, doctors, nurse practitioners, midwives and those types of folks with patients. We are going to take that experience, what we learn from there, and, as well, the work that has been done on electronic health records to allow us to expand, eventually, to electronic health record capacity throughout the North. Thank you.

Thank you, Mr. Minister. Ms. Lee.

Thank you, Mr. Chair. I guess I asked for that when I listed all of those items, but we only have one more budget left in this Assembly. I think this is the Minister’s fifth year mandate. There are a lot of things in the books. Are we to expect some results on what his concrete proposals are on all of these areas in the next business plan cycle? Thank you, Mr. Chair.

Thank you, Ms. Lee. Mr. Minister.

Thank you, Mr. Chair. On the consolidated clinic piece, we are working towards bringing forward that plan in time for the 2007-08 budget. The intent, of course, is as well everything falls to the new Legislature. They will make the decisions. As a system, we are going to have a plan in place, a strategic action plan, that is going to take us at least to 2010. These key pieces will be built in. My assumption is that they will make such good sense to the 16th Legislature that they will be carried on with and the work will continue. Thank you.

Thank you, Mr. Minister. I have Mr. Braden next. Mr. Braden.

Thank you, Mr. Chair. One of the most difficult times that I have experienced in this Legislature occurred in the matter under this department and this Minister’s jurisdiction, and that was the surprise decision to move the Territorial Treatment Centre from Yellowknife to another community. Mr. Chair, this one hurt because it was something of great significance in my riding and to this city. It was an action that the government, after considerable review and investigation, went ahead with, by its own admission, for political purposes, against the clinical program, psychological and professional advice of a number of different agencies in this community. The impact of that, I think, continues to be felt, even though the facility is still physically here. According to a schedule that I have seen, if I recall it, Mr. Chair, the transfer is due to be enacted sometime next year in 2007. There are consequences, Mr. Chair, especially to the existing contractor and the ability that they are having, as I understand, to retain staff, knowing that they have to let them go in a short period of time. So that is impacting the level of teamwork and the level of care that is given to the children who are in this facility.

Mr. Chair, even in light of this decision I will forever oppose and argue against, what is the status of the existing service and the ability of the contractor to maintain its level of care as contractor?

Thank you, Mr. Braden. Mr. Minister.

Thank you, Mr. Chair. Mr. Chair, I will say that planning is proceeding in pace, as has been laid out for the committee. I will ask, with your indulgence, Mr. Chair, that Mr. Murray speak to the detail of how things are proceeding. Thank you.

Thank you, Mr. Minister. Mr. Murray.

Thank you, Mr. Chair. We are working with the present contractor, Bosco Homes, on the planning and the programming for the move of the facility to Hay River. We are willing to sit down and work with them, as the contractor for the Hay River facility, to provide that continuity between what is offered today there. We have also been, I believe the Member is aware, looking at what services from the South could be repatriated back to the North. We believe, on an annual basis, anywhere from 10 to 20 of the young people that we do send south, children and youth, could be provided services within the NWT. We have been in discussion with Bosco to see if they are interested in providing some services to us with some of those repatriated individuals. The individuals who change, we are looking at some kind of a program that would be potentially providing some group home assistance and those kinds of things, as well. Those discussions are ongoing. In fact, I am expecting a proposal from Bosco soon.

Thank you, Mr. Murray. Mr. Braden.

Thank you, Mr. Chair and Mr. Murray. One of the big challenges that agencies which are familiar with performing or delivering this service here in Yellowknife have indicated, that to expect a similar level or calibre of service can also be delivered in Hay River is quite an expectation. This is not a slight at all against Hay River, Mr. Chair. It is simply a matter of looking at the different scales of economy, the size of communities, the levels of professional caregivers that are here in this city, and other duties that could not be supported in a much smaller community such as Hay River. I guess where I am going with this, Mr. Chair, and assuming from what Mr. Murray said, Bosco has already been awarded the contract to continue services in Hay River. How do they see being able to continue to deliver the calibre, the range and the sophistication of services as at least we know it here in Yellowknife? Thank you, Mr. Chair.

Thank you, Mr. Braden. Mr. Minister.

Thank you, Mr. Chair. Mr. Chair, in my opinion, we will be able to provide the same level of service that the calibre of staff that work on the floor with the kids is available in Hay River. It is available now in Fort Smith and Inuvik. We also invest in training northerners. Yellowknife is not the only jurisdiction or community that has the capacity to look after children; children, many of which, don't come from Yellowknife. The quality of education in Hay River, I would suggest, is as good as it is in Yellowknife. The access to specialist services is the one difference, and it's about 20 minutes or half-an-hour farther away than it is for the children in Yellowknife. So I categorically state, and I have enough experience in this business having run the facilities for a number of years myself, that you can train northerners, that you have very skilled, compassionate, caring people in the communities that can deliver this service under the expert direction provided by Bosco Homes.

So I'll restate that this program will be delivered. It will be delivered very well in Hay River and that's what we're intending to do. Thank you.

Thank you, Mr. Minister. Mr. Braden.

Yes, Mr. Chairman. I'm very familiar with the Minister's confidence, and I share with him the confidence of a large majority of the people who are needed, and trained and committed to the care of children. But the exception, as the Minister pointed out, is amongst the more sophisticated, if you will, psychological and medical and clinical services. Yes, the Minister is quite right; it is potentially only a half-hour plane ride from Yellowknife, but there's a lot more involved than sort of transporting people back and forth on airplanes.

So let's park that one there. We're hoping and I'm entirely supportive of trying to achieve some repatriation, Madam Chair, and anticipating that we are going to be undertaking more of the cost in order to do this. I look at information that the department supplied in response to a question from me in October of last year, Madam Chair, and the response indicates that for the eight clients or beds that are presently provided for children at the Territorial Treatment Centre, there's a cost assessed here of about $145,000 per year per bed, or per client if all those beds are full. Madam Chair, the letter then indicates that providing specialized services for children that are not available in the NWT, we had 27 clients in care for a cost that amounted to $45,000 per client. So we have $145,000 to deliver a service here with the arrangements as we know it under the TTC, and $45,000 in the South. That is a major, major difference in cost. I'm wondering if the department can give some sort of reconciliation of how the economies of scale are going to shift. I don't want to assume here that I'm an advocate of keeping all these kids in the South, not at all. But there is a $100,000 difference per client of the service between the South and the North. Are we going to be able to reduce that? How much? When, Madam Chair?

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, I don't have the letter before me. Once again, I can only assume that it's an average, because I do know that we spend significant amounts of money down south, as well. It is, on a dollar basis, in most cases cheaper to have children down south, but oftentimes we send children down south because they have a complexity of need that's not able to be met in the North.

I guess the other value that I would suggest is it's hard to put a dollar figure on them when you have children treated in the North, as the value of having them close to home within an environment and culture that they know and that their families can access in a somewhat easier way, but, very clearly, we think there's a value to looking at repatriation. I can only assume that the $45,000 per child is an average. I know that last year we spent down south on children about $4.7 million for a total of 41 children. So those are the stats for '04-05. So it's a very expensive business no matter where you do it. Thank you.

Thank you, Minister Miltenberger. Next on the list, general comments, I have Mr. Villeneuve.

Thank you, Madam Chair. I just want to thank the Minister for his opening comments. I think this year's health budget is basically going to deliver a lot of good changes that people were asking for and have been asking for for a long time.

I just want to mention something about the medical travel concerns that seems like everybody has got an issue with. First off, I know we had the telehealth line and the toll-free nursing line available on a 24-hour basis. I know it's been mentioned to the department before, of whether they're going to establish a medical travel toll-free line that people can phone from anywhere, anytime. It seems to me that every time I'm picking up people from the airport or bringing them to the airport, that people at the airport who don't know who to contact in the government that takes care of travel, and the people that are travelling don't know who they were talking to, because it seems like there's different people at the end of the line all the time. So I'm just wondering, just to alleviate the stress that these patients are going through while travelling, to alleviate the travel stress, is there any review or consultation been done within the department to setting up a medical travel toll-free line?

Thank you, Mr. Villeneuve. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, the Member's correct; this issue has been raised before, and I've just had discussion in the department. But of great importance to us is looking at the system and the exceptions that happen that cause concerns to be raised, or MLAs to be approached so that they have to come either to myself or to the deputy to resolve issues, and we're trying to eliminate those. So as I indicated to the Member from Nunakput, we're constantly trying to improve the service. We know that this is a very critical time in person's lives, when they're on their way for medical treatment, and we tend to hear about the exceptions. We do our best to resolve them. We haven't made a final decision about how we could possibly move ahead on a toll-free medical line. It would be much different than the line we have to phone nurses. This would be talking about very specific circumstances, policy interpretation, sort of online adjudication in trying to sort out the information so that you could, in fact, make that kind of determination which would be very difficult when you're, for example, on the phone with a distraught individual from the Hay River Airport on their way to Edmonton and things haven't fallen into place and it's 4:00 on a Saturday. We tend to respond to these on an emergency basis, and as the best way to deal with those circumstances, and then try to sort out what happened after that, make sure that the immediate need is met, and then we try to adjust to make sure it doesn't happen again. Thank you.

Thank you, Mr. Miltenberger. Mr. Villeneuve.

Thank you, Madam Chair. I'm just having a problem seeing the big problem with having a medical travel toll-free line, and just for the fact that medical travel is basically pretty cut and dried, as far as I can tell. When people get the authorization to travel somewhere, it’s just as easy to phone a travel agent and make those arrangements themselves, where as they have the Stanton travel and authority to do that for them. There are many instances where people wind up at the airports with no information on travel arrangements, and the agents at the airport don’t have any information themselves and nobody has a number that they can call.

So is there a possibility that we can set up a 1-800 line that people can phone in and the person at the other end of the line will have access to a computer system that I am sure will be able to handle all bookings that Stanton works with or makes for any individual in the NWT, to find out whether or not their travel has been confirmed, who it’s been confirmed with, and by whom and when? If it hasn’t been confirmed, the person at the other end of the line or some authorization to issue a ticket, be it over the line, through a credit card or through whatever means that they might have at their disposal. Just something that might be a little more instant than having to go running to the Minister’s office every time somebody gets stranded at the airport. I just don’t know why that is such a difficult area to build on. We have telehealth lines and nursing lines and we have experts at the end of those. We are just looking for a travel agent at the end of this one, somebody who knows how to make the change, and make the necessary adjustments, and do the necessary billing arrangements and invoicing. Is that something that the department is considering now, or are they just going to research more into why? How is it so difficult? Thank you.

Thank you, Mr. Villeneuve. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, I can appreciate the Member’s concern and frustration because it is an issue that, as I have indicated, gets a lot of traffic with MLAs through the Minister of Health’s office. The circumstance is as the Member said, it provokes a response and it’s not always as cut and dried as it would seem, that’s why we end up with these calls that something hasn’t worked. What I will commit to the Member to do is we will layout what we are doing, what we are going to do to improve the service. As well, we will come back with our assessment, a specific written assessment on what we think is the validity and the aptitude of using a 1-800 number. Does it make sense? We’ll give the Member and this House and the Social Programs committee our best advice. If there is a way to do that, we will give it a serious look. If not, we will be looking at other ways to try to give people some way to get basic information, as the Member indicated, about flights being reserved and confirming travel arrangements. Thank you.

Thank you, Mr. Miltenberger. Mr. Villeneuve.

Thank you, Madam Chair. I am glad I got a commitment from the Minister for that. I look forward to seeing what gets presented to Social Programs.

Still sticking with the medical travel issue, the issue with medical travel escorts has always come to my attention, also. I know the patients themselves don’t really have much say in whether they want an escort or not. It’s basically up to the nurse practitioner or the community health representative to make the call on the escort and then people are coming here, travelling, they are distraught, they don’t know how to handle a lot of the inquiries if the tickets aren’t there. I don’t think the escort is just there for emotional support, but I think a lot of them help the patients to move along and to carry their luggage and bring them to the hospital and make sure they are eating and everything else. I don’t think it’s just for some emotional or psychological support, or just to overcome the language barrier are the only reasons an escort should be allowed to travel with the patient. Is there any movement on the department’s side to be a little more flexible on the escort rules? Thank you.

Thank you, Mr. Villeneuve. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, the escort provision of the service we provide is geared around a medical determination of whether an escort is required. As the Member indicated, that assessment is made by the doctor, the nurse, or the nurse practitioner who is with the patient. We are working constantly with the authorities and with the various facilities and the staff to make them aware that there is some flexibility required; that a medical escort may include being able to make sure, for example, that there’s adequate interpretation services, or that if the person may not be very sick but is infirm and has difficulty walking, those types of assessments and that it is not a rigid assessment. There are always extenuating circumstances. But there has been no move towards going back to what used to be called compassionate travel, which became a prohibitively expensive service. Thank you.

Thank you, Minister Miltenberger. General comments. Ms. Lee.

Thank you, Madam Chair. I just have one question about the new Chalmers Report. I know that the report has come out and the Minister offered to give us a briefing, but we could just not put that on the agenda. I just want to know if this new budget reflects any recommendations coming out of that report. Thank you.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, the recommendations in the Chalmers Report haven’t been fully assessed and we are working on our response of how we are going to incorporate those. What is in the budget, though, is the third year funding for the Mental Health and Addictions Strategy, which we haven’t fully implemented yet pending the outcome of the Chalmers Report, which will give us some flexibility to be able to respond to some of the recommendations. Thank you.

Thank you, Mr. Miltenberger. Ms. Lee.

Thank you, Madam Chair. I think the Social Programs committee will have an opportunity to deal with that, then, because I wasn’t sure if it was incorporated here. Sorry. I will look into that later.

Just on the Nurse Practitioner Program, Madam Chair, I just want to comment on this program because I didn’t get a chance to do that when I was commenting on all the other things the Minister is working on in health care delivery in Yellowknife and downtown clinics. I have to say that I think that is one addition in the clinics that is working well, and I know that the Minister is planning on spreading that as much as possible, but I would like to know what the level of training is and how that’s going along. The question comes up often when we are travelling to communities and talking to Members from outside of Yellowknife, whether or not it is expected that the nurse in charge or senior nurses will be the ones that would be taken away as nurse practitioners, or they would be the better suited candidates to take the Nurse Practitioner Program, which may produce more nurse practitioners, but it may have the effect of creating a vacancy for senior nurses in communities that are vital. I just want to get a quick update on what the latest is on this Nurse Practitioner Program. Thank you.

Thank you, Ms. Lee. Mr. Miltenberger.