Debates of February 14, 2011 (day 38)

Thank you, Mr. Abernethy. Minister Lee.

Thank you, Mr. Chairman. I was talking about CHN program, which the Member for Kam Lake was referring to. I am not sure if he was referring to that as an Aurora College program but I was speaking of it in the context of overall human resource training programs for health and social services assistance. CHN program is fully subscribed, as the Member is aware because I have stated that a number of times. Thank you.

It just gets more and more confusing all the time. Aurora College does not deliver Community Health Nurse Development Program. It is not a program run by Aurora College, it is a program that is funded by the Department of Health and Social Services through the Department of Human Resources, if that is the program that she is referring to. Can she confirm that that is the program she is referring to or is she referring to a different program? Thank you.

Thank you, Mr. Abernethy. I believe the Minister did confirm that she was referring to that one, but, Minister Lee, for clarification please.

Thank you, Mr. Chairman. Yes, I did say I was referring to Community Health Nurse Development Program and I don’t believe we suggested that that was being delivered out of Aurora College. I would not question the Member’s knowledge of that area, I was simply answering the MLA for Kam Lake.

So we are talking about the Community Health Nurse Development Program that is delivered by the Department of Human Resources on behalf of the Department of Health and Social Services. The Minister has said that this program is fully subscribed and, quite frankly, I don’t understand that, because I asked questions in the House in October, I sent letters to the Minister and that program, from what I understand in responses provided to me by the Minister, one person enrolled, and that person might even have graduated by now, and they indicated that there probably isn’t going to be an intake for 2011-2012. So quite frankly, I don’t understand fully subscribed, I don’t get it, so I am wondering if the Minister can give me some information on what or how she defines fully subscribed. This has a budget of nearly half a million dollars, this section, and if there is nobody enrolled, then how are they spending the money? Can we expect an intake in 2011-2012? Are we going to see this program utilized? Thank you, Mr. Chairman.

We have provided this info as a response to lots of questions that the Member has raised. He is right; he has raised this before. This program is oversubscribed; it went way beyond its budget. We have one person in there and we are spending all the money that we have available in that budget and we are not able to take in new people unless we come with new money, which is the reason why we need to review this as we need to review the Nurse Practitioner Program and nursing programs. We need to look at all the demands on educational programs for health and social services staffing and we need to set our priorities. There are new areas that we haven’t been training, like home care programming and counselling programming and other things. This is something we need to look at as a Legislature and, as I stated earlier, I need to come and talk to the Standing Committee on Social Programs about what the demands are and how do we go forward within the limited resources we have. Thank you.

All these questions started when it came up about some of the grad placements and our true need, our true area of focus here, is we need to get nurses into community health centres. Nobody could deny that. We’ve got continual turnover of locums, we’ve got continual turnover of nurses in there and we need to find solutions and solutions to train Northerners for northern jobs.

The Community Health Nurse Development Program is a great program that puts indigenous Aboriginal and non-Aboriginals in community health centres with the training and the skill they need to be competent and professional. I find it offensive that the Minister tells me that one position expends the entire budget for that division. In ‘11-12 that person, I believe, is actually graduating for ‘11-12, so I’m kind of offended that there’s going to be no intake for ‘11-12. The money should be there, it should be for the program, we should be out pursuing Northerners to take that training. So quite frankly, I don’t understand anything the Minister is saying. It doesn’t make any sense to me whatsoever. It seems completely, you know, devoid of sense.

I think the department needs to take a better look at this Community Health Nurse Development Program in light of the fact that we’ve got so many grads coming our way. We have got so many grads and we have so much need in the communities and here’s a program that’s doing it. Unfortunately, I also know that the department has cancelled the Community Health Nurse Development Program bursary, which was an incentive for people to go into the program. So they’ve cancelled the bursary that would encourage people to go into the program and then they claim they’re over-expended on the program and they’re only running one person through it doesn’t make any sense. I’d defy any accountant in the world to look at this and make any sense of it. It’s crazy.

Now I’m going to come back to the Introduction to Advanced Practice. That’s the one that doesn’t appear in the catalogue at Aurora College. That’s the one that I believe Mr. Ramsay was talking about, and I also find it completely insane that our enrolment is going down in there because a lot of the people we put through there were short-term placements and they leave. So I know there’s a need, I’ve heard people say there’s a need, I know that the students at Aurora College want to take the program because the Introduction to Advanced Practice gives them some skills that will be valuable and assist them in their future careers, but I also do know that once upon a time we used to ask our staff to take that program, especially our staff in the community health centres and I know we’re not asking them to do that anymore.

So the reason the enrolment is down is because we’re not requiring it anymore and that, to me, is a concern that everybody who lives in a community should have. Those people that live in the communities want to be sure that those nurses are competent and professional and, yes, they are, but that skill set they get from advanced practice introduction gives them suturing skills and gives them skills they don’t get through their normal schooling practice. So let’s not get rid of the Introduction to Advanced Practice. I think it’s the wrong direction, I think it’s a mistake and anybody who thinks that taking away that training is going to be good for the people of the Northwest Territories because our enrolments are down, they’re down because of the way we’re doing business, not because the actual need is down. I think the department needs to seriously look at these things. It’s crazy to be taking away the programs that work, add value and put people in our communities.

I’d like to see a briefing note on how they justify this, I want to see a briefing note on how they justify the spending on the Community Health Nurse Development Program because, quite frankly, one person does not make a program. The program was designed to run four or five. How one person has consumed the whole budget screams mismanagement to me, mismanagement by the department. One person for the $400,000 budget is crazy. It’s crazy.

Our communities are more important than this. We need to make sure they have competent, qualified professionals in there doing the work and this program is the one that’s going to help them and it’s going to put Northerners in there. I’m so tired, tired, of putting Southerners in these jobs when we have Northerners who with just a little bit of support could do this work. So stop making excuses and stop talking about lowly subscribed when your department mismanaged the funds and allowed one person to consume an entire budget. Fix it, make it run and go and let’s get Northerners back into these jobs. I mean, everything that is being said doesn’t make sense, Mr. Chair. It’s crazy.

The MLA for Yellowknife Centre used the word “mismanagement” on Friday and I believe that’s the reason why he apologized today. I don’t know for sure. So I would like the Member for Great Slave to reconsider what he said.

As the Member knows, because that’s his background, and I understand -- well, he lets us know that’s his background -- the CHN program is run by Human Resources, so if he’s suggesting somebody mismanaged, perhaps the Minister of HR should answer to that. I am not disagreeing with the Member that we need to review this, but it is quite something else to say I don’t believe anything you say and you’re mismanaging. That’s not fair to the staff.

I said earlier that we need to look at it and I’m sure the Member is interested in that because I know he’s interested in health and social services, and I’m telling you that as we go forward there are lots of demands for HR needs in helping social services. We need to train our home care workers, because we want to expand our program. We need to expand counselling services, so there’s a need for training in that. We’ve been training nurses, northern nurses, which has been hugely successful, but in the next three years we’re going to get 70 to 80 nurses. So we need to look at our Human Resource Training Program and the Member being a Member of the Standing Committee on Social Programs, he’d have lots to add to that.

So, Mr. Chairman, I’m not sure if I could do anything more if the Members don’t want to accept what we are saying, but I want to offer again that it is high time for us to look at who we are training, how we are training, how we are using Aurora College services, how we could work together between Health and Social Services and Education, and I’m committed to coming back to the committee with the information in hand and make decisions together about how we move forward. Thank you.

Thank you, Minister. The time is up for that questioner; I’ve put you back on the list. Mr. Ramsay.

Thank you, Mr. Chairman. A few other things. I just wanted to follow up and all I’m looking for is a short, concise answer from the Minister. What assurances have we got that the Graduate Placement Program will be around in the following year? I know the letter stated it’s available this year, the funding is there. What about next year and it’s 65 grads in the next three years, not 70 to 80? Thank you.

Thank you, Mr. Ramsay. Minister Lee.

Thank you, Mr. Chairman. We’re speaking about this year’s budget. We’re involved for ‘11 and ‘12. I can’t speak for future governments and future plans and that’s one more reason why we need to review this program. I mean, review the training needs and how Department of Health and Social Services system needs for trained people marry up with what we are doing in Aurora College in all of its branches and how HR works with us.

I think Members would agree we need to look at how we go forward. Thank you.

I guess it’s okay for the Minister to talk about the future, but I guess in our questions we can’t. I appreciate and understand that and I’ll move on to my next question.

I know my colleague Mr. Abernethy was talking about the incentives being taken away for community health nurses and I’d like to ask the Minister why aren’t we providing more incentives and encouraging northern residents to stay and live in the smaller communities. It’s got to be cheaper than locum nurses, Mr. Chairman. I’d like to ask the Minister why are we providing incentives and encouraging folks to get into that program. Thank you.

Mr. Chairman, we do, and that program was highly successful, a lot of people went into it, it was oversubscribed, we never have enough money to meet the demands of everyone. It is oversubscribed now and we have an obligation to deliver our programs with the money we have. We’re not allowed to just oversubscribe. So we are using the money we have now and we do support our community people to go get trained. There are all kinds of programs for that. So, Mr. Chairman, I don’t think there’s any question about that. Thank you.

I just don’t see myself making any progress on this so I’ll give up at that. Thank you.

Thank you, Mr. Ramsay. Next on my list is Mr. Abernethy.

Thank you, Mr. Chair, and for the record the Minister is right; I shouldn’t be referring to mismanagement, and also for the record I have nothing but respect for the staff and employees of the GNWT, in particular in health care, social services. I think they have some of the hardest work out there and I have nothing but respect for them and if what I have said has offended them in any way, I apologize and I withdraw that.

Having said that, one person in a program that costs $400,000 means something didn’t happen correctly and ultimately the Minister is responsible for that and the Minister needs to explain that. She needs to explain how a $400,000 program that was designed to run four or five people in it with one person managed to get over budget. Ultimately she’s responsible for that. Ultimately we have to hold her to account for that. Ultimately we need to see this program running.

It’s unfortunate what happened yesterday. You know, last fiscal year when they managed to spend all this money, when the Minister’s department managed to spend all this money on one person, but it’s 2011-2012 we’re talking about; 2011-2012. Where’s the budget for 2011-2012 if all the people who finished this program... There’s nobody in it. Where’s the money? What are they using the money for? How are they using the money to train our Northerners for northern jobs? How come there’s no intake? That’s what I want to know and it doesn’t make any sense that we aren’t doing these things. I want to see Northerners in northern jobs. That’s what this money was supposed to be for.

I apologize for accusing anybody of mismanagement. I respect the staff. If I’ve offended them, I withdraw that. But come on. Let’s find out what’s happening with this money. Let’s find out how we’re using it. Let’s put it to the use that was intended. You can always defer and start talking about all of the other areas we need to do training. What area costs us the most money? What do we hear about most in the communities when we go out there? We hear about how come there’s no permanent nurses? How come there’s no consistency of care? It’s nurses.

How are we spending the $400,000-plus on this program to make sure that we get them in there? It used to work. It used to be a great program. Why does there appear to be no interest in it anymore?

Thank you, Mr. Abernethy. Minister Lee.

The Member knows we’ve had lots of success in training and supporting our northern workforce in the health and social services system. The Member was part of that when he worked in the system. We’ve had lots of success. I don’t think anybody here is questioning the need and achievements in that area.

I’d be happy to provide him with more information. As the Member knows, the CHN program is administered by HR, so I’d be happy to work with the HR Minister and get back to the Member on the detailed information. I believe this has been brought up and we have given the Member information on that. Once again I’d like to offer to the Members on the other side that we do need to review what we are doing with our training program and maximize our dollars.

I’d like it if we could share that information with all my colleagues.

Just one last thing, just a reminder: yes, it may be delivered by HR, but the people who are making the decisions on the budget are sitting at that table. The Minister is responsible for this budget, she’s the one who’s making decisions on the budget, HR is delivering a program that this Department of Health and Social Services is responsible for and makes the final signing off on all budget lines. We can involve HR, they are administering the program, but ultimately no matter how you look at it, the Minister of health is accountable. It’s her budget line, not HR’s.

Thank you. Just a comment there. I have nobody else on my list. Committee, I’ll remind you we’re on page 8-21, Health and Social Services, activity summary, health services programs, operations expenditure summary, $188.658 million. Agreed?

Agreed.

Thank you, committee. Returning to page 8-29, Health and Social Services, activity summary, community health programs, operations expenditure summary, $87.631 million. Agreed?

Agreed.

Page 8-30, Health and Social Services, activity summary, community health programs, grants and contributions, contributions. Agreed? Ms. Bisaro.

Thank you, Mr. Chairman. I have a question under the prevention and promotion paragraph on page 8-30. There’s a huge increase in the money going to authorities and agencies from the revised estimates from 2010-2011 to the main estimates for 2011-2012; about $600,000. Could I get an explanation of what that’s for?

Thank you, Ms. Bisaro. Ms. Lee.

Thank you, Mr. Chairman. That’s part of our Strategic Initiatives committee Building Our Future investments and Healthy Choices Framework and $254,000, for a total of $500,000. It will be sent to Beaufort-Delta and Dehcho.

I’m sorry, I need clarification on those numbers. I heard $250,000 for a total of $500,000. Could I get the other half of the $500,000, please?

It’s a $500,000 increase; $250,000 going to Beaufort-Delta Health and Social Services Authority and $246,000 to Dehcho Health and Social Services Authority.

Thanks for the explanation. I did have a question under children services as well. Maybe it’s not so much a question as a comment. I look at these numbers and we spend almost $7.7 million on foster care and about $3.6 million on residential care, yet we spend $858,000 on intervention and protective services. I guess that’s apprehensions. If we look at the paragraph below we spend some $900,000 on prevention and promotion. It seems to me that we’ve got these numbers in the wrong place. I know it costs money to put children into foster care but it goes to the recommendations from the Child and Family Services Act review, it goes to statements that have been made by Members more often than not in this House and on this side of the House.

Prevention is paramount. If we can put programs in place, if we can work on prevention, if we can work on creating healthy children at an early age from zero to six it’s going to reap huge rewards as we go down the line. In terms of foster care, if we can put in place the recommendations that are in the Child and Family Services Act review we will not need to put children in foster care and that $7.7 million amount is going to be reduced significantly. I know it’s going to take time, but again we need to be putting more money into prevention, into dealing with children at a really early age. I don’t see that in here and it dismays me.

I didn’t hear a question there. I take the Member’s comment and I don’t believe we disagree with that finding and suggestion made in the CFSA report.

I appreciate that the Minister and the department don’t disagree with my point of view but, unfortunately, there’s no indication on the part of the department that money is going to be attached to this particular philosophy. That is a large concern. Thank you. No question there either.

Thank you, Ms. Bisaro. Although there’s no question, I’ll still go to the Minister to see if she has any sort of response.

Yes, it’s true that there’s no new money in this budget but our response is that we will put it through the next business plan cycle, which is the way financial business is done.

Thank you, Ms. Lee. Next on my list is Mr. Ramsay.

Thank you, Mr. Chairman. Just a couple of questions here. I’m just wondering, a couple of years back we had talked about a campaign to curb alcohol abuse. As anybody knows, alcohol is the biggest problem that we have out there, the biggest social ill that we have. We had talked about the department coming up with a campaign much like the Don’t Be a Butthead campaign to try to target alcohol and the ravages that it has on our communities. I’m just wondering where that’s at in the department’s plans or if there’s any money in this budget for that type of campaign.

Thank you, Mr. Ramsay. Ms. Lee.

Thank you, Mr. Chairman. It would be part of health promotion.

Could the Minister elaborate on that? Are we going to come up with a new campaign? What is the strategy that the department has to prevent alcohol abuse in the Northwest Territories? It’s a huge problem. What are we doing about it?

As I recall, I believe we were talking about a campaign similar to Don’t Be a Butthead and there were some suggestions such as Don’t Be a Bottleneck or something like that. That was about two budget cycles ago. We were working on more investment money under Strategic Initiatives committees, but as the Member knows and the Legislature is aware, we’ve had to curb the money available under those initiatives. So the work that we do on addictions and dangers of alcohol abuse and such is done as part of our everyday business. We were not able to launch a whole new program similar to Don’t Be a Butthead because we were not able to get that extra funding under Strategic Initiative committees because we had to reduce that as a government. It’s not just a department but government-wide, as the Member is aware.

I think that’s some work that we have to continue on and that should take priority going down the road, that’s for sure. Like I said, alcohol is the biggest scourge that’s out there.

The other question that I have, I just wanted to ask the Minister whether or not the Department of Health and Social Services, under prevention, promotion, and health awareness, were you consulted with prior to the Department of Finance making a decision to raise taxes on cigarettes and alcohol?

Yes, of course we were.

Maybe could the Minister elaborate a little bit on what the stance of the department was in increasing alcohol and tobacco taxes and whether or not that might have a negative impact on families around the Northwest Territories? Because as I’m sure I’ve mentioned before, the people who are addicted to alcohol and tobacco are going to get their alcohol and tobacco no matter how much it costs, and the people who are going to pay the price are the kids in that home and the families in the small communities who are struggling to get by as it is. If you increase costs for alcohol and tobacco, I think it’s a perverse effect you’re having on families around this Territory. I’d like to hear what the department had to say about that.

I don’t think I could counter that. I think that’s something that could be argued. All sin taxes we have to weigh the balance between providing a disincentive by raising the taxes, but we are aware that those who are severely addicted will get those items no matter what, against their self-interest and the well-being of themselves and the families around them. The flip side of that coin is if even without taxes being raised, probably those other people who because of their addiction issues do not spend money where they should be, on their families, anyway. I don’t think there’s any right or wrong answer to that.

Going back to your original question, the deputy ministers are on the steering committee that review those implications and the Ministers discuss and consider all those impacts as well.

I’m just wondering whether or not the department did any analysis on the increase to taxes on alcohol and tobacco and if the Minister could share that analysis with the committee.

I could provide the Member with what we have in the department on that topic.

Just one other thing. I’m just wondering if we’ve ever given any consideration to taking the tax that’s derived from cigarettes and alcohol in the Territory and instead of putting it into general revenue, earmarking it for activities under prevention and promotion. Maybe we should be identifying those dollars and using them in the right way.