Debates of February 19, 2014 (day 14)

Thank you, committee. We left off with the Department of Health. Minister, do you have witnesses to bring into the House?

I do, Mr. Chair.

Thank you, Minister Abernethy. Does committee agree?

Speaker: SOME HON. MEMBERS

Agreed.

Thank you. I’ll ask the Sergeant-at-Arms to escort the witnesses into the Chamber.

Thank you, Minister Abernethy. I’ll ask you to introduce your witnesses, please.

Glen Abernethy

Great Slave

Thank you, Mr. Chair. With me today are Debbie DeLancey, the deputy minister of Health and Social Services; and Jeannie Mathieson, director of Finance.

Thank you, Minister. I’ll now open the floor to general comments on the Department of Health. General comments. Mr. Dolynny.

Thank you, Mr. Chair. I’d like to welcome the Department of Health and Social Services here today. We’ve got a fairly daunting task before us here in the next day or two. I’m hoping to try to evaluate the current budget here for the Department of Health and Social Services. I did have a chance to read the Minister’s opening remarks again, and obviously, I had a chance to read one of his statements earlier today on the health and social services system. So I’ll try to amalgamate both here today in kind of a general overview at a high level here.

I think we are in a ripe position to reposition the department where it is today. I want to make sure that the message is loud and clear that just by changing the leadership as we did here a couple of months ago, in my humble opinion, isn’t going to fix all of our problems. It’s just one of the many solutions that we have before us. We are encouraged by some of the recent actions by the Minister and have seen some great strides in a short period of time.

That said, there is definitely still room for improvement and I think the Minister and the department would probably agree with that. I believe the system in itself is doing a relatively good job and I think our territory is recognized to being comparable to across Canada.

We are definitely falling short in some key areas and some of the real disparities still to this day are the levels of care between Aboriginal and non-Aboriginal. I think I’d like to hear more about narrowing that gap of disparities as we move forward and for the remainder of the 17th Assembly. We know that we’ve got the highest rates in Canada for alcohol consumption, binge drinking, smoking and suicide and yet some of the programs we have aren’t really hitting those numbers and bringing them down. We’re seeing some decrease, but quite frankly, we’ve got such a large margin to improve upon that I think we need to take a better look at a larger number of bringing those numbers down.

We have a very high hospital admission rate which is still concerning, given the ratio of population base. I believe our injury rates vis-à-vis the rest of Canada are 10 times higher than the national average. So, we’re dealing with some pretty daunting statistics and we’re facing a lot of challenges in the Northwest Territories in meeting the high quality of health and social services deliveries.

Of course, we have a lot of things that are still plaguing a lot of our areas in our health authorities. We’re still having issues in recruiting the right calibre of professional staff. We still have a lot of technology that’s missing in our communities to allow that emerging technology to reduce wait times, better outcomes and everything else. I know there are lots of variables that are coming to light. The fibre optic line that should be operational in 2016 will definitely be a benefit.

One of the areas that I find the budget is not addressing enough of, and we’ve heard a little bit here today and in the last couple of days, is our aging population. Again, it would be nice to get more of a positioning statement from the department where the aging population fits in the health care sector.

The Minister has been showing strong leadership and championing a bit of a reform, if you like, in terms of how the overall structure of our health system is currently being handled and ways of improving. It’s enlightening to hear that we’re actually moving and making headway on that. I didn’t capture a lot of that in the opening comments, but I think 2014 will be one of those years of change. I’m looking forward to working with the department, working with the Minister and working with all the stakeholders, including the Joint Leadership Council, with Regular Members and committee to create a more cohesive and stronger health care system delivery.

However, there is still the issue of quality of care. That quality of care, I find, is not the same standard across the Northwest Territories. We have, in many cases in today’s environment, many of the authorities not delivering the programs consistent to the standard of care that many of us take for granted, and I think that’s something that needs to be highly emphasized more than what we’re hearing today. I think there is still a feeling out there that many patients are falling through the cracks, and the follow-up process that we deal with a lot of our patients, once they receive primary care in our hospitals, are finding that they’re not getting that follow-up care in their respective communities on their return home. I think that’s something we still need to look at.

When it comes to tracking our key indicators and how we’re doing as a system, again in referencing even in today’s delivery from the Minister here, we’ve got a number of reports – Health Status Report, physician services utilization report, addictions and substance use report – and a lot of these reports are great. Unfortunately, they’re so sporadic, some of them are five years in length, some of them are three years in length, and we may literally only see one of these reports in the life of this Assembly, which is very hard to try to gauge and create those compass points in terms of how effective some of these changes might be occurring. I know there are costs involved for providing these accounting and key indicators, but without key indicators, without any type of gauge really, how do you evaluate your performance? This is something that I’d like to work with the department, I’d like to work with the Minister to try to see if we could tighten up some of the lapsed time between some of these major reports, maybe looking at a more cohesive look at key indicators and have a bit more of a dashboard, ongoing, real-time dashboard monthly on key issues that affect the Northwest Territories as a whole. These are opportunities, these are barriers that have been overcome in other provinces and in many areas in the United States where they’ve actually been able to overcome that. I think there’s opportunity here. I’d like to hear it from the department as well.

When it also comes to accountability, I’d have to say although I believe most authorities are doing well when it comes to spending their budgets appropriately, still to this day – and I’m echoing the same words of the Auditor General report – we have contribution agreements in place but we don’t have all performance in place, to my knowledge. If that’s the case, we still have authorities with surpluses and deficits, and sometimes the same authorities that have those in tow, which again should raise alarm bells. If you haven’t spent all your money, have you delivered all the programs? Again, it goes back to my first question, how do you evaluate that in a real time setting, and I think, again, I feel that there is opportunity there. Also, I find that when you do travel from authority to authority, I’m not sure if that standard of care is all there in relationship to possibly what you may get in an urban setting. What I mean by that is that a lot of them will have their own strategic plans, some of their own visions and goals and measured goals and outcomes, and it would be nice to see us, with time, having a standard level of care. Again, going back to my earlier comment, minimizing the gap between Aboriginal and non-Aboriginal, I believe there is definitely opportunity as we move forward.

I guess last, but not least, and again in no particular order, I think it is very, very important because language really is the conduit of understanding our health care. We still struggle in a lot of our communities in having that service provided in that first language of choice. We hear this not only in health. We’re hearing that in justice. We’re hearing that in other types of services. I don’t want to be oblivious to the fact that I know you’ve got to find translators, there are costs involved, but if we can’t communicate, how do you deliver a service? It’s almost counterintuitive. I think we need to look at language as being the conduit of the transition of care for all communities, even to the smallest ones in the remote areas. I just don’t think it’s quite there yet. I want to hear that. I want to hear the Minister, I want to hear the deputy minister, I want to hear the Department of Health and Social Services shout this out more and more. I’m giving it more emphasis at the end of my opening comments because that’s probably one of the big areas, I think, of opportunity.

I appreciate the committee’s indulgence for allowing me almost a full 10 minutes here, but again, generally we’re seeing some good things here, but there are some huge opportunities as we move forward and looking forward to working with the new Minister for the remaining life of the 17th Assembly.

Thank you, Mr. Dolynny. Committee, I’ll just remind you, we’re going to go through all the general comments and then have the Minister speak. Next on my list I have Mr. Menicoche.

Kevin A. Menicoche

Nahendeh

Thank you very much, Mr. Chair. I just wanted to begin with some caution, I guess. I know the Minister is trying to streamline and provide quality service by having standardized levels of servicing in all our regions. I guess the concern that he heard when he traveled with me to Fort Simpson was there is still a need for some type of regional autonomy, community councils, along with some type of appointed members do want to still have their concerns at some board type level. I will just mention that to him again.

Recently, of course, I just spoke in the House about an elder being misdiagnosed, and just reviewing my notes, it has happened before. There were actually two incidents in Wrigley, two young girls in 2005 had their legs broken and weren’t diagnosed until about four days later. These types of things are continuing. I’ll ask the Minister in the House, I know that he just tabled a 25-year report. I haven’t had a chance to look at it, but it’s just about how do we track our clients being misdiagnosed and is one region higher than the other. That kind of approach will help our system keep track of how things are done, because, actually, when there’s a follow-up incident or follow-up investigation, we all should learn from it, much like I guess the coroner’s office does. How do we learn from this incident? How do we make it better for everybody else. Most recently, the elder that had cracked her hip in Fort Simpson, she spent four days at home before she was diagnosed with a broken hip and was medevaced to Yellowknife to receive the proper care and attention that she deserved. But it’s about examining that. In fact, the family told me that to raise it in the House only so that it doesn’t happen to somebody else again. It’s very stressing. Her children had to work and take time off from work to take care of her and that kind of stuff. If we had the proper procedures, I believe that she could have received her attention sooner.

On a similar note, it’s the care and attention that Wrigley residents want as well. They want consistent care and attention, that’s why they’re consistently asking for full-time nursing services in Wrigley. I spoke about two young girls that broke their legs in 2005, only because there wasn’t a certified nurse on site to make the call at that time. In fact, it was almost the fifth day by the time the nurse got there because there was a one day delay by fog. There’s an incident there. Then in 2009 in the community of Wrigley, out of 175 residents, 100 of them suffered from flu-like symptoms and with nursing in the community, that kind of stuff could have been monitored, picked up early enough. In fact, that lasted a week long. The Minister assures me, I think he said the nurse goes in there weekly, but for whatever reason the nurse didn’t go in there. The only reason we sent medical staff in there was the chief and council had to get hold of Indian Affairs at that time, their health department, and they contacted us to send in medical staff to see what’s going on with these 100 residents that had flu-like symptoms. It was pretty scary. It was right in the midst of the bird flu scare at that time, as well, so nobody knew what was going on. It was only because we didn’t have staff on the ground.

We’ve been making progress towards that. We’ve got full-time dedicated RCMP services up there. I do know that Fort Simpson has dedicated staff that go into Wrigley as well. I’m hoping that we can arrange things so that these full-time paid positions can eventually relocate to Wrigley. I’ve been pressing the case that increased development in the Sahtu is increasing the pressures of the community as well. I think that was the same in about 1973 when the first Mackenzie Valley gas pipeline was planned. There was a highway going into Wrigley so everybody knew the increased pressures of modernization, as it were, I guess, so there was nursing in Wrigley and there was actually a staff RCMP housing plus a small jail there in Wrigley at that time. But over the years the pipeline didn’t go and so those services were withdrawn.

But having professional services there at that time made it a vibrant and healthy community, and now that those professional services are gone, the policing services, the community is really, really struggling at this point. The Minister spoke about the community wellness plan. With great effort they do have a community wellness plan, but I feel that without policing or nursing there that the wellness plan is not going to have a good chance of succeeding. At any rate, I’m pressing the case there that with increased development that we should restore their services to the community because it’s only going to get worse in the long term because with the development of the Sahtu it’s not only the winter roads now. They’re talking about increasing the pipeline, the oil rigs, or the Sahtu connecting to the existing Enbridge pipeline. There might even be two pipelines. It’s going to have a huge impact on the community.

With that, those are my opening comments. Thank you.

Thank you, Mr. Menicoche. Next on my list I have Mr. Moses.

Alfred Moses

Inuvik Boot Lake

Thank you, Mr. Chair. Welcome to the Minister and his staff to the House here. This is kind of our third kick at the can with the operations budget and it’s been an educational one, I think, for both the department as well as for Members of the House in terms of how we look at doing things differently or looking at things more efficiently and looking at where we can improve within the department itself.

With that said, I know this is the biggest budget in the government, but it is also one of the departments that has some of the more unique challenges that we don’t see in other departments. It is really hard to address and I commend the hardworking staff on the work that they do with the amount of dollars that we have and, as I mentioned, the challenges that we have.

With that said, before I get into some of the ongoing concerns and questions in areas that I would like to highlight moving forward, I know in the federal budget it was announced last week that all three territories are going to get a three-year funding of $70 million, so just moving forward, I want to make kind of a general comment on how those dollars will be allocated, or will something come before committee? Will committee have some type of input on looking at some of the priorities of this Legislative Assembly as a whole but also some of the initiatives that came out of standing committee moving forward?

It is always a concern for me, and something that I have tried to address and continue to address, I’m glad to see that the Mental Health Act is on the legislative list to be amended moving forward. Some concerns that I do have is that we have a lot of counsellors, 65 counsellors, but only in 19 communities. That is something that continues to stick with me, because in my discussions with the chief coroner as well as other constituents and people in the small communities, we need to address mental health issues. It is not always readily available. I appreciate the update that the Minister gave in the House yesterday on the NWT Helpline, that on March 1st it is moving to 24 hours and staffed 24/7, so that is good news.

Something that I have kind of done on my own, working with my constituents back home that have gone to treatment, is having something in place within the government, possibly, that we have that ongoing support, ongoing treatment from the North with the individuals who are out of jurisdiction because, I guess dealing with a couple of cases here, individuals who do need treatment, sometimes they are left on their own and get stranded down south or have incidents where they have to try to find their own way back into their communities.

I am just going to stay on topic here with some of my Member’s statement today in the House in regards to oral health care. I know that we have had some money that sunsetted this year, I think $438,000 or something in that area, and with that money that is coming back, I know there was some references in other back and forth communities with the high rates of incidents of early childhood kids that are dealing with dental issues before the age of five, so we have the stats, they are known, so we just need that action plan to come forth. I think that is a big one, because when I did more research on it, I saw that gum disease, tooth decay, can actually lead to more serious issues with the heart and other major organs.

With seniors, that issue I was dealing with in Inuvik just recently, so I looked at some of the things that we do here within our government and when I was looking on the website, I saw that we have a Seniors’ Action Plan from 2003. I think that needs to be looked at and possibly revised. Some policies that deal with seniors, whether it is with income assistance, income support or housing, or people living with disabilities, there is an opportunity to modernize that a little bit more with things that we are dealing with in today’s society, especially with the seniors population increasing.

Next month, the Minister does know, and staff probably know, that we are going to get a report back from the Office of the Auditor General in regards to child and family services recommendations that were brought forth and that is going to be interesting to see the results of that. I am not sure if I will be seeing any big dollars in the budget for that. How do they adjust those recommendations moving forward? I think there will be some action items that are going to need to be taken to task. That is why we are going through the process of possibly looking at trying to change the budgets and how to reallocate more funding dollars toward the Child and Family Services Act, especially when the Auditor General’s report comes out next month.

Something that was brought to my attention, and I know they do it here at Stanton Hospital and in some cases at the long-term care ward in Inuvik, is to deal with traditional foods. I do visits to the hospital and chat with some of the elders, but also some of the patients, and sometimes they don’t even eat because the food isn’t always up to par. That needs to be addressed and I think there has to be a better way to get some of the traditional foods in our communities, especially when we get residents from the small communities going into, say, regional centres or even here in Yellowknife, when they might not know a lot of people in the community that might be able to help and assist them.

One occurring thing that I have noticed up in the Beaufort-Delta is that there is a constant challenge with overtime and call-backs as well as authorities working in deficits every year. I know Inuvik, the Minister was up there and listened to some of the cost-saving practices that they did – and I think that this is something that needs to be adopted right across the Territories – ways that we can better improve our staffing in some of the department divisions and to deal with some of these call-backs and overtime, but some of the costs that are associated with it.

One thing that I am not sure is really taken into account here is the high cost of travel, specifically in the Beaufort-Delta in getting to the coastal communities is quite challenging at best. Even just dealing with the weather, but there is also an added cost to that moving forward.

They are all concerns, but as some of my colleagues have stated, there has been a lot of good work that has been done with the department and committee. I know the department has come before committee on numerous occasions where we have had really good debate and good discussion on a lot of issues, how do we deal with them and address them. I look forward to continuing those debates and discussions, those discussions with their partners, to come up with the best solutions for residents of the Northwest Territories.

One last thing, and colleagues have been bringing it up in the House on numerous occasions, and that is nurses in the small communities. I think we need to find a legislation that is going to work with that. I know it does deal with police presence and the RCMP presence in the small communities, but I think there is a way we need to try to adjust that, because there are mental health issues, there are a lot of health issues in the small communities that need to be addressed sooner than later.

I appreciate that there is midwifery dollars in this one. The Anti-Poverty Strategy, moving forward on that, that is really great news as well. Something that is also being reviewed, and I am glad that it is being reviewed, is the Medical Travel Policy. I know that one is always a tough one to deal with. I think we have to get something in place that is really strong and we can refer to whenever we send our residents south or even to regional centres like Yellowknife.

I guess to finish up with just translators. I know that is something that we have mentioned numerous times, possibly at every budget session, is getting proper translators for our elderly residents or our patients that only speak their own Aboriginal language. That needs to be addressed when they come in, and we have to look at the terminology. Obviously that is going to be a big, big project moving forward and I just want to bring that to the department’s attention as well.

I look forward to going through this budget and continuing the work that we have had with the department. Thank you, Mr. Chair.

Thank you, Mr. Moses. Next on my list I have Mr. Nadli.

Michael Nadli

Deh Cho

Thank you, Mr. Chair. I have a few comments, at least five points I want to raise, just to highlight.

First of all, I think this department is the biggest department and, of course, the most challenged because you are dealing with very core, primary issues related to the health and well-being of people. Obviously, it comes to how programs and services are carried out and delivered. At the receiving end of the services the government provides are people, people who live in large centres, regional centres, cities, but for the most part in small and remote communities.

That being said, there are major initiatives that have come across in Fort Providence, at least, one of four communities that I represent, is the new health centre. I know the foundation is complete and things are steaming forward. There’s a reprieve at this time and I understand contrition is likely to begin in the new fiscal year.

In small communities we’re challenged with infrastructure and buildings that can be available that can be converted and provide a service to another sector of the population, whether it's youth or elderly care programs. So I hope there is a dialogue that has been done with the local communities in terms of looking at some options on how the old health centre can be procured and its fate decided at some point. I encourage the department, if there is dialogue going on, to maintain that dialogue. Don’t discount the people at the local level. For the most part, we’re challenged to find buildings to house programs and services and offices.

The other point I wanted to make is in terms of the regional health boards. I know there are some cost-saving measures. This is the biggest department and has the biggest budget. It carries the highest expenditures, so we have to look at ways of curbing expenditures and, at the same time, being very efficient with what we have and make the best use of it. That’s the price of democracy, ensuring people from the regional centres and communities do have input and continue to at least have a major say in how programs and services are delivered in regions and communities.

That being said, if indeed we go down the path of restructuring boards, what we’re basically doing in this government is walking away for a template of a regional model that could serve as the basis of self-government when First Nations go down the line of achieving the status of making their own decisions.

That point being made, seniors, in terms of their care, is a growing concern. Most seniors want to continue living in their homes for as long as they can. Either themselves, if they are independent enough, or with their children and grandchildren. Sometimes policies don’t consider that. We have to be mindful that we have different cultures and different expectations, and at the same time, we have an obligation to service the needs of people. Once again, if there is a possibility of looking at the fate of the old health centre in Fort Providence and converting it into a long-term care facility for seniors as our population of elders grow in most communities, then by all means, let’s explore the possibility.

The other point that I wanted to make is I think this government has been a major precedence, it has responded, it’s doing something. With the on-the-land program, I think the government has responded and it’s good. What it tells me and the people in the communities is that we have developed a culturally appropriate model to address the addictions problems in our communities, whether it’s drugs or alcohol. We are trying to at least create a system so that people can make decisions for themselves in terms of making a choice of living a healthy and well lifestyle.

I think that’s a major precedent that we’ve set for ourselves. I‘m hoping at some point there will be advances to ensure we invoke practices such as allowing traditional foods in hospitals for elders. I think that’s the next step in developing culturally appropriate programs and services.

The other point I want to want to make is with Nats'ejee K'eh Treatment Centre. I think it was widely known that there was a lot of disappointment and disbelief in terms of the only addictions centre in the NWT. We’ve kind of repositioned the priorities in advancing the on-the-land programs. There again, I don’t know what’s going to happen with that building. I know there’s been some discussion with the local First Nation in terms of the use of the building and ensuring that it’s available, whether it’s for programs and services, and not just abandoned but put to the best use by local people of the K’atlodeeche First Nation.

The other point in the same instance is this government, of course, has made advances, again how great leadership in establishing the Anne Buggins Wellness Centre. That was a great achievement and I was very pleased to see that. They had a very nice ceremony. From what I see there, it’s an establishment of the GNWT working to wrangle their jurisdictions of layers of policies and procedures that sometimes become a hindrance in delivering quality programs and services to people on the reserve. I encourage the department to continue advancing to ensure that we determine very good programs and services delivered on the reserve. I think that’s doable and I encourage the department to keep on working with the communities.

Those are just some of my comments today. I am reminded of the statement I made today on child poverty. That’s a very strong hindrance in trying to promote advancement and well-being of children. It’s a big issue that a big portion of our population is stagnant. It’s not growing; it’s not declining. I think as we look to the future, our children are our future and we need to do our best to ensure we have programs and services available to families so they succeed either in education or advancement of careers and making their homes in the NWT.

Those are just some of the points I had, Mr. Chair. Mahsi.

Thank you, Mr. Nadli. Next on my list is Ms. Bisaro.

Wendy Bisaro

Frame Lake

Thank you, Mr. Chair. My comments are in no particular order and I would like to thank the Minister and his staff for being here.

The department, in my mind, has a huge responsibility. They’ve got a huge section of our total territorial budget. By and large, I think the department is doing a pretty good job. Certainly there are wishes from Members for the department to do more but, you know, when push comes to shove, we kind of all would like to have more.

That said, there are some priorities which I feel are priorities to me and also to some other Members on this side of the House that aren’t getting the attention I think they should, and by attention I mean financial attention. I know the staff are working very hard to do what they can, but you can only go so far with what money you have.

So, some of these are reflective of my priorities. Some of them are just general comments on the department, as a whole.

I know the department is working towards a change in the governance and our system of authorities. I think it’s something which is overdue and I commend the Minister and the department for taking what I see as action at this point. It has been talked about for quite a long time and I’m glad to see that I think we’re going to be moving forward in the near future on making some concrete changes. We have been making changes in terms of sort of operational activities, but we need to talk about how we are governing our health system. We’ve been talking about it, but we need to actually make some changes to our system and I think we’ll find efficiencies if we do that both in terms of PYs, but also in terms of actual dollars.

The Minister has said a number of times to Members in committee and outside of committee that early childhood development is a high priority for the department. I’m hugely supportive of that and I think the early development instrument results, although they were preliminary results, but we’ve had those in the last couple of months and those are very indicative of the attention that we need to pay to our zero to three-year-olds. It’s my belief that we should be putting more money than what’s in the budget into child and family resource centres. If not centres, because we’ve had two and I don’t know if we’ve had a chance to evaluate them, but certainly on paper they look to me like they’re the best way to go, but if we’re not going to be putting money into that particular program or activity, then we need to put it into another activity. I just don’t think that this budget reflects as much emphasis and as much spending on our zero to three and zero to four-year-olds as it should.

The Minister tabled an updated Mental Health and Addictions Action Plan just within the last week or so I think. I’m glad to see that there has been some recognition of some of the activities that have taken place and some of the other plans that have been put in place in that there’s a change to the Mental Health and Addictions Plan which came out last year sometime. I would hope that all the plans that the government is dealing with not just within Health but that all departments would do the same thing, that an action plan doesn’t come out and then sit there stagnant for five years. They should be a living document, much like a strategic plan.

I note in the Minister’s opening remarks that $3.2 million will address a base deficiency in Stanton’s medical travel budget. This has been an issue for many years and I would just like confirmation from the Minister that this is an ongoing $3 million that is going to be addressing the deficiency in the medical travel budget, but at the same time, I thought I had heard noises that medical travel and the costs for medical travel was going to be moved to the department. So, I’m a little confused if this $3 million is being added to Stanton’s budget or if medical travel is going to be at the department level.

Right after that the Minister said $5.2 million has been added to the budget to address increased costs for residential placements outside of the NWT, and that again has been a cost which we have been funding by supplementary appropriations, certainly as long as I’ve been here, and I would like confirmation that this has been added to the base and that we will be better budgeting for the costs for our residential placements outside of the NWT in the future. That’s what it sounds like, but I’m just not sure of it.

The other thing with medical travel and somebody mentioned that we’re reviewing the policy and absolutely we need to review the policy. I think the Minister mentioned the Med-Response, and the Med-Response system, I think, is going to assist in some efficiencies with medical travel. I certainly hope so. I’d appreciate confirmation on that. I’d also like to know when the Med-Response system is going to take effect. I don’t believe the Minister mentioned when Med-Response is going to take flight.

The Midwifery Program, I’m very glad to see that there’s money in the budget for this program. I am disappointed, however, that during last year’s budget deliberations there was money added to the budget for midwifery to advance the Midwifery Program and that didn’t happen. I presume that that money lapsed. Members on this side of the House felt that we wanted to get midwifery in Hay River sooner than what the department was planning. We also wanted to get it started in Inuvik sooner than what the department was planning. So I was really disappointed that that didn’t happen. I presume it was a capacity issue with the department, but I would hope and I’m not sure exactly when we’re expecting to have a midwife or a Midwifery Program in action in Inuvik, but I’d appreciate confirmation of when.

The Minister has advised us that the department is working on assessing our long-term care needs and I have a particular interest because of the long-term care facility which exists here in my community in Yellowknife. The Aven Centre is looking at an expansion and I know the Minister has said that the capacity at Avens will be considered in conjunction with the long-term care needs right across the territory. So there is a report coming, I understand. It’s been coming for quite some time. I’d appreciate knowing from the Minister when we can expect that report. As has been mentioned by a couple of Members already, seniors are an ever growing part of our population and I think as is pointed out in the Aven’s proposal, which the Minister has seen, the need for long-term care beds for seniors and for care for seniors, whether it’s acute care or not, it’s huge.

The need for enhanced and identified services, and generally mental health services related to wellness courts, the needs for services for wellness courts I don’t think has been totally identified by the department. I know that the recognition is there that we need to have those services in order for wellness courts to go ahead, but I think the department should be putting more emphasis on making sure those services are in place so the wellness courts can basically get going. We’ve been talking about this, again, for a very long time.

There’s no mention in the Minister’s opening remarks about the child and family service committees. I know that’s been a really difficult program to get going, I would just be interested in knowing whether or not that program has been kind of put off to one side because it has been so difficult.

The Anti-Poverty Strategy was mentioned and I am very supportive of the work that the Minister has done on the Anti-Poverty Strategy. He has involved people outside of government, he’s involved many aspects of our community outside of government and it’s proven to have produced us a pretty good document, and they’re working on the action plan right now. I think my biggest concern with the Anti-Poverty Strategy is that I don’t know that that strategy and the action plan that’s being developed is going to look at the difficulties and the impediments that policies across government create for people who are in poverty and/or particularly assessing income assistance and other programs. In my mind, in order for us to actually have the Anti-Poverty Strategy work, we have to make sure that we don’t have policies that are working at cross-purposes to each other. We’ve talked about this before, but I’m not so sure that the government has taken it on as an issue that is extremely important.

Lastly, I want to make a comment about deficits for a couple of our health authorities, particularly the Beau-Del and Stanton. I guess there’s been, again, a lot of talk about sort of how to fix it and if we are going to fix it. So I would appreciate knowing from the Minister at some point what his plans are to try and make sure that we fund authorities appropriately so that they’re not in deficit because, in general, I think they’re in deficit because we aren’t funding them properly.

I have the same concern about my own local Yellowknife Health and Social Services Authority. Their deficit is not nearly as large as Stanton, for instance, but they’re still operating in a deficit and the Minister needs to do something to look at all of our authorities, and maybe the governance will change things, but we have to look at all our authorities and make sure we fund them properly so they aren’t operating in a deficit.

I see my time now is up so I am now done. Thank you, Mr. Chair.

Thank you, Ms. Bisaro. Next on my list I have Mr. Bromley.

Bob Bromley

Weledeh

Thank you, Mr. Chair. There’s certainly a little overlap. I know the Minister is hearing that, so I’ll try not to repeat too much. This department is up 8 percent in budget and that’s the reality, but it is a high increase this year. Although I do note, as I think it’s been noted, that the Territorial Health System Sustainability Initiative funding came in after this budget was drafted, so I’ll be looking for an update when we get into detail. Just a heads up there.

I notice in the directorate that it’s up 25 percent over two years, which is not typical of the rest of the divisions. On closer examination, a lot of it is compensation, but again that didn’t happen with the other divisions, so I will have questions on that. I also note that there’s a modest contribution to the Anti-Poverty Strategy, which is a smaller proportion of that increase.

The ECD, early childhood development, obviously needs extremely strong partnership and collaboration between Health and Social Services and ECE, but I’d like the Minister to know that I do support the suggestion that Health and Social Services should take the lead role, especially for the zero to three category of early childhood development, recognizing that it depends on big efforts on both departments and real collaboration. I think the problem is that ECE is so overwhelmingly domineered by their education commitments, and perhaps rightfully so, that it tends to distort the absolutely essential, the absolute requirement that we bring this focus as the topmost priority in our ECD work to zero to three, and I know there are lots of things starting to happen and that have been happening. I think this is not a new recognition, but we do need a renewed emphasis.

I am very pleased, as I know others are, with the establishment of the Aboriginal health and community wellness division, and I’m looking forward to a positive start with that work on mental health and addictions. Again, the Minister knows my and committee’s view that mental health or a wellness court can really be one of the most effective things that we can do to address one of the most serious and costly sets of cases that we deal with for many reasons, and I won’t drearily go over them again here, that we must deal with. Again, we’ve been at it. Let’s really get going on this. What we’ve heard to date is too modest. It’s not acceptable, so we’re looking for better effort there.

There is some reorganization, perhaps, that will be coming down the pipe. We really do need to clarify and simplify our lines of authority to seek consistent direction and emphasis, the things that you would expect from a leader, and I think the department needs to provide that in the management of this huge health system. I’m not totally knowledgeable on this. I know it’s early days and the Minister is working hard on this effort. I’m supportive to the degree that I am aware of it and know anything about it. It seems like we’re going in a good direction there now and I urge the Minister to continue with that development and implementation.

Some concerns, I know that the department has not fulfilled the direction provided by the House in, for example, areas where we have provided specific resources in the past, and the examples that come to mind, as we’ve heard, are ECD and midwifery. I did hear the Minister’s reference to starting work in the Beau-Del. That’s very positive and that would catch him up, as the Minister can do that, this fiscal year that’s coming up and complete the Hay River work. I think there would be a little catch-up happening there and I’d be very happy to see that.

The last thing, long-term care beds. We are doing things in this area, but I know the Minister is aware that we need a lot more. We’ve heard ad infinitum that our age structure is changing demographics. Perhaps we’ll hear more about the plan to address that and come up with a well thought out, comprehensive plan. I was disappointed to hear that Avens is backing off on their efforts, because I think one of the worst areas will certainly be Yellowknife where people tend to migrate to when they have particular needs. I hope that will be recognized in the plan and that the Minister will get busy on this. I’d hate to see us 5 or 10 years down the road seeing a lot of seniors suffer because we haven’t done the work to get that in place.

I think we’ll get into the details here. I’ll leave it at that. I’m not expecting the Minister to respond to a lot of these, because I know they will be coming up in detail, but I did want to bring them up because I think they’re important enough to be repeated.

Thank you, Mr. Bromley. Again, moving with general comments, I have Mr. Blake.

Frederick Blake Jr.

Mackenzie Delta

Thank you, Mr. Chair. I just have a few comments and concerns to raise with the Minister. First off, it’s been about two years now that through the department we’ve had a commitment to implement the Beaufort-Delta health board back up in the Beaufort-Delta region, and the residents up there are still waiting for a voice from the community to represent them. That’s really lacking up in the region. Although a lot of services are improving, the residents still would like a voice on the board. I think all we need to do is do a bit more training in the financial area. That’s where a lot of the past board members felt that there was really no education for the board members in that area. I think that simple little training that if we apply it to those board members, whoever they may be in the future. I’m really looking forward to that and I hope by the end of our term that we could have this board in place.

Also, I’d like to commend the department on the improvements with the medical escorts over the last couple of years. A lot of the elders that are travelling had a lot of difficulty, especially travelling to Edmonton. Many of them have gone there for the first time and they don’t know where to go even in the airport. It’s really stressful on them, especially if they’re dealing with major issues like cancer and other life-threatening issues. It’s added stress. I’m glad to hear that the department is offering counselling to those that are affected by that.

Next, a lot of concern in the Beaufort-Delta riding that we need a health care facility, whether it’s in Aklavik or Fort McPherson. Fort McPherson is larger and has a larger population of elders in that community. In my riding alone we have 350 elders that are over the age of 60. That’s a clear demand there. Inuvik has a small facility that could hold, I believe, roughly 20 people or so. This is going to be needed in the future, and I highly recommend that we put it in Fort McPherson because they do have a full-time road that’s accessible, which I believe would cut costs.

Also, nursing in Tsiigehtchic, as I mentioned, it’s been just a few years back that we did have a full-time nurse there, 10 years or so, but if we could do it then, we could do it now, and there’s a clear demand there as well.

Also, for the positions that are in the budget for Fort McPherson and Aklavik for nursing, I highly recommend that we fill those positions and willing the work of the department to do that. If it’s not possible to fill those positions, maybe we could transfer them to Tsiigehtchic and that would make things a lot better.

Those are just a few comments that I had, Mr. Chairman, and I look forward to the response. Thank you.

Thank you, Mr. Blake. Moving on with general comments, I have Mr. Yakeleya.

Norman Yakeleya

Sahtu

Thank you, Mr. Chair. I want to make my comments to the Minister and I want to thank the Minister and his colleagues for the continuous efforts and push towards the new wellness centre in the Sahtu and the territorial long-term care facility and the exciting news about putting the training program and what we need to do to get that operational, off the ground and put forward to having some sort of ceremony, maybe this summer, to kick-start the excitement, and the previous Minister also was involved with that. I want to thank the department for their efforts to take my questions as I nag you through the system, because it is exciting and we want to make sure that it stays in the books and I thank the government for making those commitments.

In saying that, I would like to follow through this venue here, another venue that the Tulita health centre has been in the planning books. I know there is one last piece of detail that we have to look at before we start looking for money for the Tulita wellness centre. I am just calling the Metis right now in Tulita, because that is where the letter went, to see where things are at. I know that there was a meeting set up to see what we have to do to maintain that piece of infrastructure on the books, given all our other infrastructures that we wish to have. I wanted to thank the Minister for keeping that also on the radar here.

Mr. Chair, I do want to say that the issue that I talked somewhat to the Minister on not too much, but one that I brought to his attention is that we have elders that fly out of our small communities. They come down to Yellowknife or Edmonton for medical services and the way the airline operates and the timing is not conducive to some of our elders. The ones I am speaking about are ones in wheelchairs or walkers, or are fairly old and fragile. Because of the airline schedule, sometimes these elders have to stay at the Norman Wells Airport for an extended period of time. I was asking if the departments operations and maintenance can look at an elder who has cancer goes for treatment or elders who are with walkers or disabled, that they could be put in a place where they can rest. Work with the health centre in Norman Wells so they can have a place where they can rest, have something to eat, have some tea, watch some TV maybe, but not just stay at the Norman Wells Airport for two or three or four hours. We are young, so we can handle it, right Minister? So, we look out for most of the elderly people. That is what I would like to look at and go to. It is not going to be all the time, it is when these elders have to come to Norman Wells to catch a flight south. That is what I am asking for. I have run into some incidents where some of our elders have been staying at the airport for five hours. I am not too sure if they ate or had any tea or they were looked after. It makes me sad to see how we treat them, so I asked the Minister if he would put a little effort into looking at something like that, where he could make it work. It would be on a case-by-case basis. Just so that elders that have cancer, they could go to a place, so I ask for some civility, I guess, to see what we can do there.

In Tulita we have people over 60 years of age. There are 74 of them, according to my stats here. In Deline we have 54; Colville Lake, 16; Fort Good Hope we have 64, and in Norman Wells we have 85 people who are 60 and over.

In doing my homework here, these elders that I listed off, in Colville Lake 94 percent of people consume food from the land. In Good Hope and Deline, 77 percent; in Tulita, 79 percent; in Norman Wells, 29 percent. I say this for a reason, Mr. Chairman, because of these high percentages of numbers where our people consume food from the land, so that goes to the point I want to talk about. I want to talk about food that is offered in our health centres.

In Stanton Hospital, I know the Minister is working on that. In any facility now that we have elders in, like the Aven Manor, or up in Inuvik, or Simpson maybe, in our hospitals, these elders grew up from eating food on the land. There is a health benefit also to it. I know you have the Aboriginal wellness council going pretty strong and pretty forceful, and I like to see where the Aboriginal patients have a direct access to getting food from the land served to them by our government. It should be representative, just like we have a policy where we have employees representing the population. So if there’s 65 percent Aboriginal people, we should have at least 65 percent of Aboriginal foods in the hospitals, not 5 percent or 10 percent or whatever. Boiling fish is good, fish broth is good, ducks, geese, beaver, rats, they have to have all that food. That is what they grew up on, so we cannot deny them that. I wanted to raise that with the Minister to bring those numbers up. I do want to say to the Minister, I really, really support the Aboriginal Wellness Initiative, the directive, the on-the-land healing programs, all those good things that are going to plant the seed now. It is good that the department is listening now, we have dedicated money to those initiatives. For 10 years I have been saying this, now we are finally starting to see. Now let’s give that a chance, let’s give it a whirl and see what we can do for our people.

I want to say to the Minister that the medical travel certainly needs to be something that is revamped and looked at for our people. I also want to say, on the same thing, medical travel has done some things that have helped my people also. I am not going to be too hard on them because they have done some things that I think have helped me, as a Member, in getting my people back home. So it is not all criticizing the system or the people in there, it is just what we have set up.

The issue that I want to raise, and the Minister certainly heard it from three of us a couple of days ago, is on increasing the nurse presence in our small communities. Without nurses, we don’t have any nursing in our communities and there are nine communities in the Northwest Territories. I look forward to a discussion paper, something that will say this is how or when we will want to get these communities on to the same level of health care as the rest of the communities in the Northwest Territories.

The challenge, and I know the Minister is up for a challenge, actually he has had some pretty good programs when he was working in it some time ago. I think that’s what I want to do too. Work hard for us. The budget is pretty good in the health field here and I certainly hope we have some further discussions on the federal government’s announcement on having money come to the Northwest Territories and how we’re going to use that money. That’s all I have to say, Mr. Chair. Thank you.

Thank you, Mr. Yakeleya. Moving on with general comments, I have Mr. Hawkins.

Robert Hawkins

Yellowknife Centre

Thank you, Mr. Chairman. I’m just going to use this opportunity to highlight a few areas of general concern. Of course, I’d certainly like to see ourselves do a little more in the treatment area. I’m not sure that the Minister’s Forum, in my view, was their forum panel, and certainly research done on addictions and whatnot was the approach I would have liked to have seen. They have come up with some recommendations, but like anything, it’s all about implementation and how we follow through. There was a commitment in there, the observation of making a treatment centre available or treatment spots available in the North and South and I have yet to see them emerge, so I certainly look forward to the application of that and not sort of the two-step dance away from accountability, so we’ll have to see that.

You know, you don’t have to go very far in this city for people to call upon the government, asking yet again where are these treatment centres that they want their government to commit to. Ironically, accountability is a funny thing. It seems to be a difficult thing to put our finger on around here, because this is what the public wants but yet the government finds new ways to avoid it. I certainly hope this is coming to an end, at least the excuses, that is, because, quite frankly, the constituents and the people of the Territories deserve the follow through on these types of initiatives that they’re asking for. I mean, if the people are asking for them, I find it odd that the government cannot respond to that need. Yet again they use their many, many people studies and resources to deny the public what they are truly looking for.

The homeless problem continues to be an issue. I often hear this brought up at regular discussions when I’m out visiting folks. People would like to see more initiatives on this. This isn’t just a Yellowknife problem. I think Yellowknife certainly has its own problems with it specifically, but what I think needs to be done more so by the government and certainly by the Department of Health is to find money for programs, for regional centres. The reason I say that is when we are presented anecdotal evidence, we find a very low percent of the people attending these opportunities for people who are homeless. What we find is the vast majority of these folks really belong and are from the communities and regional areas and they want to go home, but of course, if you ask them where they’re from, then they’ll say that there’s nothing there for them to go to. That continues to be a fundamental issue that I’d like to see addressed as an emerging focus and a problem that needs some real help and heavy lifting. If we had more money invested into homeless centres in regional areas, people would be able to be more connected with their regions and certainly their families. I would say those interties are so important they could help us down the road with other issues.

I won’t be spending any time at this particular second, but I do look forward to asking about position vacancy in every area I get a chance. I’m going to be asking about funded positions and unfunded positions and certainly how we fund them. I mean, let’s get to the bottom of some of these things and why are we running positions in existence that aren’t funded, so why aren’t we asking for the money to fund them.

At the same token, this money doesn’t fall… I think it was so eloquently quoted today that they don’t just show up because of pixie dust. I’m not sure what fairy is dropping that funding off. But that said, that money has to be coming from somewhere. Hence, that now leads into the next point of saying I certainly look forward to the updates on each regional health authority to find out what their current deficit is, how are they addressing these things, what are their plans and their focus. I’d like to know things about the establishment of the boards and why don’t we have boards in certain areas. I think there are lots of good questions about those particular areas and I’m sure we’ll hear lots of good answers. I am certainly optimistic we’ll hear those answers.

One of the issues I continue to raise, and I will continue to raise in speaking of deficits when it comes to health authorities, is the doctors’ pay, which I think is such an embarrassment of this government to put these doctors’ costs on these health authorities, which truly should be a departmental cost. This is very frustrating to watch that these authorities have to carry these things. For example, Yellowknife Health and Social Services Authority has to carry the doctors and they have to send them out, they have to find overtime, they have to do training time. I mean, just the headaches alone. If this government was proactive, not reactive, we would place these doctors all sorts of we’ll call it from an accountability framework point of view and they would make them financially accountable at the department. I think ultimately that would take some of the stress off the authorities. When we look at and wonder where some of the money is coming forward to pay for these things, they have two choices: find it somewhere within, which means they either, you know the old saying, steal from Peter to pay Paul, or, of course, they run without and that means they run with a position that’s empty, reallocate. Who knows how they get through their budget year? I mean, sometimes we just don’t know. Hence we end up with authorities with deficits. Frankly, I’ve never once really heard a good excuse why and I don’t think anyone believes it.

I think moving doctor pay to the department could go a long way in solving that. I don’t know of any MLA that wouldn’t support an initiative if we had a crisis that needed support. I mean, I know a couple of years we’ve had different sorts of fallouts of problems that have come forward and we know when it’s important and, by golly, if it’s important, bring it to the Legislative Assembly and don’t be afraid to ask for money. If it’s meaningful, we’ll support it and if it’s not meaningful and important, well, then you’ll get your answer.

As was probably mentioned by my colleagues, we continue to have the call of the naturopaths wanting to be regulated. I’m not sure if my other colleagues mentioned it today, but it’s certainly worth mentioning because it’s something that needs to be looked at. I’ve even received an e-mail, and I think MLA Bisaro spoke about it yesterday or the day before, that they want to extend their authority to be able to do some stuff. I’ve heard cases where naturopaths want to prescribe therapy but they have to go through a doctor and then they have to get a doctor to sign off on certain elements of we’ll call it the investigation process and then that doctor takes responsibility. But some of the naturopaths are very credited and credible, very insightful and very capable, and we should be asking ourselves why aren’t we using this resource for what it is. Yet again the public speaks. Yet again the government falls deaf to the cries of the people. It’s frustrating to watch.

It’s days like this, you know, I wish we were a typical party system because we could throw those folks out of Cabinet because they’re not answering to the needs of the public, but we’re not a typical party system and nobody is accountable to these things, because they always just blame it on the last government and no one is around to take those responsibilities.

I’ve asked for suntan beds to be legislated. Although this is a small issue, it’s an important one. I think if we were wise, we’d certainly be going down that path.

Let me continue to reaffirm – I’m not sure if my colleagues have mentioned this one – the importance of midwifery and the expansion of it. It has turned down to a dull roar on this particular issue right and I think what’s happened here is the need for the service has sort of gone to a whisper. Yes, it’s important, but I think people have given up on it because they just see our government dragging our heels on this. It’s a service people want, a service people definitely need, a service we can certainly divert out of our typical normal process of needing a doctor in a standard healthy case.

Again, another demonstration of the needs and the direction and the wants of the people are, well, quite frankly, being ignored. The government always finds money for subsidies of their projects, but when the public comes forward very strongly and says they want something, it just seems like you cannot garner any attention of the government. I often wonder what you do. We continue to raise the issue and they just continue to chuckle and say, don’t worry; we’ve got money for our projects and our ideas in Cabinet but just no money for the people’s ideas. I wish we could exercise more authority.

The last area I’d like to highlight, although I can’t specifically say where the project is now, but I would certainly make special note that the project over at Aven Manor is still on the horizon, although I don’t think it’s on the front burner of activity of development. I think there’s still a continued underutilized resource there. There’s energy behind the board, there’s optimism behind the organization, and certainly there’s land and resources and a partnership that I think isn’t being embraced the way it could be. I like the fact and I love going to the Aven’s area where you see seniors active and enjoying life and being part of it. I think it’s a phenomenal community that I would like to see personally that we develop in other regions in the Northwest Territories. I don’t know why we can’t have more of these things. It all starts with some vision and some support. Whether it’s housing or it’s health or it’s a partnership thereof in some manner or some form, I think it’s a real missed opportunity that we’re not developing these types of things.

Again, I said this and I mean this. I can’t speak to the present state of that project and expansion that they want to do over there. It may be on the back burner, but the problem is we need some support from this government. Of course, they will say that they don’t have any money, which when it’s a Member’s idea, of course, they don’t have any money. I’d be shocked if they ever said yes. But that said, it’s something that I would hope the Department of Health would be finding and helping advocate for and certainly working with them to leverage new opportunities and partners with everyone else.

Just a few random thoughts with health and I will have more. Like I said, I will be asking, when appropriate, some questions regarding position staff, money, funding, where it is and why it isn’t there, et cetera. We will be there. Thank you.

Thank you, Mr. Hawkins. Moving on with general comments, I have Mr. Bouchard.