Thank you, Mr. Bouchard. General comments. Mrs. Groenewegen.
Thank you, Mr. Chairman. I’m not really a big general comment kind of person in Committee of the Whole, but I just wanted to make a few comments on Health and Social Services. It’s a big department, it’s a tough department and I have to say that I am pleased with the general direction that the leadership and the department are taking things. I see some innovative things. I wish there was more that we could do to inspire people to be more caring about and taking personal responsibility for some of the challenges that we face. As a government, we try to fix things and sometimes I think we have to find a balance between trying to fix things and maybe getting on the front end and try to prevent things and try to denormalize things such as the degree to which people consume alcohol and are involved in other destructive behaviours. That’s always the balance, that’s always the struggle. But overall, whether it’s medical, social, the leadership that the department is providing on these fronts I am generally happy with and as we had in committee the other day, one of the leaders on the front line overseeing the Community Wellness Initiative, these are good things. As my colleague Mr. Bouchard said, we need to give communities a say in what they feel are the things that will make the most impact for them in achieving wellness.
So a long ways to go. Like I said, a challenging, big department, it covers so many areas, but I think we have, as a government, devoted a lot of resources to this area and we hope to have good results as a result of those investments. We’ll carry on with making our comments and having our input where applicable. Thank you, Mr. Chairman.
Thank you, Mrs. Groenewegen. General comments. Okay, we’ll allow the Minister an opportunity to reply. Minister Abernethy.
Thank you, Mr. Chair, and thanks to all the Members for their comments and thoughts.
There are a number of areas that the Members brought up that there was some clear cross-over. So I’ll attempt to address as many of the questions as I can with my comments and if I do miss any, please remind me in detail and I’ll make sure to answer them at that time.
MLA Dolynny started off talking about some of the challenges and indicating that there’s room for improvement and, quite frankly, I agree, absolutely. We need to have a system focused on better health, better care and a better future for all of our residents in the Northwest Territories. Since I’ve become the Minister of Health and Social Services, I’ve had a lot of discussions with the senior management of the department. For me and for the department, our top priority is to improve care and services of NWT residents. For me, every decision that we make with respect to our system has to focus on what is best for the patient, or what is best for the client. That’s the premise that I and the department are moving forward as we are bringing forward decisions, but also discussions with our colleagues.
There’s no question that the system needs to be accountable and responsive to the needs of communities and regions, and that’s all communities in the Northwest Territories and all regions. Roles and accountability must be clearly defined. In my opinion, at present, they’re not.
Regions must be adequately resourced to meet the service demands in a timely fashion. I heard this several times about resourcing the authorities properly with every authority running a deficit. Clearly, they’re not.
Our current model does not offer enough flexibility to respond to significant changes in service demands across the Northwest Territories. Moreover, there’s no consistency in the current formula for distribution of resources across the Northwest Territories. We heard that from the Auditor General.
The system needs to be compatible with emerging Aboriginal self-government aspirations and we don’t want to build more silos. We have eight silos in the Northwest Territories. We don’t have a health care system, we have eight health care systems and they don’t always work really well together. Where they do work together it’s not by design, it’s by good will of the incredible people that we have working in the system, not by design.
We need to come up with a system that gives our residents seamless, competent, quality care. It must be client and patient focused. Clearly, communications throughout must be improved and this includes follow-up and after-care.
We need more focus on prevention. I know the Members of this House have talked an awful lot about prevention, and working with Members, we have put additional dollars into prevention over the last couple of years. The allocation of resources must meet and be reflective of community realities and community needs, and our regions must retain the ability to deliver programs and services in a manner that meets the unique needs of their respective catchment areas.
Who is best to help us figure out what services to deliver in a community like Deline other than the people from Deline? We need to make sure that we have a mechanism that gives us an opportunity to hear the voices of our residents.
There must be a balance between traditional western medicine as well as traditional healing practices, and all of our programs need to be delivered in a culturally sensitive manner that engages our clients and our patients, once again, focusing on our clients and our patients. All of this has to be done in a system that is sustainable. We all know the fiscal reality of the Government of the Northwest Territories. We’ve got to find $20 million this fiscal year and we’ve got to find $10 million more next fiscal year just so that we can deliver the programs that we’re committing to here today.
Collaborative shared services and governance reform are not centralization, and I’m throwing that out today because I know that some people think that. I just want to be clear that it’s not centralization. We want to build a system that is both simple and able to make best uses of the resources to meet the needs of our citizens regardless of where they live in the Northwest Territories.
We’re not talking about saving money here. We’re talking about finding ways to utilize in the most effective, responsive way that will give the best results for our clients and our residents and will help us control the rapidly escalating cost of health care in the Northwest Territories. We are not alone. The cost of health care across Canada is escalating rapidly and if we don’t change the way we do business, we will price ourselves right out of the ability to provide anything. So we have to be conscious and aware of the cost and we feel we can provide better health, better care and a better future without rapidly or unrealistically increasing the funds. But it does mean that we do have to do things in a different way.
As I’ve said, we want to focus on the patient, we want to focus on the residents, we want to support residents. We know we have to have a voice, and this goes to comments made by Mr. Menicoche, Mr. Blake and Mr. Bouchard about getting some of these authorities in some capacity back up and running because we want to make sure that we have an opportunity to make sure that the people’s voices are heard with the respective delivery of their care. We have to do that. There is no question.
So going back to Mr. Dolynny’s point, yes, we’re not meeting the needs of the people of the Northwest Territories. Yes, absolutely, without question we can do better and we can do better with the resources we have at hand. Now we are going to have to do an awful lot of work, and I look forward to working with committee, with Members and with residents of the Northwest Territories as we move forward and redesign this system so that it meets the needs of our patients and clients, while at the same time allowing meaningful input from the program delivery at the community and regional levels. It doesn’t mean we’re not doing anything, it means we’re doing an awful lot.
There are a number of things that we’re doing already, and we’re talking about a collaborative shared services model and I have discussed this with Members in the types of things we’re doing. Finding ways to share IT services, finding ways to have a territorial-wide physician pool, or a territorial physician staff. We are talking about Med-Response that’s available at the territorial level. We’re talking about territorial purchasing and these things are happening right now. We are making headway on these things right now. Unfortunately, we do know we’ll hit a point with those where we can only go so far without making some structural change and I will certainly be having conversations with everybody on that as we approach that.
In the meantime, I am continuing to have dialogue with committee. I am going to communities and meeting with regional leadership and community residents to talk about our system here in the Northwest Territories and getting feedback from them on how we can make it better.
Mr. Dolynny talked about some of the reports that we have and how they are sporadic, and I agree. Five years seems pretty excessive but, unfortunately, many of our statistics rely on federal databases. This is unfortunate and it is not where we want to be. We are looking at making improvements, but some of those improvements are going to require us making headway on some of the things I talked to previously, but also technology. EMR, by way of example, will help us get timely statistics so that we know what true population trends are now as opposed to five years from now. We’ll have more timely access to data, more up-to-date data once we roll the system out and start putting the data in. I agree completely, and we are working to address that.
A number of Members have raised the issues around the aging population. We have an aging population. I think it was Member Yakeleya who actually gave us some of the numbers of the individuals, the seniors in his riding and how those numbers are going up. It’s reality and we have to be prepared to deal with it. We have just completed and distributed to Members the continuing care review. That went out yesterday. That is going to help us form and inform the Aging in Place Strategy that we will be bringing to Members for discussion, or at least distributing to Members and arranging some opportunity for discussion by the end of March. We know we need to do more. We know we need to be prepared for the increased number of seniors that are coming into the Northwest Territories.
Going back… I don’t mean to jump around. I apologize. Going back to some of the governance thing, and for a number of Members mentioned this, is the lack of consistency in the provision of health and social services across the Northwest Territories. Yes, you’re right; there is and we need to fix it. Absolutely, without question. We need to have some standards of care. It’s very difficult to have standards of care where we have eight separate silos that make their own decisions with respect to how they’re going to interpret GNWT regs and policies. We know we need to move forward and we need to improve this. We have hired, I’m happy to say, a chief clinical advisor who is a medical professional, a long-time Northerner, and is going to be able to provide us some real solid advice and guidance on the development of clinical standards which will be applicable across the Northwest Territories once we get to a more unified system here in the Northwest Territories.
There was conversation by a number of Members about quality assurance. Mr. Menicoche talked about an individual being misdiagnosed several times. This is something we never want to hear. This is something that obviously really undermines our system as whole, and we need to improve this. This goes back to the clinical guidelines, territorial and clinical guidelines we’re talking about, but it also highlights another challenge that we face, which is quality assurance in the Northwest Territories for the provision of health and social services in the Northwest Territories. Each authority is responsible for their own quality assurance, so it’s very siloed and it doesn’t look at a system as a whole, it looks at a particular location or region. This is something else that we need to fix, and if we go to a more streamlined, unified health and social services system instead of what we have now, we’ll be able to provide quality assurance across the system, and the nice thing is if a quality assurance person in the Deh Cho retires, leaves and is unavailable, we will have other professionals that they can go to get the supports they need. With these things we will be able to have better results for those individuals in communities like Wrigley who happen to break their leg.
A number of Members talked about more nursing in some of the small communities, and I hear you. I hear you loud and clear. Yesterday in the House I talked about the ISDM, and I have directed the department to go back and do a bit of an audit of the – audit is not the right word – but a review of the ISDM with respect to provision of services in the smaller isolated communities, and we will be working with committee. We will meet with committee. We will bring that assessment forward so that we can have an informed discussion and try to come up with some creative solutions for the provision of services in those small communities.
A lot of Members talked about THSSI. I’m going to leave that one until the end.
Mr. Moses talked about the Mental Health Act and his frustration with the number of counsellors that we have in the Northwest Territories, especially the lack of counsellors in the small communities. With our Mental Health and Addictions Action Plan that came out recently, we’re trying to find, better yet, we’re trying to offer our residents options. In the Northwest Territories now, we have access to four treatment facilities in southern Canada. We have expedited the referral process so clients can get into, or rather, be approved for going to these facilities within a 24-hour period. Yes, sometimes it takes them a bit longer to get into the facility, they may not want to travel when the opportunity comes, they may not be exactly ready, but the referral could be approved within 24 hours. This is significant.
Now, we also have four facilities. We’ve got two in Calgary, one for men, one for women. We’ve got Poundmaker’s and we’ve got Edgewood in BC. We can get our residents into these programs to receive high calibre services and programming in a very timely way with minimal, minimal wait times. There are much better services than we had when we were basically working on one treatment facility here in the Northwest Territories, and we do this at a really reasonable rate. These four facilities, with the beds that we have access to, which is far greater than what we had before, is about 750 to 800 plus thousand dollars a year. We couldn’t run a treatment facility in the Northwest Territories and guarantee the high calibre of programming that we’re getting for those dollars at this time. It doesn’t mean we aren’t interested in a treatment facility in the North, but it means we’ve got a long way to go, and we have to do some additional work, and work with communities, Aboriginal governments, community governments to see what options may exist.
We’re also exploring the mobile treatment. Yes, we did say that we wanted to have something to pilot this year. That did not work out. This fiscal year, I mean. That did not work out. But Poundmaker’s has indicated that they are very interested in working with us, they’re just not available until after March 31st.
We’re also moving forward with on-the-land programming, and I think this was a clear message from the people. I know that it has been suggested that we don’t listen to the people, and Cabinet doesn’t care about the people, and frankly, I find that insulting, but we do listen to the people and we do listen to the residents of the Northwest Territories, and we heard clearly, without question or equivocation, that people want on-the-land programming. We’re doing it. We’re putting it in. We’re going to pilot it. We’ve asked for more money so that we can do more of it, and we’re looking forward to the success of those programs. Now our residents in the Northwest Territories, compared to two years ago, have an option of four treatment facilities providing a variety of programming, high calibre programming. We’re going to have mobile treatment; we’re going to have on-the-land programming. We continue to have community counsellors and mental health addictions workers, and we have a relationship with a number of NGOs who are helping us provide services. Is more needed? Yes, and we will continue to find solutions and work with our partners to find solutions.
ECD, and Mr. Moses brought up some dental issues. In 2013-14, the fiscal year that we’re in right now, we do have some THSSI dollars available that we’re using to help us come up with a plan. Through THSSI we got some money to lead a Pan-Territorial Oral Health Initiative focused on reducing the reliance on the health care system to deal with dental extractions by improving oral health and reducing cavities, strengthening community level access to services, and training and recruiting additional service providers. This money lapses, or rather, expires on March 31st. Although the feds have announced some money, it is not THSSI. I just want to be clear that the money they have announced is not THSSI. This ends. By March 31st we intend to have a plan and Oral Health Strategy that will look at dental services and oral health promotion and prevention with an emphasis on children and youth in the Northwest Territories, and we hope to have that strategy done shortly after we complete the Pan-Territorial Oral Health Initiative review.
Work is being done. We need to, obviously, find ways to do this. There are some challenges there. One of the challenges we have in that particular area, and it’s super frustrating to me, is that we actually have no more professionals being developed in this country to fill our dental therapist positions in the Northwest Territories. That school program actually started here in Fort Smith years and years and years ago and then it moved to Saskatchewan and it was recently cancelled. There are no new dental therapists coming into the system, and I find that frustrating and frightening.
---Interjection
By the dental therapists that we do have, yes.
Child and Family Services Act, Mr. Moses brought this up and I think a number of the other Members did bring this up as well. An Auditor General report is coming forward shortly. I haven’t seen it, the system works in such a way that I don’t actually see it until basically the same time you do, but I have heard anecdotally that it is going to be rough. We look forward to seeing the report and coming up with solutions to address the issues that are outlined in it.
A number of Members have talked about traditional foods and this is one I would love to say yes to, but unfortunately, we know bringing foods into a facility comes with its own challenges and we will continue to have discussions with people in the facilities to see what options exist, but it is challenging. I know it sounds like it should be something that is easy but it is not, because there is actually a number of regulations that limit what we can prepare commercially in our kitchens. We recognize the desire and we will continue to work forward and try to address that.
Mr. Nadli talked about the health centre and the option to use the building, the current health centre, for other purposes. Obviously, we are always interested in something like that. The Department of Health and Social Services, once we open the new health facility, will surplus that building unless there are any other uses that we have for it, which we don’t believe is the case at the time, and it will go through the normal distribution process and Public Works and Services has that well laid out, so the community will certainly have an opportunity to discuss the use of that facility in the future.
Mr. Nadli did talk about regional health boards and I think that I have talked about the need for moving forward with some change and improving the system. I think Mr. Nadli – and I apologize if I am getting this wrong – had a concern about not losing the voice of the people, and we share that desire, to make sure that the voice is heard.
Mr. Nadli also talked about seniors and I have talked a little bit about our continuing care and how we are going to move forward with the Aging in Place Strategy, which we will certainly have more discussions with committee.
A number of the Members mentioned Nats'ejee K'eh. Yes, the facility shut down. We do need to find a use for that facility. I have had an opportunity to talk to the chief from the Hay River Reserve about the facility and about options for usages and we are exploring some usages that will give us some really positive results for the community, but also the Northwest Territories. Nothing has been decided. I am still talking to committee about that as well as to the community, but we are looking for some immediate use for that facility.
A number of Members talked about an Avens expansion. I have had a number of meetings with the board of directors at Avens, also the staff have been meeting with Avens. I know it was suggested by a Member that we don’t necessarily care about what is happening at Avens and that we aren’t engaging them, that is not the case. We are actively involved with them and we are exploring mutually beneficial opportunities, and there are a number of them that we are discussing. They are not necessarily asking us to fund the construction, I think they have come up with some solutions that will allow them to move forward without our involvement, but it will mean more programming and we will have to find more ways to support that. We are working with Avens, we are working with them on a regular basis, trying to find solutions and discussing mutually beneficial opportunities. Some of this will be, obviously, issues that will come up in an aging place.
Ms. Bisaro talked a little bit about the Anti-Poverty Strategy, and I thank her for her kind comments. This is something the Premier committed to and the departments have been working together on, our response, rather, to the framework that was put together by the working group that consisted of non-government organizations, community governments, Aboriginal governments, but I hear the Member say that she is looking for ways to see if there is any opportunity that we can look at where government policies create barriers or challenges. This is something that I can say the social envelope committee of Cabinet has been discussing and we recognize, and I know Mr. Bromley has brought it up many, many times before, and we hear you and we’re trying to find ways to get past some of this. One of the ways is the integrated case management pilot. We feel that this is an opportunity to look at some of the areas that might be butting heads, to see what we can do to improve services. There are more. We recognize that, but we have to start somewhere.
Ms. Bisaro wasn’t the only one and I know I’ve talked a little bit about the deficits. The deficits are real. We have authorities all purchasing things in their own ways. We have authorities with different accounting systems. We have authorities that are set up who aren’t on EMR, who have different computer systems, there’s no tie-in. All those things create inefficiencies, plus we also have a high demand from our residents. The costs are high. We have to find a way to better understand the needs financially and a better way to flow it into the system so that it makes sense, but this year we are running deficits once again.
Mr. Bromley talked about why there was such a large increase in the directorate. I will just throw it out real quickly. This is where we put the anti-poverty section of the Department of Health and Social Services. We’ve hired the clinical advisor and a number of other things. Mr. Bromley wants us to take a lead on ECD. I would say we are working collaboratively together with Education, Culture and Employment and with respect to the four categories or the four action items out of the 22 that are health-specific, most of them deal with zero to three, so we are taking a lead in that area. But we are working together and it has to be collaborative. People keep handing me notes and I’m running out of time.
I can keep going; I mean, there are a lot of things missing. Do you want me to keep going? I’ll keep going until someone says I will rise and report progress. How does that sound?
Mr. Bromley also talked about wellness courts and work is being done on the wellness courts and it is continuing to move forward. There is money in the budget this year for an integrated case management pilot which is going to be a key component of the moving forward with the wellness courts. Once again, there was conversation about lines of authority. We are talking about governance, and I will continue to work with committee.
It was suggested that we did not fulfill the direction of the House with respect to ECD and midwifery. I’m not sure what the Member was referring to by not fulfilling our direction with respect to ECD. We are doing incredibly good work there.
Midwifery, we didn’t make as much progress as we had wanted, but I can tell you today that we are shortly going to be going out for competition for the midwives in Hay River. We are hoping to actually expedite it. We were planning to back it from the opening of the facility to give enough time for people to provide programs and services so it would line up nicely with delivery or the opening of the new facility, but we are going to do some minor renovations in the old facility that will allow us to do that before. We are hoping to hire somebody in short order so that we can get those midwifery services. All the clinical governance guideline work has been done, so we are pretty close to being ready to go there.
Mr. Blake talked about medical escorts and medical travel. We are reviewing the Medical Travel Policy. I have shared the timeline with committee on when that work is going to get done. We will continue to move forward with that. I will continue to work with committee. I like what Mr. Yakeleya had to say about we have to have a sympathetic system that recognizes that people that are having layovers in a community like Norman Wells, that putting someone on crutches or in a wheelchair and leaving them in an airport for five to six hours may not be the most reasonable thing or fair or sympathetic. I take his point and we will work on that.
Sorry, Norman, you’re going to have to ask me some questions.
We talked about naturopaths yesterday. It has been suggested that when it comes to naturopaths, the people’s wishes are falling on deaf ears. That is just frankly not true. Naturopaths, I have moved them up on the list as far as regulation. They are fourth on the list. I have a meeting with the naturopaths in the next couple of weeks to talk about their concerns. They are being heard and we will work with them.
Doctors’ pay, we are going with the Territorial Physicians Staffing Model through the collaborative shared services area.
Just for the record, we don’t always ignore Members. In fact, I’d say we never ignore Members. By way of an example, it has been suggested that we have ignored Members. Just a really small example, one of the Members in this House brought forward an idea that we have to put some regulations around suntanning beds. We did that. Absolutely we did that. In March 2013, after the Member brought it up, we put regulations on beds. People under 19 can’t use them and we have shared all this information with all the nine facilities that provide tanning in the Northwest Territories and they all hang signing up that we have provided. So we do listen to Members and we do respond to Members’ desires.
I think I’m on Jane and…I mean Mr. Bouchard and Mrs. Groenewegen. I’m almost done. You know what? I think I’ve actually addressed all the issues of Mr. Bouchard and Mrs. Groenewegen, so I’ll stop. How does that sound?
Can I have the report of Committee of the Whole, Mr. Dolynny.
Thank you, Mr. Speaker. Your committee has been considering Tabled Document 22-17(5), Northwest Territories Main Estimates 2014-2015, and would like to report progress. Mr. Speaker, I move that the report of Committee of the Whole be concurred with. Thank you.
Thank you, Mr. Dolynny. Do I have a seconder? Mr. Lafferty.
---Carried
Thank you, Mr. Speaker. Orders of the day for Thursday, February 20, 2014, at 1:30 p.m.:
Prayer
Ministers’ Statements
Members’ Statements
Reports of Standing and Special Committees
Returns to Oral Questions
Recognition of Visitors in the Gallery
Acknowledgements
Oral Questions
Written Questions
Returns to Written Questions
Replies to Opening Address
Petitions
Reports of Committees on the Review of Bills
Tabling of Documents
Notices of Motion
Notices of Motion for First Reading of Bills
Motions
Motion 11-17(5),
First Reading of Bills
Second Reading of Bills
Bill 8, Write-off of Debts Act, 2013-2014
Bill 9, Forgiveness of Debts Act, 2013-2014
Consideration in Committee of the Whole of Bills and Other Matters
Tabled Document 4-17(5), Northwest Territories Electoral Boundaries Commission 2013 Final Report
Tabled Document 22-17(5), Northwest Territories Main Estimates 2014-2015
Bill 5, An Act to Amend the Motor Vehicles Act
Report of Committee of the Whole
Third Reading of Bills
Orders of the Day
Thank you, Madam Clerk. Accordingly, this House stands adjourned until Thursday, February 20th, at 1:30 p.m.
---ADJOURNMENT
The House adjourned at 6:04 p.m.
