Thank you for that information, Madam Minister. Mr. Chair, the TeleSpeech implementation, I look forward to the rollout of the implementation when you’re saying that the Sahtu communities are on the list as possibly one of the first projects that are going to be used. So I look forward to that. I do thank the Minister for that information.
Would this be similar to our experience with the telehealth? It’s not being used today and that’s a shame that this is not being used to its full utilization because that would sure help a lot of people. Now, I could be corrected on this here, however, this is the information I have in terms of these TeleSpeech, telehealth projects here.
Thank you, Mr. Chairman. Just speaking from a layperson perspective, these TeleSpeech, telehealth machines are big, nice, flat-screen TVs that could be connected to anywhere there is a service provider on the other side. Telehealth was the initial part of that and TeleSpeech is a program that’s offered through telehealth. This is something that would expand as we get more people and more connection from point A to point B. Health care professionals have spoken to me about the possibility of diagnosing through telehealth. Somebody could sit in Deline and talk to a radiologist or neurosurgeon maybe, especially in follow-ups, especially right now. We have DI/PACS where X-rays could travel electronically and they don’t actually have to be moved physically. So it is possible, by use of this machine, where we could have people sitting in our communities and get services that are not available, especially in follow-ups, because sometimes you have surgery on your ankle, for example, and then sometimes you need to have that looked at by an orthopaedic surgeon two or three times just to make sure the bones are healing right, but they may not necessarily have to go physically to get those done. It’s possible to even do surgery. I mean, that’s like looking years down the road, but obviously this is a communication machine and it can only work with the people that would operate it at both ends and they have to be trained and we will work in a phase-in process as the providers are ready to take it as we have the money to deliver those programs and provide necessary support to the staff so that they feel more comfortable using this device. It is something new to us in the North too. So it will take effort and we are working on that to incorporate it into our everyday practice. Thank you.
Thank you, Minister Lee. Anything further, Mr. Yakeleya? No. Mr. Hawkins, did you have something?
Thank you, Mr. Chairman. Are we operating off the 8-8 or 8-9? Because my question specifically points to 8-9, which I thought we were on. I’m just making sure we didn’t go back.
Page 8-8.
Agreed.
Okay, page 8-9. Mr. Hawkins.
Thank you, Mr. Chairman. Under revenue summary, I’m just curious as to finding out what particular money is built into this bottom line here that emphasizes the money paid to us through our NIHB figures. Thank you.
Minister Lee.
Thank you, Mr. Chairman. Is the Member, I don’t see the area that he is talking about on page 8-9... Oh. Could he be more specific?
It’s my assumption that hospital care under Indians and Inuit, as well as medical care under Indian and Inuit, maybe the Minister can help me find out where that money is specifically earmarked from and does it cover some of the NIHB money that is owed to this government? If not, perhaps the Minister can point to the relevant page. That’s my specific area of concern. I assumed that’s what that line meant. Thank you.
This is money we get from DIAND for hospital and doctor care for our aboriginal people. There is NIHB separately later on under 4 and 5, which is a technical language, but I think it’s under extended health. It’s under 8-36. Thank you.
Thank you for clarifying which page my specific question would be on. Seeing how it is related, I’d like to continue. What is the present formula that causes us to get $21 million for that type of care in this particular budget cycle? What type of inflationary factors are built in? As I understand it, the territorial government services cost more than we’re being paid. In other words, did we put in a particular figure and did the federal government respond with a particular figure and, of course, what would that figure be? Thank you.
This is one where we have a longstanding agreement with the federal government. I believe it was signed in early 2000, or somewhere around there. There’s a built-in escalator there at 2 percent. That’s the funding formula that’s being used.
Thank you for the answer there. What is the actual cost that’s being predicted this year for those types of services and, therefore, what would the territorial government be subsidizing as the actual gap between what’s the estimated cost to do the actual services that we’re providing and, furthermore, trying to get a grip on how much money are we losing on this endeavour? Thank you.
I’m not sure if it’s correct to say that we’re subsidizing this care, because every province and territory is responsible for the delivery of health care to their residents. So whether we get any money from the federal government or not, we would be providing health care to every resident, and doctor care to every resident in the Territories. In the case of aboriginal peoples in the Territories, we get money from the federal government. The federal government’s position is that they are funding for the health care for aboriginal people by this agreement plus the transfer payments that they make to us.
I appreciate that answer but, with all due respect, I think that’s an issue of semantics where we’re saying something similar. Ultimately, I think that it goes back to the question why are they funding us that particular case and on what basis are they funding us that particular case? Thank you.
I believe that’s what the agreement is and we will have to continue to look into that to see whether that could be changed or not. I can refer to the deputy minister to see if she wants to add more to that.
Deputy Minister Meade.
Thank you, Mr. Chairman. I think the agreement is both technical and it can’t be seen in isolation, so to be able to provide that information it’s probably best to give a written explanation through my Minister. The bottom line is the federal government sets the ongoing increases to any of their transfer funding and we can go to the negotiation table. I am working with both the deputy of financial management and also the deputy of Aboriginal Affairs in our approach to these discussions with the federal government, but it is set for the coming year.
Thank you, Ms. Meade. We look forward to getting that information. Mr. Hawkins.
Thank you. I certainly hope that all that information can be shared amongst all Members. Mr. Chairman, just to continue a little further, when the original agreement... Or let me say it this way. The present agreement had been signed, it must have an expiry date when the whole contract, if I may describe it that way, or agreement, was to go forward. When does this particular agreement come up for full renewal or is that what the territorial government is presently working on when you refer to I think you said about a year from now? Is that when it’s intended to expire or are you trying to find some way to open up the agreement and reflect the true cost to provide health care that the federal government is responsible for. Thank you.
The Minister of Health, Ms. Lee.
Thank you, Mr. Chairman. This agreement is renewed every year on a year-by-year basis. For the last two years my focus and concentration has been to renew the THAF funding, but we are working to strengthen our position on this particular agreement to see if we could renegotiate the terms. I would be happy to get the Member more information on what the terms of the contract are. There is not a lot of room for negotiating in terms of the escalating clause and such, but we are doing everything we can to see how we can strengthen our negotiating position.
Mr. Chairman, this may not be the time or place in the context of that level of detail, but I’m just trying to understand if it’s a year-by-year agreement, what are we actually negotiating or renewing if it sounds like it automatically renews at a flat escalator of 2 percent? I mean, I’m just trying to understand what are we renewing. Thank you.
The agreement is such that there is a set amount of money that they will give us for the medical and hospital services for our aboriginal people. That’s a big chunk of money: $21 million. So every year we do sign the agreement because we do need to have that revenue coming in while we are reviewing the clause to see how we could renegotiate that. There’s not a lot of room for negotiation. It’s a contract that was signed long ago. The terms are quite strict and unilateral in a certain sense.
If I understand the Minister correctly, we’re not actually negotiating anything. We’re just agreeing to what they’re suggesting that they’ll pay us for services. If that’s the case, I’ll just wait until I get the documentation to help clarify this.
The last point on this particular section: is the Minister aware… Although I asked it earlier, it somewhat buckled into the same problem. Is the Minister aware of the actual dollar amount that is believed to be outstanding by the federal government that is owed to the territorial government?
I would be happy to provide the Members with the terms of the agreement and some of the related issues on that, and I would be happy to meet with committee or the Members to give more information. I think it is a misnomer to say an outstanding amount, because the contract is pretty clear. It was signed by previous governments. It states what they’re going to pay and how much they will pay every year, and for reasons I am not aware of, there were not a lot of provisions put in there for renegotiating or increasing the amount of money the federal government is willing to give. So we have to basically, I think, work on a new contract. In the meantime, we do need to get $20-some million for the services we provide. I’d be happy to provide the Member with more information on this issue. Thank you.
Just one last thing -- sorry -- on this particular file. Has our Health Minister ever written the federal Minister of Health in regard to this specific concern? Would the Minister be willing to provide any correspondence if the department did so, and would the Minister be willing to provide any response as to how the federal government has provided her in her action to help address this problem? Thank you.
Yes, I’d be happy to do that. I’ve been communicating with the Minister of DIAND on this issue, as well as the Premier, who had contacted the DIAND Minister on this issue. I would be happy to provide the Member with that correspondence. Thank you.
Next on the list I have Mr. Bromley and then Ms. Bisaro. Mr. Bromley.
Thank you, Mr. Chairman. Just on that, a follow-up to my colleague’s questions, we have thrown out some numbers in previous years when we discussed the budget but, as I recall, just for confirmation, I think the realm of contention for these federal dollars was in the tens of millions of dollars, fairly substantial to this government. Is that a correct understanding?
Minister Lee.
Mr. Chairman, I remember looking at that very closely as a Regular Member too, so the minute I came into this office I reviewed that. Since then, my understanding of the contract is, we have to go back to the history of this, but I think the agreement was signed by the Minister at the time of 11th or 12th Assembly and it is a pretty clear cut, short agreement on how much the federal government is willing to pay for the doctor service and hospital service for our aboriginal people. There’s not a whole lot of negotiating clauses built into that. It is renewable every year, so it is either we don’t renew it and do not get the money or we try to renew the agreement so that we could continue to get the revenue but work on our negotiating position which is what we are doing. Just understand that there is a very different view about this agreement. Obviously our government feels it is a different agreement than how the federal government sees it. But the federal government is trying to believe that they fund for the health care and medical care for all of our residents by various transfers and that this is just one of the payments. Thank you.
Mr. Chairman, that sounds like the two negotiating parties are at the extremes of the spectrum there. I imagine some thinking must be going on as to how much we spend on negotiations on that sort of situation. I think it would be an appropriate topic for committee briefing and discussion just so we are all on the same page on that one.
I want to ask about the Territorial Health Access Fund. As I mentioned in my general remark,. $7.5 million would be significant if… Just to start with, is this the typical sort of range for the other territories as well? Is this just restricted to the northern territories?
Mr. Chairman, this is a one-time multi-year funding that the federal government agreed to provide to all three territories. An agreement was reached I believe back in 2003 or 2004. The payments didn’t begin to flow until a year later, which is why it is expiring at the end of March. The agreement lasted from 2005 to 2010. It is a $150 million program over five years so it is about $30 million a year. The portions of money that Yukon, Nunavut and NWT get are different. Nunavut gets more money for medical travel than we do and Yukon gets less. There are some other portions to that. It is based on formula. Out of that, we get about $7.5 million a year. Yukon is the one that is managing this fund as an administrative body. Thank you.
Mr. Chairman, thank you for that information. Just so I don’t waste time, does the Minister have any insight or information here that causes her not to be at all concerned about not getting this renewed when it comes April 1st? Thank you.
I am afraid I am not on the inside of Minister Flaherty or Minister Stockwell who is now the new Treasury chair. I can tell you that Nunavut government, Yukon government and this government have worked hard, methodically and substantively to get this program renewed. The proposal we have is asking for about $200 million because we want to build in the escalator. There has been a working group of assistant deputy ministers of health of all three governments. We have the Yukon, Nunavut and myself; Ministers over the last two years have had meetings with the Minister of Health. In the most recent occasion when I was in Whitehorse attending the Ministers of Finance meeting on behalf of Minister Miltenberger, I had a chance to bring that up again. We have been working diligently on this. I want to tell you that I have no inside information. I want to stay optimistic. We are not going to know. There was some indication that the federal government, while they may not be able to renew the whole thing, they may be interested in extending it. We have no information whatsoever, so I am keeping my fingers crossed knowing that we did everything that we can. But we have to get ready for contingency plans in the event that it doesn’t happen. That is something that we are working on. We are working on this. We would be happy to meet with the committee to get more details on that, if the Members would like to hear it. Thank you.
Mr. Chairman, thanks for those details again. What exactly do these dollars provide in terms of health services? If I can get a brief description there, thank you.
Mr. Chairman, in general and some of the highlights are we are funding STI nursing in Yellowknife; community health nurses in Gameti and Sachs Harbour; we have nurse practitioners in Yellowknife, Fort Smith, Tlicho, Deh Cho, Beaufort-Delta; midwifery services, one of the positions is in Fort Smith; continuing care respite services in Yellowknife, Beaufort-Delta, Hay River; Dialysis Program in Stanton; Northern Women’s Health Program in Stanton; ...(inaudible)... community care in Fort Smith, Hay River, Deh Cho and Sahtu; physician staffing, physician recruitment and retention, Physician Resident Support Program and accreditation and quality improvement in Deh Cho, Tlicho, Sahtu, Yellowknife; and Foundation for Change implementation. That amounts to about $5 million out of $7.5 million.
Mr. Chairman, obviously that is an amazing list including our plans for going forward here. If we are going to fund that internally, if we have to -- and $200 million to this federal government must be a bit of a daunting figure to contemplate -- what exact planning are we doing internally as to where we would take the resources and how we would redistribute our existing resources to make sure that some of my clients get their dialysis done twice a week and the Foundation for Change starts and so on? Thank you.
Mr. Chairman, as I have stated in the committee when we were reviewing this plan, it is important for people to know that we are working on the contingency plan and we are working in partnership with all of the authorities. We believe this funding was supposed to be a transformational… It was to be aimed at changing the way we build up our service and strengthening primary care in the front line, like the midwifery and nurse practitioners, but we know that these programs have embedded into our entire service delivery. They are an essential part of our service delivery. So we are working, and my deputy minister has been working, actually for months together with the authority to make sure that we do everything we can to deliver the programs, develop options, to not affect the persons in the jobs. So we are working on a plan and options. So I just want to send the message out there that people should not panic and should not be alarmed, we are working on it and I would be happy to come to the committee and go through the details on that.
I would say that is really important and I think at the very least we should have some committee briefing and discussion on this. It is a huge, very key list of services that we are provided and I know that we are going to continue with those, but at what cost to other programs and so on. Is there any criteria that has been used with the authorities that the public could know about? There is 55 days left here until one thing happens or the other. So these are substantial enough that obviously some major planning work must be happening. So I think anything the Minister can offer to assure us rather than just trust me that it’s happening, which, you know I am not here to question that, I am here to really try and get out the specifics of how we are addressing this. Thank you.
I think it is important for us to know that this is contingent on the federal budget. We do not prejudge what the federal government is going to do. I would like the federal government to extend this program. We do not want to relieve the federal government of coming up with this by us coming up with plans. We understand that we need to work on a contingency plan. This is why we don’t have it in the budget, but we feel we made a good case to the federal government and Premier Fentie had a private meeting with Mr. Flaherty. The Nunavut government has been pushing this hard. If anything, as important as this is to us, it is even more important for Nunavut. It is really important and I would like to ask support from the Members to not create panic. We did not want to have a plan sort of prejudging, then that is assuming that the federal government is not going to fund us. I don’t want to do that because we have done everything we can to convince them.
Obviously, we are passing this budget so that all of the jobs and the work will continue past April, because the federal budget is not going to come until March. We are and have been working on a contingency plan with all of the authorities. We will try to fund from within to continue programs or we will have to go for supp if that is necessary, and I promised... I am telling you trust us, this is the only way we could deal with this because we want the federal government to still be part of the picture. I would be happy to come to the committee and work out the details on how we move forward and what options we have after the federal government brings down the budget. Thank you.
Thank you, Ms. Lee. Ms. Bisaro.
My questions will be somewhat shorter. I had many of the same concerns as Mr. Bromley and he has asked the questions and secured the answers for me that I think I was looking for.
I am, as well, extremely concerned about the loss of the THAF funding, if that is what should transpire and I certainly hope it doesn’t. When we reviewed the business plans, there were some 21 positions which are funded by THAF and they are basic to our provision of health services primary care through nurse practitioners and midwives and so on. I was a little alarmed, though, to hear the Minister say that the Foundation for Change position is coming from the THAF funding and I would certainly hope that that position is one that is going to be maintained, maybe at the top of the list, I guess. I did have a question as to sort of how we are going to go forward come April 1st. The Minister has answered that, if I understood her correctly. We will carry on with all the positions that we currently have, basically the same thing next year as we have in this current year and if we don’t get the funding, then the Minister will come back for a supp to fund what can’t be dealt with internally. If I can just get that confirmed, please, Mr. Chairman.
Ms. Lee
Yes, Mr. Chairman, that is correct. That is what I said.
I have another question on this page relative to the other recoveries and the reciprocal billing for Nunavut, basically. In reviewing the Stanton Territorial Hospital annual report, I was struck that in some areas, many of the areas, up to 25 percent of their provision of services, the cost of the provision of those services is for Nunavut patients and for servicing Nunavut communities. It varies, depending upon the area, anywhere from 10 to 25 percent, from what I could figure out. It really struck me that we are probably being paid back for the actual physician costs and for the actual cost of supplies and so on and the travel that physicians do in order to get to communities in Nunavut. It also struck me that I suspect that there is nothing in our agreement with Nunavut that covers the physical cost of the building and the actual capital cost of maintaining the building, upgrading the building, which we have spent many millions on in the last few years, and which we need to spend more millions on in the coming years. So if in places, 25 percent of the work that we are doing out of the territorial hospital is going to Nunavut, is there any opportunity for us to get something from Nunavut for a capital building, structure that we have to maintain and pay for and develop, where they are basically getting off without having to build a hospital? Thank you.
That is the deputy minister’s specialty area, so I would ask her to answer that. Thank you.
