Deputy Minister Meade.
Thank you. First of all, the jurisdictions between the provinces and the territories have reciprocal billing and the standards are set across by all of us, so the reciprocal billing would cover the same as we are charged by Alberta for Edmonton and Calgary hospitals. Those are looked at every few years by the jurisdictions. With respect to Nunavut, the contract captures use and, therefore, there is, within the territories, administrative or cost specific to equipment or specific to a building. You can’t tease that out. It is based on a type of service and hours. That said, the agreement and the contract is in place verbally and we are just finalizing the language within the contract. But the issue about suddenly denying services is part of the Canada Health Act around reportability and just as we use other resources or the residents do when they travel, it is an issue around who pays for what that the jurisdictions agreed to when they kept health services.
Ms. Bisaro.
Thank you Mr. Chairman. Just a quick comment and that is unfortunately the answer that I expected to hear. I guess my only hope would be that if we are ever renegotiating the agreement or renewing the agreement, particularly with Nunavut, I would think if there is any opportunity to try and recoup funds that could go towards the capital costs that we have to bear, then that would be a good thing. Just a comment. Thank you, Mr. Chairman.
Thank you, Ms. Bisaro. Next I have on my list Mr. Krutko.
My question is around the area of Non-Insured Health Benefits, especially when it comes to treaty Indians. Again, it comes back to my issue with the Tsiigehtchic situation where under treaties you have the right that was basically recognized in the treaties signed in 1898 and also 1921. They recognize First Nations people have the right to education, health care and also have other rights that come out of those treaties. Again, for the community of Tsiigehtchic not having health care, which this government gets funding for on behalf of those people and I think that for me it shows that this government is basically reneging on its responsibility when it comes to First Nations health care. So I’d like to ask the Minister in regard to the situation where aboriginal health is the responsibility of this government, which is funded by way of non-insured funding from the federal government, but yet there’s also a treaty obligation to provide that service to those people. So I know that you didn’t say much about small communities. I know there was a lot of questions asked yesterday, but I’d like to ask again where do those aboriginal communities have to go to get health care services from this government? Do they have to go back to Ottawa and renegotiate their treaties or basically have the Minister of Indian Affairs take their dollars and give it to the communities so they can provide their own health care since they’re not getting anything right now? Thank you.
Thank you, Mr. Krutko. Ms. Lee.
Thank you, Mr. Chairman. I don’t think it’s accurate to say, and in fact I know it’s not true to say, that anybody in the Territory is not getting health care service. Tsiigehtchic does get health care service. They do get doctors’ visits, they do get nursing care, they have a community health rep. So I understand when the Member says that he would like to see more, but that’s not to say that there is no health care in Tsiigehtchic. We share doctors like everybody else does. There are no communities in the Territories other than Yellowknife and Inuvik that have resident doctors. Everybody is getting locum service. Like I said before, health care is a challenge and every authority and people around the country are trying to provide health care services to our residents in the best way possible. And Tsiigehtchic has had nurses visit there at least I believe about upwards of... I can’t remember the exact dates but, anyway, they do have health care. So that’s not true to say that they don’t get health care. Thank you.
Okay, I’ll clarify. The lack of services to the residents of Tsiigehtchic, that should be about as precise as you can get to the type of service that they get, which is minimal compared to what other larger communities receive and I think it’s the service that we’re talking about here. I think that health care is a right in regards to the Canadian Health Act in which people have to be prescribed health care and that’s what we get the money for from the federal government. I think if we’re going to start determining service on basically some model in regard to the size of a community, the number of visits, but I think at the end of the day it’s having a detrimental effect on the care of the people in the communities because of the lack of that service, and we do have a problem.
Again, it comes back to my original question that aboriginal people have a treaty right to health care. It’s in the treaties. That’s why they have a treaty card. So knowing that we do receive dollars on behalf of those people to provide that service and that care, and if we’re not doing it, what happens to those dollars that are not being expended in those communities for those people that have those rights?
This government spends $320-plus million on health and social services authorities. We provide health and social services dollars across the authorities for them to provide their service. Tsiigehtchic does get doctors’ visits like every other community. I understand in the last year they had some logistical issues and so they had less visits than normal, but this year they are scheduled to have 10 visits to McPherson, 10 visits to Aklavik, 10 visits to Tuktoyaktuk, nine visits to Paulatuk, six visits to Sachs, nine visits to Ulukhaktok and eight visits to Tsiigehtchic. Dr. DeKlerk and his complement of doctors do their best to use their resources where they have emergency coverage in Inuvik and clinic coverage, and the rest of the doctors travel all around the Beaufort-Delta to provide those services.
With respect to nursing services, in the last year Tsiigehtchic had a seven-week coverage between spring breakup and the fall breakup, that’s 14 weeks, plus 20 weeks. That’s 34 weeks, which adds up to about six months, which is about hours-plus, for 170 people that we know of in Tsiigehtchic. If you did that calculation anywhere, I’d say that Tsiigehtchic residents are getting the health care that they need.
I understand that the Member is an advocate for enhanced services and we have said that under the Foundation for Change and in other ways we are looking to see how we could have a better coordinated, more seamless team of primary care services in our communities and we are doing that under the plan as part of a review of the Community Wellness Plan, as well as many initiatives that the new deputy minister is working on at the moment that we will be updating the committee on. Thank you.
If the Minister can provide me with that information, I think it would be helpful. I just want to compare the numbers in regard to the expenditure of health care prior to division and now where we are today, because I think prior to division we were spending more money in those smaller communities than we are today. Again, it comes back to my original question in regard to, you know, we always hear, especially, why does the federal government pay these dollars for indigenous people and I think, again, it comes down to they have an obligation under the treaties. They have to pay those dollars. I think that people assume that the federal government is doing it because they have these agreements and the thing is that those agreements, you can go anywhere in the country with your treaty card and go get that health care provided in any jurisdiction in Canada. I think that sometimes we seem to put the focus on why do we get these dollars. I think it’s a not a question of why, I think it’s a question of we’re obligated to provide that service.
Again, it comes back to my original point, that these are treaty obligations and I think sometimes we tend to lose sight of that. I know that there have been questions raised in regard to Mr. Hawkins and whatnot, but, again, these are treaty obligations that the federal government has signed by way of treaties and also obligations we’re working toward in modern treaties so that we can identify those extra resources and dollars that are going to be needed to provide health care service in First Nations communities.
I’d like to ask the Minister exactly, you know, you mentioned talking to the Minister of Indian Affairs and Northern Development, I think if anything that there should be an issue dealing with aboriginal health in the Northwest Territories like they have in Alaska, they have in the Yukon, in regard to the aboriginal involvement in health care and not just simply see them as a patient type of a relationship. So I’d just like to ask exactly is there any way of finding a way of more inclusion of aboriginal and First Nations people in regard to the health care provisions and also look at more involvement in regards to the delivery side of health care. I know we use a lot of NGOs and whatnot, but a lot of those are mostly Yellowknife-based organizations, but I don’t see a real intake from aboriginal organizations. Again, I use the Tl’oondih Healing Society. I know the Gwich’in have looked at the service in regard to the camp outside of Inuvik. These are steps that those people are taking, but, again, the government has to support those organizations by supporting their initiatives regardless if it’s seen as a tribal council initiative and also the federal government initiative. I think that they probably have seen more success by way of federal funding than they do from this government. I’d just like to ask exactly what type of engagement are we having with the First Nations people when it comes to health care.
I’ve not been to Alaska, but I have had the occasion to look at the health care services available in the Yukon. I’ve also had the opportunity to go to Navajo. I have to say that I would compare our care to anybody in Canada. This is not about aboriginal care in our communities, I believe.
As we have already stated, this government spends $326 million. I think our aboriginal people are a power-base in the Territories. They sit on all of the authorities. They are the chairs of our authorities. They have a say on what gets done. This House is made up of aboriginal leaders. If you look at the H1N1 response and compare that to our communities, compared to any other aboriginal communities in the country, I think we would be head and shoulders above. In fact, they’re asking for information from us to see how they could use ours as an example. I think that really expressed how capable our primary care response teams are in the North and our health structure.
I understand there is more room to grow, but I don’t think it’s about aboriginal health care issues. What it is, is we are challenged, as we have said before. We are challenged to provide doctor services where doctors are really hard to get, and nursing coverage where there is, out of 61 nurse practitioner positions, we have 21 vacant. We have about a third of nursing positions vacant at any given time. So Beaufort-Delta Health Authority is challenged, like any other authority, to look at what resources they have and to spread their nursing services and doctor services around.
What our point is, is that this is not going to get any better and it’s not about just dollars. But I can tell you that right now the stats show that the Beaufort-Delta region has one family doctor per 589 people. That is better than the Yellowknife area, which is one doctor per 664 people, and that’s not including the fact that Yellowknife doctors serve Lutselk'e, Resolution and Behchoko. Then the Member talked about some…
Thank you. Page 8-10, information item, active position summary. Agreed? Mr. Krutko.
In regard to the 18 positions for the Beaufort-Delta, what are those positions?
Thank you, Mr. Krutko. Minister Lee.
Almost all of these changes have to do with THAF program that’s expiring, that we had to put in the book as being ended. But we’ve already talked about the fact that we’re working on a contingency plan, but we don’t want to prejudge.
Thank you. We’re on page 8-10, information item, active position summary. Agreed?
Agreed.
Thank you, committee. Moving to 8-11, information item, active positions - health and social services authorities. Mr. Krutko.
Thank you, Mr. Chairman. In regard to the Beaufort-Delta, they have some 208 positions. I’d just like to ask the question again to the Minister: why is it that they can’t find a full-time nurse for Tsiigehtchic, considering they have 208 positions operating in that health authority?
Thank you, Mr. Krutko. Minister Lee.
Thank you, Mr. Chairman. The fact is, the way our authorities are set up, authorities work as a unit. Authorities hire doctors and nurses, and they have to rotate them and other health care professionals. When a nurse or somebody gets hired by our authority, they’re not necessarily hired into a community but hired as an employee of the authority. Somewhat like a school board; when you get hired in the school board you work in whatever schools they send you to.
As I said already, the Beaufort-Delta Health and Social Services is not alone in not being able to recruit all of the nurses and doctors they need. It’s the same situation in almost all authorities in the NWT and throughout Canada. When we have vacancies, it doesn’t mean that money is sitting there waiting to be spent. It’s not like a typical government employee where you have a vacancy, that money is not being used. In health care, if you don’t have somebody hired, you have to bring in a locum to provide the service. So the money does get used. Right now, the Beaufort-Delta is providing coverage to all the communities based on their community size and community needs. Thank you.
Mr. Chair, in regard to the Minister’s earlier comments, right now you spend something like 14 weeks in the community during breakup and freeze-up, so you already fill that gap during breakup and freeze-up, so why couldn’t you fill the gap for the rest of the year using that same type of a scenario? I’ve been talking about this issue for so long that I’m starting to feel like a broken record, just keep asking the same question and getting the same answers. I think that, at the end of the day, we have to find a resolution to this problem. I think that knowing there have been nurses or locums who have committed to the chief, to people in the communities that they’re willing to sign a two-year contract to stay in the community, but because of the health board authority saying sorry, we want to have control over you. I think that there has to be a point where, basically, you have to find a way of ensuring that we do have that service being provided on the basis of a year-round service and not simply during breakup and freeze-up. I know you mentioned 34 weeks, but again, those are when they come in by way of from McPherson or from Inuvik and whatnot.
Again, I’d like to know why haven’t we found a solution similar to how we are looking at the situation of policing services, where we’re looking at increasing the policing staff in Fort McPherson, allowing them to serve the community of Tsiigehtchic out of Fort McPherson so we’re able to provide the safety and the security of the community and the officers who will basically have to provide that service. I mean, we have to find ways around this issue regardless of which community, be it Sachs Harbour or Tsiigehtchic or Colville Lake or wherever else. I mean, we have this scenario throughout the Northwest Territories, but again, we have to find a fix to this problem. I’d just like to ask why is it that they couldn’t obligate themselves to… If we’re doing it during breakup or freeze-up, why couldn’t we ensure that we increase those numbers so the community does feel that they’re being serviced adequately in regard to their interpretation of service delivery?
During the freeze-up and breakup the nurses are there to provide the emergency response and services that they need, because they have no road access. When it is not time for freeze-up and breakup, obviously, they do have road access to receive services that they might need. I understand that’s not the most convenient way, but they do have a service available in a way that they don’t when they are cut off from freeze-up and breakup.
Mr. Chairman, I have committed, and the Member is right, we have talked about this issue for a long time. Previously, I have committed to expand the services of nursing service there in a similar way that we are doing with the RCMP. So the RCMP is coming from McPherson to provide service to Tsiigehtchic. I think that is really a plus. That is what we are doing with the nursing service as well. We are continually working to enhance services there.
I think it is really important for also us to know that health care comes in different ways too. Nurses are not the only person who could provide health care. Nurses can’t work in isolation. They cannot be hired by a community and just work for the community. They need professional backup. They need support from other nursing care services. They need training. They need all kinds of things. That is why they need to be connected within the authorities to practice their profession as much as possible. Thank you.
I know the Minister mentioned that there are a number of vacancies. Do you have a breakdown of what the numbers of vacancies are in those different authorities so that you can see the health authorities that have large numbers of vacancies versus the ones that are actually filled?
Mr. Chairman, we could provide the Member with that information, but understanding that those vacancies on any given profession like nurses or social workers change constantly. On average, the vacancies for nurses in the Territories is about 30 percent, so Beaufort-Delta will be somewhere near that as well, I would think. But we could get that information for the Member. Thank you.
Thank you, Minister, and perhaps for the whole committee. Mr. Krutko.
Thank you, Mr. Chairman. I think it is important that we do get that information, because I believe there is a major increase in the collective bargaining, especially for those in health authorities, especially in Inuvik and whatnot where there has been an increase in the collective bargaining agreement, in regards to trying to find ways of dealing with the challenge of vacancies and trying to get more doctors and professions into those areas of the Territories by way of different types of bonuses or pay levels and whatnot to attract more professions in those areas. It would be interesting to see with the new collective bargaining agreement exactly has it really achieved the results we are hoping to achieve by ensuring we get more professions in those parts of the Territories where we are having challenges by filling these vacancies. I look forward to getting that information.
Thank you, Mr. Krutko. There was no question there. Committee, we are on page 8-11, information item, active positions - health and social services authorities. Agreed?
Agreed.
We are on page 8-12, 8-13, activity summary, directorate, operations expenditure summary, $5.957 million.
Agreed.
Comments from committee. Ms. Bisaro.
Thank you, Mr. Chairman. I have a couple of questions here. The first one relates to, again, the Foundation for Change document proposal and the changes that are being worked through. About a year ago, we dealt with a very difficult issue of board reform. I am just wondering if the Minister has any idea at this point how the Foundation for Change planning will impact or will coordinate with any possible changes in terms of board reform. Thank you.
Thank you, Ms. Bisaro. Minister Lee.
Mr. Chairman, I don’t think we are doing board reform initiative in Foundation for Change, but, obviously, that initiative was introduced. It is being put back and it is being revised. But within the health care system we recognize the governance and accountability framework is important. I want to ask the deputy minister to explain a bit about the work that we are doing in that regard.
Ms. Meade.
This is a work in progress so I will just give you high level of the direction. First of all, we issue around role clarity, which is an issue not unique here but when you have boards and a delivery arm in health care and multiple stakeholder-like providers, we have a request for proposal, a request, interest out on the street. It closes in two weeks and the CEOs are aware of that around exactly that; role clarity of the two arms, the policy monitoring, set-the-standard arm and the delivery arm. That will also look at accountabilities, bringing in greater accountabilities in the system, both at a regional level as well as initiative-specific. We have, under that, the issue around the funding models and accountability framework. So that piece is started and we’ll have information and part of the regular Foundation for Change updates.
We are looking at medical travel, in particular because of the issue of case management and whether there’s good handoff, what type of services are we utilizing, so some of the accountabilities in case management. Finally, another big arm is the issue around both administrative and medical oversight. So I have met with the Medical Directors Forum and they have reignited. We are looking at a few of the positions doing algorhythms or decision points around how we move between regions and the accountabilities in that. So that’s just the high level. We have several others we have started with the CEOs and the various providers inclusive of hand-offs between southern specialists and a better way to manage and the accountabilities there around clinical and case management. Now, these are not easy to work on and they are not immediate, but the work has begun on all of those fronts.
Thank you, Ms. Meade. Ms. Bisaro.
Thank you, Mr. Chairman, and thanks to the deputy minister for that information. That’s very challenging. The whole issue is challenging, but it’s good to hear that there’s lots of work happening.
My other question has to do with the legislation and when we went through the business plans, the proposed schedule for legislation the department is considering doing in the next fiscal year is quite ambitious. I was impressed with the number of bills which presumably want to be amended and/or new bills coming forward. My question, I guess, is whether or not the department thinks they are going to be able to get them all done. Are all of these changes, all of these amendments, all of these new acts, are they vital? I guess I am somewhat suspicious that we may be doing legislation at the risk of the front-line provision of services for both health and social services. So just a general comment in terms of the legislation that is proposed and is it all really necessary and are you going to get it all done. Thank you.
Thank you, Ms. Bisaro. Minister Lee.
Thank you, Mr. Chairman. I don’t have the list of legislation that the Member is looking at, but in general I can tell you that the resources for doing legislation is so scarce, not just in the department but with the Justice lawyers, that we wouldn’t be doing anything unless we need to. Sometimes things come up and I can also tell you that those lists have been on the books for a long time. They are making their way up and a lot of work would have been done, not just in this Assembly but in previous Assemblies as well. So I think there’s a constant scrutiny to see what is a priority because there are such scarce resources and time. Thank you.
Point taken. I understand totally. Thank you very much.
Thank you, Ms. Bisaro. Next I have Mr. Krutko.
Thank you, Mr. Chair. In regards to the Minister’s authority to manage health board authorities, there has been situations with the Stanton board in the past because of the financial situation they found themselves in, the Minister intervened by abolishing the board and putting forward a manager of some sort to manage the affairs of the health authority.
I am wondering with regard to the situation you mentioned about the reforms you are looking at bringing forward. I think at any agency, board or even NGO is responsible for the accountability of the public funds we give them and I think there has to be stringent requirements that we see the accountability for those public funds. More importantly, to ensure the public purse is being expended the way it should be and it’s not been wasted on things that it shouldn’t be expended on. So I would just like to know, with regard to this reform process you’re talking about and ministerial authorities, is there anything there that will give us the comfort that that we’d like to see by government expenditures. When we transfer funds to organizations, regardless of whether it’s NGOs, health boards or whatnot, that the accountability is upfront in ensuring we do see the documentation that is required. I’d like to ask the Minister when you talk about financial services and accountability and management services, budgetary accountability and management services, for me that’s an area that has been lacking in some health authorities. The majority of health authorities in the Territories have been managing their affairs aboveboard, but there have been a few authorities that have been running deficits year after year after year and not fulfilling their financial obligations. So I would just like to know how far are we willing to go in regards to that directorate.
Thank you, Mr. Krutko. Minister Lee.
Thank you, Mr. Chairman. Much of what the deputy minister said in terms of the work we are doing on the governance model and role clarity, that does deal with the thing that the MLA Krutko just brought up. We are working to strengthen accountability in service delivery and financial accountability plus I’m just saying this in my own language here, but it’s written in a more fancy way in the book... We are working for service accountability, financial accountability and coordination accountability.
Right now, the way our authorities are set up, they are quite independent. They get bulk funding of their money and they are quite free to do a lot of things and we do not have control over that. Now, at the same time, I think we should know, to be fair to the authorities, they are doing what they are tasked to do. They are doing everything in a way they are supposed to be doing it. The onus is on us to make some changes to make sure that there is a more across-the-system look at how we can use our resources better, how we can help each other in providing necessary services, how we help each other inside in the back offices so we reduce the overhead costs, so that our health care resources are spent at the frontline in the communities in the service delivery, that there’s not a whole lot of duplication. All these are not built in right now, so we are working on what the Member said we should be and just to say the authorities have to be part of this, they are the ones who are delivering the services and we don’t want to have to... We can’t be imposing this on them. We have to buy into this new arrangement and so it’s an ongoing process to get them to agree with us on how we go forward and that’s part of the Foundation for Change. Thank you.
With regard to the Foundation for Change, how soon do you see it conclude and ready for implementation so that the authorities will have some, I don’t want to say marching orders, but a process that is clear and transparent and spelled out with regard to what their obligations are and also what we expect of them for service delivery and accountability?
The Foundation for Change is a three-year plan. It goes from 2009-12. There is a lot of stuff in there that we are going to move as the money... It’s the changes we could make and supports and funding we can find. Specifically to the accountability framework with regard to the governance and more accountability we can build into the authorities, we are hoping to have those agreements finalized by the end of this fiscal year, not by March 2010, but March 2011 or before that. We are going to be reviewing our contribution agreements and relationship agreements, so we can build in more accountability, but that should happen sooner. So our plan has different phases of implementation plan depending on what the issue is. Thank you.
Thank you, Minister Lee. Committee, we are on page 8-18. Mr. Krutko.
