Debates of February 22, 2013 (day 12)

Thank you, Mr. Moses. Mr. Beaulieu.

Thank you, Madam Chair. Right now some of the positions at health centres and hospitals have built into their jobs that they would be able to do interpreting or translating. I’m not sure what the correct term is. I don’t have the information here. I would rather say to fully draw out what we plan on doing for translation or interpretive services at the hospitals.

The Minister mentioned that some jobs have the translator services built into their positions and duties. Are those extra responsibilities funded on top of their job duties, and if there are already positions in place where people have the opportunity to be translators, can he supply committee with all the hospitals and regional centres or health centres that do provide translator services in the Northwest Territories so that we know who to speak to and we know which hospitals and health centres actually provide that service?

We have no problem providing that information. If we are able to pull that information, the department is listening and is able to pull that information together before the end of the review, we will provide that in the House. If not, we will provide that to the Members at a later date.

Yes, just continuing on. Would the Minister be looking at creating a specific program on translation, in terms of medical terminology, that would either help support, maybe, our community health representatives who are probably some of our longest-standing employees in the Health and Social Services system? Would he be looking at possibly creating that program with the medical terminology, and make it part of either that program or some other program that local nurses could take, so that they can provide those services to our patients, especially the patients who don’t speak English?

Along those lines, we have recently hired an official languages manager. That was with the intention of updating our services on the official languages. We are also running a medical terminology specific to cancer, in Fort Good Hope as a pilot. Once the workshop is able to come back to us with terminology that we should be using to describe some of the things related to cancer, we will see the success of that type of workshop and then expand on that.

I look forward to seeing the results of that pilot project.

Under the policy area, under the directorate, would the Minister be willing to look at the policy right now for the Health Promotion Fund? I’m not sure if I should bring it under here or program services, but since it is under the directorate and they cover policy, would the Minister look at the policy for the Health Promotion Fund, and instead of having a one-year contribution agreement, would he be willing to make it a multi-year policy to reflect successful programs that we have in the small communities and the regions?

We have that ability now. We are able to do multi-year funding project by project.

Just specifically, up to how many years with that policy can one organization apply for the multi-year funding? How many years would they be able to receive funding under that policy?

My understanding is there is no cap in as far as time, but the flow of the funding within that agreement is contingent upon approvals in the Assembly.

With the little time I have left here, and looking in terms of policy and legislation, and the Minister alluded to it yesterday in his opening response to the general comments, but that was in terms of the second medical opinion and the right to have a second medical opinion, I wanted to get an update from the Minister on whether they’re going to be pursuing this, where they are in terms of providing that right to a second medical opinion for our residents.

In my response to MLA Menicoche, I indicated that we had hired a policy officer to review health benefits. That review of a second opinion is within that review.

When can committee members and Members of this Legislative Assembly see a review on those policies, but specifically to the one that I had mentioned, the right to a second medical opinion? When can we see the review specifically for that?

We are just starting to put the pieces of this review together now. The position will come on, hopefully, soon in the new fiscal year. We believe that it will take all of the 12 months in that fiscal year to complete this review.

I think, in terms of this, the right to the second medical opinion, I feel that, you know, we possibly could get ourselves in some hot water if we don’t have that right now, in terms of some people not being diagnosed properly or not being diagnosed at all and continue to… Some Members have stated in this House during question period, they go to the health centres and they’re just given some Tylenol to go home when there are bigger concerns. I think the longer we wait, we’re doing a disservice to the residents of the NWT.

As the Minister knows, we do have challenges in securing doctors, physicians and nurses in some of the communities. Is there any way that this Minister can use his ministerial authority to try and see if we can get something up and running, a review specifically for this program in place a lot sooner than later, because I feel that this department and this government could get themselves into some trouble knowing that we’re bringing this up now and discussing it and we’re probably going to see a review maybe in two years or something. Can the Minister use his authority and look at trying to fast-track this right to a second medical opinion?

We will do everything we can to speed the process up with the understanding that this review is going to be cross referenced to insured services, appeal process, two parts of the health benefits review that need to be done with extreme diligence. The case file review is something that we’re currently using and will continue to use until there are changes in this health benefits policy. On a case-by-case basis, we will use the case file reviews in situations where we think that an individual, or an individual has come to us through some medium that they need to have a second opinion. Then we would do that through a case-by-case review of the file.

Thank you, Mr. Beaulieu. Mr. Moses, your 10 minutes is up, so I’m going to move on to some of the other people who are on the list for this page. Just so that Members know who is on the list, this is the order that I have: Mr. Menicoche, Mr. Nadli, Ms. Bisaro, Mr. Yakeleya and Mr. Dolynny, on this page. Thank you. Next I have Mr. Menicoche.

Thank you very much, Madam Chair. Just with regard to establishing an agreement with the Northern BC Health Authority and our government, in terms of accommodating Fort Liard residents, and as well, I spoke about it in the House, about even having an impact on our medical travel costs out of the Nahendeh region. I believe that utilizing the services from the Northern BC Health Authority will greatly not only make life easier and better for the residents of Fort Liard, but also in terms of our medical travel. Just with that, I had a discussion and raised a Member’s statement and raised oral questions with the Minister with regard to that. I’d just like to know what his plan is about moving forward in discussions with the BC government with regard to a trans-border agreement. Thanks.

Thank you, Mr. Menicoche. Minister Beaulieu.

Madam Chair, as I indicated earlier, we are going to have a discussion with the leadership in Fort Liard. After that, all things being equal, and then wanting to move in that direction, and we think they probably do, but we need to have that discussion just the same.

We would then have discussions with British Columbia Health to sort out the out-of-territory billing and then return emergent referrals from Nelson to the nearest centre where the required services are available. So if they are getting a service there and they need to have further services beyond what Nelson is able to provide, then we have to decide whether or not they are going to send them to Edmonton or Yellowknife. So you can appreciate that that work has to also happen.

We also need to review the capacity of Fort Nelson to serve the additional clients. Usually a system, no matter where, has a capacity to deal with the current load that they carry. With us putting additional community in for the majority of medical services onto Fort Nelson, a community the size of Liard, we need to know that that health system has the capacity to take our patients.

Madam Chair, I can assure the Minister that’s the confidence that the leadership of Fort Liard and the constituents do want me to raise this issue. I would like to get some assurance that the Minister can begin the process of negotiating or talking with the BC government in advance of him coming over to Fort Liard. I know that we’re working on something for him to come over in June, but I don’t want the Minister to go there and say, thank you for letting me know, we’ll check into it now. He should be checking into it. That’s why I’m raising it in this House and raising it during Member’s statements and oral questions. This is something we should be prepared for when we go to Fort Liard to say, alright, here is the plan, here is how it’s going to work. Like he said, there are a lot of issues to be addressed. Hopefully he can begin some of the preliminary work. If I can just get the Minister assurance that he can do some background work.

It is kind of like Fort Liard. What they tell me is that they have a sore knee, so they’re driving to Fort Simpson for three hours, they get in a plane to come here, they’re overnighting, and the doctor tells them they have a sore knee, and then they have to go all the way back home. That’s what the Minister is telling me, is that, well, we have to go to Fort Liard and look at their sore knee, kind of thing. I’m telling you that the knee is sore, that the need is to go into Fort Liard, and they do have some baseline relationship. Most constituents do. But when it comes to the health care and travel needs, I think if we can begin this discussion and begin those arrangements, the sooner we can make lives better for the communities and the constituents in Fort Liard.

Madam Chair, yes, we can proceed with discussions with BC Health and then, from our findings there, we can then go back to Fort Liard for reasons of speeding up the process a bit.

Just with that, of course, we continue to invest into our medical record system. The whole point of it is to be compatible throughout Canada. Does the ministry know if our medical records expenditures will be consistent with northern BC Health? The concern that I heard from medical staff in Fort Liard is that they want to be assured that if someone is getting treatment in Fort Nelson, that they’re not getting sick and then getting – I forget the term – on one medication and they’re given another, that they don’t want some kind of conflict and, of course, cause further harm to a client.

With our medical health records, is it Canada-wide? Is that something that will be consistent and accessible on the BC side? Thank you.

Madam Chair, that would be one of the huge issues in dealing with BC Health in Fort Nelson. At this point, the electronic medical records are for the NWT, and then we have a long history dealing with Health in Alberta, in Edmonton. We have some compatibilities there, but none in British Columbia. So that would be an issue that would be a barrier that we would have to deal with.

Madam Chair, I know there’s lots of history there, but at the same time, we’re talking about a community of about 500 people and I think that’s all it’s going to impact. I don’t think we’re pushing to have clients from Ulukhaktok to go to Fort Nelson, either, just the ability to make lives easier for the residents of Fort Liard. It’s basically a two and a half hour drive from there to get their medical needs met in Fort Nelson, BC. I don’t think it would be a huge impact on their services. As well, it’s about developing the same kind of relationship that we have with Alberta Health Services and developing a baseline as we go along. Thanks.

Madam Chair, we will work on this as I agreed to do. I’ve only mentioned a few of the issues that we have to deal with. Even the privacy of individual files has to be something that we would deal with BC Health. We will try to employ the same type of systems that we do when we deal with Alberta Health and British Columbia, for the most part, but… As we do with Alberta, pardon me. For the most part, we will try to do that, but then BC Health also has their own regulations and restrictions on how they deal with patients. Those are things that we do have to deal with.

Madam Chair, I think for the most part, residents of Fort Liard do have some type of working relationship just on an individual basis, so we’re going to have to work to support that, because I know that even some of the elders, when they get sick, end up in the Fort Nelson hospital. I’m glad for them because they are closer to family, cousins and relatives, but we have to support it and look for some kind of model and arrangements to continue those services there. Then we’ll begin on the whole area of dental services as well. That’s something that residents would like to go to Fort Nelson for.

If we start looking at it, concentrating on it seriously and support our constituents and residents as they get their services met in Fort Nelson, and if there is an agreement that has to be made, I believe we should be working hard on finding out what those mechanisms are. Thank you, Madam Chair.

Madam Chair, like I said, we will work on it. We have something that the Member has brought up, the non-insured services that we work with the federal government in providing non-insured health benefits. Like dental, those will be something that, again, would be another area that we have to work on with BC Health in order to get the patients for their various medical dental services through Fort Nelson. We fully intend to start the process of working on that.

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

Thank you, Madam Chair. Right now my mind is at the community level, at the ground level. On the reserve we have a building that was constructed that has been sitting empty for some time and it’s called a health centre. I wanted to ask some questions regarding this and to try to get a sense in terms of the timeline and the priorities that have been directed to ensure that at least this place can be operable.

So, at the community level on the reserve, normally what happens on the reserve – and this is perhaps looking at the view from the examples from down south – is that First Nations usually have a governance arrangement with the federal government, or programs and services such as education and health are given to the reserves to administer to its citizens. But here in the North we have a different set of circumstances and those program responsibilities, for the most part, are set with the GNWT. The reserve, of course, is the only reserve in the Northwest Territories. So, obviously, there are some obstacles, but we had these discussions with the Minister and my understanding was that there have been some discussions in terms of trying to wrangle through the jurisdictional matters and to try to come to a point where the new health centre on the reserve could be operable. So I just want to get a status from the Minister in terms of where that might be at. Mahsi.

Thank you, Mr. Nadli. Minister Beaulieu.

Thank you, Madam Chair. We are very close to having the land tenure sorted out with ANSI and we’re very close. They didn’t want to proceed on dealing with the land tenure issue until the project was substantially complete. So this is what we’ve done. We’ve completed the facility as of August 2012, this past August the unit was considered to be final and, therefore, we’ve moved with the Aboriginal and Northern Affairs Canada in the process of finalizing land tenure and we are at the very final stage where we’re expecting to have that resolved very soon. I can’t give the exact date, unfortunately, but we’ve been moving forward on this.

I’d like to thank the Minister for that response. It gives me a sense in terms of where the problem may lie. It is a fundamental issue in terms of the land and the jurisdiction.

I know there have been some discussions in trying to bring the service to the ground level. There have been some talks with the two health authorities, including the Deh Cho and the Hay River Health Authority. Where is that at and are we going to see an alignment of this initiative along with the move to try to sort out the land issue and to ultimately have the health centre operable? At what point can we expect or the reserve residents expect the health centre to be open?

Thank you. We have had the two CEOs from Deh Cho Health and Social Services and the CEO of the Hay River Health and Social Services discussing how they’re going to be able to provide a service to the people on the reserve using that health centre. So the plan is that we’re going to be most likely using the medical services out of Hay River to come across and provide service on the reserve. So right now it’s just sorting out some of the details.

I mean, as soon as the land tenure is done, that place will be operational. We’re just going to sort out the details and then between the two CEOs they’re going to come up with a plan and remembering that this involves an Integrated Service Delivery Model. So we would look at what services can be provided right out of that health centre and so that individuals don’t have to go from the reserve across to Hay River, especially a 15-kilometre drive in the summer months to see the medical clinic when maybe there will be a doctor in Hay River one day a week or one day every two weeks, maybe a nurse practitioner a few days a week, a registered nurse and so on and so forth. So we were going to try to find the right integrated service that’s needed, the right medical services that are needed for Hay River and we’re going to try to put those services in that building using the staff at the Hay River Health and Social Services.

I just wanted to ask about the land tenure. Are those discussions primarily with Health and Social Services and the First Nations? Is the federal government involved with those discussions and at what point would there be an agreement?

Thank you. The actual discussions are between Municipal and Community Affairs, Public Works and ourselves with the federal government.

Thank you. The point that I think that I wanted to inquire about is what level of discussions have been happening with the federal government to ensure that they’re part of these discussions. Because what could happen is that as you path out, at least to wrangle through the jurisdictional layers and to get to the ground level to ensure that the health centre is operable, perhaps you could be setting a template for perhaps other departments to work cooperatively and collaboratively with the reserve.

We don’t have the detail of the level of discussion between officials for the GNWT and the federal government through ANSI, the federal government, Aboriginal Affairs. So we can provide that information to the membership or to this Member. It shouldn’t be difficult to pull that information together. We can pull that information and provide that to the Member.

Thank you. This is perhaps my final question. Can we expect the health centre to be open by the new fiscal year?

Thank you. We’re expecting the health centre to be open early in the new fiscal year, early.

Thank you, Minister Beaulieu. Next on my list… First of all let’s recap where we are. We’re on Health and Social Services, directorate, operations expenditure summary, $8.599 million. Next I have Ms. Bisaro.

Thank you, Madam Chair. I have a number of questions on this page. I wanted to start off with looking at the federal funding that we have, which is due to expire in a year’s time, give or take. The information that we have currently indicates that much of the federal funding is being used for supplementing, I guess, our medical staff, doctors, nurse practitioners and the other large piece is supplementing our medical travel.

I mentioned in my comments the other day that I’m quite concerned with the fact that we haven’t yet got an extension of this federal funding. I appreciate the fact that the department is working on it, but I’d like to ask the Minister specifically about the money, federal money that we have, which is used to supplement physician services and supplement nurse practitioners. I think it’s also used to supplement nurses in small communities as well to a certain extent.

So I’d like to know from the Minister, he mentioned yesterday that while if we lose the money we’re just going to have to find it. I’d like to know from the Minister if we don’t have a bit of a better plan than just sort of a wing and a prayer and hoping that we’re going to get this money and if we don’t, well, then we’ll look at things at that time. What kind of a plan do we have in place to deal with the programs which are now, in terms of physician services and nurse practitioners and other programs within those sorts of provision of medical services, what plan do we have to keep those programs going when we lose federal funding?

Thank you, Ms. Bisaro. Mr. Beaulieu.

Thank you, Madam Chair. Our first plan A is to try and retain the THSSI funding. We are on the schedule of the federal Minister, and when the federal Minister wishes to discuss the plan or the furtherance of the THSSI funding with us, then at that time we will have that discussion. If there is no discussion and the money is sunsetted or lapsed, then we will need to come back to the Legislative Assembly to fill the gaps. We really don’t think it’s an option to reduce medical travel by that amount. We really don’t think it’s an option to lay off six nurse practitioners. We really don’t think it’s an option to reduce physician funding in Stanton.

I’m glad to hear the Minister say that it’s not an option to reduce physician support and nurse practitioners and that we will continue to fund those. I also sincerely hope that we will get an extension of this federal funding, because we desperately need it in order to provide the proper physician and nursing support that we need for our hospitals and health centres.

With regard to medical travel, it’s been mentioned by many Members and with regard to the amount of money that we currently put in to medical travel from our federal funding, it’s a large amount. What plan – and the Minister’s talked about a review of the Medical Travel Policy – exists specifically to medical travel to either (a) reduce the costs of our medical travel, or (b) find another revenue source to supplement the medical travel costs that we endure?

Just off the top of my head, a lot of the prevention work will reduce medical travel. Electronic medical records will reduce medical travel. E-health also will reduce medical travel. The TSN, I think we have a different name for that now, Territorial Support Network, where there’s a doctor on call who is able to assist people in remote communities through the telehealth system. Those items are intended to reduce the cost of medical travel. Otherwise we’re back to, without THSSI funding, the increase in the Canada Health Transfer will probably end up filling the gaps in 2014-2015.

Thanks to the Minister. The Minister mentioned a number of things that the department is hopeful will create a reduction in the cost of our medical travel. Could I get an indication from the department as to how much money we are, how much federal money is going into medical travel at this point and can I get an indication of what kind of cost savings the Minister is talking about when he mentions the programs that he mentioned.

The federal portion of medical travel is $3.2 million. There are many factors that are involved in reducing medical travel costs. Inflation is an issue. Any contracts within the medical travel system could also be an issue, depending on how much we’re able to sign contracts for, such as medevac, ground services and so on. These are things that are very difficult to predict. Also, the usage of some of the systems that are made available, how effective they are at using the system. The electronic system is designed to reduce this and, actually, mainly designed to provide a better service to the people. It’s difficult to really say. We do things this way because we can see that it should save, but costs seem to go up. Maybe we can contain the costs. That would be something that may be the best we could hope for. The thought is this would save some travel money.

I appreciate the Minister’s point that things change and we can’t predict everything. I realize that contract amounts change, inflation has an impact, but I’m troubled by the way this is presented in that we think we’re going to save money because it looks like we should. I would hope that the Minister, I’m going to ask the Minister, does the department not have a better method of deciding what changes we’re going to make? It sounds to me like, well, this looks like a pretty good idea so let’s just try this one. Surely the Minister should be able to, and the department should be able to, estimate, give or take a certain amount of money, the savings that will be generated by any one of the things that he mentioned relative to medical travel. That’s what I’m looking for, is a general estimate of cost savings relative to this $3.2 million which we’re now using of federal money.

The other point I want to make is, I didn’t hear anything in the Minister’s response to indicate that there’s going to be an evaluation of the changes that we have put in place, or that we are going to be putting in place, to determine whether or not these changes are helping us to reduce costs in medical travel. To those two things: an estimate of savings, is that at all possible from the department, and is the department doing an evaluation of the changes they’ve put in place to determine if they’re good or bad?