Debates of February 22, 2013 (day 12)

We are going to be putting an RFP out for medevac services. This spring we are starting the evaluation of the service that we currently have. The detailed information we get from the current medevac services is going to give us the information that we need to draft an RFP that’s going to be able to provide the best service to the patients possible. The RFP would not indicate that we need a decentralized model, that you have to have a plane in Norman Wells or you have to have a plane in Inuvik. It’s not going to request that kind of detail. It’s going to request that the best service possible be provided within the call for RFP. The companies would then determine whether or not putting a plane in a place like Norman Wells or Inuvik or someplace outside of Yellowknife, assuming they have more than one plane, that if they would put a plane there they would be able to provide the safest, best medical service to patients in the NWT, period. So it would be based on that that we would evaluate the RFP.

There are companies that do believe that something closer to the centre of the Northwest Territories needs to be a plan on the ground. That way you can get into more communities that are further away from Yellowknife a lot quicker. When we look at the RFP we will be thinking that it’s going to provide the best service possible for the patients.

Norman Yakeleya

Sahtu

Madam Chair, the Minister has highlighted a critical point for us in the Sahtu. As the Minister of ITI and I have noted, the activity in the Tulita and Norman Wells area is very busy with oil and gas activity, and more and more people are coming into our area. With the lifting of the unrestricted liquor sales, it just adds to the issue of services in health care.

Medevac is one that is dearly held to our hearts because that’s our lifeline outside to services in Yellowknife or in Edmonton. We don’t have the luxury of an all-weather road yet. Hopefully that will be some time down the future. That’s something that the Minister has spoken on, the reality. With the RFP coming out based on doing that evaluation of what is the best way to provide the best services for our patients, that’s key for me.

One of the things in the background is the dollar signs, the money. You gave us the numbers of what it costs to fly in to our communities and what it costs to fly out of our communities. I want to ask the Minister what times are we looking at when the evaluation will be done and then when the RFP would come out, roughly.

There are people within the airline companies that want to work together. They don’t have to compete; they can work together. I know that’s true. I heard them this morning say that we don’t have to compete against anyone. We can work together on this. That’s what we’re looking at because we just don’t want one company to have everything and the rest of the companies are saying, well, what about us. These airline companies want to work together, and I think we can do it. I think that’s what I’m looking for.

In the Sahtu we have some good companies, and in Inuvik and in Yellowknife here or in the Deh Cho. We have good companies that could help each other out here. That’s all I’m asking for, is to give us a fair chance and let’s work together in the North because there are not very much of us to get this work, and we’re all Northerners. We all live here, and pilots are one of the most respected professions in life because they fly in all types of weather.

The key here – I liked what the Minister said – is the best service for our patients. That’s key for us in the Sahtu where there is no other transportation. Other than our short period of winter roads and boats in the summer, we fly.

The evaluation process is very critical in the RFP. The evaluation is going to give us a very clear indication of where the medevacs are coming from. If the Member from the Sahtu is accurate in his thinking, then, yes, many of the issues resulting from perhaps unrestricted alcohol sales and many people, just many people, period, in the area as a result of resource development, then it is possible that many of the medevacs will originate out of the Sahtu communities. That would be in the evaluation.

When we put out the RFP, I think there’s an indication in the RFP as some background information, as the response is being made that this is background information that can be given to companies, that companies want to know where the majority of the medevacs are coming from, whether they’re coming out of Yellowknife because half the population is here, or the majority of them are coming from outside of Yellowknife.

The other point is it is not a tender, so it’s not based on cost. The cost implications in the RFP are weighted. There’s a weight to the cost, but it’s not the determining factor. It’s weighed just like anything else, and we’re trying to structure our RFP to try to provide the best, safest service to the patients.

Thank you, Mr. Beaulieu. Mr. Yakeleya, your time is up. I’ll put you back on the list, if you wish. Next on my list is Mr. Dolynny.

Daryl Dolynny

Range Lake

Thank you, Madam Chair. Again, welcome to the Minister and the health team here.

I’ve got two broad topics within the area of the directorate here. I’ll start with the first one here. Just to set the lay of the land to the question, we’ve got three health boards that have been dissolved over the years that are run by public administrators. That’s Stanton, Hay River and Inuvik. What’s interesting is that through our budget dialogues, the back and forth that I have seen in the last 16 months, there have been many areas where we talked about barriers to accountability when it comes to the delivery of service to our health authorities. There have been issues in information sharing. There have been issues in risk management, efficiency, the consistency of the delivery of clinical practices, the consistency of delivery of patient care or the seamless patient care. We’ve even seen competition for professional staff within the NWT within all of these health authorities.

On top of that, it was clear and evident through the Auditor General’s report of 2011, which clearly indicated that we had contribution agreements to all these health authorities, we had very few performance agreements to the same tune, which caused a lot of issues for the Auditor General of Canada, and I think it caused a lot of concerns for the Standing Committee on Social Programs.

Given what I’ve just indicated, can the Minister indicate what the future long-term goal, the structure, the governance structure for the NWT health system is?

Thank you, Mr. Dolynny. Minister Beaulieu.

Thank you, Madam Chair. The future long-term goal of the health structure, if we’re talking about structure as in personnel, physician services, other health services in the territory, we are hoping that we have a system that is where we have physicians that are available equally to all residents of the Northwest Territories. That’s ultimately our objective.

Now, we’re probably going to have a lot of difficulty providing medical services, as in physician services, on a full-time basis to all communities. That’s going to be something that we’re probably never going to achieve, and that is because of the lower populations in some of the communities. But we will use the Integrated Service Delivery Model to determine what type of service has to be on the ground in which community.

Right now, our work has netted us some results, and we know that there are five new doctors in Inuvik, two new doctors in Fort Smith, and we’re continuing to work with the NWT Medical Association to do something about providing doctors into Hay River. In Hay River, it is an opportune time now, with a new health centre being built there. We are working with the new president of the NWT Medical Association to talk about putting, perhaps, some residents into Hay River that would be Hay River doctors. Whether they lived in Hay River or Yellowknife, that would be determined.

Essentially, at the end of the day, we hope to have a pool of territorial doctors, whether they be in Fort Smith, Norman Wells, Inuvik, Hay River or Yellowknife. An example is of the two doctors in Fort Smith, one of them comes to the Stanton Hospital and works here on a regular basis as well. We are not necessarily always saying that we’re going to put all the doctors here and they’re going to work everywhere else. It could be a variety of ways that we would look at providing physician services to communities. That being one of the key changes that I see in the future for the Territories, that we’re going to be able to provide physician services regionally that will go out to the communities on a scheduled basis, based on the Integrated Service Delivery Model. Thank you.

Daryl Dolynny

Range Lake

Madam Chair, I appreciate the Minister sharing views regarding the physician services and a bit of a glimpse of a renewed Integrated Service Model. However, I believe my question was a bit more at a higher level of governance. If I can use the term loosely, board reform or the new landscape of how the delivery of our health care will look in the future, given the fact that we’ve had, as I indicated earlier, a lot of barriers to accountability. These were clearly notified by the Auditor General of Canada, to which I believe does deserve the right lens and the appropriate intervention to make sure that we are as efficient as possible, as the Minister said, with physician services.

I am going to leave that question because I’m assuming we’re going to probably get a very similar response if I ask the question again. So I’ll leave that for another rainy day.

My second component regarding the directorate in terms of governance, is the annual reporting. My question has to do with the timeliness of the reports. We’ve seen, in the past, reporting from the Department of Health and Social Services has been very sparse at times. We have even seen the fact that a lot of the health authorities have been noncompliant. Just for the record, the Financial Administration Act clearly indicates that health authorities are bound by the act to report on an annual basis to show what their performance is to the people of the Northwest Territories.

Can the Minister give the committee here some indication? Because they are part of the directorate, this falls under the responsibility of strategic direction of this area that we are in. Can we get some indication, has this been a focus with the Minister, and can we see improvements in this area this year and for the remainder of the 17th Assembly? Thank you.

Madam Chair, this response needs to have a lot of detail in it because of things that we’re doing. So I’m going to ask the deputy minister to provide a detailed response on this whole question, and perhaps the director of finance may also add to the response. I’ll ask the deputy minister to start off the response.

Thanks, Mr. Beaulieu. Ms. DeLancey.

Speaker: MS. DELANCEY

Thank you, Madam Chair. For the most part, we believe that the health and social services authorities have met their legislative requirements for reporting. We have a number of legislative reporting requirements for the system. The department is required to table an annual report, under the Medical Care Act, which has been done most years except there were two years missed in the last 10 years, 2008-09 and 2010-11. The department has a strategic plan which commits to annual reporting and we did table a report last fall in the Legislative Assembly which provides a progress report on the status of every measure in the strategic plan.

Health and social services authorities are required to report to the Minister on an annual basis, which they do. As well, they have a number of financial reporting requirements to the department, including quarterly variance reports. Our contribution agreements with the health and social services authorities do include a fair amount of financial detail, in order to start complying with the recommendations from the Auditor General that we move towards broader performance agreements. For this year’s contribution agreements in 2012-13, we have requested authorities to provide a significant amount of additional details specifically on issues like number of ER visits, numbers of no-shows and numbers of medical travel events, which have not previously been reported. Again, in response to the Auditor General recommendations, we have, through a request for proposals process, retained consultants who are working right now on developing a set of system-wide performance indicators that every authority will be required to report on. We expect to have that work done by this August. Thank you, Madam Chair.

Thank you, Ms. DeLancey. Mr. Dolynny.

Daryl Dolynny

Range Lake

Thank you, Madam Chair. I appreciate the response. It sounds like we are working towards that end goal. For the record, are we able to say with a degree of confidence that all of the performance agreements with the health authorities will be in place 100 percent within this fiscal year? Thank you.

Speaker: MS. DELANCEY

The answer is no. We do not think that we can finalize the move towards complete broad-based performance agreements until we have finished the updating of the Integrated Service Delivery Model, which will then allow us to move to update our funding model.

Right now our funding model for authorities is based on historical precedent rather than some kind of a formula allocation basis. As we finish the updated Integrated Service Delivery Model, as we get the system-wide indicators recommendations from our consultants, which, as I said, won’t be until the middle of next fiscal year, we will draw that together and move towards full-fledged performance agreements.

As I said, for this fiscal year we’ve tried to expand the reporting requirements on the authorities. In the 2013-14 contribution agreements, we will cast a broader net and require some additional reporting, but we won’t have made the shift to full performance agreements until the 2014-15 fiscal year. Thank you.

Thanks, Ms. DeLancey. Noting the clock, Members, I will call a halt for today and I will rise and report progress. Sergeant-at-Arms, will you please escort the witnesses from the Chamber. Thank you, witnesses, for your attendance.

Speaker: MR. SPEAKER

It’s good to see everybody happy.

It’s good to see you.

Speaker: MR. SPEAKER

I’m happy to see you, too.

Report of Committee of the Whole

Speaker: MR. SPEAKER

Can I have the report of Committee of the Whole, please, Ms. Bisaro.