Thank you, Madam Chair. We didn’t hear the question.
Great, thank you, Mr. Beaulieu. Some discussion going on here about what page we’re on. I know I had called Health and Social Services, directive, active positions, information item. Agreed?
Agreed.
Agreed, thank you. Health and Social Services, program delivery support, operations expenditure summary, $40.686 million. Mr. Hawkins.
Thank you again, Madam Chair. I’m wondering if the Minister can provide some details as to what activities are associated with the management and administration under the health authority administration, if he could provide a breakdown as to what that is. Thank you.
Thank you, Mr. Hawkins. Minister Beaulieu.
Thank you, Madam Chair. We’re talking about 8-17, the health services administration division. I just want to get clarification because I’m not clear on what page we’re on here.
Thank you, Mr. Minister. We’re on page 8-17. Mr. Hawkins.
Yes, Madam Chair, the funding actually shows up on that page, but the detail of the heading title is on page 8-16, which we deal with together.
Thank you, Mr. Hawkins. Minister Beaulieu.
Thank you, Madam Chair. I will have the director of finance provide the response.
Thank you, Mr. Beaulieu. Ms. Mathison.
Thank you, Madam Chair. That budget line is for the staff of the health services administration office. Thank you.
Thank you, Ms. Mathison. Mr. Hawkins.
Thank you. So is the whole sum total paid out for the staff, or are there other activities associated with the management and administration?
Thank you. $1.486 million of the amount is for compensation and benefits. The remainder is for other expenses, travel, materials and supplies.
Sorry; did I hear the director correctly, tourism supplies did she say? I was making a note. Maybe if she could explain what that is under this health line. Thank you, if that’s what she actually said.
Thank you. It’s for materials and supplies. So for office supplies and that kind of thing.
Okay, there is such a thing as medical tourism, but that’s not what she said. Okay, thank you, Mr. Hawkins. Next I have Ms. Bisaro.
Thank you, Madam Chair. I have a number of questions in this section. I want to first talk about midwifery, and we’ve talked a great deal about midwifery in our statements and oral questions in the House, but I want to try and get my point across to the Minister here that I don’t believe we need a clinical coordinator position, which is what is called for in this budget. I believe that we don’t need to do any more planning. I believe that we have the act on the regulations in place which are currently governing the Midwifery Program in Fort Smith, and I believe really strongly that we can hire a couple of midwives and put them into Hay River and start the program in Hay River in 2013-14, as opposed to spending the year and the money planning and start the program in ‘14-15.
I think we do this too often. We plan more than we need to, and I recognize that the regulations may be out of date, but the regulations seem to be doing just fine, thank you very much, for Fort Smith and have been doing just fine since 2005. So I don’t quite buy the argument of the department and the Minister that we need to put money into a coordinator, or to put midwifery into a new community, and I don’t buy the argument of the department that we need to spend a year planning and drafting regulations and policies and whatever. So I wanted to make that statement.
I wanted to also ask a question with regard to the health services administration division. The administration of our health benefits programs is done through Inuvik, the department has located that section of the department there. There have been, I think the Minister is well aware, a number of issues with customer service and particularly with an inability for residents to get somebody to call them back. I understand that often staff are busy, but there have been situations that I am aware of where people either e-mail or phone, and the e-mail is never responded to, the phone calls or the phone message that is left is not responded to. In one situation the resident had to contact me as their MLA and ask me to intervene. For whatever reason, our phone call, the phone call from my office got results within a couple of days, but this person had been trying for two and three months to get an answer out of health services in Inuvik. So I would like to suggest that the Minister needs to look at the operation of the office in Inuvik and try to not streamline it, because I don’t think we need to streamline it any more, but we do need to look at it with a view to better customer service.
My question here has to do with health care cards, and I think somebody mentioned it last week, that there’s always been the perception that we have more people with health care cards than we do have residents in the NWT, and a couple of years ago the Health and Social Services department did do, I think, an audit of health care cards. I’d like to know the results of that audit and I’d like to know if the current practice of asking people to reapply for their health care card is expected to solve the problem of people with health care cards not living in the Territories. Thank you.
Solve the problem if it ever existed. Thank you, Ms. Bisaro. The result of the study, Mr. Beaulieu.
Thank you, Madam Chair. The whole issue of midwifery, if we put midwives on the ground, we will do it without working with physicians and doctors that are in place now. We will do it without community consultation. We will do it without educational standards for midwives. We will do it without having territorial standards for midwives. These are the things that we want to put in place before we proceed.
We’re going to get the money on April 1st. We think that, as people working in the system, developing standards in education, setting up other standards territorial-wide, and working with the physicians on the role of the midwives in the whole system are important. We think it’s important to do some community consultation. We don’t really think we should rush into this. We don’t really understand why there is an insistence that we rush into this and hire midwives immediately. We think that we want to develop a program that will have long-term success, not something that we want to put in place and then try to make it work as we are running through the system.
Right now we have an opportunity to what I think is put a good complementary system in place for midwives that work with the physicians in the system. We seem to be getting a lot of pressure to be able to just hire midwives. We need an opportunity to go through the system, not slowly but in a reasonable time in order to make good decisions with this.
On the health care cards, we are trying to improve the system. We recognize that a few people have had issues in the system as we change the way we are going about renewing health care cards. Instead of sending out forms to individuals, we’re sending out postcards, giving people personal responsibility to fill out the forms and get them into the office and then a new health care card would be provided. We recognize that there are some glitches in the system and that there is some fine-tuning that is needed. We have a systems navigator in place at Health and Social Services that can work with individuals that have issues with health care cards. There is a 1-800 number. If there is an issue with communicating that to people, that we have someone that’s prepared to, in the system, help them with getting their health care cards in time, then we can send that information. We can communicate that out to the general public.
The majority of the time it is not an issue, but as issues come up in the system, then yes, we hope to address the issues. We are doing health care cards expiring, I think, over the next two years. We have indicated that we thought there might be about 3,000 per month, but it could be less than that, as well, depending on how many of them are expiring next year as opposed to expiring this year.
Madam Chair, I didn’t hear an answer to the customer service issue there, but I’ll just leave it at that. It was a comment.
I did want to ask the department about another change which apparently is in the works and it has to do with recruitment of physicians. There has been some talk about the development of a physicians pool to try and deal with the absence of physicians in some communities; Hay River, for instance.
I’d like to ask the department with regard to this change in our system to go to a physicians pool. Is that something which is still in the works? When can we expect to see that finished if it is? Thank you.
Madam Chair, yes, that is in the works. As I indicated in the House several times, we are making a strong effort with the health authorities to bring doctors to communities where the doctors should be. We are definitely having difficulties getting doctors into Hay River. We are hoping that with the new health centre, plus our work with the NWT Medical Association, we are going to be able to have doctors in Hay River. If that doesn’t work, and if that doesn’t work in any of the other communities where there should be doctors, then yes, a plan B would be to move to a pool within the NWT, a territorial pool where doctors would be located somewhere in the Northwest Territories that could be working in one of the communities designated to have doctors.
Right now the schedule as is, there are nine doctors in Inuvik, of which we have five; two doctors in Norman Wells; two in Simpson, neither of which has doctors living in them; two doctors in Behchoko that live here; five doctors scheduled for Fort Smith, of which we have two; and seven scheduled in Hay River, which we have none. The plan is, once we work with the Joint Leadership Council – that is the chairs and the public administrators of all the health authorities across the territory – then we will develop something such as a territorial pool that would… The territorial pool of doctors would not necessarily be in Yellowknife, but somewhere in the territory. In reality, we could have a territorial pool of doctors, as an example, in Inuvik that would work the Sahtu. We could even have a territorial pool doctors in Smith or Hay River that work in other parts. Like, many of them do come to Stanton to work in Stanton.
An example is of the two doctors we have in Fort Smith, one of the doctors does shifts up here at the Stanton. That would be an example where doctors would be free to move around within the system to provide a better service for the people of the Territories.
Thank you, Mr. Beaulieu. Ms. Bisaro, your time is up. We are moving on now to Mr. Moses, please.
Thank you, Madam Chair. I had some questions earlier, so there was a little bit of mix-up over on this side of the table here.
In terms of the telehealth coordinator position, I would like to ask the Minister if he can give us just a quick update on how the telehealth program is being administered, and the effectiveness, and how many of all the communities hooked up to the telehealth system are actually utilizing the telehealth services. Thank you, Madam Chair.
Thank you, Mr. Moses. Minister Beaulieu.
Madam Chair, we can provide a general response. I will have the deputy minister do that.
Thank you, Mr. Beaulieu. Ms. DeLancey.
Thank you, Madam Chair. We will certainly get some further information. I don’t believe we have one telehealth coordinator in the system. Most authorities have either a telehealth coordinator or an individual whose job it is to do that in addition to other duties.
We do have telehealth capability in all of our communities. We understand that while usage is increasing, there is still some reluctance to use telehealth. In some cases, it’s simply because we are relying on locum physicians or locum nurses who may not be familiar with it or know how to use it. In other cases, we have heard there is some concern about using it when the technology is not 100 percent reliable. We still have delays. We still have slower services in many regions than we do in Yellowknife. In some cases, it’s simply an infrastructure issue where the telehealth equipment may not be attractive or readily accessible. For example, I believe it’s in the Beaufort-Delta that they’re looking at actually relocating it so that it’s more an integral part of the clinic and the physicians find it more convenient.
We do still have some challenges to overcome but, certainly, the measures that were tabled last fall, we do see an increase in utilization. It’s being used extensively for speech language pathology. It’s being used for professional meetings and discussions. It’s being used for professional education as well as for actual direct treatment. Then, of course, quite exciting is the recent partnership that we’ve entered into with Dalhousie University where we are now not only getting psychiatric services here on a rotating basis but psychiatric telehealth from Dal when there’s not a psychiatrist available in Yellowknife.
Thank you, Ms. DeLancey. Mr. Moses.
The question that I wanted to ask earlier was with the Health Promotion Fund. Can the Minister maybe just give us an update in terms of funding for the dollars, if there has been an increase in the terms of dollars specifically towards the Health Promotion Fund over the last, let’s say, maybe three or four years. If he can give us an update on that.
Thank you, Mr. Moses. Minister Beaulieu.
Thank you, Madam Chair. We don’t believe there has been an increase. If there has been an increase, then we can get back to the Member, but we don’t believe there has been an increase in that area in the last three or four years.
I think it was during general comments that I made some comments towards the Health Promotion Fund and asked about multi-year funding. The Minister did confirm that there was multi-year funding with no cap on the years that a certain organization can continue to get that funding, and if it is a successful program, it would possibly turn into core programming dollars to fund the successful program. In terms of the Health Promotion Fund, if it hasn’t increased and we do get the same organizations utilizing the same dollars for successful programs, that doesn’t free up any new dollars for any other organizations that are coming up with unique or innovative ideas that can have an impact on the health of our residents of the Northwest Territories.
In that sense, does the department look at creating some type of limit on the number of years that an organization can access funding? If it’s continued, then it just becomes core funding, from what I’m thinking.
There is no limit in the time that we can provide funding to an organization, and then we look at any new organization in this area on a case-by-case basis.
A last question on this page here. It goes back to the Midwifery Program and some questions that were brought forward by my colleagues here. In the midwifery report there was a standard of practice for registered midwives in the NWT, February 2005. You go through it and there is some really good information there in terms of standards for midwives that would practice in the Northwest Territories. We constantly hear the Minister say that they need this coordinator to develop regulations, standards and competencies before moving forward.
I’d like the Minister to give me his reasoning why we’re not using these standards of practices for midwives that were signed off by one of our previous Ministers of Health, and why do we have to reinvent the wheel. Why do we have to go back out and continue to try to develop these standards that are sitting right in front of me? I’d like to ask the Minister why we are going to waste a year developing standards when there are midwives in the communities that need healthy pregnancies and healthy deliveries.
This is the 2005 standards that will have to be updated. I do believe that the 2005 standards were developed for community midwifery, which was midwifery that is continuing on in Fort Smith. We recognize that that has been a successful program. We’re trying to develop territorial standards. We are trying to build on the standards around the education requirements for midwives. As I indicated, there is going to be some consultation within our system with physicians and also community consultation. Also, the plan was to have a discussion and utilize the current midwives in order to develop and update the standards. We don’t consider it a waste of our time to be doing this work.
Just continuing on, the Minister mentioned that these standards were made for a community recommendation, and the recommended model that was based out of the midwifery report specifically asks for community-based models. That’s what we’re trying to get started up in Hay River, on-the-ground running. We have the standards.
With that said, can I ask the Minister what standards are the midwives in Fort Smith using right now? If these need to be revised, and it’s a successful program in Smith, and we’re going to support it, what standards are they using in Smith, and why do we have to revise if it’s a successful program? It confuses me and this Minister’s confusing me.
We will revise or upgrade the standards to the standards of today. Those midwifery standards were community standards also developed in 2005. I’m assuming that even in Fort Smith we were planning on updating the standards, even with the one that’s operational in Fort Smith.
Also, the thought is that Hay River would become more of a regional midwifery operation, so that we’re going to look at incorporating the regional standards into this, and so that when we move to Inuvik we will have a lot of the standards developed. But then in Inuvik it’s going to be slightly different, because in Inuvik the catchment area for the midwives in Inuvik would be some communities that are fly-in only. There are some regulations around the flights people are taking, pregnant women, on when they would fly, when they would see the midwives and so on, assuming they choose to have their deliveries with a midwife.
In Hay River, the regional program there, we’re going to have the catchment area there all be driving into Hay River. The standards are going to be slightly different than just the community one. We’re looking at upgrading or revising the standards to develop standards that would encompass every midwifery program available. The education standards we also consider to be important. Right now we don’t know if we’re going to educate our own midwives or if we’re going to draw on midwives that are already educated in other parts of Canada or other parts of the world. Right now we want to look at our education standards around the midwives also.
We’re hoping that at the end of this coming fiscal year we’re able to have children from Hay River born in Hay River. We also hope by that time there is also physicians in place that will support that. We think that the fact that two new physicians have come to Fort Smith, it’s going to increase the amount of children from Fort Smith born right in Fort Smith. Right now, with only midwives, about 50 percent of the children from Fort Smith are born in Fort Smith. We’re hoping to increase that number by introducing physicians. In Hay River we hope to have the same type of success when the midwives are in place and there are also Hay River doctors in place.
Thank you, Mr. Beaulieu. Mr. Moses, your time is up. I can put you back on the list if necessary. Next on the list is Mr. Bromley.
Thank you, Madam Chair. I guess I just want to start by saying I support my colleagues on this demand for midwifery service now in Hay River. I recognize that we could do public consultation on this, but I don’t see any conflict with getting something going now. I am surprised by the Minister’s question about why are we pushing this. I wish he’d had time to go out and speak to the young ladies, young families, moms and dads and kids that were walking outside the building here a couple days ago. The demand is there. People want it and they want it now.
We have had programs. We’ve cut back on our programs. That was years ago now. It was so-called temporary, cutting back the Yellowknife program. Now Yellowknife is completely out of the ballgame here. There is certainly no level of trust in the public on this issue. People want action now. They don’t want us talking about it anymore. We are supporting our public in this case.
My understanding is the federal funding for the midwife goes through 2013-2014. If that’s the case, we should be using that money to hire midwives. The bottom line is we have to get something on the ground in Hay River, be it a couple of part-time, half-time midwives or whatever, but let’s get going. None of that would prevent the Minister’s methodic and thorough, and some might say pedantic but I realize that work needs to be done, but none of that would be delayed. That could be ongoing.
I certainly agree with comments on standards. We have a very happy community that is, as far as I know, enjoying a sterling record of midwifery services without kerfuffles, given the standards that they’re meeting. The experience communicating with other providers, physicians and so on, are there. We have those, and those are available for consultation as we put this program in place in Hay River. I don’t have questions there.
We have a report that again outlines many of the benefits which I know the Minister recognizes. Again, there is no question in terms of why we want this. They demand it, and the benefits are huge. That’s why they’re demanding it. So let’s get going with some on-the-ground services on midwifery.
The Healthy Families program, I believe that’s under this page, but it may come under community health later. I see community health programs are here as well as later. I’m just wondering what our expansion plans are for Healthy Families this fiscal year that is being proposed, 2013-2014. I know we’ve done some expansion in the past on this program that I heartily endorse, and I appreciate the efforts of the department to do that expansion. I’m wondering where our expansion is this year.
Thank you, Mr. Bromley. Mr. Beaulieu.
Thank you, Madam Chair. I guess for clarification, I just want to explain what it is that we’re doing with Healthy Families and the internal discussions we’re having for expansion. The Healthy Families have been expanding to all of the regions. I believe we have a program in every region. Just expanding now into the Sahtu, and then that would place us into all of the regions.
The next plan for expansion, I guess contingent upon getting the funding through the business planning process, is to expand to the larger communities in the regions that don’t have a Healthy Families program. It is very much contingent upon where the children are born, which community the children are born in. If we have a lot of births out of Tuk and Aklavik, then the plan is to expand into those two communities.
So any communities where we have a lot of births, that is the plan. But for now what we have on the books is what we’re funded for. Anything beyond that, we come back through the business planning process for additional dollars to expand beyond the last thing we’re putting in the Sahtu.
Thanks to the Minister. That sounds like a plan. Is the Sahtu being done during this current fiscal year that we’re in? And if that’s the case, and we’ve heard the plan to go where there are lots of new babies, where in the budget do we have the proposal for expanded healthy families programs for this fiscal year coming?
We don’t, beyond what is indicated in our business plan now, have in our mains more money targeted in here. However, we are working with the Department of Education, Culture and Employment in the early childhood development. Some of that money could be used to expand Healthy Families beyond what we have laid out, which would, I think, include most communities where there are a number of births.
I guess I’m disappointed that we’re not identifying new dollars for this year, but I appreciate the Minister’s answer there. I will just mention that the Healthy Families program is what I consider promotion and prevention. It’s the number one program in the promotion and prevention. I know we’re going to be speaking to that throughout the department here, but I want to raise that flag.
I guess my last question. Do we have regional programs? I know in Yellowknife we have a number of homes for people who require supportive living. It’s almost independent supported living, but often in groups. I believe that is a co-operative program between Health and Housing. I’m wondering, do we have those programs in our regions, and do we have an inventory of the people who require this sort of support and housing?
We would be able to provide an inventory of units that are targeted to supported living, but we don’t have that information with us here today.
Thank you, Mr. Beaulieu. Mr. Bromley, you have 53 seconds. Do you have another question?
Thank you, Madam Chair. That’s all I have for this page.
