There have been a number of initiatives, so I would like to get the deputy minister to just highlight some of them. Thank you.
Thank you. Ms. Meade.
There are several and the main area that we work on these is with the joint senior management, which is this administration and the CEOs. First of all, in the area of governance, we’ve moved to system reviews. So it’s not just authority by authority whether that’s on budgets or flow of patients. A key area that both bring in efficiencies as well as patient safety is on quality. So we’re developing quality measures and risk management measures. We’ve also raised the profile of risk management committees. This was not understood well by all authorities initially as to how to operate those and what the needs are. The other area is on the fiscal reporting and looking at how we can share capacity. A big focus was on billing and revenue recouping. So there are multiple areas around the whole accountability and governance.
Some of the things that we’ve made changes on is the role of the medical directors. You have to have the medical directors aligned and the clinical decisions and them also sharing budget and efficiencies. We’re reviewing currently the physician resources, number of specialists, best way to use that. We’re looking at a centralized bed management. Right now we’re doing that manually, but because of the flow it can’t just be one authority’s fold, there has to be movement of patients. We’re also looking at our wait time management. Again, we’ve reviewed this with standard benchmarks both through the CEOs and the medical directors, looking at a way of managing that centrally and how we will pull off where we start to have wait lists. An example is the extra mammograms and colonoscopies we did this year to reduce the backload. We’ve reviewed both how we do scopes, the standards, referrals to make that standard, the specialist referral. I can go on and on, but a lot of this has been how you start to turn the system, raising the profile around patient safety, quality risk management and efficiencies.
That’s really just the beginning. Some of the things the standing committee has been advised on is the overall governance in how we can pool some of the administrative back office capacity deficits that we have and better ways to manage in that area in financial and administration. So it’s an ongoing process when you’re attempting large-scale change in a complex health system. Thank you.
Thank you, Ms. Meade. Ms. Bisaro.
Thank you, Mr. Chair, and thanks for the explanation. There’s lots going on and I understand that much of it is probably efficiencies as opposed to savings, but I’d appreciate an explanation from either the Minister or the deputy minister as to sort of what the expectations are. Will all these changes end up basically allowing us to spend the same money for more, or are we anticipating that we’ll get some savings through these changes? Thank you.
Thank you, Ms. Bisaro. Ms. Lee.
Thank you, Mr. Chairman. I think I can safely say that there is no such thing as savings in the health and social services system. We’ve said many times that it’s about bending the trend, if you are lucky, and that’s what we are trying to do. Also to make sure that we look after the care and the quality and the safety of our patients. So a lot of the work that the deputy minister outlined are the things that need to be done on an ongoing basis for any health care system, but we also believe that it is a way and we use the Foundation for Change as the overriding sort of action plan and it is to realign and change the way we do things.
To deliver programs we are looking to have all of the authorities working together. We are encouraging them and working with them to see the whole picture, not just their authority from their perspective, which they’ve been trying to do for many years. So in the health care system there is no such thing as savings, but there is a lot of room for efficiency and more smooth delivery of the program and trying to bend the trend by changing the system. Thank you.
I’d like to know if the Minister could advise -- I hope it goes on this page, it’s kind of hard to tell -- but one of the things that we discovered in the Child and Family Services Act was the need to I want to say update but I actually mean to throw out the current system that the social services division works on and replace it with a new, modern, updated, CFIS system or some other system. I’d like to know from the Minister whether or not there’s any money in this budget to begin that work and when we might expect a replacement of the current computer system that social services uses.
That would be a capital item and it would have to go through the capital planning process.
Can the Minister advise if there is any money within this budget within the department to start planning for that capital replacement?
No, there is a pretty strict and well laid out capital planning process that we need to meet to go through for all departments when they’re asking for new capital funding. We would have to work through that process and we don’t have the money set aside here for that.
Thank you. One quick last one. I didn’t hear the end of the Minister’s statement but I have to assume that at some point in time the department is going to have to produce a document that goes to the Cabinet for the capital planning process, so is that intended to be started within this budget funded from within?
I guess the Member is asking, well, not having money in this budget, which was a question, that work would have to be done as a part of a regular process that the staff at the department that works on getting the capital planning process ready.
Thank you, Ms. Lee. I shortchanged you, Ms. Bisaro, on time. If you have one more question, I’ll allow it.
Thank you. I was going to ask you to put me back on the list, but there we are. I’ll leave the question that I tried to get an answer to and ask another one.
The Assembly has passed the motion to the government asking for the development of an Anti-Poverty Strategy and I know that there is a working group that is currently doing some work. I’d like to ask the Minister two things: what kind of a priority is the development of this strategy for her department, and how is her department involved in the working group, or are they?
Thank you, Ms. Bisaro. Minister Lee.
That’s a government-wide work that we’re undertaking and it is a priority for our department. Our director of policy sits on the steering committee and we are involved.
Thank you, Ms. Lee. Next I have on my list Mr. Yakeleya.
Mr. Chairman, I want to ask the Minister regarding the change of the health benefits programs that we’re administering. I know that puts a lot of pressure onto our financial pocket here in the GNWT in terms of how that rolls out. I want to ask the Minister about the challenges that we’re going to see changing the program and if that puts any constraint onto some of the programs we want to see in our communities or resources in our communities such as the community of Colville Lake having a nurse there or having a social worker there. We just seem to be operating on the accessibility from Fort Good Hope or Norman Wells to fly into Colville Lake, do the program, and then they leave. People again left without really having a health worker there or social worker there like other communities and now they’re starting to put some pressure on me to put pressure to the department on how we work around this so that basic services in the North are there when people need them. I want to ask the Minister how to work around these tough challenges to see that equal accessibility of health care workers are the same in the North.
Thank you, Mr. Yakeleya. Ms. Lee.
Thank you, Mr. Chairman. That’s a very, very broad question that could lead to a very broad discussion. Let me just say that with respect to extended health benefits, we do not use the language “supplementary health benefits” anymore because that policy has been rescinded. We are following the guidelines of the Joint Working Group. We have been having discussions with the standing committee and we are working on making some changes that would follow the Joint Working Group recommendation. So basically until something is changed, the status quo remains.
The Member is asking how that impacts the general service level of the system and I think that question is much larger than that. We as a system are under pressure. We’re not the only one. Health and Social Services spending keeps rising and, as Senator Kirby said, there are only two options: it’s either you bring more money into the system or you have to cut the programs. We have experienced that nobody wants anything reduced. If anything, our people want to see more services. What we are doing as a system is trying to do as much as we can with the resources we have, making necessary adjustments so that we become efficient to work together better, authorities work as one, we work as a system and we put all our practitioners in every field to their fullest scope, that we talk to each other more, we avoid duplicates. All kinds of system things that we can come up with to manage our system. At the end of the day we’re not going to make changes to our system unless we as an Assembly make real tough choices.
I pose this question because it’s a big issue. That’s what we’re dealing with in our communities, some of the changes. We could have a discussion but somewhere it gets lost in the system. Some of the communities in my region want to have some programs, like, for example, to develop their own home care service in Colville Lake, but we’re just unable to get into the system. Why not have the system get into the needs of Colville Lake? The books and policies say we can’t do this, we know you’re going to do this, you shouldn’t do this. It gets lost and after awhile they say we’re not really serving our people, we’re serving the system.
This proposal that came from Fort Good Hope to the system, to the Minister, on a drug and alcohol program doesn’t quite meet what the funding is there for, so we have to work on it. They want a drug and alcohol program that will meet the needs of the people. That’s where we have the philosophical differences between do we serve the people or do we serve the system.
Right now the system is busting at the seams in terms of health care. Something’s got to give. There’s still the $345 million in the budget. Six percent increase. That’s $20 million in forced growth. You have something here. The majority of the people that I represent are Aboriginal people. They have a system of health care prevention, but we’re not really using it to the extent that we think we should be using it, yet the cost is increasing. That’s why I give this long, philosophical question to the Minister. It’s not to say we need more discussion on this. It’s to say it’s coming down to the basics of health care.
Like I said, if we had a social worker in Tulita three years ago I wouldn’t be raising this question. The Minister is right; there was a social worker scheduled. They had a family relationship that prevented the social worker from coming in. There were housing issues that prevented the social worker from coming in. She was willing to work with the community but somewhere we didn’t follow through. We weren’t strong enough. That’s what I’m saying.
I’m not going to harp too long on this page here, but we need to change the program delivery services in our community. It’s going to require more than just running through the O and M budget right now. That’s what we’re doing now. That’s why I just wanted to give a piece of my mind to the Minister on how health and social services needs to be looked at from our communities. I’ll leave it at that. It’s more of a comment to the department. You can have another discussion at another time.
Thank you, Mr. Yakeleya. Just a comment. I’ll give the Minister an opportunity to comment.
Thank you, Mr. Chairman. I take his comments. These are ongoing files that I’ve been working on and I will get back to the Member.
Thank you, Ms. Lee. Committee, we’re on page 8-17. I don’t have any further people for comments here. Ms. Bisaro.
Thank you, Mr. Chairman. Just one question in relation to the contract services on page 8-17. It’s increased about $500,000 or so. Could I get an explanation why?
Thank you, Ms. Bisaro. Mr. Elkin.
Thank you. The increase of $497,000 is due to the funding from the strategic initiatives related to $375,000 for health services administration increases and $133,000 for continuing care services and a small increase to the HPV of $10,000 for 2011-2012.
A further question. The health services administration, is that not covered under the health and social services authorities agency administration, the $14 million at the bottom of the page?
Thank you, Ms. Bisaro. I see there’s a health services administration just above that, but I’ll go to Mr. Elkin for further clarification there.
That was additional funding that was related to the implementation of the changes to the Extended Health Benefits Program.
Okay. Have we made changes, then, to the implementation of the program, or was it in anticipation and they may perhaps not be needed?
Thank you, Ms. Bisaro. Ms. Lee.
Thank you, Mr. Chairman. That money was put in in anticipation of changes and, as the Member knows, we are discussing making some changes and we will need the resources still.
Thank you, Ms. Lee. Committee, we are on page 8-17, Health and Social Services, activity summary, program delivery and support, operations expenditure summary, $34.32 million. Agreed?
Agreed.
Page 8-18, Health and Social Services, activity summary, program delivery support, grants and contributions, contributions, $17.619 million. Ms. Bisaro.
Thank you, Mr. Chairman. The professional development recruitment and retention increased significantly from main estimates to revised estimates in this current budget year and then we have estimated the same amount in 2011-2012 as the revised estimates from this current budget year. What was the reason for the huge increase from $1.6 million to $2.9 million in this current year? Thank you.
Thank you, Ms. Bisaro. Mr. Elkin.
Thank you. The overall budget for the professional development recruitment and retention had not changed but we changed from operations funding to grants and contributions funding as to how we administered the funding.
So does that mean that it is a shuffling of the money from one pot to another and nothing has changed, the totals haven’t changed? I need an interpretation. Thank you.
Thank you. That is correct; the bottom line hasn’t changed. We just moved between where the money sits in the budget line.
Thank you Mr. Elkin. Committee, again, we are on page 8-18, Health and Social Services, activity summary, program delivery support, grants and contributions, contributions, $17.619 million. Agreed?
Agreed.
Thank you, Page 8-19, Health and Social Services, information item, program delivery support. Agreed?
Agreed.
Thank you, committee. Page 8-21, Health and Social Services, activity summary, health services programs. Mr. Abernethy.
Thank you, Mr. Chairman. This is probably one of the largest expenditure sections in the Department of Health and Social Services at $188 million-plus. There has been a lot of talk in the last couple of years about deficits and increased debt at some of our authorities, in particular Stanton and Beaufort-Delta. Could the Minister tell me what the projected debt and deficits are for both those authorities for the 2010-2011 fiscal year, and how that affects us coming into the 2011-2012 fiscal year and the amount that is going to be transferred to them?
Thank you, Mr. Abernethy. Mr Elkin.
Thank you. We are currently in the process, actually in the last couple of weeks, working with the authorities on their revised year-end projections, but the latest figures we have prior to that is Beaufort-Delta projecting a $3.9 million deficit and Stanton is projecting a $5.9 million deficit for 2010-2011.
