Thank you, Mr. Chairman. What does that put us at for total debt for those two facilities?
Thank you. For Beaufort-Delta the projected accumulated deficit will be $9.4 million and for Stanton the projected accumulated deficit will be roughly $19 million.
In the life of this 16th Assembly there has been an awful lot of conversation about the debt and deficits of both those institutions and there has been reference to plans and action items and things we are going to do to reduce those debts, but they keep growing. I know the department is doing a lot of things. I know Stanton and Beaufort-Delta are trying things. I know there has been some changes in the Beaufort-Delta and now it is under the control, I guess, of a public administrator, but what kind of things, what kind of large activities are we doing out of Foundation for Change or any of the other reviews, to help us get this deficit and debt under control? I know, personally, I think it is underfunded but we have what we have and we have to do what we have to do, but what is being done to control these types of things and can we see any improvements for 2011-2012 fiscal year, going into the life of the 17th Assembly?
Thank you Mr. Abernethy. Minister Lee.
Thank you Mr. Chairman. This is a big and important topic, so I am going to ask the deputy minister, who is also public administrator for a couple of authorities, to elaborate.
But before I do that, I just want to say that you will see from the debt figures that the debt amount, the trend has stabilized somewhat over the last couple of years and also the Member does have a point in saying he believes some of the authorities are underfunded. That might be true, but as a system we need to be able to justify how so, not look at the whole thing but we need to be able to break it down to see where is it funded or not funded in a correct way and then what can we do as a system, what changes we need to make to change the way we are doing things. Because I would think that not only as a Legislature here, but as a Cabinet Minister, if you are getting a presentation from the Department of Health and Social Services about where we really think the deficit lies or the reason for it, we need to be able to establish and come up with that blue chip information, which is what we have been working on.
So I am going to ask Paddy to highlight some of the findings that she has had and she is working on, because I think in a year and a half I believe that we are coming to a time where we will have a lot more clear picture than we ever had before. Thank you.
Thank you, Minister Lee. Deputy Minister Meade.
So there has been a zero-based review done of Stanton, but what happens is it doesn’t show you where the change has to be, it just shows you where the money is going to go. So the drill-down in both, Stanton is ahead of this, has been where is the actual money being spent, where do we see the system offloading and creating that deficit, because the money actually hasn’t been realigned since 1998 and the way we are delivering health care in the Northwest Territories has changed and the movement of patients.
So some of the things we have done, a specialists review, we started that with Stanton but we found out that specialists are being used by some of the other authorities, and some of the use of those specialists might be avoided if we look at how we better utilize the specialists at Stanton, so that is both what are the real services we must and need to apply here.
There has not been a business case come forward, so again the specialists have, I think there are at least 10 specialists that have been added to over time without the funding, because the business case wasn’t made. Those specialties are not nice to have, they are actually must haves to run the kind of acute system we have. The specialist review is now looking at so what about the other specialists. For example, we have used a specialists model at Beaufort-Delta and we may be able to save costs and efficiency by marrying that better with Stanton and looking at a general practitioner model where they have the ticket and that is done in many rural and remote areas. So it is not just what is the actual funding required but what is the funding and how do we find that internally by better use of resources.
The same thing with the physician model. If you see the physician resources and a territorial resource as opposed to authority by authority, you can actually expand the use of nurse practitioners. This is where the Territorial Support Network and the use of electronics to maximize that use is coming in. When you are in the health system, you have to have the key decision-makers and providers lined up, and a lot of the work was rejigging and realigning the medical directors forum and getting them back into the leadership piece. The other professions have to follow suit, but that was a major piece of it because the medical leaders have to take leadership around the number of labs, the number of tests, the kinds of things that both the locums and general practitioners are doing. So they have looked at standardization of referrals, clinical screening guidelines, all of which brings efficiency and patient safety and quality into it. Some of the other things have been what is a better way of covering off, how do you manage your ORs. You have greater efficiency in large hospitals, but even looking at the amount of time to turn over an OR and is there a way of increasing that. So we’ve looked. Hay River can turn it around fast. How can we bring that over into Stanton and Beaufort-Delta? Some of it is equipment sterilization. Some of it is manpower and how we better utilize them. So your efficiencies are less about deficit but they’ve hit that cost curve on deficit because of the ongoing increase in need. So it’s everything from staffing mix, how are we using our specialists, what kind of programs are in each authority, and can we do that as a system better. Quite frankly, over time there have been a lot of services that are managed by those authorities currently in deficit or close to -- I would throw Yellowknife Health and Social Services into that -- and how do you align where you have a surplus. Part of that has been that those services can’t be and won’t be provided in those authorities so how do you have the dollars basically flow with the patient?
It’s quite a massive undertaking. Every time you peel this one it gets more interesting. I do think that there are efficiencies for scale, less so at Beaufort-Delta just because of size, but certainly as a system there are efficiencies. So when you’re talking about what are we doing, we’re trying to address that cost curve and live within the growth that’s been given to us but also to make a business case of where money has to move or where we have to reprioritize within the system. That’s just a highlight.
Thank you, Ms. Meade. Mr. Abernethy.
Excellent. There’s still a little bit of time on the clock too. Thanks for that. That’s all good information. I’m happy to hear that. There are some areas that I don’t hear much talk about and I’d like to hear a little bit more from the Minister or the deputy minister on this area.
Under this area we have hospital services and NWT health centres. Now, there’s certainly one thing that crosses over that, and that is nurses. We need nurses in hospitals and we need nurses in health centres. There’s still an international and national shortage of nurses in the country and around the globe, and as a result, we have in the past had significant use of agency nurses where we hire the nurses that are identified by the agencies, we pay them a salary based on our Collective Agreement, but then we also pay a finder’s fee to the agencies who happen to have identified the nurses. I’ve seen those rates and they range anywhere from $90 a day to $450 a day.
I’m curious how many agency nurses that fall under this category were used in 2010-11. Actually, you know what I want? I want the department to give me a summary for the last five years on agency nurse usage, how many agency nurses we’ve utilized, how much we paid in salary, but also how much we’ve paid in the top-up, the fee to the agencies. I also want a bit of a summary on nurses that we’ve hired as locums or backfill in community health centres and the hospital over that same period. Those are the ones that we hire as employees that we don’t go through an agency, and there are some that we have in our own relief pool, I know that too. Can I get those two breakdowns so we get a bit of a sense of what this backfill is costing us?
The reason I’m bringing it up is I think that’s an area where we need to find some efficiencies. Agency nurses are just really expensive and a necessary evil now, but what are we doing to break that dependence from the agencies? I think that could save us some money that we can reprofile back in, but also creating some stability in the communities with respect to community health nurses.
Now, we had a really great program, in my opinion, Community Health Nurse Development Program, which wasn’t used in 2010-11, or at least to the capacity I think it could. What are our plans for those types of programs in the future? I think those should be expanded as opposed to cut back. If we truly want to get northern nurses back into the communities, we better make sure they have the skills to go in there. So I want some information on that as well.
And while we’re here, once again, just go back to Hansard and re-read everything I said on broadband because I think it fits this section as well. So I want some statistics on what the agency nurses are costing us, what our locum nurses are costing us, and what we’re doing and what our plan is to transition away from our reliance on this model when we’re training nurses at Aurora College and we’re having larger and larger grad classes. What are we doing to break the model of our dependence on agencies and locums?
Thank you, Mr. Abernethy. Minister Lee.
Thank you, Mr. Chairman. There was a lot there that the Member has raised so we will have to get back to the Member with more detailed information.
I haven’t seen the latest information on agency nurses, but the last stats I saw, I believe, showed that it is something that should get a lot more positive light on. We have substantially reduced the use of agency nurses by a huge amount. That was, I think, the latest stat about six months ago. I need to get the information for the Member, but over the last three to five years we have substantially, 60 to 80 percent reduction in agency nurse use. Thank you.
Thank you, Ms. Lee. Next on my list I have Mr. Yakeleya.
Thank you, Mr. Chair. I want to say to the Minister, in terms of the health care services in our small communities and some of the equipment that I’ve seen, now it certainly shows that there’s a great improvement to the health centres. There’s actually some equipment there that’s beneficial to the people and their residents. I really want to thank the Minister for putting those in our communities. It makes a big difference when we have people come to our health centres on an emergency basis and there’s actually equipment there that’s being used by our nurses now. They’re very appreciative of that equipment going into our centres now.
I want to ask the Minister when she’s doing the health care planning facilities, is there anything in there in terms of the health centres that we have in the Sahtu; specifically Colville Lake? I know right now they don’t have any running water or they have no proper, I guess they call it now, washroom facilities. It’s still back into the honey bucket system there. Is there something in the planning system that would advance it to a capital infrastructure when they’re looking at health centre funding? I wanted to ask the Minister in that respect.
Thank you, Mr. Yakeleya. Minister Lee.
Thank you, Mr. Chairman. I don’t have the information here on the capital and I don’t know where exactly Colville is, but I will look into that. I can tell you that as the department we’ve worked over the last fiscal year to put more focus on some of the small equipment that has fallen behind in the line-up using the regular process, and my colleagues have been positive in responding in that regard so that we can address some of the equipment issues in the health care system. Thank you.
I certainly look forward to seeing what type of information the Minister can provide to me. I know we’re in operations and maintenance expense budget and I’m not too sure of where it fits in terms of operations and maintenance of the Colville Lake Health Centre there, our nursing centre, in terms of what I’m asking for in terms of the planning or to advance it to funding for capital expenditures, and if that’s something that should be at another table here. I look forward to whatever the Minister can give in terms of how do we improve that health centre there to where now they’re going to have running tap water and use of a proper facility, a flushing toilet rather than the honey bucket system. I think we need to move out of that era there and bring it up to the modern society. Thank you.
I hear what the Member is saying. I will undertake to look to see what we have for capital items for Colville Lake, but that’s not part of this budget we are dealing with here, so I do not have that information readily available. Thank you.
Mr. Chairman, I certainly appreciate that from the Minister. I know that another area that I need to talk about and because this is an operation and maintenance budget, I have...(inaudible)...in terms of at least the planning of the operations and maintenance. Anyhow, I won’t get into the details.
I want to tell the Minister that if they had a hospital or services that I saw firsthand in Edmonton... I appreciate the Territories have a staff person at our hospital. She was very helpful with some of the stuff I had to deal with. It sure does make a big difference when you are out looking at things that we need to take care of. She was there. I want to say that the money is well spent in that area in terms of who we had down there and how this person helped out of our Territory’s hospital. The person was a good thing for us. I just want to commend the Minister and the department on that person here. I just want to leave it at that. I have no other questions.
I appreciate his comments. Thank you.
Thank you, Minister Lee. The next on my list is Mr. Hawkins.
Thank you, Mr. Chairman. In listening to some of the comments provided by the deputy minister of health, she mentioned that there was a zero-based review on Stanton. Could she elaborate a little further and even if it is for my benefit if I didn’t hear her give the answer? My question is specific. What year was the zero-based budget review done? Is there a copy of it that can be provided to Members? If so, can I have an electronic copy? Thank you.
Minister Lee.
Mr. Chairman, it was started before I went into office. It was completed, I believe, around that time, three years ago. Thank you.
Thank you, Minister Lee. To Mr. Hawkins’ second question about getting a copy.
Thank you, Mr. Chairman. That information is not a public document. There was not a formal report per se. It was more of an internal working document as to where the money was spent. It was basically a budget document. Thank you.
Thank you, Ms. Lee. Mr. Hawkins.
Mr. Chairman, can I request a copy of that informal document? Thank you.
Mr. Chairman, I will see if that is available and whether or not it can be made available. Thank you.
Thank you, Minister Lee. If it can be shared, we would like it shared with the entire committee. Mr. Hawkins.
Thank you, Mr. Chairman. I don’t want to muddy the waters. I will take the yes. Would the Minister make the commitment to get it back to either me or this committee in some form by tomorrow to find out if that will be the case, that she should be able to provide a copy to the House or the Members or whatever form is appropriate, but could she do that by tomorrow? Thank you.
Mr. Chairman, I will look to see what we can do. Thank you. It is actually a real old internal document. I need to track it down and work with other agencies, but I will do what I can. Thank you.
Mr. Chairman, well, if it is only two years old or even two and a half years old, I wouldn’t define it as old. I am sure we are dealing with other facts that are much older than that. Does the Minister or anyone, for that case, know what that zero-based review would have cost to do? Furthermore, what results have been driven out of this? So the costs and results that have been formalized. Thank you.
Mr. Chairman, it was done internally in the department and by the program office, I think, in FMBS was involved as well. I think we talked about this three years ago. Thank you.
Well, actually that doesn’t sound familiar. Now, when you are suggesting that committee members talked about that, can you also provide... Obviously, then, there must be some subsequent briefing documents that reflect upon the observations it made as well as direction and decisions that could be made on the particular document. Can you provide those pieces of information? Just to be clear, the only thing I am looking for a yes tomorrow is can we get a copy of this information? Of course, we will sort out the timeliness of the remainder. Thank you.
Mr. Chairman, yes, I will get back to the Member and Members here. Thank you.
Thank you, Minister Lee. Next on my list is Mr. Bromley.
Thank you, Mr. Chairman. The first question concerns the budget for hospital services. I see that is going up by $5 million and I am wondering where that is going. Is that Stanton dollars or is that divided amongst the authorities?
Thank you, Mr. Bromley. Mr. Elkin.
Mr. Chairman, it is going up by $6.5 million: $2.4 million as related to Collective Agreement increase for that year; $1.8 million is for Stanton and Beau-Del to fund their benefits from 17 percent up to 23 percent because they are a 24/7 operation; as well, another $800,000 roughly for Beau-Del for relief costing. Stanton previously received that in the previous budget. There is also some various contract increases across all authorities, about $500,000, and $400,000 for additional staff at the medical daycare unit at Stanton. There is also $790,000 related to the Territorial Health Sustainability Initiative going to authorities as well.
Mr. Chairman, what is the relief costing for? Is that for physicians or nurses, that sort of thing?
Mr. Chairman, it is funding for relief in call back of nurses in the hospital which is not core funded in their base salary.
I am not sure what that means exactly. If we have nurses, how can we not include that sort of thing for them? If this is for the absence of nurses, unfilled positions that are going out to agency nurses, I would like to know that. Thank you.
Thank you, Mr. Bromley. Ms. Meade.
This relates to how we are funded. We are funded by the position, so we are not provided the call-back money when a nurse is called back, because on a 24-hour operation, you can’t run the position vacant. This isn’t about agency nurses. This is the backfill when someone is called in, and under the agreement there are ways that is done and what they are paid for. That was never funded, so we came forward and asked for that balancing and that is what you see.
Mr. Chairman, thank you for that information. I believe I heard Mr. Elkin say that we did that last year too, or perhaps that is current year. Is this now a regular part of our budget? We can expect that this is now funded?
Yes, it will now be part of the core funding.
Mr. Chairman, I note that we have a physician for inside the NWT and for outside the NWT. I am just wondering if there is any way to report on a regular basis the services we pay for from nurses who are part of our staff and those that are brought in on a local or temporary basis. Thank you.
The physician resources that are outside of the Territory are not the physicians that we are bringing in as a specialty. It is anytime someone goes south and they are seen by a physician or they’re in Edmonton, and they’re all fee-for-service. So all of those are billing codes that come as per the reciprocal billing. That’s very different than nurse locums, which I believe we were asked earlier for trying to find to the best of our ability how much we’ve been spending on the use of locums. They are different.
I realize they are different. I’ll look forward to that information coming forward from an earlier request.
I also wanted to talk about the -- sorry, I still think of it as Community Call Coverage System -- the Territorial Support Network. How is that reflected in this? My impression, from the briefings we’ve had and so on, is that there is some capacity building that’s needed. I believe we have a lot of new equipment out in our health centres now in terms of X-ray capability and ultrasound and so on; perhaps some training needs still. I know bandwidth might be part of the whole equation. I’m sure there are others. How is work on that achieving an effective and efficient operational Territorial Support Network reflected in this part of the budget?
The work of the Territorial Support Network, or the TSN, is very much in the design phase. This is a very complex, new way of doing business. We’re looking at doing this maximizing the equipment that we have, maximizing the resources. So there’s a committee that meets twice weekly. We do have some research funding, it looks like, from Health Canada, because we have to evaluate and do research as we come along. That model is still very much in its infancy development and then we hope to take that both to medical directors and the joint leadership and management committees. It will have to have a lot of the tires kicked as to implementation and how we’ll implement this slowly. I think as we have that model further developed, we’ll be able to do more costing. It’s very exciting work. I can tell you that the physicians, nurses and authority leads that are involved in this work are very enthusiastic and working very hard, but it is very preliminary at this stage.
