I’d like to call Committee of the Whole back to order. Before we went on break, committee agreed to review Tabled Document 133-16(5), Main Estimates, 2011-2012, with the Department of Health and Social Services where we left off, which was page 8-21. Ms. Lee, would you like to bring witnesses into the House?
Yes, please. Thank you.
Is committee agreed?
Agreed.
Thank you. Sergeant-at-Arms, if you could please escort the witnesses into the Chamber.
Ms. Lee, for the record, can I please get you to introduce your witnesses?
Thank you, Mr. Chairman. To my left is Paddy Meade, deputy minister of Health and Social Services. To my right is Mr. Derek Elkin, director of finance. To my far right is Mr. Dana Heide, assistant deputy minister of operations.
Thank you, Ms. Lee. I’d like to welcome the witnesses to the House. When we left last time we were on page 8-21 in the Department of Health and Social Services. So we’ll return to page 8-21. Is committee agreed?
Agreed.
Page 8-21, Health and Social Services, activity summary, health services programs, operations expenditure summary, $188.658 million.
Agreed.
We’ll now move along to page 8-22, Health and Social Services, activity summary, health services programs, grants and contributions, grants, $40,000.
Agreed.
Page 8-22, Health and Social Services, activity summary, health services programs, grants and contributions, contributions, $145.171 million.
Agreed.
Page 8-22, Health and Social Services, activity summary, health services programs, grants and contributions, total grants and contributions, $145.211 million.
Agreed.
We’ll now move along to page 8-25, Health and Social Services, supplementary health programs. Mr. Beaulieu.
Thank you, Mr. Chairman. I have a question for the Minister on medical travel. I just wanted to give a little bit of a background on some of the stuff that you’re dealing with at the community level. I’m trying to see if the Minister would look at putting some sort of flexibility into the Medical Travel Policy or the medical travel benefit, I guess it is.
What’s happening is people are facing some hardships. We have experienced in the past and we continue to experience situations where people are sick or injured and have to remain in hospital, whether it be in Yellowknife or Edmonton. Medical travel will support one individual to support the person and depending on the nature of the sickness or the injury, I find that more than one individual is needed in order to provide proper support to individuals.
I’m wondering if the Minister could give me some assurance that the department would look at something on a case-by-case basis, I suppose, where I currently have a situation where I think that even a young man is seriously injured in a car accident and the family, even the mother and father, need to support each other and need to be with him, but medical travel is fairly restrictive as to who can provide assistance. It’s kind of like looking at these things on a case-by-case basis, not trying to get a bunch of people to go travel with someone unnecessarily. I understand that. This is very important to families. Of course, there’s low income as well.
I’m wondering if, I guess to be really specific with my question, based on income, will the Minister or department look at providing a benefit to more than just one individual in situations where a person is seriously injured or sick.
Thank you, Mr. Beaulieu. Ms. Lee.
Thank you, Mr. Chairman. The flexibility that the Member is suggesting would be a policy change and I think what we need is we want to be clear about our policies. If we want to change the policy, we should change them. Adding a flexibility makes it too difficult for staff in the system to administer.
What the Member is speaking to is a compassionate medical escort and a compassionate escort is not provided for under our policy. We are reviewing our Medical Travel Policy right now including an escort issue, because we are inundated every day with families who would like us to assist more. We as a Legislature have to make decisions on that and how much money we are willing to invest on that, because the needs and demands would increase.
Every family, every situation, I could give you dozens of examples over the last year where, whether it’s a little child, a young man, different levels of disability, an elder. We have a situation where an entire extended family wanted to be able to go and visit their family in need. The demands are endless and we are talking about if we implement those, we’re talking about doubling or tripling the expenditure. If that’s what the Legislature wants to do and that’s how we want to spend our health budget, that is a decision for us to make, but I would suggest that it can’t be done as a case-by-case flexibility situation because it could not be administered.
I just want to let the Member know that the department is reviewing the Medical Travel Policy. We are reviewing the Escort Policy. I will come back to standing committee on what our options are, what may need to be changed, and what the cost implications are so we have a very clear picture about choices that we face.
I actually think that changing the policy would actually make us go too far over to that side, that I think putting some flexibility into the policy makes it easier to administer, actually, because of the case-by-case basis and the rough parameters of income and the nature of the issue. I think it’s something that can be developed. If we look at a policy change, it’s going to be something that’s going to take a long period of time to do, number one. Number two, it tends to put us in a box. That’s what most of the policies seem to do in the government. The government makes a policy and does not deviate from outside the policy no matter how reasonable and needy the situation is.
I think that just to again look at asking the Minister to look at some flexibility in the current policy and if that’s difficult to do, maybe to add some sort of parameters around the development -- I don’t even want to say development of a policy because I think that means a lot of work by a lot of different people and a long period of time -- asking the Minister to develop some sort of parameters that would make the policy more flexible, more humane, actually, I guess. Because right now it’s not really that way.
We have elders that are sick here, where it was difficult for the family to provide them support. Especially family members that don’t have other family members living in the city of Yellowknife that have to come in and set up here in order to support the individual that’s sick. I don’t know the process or who the Minister could report this back to, but maybe just to the Priorities and Planning committee on looking at some flexibility in the policy.
Introducing an income threshold for determining eligibility about medical escort would be a policy change. If that’s what the Members would like to consider, that’s something that needs to be discussed and changed in the policy and we know how difficult it is to determine eligibility of house benefits by income. I personally believe we should help those who need the help the most, and often it’s those who are under low income.
Mr. Chairman, as I stated, we are reviewing the Medical Travel Policy and there will be some recommendations coming out of that. Under current policy there is room for flexibility where a case can be made that someone needs more than one escort medically, but it has to be medically evidenced.
My experience has been that most cases that come forward and ask to be looked at by giving more flexibility, we are talking about compassionate cases, and our policy does not allow compassionate medical travel because, as you can see, how do we determine that somebody who has a three-year-old child waiting for a heart transplant or a young man who is older than 18 but who needs his family but they’re not really a child? At what spectrum of medical condition do you determine that somebody needs a compassionate escort more than others? That is a real huge Pandora’s Box. For that reason, just for clarity and simplicity and ease of administration and for the people to know what they’re eligible for, that we need to have very, very clear guidelines and stick to them.
I’m not deflecting the Member’s question. This is a very, very complex area. If we’re going to change it, we need to change the policy. I am coming back to the Standing Committee on Social Programs with the results of our medical review and escorts will be a big part of that, so I look forward to having the discussion with the committee. Thank you.
Thank you, Minister Lee. Mr. Beaulieu, your time is expired. I’ll go to the next person on my list. Mr. Ramsay.
Thank you, Mr. Chairman. I seek the committee’s indulgence to return to 8-21. I just had a couple of questions I wanted to follow up on there. Thank you.
Is committee agreed that return to page 8-21?
Agreed.
Alright, committee, we’ll go back to page 8-21 and go to Mr. Ramsay.
Thank you, Mr. Chairman. Yesterday I was talking about some work that I think the department should be looking at in the area of the impending closure of the municipal airport in Edmonton. I listened to the Minister’s response yesterday and she said it could take up to three years. You might be right, Madam Minister, but it could happen sometime this year and I think we need to be heavily involved in the planning of that. We have to get a better understanding of what the impact is going to be on our budget going forward and I’d like to see that work begin in earnest.
The other issue that I wanted to bring up, and we talked a little bit about it yesterday, was the rapid repatriation protocol between our government and the Government of Alberta. Mr. Chairman, I guess I’m struggling to understand or figure out how we are planning for the more rapid repatriation of patients from Alberta hospitals back to the Northwest Territories and the corresponding cost associated with that happening. It runs the full gamut, everywhere from janitorial services to food services, the nursing component, other staff, doctors’ services. There’s going to be costs incurred across the board not only at Stanton but in Inuvik and Hay River and Fort Smith. What work are we doing upfront on this? I’d like to see it somewhere presented in the budget. The budgets don’t seem to be going up. Are we just going to be rolling with the punches as they come, Mr. Chairman?
Thank you, Mr. Ramsay. Minister Lee.
We are far from rolling with the punches. This is something that occupies us 24 hours a day. I’m going to get the deputy minister to give a full detail of the actions we are taking. Thank you.
Thank you, Minister Lee. Ms. Meade.
Thank you. I am going to speak about the airport situation first. The Edmonton airport, I actually have been on the consulting group with the consultant that was hired by Alberta Health Services to look at the triaging at the Edmonton airport. So I’ve had input for the last two years. I was also one of the stakeholders that was interviewed by the Health Quality Council and I’ve added several other people to that, physicians in our emergency, those working with me on the medevac procedures so that we have a broader input on that one.
But the planning is not just the Edmonton airport closure. Alberta has been talking for awhile about needing to expand its services to some of its other hospitals. Grande Prairie will actually start to take cancer and some others, there are Red Deer facilities and even Camrose will expand, and they’re looking at different procedures between Edmonton and Calgary. So we are already looking at a change to our regular flight patterns and what hospitals are used.
Then the issue of the 48-hour repatriation. This is one thing that they have just advised us of in this past year and also we have to add to that their emergency protocols that have also just happened, because that also impacts the movement. We’re dealing very closely with them. As far as how we can move quickly, there will be a cost, but right now we’re looking at what’s the cost, how’s this happening, and our bed management. Have we got on-call? We weren’t full over Christmas when we really started to see the impact. We are fairly full now. We are triaging from Stanton to Hay River and Inuvik, but, of course, that’s going to be a cost issue for us to start to fly patients to Inuvik for beds.
At this point we’re starting to look at how we’re going to capture these costs that are true costs from this increase, because at the same time we’re already seeing an increase in our bed use and in our medevacs.
Separating out what’s an Alberta pressure from overall is quite difficult. We have actually, I think, made significant impacts on medevac and medical travel, but you don’t see that. What you still see is a deficit, but when I look at the increase around age, chronic disease, some of the other issues that we’re coming in for.
What are we doing about this? We’re working with the CEOs, in particular those three major facilities of Stanton, Hay River. We’re trying to capture quickly what’s the data, what’s the impact in our home care. So far, actually, we’ve been able to manage the repatriation. There’s been some where Alberta has flown back to us but we’ve had a bed without having to move. The real issue will be trying to measure what’s the next level of acuity for home care. That’s going to be more difficult to see what’s the training and what kind of equipment. There are groups starting to monitor the patients. I think it’s quite early because there are so many things coming at us, but it is definitely a work in progress and we’re struggling with how we most easily capture the data that we’re going to need.
Thank you, Ms. Meade. Mr. Ramsay.
I appreciate the response from the deputy minister. I guess, from my perspective, especially the Beaufort-Delta and Stanton are in such dire straits financially, running up big deficits at those two authorities, my fear is that when you throw this on top of everything else, it has the potential to send them spiralling again further into a deficit situation. I’d like to see the department budgeting for… And these are costs that I don’t think would be too hard to even guess at what your costs are going to be. Your costs are going to go up. If you have to repatriate people within 48 hours, it’s going to have an impact, like I said, all the way through the system. Whether that’s 4 percent, 5 percent, who knows? I’m not going to throw a guess out there but it is going to cost you more money.
I guess the thing I’d like to get at, Mr. Chairman, is how are we budgeting for it? We know it’s coming. How are we budgeting for it? Or, like I said, are we just going to wait and just let it happen, let the deficits keep accruing at the authorities and deal with it later? Is that how we’re budgeting for these changes? Thank you.
Thank you, Mr. Ramsay. Minister Lee.
We need to consider separate factors from what the Member has suggested. What he’s saying is we should be able to neatly budget what the costs will be and have better control, although that’s one definition of control.
The second thing is, are you just going to spend and spend and spend and not have control? In health care we need a third factor, which is what we’ve been saying all along, that we are working within the system to be ready to respond to manage our resources wisely, but there is no way you are going to have a budget that is going to anticipate, predict and neatly categorize that we are going to have a 3 percent increase, 4 percent increase or a 5 percent increase. That is not possible. One person could walk in tomorrow and need a blood transfusion and that is a $600,000 item. It may not happen, but it could happen. We could have a major... Cost control in that way in health care is not possible.
I know the Member would like us to have a budget prediction, be able to forecast everything, but that is not possible because we respond to the demands of the people. When they need their procedures, they get them. We pay for them. If they need medical travel, they get them. If they need an MRI, they get them. If they need a CT or if they need their knees or hips replaced, we do them. We don’t know how many people are going to need them.
What we could do is we respond as a system to make sure that we use our resources wisely. Even with the Edmonton situation at the airport or the 48-hour rapid repatriation, our system is responding by working our resources wisely and communicating better. But the health care budget is not like the transportation budget or even the education budget where you can see the trend of population at schools. Thank you.
Mr. Chairman, I guess I will just disagree with what the Minister is saying because I think going forward we know the new rules of engagement with the Government of Alberta. We know it is going to cost us more money. Why isn’t there a corresponding increase in the operations and the maintenance of the authorities and the department to address those concerns? That is the question that I have. We know it is coming. It is going to hit us squarely in the pocketbook. How come we are not budgeting for it? That is my beef, Mr. Chairman. Thank you.
Thank you, Mr. Ramsay. That is more of a comment, not a real question. We are on page 8-21. I have a list of speakers, but I believe those are for 8-24. Is there anyone who would like to make comments on 8-21? Okay. Ms. Bisaro.
Thank you, Mr. Chairman. I have a couple of questions here. We talked, I guess it was just yesterday. It feels like a week ago when we talked about the deficits in the Beau-Del Health and Social Services Authority and the Stanton Health Authority. I wonder if the Minister could advise whether or not there is a debt reduction plan for each of those health and social services authorities to deal with their debt and their deficit. Thank you.
Thank you, Ms. Bisaro. Minister Lee.
Mr. Chairman, no, we do not have a debt reduction plan for each authority because we do not consider this debt as being an authority debt. We have been saying that for three years. We consider this as a system debt. We are making systematic changes through Foundation for Change. We believe that we need to make systematic changes to make sure that each authority has the right budget, that they do things without duplication, that they are a better transition of services and patients across the authorities.
Right now we have some authorities that are having a surplus and some that are in deficit, but we don’t consider them a deficit of that authority. This is why I have had my deputy minister speak at every occasion about things that she is doing to change the system. These are all interconnected. Foundation for Change is interconnected. Getting some money for the relief staffing cost is inter-related. Getting money for technology is inter-related to dealing with this deficit situation, so it is a complex multi-faceted way of managing the health care system. So, no, I have no intention of sending a direction to Stanton and say you are in deficit for $5 million as of this fiscal year and I expect to clear the budget, because the understanding of our system is that they can’t do that. I can’t do that. We have to respond as a system. Thank you.
Mr. Chairman, I guess it begs the question to the Minister: if it is a system debt and it has been three years that they have been trying to rework the system debt, how come we haven’t seen any change in the various health authorities? Why are they still working with budgets which are obviously unworkable? They are obviously underfunded.
The Minister referenced a number of things that the department is doing. I support all of those things, but I guess I am wondering why we aren’t seeing some effect of the changes that are happening, the efficiencies that are being found, the reworking of programs and services between authorities. Why is that not reflected in the budgets at least to a certain extent? Thank you.
Mr. Chairman, it is reflected in the budget to a certain extent. We have improved in our medical travel component of Stanton Territorial Health Authority, for example. This year’s deficit is less than last year’s. It is reflected. I need to get the DM to give a little bit more detail on how our deficit picture has changed as a system. Thank you.
Ms. Meade.
Mr. Chairman, I think some of the initiatives are as a result of seeing where the patient flow and where the needs are. That has to come up as to what is the real issue and what is causing the deficits. I think there has been lots of attempt at deficit but it wasn’t from a full system change. To look at the Beaufort-Delta Authority in isolation of what they are picking up from other authorities and also the economies of scale and ways of doing business. As the PA for both of those large ones, I can tell you that there are ongoing budget reviews and looks at how we can plan to reduce the debt or manage within the budget the increased pressures on those health systems.
One of the things, for example, that the Beaufort-Delta was looking at was lab costs to see that, in fact, it was a lack of discipline in the Sahtu that actually was driving the lab costs and spent the budget. So now we are looking at how we actually streamline and get medical directors involved in monitoring repetitive lab costs throughout the whole system.
I think that you see less about a full deficit reduction as more as bending the curve on these things initially. We are also looking at what should be the right budgets in those different authorities as we change the patient flow.
Things are coming at us very quickly as we started this work. We didn’t know about the Alberta pressures, the issues around how we could do some special programs ourselves.
To implement change and to deal with efficiencies has also taken some education and some understanding at the authority level and at the key provider and stakeholder level, for them to buy in and see their own role in efficiencies. I think we are starting to see that. While it has taken some time, for example, at Stanton, we are with both coming forward on critical funding areas that hadn’t been identified before through supp funding through support by the Financial Management Board, but we are also starting to see a reduction in the overall deficit at Stanton. That is with increased pressure and increased use of their specialists, ORs and beds.
I think the bigger issue is you are starting to see a system change. This is something that all of the health systems are struggling with in Canada, but getting a handle on it as a system and really drilling down to where can we start to make the change and what is going to have public support and understanding has taken some time and will continue. I think we have made great progress in the last couple of years.
Thank you, Ms. Meade. Ms. Bisaro.
Mr. Chairman, thanks for the comments. I don’t doubt that there has been progress. I guess I am just looking to see that that progress is reflected in the various authorities’ budgets. I think I heard the deputy minister say that there has been some.
I did want to ask, as well, about the client navigator position. My understanding from previous information, I believe, is that the client navigator position is going to be dropped in this budget. I have a concern. I’d like to know a couple of things. Just what is the job of the client navigator, and the second part is that I understand it’s going to be delivered through the single-window service centre, which I believe is being set up by the Department of ECE, I think, or maybe it’s the Executive, but I have concerns about how a client navigator for health can deliver services through a single-window service centre in various communities. So if I could get a definition of the job and then how that job is going to be done through the single-window service centres. Thank you.
Thank you, Ms. Bisaro. Ms. Meade.
The Foundation for Change document referenced a client navigator and already the system needs and priorities have changed. So a client navigator doesn’t really assist much. A client navigator can be a specialist, for example. We do have one, we intend to keep one who deals with cancer patients and the flow between Edmonton and Stanton and then dealing with treatment. A navigator helps you interface with the various specialists, the variety of specialists and treatment needs and appointments you need. They arose out of large centres where you were probably going to four or five different hospitals and clinics and specialists.
We’re now looking at, within our Chronic Disease Management Strategy that we’re bringing all the authorities into, is that are there key areas where a navigator would be helpful. A navigator is anything from somebody who gets you through a particular hospital instead of clinics, to somebody who helps you manage and it’s an information. I think there was some discussion earlier about is this somebody that really just provides information, but that’s not a clinical navigator and we are feeling that the clinical navigator in the area of chronic disease. So while it never was in the budget, it was in Foundation for Change. We feel that we need to rethink the best use of a navigator program and link it to chronic disease and look at within both existing resources and what we would need in the future.
Thanks for that explanation on the client navigator.
I just have one quick question. The Minister made a statement this week about Drop the Pop and I wondered if I could get an explanation from her, or a bit of an elaboration on whether or not this program will also target energy drinks, which I think are probably even more evil than pop is. Thank you.
