Thank you, Ms. Bisaro. Minister Lee.
Thank you, Mr. Chairman. It is not part of the Drop the Pop program right now, but we are reviewing that within the plan, including that in the future. Thank you.
Thank you, Minister Lee. Next on my list for page 8-21 is Mr. Hawkins.
Thank you, Mr. Chairman. On page 8-21 I just wanted to follow up with a couple of questions I noted under physicians inside the NWT and, as well, sort of cost to our health service centres. One of the particular issues I’ve noticed, and I’ve talked to the Minister and deputy minister, is the cost to health centres in how they distribute or reallocate funds; namely doctors’ cost and if we have a particular case where a health centre, or I should call it a health authority, where they are unable to find a doctor, they have excess funds sitting around, but they’re not allowed to hire NPs in the interim to fill some of those needs and gaps created. I raised that specific issue to the deputy minister one day in the building here and I’m wondering what headway have they made in that particular case. So as I understand it, doctor money is prescribed specifically to hire a doctor, but if you can’t hire a doctor in that particular authority for that particular hospital, the doctor money sits there and that therein lies the problem. Thank you.
Thank you, Mr. Hawkins. Ms. Meade.
First of all we are looking at the physician resources as a territorial resource. Currently the funding is per authority and it is circled for doctors only, but we are making the business case and we’ll come back to look at it shouldn’t be physician money per authority because that’s not how we’re delivering the service anymore. If you go to a virtual support, it could be physicians that, for example, Yellowknife provides the hospitalist service in Stanton and so those budgets aren’t aligned, or the services that are provided to some of the other authorities by Stanton are the Beaufort-Delta physicians. Using that money for NPs, currently we can’t use that money, but we are looking at an NP model in this and it will also fit with the Territorial Support Network.
So the progress is that the medical directors are finalizing a physician resource that will come back to the JSMC around what service is where and how we can supplement that with NPs and also with the support services network. So it’s still a work in progress, but I think it’s moving.
I don’t have a solution for you yet. It’s something we have to come back in our business planning and also make the business case around why the money needs to be reallocated across the authorities.
Thank you. Speaking specifically to the authority problem or the redirection of the actual funds, at the time we had this discussion you made me aware that FMB is essentially the problem. We have FMB in the room in an informal process and what headway has been made with breaking down those barriers at FMB to allow the department, or I should say the authority, the flexibility of spending the money where it needs to be, which is in essence allowing people on the ground to do the work they need to do. Thank you.
Thank you, Mr. Hawkins. Minister Lee.
Thank you, Mr. Chairman. As a Member of FMB as well as Minister of Health and Social Services, I need to say that nobody is getting in the way of making decisions about this sort of thing. We know, Mr. Chairman, that health care costs in the budget is the largest item in the government’s budget. We work hard to be efficient and use our resources wisely and as FMB we have given directions to authorities and departments to make sure that the money is spent for what it’s meant to do. That balances with the need for our system to respond. So I work with the Joint Leadership Council, the chairs of the authorities, and when the authorities have an idea to do things differently, we entertain them there. So there is a back and forth flexibility as well as the discipline that’s required in delivering the health care system. Thank you.
I don’t think that actually answered the question, which is I thought the policy restricted physician money being reallocated to, for example, NP money. So in other words, I can understand the FMB policy to ensure that if you didn’t hire a physician, you don’t run out and buy a whole whack of new laptops and photocopiers and fancy pens and whatnot. That would be a poor use of human resource money that’s meant for a job related to human resource function in that regard.
I understood it as the FMB policy did not allow you to reallocate to do the same type of similar service, if I may describe it, I don’t want to give anyone the impression I think the NP can do a physician’s job and vice versa. So that is the particular quagmire I am trying to navigate through and get some clarity. Is an FMB policy, without a lengthy sort of tangent response, is the FMB policy still standing in the way of that money being reallocated to human resource response to a problem? Thank you.
Thank you. I want to make sure I answer the question and what I said was FMB wants to have and we do want to have some discipline on health care budgets. At the same time we understand that we need to have flexibility and we have asked the authorities to come up with the business case to change the spending to accommodate local needs. I don’t want to talk about individual authorities, but the authorities get block funding to deliver health care programs and there are situations where they have a budget for physicians, but they may not have a full spectrum of physicians. Actually, they use a lot of that money for locums, but sometimes they want to do different things with that money and we do entertain them and we will consider them, but we have to make the case and that’s what the DM is required to do and that’s what all the authorities are required to do.
I do believe that I am answering the Member’s question. It is not that black and white, clear cut. I’m a member of the FMB, as well, and we want our authorities and everybody to spend the money the way that it was intended. There is room for flexibility as long as you build a case for it. We are doing that in the health care system.
So there’s no policy in FMB stopping the authority from spending what would be directly physician money on an NP to make up sort of some of the shortfall when it comes to human resource ability.
I don’t believe there is a clear rule that says you can’t, but the authorities are block funded with guidelines on what the money is supposed to be spent on. There is room for flexibility as long as we make the case for it and go back to FMB.
I would ask if the Minister could clarify that officially, because I think the last time I spoke to the deputy it was the reverse problem, which is the FMB’s authority -- to make sure it’s very clear -- restricts the use of those allocations in any other form but in the prescribed form.
Setting that aside with very little time left on the clock, I’ve raised, oddly enough in the same sort of circumstance, a timing that is raised with the deputy minister about what work is being done of rolling in physician costs into the departmental costs. One of the problems I’ve noticed is juggling those costs and managing them. As the Minister had said, and I believe she’s correct, is that if you’re using a physician cost and you don’t have a physician, you can get a locum. Obviously, that’s the pot that you pay that particular locum in. We know that’s not the cheapest solution and there becomes problems of funding and balancing those particular funds and paying across authorities, et cetera, et cetera. Without a lengthy sort of description, I’m sure everyone gets the issue.
What work is being done, in my view, which would be a better solution over the long haul, to roll physician costs into the departmental costs? Therefore it would be organized and probably streamlined for when we transfer physicians to provide services outside of their normal authority. A department could carry the locum costs which are usually blamed for part of the reason they go over their budget and require extra funds. So in other words, what type of work is being done to address that type of issue with the solution I am trying to propose that I think could go a long way?
Because it’s important, I’m going to make one last attempt to just clarify the answer to his previous question. The reason why I say there is no black and white rule about the limitations on how we can spend doctors’ money or other money or the budget for physicians, what I meant by that is over the last two or three years FMB has directed when we are, for example, approving extra budget for, say, out-of-territory residential treatment or something, FMB has directed very clearly that that money is allocated for that item and it cannot be spent for anything else. Obviously, there is a lot of merit for having that sort of discipline. At the same time, there are some local situations and unique situations in each authority and if we feel that we can improve the system by changing the way the money is being spent, then we can go back to FMB with a business case. That’s the way it is and that’s the way the department responds.
The second thing about the Member suggesting that we should move the physician money into the department so that we can manage it better, I’m not sure about that. We do know that physician costs are one of the largest ticket items in Health and Social Services budget. I’m not sure if where it’s located makes that much difference on how we manage that as much as what we are doing to manage that. I think the largest portion of that money is at Stanton. Each authority has a physicians’ budget. As the DM has spoken of many times and I have, what we are doing is part of the Foundation for Change and managing our health care system, is that we manage physician resources as NWT resources regardless of where it’s located, and we want to maximize the work that they do, we want to maximize the efficiency. We want to make sure that the doctors are working together and cooperating so that we lessen the possibility for inefficiency, and that’s why we have medical directors working together. It goes on and on. I don’t think where the budget item is allocated makes that much difference on how we manage them.
Thank you, Ms. Lee. We’re still on page 8-21. Next on my list for that page is Mr. Bromley.
Thank you, Mr. Chairman. I’d just like to quickly follow up. As the component the Minister just recognized, one of the largest of the health and Social Services delivery costs, that’s physician salaries and benefits. I’d like to request of the Minister what are physician salaries and benefits in comparison of that with other jurisdictions in Canada, by category, of course. I think that’s information that we’ve expressed an interest in for some time now. I appreciate that we’re managing this talent better and making some good advance on how we’re able to maximize their contributions to really appreciate, and this is strictly a financial component that I’m asking the Minister for.
Thank you, Mr. Bromley. Ms. Meade.
There are very few jurisdictions that have physicians with salary and benefits. Most are on a fee-for-service. Those that have alternative payments for academics, those physicians that also teach at the university, or in some areas specialized practice in some of the very large hospitals in Canada also don’t include benefits. So the comparison is difficult. For example, if you are in private practice fee-for-service, in some jurisdictions you may have support for electronic health records and not in other jurisdictions. It’s all massed in your compensation.
We can certainly give you the most updated of the ones we have, but to do a comparison is difficult because of the salary to benefit and how the different jurisdictions compensate their physicians. There are also several that it would be very dated because there’s about three, I think, currently in negotiations, but we can give you a breakdown of what fee-for-service in general doctors are making per year. Again it depends where they’re working full time and whether you’re seeing 60 patients a day or 15 in a fee-for-service environment.
I’m sure the department knows much better than I on the appropriate categories, so I will leave that to the department.
I know I see a physician regularly and a lot of us do. I know that there are collective agreements and so on. My request is for what we are paying our physicians in terms of salaries and benefits compared to other jurisdictions within whatever categories are appropriate.
Thank you, Mr. Bromley. Ms. Lee.
I’m not sure if it’s something that we could be speaking about here, but I’ll be happy to get the Member details privately.
Maybe is there a figure that we can point to as our costs for physician services in the budget here? Is that the physicians inside the NWT/outside the NWT?
Yes, that’s exactly right. On page 8-21.
Thank you, Ms. Lee. Next on my list for page 8-21 is Mr. Ramsay.
Thank you, Mr. Chairman. I’m just wondering if the Minister, I know she was answering some questions from Ms. Bisaro about the deficits at the authorities. Yesterday I had asked for correspondence from the department to the authorities, whatever that correspondence is, on instructions on how to deal with deficit. I was hoping the Minister could perhaps give the committee copies of that correspondence. I’d like to see what the department is telling the authorities.
Come the end of March it’s going to be up close to $30 million in accrued deficits around the authorities. I mentioned to the Minister it was only 18 months ago that we had the Minister with this deficit-fighting plan and she came to committee and was parading that around like it was going to happen and it never saw the light of day. Given some of these extraordinary circumstances that are playing themselves out right now, we have to be very mindful of our budgets, especially at the authorities. I just wondered if maybe the Minister could talk a little bit about how it is we are going to mitigate the deficits at the authorities. I’d appreciate that response.
Thank you, Mr. Ramsay. Ms. Lee.
Thank you. On the first point, we are compiling documents to respond to the various commitments that we’ve made over yesterday and today and we will get it to the Members as soon as possible. I mean within hours and days here as the staff put it together.
I know that the Member has mentioned many a time about me coming to the standing committee with a document that showed that we were going to reduce the deficit at Stanton to zero. Honestly I cannot see how that kind of document could have been possible. I am aware that we had many, many discussions, because, as the Member has referred to a number of times, Stanton, Beaufort-Delta and Yellowknife on a number of occasions have experienced deficit.
I don’t think any government or department could put as its objective that year, that year two or three we’re going to balance the budget in health care. That just cannot be an objective of any government. The objective has to be we want to deliver quality health care services in the most efficient and effective way possible. That has been my goal for the last three and a half years.
The way we do that is, with the deputy minister being the PA of both authorities, we are looking at system changes. We are looking at how we are using our physician resources. If there are areas that are underfunded, we are making cases to FMB to make those cases where we could change the scope of practice of our professions to deliver the system better. We are doing that where we could access resources for electronic means and information technology to help us deliver the programs better. We are doing that.
Every day of our work in delivering health care is about delivering health care but also of managing the budget. I know the Member has mentioned that a lot, but I really don’t think we’ve had a discussion where our objective is to balance the budget to zero. I don’t think any government could do that. I don’t think we could take $30 million out of our health care budget and see no effect. Our entire government is under restraint mode. We’re mindful of our budget restraints. I don’t think you could cut a lot. I think what we can do is try to be efficient and effective with the resources we have.
I appreciate the Minister’s comments. I’ll make sure that I get her a copy of the deck that she presented to the Standing Committee on Social Programs that day so that she has a copy of that. That was about 18 months ago. What I’m getting at is when the Minister talked about running an efficient and effective health care system here in the Northwest Territories, in my mind if we run enough deficits at some of our authorities to the magnitude that they currently are in, then are we managing and effectively utilizing the dollars that we have if those deficits are being allowed to build up like they are. In my mind, we’re missing something here. I’ve said it before and I’ll say it again, I don’t understand why, if we continue to bleed red ink in the authorities, why we don’t look at amalgamating all of the authorities and bringing them all under one roof so that we can better manage the growing expenditures in health care. It doesn’t make sense to have so many moving parts out there.
It’s nice to have control at the community level, Mr. Chairman, but I think we can have community input, we can have advisory boards at the community level, but the financial management and the financial control of what little health dollars we have has to be managed by one place. Not by eight, by one. I think unless we take that big step and do that, I think we’re going to continue on a yearly basis to be fighting about deficits at the various authorities. There has to be more accountability and responsibility taken when you’re talking about millions of dollars.
You’re right, Madam Minister, you can’t just wipe out $30 million all out once, but you know what you can do is come back time and time again to this House, a few million here, a few million there, to wipe out the deficits. That’s what’s been the practice of the government when it comes to dealing with deficits at the authorities. They come back through supplementary appropriation to this House time and time again and, Mr. Chairman, it’s not getting any better. So again, the question I have for the Minister is: is the department truly moving towards amalgamating those authorities, bringing them back under one roof so that we can better manage what we have? It makes no sense to continue down the path that we’ve been going down, Mr. Chairman, because it’s not working. Thank you.
I don’t see why we cannot contemplate that, and if that’s what the Member would like to see, then it’s something that we, as the government and the Legislature, especially in transition could consider. I would caution, though, that I don’t believe there is any evidence that says that if you had one authority, that would be the silver bullet fixer to managing finances. Alberta is a recent example of that. They blew up the boards, they tried to find efficiencies, and I don’t think there is any evidence to show that they are in any way saving their money.
We have a governance review that we are engaged in and that we are going to be sharing with the Members, and how we align, I think, the board governance for the entire Territory should be part of that discussion. What we are trying to do, in substance though, is that we are trying to get all of the authorities to work together. I mean, it may eventually lead to having one authority or a more harmonized authority, but we are by function encouraging and by policy or by direction, by just having regular dialogue with the authorities and at the senior management level we are working to coordinate our finances better. The backroom office is better. Going forward I think we will continue to have capacity issues in our authorities and we may, a future Legislature may have to look at amalgamating or having one board, but that’s a political discussion and it’s not a quick fix to deficit reduction. I don’t think we should look at it that way. I don’t think there’s any evidence to show that. Thank you.
What there is clear evidence of is that the authorities have been grossly underfunded for a number of years, and I think that’s a large piece of the deficit that’s been allowed to build up. The reason is because they’ve been underfunded. I’m wondering what steps the Minister can take. Obviously, I don’t think that’s been addressed in this budget, but they need to be funded to a more appropriate level and how are we addressing that? I guess that’s the question I’ll leave the Minister with. I know my time is up. Thank you.
We are working toward right sizing the budget for the eight authorities and we will be making recommendations on how we do that going forward. I do take the Member’s point and appreciate it. Thank you.
Thank you, Minister Lee. The next person on my list for 8-21 is Ms. Bisaro.
Thank you, Mr. Chair. I’d forgotten what I wanted to ask but I did remember. I just wanted clarification on Mr. Bromley’s question to the cost of physician services. The Minister mentioned that on page 8-21 it was physicians inside and outside the NWT, which is, give or take, $47 million, but on page 8-22 there are hospital services for $79 million and physician services to residents for almost $38 million. Both reference physicians, one in hospitals and one not. Is it $47 million for physicians or is it more like the $117 million that’s on page 8-22? Thank you.
Thank you, Ms. Bisaro. Mr. Elkin.
Thank you. The larger number on page 8-21 is the full cost which includes clinic costs as well as we do have some fee-for-service physicians in the NWT. Whereas the number on the other page is the salary...(inaudible)...contributions to the authorities. There are some clinic costs and some fee-for-services, as well, for the difference.
I’m sorry. That didn’t really help. Maybe I should ask the question what do physicians, an approximation of the number that physicians cost us on an annual basis. Thank you.
Thank you, Ms. Bisaro. Minister Lee.
We’re back to page 8-21 and $41.920 million for physicians in the Territories.
Then what are the numbers on page 8-22 for? The $79.041 million and the $37.928 million? Thank you.
Thank you, Ms. Bisaro. Mr. Elkin.
On page 8-22 is just the contributions to the authorities, which is for the $37 million for their salaried positions. The $41 million on page 8-21 also includes fee-for-service payments, which are paid directly by the department and not by the authorities.
Thank you, Mr. Elkin. We’re on page 8-21. I have nobody else on my list. Page 8-21, Health and Social Services, activity summary, health services programs, operations expenditures. Mr. Bromley.
Thank you, Mr. Chairman. I’m just about there, but I don’t think things were clear yet on that last question and I’m interested in that too. The $79 million provided to hospital services for primary and secondary emergency care by physicians in hospitals is obviously much greater than the $47 million referred to on page 8-21. I would just like to get clarification on whether that $79 million is for physician services or not, including or excluding fee-for-service. Thank you.
Thank you, Mr. Bromley, Minister Lee.
Thank you, Mr. Chairman. I think I’m going to have to do a better breakdown and get back to you, but the hospital block funding includes doctors working in those health centres and other services we provide. I’m going to get Mr. Elkin to explain.
Mr. Elkin.
The $79 million is just for the operating costs, including nursing staff, excluding physicians, for Inuvik, Stanton, Fort Smith and Hay River. It does not include any physician costs in that $79 million for hospitals. The physicians are in the physician line below, which is the $37 million. And health centres, the $27 million would just be the community health centres in each region and no physicians.
Thank you, Mr. Elkin. Mr. Bromley.
Thank you, Mr. Chairman. I just suggested the wording needs correction there because it says very explicitly for primary, secondary and emergency care provided by physicians, and now I am understanding that is for other operating costs and nurses. If that is correct and the Minister can agree to that, I am clarified. Thank you.
