Thank you, Mr. Bromley. Minister Lee.
The Member is absolutely right. We will ask to have that reworded. Thank you.
Thank you, Minister Lee. Mr. Bromley, any further questions? Okay, we are on page 8-21, Health and Social Services, activity summary, health services programs, operations expenditure summary, $188.658 million. Agreed?
Agreed.
So we will turn back to page 8-25 and next on my list for 8-25 was Mr. Menicoche.
Thank you very much, Mr. Chairman. I just wanted to re-raise the issue of medical travel and issues by constituents. I know that the Minister had indicated that they are currently reviewing the guidelines, and many of the issues that cross my desk and what I raise in the issue is not dissimilar than Mr. Beaulieu’s. The few others are some elders that are being medevaced, are being medevaced without an escort with them, especially those that require translation. I have got constituents in my riding that do what they can for the elders and those that are sick and in need, and they often go on these medical travel trips, often for days, sometimes weeks at a time and they are low income or no income. So I have requested over time to allow for at least incidentals, because I know that when they do come to Yellowknife, they are given a place to stay, a place to eat, but at the same time they have no income at all, so I would just like them to review, to allow them for some type of daily incidentals or something.
As well, during the springtime I had an incident where the patient is in the hospital in Yellowknife or in Edmonton for lengthy periods, there is actually a replacement of escort policy, I think it is, I am not quite sure, maybe the Minister can inform me, but I think it is, like, two weeks. But I think in most cases, Mr. Chairman, is that the escort is going with the elder or whoever is sick and they are prepared for only two or three days and when the illness does take a turn for the worse or else it is extended, then the person asks for medical travel so they can go home but medical travel tells them they have to be there for two weeks and they are often without money or unprepared, but that is their rule of thumb, but that is there, flexibility. I don’t know if flexibility or those things must be built in to the review of the Medical Escort Policy, which leads me to the next question, Mr. Chairman.
I know that when I raised these questions in the House, I think in the fall time, the Minister indicated that the policy is being reviewed, so I would just like to know the timing of it and I certainly would like, as a Regular Member, I certainly am not on the Social Programs committee, but I would like to have input into that reviewing of the policy and as it moves forward. So just in terms of timing, when will we be looking at receiving this initiative and how much work have they done to date, Mr. Chairman? Thank you.
Thank you, Mr. Menicoche. Minister Lee.
Thank you, Mr. Chairman. The issues that the Member is mentioning here are a part of the review, so we expect to have the review done by the end of this fiscal year and to be able to bring forward to the standing committee for discussion with recommendations following that in April or May. Thank you.
So the department is working on it and they will review it with the Social Programs committee and it will be at that point that the committee and the Regular Members will have input into the new policy. Thank you.
Yes, Mr. Chairman.
Thank you. Next on my list for 8-25 is Mr. Bromley.
Thank you Mr. Chairman. My first question is, though I recognize we have come a long ways in our extended health benefits discussions and that the grandfathering that was provided in the past has been dropped as of I believe this April, or maybe it has been already, and I am wondering if we know what sort of savings that will provide. Thank you.
Thank you, Mr. Bromley. Minister Lee.
Thank you, Mr. Chairman. The grandfathering will be dropped as of April 1st. So far the transition is quite smooth. We don’t believe there will be a savings per se, it is more so about consistency and fairness in applying the policy across the board so that we don’t have this class of people that has been grandfathered in perpetuity, which I would think would add more complications. I am going to ask Paddy to give more detail on numbers, if she has them. Thanks.
Thank you, Minister Lee. Ms. Meade.
For many of these, they have been asked to see their physician to see if the generic or the drug that is on NIHB can actually accommodate their need. We do know of two rare disease drugs that we won’t be able to change and those are very high-cost drugs. I think there will be some savings but it will only be in the case where the product can move to a generic, and in most cases the list got quite small. I think it is more on a go forward that we start to follow the set formulary, so there will be some costs, but it will be limited. Thank you.
Thank you, Ms. Meade. Mr. Bromley.
Thank you Mr. Chairman. My other question, my second question, is, I think that the working group and Members agreed to a number of principles and high amongst those principles is making sure that everybody is under the fold somehow to get coverage. What is the plan going forward for providing coverage to those who don’t have coverage now and is that going to be part of the 2011-2012 activity and budget? Thank you.
Thank you, Mr. Bromley. Minister Lee.
Thank you, Mr. Chairman. As the Member knows, this is under discussion at committee level and I need to get back to Cabinet for further direction and then dissemination of the information to the public. But as the Member knows, following the two or three-year debate we have had on what was then known as Supplementary Health Benefits Policy, which has now been rescinded and that policy allowed for extension of coverage to what we know as the working poor, but with the rescinding of the policy we are basically back to status quo, subject to some of the changes we are making or we are suggesting that we make that we are under discussion on. So I don’t believe we could make those changes without coming up with a new policy, so any policy changes will have to be part of the next round of discussions, if the next government wants to engage in that. Thank you.
I don’t disagree with the Minister and I think it was a solid principle. I know there is a number of ways that have been contemplated for addressing it but I just want to make sure that it is addressed in this coming fiscal year, because I think it was something that everybody did agree to and I think there probably is some coverage, at least for pharmaceuticals out there to help everybody in the Northwest Territories and perhaps that information is getting out there.
On the question of pharmaceuticals, I wonder if the Minister is aware that in the Canadian negotiations with Europe right now for European-North American Free Trade Agreement, they are talking about pharmaceuticals and the estimate is that it will raise pharmaceutical costs by $2.2 billion for Canada. My understanding is that it translates to $2 million in additional costs for the NWT. Is the Minister aware of this? Is she acting to prevent that from happening and avoid those additional pharmaceutical costs? Thank you.
Yes, Mr. Chairman, I am aware of that issue. It is at a preliminary discussion stage. The federal government has made it clear that they would not be signing something that would have that sort of adverse impact on our government, but I could tell the Member that this is not advanced to a stage where you wouldn’t even get to FPT. If it were to get anywhere near that, it would be at FPT level. This is just something that is floating around on a global level.
But something in Canada, we have a federation. We have a health care federation. Provincial and territorial governments have a lot to say on how these are implemented. That could not be done without our input. Thank you.
Mr. Chairman, I appreciate the Minister’s comments. I assume from that, that obviously she is a participant on that committee and that she would express that sentiment strongly that we would fight. I always think it is progressive to the Minister on my recommendation to the Minister to take it or leave it, would be to write and be on the record right now of the Prime Minister and whoever the Minister is dealing with on these negotiations.
My next question is on the specific issue of macular degeneration. It is an issue that leads to blindness in people. It has come up amongst my constituents. I know there are a number of people, typically the elderly, that experience this disease. There are two forms: one that can be treated and prevent blindness, the other can’t right now. The drugs are changing on this. I know that the new drugs have been accepted by other jurisdictions. Are we on the road to accepting those ourselves? Are we planning to cover that? Beyond that, we have a lot of travel costs on this. Do we have a capability to deliver that service in the North? Thank you.
Thank you, Mr. Bromley. Ms. Meade.
Thank you. The drug used is Lucentis and it is not the drug that has changed, it is the funding. Most jurisdictions were not funding this procedure. A lot of our residents -- not a lot, there are about 30 that were doing this -- were going to Alberta because they were able to go to a clinic where the cost was paid for. So we have just discovered these numbers because Alberta has made a change, put it on their formulary and, therefore, they are not being covered by this clinic. Because we didn’t know and approved the preapproval, it has been hard to find the exact numbers. We are looking at two things. The business case for the cost will be quite significant to add this to the formulary and in particular when you include the medical travel costs. We are also looking at, because the procedure is an injection and requires training and equipment, whether we could actually do that at Stanton. So all of that is being reviewed and we should be able to come forward to the Minister quite soon with that.
This often happens when you have a new use of a drug or a new procedure, that it takes a while in different jurisdictions, add it to their formula over time. But the other issue on this is that if you do it, you actually only approve it for so many injections because it does not treat all people. We didn’t have any control. You would set a stage of three injections and then see for progress. If there wasn’t, it wouldn’t be an automatic continuation. All of those are being done within the department and also with the medical advisor as to what the actual protocol should be and if we can do it. Thank you.
Mr. Chairman, I appreciate those remarks. I hope we can deal with this fairly straightforwardly and get a consistent message out there to those 30 or so patients.
My last question, Mr. Chairman, is on pharmaceutical expertise within the department. I understand that we have vacancies. There are some challenges there. What are those positions that we have on staff that require the pharmaceutical expertise and where are we in terms of vacancies and getting those positions filled? Thank you.
Mr. Chairman, there are no pharmacy positions in the department. The positions that we have had some difficulty with were in Stanton long term. We have been filling that with locums. We do have a longer term locum that -- please be nice to them when you see them because we are trying to make them go from a locum to a term -- that has been filled. There are three hospital pharmacist positions in the full system across the authorities. We also augment so the medical directors and the medical advisor will consult and in the department also, and this is often the case.
You can consult with the pharmacy medical school. The U of A has a pharmacy and the dean there has always historically been quite cooperative and supportive. Recent discussions with the pharmacists, we do have pharmacists on the therapeutic and treatment committee. We are looking at how we can increase the use of the current pharmacies within the... There are 30-some licensed and about 22 practising throughout the whole Territories. I think it is 22 now that we can tap into some of their expertise. The physicians do use them as well.
Thank you, Ms. Meade. The next person on my list for page 8-25 is Mr. Hawkins.
Thank you, Mr. Chairman. I just wanted to do some follow-up as to a specific concern regarding supplementary health benefits. I understand some changes are being proposed or considered and juggled. I wonder where the public benefits are going to be brought into this from a communication point of view as to some of the changes and the adjustments. As I understand it, there are no big dramatic changes from the existing plan, but, of course, the public is still keenly aware of this particular issue. Does the Minister have any sort of update that she could provide the House? Thank you.
Thank you, Mr. Hawkins. Minister Lee.
Mr. Chairman, on this issue, I am following the process that we have set for ourselves within this Legislature. As the Member knows, we had a Joint Working Group on this issue, released a report last fall. The department had a chance to review those and to work on them. We are consulting with the standing committee as we are expected to do. We have received feedback on that and the next stage is for the Cabinet to look at it, and that would include a communication strategy as well as making sure that our public is informed of what we are proposing or what the recommendations were coming out of the internal working group report.
As the Member stated, the information is already out there. What we are considering is what was in that Joint Working Group report and simply we have had to do more analysis of what those recommendations meant. Thank you.
Mr. Chairman, I guess by and large the concern from a number of constituents is that once the rally cry was heard and government decided to respond in what I would define as a favourable way, the public that spoke to me is the concern that they have disappeared on this particular issue and they are worried about what government may be fine tuning without sort of a public progress report of some sort. It is great that the Minister is speaking to the standing committee. I am aware of that, but from a public point of view, it is kind of scary to know that the government is taking care of you. It has a lot of people worried too. Is the Minister able to provide, for lack of better terms, a public progress report on the development and, more specific, some further principles to dial down into specific areas of adjustment? In essence, the public is concerned. This is a particular issue that people want to make sure they’re following fairly reasonably.
I am aware of the public’s interest on this issue and I am wanting to get the information out as well. So we will be going to the public in very short order. Thank you.
In the context of this is what we’ll be doing or is it in the context of a progress report working to the final fine-tuning position? Thank you.
It will be in the context of working with the recommendations from the Joint Working Group report, which is out there in the public. So we are responding to the direction from the Legislature by way of that committee report. Thank you.
When can the public have an expectation to be able to see something that they can put their hands on or read to see where the government is fully going? I have heard the Minister’s response each time when she says the Joint Working Group’s direction, we’ll call it that, when they cast a position and it seems to be the one that the government’s following, but like anything, the devil is always in the detail and that’s where they’re a little nervous. So, in other words, when can we expect something in paper form or official form? I’ll say it that way. I don’t really care if it’s in paper or not. When can they see it and have a chance to comment on the progress government is making? Thank you.
I would think that we will have that out in the next two or three weeks. Thank you.
Okay, thank you, Minister Lee. Next on my list is Mr. Yakeleya.
Thank you. Just to follow up, Mr. Chair, on the supplementary health benefits and the recommendations that came from the committee. I know in the Minister’s sessional statement from the last session she talked about this spring we would have new policies coming out and see where things are going to be followed up on the recommendations. I guess I just wanted to get clarification in terms of what she’s exchanging with MLA Hawkins in terms of their report that the government is now implementing on the supplementary health. I want to see where the working poor, how that issue is being followed up in seeing that the working poor has access to some of the health benefits now that we have. So is it two or three weeks or is it this spring that we’re going to see some of the policies that are going to be implemented based on the recommendations that the report suggested?
Thank you, Mr. Yakeleya. Minister Lee.
Thank you, Mr. Chairman. As I indicated, we’ve completed our internal work. We would like to get them out to the public. I’m just wanting to let everybody know that the framework within which we’ve been working on is the recommendations from the Joint Working Group report. At this point, having heard what we have heard, we are not anticipating coming out with a whole new policy or making sweeping changes. What we are trying to do is do what we can within the existing policy framework and to try to accommodate some of the recommendations that were brought up by the Joint Working Group. I appreciate that there are people who are interested in this, so we will get them out as soon as possible so everyone can have a look at it. Thank you.
I look forward to the report the Minister is going to release.
I want to ask the Minister about this budget line item on medical travel. In the 2010-11 revised estimates, there’s $19 million. In the 2011-12 main estimates, it’s $15 million. I want to ask the Minister what justified the lowering of that number? What happened there?
Mr. Elkin, please.
Thank you, Minister Lee. Mr. Elkin.
Thank you. The revised figure in 2010-11 included two supplementary appropriations, one for $3.2 million for the Territorial Health Systems Sustainability Initiatives funding. It also included $3.6 million in prior year deficit for Stanton for 2009-10, but it had to be recorded on our books in ‘10-11, but it was for the deficit Stanton incurred the prior year. So that explains the $19 million figure. So the difference between $12 million and $15 million for ‘11-12 is we, again, have the $3.2 million from the territorial federal funding.
Thank you, Mr. Elkin. Mr. Yakeleya.
Thank you, Mr. Chair, and thank you for the explanation. I want to ask the Minister about the billing issues in medical travel. Do we still have some disputes with the federal government in regard to medevac or any type of billing issues? I know we have a history and we used to have some issues there. Do we still carry on with some of the outstanding issues that we had in the past with the feds?
Thank you, Mr. Yakeleya. Minister Lee.
Thank you, Mr. Chairman. We don’t have a dispute with the federal government on billing issues with medical travel. In fact, what Mr. Elkin referred to THAF, we received extra funding to deal with medical travel issues. As the Members know, we have an extension of two years and part of our obligation is to exit out of the program and determine how we are going to support this program from within. So that’s one of the reasons why we’re reviewing the medical travel, but as Mr. Elkin mentioned, we were able to extend THAF and now it’s called THSSI and we were able to secure some extra money for medical travel for the next two years. Thank you.
Again, I’d like to ask the Minister about medical travel. I understand that the department will be reviewing its Medical Travel Policy and I myself being personally involved in medical travel in the Northwest Territories, look forward to having some meaningful discussions with the Minister and the staff about my own experience with medical travel. I won’t take up the time now to talk about it, but at a different time in terms of how medical has been with me at least and my family and I’m not very happy with it. I don’t need to say any more right now, but I wanted to have the opportunity to have that time with the Minister to go further into details and to talk about that.
