Thank you, Minister Lee. We’ll go on to Mr. Robert McLeod next.
Thank you, Mr. Chair. I’m not sure if this is the forum or not, but I’m trying to understand the process of the hospital. That, I think, will go a long way to my understanding the reasons, especially in respect to the $4.3 million at the Beau-Del regional hospital.
Maybe the first question I could ask is…. I’ll ask two at the same time here. The $4.3 — is that just for this year or is that over three years like Stanton? My second question is: when the Beaufort-Delta regional hospital provides services, they are required to invoice. I believe that’s correct; I think that could be my second question, Mr. Chair.
Thank you, Mr. McLeod. Minister Roland.
Thank you, Mr. Chairman. The deficit of Beaufort-Delta Health and Social Services started as far back as 1998–99 and grew. At that point it was in the range of half a million dollars. It fluctuated. They came out of the situation for a couple of years, but back in 2003–04 it started again, and they continued to grow a deficit. At the same time we, as a government, over a number of years through supplementary appropriation, funded half of their deficit situation.
Some of this, for example, is when there are utilities costs that go up on an annual basis that were not budgeted for at the beginning of the year. They grow throughout the year, and we have to look at addressing that. We’ve done that with departments a number of times. When you look at, for example…. Fuel costs that were not budgeted for at the beginning of the year have risen; there has been a number of supplementary appropriations that came back. From time to time we’ve — not only health authorities but departments — told them we would pay half of it and they would have to fund the other half. As we see costs continue to rise, we’ve realized it is not in the ability of the authorities to pay down those costs, which continue to climb and are out of their control.
Some of these are due to the fact they’ve also gone for a number of years having revenue owed to them that was not collected. That is where we, as FMBS, have become involved — in the collections side of the authorities as well.
I thank the Minister for that. He did mention the collection of the revenue, but my second question is: the authority invoices for services they provide; if those invoices are not sent out quickly enough, is that reflected in this $4.3 million too?
It is reflected in these numbers. When invoices are not sent out in a timely fashion, they become, for that year, a debt owed to the authority. It continues to grow after that. That’s why we’ve become involved, now, in looking at the collections side of the ledger.
So FMB is going to look after the collections and the invoicing. Do we have any idea how much we have outstanding in invoices? Were these invoices ever sent out? You’d have to send an invoice out to not get paid and then have FMB come and do the collection. I’m just concerned that…. Is there a box full of invoices that were never sent out and therefore can’t be collected on? With FMB getting involved, were you going to go into the office there and go through all the paperwork and determine if we have a lot of outstanding invoices that haven’t been sent out or haven’t yet been collected? Thank you, Mr. Chair; I think there was a question there.
Mr. Chairman, the Department of Health and Social Services in the previous Assembly did, in fact, send up an individual and help the authority go through its finances and begin to look at its books to see where it was having problems. So some of that work has been started. FMBS at Stanton, as I’ve stated, has become directly involved with the collections side. Invoices have been sent out and are due. We’re working with the appropriate bodies to get payment on those.
Just in closing…. I’m not one to point fingers, but if we’re having an issue with collections or invoicing, my opinion would be that it’s up to the CEO to monitor and make sure these invoices are going out and being collected on. It does, as the Minister said, reflect in this $4.3 million. I think if that gets tightened up just a bit, we may not see a deficit coming forward in the future — hopefully. The Minister did state that, before, there were a couple of years where we didn’t have a deficit. Maybe those were the years the invoices went out in a prompt manner and were collected on as soon as possible.
Like I said, I’m not one to point fingers, but we talk about accountability and that in the Assembly here, and we all feel we’re accountable. I think all the departments should be accountable to the Legislative Assembly. We’re talking $17.3 million here — that’s quite an amount of money. I think I did ask the Minister before: does FMB have any idea of the actual dollar amount of unpaid invoices for the Beaufort-Delta regional hospital?
There’s a number of questions there. The issue of the CEO and taking account for what’s happening within a facility is one that is accurate, but the CEOs report to boards, and boards…. We work at arm’s length through the territorial health and social services act in delivery of that service. That is one of the reasons we have to look at the boards’ and agencies’ work in this Assembly and come up with another model for delivery if we can’t get a hold of what’s going on, or change the process we’re involved in, in this environment. FMBS has worked with the authorities, and we have come up with the figure from the authorities. For the Beaufort-Delta, we’re looking at $2 million dollars in receivables. At Stanton I understand we’re about $12 million in receivables.
Thank you, Mr. Roland. Mr. Bromley.
Thank you, Mr. Chair. Just following up on those comments of the Minister and the collections brought up by my colleague. For Stanton, I believe about half of the debt for the Stanton Territorial Health Authority is due to billing disputes for services to Nunavut residents. I’m wondering if the basis of this dispute has been remedied. Are we no longer accruing debts because of billing disputes, and do we have a billing protocol that’s acceptable now in place?
Thank you, Mr. Bromley. Minister Roland.
Of the $12 million, approximately $6 million is billing to Nunavut. We have been working with Nunavut to try to come up with a satisfactory arrangement. For that detail I’ll get Ms. LeClair to give some more information.
Thank you, Minister Roland. Ms. LeClair.
Thank you, Mr. Chair. At Comptroller General I have been working with my counterpart in Nunavut to bring to their attention the large accumulated amounts that are owed to the Government of the Northwest Territories. We’ve been making some progress in getting the detail on exactly what those bills are. I will be meeting in the next couple of weeks with Nunavut officials to go over those details and, hopefully, get this issue resolved.
Thanks for those comments. So we don’t know…. We may still be accruing additional debt here. It sounds like we’re working on the process, though, that’s causing that debt to accumulate. Is that correct?
Not getting into detailed information that would relate to individuals — that’s best for another discussion we could have — there is some debt still accruing with the arrangement we have right now with Nunavut. As Ms. LeClair pointed out, we are working to clarify that and get that rectified.
Thank you, Minister Roland. Moving along to Mr. Krutko.
My question is in regard to the Beaufort-Delta Health and Social Services Authority at $4.3 million. I’d just like to ask the Minister if he can give me a breakdown of the $4.3 million. Exactly what’s the deficit for?
Thank you, Mr. Krutko. Minister Roland.
Mr. Chairman, $2 million of that debt is in receivables. For the other information I’d have to go to the Minister responsible for Health and Social Services.
The information I have is that it is an accumulated deficit over three years. That would take into consideration all the receivables and payroll, but it’s an accumulated deficit over three years since ’05–06, ’06–07 and ’07–08.
Is there a possibility we could get a breakdown of exactly what the deficit is? Is it a deficit by way of retention or travel or in regard to the cost of locums? We should have an idea of what those expenditures are.
We don’t have that level of detail on exactly what’s causing the shortfall there.
The breakdown…. Because it’s over a number of years and because we fund Health and Social Services authorities by block funding, we do have certain areas that money is allocated to, but there’s flexibility within that.
Part of it could be the different years. They may have had increased use of locum doctors or agency nurses or utilities costs going up. That’s one of the reasons FMBS has become involved in looking at a zero-based review and exactly how the money’s being spent on a day-to-day basis, coming forward with a plan and working with the Department of Health and Social Services on how we can rectify this so we don’t end up in this situation again.
One of the concerns I have — especially representing small communities — is that we seem to have seen a real decline in services in our communities in health and social services in regard to vacancies; lack of programs being delivered by mental health, alcohol and drug workers; doctor visits; dental care.
I’m wondering if one of the reasons we’re seeing fewer services is because of the deficit situation at the Inuvik health board, which is affecting the ability of the board to deliver the essential services to our communities. Where we’re seeing a decline in those services, I’m wondering if there’s a correlation between those.
Also, I’d like to know exactly when the last time was that the Beaufort-Delta health authority had a surplus.
It fluctuated between years. It started as early as 1998–1999. There were a couple of years there that it did come out: 2001–02 was the year they had a small surplus; in 2002–03 they had another small surplus; and in 2003–04 they started going back into a deficit position. I believe the last time they had a positive entry was 2004–05.
I was saying, Mr. Chairman, the fact that the department has been working with authorities and trying to get them to live within their means…. But the simple fact that they had been spending more than they had been bringing in is an example of everything the Member’s raised; for example, further increasing the costs of delivery across the Territories in a number of these authorities. It is something we’re going to have to get a grip on and make the necessary changes to start living within the budgeted amounts that are provided.
Mr. Chair, I think that if any review is going to take place, we also have to do a review in regard to looking at the services that are being provided through this funding, because every community — when you look at the tracking system we have in government — has earmarked a dollar amount for health and social services if you look at GNWT tracking. Every community says if we have this money, why is it not being spent or why aren’t those positions filled in our communities? Someone else is spending that money on our behalf.
I think that if you are going to do any review, you’ll have to also look at the service side of the review, ensuring that the fundamental programs and services are being delivered — and if they’re not delivered, why not? For myself, I’d just like that question answered. When communities know there’s a set amount for health and social services, education, policing, municipal services and whatnot budgeted by community through government tracking, and that money is not being expended in a community, then the question is: where is it being expended? If you are doing a review, is that something that’s also going to be looked at?
Mr. Chairman, geographic tracking processes are done by the department and the FMBS as well. That breakdown is territorial, regional, community; looking at service delivery, looking at all departments. As Members are aware, although it’s broken down, some of the pots of funding are held either in headquarters, even if it’s for regional dollars, or in the regional centres if it’s broken down for community dollars, depending on how it’s set up. If it’s application based…. If, for example, the jobs are put out but no one is applying, or the qualifications of those applying for jobs don’t meet the standards set out, there are a number of factors that come in to that. I believe we are about to release, if we have not just released…. We are looking at 2005–06 numbers as our latest to be able to put out there for Members and the public as well.
I’d like to ask the Minister of Finance: is there going to be some sort of a caretaker in place to look at the Inuvik Health Board review similar to what happened here in Stanton, where you basically point at someone to do the review independent of the CEO or the board, so you can get to the bottom of exactly why it is that we are continuing to run these deficits year after year?
People are running in deficit situations. Like I say, for me, we raise issues in this House time and time again in regard to health care services positions that we assume should have been in a community’s mental health positions or alcohol and drug positions. Yet when we are dealing with a doctor, if you see him once a month, now it’s coming down to seem like twice a month. Dental care is down the road a couple of months. Those services are affecting the health and well-being of people in communities, yet we seem to be focusing a lot of attention on these large regional centres and Stanton.
I’m wondering exactly what type of assurance I can get from the Minister that there will be accountability and that whatever review takes place it will get to the bottom of exactly why we’re running into this situation year after year after year.
Mr. Chairman, the fact that the authorities have been running deficits for a number of years is a concern. That is why the FMBS has become involved, both on the collection side and doing the zero-based review process. The model we put together with Stanton Territorial Health Authority is the model we will be using, or a very similar model, for all other authorities that run into this area.
We know the Beaufort-Delta Health and Social Services Authority is the next authority that will undergo this review. Previously, the Department of Health and Social Services had sent someone in from outside that organization to look at its work in the financial area and pull the information together and try to help out. Yes, this next phase the Minister of Health and Social Services is undertaking is looking at the actual delivery and areas of delivery and looking at where we can then go with levels of service in the communities and across the territory.
Thank you, Mr. Roland. Mr. Ramsay.
Thank you, Mr. Chairman. I wanted to ask for the third time — it’s not the financial Minister; it’s the Minister of Health. It’s the third time I’ve asked the question, and I’d like a straight answer on how many unfunded programs there are at Stanton, how many unfunded positions there are. She guessed 27, but I’d like to know the exact number. I’d also like to know under what authority were the unfunded programs and positions approved and who approved it.
Thank you, Mr. Ramsay. Mr. Roland.
Thank you, Mr. Chairman. Again, the department has begun this review, a zero-based review, looking at program spending to determine in what areas the spending is occurring, whether it is authorized in the sense of mandated programs or has there been a growth in program delivery in areas we would call expansion of the service delivery, though it may not be directly tied to a mandate. That expectation has come in.
I’ll give you an example, Mr. Chairman. The department, when they initially looked at the area of services provided to people in the Northwest Territories — this is a number of years ago — found that through the help of companies and individuals, the Stanton Foundation helped Stanton purchase some equipment to put in service for the people of the Northwest Territories.
I’ll use the CAT scan as an example, a vital service that’s helped a lot of people. Stanton was never set up initially to deliver that, so we’ve had to, over the years, begin adding to that. They found after the first year of operation they had to double up their teams because the service was used at a higher rate than was anticipated or budgeted for. It’s examples like that we will find come to the surface. It comes to delivery.
Now, who would say that we should stop that level of service? I don’t think anybody in the North would agree with that. In fact, as we heard from a Member already, we should be enhancing some of our service delivery, whether it’s territorial, regional or community. There’s a need for a level of service across the Northwest Territories.
For the specific response, I don’t know whether the Minister would have all of that, right down to who authorized it, and I don’t think we want to get to that level of debate in this Assembly, at least in this forum. But for the information about unfunded positions and the unfunded programs I’ll go to the Minister of Health and Social Services.
Thank you, Mr. Roland. Minister Lee.
Thank you, Mr. Chairman. The number I heard was 27. I’m in the process of verifying that. I’d be happy to get that information back to the Member. When the zero-based review team went to do the zero-based review, they found that Stanton Territorial Health Authority was delivering 53 programs. They looked at the mandate and the direction that each program got, and they’re all varying degrees of direction. In total, the authority does deliver 53 programs with varying degrees of mandates.
Mr. Chairman, I find it awfully hard to believe we’d go through a zero-based review at that hospital and not know exactly how many unfunded positions there are or exactly how many unfunded programs there are. To me, that’s unfathomable. I don’t understand it.
It’s a good thing we’re not doctors, because it’s taken us — and still taking us — over three years, and we still haven’t figured out how to stop the bleeding. It’s a good thing we’re in the profession we’re in, I guess, and not doctors. We really need to get a handle on what’s happening out there.
If the Minister doesn’t have the answers to those questions, I’d also like to ask the Minister of Health: how is Stanton going to pay back the $26 million? I’ve heard varying amounts on what the accounts receivable are at today.
I know Nunavut owes us some money, but I think $6 million is what I’ve heard. That doesn’t come close to paying back the $26 million. I’d like to know where we’re going to get that $26 million from. Maybe the Minister can help me understand that a little bit better.
There’s no $26 million request in this supplementary appropriation. That, the department is working to come together on. Of course, FMBS is involved in some of that work, and some of that is receivables, and some of it is the ongoing delivery of programs and services. Again, that started a couple of years ago, intermittently, initially. But in this last number of months it’s been on a regular basis.
As we go through this work and look at the service delivery, the mandates and the program levels, we’ll be coming back to Members with this type of information.
I know the issue of the $26 million is not in this supp, but I think it’s germane to the debate we’re having on the $11.5 million of accrued deficit the government wants us to approve in this supplementary appropriation. I want to have some peace of mind that the cause of their accrued deficit at Stanton is going to be addressed.
I’m having another tough time understanding how it is that we could bring in a public administrator for three months and they’re going to solve what’s wrong with Stanton in three months. That contract’s up. We’re over halfway through that contract. I’d like to ask the Minister: what plans are there going forward for the administration of that hospital and the management of that hospital so Members can have some peace of mind that it’s going to be run effectively and efficiently?
Mr. Chairman, the first part — not all the work is going to be done within a matter of three and a half months. Most of that work has been undertaken already within the different departments, which are working with Health and Social Services to come up with the figures, the program delivery levels and what’s been mandated for delivery.
There are a number of areas and departments working at coming up with all the information and the potential results of that in the sense of what levels of services we are going to continue to fund and what level of services we are going to say that, as the Government of the Northwest Territories, we can no longer stay in. I will almost guarantee Members that once we get to that level of debate across the Territories, in this Assembly, you will be getting lots of concerned calls about the fact that there’s been any change in delivery of programs and services, much less than what we’ve had in the debate on the budget to date.
For the details of expectation — where that’s sitting at, that work — I’ll have to go the Minister of Health and Social Services.
The Premier is correct in saying the PA’s work is not time specific. He’s been appointed as the public administrator, and he will be in that office until such time as he’s removed by me as Minister.
What I meant when I said in the House that I have given the public administrator three months to do some work and give me some recommendations is that it was specifically to the work following the zero-based review. As I stated earlier, the zero-based review gave us lots of information that required additional analysis, and he’s using that information as a guideline. Also, he’s on the ground looking at the programs and operations of the facility to see how we can address the issues arising out of what’s causing the deficit and how we could move forward in balancing the budget without impacting the front line too much.
His specific task right now is three months, but his work will continue beyond three months.
I won’t keep this going much longer. Getting back to who has the authority to put positions into place that are unfunded and to put programs into place that are unfunded, I think maybe we don’t want to go there. I’m not sure. What other forum is there for me to ask questions about who has the authority to fund programs? We approve the budget every year. I’d like to have some say in who has the authority. I think that’s part of the problem, why we’re at the $17.3 million. There are unfunded positions, there are unfunded programs, and somebody approved them along the way. It wasn’t us, so who was it? I think that’s a question that needs to be answered, Mr. Chairman.
The relationship is spelled out, initially, quite clearly in the territorial health and social services act — the relationship between the authorities and the Department of Health and Social Services.
At times, working with authorities, the department would initiate new programs and program delivery. Telehealth was one the department initiated and worked with authorities in that delivery. There are examples of that where the department has become involved and has encouraged authorities to come on line.
When it comes to other service delivery and the level of delivery, the department gets involved with authorities again. So it’s a combination. Ultimately, the authorities, through their management…. They meet. They discuss the spending and the requirements. They make decisions, and on a yearly basis they would come forward, first through the Department of Health and Social Services, requesting more funding. If they see a growth in expenditures — whether it’s utilities or staff growth or program and service delivery growth — that would be approved on an annual basis. When it comes right down to it, the Department of Health and Social Services would be aware of service delivery requests and levels of delivery.
Now, if they’re not getting all of the information, then we’ve got a definite problem between the relationship of an authority and the department, hence the reason FMBS is involved in a zero-based review as well as the government overall. We’re looking at boards and agencies and the role they play in delivery of health and social services and education across the North.
Thank you, Mr. Roland. Mr. Abernethy.
Thank you, Mr. Chair. I’m going to ask my questions specific to Stanton, but they’d be true for all the authorities. I see the $11.5 million that you’re asking for, for Stanton. Does that bring them to a zero balance as far as debt is concerned, or are they still further in debt than the $11.5 million?
Thank you, Mr. Abernethy. Minister Roland.
Thank you, Mr. Chairman. The request is asking for the accumulated debt, and that is a debt that grows year to year. It just keeps adding up. It does not take in this year that we’re operating in.
So this clears up previous fiscal years, up to 2006–07, but doesn’t deal with 2007–2008; they’re going into this fiscal year with some additional debt. Do I understand that correctly? The current year’s debt. The current fiscal year’s deficit of $26 million.
