Thank you, Mr. Chairman. I do not have information on unfunded positions for authorities. I would be happy to make a commitment to get back to the Member about Stanton.
I have heard it was as high as 26 at Stanton, but I guess I’ll wait for the Minister to get us that information.
I would be interested in knowing, not just at Stanton but in the rest of the authorities, what the unfunded position level is.
I’ll get that for the Member.
We’re on page 6-10, Active Positions – Health and Social Services Authorities.
Department of Health and Social Services, Active Positions – Health and Social Services Authorities, approved.
Moving along to 6-11, Department of Health and Social Services, information item, Health and Social Services Authorities, Active Positions – Community Allocations.
Department of Health and Social Services, Health and Social Services Authorities, Active Positions – Community Allocation, approved.
Moving along to 6-12, information item, Revenue Summary. Mr. Bromley.
Thank you, Mr. Chair. My understanding is that the Government of Canada has a fiduciary and legal role to provide health care services for aboriginal people in Canada, including the Northwest Territories, but that there is an agreement for this department to cover those services in the Northwest Territories.
I understand that the federal government compensates the department with about a 3 per cent annual growth for increasing costs, but we’ve been experiencing something like a 7.8 per cent, or thereabouts, average increase in annual costs. I’m wondering, if I’ve got that right: what is our current estimate of the accumulated debt that the department views is owed by the federal government and over what period of time does that apply to?
Thank you, Mr. Bromley. Minister Lee.
Mr. Chairman, the Government of Canada under supervision of DIAND department is responsible for funding for insured hospital and doctors’ services to our Inuit and Indian peoples of the Territories.
That’s in line with the practice before the health programming and service delivering was transferred to GNWT in 1988. At that time there was an agreement in place that put a 2 per cent cap on the funding they would provide. How we would do it is that they would provide the services to our aboriginal peoples and then we bill DIAND for those programs. The stats we have available is that since 1999 the expenditure has been a lot larger than 2 per cent, obviously, and the accumulated deficit there is about $95 million.
I’m wondering what the estimate for this particular year will be for the addition to that debt and where that shows up in the budget here and where we’re at in the process to recapture those costs.
We estimate that this year’s expenditure will be at about $41 million, and the expenditures we could claim as per the agreement will be about $25.6 million, which gives us a gap of about $15 million a year.
I’m wondering where we’re at in negotiations with the Government of Canada or DIAND to recapture those dollars and the accumulated debt. Also, does it show up here in the book somewhere?
It does show up on the page that we’re on, 6-12 under the Hospital Care and Medical Care for Indians and Inuit. Those are the expenditures we are incurring. Then we submit our reimbursements. We will be submitting last year’s reimbursement this year.
We have been going back and forth in the House about some of the actions and interactions the Premier has had with the DIAND Minister and the Prime Minister in his previous role as Minister of Health and Social Services. There are two federal departments involved in this issue. The major one is the DIAND Minister and the Prime Minister, obviously, and then on the side is the federal Minister of Health, Tony Clement.
I think we need to renegotiate, and the Member may appreciate that in order to negotiate you need two parties to come to the table. We’re asking the federal government to come to the table and negotiate a better term and to remove that cap, but I believe the federal government feels that some of these fundings are being provided through other means — their transfer payments and such. We will continue to pursue this issue and see if we can renegotiate and raise the cap.
Thank you, Minister Lee. Any other questions on page 6-12? Ms. Bisaro.
Thank you, Mr. Chair. I must be having a tough day, because I’m confused again with the numbers. Page 6-12 is titled Revenue Summary, yet the two amounts that were referenced by the Minister add up to about $25 million to $26 million, which I thought she said was the amount we incur in expenses, and we only get $15 million back in revenue. If I could have a clarification, please.
Thank you, Ms. Bisaro. Mr. Elkin.
The $26 million for the agreement is reflected in the two lines: one says Hospital Care Indian and Inuit and the other one, Medical Care Indian and Inuit. But we receive that full amount. Our expenditures are $40 million.
Okay. I am having a bad day. I did have a question, as well, on this page. There are two numbers, a 1 and a 2, that reference notes, I presume. But I don’t know where those notes are in the document. If they’re important, I guess I need to know. What are they referencing?
Thank you, Ms. Bisaro. Ms. Lee.
Thank you, Mr. Bromley. I have the same copy as the Members do, so I can answer that. I will undertake to get that information for you.
Thank you, Minister. Further questions? Page 6-12, Revenue Summary, information item.
Department of Health and Social Services, Department Summary, Revenue Summary, approved.
Moving on, under Directorate, page 6-14.
Department of Health and Social Services, Activity Summary, Directorate, approved.
Page 6-15, Operations Expenditures Summary, votable activity: $6.780 million. Questions? All agreed?
Department of Health and Social Services, Activity Summary, Directorate, Operations Expenditure Summary: $6.780 million, approved.
Page 6-15. We’re agreed. Moving on, page 6-16, information item, Directorate, Active Positions. Questions? Mr. Robert McLeod.
Thank you. Not so much a question, Mr. Chair, as a comment. I was just noticing the staff at the headquarter level and something I’ve been telling the departments I’ve been speaking to. Taking more staff from headquarters and leaving the program staff on the front lines is something I appreciate. I think more of the departments should have been looking along those lines and saving a lot of people on the front lines, especially if they’re positions that are not really needed or vacant positions. I just wanted to comment that I thought this was a good move on Health and Social Services’ part.
Thank you, Mr. McLeod. Comment only. Mr. Hawkins.
Thank you, Mr. Chairman. Earlier today we were provided with a list of position reductions under Health and Social Services. I just want to be clear. Under Active Positions here there seems to be a loss of eight positions. If the Minister could clarify which positions have been re-profiled in the bigger scheme of things.
Minister Lee.
Thank you, Mr. Chairman. We have the seven positions that were provided already — FTP policy adviser; graphic design and communications specialist; communications planning specialist; senior adviser, financial planning and analysis; junior financial board analyst; data entry clerk; manager of planning and reporting, impact assessment analyst. Those are the seven position reductions, not eight positions.
No, it didn’t seem quite clear. There may have been a position missing or something there. Could we clarify that? If we have 15 positions here, two to be determined, and this is headquarters, that’s minus eight. If I read this paper, there are 15. The paper I’m citing is the one. I just want to make sure.
Thank you, Mr. Hawkins. I believe the eight positions are the first eight listed on the page there. Is that correct, Minister Lee?
Yes, those are the first eight. I think the other positions are under other tabs.
Thank you, Ms. Lee. Anything further, Mr. Hawkins?
No, that’s it.
On page 6-16, Directorate, Active Positions
Department of Health and Social Services, Activity Summary, Directorate, Active Positions, approved.
Moving on, page 6-17. Questions? Mr. Hawkins.
Thank you, Mr. Chairman. Under the third paragraph down we have a section highlighted under the recruitment....
Excuse me, Mr. Hawkins. We were still on page 6-17, Directorate, Active Positions.
Department of Health and Social Services, Activity Summary, Directorate, Active Positions, approved.
Moving on, 6-18, Program Delivery Support, Activity Description. Mr. Hawkins.
Thank you, Mr. Chairman, and thank you, colleagues, for that.
Mr. Chairman, there’s a section under Human Resources, and it talks about recruitment and retention. If I understand it, there’s the difficulty of balancing this out. I’m just trying to find out what the activities are that this would apply to. If I can get some breakdown as to some examples of how they’re reaching out.
Mr. Cummings.
Okay. The activities under human resources recruitment are the recruitment and retention activities we have the Human Resources Department do on behalf of the Department of Health and Social Services. They include programs such as the Community Health Nurse Development Program, the nurse mentor program, the nurse practitioner development program, the medical bursary program for physicians. Those are the programs the Department of Human Resources administers on behalf of the Department of Health and Social Services.
I thank the deputy minister for that detail. As I understand it, for better or for worse there are nurse practitioners out there on term positions. They haven’t been made permanent, in other words.
That said, I’m under the understanding that this section, through this type of program, goes out to continue to find more potential nurses to become nurse practitioners who we don’t have jobs for. As I understand it, the situation is that you need to be a practising nurse practitioner in order to keep your credentials active and useful. It’s not a question of losing typical RN status. It’s more in the sense of how are we investing. If we continue to pay people to become nurse practitioners when we don’t have positions for them, that’s a concern. If I can get some information as to how they deliver this program for nurse practitioners. How many do they train? What positions exist for this transition from training to practical work?
Minister Lee.
Yesterday I think I touched on this when I stated, and I want to state again, that the nurse practitioner program is very important to us. As Ms. Bisaro mentioned yesterday, hopefully it’s more than a six-month situation at Stanton. I want to make it clear that what we know happened at Stanton should not be construed as a reflection or any sort of…. It’s hard to explain. It’s a situation that is really internal to the operation of the hospital in that those two positions were put there to be incorporated into the operation. That’s the understanding of all the authorities.
All the authorities are very proactive, and they’re open to hiring as many NPs as possible. We have lots of NPs in the Yellowknife Health Authority; we have an NP placed in Fort McPherson; we have one trained and placed in Fort Resolution. This is the way to go for the future, and you’ll see there is a lot more money being put toward training our nurse practitioners and placing them.
The difficulty a few NP positions at Stanton ran into was with the fact that the hospital setting was not as conducive to accommodating positions in a way that they are able to do in more primary clinic settings, such as the Yellowknife Health or in other regional centres. If we are to continue, and we are going to continue to rely on NP positions to enhance our services and to lessen the burden on the medical practitioners, it’s incumbent on our operators to use these NPs and to incorporate their work into the practice. It’s not supposed to mean extra services, but it’s a service that would replace some of the nursing positions or take on some of the work that is not typically done by nurses.
I just want to advise the Members here that the situation that happened at Stanton is an anomaly. It should not in any way reflect negatively on the commitment this government has, and that I have as Minister, to continue to pursue and support the NP program.
Through this program is the Government of the Northwest Territories paying for the training for RNs to become NPs at a rate at which we cannot fill empty positions? Because they do not exist. If that’s the case, how many do we have in training school? How many have we trained to date? How many openings do we have to provide for these people who have taken this training the territorial government has paid for?
The system as a whole is open to accepting all of the NPs we train. I could get the information on exactly how many NPs were trained. The situation is that they are meant to be in a primary care setting and we may not be able to have those NPs exactly where they want them and in exactly the jobs they want. I think we have to respect the ability of the health authorities to make decisions about where to place those NPs. Those are the things we need to iron out. It needs partnership and collaboration with all of the parties involved, with all the health care professionals that work with the NPs. But so far we have been able to place all the NPs we train.
Moving on, we’re on page 6-18. Mr. Krutko.
Thank you, Mr. Chair. In regard to the area of program delivery and services, I think as a government we have tried different things in the past. Some things have worked out, and other things have been problems by way of recruitment, implementation. I’ll use some examples. The midwifery legislation that was passed — and we were able to activate that program — seemed to be originating in one community, which is Fort Smith. But to enhance that program to other regions and other communities…. I know my colleague from Deh Cho made reference that it was something that community would like to also consider. I think that’s something communities elsewhere throughout the Territories could probably access. The legislation is there, but it’s not really being implemented to its fullest.
The same thing applies in regard to the mental health positions. We’ve implemented legislation to bring people under the public workforce whereas, before, a lot of these positions, such as alcohol and drug programs, were run out of the communities that needed them — government employees. Yet we made it so stringent that it’s very ineffective to find people for those positions. The qualifications are so high and so stringent we are having problems attracting and recruiting and, more importantly, training our own people to take on those positions.
I think also in regard to programs we have in this government, we seem to be quick on the draw, passing legislation, establishing these particular legislative authorities to do so, but it’s the implementation side I think we’re lacking in. I think we have to find a way to have the flexibility in the legislation, to realize we’re unique and we have some unique challenges. Through the ways that individuals, either at the regional level or at the territorial level, interpret that legislation, they have to have some flexibility or basic moral understanding of the people, the communities and the regions they’re serving, and work with those NGOs and community organizations to deliver a lot of these programs and services.
I talked about the Tl’oondih program. They had 200 and something people go through that program. It was unique because it was the first time in Canada, I think, they had a program strictly designed to deal with family issues, to deal with the children, the husbands, the wives, the grandparents and whatnot. It was unique in the sense that a lot of the problems we see in our communities and in our families you can track back decades to residential schools, going back to first contact. I think it’s important that we work with our community and aboriginal organizations to develop programs and services that meet their needs, meet their goals of trying to achieve some of these successes and not put road blocks in their place because we had so much legislative red tape in there.
I’m wondering if there is anything this government is doing by way of reviewing its policies, procedures and legislation, seeing if there are ways we can, not overhaul the system but review the procedures and policies and see if we can make it not as restrictive as it is right now.
Minister Lee.
