At this time I’d like to ask the Minister of Health to introduce her witnesses.
Thank you, Mr. Chairman. To my left is Deputy Minister of Health and Social Services Mr. Greg Cummings. To my right is Director of Finance Mr. Derek Elkin.
Thank you, Ms. Lee. Welcome, witnesses. General comments. Mr. Hawkins.
Thank you, Mr. Chairman. This is as good an opportunity as any to bring this up. I notice that the Minister’s opening remarks, with the eight pages…. As highlighted by another Member, it seems to be lacking in recognition or a plan — or, I should say, even further — on addictions. Addictions, as we know, is a very significant problem here. It’s horrible. That’s all I’m going to say. I could probably go on at length about that. The fact is that addictions isn’t highlighted. I’ve looked through the budget, and of course, we don’t have any specific line item for addictions.
The problem with that, Mr. Chairman, is that just the other day we gave away, through a negotiated deal, our Territorial Treatment Centre, which will now become a training centre. Addiction problems continue to rise at an alarming rate, and treatment for larger challenges, such as cocaine and crack and whatnot, require specialized treatment, yet this budget seems to be lacking that recognition. If it is there, I’d certainly like to know where it is, and I’d certainly like to know why it seems to be missing or why no recognition of this problem is in the Minister’s opening remarks.
Thank you, Mr. Hawkins. Ms. Lee.
Thank you, Mr. Chairman. I don’t agree with the Member — the way he puts that. There are programs and services for addiction services. The mental health unit at Stanton is the more acute-care facility for addiction treatment, more intensive care, under the supervision of the medical professionals.
We have mental health addictions specialists and community wellness workers placed in most of the communities. We invest up to almost $1 million to Nats’ejėe K’eh, which is the treatment centre facility in the Hay River Reserve, K’atlodeeche band land. We also provide funding to the Salvation Army, which has a treatment program that is not recognized as much as it should be. We also spend a significant amount of money in counselling here — family counselling services in Yellowknife and all of the territories. I’d be happy to provide the Members with more information.
We work with the Tree of Peace. Yellowknife Health and Social Services provides services for Yellowknife and the North Slave area, but all of the authorities have money allocated for addiction counselling. When we go into the specific item, I’d be happy to point that out to the Member.
Also, with respect to individuals who are looking…. I realize the Member is from Yellowknife and he may be referring to cases in Yellowknife. In my office I get lots of inquiries and calls from people who want to get outside of the NWT treatment services. They’re treated on a case-by-case basis; they’re treated on a confidential basis. I can tell you that anybody who needs assistance is given support and counselling to do that. What I do ask for is that when I get inquiries from a Member who’s asking a question, or the general public, I would like the initiative and action to be taken by the people in question. We follow that up.
I do not agree with the Member that we don’t have enough of that, although it may not be obvious to the Member, and I will be happy to point that out. As we go forward, the mental health strategy and action plan as a whole is something I want to revisit. I look forward to having those discussions in this fine process.
Well, I disagree with the Minister’s assertion on that, because quite frankly, we don’t have a specialized program that deals with crack. That’s taking over a number of our areas in the community, and it’s becoming the drug of choice, which is a real shame.
Sending someone to intense treatment in a hospital is not an appropriate use of our hospital. Furthermore, when we describe it as “We send them to the mental health unit,” I wouldn’t typically want to describe someone who has a drug addiction problem and wants to seek treatment as having a mental health problem. I would say that’s someone who has been attracted to a dark side of life, and they can’t shake it and they need some help. I don’t think sending someone to a mental health unit is the appropriate source.
The Minister further asserted that Nats’ejėe K’eh is the treatment centre. I do recognize that, and I’ve spoken in favour and support of that in the past, and I will today. But the fact is that it’s an alcohol, spiritual-based program, and if you’re burdened with the pains of crack addiction, that’s the last place you need to be. You need to be in an intensified treatment centre that focuses on those things. The way the existing program goes now, you have to be sent to Nats’ejėe K’eh, fail and then be further referred out south. Now, I’m not saying that’s the exclusive formula for how that process happens, but that’s the typical formula.
The Minister has suggested that she will get us details and whatnot, but I still have a number of questions outstanding regarding treatment programming and services provided in the Northwest Territories. When I say investment, I’m talking about real investment that provides real programs for people in those areas. The Salvation Army, I understand, offers a program. I know the Tree of Peace offers a program. I understand they’re successful for the levels of what they offer. But they are not the high-intensity programs required when you have that addiction. We do not have family-related programs, so when you have a codependency on drugs, we have nothing that focuses on that. We have nothing for children that offers that.
What I’m stressing is we have a number of these addictions. It’s not new to this Minister; it’s not new to this Assembly by any stretch of any imagination. The fact is, as I said today about watching drug dealers take over our community, it’s time this sort of spectator sport ends, from the sense of a bureaucratic approach. I believe to the bottom of my heart that this territory needs a high-intensity crack-addiction treatment centre to deal with people in that scenario. If we can’t help them with the demons in their life, I don’t know where they have to turn. The problem is, I think, that this government continues to offer a soft “sit around and talk through your problem” process, and the fact is that this requires a high-intensity situation of treatment.
Sending people to the hospital for addictions is not a reasonable approach. I don’t think it’s fair when we talk about the stress that Stanton itself has. It has been highlighted by other Members about burdening Stanton with office space. It’s not designed that way. In my opinion, Stanton isn’t designed as a treatment centre for people like this. We need a facility that focuses on this. Personally, I really don’t care where it is; I really don’t. If it’s in Sachs Harbour or Resolution, I don’t really care. The fact is this is the type of real investment in people we need to make. I think you’ll hear outstanding support even from people in the Yellowknife community. They don’t care if this is built here; they just want to see it built.
The fact is that people are suffering from this problem. Whether you’re a parent watching your children, whether you’re a spouse watching your partner, whether you’re a child watching your parent, it doesn’t really matter. The fact is that people want solutions to this problem, and I don’t think it’s being met head-on. Money is being given to service organizations to sit there and talk, who I think to some degree are worried about their little “kum ba yah” approach, and having people come in and sit there and talk their way through it. We’re not talking about soft drugs, where people can control themselves or get some support from friends and neighbours to work through the problem. We need real intense treatment, and I think that is the real move on this problem that needs to be done.
As I cited, I don’t see a significant investment in that area. As I even further highlighted the other day, we just gave away, to a large extent, our only treatment centre for this type of thing. That’s not speaking in any negative fashion to the fact that it’s going to actually finally be put to good use. I believe it will have a good use as a training centre, and I think that’s fine. I’m glad to see we’ve stopped heating an empty building for a number of years — which kind of draws into the question of why it sat empty for so long.
My time is running out, and I’m sure I made my point a number of times. Maybe Cabinet’s smiling because they agree with me on the sense that this issue needs to be done. Do I hear they’re finally willing to make that commitment? I’m not sure.
I’m going to leave it at that. I think I’ve made my point a few times. This is a significant issue in my riding downtown; a lot of the citizens have always highlighted this and they look for leadership from the government.
Mr. Chairman, just briefly, as the Member pointed out, late in the evening yesterday he thanked the government for the capital projects: a territorial dementia facility and the Yellowknife consolidated clinic. There is no plan to build a treatment centre in Yellowknife. I think we have a lot of good capital projects happening there.
I don’t think there’s anybody in this Assembly qualified to speak about what exact services should be provided to those suffering from crack addiction or some of the major addiction issues. What I was trying to simply point out is that if you talk to anybody who has these addictions and mental health issues, it is bracketed as the same issue. Addictions is part of mental health issues, and there is a spectrum of services you need to provide, right from medical intervention at the most acute stage, which has to be provided by psychiatrists at the hospital, who are qualified medical doctors, down to the program that Byrne Richards provides in Yellowknife, which is called Crackbusters. So it is very important that we have a whole spectrum of services available. A treatment centre is only one component of that.
I want to assure the Member again, and it’s up to the Member if…. I accept the fact that he would never probably agree with anything I present, but it’s not for me to speak; it’s not for me to convince him. He will do with information that he has. But let me tell you, as the Minister of Health and Social Services, that anybody within our system who is suffering from addiction of any kind, who is in need of support and services and counselling — the services are available for them to tap into in every community throughout the Territories. We have the services available in the whole spectrum — for the children, for the youth. It’s not a simple, black-and-white “enter into this door A and everything to do with your issues is going to be taken care of.” That’s not the approach with respect to a very complex area of mental health and addictions.
Another thing I want to talk about with Nats’ejėe K’eh programming is that I was just there visiting as the Minister as well. They organize their programs very much based on the clientele that is in the place at any specific time. I think that it’s very simplistic to suggest they are doing some simple alcohol- and spiritual-counselling thing. They are professionals and they provide services.
Anyway, I just want to say that we focus on individual-based treatment programming and services for those people who walk into our facilities, and we tailor our programming to suit the individual’s needs.
General comments? Do we agree we move to detail?
Agreed.
Okay, we can turn to page 6-7, Operations Expenditure Summary. We’ll defer that till later. The first page up is page 6-8, information item, Active Positions. Mr. Abernethy.
Thank you, Mr. Chair. I see by looking at this page that 15 positions are being eliminated from headquarters. I was wondering if the Minister could go through the process they followed in order to determine which positions would be eliminated. Of those positions, which ones are currently filled and which ones are vacant?
Minister Lee.
As I indicated yesterday, in adhering to the realignment exercises that we’ve had to go through, my department placed the most minimal impact on the front-line services as much as possible. That is the reason most of the reductions are within the headquarters, within the Department of Health, not in the authorities.
There are reductions of 17 positions from the department, and that is about 12.5 per cent of the entire workforce of the department. I do have a table here for the Members that I can provide to the Clerk. I can advise the Members that out of the 17 positions, nine positions are vacant, six positions are filled, and five of the six have been placed or other arrangements have been made. There are two positions to be determined, and they are placed in headquarters. They’re not in any of the authorities.
The reason those are to be determined is that our reduction exercise for these positions spans over two years. It starts this year; some of the savings are this year, as I stated in my opening statement. But some of the reductions will be implemented next year because of the planning we need to do with programs and services to make sure our alignment is done in a way that impacts the program delivery at the headquarters level as minimally as possible. Seventeen positions out of 133 is quite large in that context, and we need to make sure we do it the right way. I’d be happy to provide the Member with that table.
Yes, I’d like to see that table, please. In thinking about the positions you’re eliminating, I’m under the understanding that you’re getting rid of a number of positions in your communications area. How do you see that impacting the promotion and marketing that that department does with respect to the provision of health care in the Northwest Territories?
I want to assure the Member that in all of these realignment exercises we have not eliminated or taken out entire programs. It is about better using the resources we have, and I think the communications section is a good example of that.
I do want to note that the budget reduction exercise is about choices. As the Premier mentioned in his budget opening address, these are hard choices — to eliminate positions. But the way to do that is to make sure we minimize the impact on the programs and services as much as possible and that we make every effort to make sure our employees affected are given all the opportunities to be reassigned wherever possible.
With respect to the communication section, we will be eliminating a communications officer position, which has been on transfer assignment for a while. We will be eliminating a graphic design area, but we do have resources there, so we could continue to do the web site work and other services. That’s the principle we have applied in all of our realignment exercises.
I’ve indicated before that when it comes to the reduction exercises, I’m less concerned about vacant positions. There are still a number of positions that have incumbents in them.
In my first question, I asked you if you could go into the type of analysis you used in order to figure out which positions were going to be eliminated, what that analysis entailed with respect to the department’s mandate, and all those things. You didn’t really answer the question on what kind of analysis you used, what you used as criteria, and how you dug in and figured out which positions weren’t contributing to the mandate of the department in your selection of those positions you were going to eliminate. If you could go into some more detail as to how you actually chose, that’d be useful.
I think the Member mentioned that…. I’m not sure if I would put it that way. I mean, I don’t think a Minister or any official in the department goes into the book and says, “What mandate can we eliminate?” May I just get that reworded?
The Department of Health and Social Services has a mandate. In reviewing the positions you’re eliminating, how did you determine which ones weren’t contributing to the mandate of the department and, therefore, you were justified in eliminating? I want to know what type of analysis you did in relation to what your mandate is, and how you chose to eliminate specific positions and not adversely affect your mandate.
Mr. Chairman, I think I heard it right the first time. I don’t agree with the premise that by eliminating some of these positions we’re suggesting that any of these positions are not contributing to the mandate. I don’t think that’s fair to the positions affected or persons affected. I don’t think that’s the right conclusion to make.
I think, Mr. Chairman, communications is an important part of our mandate, as are all other divisions in the department. As I stated earlier — and I’ve said this many a time — what you will see if you look at the positions affected in the department is that we have not eliminated any mandate at all. We have not eliminated any program. What we have done is look, program by program, to see how we could reduce some of the positions and expenditures but still deliver the programs we need to deliver.
I think that with communications, you will see we have a number of positions in that area — Policy, Legislation and Communications; that’s what it used to be called before it was restructured — and that there are a number of people engaged in the communications work and graphics work and advertising work and pamphlet designing and annual report designing and web site designing. There’s a group of people who are doing the work. The best decision to make is to look at what everybody’s responsible for and see how we could do the same job with fewer resources.
If we had choices, we don’t want to do less. So to say we are reducing those positions because they were not contributing to the mandate is not fair to the employees impacted. With respect to all the employees who have been impacted, these are choices we had to make.
I think the Member should keep in mind that when we make these choices, it’s not about, “Do we not appreciate the communications section more? Do we not appreciate some of the other positions that have been impacted?” We had to make an overall department mandate, which is to provide health and social services. I have made the commitment publicly that, as much as possible as the Minister, I do not want to impact front-line workers. We’re talking about nurses, doctors or medical services — a myriad of services that we provide. I think we need to go to a bigger circle about how we make those choices.
I’d like to thank the Minister for putting words in my mouth. I’d prefer it, obviously, if she’d actually listen to what I’m saying.
The department has a mandate. I’m asking you what criteria you were using to ensure that the elimination of specific positions would not adversely affect your mandate. I’m not suggesting they weren’t doing or contributing to the mandate. But changing positions — which were obviously, at some point in the department’s history, put in there because they contributed to the mandate…. Removing them has an impact. I’m asking you what criteria you used to dig into the department to figure out which position eliminations would have the least impact on that mandate? Clear?
I’d just like to remind the House we can have some civility here and show some respect for each other. All these personal shots across the bow aren’t helping anything. I think we should be civil here. I’d just like to ask that you keep your questions directed to the page we’re on, and also if you can keep your answers short and specific to the point that’s being asked so we can move on.
I could advise the Member that the elimination of these positions does not impact, in any way, the department’s ability to follow our mandate and deliver the programs and services we have been given to do. We just have to do them differently.
Next on the list I have Mr. Bromley and Mr. Hawkins. Mr. Bromley.
Actually, Mr. Chairman, I don’t have questions until 6-12.
Mr. Hawkins.
Thank you, Mr. Chairman. My question is specific to page 6-8. I thank the Minister and the staff for providing this layout as to the description of the positions. I find it very useful, and I appreciate that work.
A similar question to Mr. Abernethy’s is: if I could get some information as to what analysis was done to determine why a specific position was needed or not needed? Was there any specific analysis to weigh out whether a position was needed or not needed?
Minister Lee.
The analysis of the department and my approach — I say it again and I’ve said it many times — is to minimize the impact on the front-line health and social service workers. For that reason, the largest brunt came in the headquarters positions. I really don’t want us to characterize these affected positions as ones that were not needed or that were not necessary. I think those are positions that had work to do, but under the circumstances and under the fiscal situation, we’ve had to reorganize the staffing to deliver the services but reduce resources where possible. Once again, it’s a choice between eliminating some of the positions in headquarters versus eliminating positions in front-line staff.
I appreciate, and I’ll make special recognition of, the fact that the Minister’s instructions were probably to ensure that whatever impact was going to happen…. I’m sure they were, to some degree, not focused on making sure we created as few ways as possible. I’ll recognize that’s probably an assumption on my part, but I would think that any reasonable person would say, Let’s try to make this as seamless as possible. Assuming that, we would have to come down to a reason as to why these specific positions were chosen over others.
With approximately 117 positions within the headquarters region of Yellowknife, when we would focus in on a specific area a couple questions arise, from my point of view. If I were in the management position of making this type of decision, something I would say to myself would be, “What impact, if I delete this position, would it have?”
I would have to take some analysis, in my mind — whether it’s strategic, where I lay out their job description and say, Well, what do they do and how will it be affected if I suck them out of the system…? I’m trying to get a sense of why these positions were determined as they are. Was that analysis done in any way as I’ve described?
Mr. Chairman, absolutely. I think that’s what I’ve been saying. Once again, there are 17 positions impacted in the Department of Health and Social Services. It’s all in the department, not in the authorities. Out of 17, nine positions were vacant, which means there are no active bodies impacted there. Out of those impacted 17 positions…. In six positions there were incumbents there, and most of them have been reassigned or they have places to go.
We looked at whether there were vacant positions, whether any of those positions could be rewritten or re-profiled so it did not impact the program, delivery and services and, most importantly for me, we did not impact the front line. I feel very strongly about this, because I believe the department officials have done a really great job of minimizing the impact wherever possible under the circumstances. I believe this was done in a way the Members had been saying it should be done.
As we move forward, I continue to share a number of Members’ frustration over trying to get the details on what type of work was done.
I’m just going to take a position here, and I want them to explain to me how it worked. It was already highlighted in the House that it was the communications position that’s been targeted for reduction. I’d like to know what analysis was done and the procedure of how they decided that communications wasn’t required or who is going to pick up those duties. That’s the type of analysis I’m trying to get to understand this.
Further highlighting the concern I’m raising is the fact that two of the positions are yet to be determined. So how do we know what analysis has been done on positions? We don’t know. And we don’t know if they’re filled; we don’t know. It sounds like a Donald Rumsfeld tongue-twister here. We’ve done analysis on positions we don’t know are going to be there, but we’re deleting them anyway and whatnot.
There are obvious questions here, Mr. Chairman. As I highlighted with the one communications position here: what analysis was done on the principle of what that job description offers and the evaluation of where those duties will be picked up?
Mr. Cummings.
Thank you, Chair. With regard to the graphics design/communication specialist, we looked at the entire staff we have in the communications division, which is four full-time positions. We looked at the current duties of all four of those positions, and the specific duties of this position, to see if we could rewrite the job descriptions of any of those people to optimize the amount of work we could get out of each one of those positions, and subsequently reduce from four to three.
With regard to the To Be Determined positions…. During the reduction exercise we were also contemplating a realignment of the Department of Health and Social Services to make it easier for us to determine which positions could be eliminated without impacting the front line and the service to the authorities too much.
Thank you to the Minister and the staff for that answer. That’s the type of answer. It sounds like someone put some thought into it.
A number of Members are concerned about the approach we’ve used. Quite often that seems to be the answer that’s missed — how someone did some analysis on potential workload and where they can do this. That’s caused a lot of frustration and some pushback that not just this Minister but all those Ministers over there should be receiving so we get that type of detail.
The frustration we’re receiving here is that…. My fear is, the fear in the public — whether it’s the public service or just the people on the street — is…. The magic eight ball was approached on the fundamental process of going to find money within a department. Should we eliminate a job? The answer is: only you will know.
That’s the type of answer I’d like on some of these, and I want to be assured that all the positions received that type of scrutiny to make sure we didn’t just tell somebody today, “We’re eliminating this position. And by the way, two seats over, you’re going to do all the work, whether you know it or not.” I think what happens is that we end up having fallout problems on top of this.
I’m running out of time here, but I certainly see there are issues as that falls out as well. I want to make sure that sort of a begin-with-the-end-in-mind approach happens with it. If you want to eliminate — go down from four positions to three…. I’m glad they’ve done some analysis to say, “Well, you know, we could spread the work out.” That was the answer I was hoping some thought had gone into.
Also, if I were a human resource specialist of some sort, my next fear in that area would be whether we have now burdened people with work they can or cannot do. On top of that, have we changed their job descriptions by now? Have we changed the phase of how we pay?
Those are other items. I’d certainly hope the Minister will have some feedback on that, to ensure we’ve done this from top to bottom, thinking it through.
I appreciate the Member’s comments. I don’t believe there were questions there.
I’d like to take a second to recognize Ms. Kathy Tetso in the gallery. She’s the CEO of the Health and Social Services Authority.
Ms. Bisaro.
Thank you, Mr. Chairman. I hate to belabour this issue of staffing, but I do have a couple of questions.
Information that the standing committee was given by the department some time ago indicated that all 17 positions we have on the new table were to be eliminated in ’08–09. I just would like to get clarification from the Minister whether that’s a typo. If it’s not, how do we eliminate two people we haven’t yet determined?
Thank you, Ms. Bisaro. Minister Lee.
Thank you, Mr. Chairman. This is the third month of ’08–09. We are, as the deputy minister indicated earlier, engaged in restructuring of the department, where the health side of the mandate is more specifically laid out. This is probably my layperson’s explanation of that. I could have the deputy minister explain more of that.
We do have the remaining nine months to finish reorganizing the department and to make sure we do more in-depth research into how to re-profile and realign the positions so we minimize the impact on the programs and services.
I could ask the deputy minister for more information. It’s your call, Mr. Chairman.
Mr. Cummings.
Thank you, Mr. Chair. Specifically in the departmental realignment, one of the items we addressed was that we had a division that was referred to as the Territorial Integrated Services, which included some aspects of health, some aspects of social services and some aspects of public health. Over the past two years there’s been an increasing sort of profile in the public health area, in particular since the SARS outbreak in Toronto. The Department of Health and Social Services felt it probably was important for us to place much more emphasis on the public health side of things. So I have tasked the chief medical officer to do some work to define for us a structure that would allow us to continue to do the work we do to support our hospitals and our primary care system but at the same time bring increased emphasis to the public health side of things.
There are positions that were identified in the health area, but we thought it would be premature to eliminate those until we had completed the realignment and I had taken the recommendations of the chief medical health officer.
Thanks for the explanation. I just want to explain that we have data that says 15 positions and then we had data that said 17. I think that’s where a lot of the confusion came from. I think I finally understand.
I did want to ask a question. There is an indication of reduction in the children and family services area. I wanted to ask how many social workers are currently employed within children and family services.
The practising social workers we have in the Health and Social Services system are all located in the authorities. The Department of Health and Social Services has program support specialists and policy people who do that kind of work for the system, but there are no practising social workers in the Department of Health and Social Services.
Mr. Ramsay.
Mr. Chairman, I want to ask a few questions on the position reductions as well. Maybe I could get a comment from the Minister on what her definition of “placed” means.
Minister Lee.
Mr. Chairman, those are people who have been notified as affected status. If they choose to do so, they have to submit a resumé and ask to be considered for other options. “Placed” means they have either been placed within the department or government-wide.
