Thank you, Mr. Chairman. There were a lot of comments here. I’m going to try to run through them without trying to repeat as much as possible. Also to try to group some of the response as best I can.
On the eHealth, we too agree that the electronic health is the way to go. Right now we have digital imaging and the DI/PACS are available in 22 communities across the North. This includes both the Stanton Hospital in Yellowknife, Inuvik Regional Hospital and then the following 20 communities: Hay River, Fort Smith, Behchoko, Simpson, Deline, Norman Wells, Tulita, Good Hope, Fort Resolution, Fort Providence, Whati, Gameti, Liard, Lutselk’e, Paulatuk, McPherson, Aklavik, Sachs Harbour, Ulukhaktok and Tuktoyaktuk. Electronic health records are available in all 33 communities and services through the telehealth are available in 73 locations in all 33 communities.
With the child and family services committees, the department has hired a coordinator recently. I don’t think we’ve made as much progress in the last year as we would have liked to have made. I think that the task was unexpectedly larger than what the department had anticipated. The immediate reaction from the department was that when we make a decision to proceed with putting child and family services committees together, that everybody would be onside and that would not be an issue. That was not the case. We have to not only educate our own health and social services authorities to identify the benefits of having child and family services committees, but also educate the people at the community level on the benefits of having these committees, and also a discussion with them with a coordinator, and so on, on the fact that maybe getting on a committee such as this is not to look into the affairs of other people’s business at the community level, and that has been a real stumbling block when we’re trying to develop these committees. We’re trying to go about it in a way that we’re making sure that all members of the community understand that people who are involved in child and family services committees are involved to benefit the community, and in the long run save costs in foster care and in the whole area of child and family services.
We have a few planning studies on the go, including Stanton Territorial Hospital. The Stanton Territorial Hospital study I believe will be, the planning is expected to be concluded very soon, this summer, and then we will have more planning and schematic designing and so on. I believe the actual construction would, if everything goes according to the plan – and I do think we have to do this work. I don’t think this is work that can be put off. This is essential. It’s essential infrastructure for the Northwest Territories to have a proper hospital. However, we need to develop the cost and also develop the plan in order to make sure that we’re moving in the right direction. We’ll be going into the next capital planning process, infrastructure acquisition process, to determine how we’re going to spend the costs out and into the capital plan.
I know the government’s overall intention is to not borrow all of the money to renovate Stanton Territorial Hospital, but rather to have half the money come from surpluses within our O and M and then borrow the other half of the money. Right now we’re working with the number less than what one of the Members had indicated it would be. She had indicated that we are probably looking at $400 million, but I don’t think it’s going to be that high. We’d also consider private partnerships, P3 projects on this.
The funding levels for the health and social services authorities are an issue. However, before we start to move the funding around within the health authorities, we are going to look at where we can be efficient, where we can use reformed governance, and where we can have shared services. I had indicated earlier that we would do shared service without having to take positions out of any of the regions or any of the communities where those services are. As far as boards around the health and social services authority, currently we do intend to put a board back in place in the Beaufort-Delta, an advisory board, as indicated by the Member for Inuvik, and continue on at this time with an advisory board and a public administrator, then perhaps later on the advisory board would have a chairperson and we would go with that system.
At this time there is no plan to put a board back in place at Stanton Hospital. At this time we are proceeding part of our plan with the governance, the shared services, and everything how we’re moving forward. We’re planning at this time to move forward with a public administrator at Stanton.
We have boards at the Yellowknife Health and Social Services Authority. We have a board in Fort Smith. We have a board in Sahtu. We have a board in the Deh Cho. In Hay River we don’t have a board. We have a public administrator in Hay River and again, we plan to move forward with a public administrator in place at this time.
We are reviewing the Medical Travel Policy. We’re trying to modernize the Medical Travel Policy. Medical travel is something that we think is an issue. A lot of the people have indicated to us that they have some issues with medical travel. There seems to be a lack of real clear understanding of what the policy is intended to do. The policy is intended, because we can’t have doctors in every community, we have to bring the people to the doctor. That’s our difference. If you’re living in a jurisdiction where you have doctors that are immediately available to people in the majority of the percentage, then you wouldn’t have to have this type of policy in place. At this time we don’t have that available to us. In fact, we may even have difficulty having doctors in the regional centres all the time because at this time we use locums and so on.
The Medical Travel Policy kind of gives us an even playing field, if that could be a term used here, to provide to bring people from the communities to the doctors, as opposed to the doctors being at the community level. Right now there are lots of issues in the Medical Travel Policy. Individuals basically feel that once you hit a certain age, you automatically have an escort, if you’re at a certain level in your health, you automatically travel with an escort, and so on. Many of those things are misconceptions and we will try to clear that up in the policy. The work that we are doing is going to be developed over this year, this summer, so we’re not going to be dragging the work out on the review of the Medical Travel Policy over a long period of time. We’re going to try to deal with it as soon as possible.
Elders removed from their homes and end up in institutions is something that many of the small communities are opposed to. It’s heart-wrenching to actually sit and listen to the families that are left behind when they have no capacity to take care of their elders, and there’s no infrastructure in the community for them to take care of their elders. It had gotten to a point where they are a danger to themselves and they are a danger to their families if they were to be left in family homes and so on for various reasons.
Therefore, right now the Department of Health and Social Services is trying to respond by trying to put some long-term care in regional centres. We have long-term care in Behchoko. We have long-term care going into Norman Wells. We have in Inuvik. The MLA for Mackenzie Delta is right; there is no long-term care in Mackenzie Delta. Interestingly enough, though, the communities are not saying that they want actual long-term care. They are saying they want a place in the community where they can take care of their elders. Where they don’t need a whole bunch of nurses in the community to work in the centre to provide what we refer to as a department as long-term care. Rather, they would want to provide care to their elders in a facility where they can provide security and caring for their elders, cooking for their elders and so on. That was the same sentiment that we heard in Deline as well. They’re saying we have a home here.
Those facilities are owned by the NWT Housing Corporation. As a department we have to work with the Housing Corporation to make a decision on whether or not we’re going to re-open those homes, allocate the units with the elders that need that type of care, work with the community to try to provide that care. This will save us money in the long run. We recognize that it’s a possibility that people will not necessarily have to go into long-term care.
Right now what’s happening in a community like Deline is that the people are at home. They’re staying in their community and they’re being cared for by the family members. The family members are getting very tired. In fact, a lady had indicated to us that if her cousin was not able to take her father, that she would have to be forced to send him back to Yellowknife. The cousin stepped forward and is now caring for her father and she too was having a difficult time at the time we spoke to her.
In order for us to try to build some sort of a continuum of care for elders and try to keep elders in their homes and then use the facilities maybe provided by the Housing Corporation just known as senior citizens homes rather than long-term care facilities, then we’re going to have to find a way to assist those people, those elders living in those homes or living in their own personal homes, and how we can help them to continue living in their homes through home care and other nursing that we can do right in the home.
The Mental Health and Addictions Action Plan will be tabled next week. Yes, it is a three-year plan. That’s why it’s an action plan as opposed to a long-term strategy. We want to be able to affect change in the area of mental health and addictions during this term so that the people sitting in this room will be responsible and will affect change in those areas. We can develop a long-term strategic plan in this area, and we can work on that. It could be a good idea to set the table for future governments, but this plan was intended to address the issues that are more immediate concerns of this Legislative Assembly.
There appears to be a decrease in the overall budget, although there isn’t, because if you compare main estimates to main estimates, then there is a slight increase of 1.6 percent. It’s an increase when you compare revised estimates with main estimates of 2012-2013 compared to the revised estimates of 2011-2012 because, as we do for firefighting, many of our costs come in throughout the year, anticipated costs come in through the year through supplementary appropriation.
The THSSI funding is something that is scheduled to expire; however, our plan is to continue to deal with the federal government where developing relationships with the federal government, have a relationship with the federal government, have sat in a room with the federal government in federal-provincial-territorial meetings and we’re hoping that relationship will continue and that the federal government will continue the THSSI funding so that we can fund some of the essential programs that we’re funding with THSSI funding.
The Family Violence Program phase 3, the plan is to get through and have these main estimates, this budget of the Legislative Assembly passed. Once the budget is passed, if the budget is passed, then the plan is to move into a supplementary appropriation presenting a supplementary appropriation back to the Assembly to take a look at phase 3 of the Family Violence Act in that way. We need to have this dealt with first and then we’ll deal with the family violence.
The supplementary appropriation… I’m going to just quickly have the deputy minister speak on supplementary appropriation, and then it will come back to me again. Thank you.
Thank you, Minister Beaulieu. Ms. DeLancey.
Thank you, Mr. Chair. I believe the Minister was inquiring whether any administrative improvements and changes had been made to the Extended Health Benefits program. There have been some minor administrative changes over the last two years, amendments to the contract with Alberta Blue Cross to take on more of the processing and to make the process more efficient. We can certainly provide more details if necessary.
Thank you, Ms. DeLancey. Minister Beaulieu.
Thank you, Mr. Chairman. The shortage of doctors at the regional level is an issue, there’s no question about it. We have had a meeting with the Joint Leadership Council. The Joint Leadership Council is the chairpersons and the public administrators of all of the health authorities, health and social services authorities. We have asked them to develop a plan, a recruitment plan for physicians, by September of this year. I’m meeting with the Joint Leadership Council again on June 15th of this year to get a bit of an update on how things are moving in that area, and we’re hoping that we’re able to put a plan together that brings doctors to the regional levels. That is doctors into Hay River, Fort Smith, Norman Wells, Fort Simpson and Inuvik. Our first plan, I guess plan A, is to have doctors living in those communities. But history tells us that that’s going to be a difficult task. So far, many years have gone by and we don’t have doctors in many of those communities.
Our second option, as we discussed with the Joint Leadership Council, is to have a territorial pool of doctors, and the pool can be in the regions, as well, or Yellowknife, as opposed to using locums all the time. For example, in Hay River, seven doctor positions in the fiscal year. The fiscal year, I think it’s 2010-2011 was the number that I was using. In that fiscal year, with seven doctor positions, that community of Hay River used 37 locums. It gives you an idea of what the costs must be when you start bringing doctors in from the South and locating them there on a short time.
What we’re hoping to do, in addition to a physician recruitment strategy, is build in flexibility in the physician funding. The flexibility will allow authorities to hire nurse practitioners and perhaps physician assistants. But the mixture – and that’s why we need to work with the authorities – is going to be something that our department and the authorities will work with, to try to make sure that we understand that this is the best mixture to address their physician needs within their authority.
I just want to touch a little bit on addictions treatment. We recognize that addictions treatment is essential in our system. Right now we have one residential treatment that is operating at under 50 percent capacity, so we’re looking at that. We’re also looking at other ways where there will be other treatment, like we talked in the communities about having on-the-land treatment. The health centres, to be specific to Hay River, the new health centre has, right now, 10 extended care beds that are not going to be carried over to the hospital. Extended care is not really a place where…or long-term care. These patients may actually be long-term care patients, and a hospital is not a home.
The intention of our department is to provide homes for these elderly people. Regardless of the mental state that they’re at, they should still be in a home, and a long-term facility is a home for them. A hospital is not a home and it’s very expensive. Hospital space is very expensive space. We want to address that issue, and we’re not going to reduce long-term care beds in Hay River. That is something we are not doing. We are going to work towards making sure that those beds are in Hay River at the end of the day. They’re just not going to be in the hospital.
I don’t know the exact numbers for the language and speech therapy across the territory, but as indicated, we have the 73 locations across 33 communities where individuals can work with people on the speech and language therapy. Sometimes these individuals travel into the communities, the therapists travel into the communities and work with the children. At this time, I don’t know the numbers but we do know that it’s being used in the schools and at the health centre and so on. In fact, when we travelled into Colville Lake, there was a therapist in the community putting some children through some sessions.
We agree that, as a department, early childhood development is big bang for the buck, that investing in children at a very early age has long-term benefits, major long-term benefits. Minister Lafferty and I attended a meeting on early childhood development and we recognize that. Everyone knows that if you invest money into children early, the earlier you invest, the greater amount of results you’ll have, cost benefits that you’ll have at the end of the day down the road. We recognize that. It’s just a matter of now making that bit of a shift into, I guess, what a lot of the Members have been asking for, is prevention. To make that shift towards prevention. To make that shift towards promoting some early development and funding some early development in zero to three and three to six.
We have a shared responsibility with education and children three to six years old. We have, I think, the responsibility for zero to three and even during pregnancy through healthy families. We’re trying to expand Healthy Families programs right across the North. Right now I think that our expansion from what we have in place, I don’t have the communities, but I know where the expansion is. The expansion on the last budget was Inuvik and expanded to McPherson and Fort Simpson, and also expanding to Liard and McPherson. Those were the two additions to the programs that we already have in Yellowknife, Behchoko, Fort Smith and Hay River. There was a concern that the Sahtu did not have a healthy family program, so we’ve put, again, going back to approving this budget, and then planning in the supplementary appropriation to address the issue of Sahtu not having a healthy family program. We’re hoping that if we can get the budget through and then deal with that appropriation, it is hoped that that appropriation will go through and that we will have healthy family program in the Sahtu.
In prevention and promotion the budget appears to have decreased; that is true. What we have done is we have taken some of the prevention budget and given the prevention budget a portion of it to the Housing Corporation and a portion of the prevention budget sunsetted. That looks like a decrease, but again, through supplementary appropriation, our intention is to put some of that money back in. I’m just going to have the deputy minister speak on seniors population, population health, if that is okay, Mr. Chair.
Ms. DeLancey.
Thank you, Mr. Chairman. I’m just flipping from my main estimates. I am sure when I get to the specific page we can speak in more detail, but a concern was raised about a decrease in the population health budget. I believe that decrease is from the 2011-12 revised main estimates.
Thank you, Ms. DeLancey. Yes, we’ll go back and we’ll do that in detail. Mr. Beaulieu.
Thank you, Mr. Chairman. In the growing seniors population, it’s a demographic that is happening right across the country. We recognize that. That is a fast growing population. In order for us to maintain the funding to support the fast growing population, we do need to put in programs, rehab programs, more funding towards long-term care and putting some good, solid assisted living programs in place to keep people in their homes and so on.
The deficits of the health and social services authorities across the region had indicated earlier that our intention is to look at that by trying to do some changes in governance. Once we have those changes working with the authority, that we would then, sort of speak, right size the budgets for each of the authorities.
The infrastructure of $36 million that was mentioned, yes, the government agrees that health infrastructure is essential and that good health care is probably the number one priority across the Territories for our citizens. That is our intention, is to put modern infrastructure in place that can respond to the needs of the people of the territory.
We don’t have plans to put detox facilities in place at this time. At this time we are looking at funding programs and we would look at programs to help people with detox. The Member for Yellowknife Centre is correct; some of the more harder drugs, street drugs, can’t be addressed with on-the-land treatment that a lot of the communities are proposing to address their addiction issues, which mostly is alcohol. We would look at that. That’s something that’s in the works. We’re hoping that we can come to some resolution with the detox areas. Like I indicated, that is more of a program, that infrastructure need.
Midwife programs and for healthy babies, we recognize that midwifery could be a good alternative for people having to travel to Yellowknife to have babies, young ladies travelling to Yellowknife staying here for several weeks, staying at the facilities around here at a substantial cost to the government. If we are able to offset that by putting midwife programs in communities where it’s viable, that’s our intention. We’ve done the evaluation to determine that maybe the next best place to put a midwife program in place would be Hay River. Many of the babies that are born are originating from Hay River and Behchoko. Behchoko is fairly close and they may be able to continue to have their babies in Yellowknife. I don’t know. We haven’t come that far down the road, but we do know that it’s probably feasible and has been feasible in Fort Smith. It’s probably feasible in Hay River.
The infrastructure planning, again, going back to infrastructure planning in Fort Simpson, we are planning to replace the health centre in Fort Simpson. Our planning study will be completed in April of 2013 to give us a chance to review our planning study and determine exactly what their infrastructure requirement is and then come forth through the capital planning process to be able to find the money and put the money in place to replace that health facility. It’s the same thing with the Tulita Health Centre, same timeline. In Tulita we’re looking at the same timeline. April 2013 is the time when we hope to have the studies completed.
Toward the response to the nursing shortages in the communities of Tsiigehtchic, Wrigley and Colville Lake, I would like to ask the deputy minister if she could provide detail for response. Thank you, Mr. Chairman.
Thank you, Mr. Beaulieu. Ms. DeLancey.
Mr. Chair, this is of course an ongoing issue and we actually have seven communities that don’t have any resident nurse in them. In most of those communities, we do have some resident health workers. For example, in Wrigley there is a full-time community health representative, part-time community health worker and a home care worker. In Tsiigehtchic we have a wellness worker and a community health rep and a home support worker.
We recognize that that is not always efficient to respond to medical emergencies. The department is in the process right now of updating our service delivery model, and one of the Members mentioned that we shouldn’t be deciding whether there is a nurse in the community based on numbers. The sad reality is that we have a number of barriers in terms of having a nurse in every community. It’s very difficult to have just one nurse in a community, as we have discussed this in the standing committee from the perspective of safety, from the perspective of overwork and sustainability. There are housing challenges in many communities.
We really need to get creative and we just recently returned from a meeting. All the Health Ministers of the provinces and territories got together to talk about how we can be more sustainable. One of the things they’re looking at is being more creative using the full scope of practice of different practitioners. For example, we heard about some small, isolated communities on islands in Nova Scotia where they trained paramedics. They don’t have a resident nurse and they don’t have highway access to a doctor, but they’re using paramedics. Some of our communities have talked about if we can’t have a registered nurse, what about a licensed practical nurse.
When we go through updating our service delivery model, we want to look at a whole range of options for these communities. When we travelled to Tsiigehtchic, the community spoke very positively about having had first responder training in the community. Other communities have asked us for that. There may be opportunities, without bringing a nurse in, to bring in a higher level of emergency response.
The last piece of the puzzle is using telehealth and electronic health. If we can have a paramedic or a first responder in a community that links up by videoconference to a physician in Inuvik or in Fort Simpson, we may be able to address the issue a different way.
I think these are some of the things that we’re looking at and we will be looking at over the next few months to try to solve this problem.
Thank you, Ms. DeLancey. We’ll go back to Minister Beaulieu.
Thank you, Mr. Chairman. In some locations across the North, we recognize that we spoke briefly on the long-term care facilities and our inability to put long-term care facilities in every community. In many of the smaller communities they were asking for much simpler, cheaper response, or less expensive response than that, and that was to increase home care workers.
So we’re looking at the integrated service delivery model. It’s 10 years old, I believe, and we want to review that and we want to be able to respond to those types of requests where they’re saying we’re not expecting you to build a facility here, put three old people in there and then have it sit empty for part of the year or have half of it sitting vacant. Why don’t you respond by putting in a different scope of practice as the deputy minister referred to just now, whether it’s a licensed nurse practitioner, home care worker or a community health nurse, which would be a registered nurse but more of a primary care approach. So a primary care team approach so that we’re able to provide a service that is needed in the community without having our resources sitting idle. That’s something we want to avoid as much as possible.
With the cost of health care, we can’t afford to have resources not doing anything. We can’t afford to have two registered nurses with home care workers in small communities where, for the most part, they’re not doing anything. What we need to do is have a primary care team that goes in there so they’re busy all the time for the work that is needed in those communities. Then we’ll bring in physicians on an as-needed basis and that’s a model that we want to look at. We want to look at modernizing the integrated service model delivery so that we have a system that responds to the community from the smallest communities to Yellowknife, that we’re able to respond in the appropriate way with the appropriate health care that’s needed in those communities.
I have some more cost-drivers, as some of the Members referred to, smoking, obesity, addictions, aging population, and we factor those things in. We factored in addictions, we’re factoring in some smoking just in our business, just in the way we are going to the schools and trying to promote no smoking, exercise, healthy eating, those types of things. When we have healthy family programs, that’s how they start. They talk to the mothers while the mothers are pregnant, to be able to indicate to the mothers that when these babies are born, we have to start feeding them in a healthy way, less sugar. We’re trying to prevent more diabetes.
Diabetes is a brutal disease and I think people and the Members in this House know that. A simple thing that I’ve been talking to the communities about is that a very simple way of not getting diabetes, if you’re a young person where there’s lots of diabetes in the family and you appear to be susceptible to diabetes, is walking 30 minutes a day, and we’ve been promoting that. We’ve gone to the communities and said walk 30 minutes a day and you probably wouldn’t get diabetes. I mean, there’s a good chance that you won’t get diabetes if you walk 30 minutes a day. This seems like such a simple thing to prevent such an awful disease, a disease where people are losing their limbs and people are dying from heart failure and people are having their quality of life, very, very poor quality of life if you have diabetes, and the amount of pills you take and the cost to the system, a cost that could be put somewhere else, costs that could be put toward trying to help the overall population of the Northwest Territories to be a better place to live and a place where we can put this money into much needed education so that our overall population is healthier and educated as is the goal of this government.
Cancer is a huge issue. We are working with Fort Good Hope. Fort Good Hope and Fort Resolution are two communities that have come forward because they’ve lost young people. In a small community like Fort Resolution and Fort Good Hope, when you lose a young person to cancer, a person dies while they still have small children themselves and they’re at an age where most adults are older than the person that dies of cancer, people start to pay attention. It becomes a real issue. In Fort Good Hope we heard that. In Fort Resolution we’ve heard that.
So we want to work with those communities. Right now, as the Member for Sahtu indicated, there’s got to be a lot of work done in early screening and so on. We’re actually doing a good job of early screening, but they are concerned that the environmental effects on the community, water, and maybe not being able to afford, as Members today spoke about the cost of living, not being able to afford healthy foods. It’s a big issue. When you’ve got communities with low employment rates, it’s difficult for them to afford healthy foods all the time.
So we’re going to go into the community in Fort Good Hope, as an example, on the 18th and 19th of June to have a workshop in the community. That’s going to start to set everything in motion for that community to start working with our department, and we’re going to do the same thing in Fort Resolution. Our intention is to go in there and do the same thing. We’re going to expand that to as many communities as possible.
The whole idea, I guess, is to try to prevent people from getting cancer. If there’s a possibility that people could go to get screened for cancer, have the various tests done so that we can pick up any cancer in the community at an early stage, I think the numbers are we can almost beat stage 1 cancer, almost always, and we almost always lose to stage 4 cancer. We lose lives to stage 4 cancer. We can always beat stage 1 cancer. So it makes sense that we want to move as much as possible to try to address the cancer issue at stage 1. So that’s something that we want to do.
Unfortunately, people do pass away and the communities want to have palliative care. Our department is looking at that. We want to make sure that people are passing away as close to home as possible, at home if possible. So the department is looking at providing palliative care to individuals so that individuals on their last days are in their own home.
There is an impact to resource development and we hear that. We hear that in Good Hope. They think that their cancer rates are impacted by development upstream. Fort Resolution thinks their cancer rates are impacted by development upstream.
We’d like to talk about dental care. Dental is actually a federal government issue, but we can talk about what we want to do is oral health. Oral health is a responsibility of the GNWT. So we’d like to see how we can expand dental therapy. We can always talk about dentists and we can talk about the federal program, whether or not it’s adequate or inadequate and we talk about it for days on end, but it’s somebody else’s responsibility. We still have to get approval from the federal government in order to do anything in that area. Oral health, on the other hand, dental therapy on the other hand is our responsibility. We want to develop a strategy on oral health. We recognize, clearly the department recognizes that good dental leads to good health. Individuals that have good dental will have good health. If you can’t chew your food properly, just to put it in simple terms, yes, you will get sick. So this is an important thing for this department as well. When we look at oral health, that’s something that we know will have positive impacts.
I guess I’m going to ask the deputy minister to respond a bit to the cost of drugs, because we’ve talked about the cost of drugs at the federal level. For a little more detail I‘m going to ask, but just to give her an opportunity to think about it for a minute, I just want to talk about the missed appointments. We know that missed appointments are a costly thing to this government, to the Department of Health. The Member used 12 percent. We in some places know that it’s 19 percent. One-fifth of the people that make appointments are missing them. If you have to come all the way to Yellowknife to see the doctor, don’t miss the appointment. It’s costing this government a lot of money. We can’t cut them off. We can’t penalize them for the future. We can’t charge them. It just ends up costing the system money. We need to address that somehow, that at the appointment stage when the appointment is being made, that we want the health practitioner to have a very serious discussion with individuals as part of the system, so that individuals don’t miss appointments and unnecessary costs to the health system.
I would like to just ask the deputy minister to respond to the cost of drugs.
Thank you, Mr. Beaulieu. We’ll go to Ms. DeLancey.
Thank you, Mr. Chairman. Yes, we’ve heard a lot about the rising cost of pharmaceuticals as being a huge cost-driver on the health system. Probably more so in other jurisdictions. It’s not as big a part of our budget proportionately, but as our population ages, we’re probably going to see more and more pressures in this area.
The provinces and territories have done a fair amount of work working together and there’s even a consortium of western provinces. One Member asked if we were part of that. In fact we are present at that table. We are working with other provinces and territories on a couple of things. There has been a lot of work on bulk purchasing of drugs. There’s been some work lead by BC and Ontario on negotiating specific prices for some very expensive drugs on a one-off basis with suppliers. There’s also some work going on looking at increased use of generic drugs to try to bring down prices. At a national level we are plugged into work that all the provinces and territories are doing.
At a more local level, we have put in our strategic plan, development of a Pharmaceutical Strategy. We have done some very early work on that. We don’t know yet what all the features of that will be. Actually, I had met with the Pharmacists Association not long ago and we’re seeking their views and have talked about renegotiating and updating our agreement with the pharmacists. We are doing some bulk purchasing of drugs locally, as well, and some of our health authorities are involved in bulk purchasing and we’re trying to bring the other health authorities in.
This really intersects with the whole issue of drug shortages, which has been an ongoing issue in Canada, because what we’ve found is that with the recent drug shortages that got quite a bit of attention in the press, the authorities that were engaged in bulk purchase agreements actually had a guaranteed source of supply, whereas the authorities that did not have a relationship with a provider were kind of left out in the cold. We’re trying to work through our system to have all our health authorities involved in contractual arrangements which will help to some extent to moderate and mitigate the drug shortages. There’s quite a lot of work going on in that area and quite a lot of work left to do.
Thank you, Ms. DeLancey. We’ll continue with Mr. Beaulieu.
Thank you, Mr. Chairman. That concludes Health and Social Services’ response to general comments.
Thank you, Mr. Beaulieu. That appears to conclude general comments. Does the committee wish to proceed to detail?
Agreed.
I’ll get everybody to turn to page 8-7. We’ll be deferring that until we have consideration of detail. Page 8-8, Health and Social Services, department summary, information item, infrastructure investment summary.
Agreed.
Page 8-9, Health and Social Services, department summary, information item, revenue summary. Page 8-10, Health and Social Services, department summary, information item, active position summary. Mr. Moses.
Thank you, Mr. Chairman. I see there was an increase of seven positions and they all went into the Yellowknife headquarters. Can I just get a quick breakdown of what these positions are, and if they were consulted into looking into the communities at all when they were first introduced?
Thank you, Mr. Moses. For that we’ll go to Ms. DeLancey.
Thank you, Mr. Chairman. I can run through those positions. There are three new indeterminate positions in the directorate. One is an associate deputy minister position. One is the director of policy, communications and legislation. This position was created basically as a result of the Auditor General’s report which recommended a stronger emphasis had to be taken on accountability and evaluation of performance measurement. What we did is we split the policy and communications and legislation off from that accountability area so that we now have two directors where there was one. One of those positions is an administrative assistant position to support the new management positions. Then the last permanent position is the Child and Family Services Committee coordinator, which we’ve talked about here earlier. That’s four positions.
Then we also have created four two-year term positions that will be funded with the funding through the Territorial Health System Sustainability Initiative, THSSI. These we’ve actually created four positions but taken one away. That’s three more positions. These positions are focusing on some of the projects in our strategic plan that really are seen as reform which will make the system more sustainable. We have one that’s focusing, and the Minister has talked about shared services amongst all the authorities. We’re doing a fairly huge project to look at where we can achieve some savings through shared services and we are dedicating a project manager to that work. We’ve also dedicated a project manager to the work on revising medical travel business processes and looking at increased use of eHealth to support a reduction in medical travel. We have a position that will specifically be working on updating the Medical Travel Policy and that position will be responsible for consultation, coordinating consultation and pulling together the results of that. Then we have a project manager position.
Of the seven positions, four are indeterminate and three of the seven additional positions are two-year term positions. We did look at whether it made sense to locate those positions outside of Yellowknife but the very nature of those project positions have to work closely with our existing finance shop, with our information services and eHealth shop, and with our policy and legislation shop. It really was difficult not to have them at headquarters.
There was mention of three positions under the THSSI funding for the two-year project. Are there any plans in place for all the good work, should this work be incomplete at the end of the two years and the THSSI funding running out, is there any plan of action to continue the work or is it just going to come to a halt? The work, especially with the shared services, I think that’s an important one. Was there any plan to look at how these positions can either continue on or how the work that these positions have been working on does continue?
Our hope is that these will not be permanent positions. There’s a lot of work involved in stepping back and looking at how you’re delivering a program, how to change it, developing the plans to implement change and to train staff while the people who are delivering the program, the medical travel staff, are doing their day-to-day work, for example.
Another possible shared service is in the area of finance. We again have finance staff in all the authorities that we can’t pull away from their day jobs to do this design. These will not be permanent positions, but the Member raises a good point that two years is not a long time to implement substantial change like this. It seems like a long time but somehow we never seem to get done when we think we will. If we are successful in negotiating an extension of THSSI funding with the federal government that might support continuing this work until such time as we’re able to implement the changes and it becomes core business. Having said that, we know we have a two-year time frame, we know we have the funding for two years and we’re making every effort to get the work done.
Thank you, Ms. DeLancey. Moving on with questions I have Mr. Yakeleya.
Thank you, Mr. Chairman. I want to ask the Minister, and maybe it might be in another section of the business plans, on the principle of the Nurse Practitioner Program. I’m not too sure if it’s in here or fits in this section or later on on these positions that are within the department of within the health board, so we have some graduates this year.
Thank you, Mr. Yakeleya. We’re going to go to Mr. Beaulieu.
Thank you, Mr. Chairman. All the nurse practitioner positions are within the authorities but we don’t have the information here on the amount of nurse practitioners who have graduated recently.
Thank you, Mr. Beaulieu. Would you be able to provide that information to the Member?
Thank you, Mr. Chairman. We can provide that information.
Thank you, Mr. Chairman. I look forward to the Minister’s information. Just on the principle again of the nurse practitioners, and the Minister can correct me if this is the place where I need to continue digging into this or just ask about it later on in the business plan, but I am asking the Minister on the principle in the policy of these active positions, if they’re working closely with the Sahtu Health Board or the Yellowknife Health and Social Services Authority, or any other authorities we have on these valuable positions and people that we have hired. Is there a policy in health that we will hire these nurse practitioners once they graduate from our training program?
Thank you, Mr. Yakeleya. Yes, we are in that same page or close to it, so I’ll allow that type of question. For that we’ll go to Mr. Beaulieu.
Thank you, Mr. Chairman. This is going to be part of our review of modernizing the integrated service delivery model.
I’ll get to that area when we talk about the modernization of this act. I want to definitely see the nurse practitioners in there and how we can continue to support them in their efforts and make it easier for us, and I hope we can have some fruitful discussion when we get to that area. I’m just lending my support to those professions.
Thank you, Mr. Yakeleya. Page 8-10, Health and Social Services, department summary, information item, active position summary.
Agreed.
Page 8-11, Health and Social Services, department summary, information summary, active positions, health and social services authorities.
Agreed.
Page 8-13, Health and Social Services, activity summary, directorate, operations expenditure summary, $7.924 million. Mr. Bromley.
Thank you, Mr. Chair. I want to just follow up a little bit. I appreciated the information the Minister shared on planning for infrastructure improvements to Stanton Territorial Hospital. I am concerned, though. He started to talk about the next steps and then stopped short of that, but he did reference that the next step after the schematics would be to enter into the capital planning process. I believe there’s an understanding that that’s typically a five-year process which, of course, is alarming to a lot of people across the Northwest Territories. Has there been any discussion yet? Does the Minister feel this is already in the capital planning process? I mean, obviously, we’ve known that as soon as we got the planning done, we want to start hammering nails or look after the ventilation or whatever. Could I get some idea where we’re at on that specific front? Thank you.
Thank you, Mr. Bromley. Minister Beaulieu.
Thank you, Mr. Chairman. This year, in this budget, our plan is to spend $4 million to complete the remaining schematic planning and the initial occupational planning. We can’t go beyond that. We have to have approval of this House to go beyond that. We’re moving forward in this area and this is part of the process, but I can’t anticipate what there’s going to be in the capital plan in future years.
The extensive communications and discussions in the House and in committee that we’ve had over the past five years have meant nothing in terms of carving a niche for planning infrastructure dollars on an expedited basis as opposed to another five-year process. Is that the Minister’s understanding? There have been no discussions in Cabinet about that? Thank you.
I think this is the final step of the planning, the program planning. I think the next step is to put money into the capital plan. This is the process for all the infrastructure that’s needed. It goes through a process when we first come up with the idea. I don’t think that the department or the government wants to see us spend $1.2 million on program planning, technical status evaluations, schematic planning, planning contingencies, and then put another $4 million in this year to complete the remaining schematic planning and occupancy planning if there isn’t an intention to seriously look at putting this into the infrastructure plan.
That’s a very good point the Minister makes. I have seen the government do strange things, but I would agree that’s a logical position to take. I’m with the Minister on that and I do want to agree with his earlier comment in response to our general comments that this is something that cannot wait. I’ll leave it at that. I know this is a capable Minister who’s going to nail down those capital dollars. Thank you.
Thank you, Mr. Bromley. Moving on with questions, I have Ms. Bisaro.
Thank you, Mr. Chair. I wanted to ask some questions here further to the comments I made initially. The first thing I wanted to ask about was the service partnership agreements that the Department of Human Resources and the Department of Health are apparently developing. Could I get an update on where those agreements are at? Have they been fully developed?
