Thank you, Madam Chair. The primary factor behind the deficits at the Beaufort-Delta authority has been nurse and front-line staff overtime, callback and relief, as well as some costs related to physician services, but less so. As well, another factor which is dealt with in this year’s budget is they were currently funded at a 17 percent benefits and the cost of benefits is actually closer to 23 percent. In the 24/7 operations they have to incur those full costs so we’re addressing that in this year’s budget.
Thanks for the description on why these deficits have accrued. Knowing that, would the Minister look at putting those into the budget for the next year and the years following? It’s something that has been trending over the years and it’s not changing. If we put it into the budget, we wouldn’t have to be coming back for supps for future and it would give the authorities a little bit more breathing room, a little bit less stress knowing that they do have the funds to do their job and not be worried about going over budget and getting into that deficit.
Thank you, Mr. Moses. Ms. DeLancey.
Thank you, Madam Chair. We are in an ongoing process of trying to base fund the authorities appropriately. As Mr. Elkin said, this year’s budget does include some base adjustments for Beaufort-Delta and Stanton to deal with issues like unfunded staffing issues. We are continuing to work with each of the authorities to do the detailed analysis, and as we do that we bring the business case forward to FMB to seek forced growth, so that we hope over the next couple of years we can actually get the authorities more right funded so that they are not constantly incurring deficits for ongoing costs that can be anticipated.
No further questions. Thank you.
Thank you, Mr. Moses. Next is Mr. Dolynny.
Thank you, Madam Chair. I do have questions for the Minister and deputy minister but, unfortunately, some of these questions pre-date their positions and for that I do apologize. However, I know that the accountability is in play, because I will be pulling questions out of the Auditor General’s report that was tabled here in March of 2011, so it is very relevant in the questions in terms of what work has been done by the department since the tabled report. Within the parameters of the report, it was very well documented that there was contribution agreements in place with a number of the health authorities but there was lacking performance agreements. My question has to deal with performance agreements. Has the Minister, has the department rectified signing all authorities making them accountable for the performance of their budgets to make sure that they are delivering all the programs that they are receiving money for?
Thank you, Mr. Dolynny. Mr. Beaulieu.
Thank you, Madam Chair. We haven’t done that yet. We set up accountability steering committees with the authorities to develop this.
I would assume that the Minister and the deputy minister, who is here, are much in line that this is a very, very important part of delivering health care to the Northwest Territories. Giving authorities money without having any strings attached really puts the delivery of patient care at risk, which leads me to my next question.
At the same time the Auditor General took an extensive look at how we deliver our services for diabetes and it was indicated at that time “that the department does not use administrative data to monitor diabetes programming, nor does it systematically collect data on diabetes prevention and treatment results.” With that comment, can we receive some assurances that disease states like diabetes, because this is an Auditor General report that has been in the hands of the department now for some time, have we made strides to deal with the comment that was just read? Thank you.
Thank you, Mr. Dolynny. Ms. DeLancey.
Thank you, Madam Chair. We are working on that. The department and the authorities had entered into pilot projects on chronic disease management with the Canadian Health Services Research Foundation providing expert support and an evaluation framework. There is a pilot project underway right now to address some of the concerns raised by the Auditor General, and it’s taking place in Yellowknife, in Behchoko and Norman Wells, with a view to then evaluating it by this September and applying the findings more broadly throughout the system.
The other tool that we are working on that will help to address the Auditor General’s recommendations is the implementation of the electronic medical record on a system-wide basis, because the electronic medical record then does provide one place to both put reminders and clinical practice guidelines for diabetes, and then to track that those things have been addressed on a timely basis.
I do appreciate the response. However, I do have to make known that the department did agree with establishing a chronic disease model and having that first draft developed in the 2011-2012 budget year, and that there was going to be a primary community care draft and response back. It appears that the department made promises to the Auditor General back then and is being very slow on delivery.
Again, I appreciate what I’m hearing, but my question would be, if I picked another disease state, cardiovascular, or if I picked a myriad of cancer issues, would the department be in a similar position? Is the department making strides to make sure, as I heard earlier, we still don’t have performance agreements in place to deliver these programs, but can we get some assurances that we are working towards resolution, given that the Auditor General basically cleared a perfect path for us to follow? Thank you.
The work that we’re doing on chronic disease management with the CHSRF focuses on three areas. It focuses on diabetes, it focuses on renal care, it focuses on mental health, but the intent is that the mechanisms that are developed and tested and the best practices will then be applied to a number of chronic diseases such as the ones the Member has mentioned. It is a process that is rolling out, sometimes more slowly than we would like, but it’s work that’s being done by practitioners throughout the system that are doing this in addition to their day job. We think that’s important because when frontline staff are involved, they understand the process and we get buy in.
I’ll be coming back to the Auditor General report here later on in this budget process.
My next question has to do with medical equipment. In the line entry here we have as medical equipment under $50,000. There seems to be a slight increase. However, it is well known that we have, especially at the territorial hospital, a number of large pieces of equipment that are nearing their lifecycles. A lot of this major equipment was purchases in the late ‘90s, early 2000’s. Some of this equipment is now entering 12 years of lifecycle and needs to be looked at. I’m speaking specifically to things like the CT scan. I’m thinking about things like the large mammography units that were purchased back then.
I don’t see much in the budget here to deal with those large ticket items above that $50,000 mark. Does the department have a plan of action? Is there an approved capital list of these products, and if so, can they share some of those top line items that could be plaguing the people of the Northwest Territories in either replacing or enhancing the current delivery of health care services across the Northwest Territories? Thank you.
Thank you, Mr. Dolynny. Mr. Elkin.
Thank you. First, the item in the budget here, items under $50,000, is a slight increase. We have a comprehensive medical equipment evergreening plan that’s managed by the biomedical department at Stanton. Every five years we update our evergreening plan. This increase reflects our forecast for the next five years of what our annual costs of evergreening minor medical equipment.
Last fall, as part of the ’12-13 capital plan, we have approved about $3.2 million of a five-year evergreening plan for our major medical equipment. We did a comprehensive review of forecasting what our annual costs would be to evergreen all of our major equipment. Items that are planned for the ’12-13 year across the health system include endoscopy, physiological monitoring, anesthesia equipment, operating microscopes and clinical chemistry analyzers. We, again, do bulk purchasing between all the major facilities, Stanton, Inuvik, Fort Smith and Hay River, to get economies of scale when we’re purchasing. Then we have a list, again, going for the next five years of all our major pieces of equipment, and then we’ll renew that evergreening plan every five years to make sure we have enough funding in the system.
I appreciate the details. Would the Minister or the department consider sharing the findings of this evergreen plan, sharing their approved capital list for outdated or near lifecycle of major capital equipment, and if this could be submitted to the Social Programs committee so we can keep a monitoring of this as these large ticket items appear over the life of the 17th Assembly? Thank you.
Thank you, Mr. Dolynny. Minister Beaulieu.
Yes, we can share that information with the Standing Committee on Social Programs.
Thank you, Mr. Beaulieu. Thank you, Mr. Dolynny. Mr. Moses.
Thank you, Madam Chair. I just wanted to get a little bit more clarification on questions I had asked yesterday in regard to the seven positions. There were four positions that were allocated through the THSSI funding, and I believe that Ms. DeLancey mentioned that three were being staffed right now. I did have a question as to the plans that the department has after two years, 2014, when those jobs do expire. I know she mentioned, I think, there were some in the shared services and administration, and the work that they do, and that we just didn’t want to leave that onto the wayside. Can she clarify? What’s the plan the department has in regard to this funding and if they’d be willing to look at funding this position within their own department should the funding not come, when the funding expires? Thank you.
Thank you, Mr. Moses. Ms. DeLancey.
Thank you, Madam Chair. There are four THSSI positions that we are in the process of filling. Three of them are deemed new positions because one was replacing a position that was an existing position. They all relate to implementing change in the system, the shared services, the Medical Travel Policy, the Medical Travel Program redesign, the territorial support network. We are looking at having the bulk of that work completed within two years. So as I said yesterday, if THSSI funding is continued, if we’re successful in negotiating an extension and the work’s not done, those terms might be extended, but they are not positions that are deemed indeterminate, so they’re not positions that we would be funding from within.
Mr. Moses has no further questions. Committee, we are on page 8-21, activity summary, Health and Social Services, health services programs, operations expenditure summary, $192.989 million. Are we agreed?
Agreed.
Thank you. Page 8-22, activity summary, Health and Social Services, health services programs, grants and contributions, grants, total grants $40,000. Are we agreed?
Agreed.
Contributions, total contributions, $149.419 million. Total grants and contributions, $149.459 million.
Agreed.
We are agreed. Thank you, committee. Page 8-25, activity summary, Health and Social Services, supplementary health programs, operations expenditure summary, $26.243 million. Mr. Dolynny.
Madam Chair, probably a clarification in order. We know that the details of other expenses both come to the same total from the revised estimates of 2011-12 to $10.471 million. Could the department indicate why the insertions of the numbers and the mannerisms that we see here before us? Thank you.
Thank you, Mr. Dolynny. Mr. Elkin.
Thank you. We have moved remaining administration of the Extended Health Benefits Program from the department to Alberta Blue Cross, so it is going from a fees and payments to a contract with Alberta Blue Cross. So we are just moving how we pay the money out.
Could the department give us more details? Is this the long-term contract we have gone in with Blue Cross? Are there measures reporting for performance? Maybe a little bit more details in terms of what this new relationship with Blue Cross is all about.
Thank you, Mr. Dolynny. Minister Beaulieu.
Madam Chair, the contract is achieved through competitive tender. We don’t have the term of the contract with us here today.
Madam Chair, I would just assume that the Minister and the department have no problems sharing the terms of the contract with the Social Programs committee.
The department has no problem sharing that information with Social Programs.
I appreciate it. Thanks to the Minister for providing that. Extended benefits or extended health benefits has gone through its ups and downs over the years with the obvious relocation of the office to Inuvik. The Minister has no doubt heard discussions that I know I have had with the Minister in terms of improvements that could be done with extended health benefits. I agree moving the processing of this to the Alberta Blue Cross Adjudication Program is definitely a step in the right direction, but there is an approval process for those items that don’t fall under the formulary. These are so-called special items. Can the Minister indicate what improvements have been undertaken to streamline the process for the people of the Northwest Territories who are waiting for items that are not considered on the formulary but are definitely needed for either disease condition, medical condition or prosthetic or medical device? Thank you, Madam Chair.
Madam Chair, we have made no improvements to that system so far, but we do have it in our work plan for this fiscal year.
Madam Chair, I appreciate the Minister making comment to that. Further to that, would the Minister agree in principle to work with the Social Programs committee to work on solutions, communication, profiling that with community to get feedback from community as we make improvements to help streamline this service for the people of the Northwest Territories? Thank you, Madam Chair.
Madam Chair, the department agrees that we will work with the Standing Committee on Social Programs to make those improvements.
Thank you, Mr. Beaulieu. We are on page 8-25, supplementary health programs, activity summary, Health and Social Services, operations expenditure summary, $26.243 million.
Agreed.
Thank you, committee. Page 8-26, activity summary, Health and Social Services, supplementary health programs, grants and contributions, contributions, total contributions, $15.772 million.
Agreed.
Thank you, committee. We will move to page 8-29, activity summary, Health and Social Services, community health programs, operations expenditure summary, $87.998 million. Mr. Dolynny.
Thank you, Madam Chair. Just some clarifications on some of the numbers on this page under the term “contract services and other expenses.” Can we get an explanation to the decrease of slightly under $2 million? Thank you.
Thank you, Mr. Dolynny. Minister Beaulieu.
