Thank you, Mr. Bromley. Minister Miltenberger.
Thank you, Mr. Chairman. We just want to clarify the numbers that Mr. Aumond was speaking to, or for insured services for non-NWT residents, so now we will respond to the question that Mr. Bromley had asked. I will ask the deputy.
Thank you, Mr. Miltenberger. Mr. Aumond.
Thank you, Mr. Chairman. For out-of-territory hospitals, the total projected cost in ‘13-14 is about $22.9 million.
Thank you, Mr. Aumond. Mr. Bromley.
Thank you, Mr. Chair. I know these costs are always going up. Is this amount generally going up from year to year, the $22.9 million, for example? Are we always requesting these extra dollars for the increased costs? Thank you.
Thank you, Mr. Bromley. Minister Miltenberger.
Thank you, Mr. Chair. Across the country, the health costs are going up on an annual basis. In some cases, it’s a modest amount, a few percent. In many cases it is 6 to 9 percent. Yes, as this supp indicates, these costs pressures are consistent and inexorable. Thank you.
Thanks to the Minister. Does our budgeting process allow us the flexibility of saying we’re going to assume a 5 percent increase this year when we’re budgeting for these costs, or do we have to basically go on what it was last year and deal with the extra costs through a supp? Thank you.
Mr. Chairman, there’s going to be a target adjustment and this money will go to the base that we’re requesting. As opposed to taking 5 percent, we know that there is a $3.7 million shortfall, so that’s going to be approved now and then added to the base for next year. Thank you.
Thanks for that information. It sounds like we’re never allowed to get ahead. We’re allowed to count for what the actual costs are this year through this unfortunate process, but wouldn’t it be great if we could do it at the beginning of the year so that we actually knew what our costs were roughly? We might even feed back a few thousand bucks at the end of the year, who knows? But I would be happy with a conservative estimate of increases based on our experience. It would just greatly reduce these sorts of costs, or at least adjustments. Thank you.
Mr. Chairman, the Legislature and the Government of the Northwest Territories have learned over the decades that what seems to be the best way to manage the money is putting a base budget, and if you are over, come back when you can justify the expense as opposed to anticipating at the beginning of the year a number, however big it would be, and then hoping it’s enough and that the things don’t expand, just spend the money available in the budget. Hard practice has shown and I know, if I can use fire fighting for example, they used to have a very rich budget. It ended up, when there was a small fire season, a lot of other things got done but the fire budget stayed the same even if they didn’t use the money. So for this and other program areas, it came to practice to give them a good base budget, and if there are costs over and above that, then come back and we will make the case to the Legislature why we should get paid for that. That’s the approach that has been consistent in my time here in this Legislature. Thank you.
It sounds like that’s the hard reality and our budgeting system does not have flexibility to do this and redefine that base even conservatively. We know typically this year the numbers I have have increased about 5.5 percent. I think in the order of 4 to 6 percent is typical across Canada, so we could adjust it by 3 or 3.5 percent theoretically, but it doesn’t sound like we have that flexibility. So, onwards.
Thank you, Mr. Bromley. I will take that as a final comment. I do have Mr. Nadli on this page as well. Mr. Nadli.
Thank you, Mr. Chair. Just an observation in terms of this section of the budget, it seems rather high, but I realize that patients that have serious injuries in some circumstances have to be sent down south because we don’t have the specialized care here in the NWT. I just wanted to get the Minister to perhaps share his vision in terms of trying to curb the costs but at the same time looking at perhaps a concept of at least a legacy in terms of ensuring that we have homemade solutions here and we have institutions that are tailored to deal with industrial-type accidents, whether that is perhaps the vision that the Minister has in his department. Thank you.
Thank you, Mr. Nadli. Mr. Miltenberger.
Thank you, Mr. Chairman. As Minister of Finance, we put forward a budget that has a very hard cap on forced growth and we’re trying to control our supplementary appropriations. We are trying to make sure that we manage those expenditures.
In regards to the vision of Health and Social Services to address some of the issues that the Member talked about, I’d ask the Minister of Health and Social Services if he wanted to make some comments as the Minister responsible and the man with the plan.
Thank you, Mr. Miltenberger. We will go to Minister Abernethy.
Thank you, Mr. Chair. If I understand the question correctly, it’s about expenditure control within the department and the authorities.
Just to get clarity, Mr. Abernethy, we will ask Mr. Nadli to summarize his question one more time. Mr. Nadli.
Thank you. I think the point is in the realm of expenditure control, but at what point do we reckon with the fact that we do need a facility or an institution of some kind here in the NWT, rather than sending patients down south that require specialized care? Say we have an increasing rate of resource development on the scale of industrial activity and thus our labour force is perhaps highly susceptible to serious injuries that involve perhaps special brain injuries that require specialized care. At what point do we look at the concept of perhaps studying the idea of a facility or institution of that nature up here?
Mr. Chair, in the areas we see the asks here with respect to children in southern placement and adults in southern placement, we have asked for money in the ‘14-15 budget which has been moved forward, added to the base so that we don’t have to come back for as large of supps in the future, but the Member does raise a good point. Having said that, the individuals that are in these southern placements are usually high needs individuals with a range of conditions. I have asked the department to do a file review of all the individuals, recognizing that many of them are very complex and we don’t have the capacity to support them, to see if there are any similar or like clients with the same type of needs. If there’s an opportunity for us to repatriate any of them through, as you said, maybe a facility, it might be cheaper to bring a group of people with similar needs back to the North and support them in the North closer to their homes. We are doing that review to see if there are any opportunities there. It’s going to take a while because each file is so different and so unique, but I will keep the committee posted as we move forward. If we do find an opportunity there to repatriate a block based on similar needs, we will certainly be coming to committee for some further discussion.
Thank you, Mr. Abernethy. Mr. Nadli.
Thank you, Mr. Chair. I have no further questions.
Thank you. Committee, we are on page 7, Health and Social Services, operations expenditures, directorate, not previously authorized, $120,000.
Agreed.
Program delivery support, not previously authorized, $567,000.
Agreed.
Health services programs, not previously authorized, $12.568 million.
Agreed.
Supplementary health programs, not previously authorized, $2.521 million. Mr. Bromley.
Thank you, Mr. Chair. I see this is a request for Medical Travel Program costs. Again, I’m disappointed here. Basically we have poured in, in both during the 16th and 17th Assemblies, tens of millions of dollars to increase the efficiency of our medical travel system. Specifically on electronic medical records, telehealth, call forward physician access, community pharmaceutical supplies, community electronic imaging capacity. I am just again wondering what’s happening here on the increasing costs that we’re seeing, or is it a budgeting issue? I understand that Stanton Territorial Hospital Authority is already in substantial operating deficit and perhaps some of it is related to this, I don’t know. What are our substantial investments in the medical travel system getting us in terms of efficiencies? Why the ongoing unexpected, apparently, or unbudgeted costs here? Thank you.
Thank you, Mr. Bromley. Minister Miltenberger.
Thank you, Mr. Chairman. First, I’d just note that we’ve done the calculations as we’re sitting here. The 2014 budget that we’ve just approved is a 9 percent increase, roughly, over last year. It’s the largest growth department, as it is just about every government of the land.
There have been some efficiencies with the changes we’ve made to personnel, how it’s managed, the navigator we put in place, the back office work were with various regions, but there are some significant cost-drivers here, the scheduled air travel, the tickets, ticket prices that have increased, reduced flight schedules. The Minister of Health indicated in the House yesterday or this week, just by not having any more flights in the mornings means you have to tack on an extra day on medical travel.
The medevac personnel contract has gone up considerably, four-hundred-and-some thousand dollars. The Edmonton city centre closure had a cost to us, and boarding home contracts, as well, have gone up. There has been a reduction in NIHB, what they pay, so that cost has been downloaded to us, unrecoverable costs, over $400,000.
So we have those pressures that drive up the cost. The other big issue is it’s demand driven, once again, the amount of travel required to move people around either in the North or from the North to the South. Thank you.
Thank you, Mr. Miltenberger. Mr. Bromley.
Thanks, Mr. Chair. Thanks to the Minister. I recognize that many of the costs he mentioned are indeed increasing. In terms of the increased travel, the intent of all our tens of millions of dollars of investments was to directly address that. I think studies have shown upwards of 50 percent of medical travel patients were out on the street an hour after they had their appointment and didn’t really need that travel. With what we’ve invested now in telehealth, electronic imaging, the direct access to physicians and so on, hopefully we’ll be saving quite a bit on that front. I’ll just leave that as a comment, but welcome any further response.
Thank you, Mr. Bromley. We’ll leave that as a comment. Committee, page 7, Health and Social Services, operations expenditures, directorate, not previously authorized, $120,000.
Agreed.
Program delivery support, not previously authorized, $567,000.
Agreed.
Health services programs, not previously authorized, $12.568 million.
Agreed.
Supplementary health programs, not previously authorized, $2.521 million.
Agreed.
Community wellness and social services, not previously authorized, $9.258 million.
Agreed.
Total department, not previously authorized, $25.034 million. Committee agree?
Agreed.
Thank you, committee. Page 8, Justice, operations expenditures, policing services, not previously authorized, $1.307 million.
Agreed.
