Debates of March 9, 2005 (day 52)

Health services programs, not previously authorized, $8.804 million.

Agreed.

Page 11, not previously authorized, supplementary health programs, $1.883 million. Mr. Braden.

Sorry, Madam Chair. I was following the pages here and didn’t quite get the break. I wanted to see if I could inquire into the additional costs for provision of hospital services from Alberta. This would be on page 10, Madam Chair.

Okay, thank you. Does the committee agree to let Mr. Braden ask a question from page 10? Nay? Oh, I’m sorry, Mr. Braden. Alright, go ahead. At the chair’s discretion…

---Interjection

Madam Chair…

Who’s blushing?

Thank you. Yes. Well, let’s see if we can…okay. Madam Chair, we spent, according to the supplementary here, about 33 percent more than forecast with the Capital Health Authority of Alberta due to increased utilization and an increase in rates. This is a considerable jump from forecast. The information says that the approved budget was $12 million, the total projected costs for this year are $16 million, so we have a shortfall of $4 million. I’m wondering if the Minister could give a bit of detail on the increased utilization, as well as the jump in rates. Thank you very much.

Thank you, Mr. Braden. Mr. Roland.

Thank you, Madam Chair. Maybe I’ll have the Minister of Health and Social Services make that response in this area. As I explained earlier, the increased actual usage of what services are provided out of territory and some of those increases in the claims that were processed. For further detail, Mr. Miltenberger can give that detail. Thank you.

Thank you, Mr. Roland. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, as the Minister previously indicated, the utilization rates increased to the tune of about $2.8 million. There’s a four percent rate increase of about $331,000. Then there was some claims processed from 2003-04 for $865,000. I could share with the Members, if they’re interested, the summary of costs by diagnosis, by summary of claims by diagnosis, and by summary of average costs by diagnosis, if that’s of interest. I’d also point out that we’ve also been looking at our costs. Alberta has been looking at our use of their facilities and I’ve indicated to committee previously that one of the things we’re doing, it’s been pointed out to us in our review, that we were shipping people south that could have been serviced in Yellowknife first, at Stanton, to the tune of anywhere between 1,000 and 1,800 bed days. We’ve taken steps in the last number of months to make sure that we have a referral process that goes through and is coordinated out of Stanton to make sure that we use our northern services first, which we hope and anticipate will reduce some of our southern costs. All these programs are demand driven, so if there’s increased usage and there’s a requirement to send them south, we do that and then we come back. When we can demonstrate the cost then we come back looking for the extra money. Thank you.

Thank you, Mr. Miltenberger. Mr. Braden.

Okay, thank you, Madam Chair. I appreciate the information and, yes, we have had a fairly good exchange about this as committee. From what I picked up on this, the department has recognized and taken action to make better utilization of our own facilities here at Stanton and see if we can do something, and I hope something quite significant, about reducing what the Minister said is potentially as many as 1,800 bed days that we did not need to send to Capital Health but, of course, ended up paying for. The Minister mentioned that this has been in effect for some months now. I’m wondering if Mr. Miltenberger would have some indication for committee if we are indeed making a difference on that. Are we better coordinating among our different health authorities? Are we reducing the cost incurred at Capital Health? Thank you.

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, it’s too early for us to determine the success but, yes, the instruction has been issued already. The processes are in place with the authorities in terms of referrals. We have it set up where they work through Stanton. So the medevacs and medical travel are coordinated. We’ve taken the steps and we’re monitoring, of course, the usage and the cost. I’ll be able to report to committee, probably in the fall when we come back to start reviewing business plans, where we are and what the numbers are telling us.

Thank you, Mr. Miltenberger. Mr. Braden.

Thank you, Madam Chair. The Minister also agreed that we’ve entered into a new agreement now with the Capital Health Authority at a 4.8 percent rate increase. What kind of term is there on this agreement, Madam Chair?

Thank you, Mr. Braden. Mr. Miltenberger.

Thank you, Madam Chair. We’ve had a contract with Capital Health now for many years. We did a major renewal a couple years ago and there are extension clauses built in, but we’ve had an arrangement now for many years with Capital Health as our nearest source of that kind of tertiary level service and specialized service. Thank you.

Thank you, Mr. Miltenberger. Mr. Braden.

So there is no fixed term and renewal contract on this. Is it sort of at pleasure then? How does that work? Thank you, Madam Chair.

Thank you, Mr. Braden. Mr. Miltenberger.

Madam Chair, we do have a contract and we do have in there clauses that allow for cost increases for things like the forced growth items that we experience as well. We negotiate a cost and we’ve changed how we negotiate. I believe it’s a five-year term, but I’ll have to double-check that. I know it has clauses built in that reflect the increased cost of business. Thank you.

Thank you, Mr. Miltenberger. Mr. Braden.

Further on that page, Madam Chair, were increases for compensation after we re-evaluated nursing and health care profession jobs to the tune of about $1.6 million. I’m wondering if this process has essentially now been concluded, Mr. Chairman, and are there any other residuals we might anticipate as a result of this re-evaluation. Thank you.

Thank you, Mr. Braden. Mr. Roland.

Thank you, Mr. Chairman. Mr. Chairman, the process hasn’t concluded, so as things continue to move on we’ll be able to provide further updates. My information is that this process is still ongoing. Thank you.

Thank you, Mr. Roland. Mr. Braden.

Thank you, Mr. Chairman. Indeed I think committee is familiar with the process. It’s fairly complex and a big piece of work. I guess I’m wondering, should we anticipate further financial consequences or is most of the work remaining of a procedural nature? Thank you, Mr. Chairman.

Thank you, Mr. Braden. Mr. Roland.

Thank you, Mr. Chairman. Mr. Chairman, there could be further financial implications as we go forward. It again all depends on the final outcomes of the processes in place. So there is that that we could be coming forward for further requests in the future. Thank you.

Thank you, Mr. Roland. Mr. Braden. Health services programs, not previously authorized, $8.804 million.

Agreed.

Page 11, supplementary health programs, not previously authorized, $1.883 million.

Agreed.

Community health programs, not previously authorized, $681,000. Mr. Braden.

Thank you, Mr. Chairman. In this area and in a couple of other programs in pages yet to come I see a very welcome expenditure here for homelessness and people encountering potentially emergency situations and we are putting assets at the disposal of communities large and small. By my math, there is somewhere in the neighbourhood of $376,000 spread amongst a couple of different departments. Mr. Chairman, while I see this, as I said, as a very welcome response and recognition to a situation out there on our streets, I’m wondering if this is potentially the beginning of creating another realm in our social programs and safety net agenda, Mr. Chairman. I haven’t seen anything framed up quite this way before. Are we expanding or potentially taking on a new prerogative here, a new mandate as regards the response to homelessness? Is there generally a policy basis that supports this? Thank you, Mr. Chairman.

Thank you, Mr. Braden. Mr. Roland.

Thank you, Mr. Chairman. Mr. Chairman, the government has always had a priority around housing. The specific issue about the homelessness issue is one that we’ve started to address through this process and maybe we can have the Minister responsible for the homeless, Mr. Miltenberger, give some more detail. Thank you.

Thank you, Mr. Roland. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, the Minister has laid out the basic facts very clearly. I’ve been tasked, as the lead Minister, to deal with the homelessness issue and I’m also the chair of the social envelope Ministers and we collaboratively got together to look at how we’re going to deal with this issue, which is quite complex. Our initial focus was to deal with what they call absolute homelessness for the coming winter, which was those folks who don’t have accommodations at all, a warm place to sleep at night. At the same time, the Minister responsible for the Housing Corporation is working on the longer-term issue of relative homelessness, those that are inadequately housed or don’t have appropriate housing. What we’ve asked for this winter is the funds to tide us over working with local organizations in Yellowknife and in the communities, recognizing that there’s a need to transport people, recognizing that there’s a need in the small communities, as well as to increase the capacity of the Salvation Army and the YWCA once again to get us through the winter. We’ve also got some short-term funding to have some of the actual staff resources to work to pull together the broader plan and the intention would be to have further work with homelessness built into the business planning process of the affected departments, which is Health and Social Services, the Housing Corporation, Education, Culture and Employment, and Municipal and Community Affairs has been at the table, as well.

Thank you, Mr. Miltenberger. Mr. Braden.

Okay. Thank you, Mr. Chairman. That’s what I’m trying to get a handle on. What I’m hearing is through the social programs Minister you’ve identified a problem and you’re taking what appears to be some really proactive action on it. Is this something that through the course of the year you’ll be able to come back to, say Social Programs committee, and see where to go on this? I guess, Mr. Chairman, if we’ve identified a problem and we’re starting to address it how are we going to be able to manage it? Or is this just the start of another social dependency that even though we recognized it for as serious a problem as it is, is it going to be something that could potentially get away on us? Thank you, Mr. Chairman.

Thank you, Mr. Braden. Mr. Roland.

Thank you, Mr. Chairman. Again, maybe the Minister responsible, Mr. Miltenberger, could give some detail on that.

Thank you, Mr. Roland. Mr. Miltenberger.

Thank you, Mr. Chairman. Mr. Chairman, this is the start of a collaborative effort within government, many departments to coordinate a response because there is overlap and this is a complex issue. If you keep in mind the United Nations definition where they distinguish between absolute homelessness and relative homelessness, absolute homelessness is somewhat more concrete and you can deal with the fact that people have no houses to stay in on a short-term basis. The longer term more difficult issue that has a tremendous connection in a host of areas is the issue of relative homelessness. Inadequate housing in communities ties into the housing strategy where we’ve already identified 3,000 housing units short and those types of things. So, yes, we intend to come forward with a coordinated plan. We’re going to try to make sure we can deal on an ongoing basis with absolute homelessness so that people don’t freeze to death in the winters. In the longer term it’s going to be to come up with a plan or better coordinate the work, much of which is already underway to deal with the issue of relative homelessness. Struggling with such things as CMHC bowing out of the housing market over the next few years and the Assembly has already instructed the Minister responsible for the Housing Corporation to come back with a plan. That’s going to tie into homelessness as well. So there’s a lot of work already underway on this, Mr. Chairman. Thank you.

Thank you, Mr. Miltenberger. Mr. Braden.

Okay. Thank you. That’s a very helpful explanation. Just finally on this matter, does the Minister anticipate that the money requested here, will this take us to the end of March, to the end of the fiscal year, or is the potential that we will have to find some more money to finish up this fiscal year?