Debates of May 15, 2007 (day 7)

Thank you, Mr. Braden. Mr. Roland.

Thank you, Mr. Chair. Mr. Chair, there is no money from the eco-Trust dollars going into this. This is part of the normal work that Public Works would be undertaking. With this process of some additional dollars, not from the eco-Trust but from our regular form of financing arrangement, with additional dollars, they requested that this be put back in. It was part of the new initiatives that they requested through the business plan, but it was not addressed as a lot of the new initiatives were. The Fort McPherson tank farm ceased delivery services in December of 2001. The last inventory from that tank farm was sold off in December 2003. The Wrigley tank farm ceased delivery services in July of 2002. The last inventory it had was sold off in the summer of 2004. They have been sitting there now. We need to proceed with decommissioning. Thank you.

Thank you, Mr. Roland. Mr. Braden.

Thank you, Mr. Chair. The total bill for this will be under the first of a three-year program, so the total cost for this work on these two tank farms is $1.3 million over three years for decommissioning and environmental remediation. Could the Minister give us a bit of an idea how much to actually do the tear down and then how much for remediation out of that $1.3 million allocation, Mr. Chair?

Thank you, Mr. Braden. Details, Mr. Roland.

Thank you, Mr. Chair. Mr. Chair, I don’t have the actual dollar breakdown per job. What we do have, for example, Fort McPherson in 2007-08, decommissioning of the tank farm and resupply pipelines will be carried out. In 2008-09, hydrocarbon remediation as well as 2009-10 and then the final report. Wrigley in 2008-09 is decommission, resupply pipeline, shore manifold with catchment basin and dispenser cabinets and then the hydrocarbon as well and hydrocarbon remediation as well in 2009-10 and then the final report. Thank you.

Thank you, Mr. Roland. Page 13, Public Works and Services, operations expenditures, asset management, not previously authorized, $1.334 million.

Agreed.

Public Works and Services, operations expenditures, total department, not previously authorized, $1.527 million.

Agreed.

Page 14 and 15, Health and Social Services, operations expenditures, directorate, not previously authorized, negative $24,000.

Agreed.

Mr. Ramsay.

Thank you, Mr. Chair. I just wanted a little bit more information on the Northern Women’s Health Program, $116,000. It looks like that is a PY. I am just wondering how that position would relate to the Aboriginal Wellness Program.

Thank you, Mr. Ramsay. Mr. Roland.

Thank you, Mr. Chair. Mr. Chair, the Member is right; the funding of $116,000 will fund a nursing position. The position will be located in Yellowknife and will be part of the services offered by the Stanton Territorial Health Authority working with the Yellowknife Health and Social Services Authority and remote communities. It will work at implementing a coordinated Prenatal Care Program for the NWT and facilitating an educational-based program for health care professionals delivering prenatal care in the NWT. Thank you.

Thank you, Mr. Roland. Mr. Ramsay.

Thank you, Mr. Chair. How is prenatal care coordinated in the NWT today? Thank you.

Thank you, Mr. Ramsay. Mr. Roland.

Thank you, Mr. Chair. Mr. Chair, health authorities right now have delivery of that program. The department does work with them in trying to set up an overall program. I feel that this is needed to help improve on that delivery aspect of it. Thank you.

Thank you, Mr. Roland. Mr. Ramsay.

That is good. Thank you.

Thank you. Page 14 and 15, Health and Social Services, operations expenditures, directorate, not previously authorized, negative $24,000.

Agreed.

Program delivery support, not previously authorized, $741,000.

Agreed.

Health services programs, not previously authorized, page 14 and page 15, $10.071 million. Mr. Ramsay.

Thank you, Mr. Chair. I have had this discussion with the Minister before in committee regarding the deficit situation at some of our health boards at Stanton and the Beaufort-Delta. Am I to understand too that there is some deficit accruing in the Sahtu as well? I would like the Minister to elaborate a little bit on what the plan is to better manage these facilities and these boards if they are allowed to run up what amounts in the last few years here over $10 million in deficit and then come back to supplementary appropriation to, in effect, wipe out their deficit. That is not a very good way to manage anything, if you ask me, Mr. Chair. Again, I just wanted to be clear on what the Department of Health and Social Services’ plan is going forward. There has been some discussion regarding are we underfunding. Is the department not paying attention to what is going on out there? Is it poor management? What is it? Or is it a variety of different things? That hasn’t been clearly spelled out for the Members of this House. All that we are expected to do is just rubberstamp a supplementary appropriation every six months. Wiping out a million dollars in accrued deficit doesn’t faze anybody. Mr. Chair, I think it should faze us. I think we should get to the bottom of it, and we should try to come up with a plan or run our health system more effectively so that we are not faced with this issue every six months. Thank you, Mr. Chair.

Thank you, Mr. Ramsay. Mr. Roland.

Thank you, Mr. Chair. Mr. Chair, the information we provided shows that the deficit situation or surplus situation fluctuates. Unfortunately, we do have a number of years where there is an operating deficit and it grows into accumulated deficit and continues to grow. We have worked with authorities on the program where if there is a projected deficit and it is realized at year end that there is a 50 percent, we will work with them to try to fund it. They would be asked to look at their expenditures and come up with 50 percent of that plan through the budget that they would be approved with. One of the other things we have looked at is the actual process that we have worked with in cooperation with the Department of Health and Social Services, Financial Management Board Secretariat, and Stanton Territorial Health Authority, is looking at the spending requirements and looked at a program to do a base review of the expenditures. With that information, then we would be able to do better planning around budget development. Thank you.

Thank you, Mr. Roland. Mr. Ramsay.

Thank you, Mr. Chair. That is good. The base review is going to be conducted at Stanton, but is there also going to be a base review done in the Beaufort-Delta and the Sahtu as well? Again, it is a systemic problem here. It is one that recurs over and over again. If boards are unable to manage what they have, then there has to be a reason for that. Is it mismanagement? Is it underfunding? What would the Minister attribute the chronic deficit situation seen in the Beaufort-Delta, the Sahtu and here at Stanton too? Thank you, Mr. Chair.

Thank you, Mr. Ramsay. Mr. Roland.

Thank you, Mr. Chair. Mr. Chair, it fluctuates from year to year. For example, southern placements where we have patients going to southern facilities, that being in Alberta or other jurisdictions, as health care is driven by the health of our constituents and people of the North. You could have one case where the procedures required are very expensive and the time out could be long in duration. That could significantly impact our out-of-territory costs. That is one of the areas. As well, if we have more clients stationed out in the South for longer terms, that does add up to the cost, as well as some of the forced growth items when it comes to just the utility and operations of our facilities in the North is another area. With what we are doing now, the base review process is established now. We will use it with Stanton and that will be used with every health authority as well. That is going to be the model we will use, the tool that we will use to look at our expenditure patterns and work to fixing the areas that need to be fixed. If we are finding areas of over-expenditures, then they would have to be justified as well. Thank you.

Thank you, Mr. Roland. Mr. Ramsay.

Thank you, Mr. Chair. Just to wrap this up, again, I know we talked about this at length now, but, to me, if we don’t send the message out there that it is not okay to run up huge deficits and come back to the Legislative Assembly to have us rubberstamp basically saying it is okay. You can run up a $7 million deficit. It is okay. We are just going to rubberstamp it and approve it anyway. I don’t think that is the message that I want to get out there. I think these health operations in the regions have to be run effectively and they have to be managed effectively. They have to be funded effectively and judging by the deficits that have been allowed to accrue, that is not happening, for whatever reason. It is not being looked after properly, Mr. Chair. So I think it is a big problem. I think the Minister understands what I am trying to say here. It shouldn’t happen. In a perfect world, I guess, it wouldn’t happen. But how do we get the message out there to the Beaufort-Delta and to Stanton that this just can’t happen? Maybe it is the department that is the problem. I am not sure. Maybe there has to be some kind of investigation with the department to try to figure out why this is happening. Are they underfunding Stanton? Are they underfunding the Beaufort-Delta? Are the Beaufort-Delta and Stanton being mismanaged? Those are questions we have to ask ourselves every time we are asked to rubberstamp this case $3.5 million and $1.6 million in the Beaufort-Delta. It adds up. Like I said, it is over $10 million in the past little while. We should be paying attention to this. We spend 30 percent of our budget on health care. It is something we should pay close attention to. We should try to monitor it properly. This isn’t good monitoring, in my book, Mr. Chair. Again, we are just forced to accept the deficit and pay it. That is it.

Thank you, Mr. Ramsay. Mr. Roland.

Thank you, Mr. Chair. Mr. Chair, the process is we start right from square one. For example, as the Department of Health and Social Services builds its budget, it goes to all the health authorities and they submit a budget for the upcoming year. Those budgets are based somewhat on the actuals they had in the previous year with some estimates of what the potential may be on certain areas. If the population has grown, if they have seen an example of certain sicknesses at different times of the year, that has an impact on their budget. Some of it is built on estimates. Those, in all worlds, are not the perfect tool. At times we find that those estimates are not agreed to either by the Department of Health and Social Services or by FMB itself, where the direction has gone back to re-look at the numbers and prove up some of those figures.

The question ultimately I guess comes down to the fact that, in our relationship, the Department of Health and Social Services builds the budget, works with authorities, brings that budget into the whole process where we review every department’s budget, we build it on that, come forward with that. But at the same time, when it comes to the variance reports, getting the background and the quarterly reports as to where expenditures are happening, if authorities aren’t quick in responding, that puts us behind the ball in trying to get the information appropriately. What you see here is not just a matter of rubberstamping. There has been significant work done by FMBS and the Department of Health and Social Services, trying to come to grips of why the numbers fluctuate as much as they do. That is why, for example, the base review has been established. I would be happy to share the terms of the base review with Members. I will provide that information to Members so that Members will see what is going to be undertaken as we proceed with this. Thank you.

Thank you, Mr. Roland. Next I have Ms. Lee.

Thank you, Mr. Chair. I have a question under 2007-08 new initiative for $100,000 for delivery of ground ambulance and highway rescue services. It is on page 14, just before the hospital federal health care funding priorities. I know that this is something that has been in the works for a while because there is unclear jurisdiction and responsibilities with respect to this and lack of consistent rules about who is responsible for paying for ground ambulance and highway rescue services. I know there has been a study done on this to figure out what to do between Health and Social Services and MACA, but I wasn’t aware that the new initiative will be by way of developing a legislative framework. I thought that there was some money being made available for the communities to tap into. Although that program is not available for cities like Yellowknife, which is a problem, but it is a first step anyway in trying to get some infrastructure set up for that. I would like to ask the Minister for more information on what this $100,000 is for and how that fits into the more general, larger framework of this initiative. Thank you.

Thank you, Ms. Lee. Mr. Roland.

Thank you, Mr. Chair. Mr. Chair, the report that was done on the ambulance and highway rescue, what you see here is the first phase of it. The $100,000 is the Department of Health and Social Services’ piece. That is working on creating the legislation. Municipal and Community Affairs has $200,000 that is available to communities that are delivering their own ambulance services at this time. There were a number of options in the final report, five of them to be exact. One, for example, was option one which was the status quo, no changes, let everybody do what they are doing. Option 1(a) was status quo with some minor enhancements. Option 2 was the status quo with GNWT legislation, and option 3 was GNWT legislates and delivers ground ambulance and highway rescue services. Option 4 was GNWT legislates ground ambulance and highway rescue services and contracts services for the private sector. What the Department of Health and Social Services and Municipal and Community Affairs are working towards is option 3. So we are looking at the first stages of dealing with those communities that provide that service on their own. There are a number of communities that it is delivered through health authorities. So that is being left as it is. The Department of Health and Social Services is working on creation of the legislation that is required to begin to occupy that field. Thank you.

Thank you, Mr. Roland. Ms. Lee.

So would that legislation then work for all the communities? So the GNWT will legislate themselves into this responsibility, basically.

Thank you, Ms. Lee. Mr. Roland.

Thank you, Mr. Chair. Yes, right now there is a void there in legislation. That is why it is in a number of areas where different groups are offering the service. So we will create the legislation and then occupy the field. Thank you.

Thank you, Mr. Roland. Ms. Lee.

Thank you. Just to be clear then, this is for the drafting of the law. How long will that take to bring forward? Thank you.

Thank you, Ms. Lee. Mr. Roland.

Thank you, Mr. Chair. Mr. Chair, the department is planning to begin this work in this upcoming year and returning to the business planning process for 2008-2011 to try to come up with how we would fit in there. It was initially over a three-year period to come in with the legislation and how we were going to implement. We have been directed to try to cut that down to bring this up to speed sooner rather than later. Thank you.