I thank the Minister for that. I think that would be very useful information and it would clear things up a little bit, because it does run across both the Standing Committee on Economic Development and Infrastructure as well as the Social Programs committee. So if that information was to go to P and P, that would be great. Thank you.
Next, Mr. Bromley.
Thank you, Mr. Chair. I have similar issues with this item. First of all, I’m concerned that it’s only five positions. As the Minister knows, the Members have called for a SWAT team, or certainly a comprehensive and focused effort with a good bump-up in number of people to deal with these arrears that are plaguing our people and our local housing offices. The five positions that are mentioned here, is that the same five positions that would have been transferred from Housing to ECE previously when the transfer took place five years ago? Thank you.
Minister of Finance.
Thank you, Mr. Chairman. I recognize that there is interest in issues broader than this supplementary appropriation. What we’re talking about today is basically carving the money out of Education and the resources out of Education to move them back into the Housing Corporation and this does not talk about any further program enhancement at this point. I mean, those are legitimate questions, once again, but sitting here with the supplementary document, it’s not something I’m in a position to speak to in this particular forum. If there’s further information, I could ask the appropriate department to provide that to committee. Thank you.
I recognize that we’re dealing with a real specific here, but in asking for approval of specifics, of course, we need to do that within the context of the larger questions. I appreciate the Minister’s commitments here. I guess I would like to point out that committee has been promised a number of times for a human resources plan in association with this transfer back, and yet here we are approving something without this plan in hand so that we can have the important context with which to approve or deny these expenditures. I will leave it at that and just ask that the Minister does pursue this and see if we can have the full context provided by a human resources plan so that we’ll know that this is being done as a step amongst many to resolve our issues for people. Thank you.
I appreciate the Member’s comments. This is a step among many others. There’s program work that’s being done. The function here today is to, as I indicated, basically reallocate the funds from Education back to the Housing Corporation to allow that transition and transfer and the program delivery as has been envisioned and supported by the House. There will continue to be other work done through the business planning process, and as the Minister of Housing, for example, indicated extensively yesterday, there are a lot of things underway at the Housing Corporation and this is one part to deal with an issue that has been of concern for some time. Thank you.
Finance, operations expenditures, deputy minister’s office, not previously authorized, $34.214 million
Agreed.
Total department, not previously authorized, $34.214 million.
Agreed.
Moving on to page 6. Health and Social Services, operations expenditures, directorate, not previously authorized, $1.024 million.
Agreed.
Program delivery support, not previously authorized, $150,000.
Agreed.
Health services programs, operations expenditures, not previously authorized, $2.909 million.
Agreed.
Moving on to page 7. Health and Social Services, continued, operations expenditures, supplementary health programs, not previously authorized, $6.801 million. Ms. Bisaro.
Thank you, Mr. Chair. I am somewhat concerned by the numbers on this page. This indicates that in both last year, fiscal 2009-10, and anticipating the cost in fiscal year 2010-11, we are overspending our medical travel budget by about $3.2 and $3.6 million. So I have to anticipate that going forward it’s probably going to be about the same kind of an overage in future years. I’d like to know from the Finance Minister whether or not he can advise what sort of actions are being taken to try and minimize the cost of medical travel, or are we just simply going to come back year after year for a supplementary appropriation to cover the deficit? Thank you.
Minister of Finance.
Thank you, Mr. Chairman. This is an issue that is consistently before the House. There is a requirement to come back, because there’s the issue of costs that tend to constantly escalate. There is work being done, as the Minister of Health has indicated, with her Foundation for Change. There’s a review through the program review office right now taking a look at the medical travel costs and drivers and structures and processes to see if there are ways to deal with this. Some of the consistent pressures are that we have, in a lot of areas on a national basis, a fairly rapidly aging population, and as we all know, for example, the requirement and degree of care required in late years are increased. I know, for example, in the South Slave, the rate and growth of seniors is very high, resulting in greater costs that are hard to anticipate. It depends on individual circumstance. So this will be an issue that I would suggest will continue to come back before this House, depending on the pressures, on a yearly basis or on a quarterly basis. Thank you.
Excuse me, could we have some order in the House. It’s getting a little loud to hear the Minister’s responses. Ms. Bisaro.
Thank you, Mr. Chair. I appreciate the comments by the Minister, but if we have over-expended in this particular item on our budget roughly the same amount two years running, I’d like to know from the Minister -- and I appreciate that we’re going to be making some plans to try and reduce the costs -- why would we not set our budget for the amount that we expect we’re going to incur? I know our budget keeps expanding, but we’ve overspent by about $3 million for two years running now, so in the next 2011-12 budget can I expect that we’re going to see a realistic figure for medical travel? Thank you.
Mr. Chairman, it’s part of the conscious decision by the government, in many cases, to fund at the levels that are there, and if there’s an overage, then the department comes back. Over time, the practice has been to avoid giving full budgets based on estimates. There was a concern in terms of accountability and the difficulty in being able to coffer the money and get it back, should those estimates come in under what was voted.
The preference and the practice have been, so that there is greater accountability not only in Health but, for example, ENR and fire budgets, there’s a base budget and the requirement is to come back. Or in other areas of health costs with children in care or adults in care, there’s a budget that’s set and there’s a conscious decision to require the program department to come back should there be a greater requirement for funds as opposed to giving based on estimates. The concern being that over time there might be a creep in the estimates just to make sure that you had sufficient money even though it may not be that accurate because it’s an estimate. Thank you.
The Minister and I have discussed the philosophy before and I have to disagree with him. I’m not so sure that funding to an unrealistic level is going to provide any more accountability than funding to a realistic level and then forcing our staff to keep to that expenditure limit.
I don’t see much accountability when before us sits a supplementary appropriation for $3.6 million for last year, $3.2 million anticipated for this year. I don’t really see how this is providing accountability in this particular aspect of our Supplementary Health Program expenditures.
I did want to ask another question. I note in the background information that we were given that we spend money on travel but we also recoup money from several places. I noted that we do recoup money from NIHB, which is aboriginal health benefits through the federal government. The differential between the revenue that we get and the expenditures we make is pretty huge, it’s about $3 million or $4 million, if I recall correctly.
I’ve often heard it said that the NIHB program does not cost this government any money and I guess I would like to know from the Minister why we have revenues of some $3 million and expenditures of some $7 million for NIHB travel.
The question is being directed to the Minister of Health, Ms. Lee.
Mr. Chairman, the way to look at that is that we in the Territories provide medical travel more generously than what NIHB does. So the federal government doesn’t cover for the kind of medical travel that we do. So where we can get reimbursement from the federal government, we get those. Then our aboriginal Dene/Inuit residents are the same as all the other residents and our government provides what we would provide non-aboriginal people. Thank you.
Ms. Bisaro.
Thank you, Mr. Chair. That’s good.
Thank you. Next I have Mr. Ramsay.
Thank you, Mr. Chairman. I just wanted to follow up on my colleague Ms. Bisaro’s questions. Again, we have a supplementary appropriation before the House where we continue to pour money into an issue and a situation that we know exists. We‘ve been talking about this for I don’t know how long. The program review office was to have a look at it, review it. We need to get a handle on this medical travel issue and if we’re not funding it appropriately, then we’ve got to tell ourselves that and start finding the money to fund it appropriately.
I agree with Ms. Bisaro; there’s no accountability when a government can just come to the Members as it sees fit and just approve millions of dollars for a program that doesn’t come under any scrutiny just because it happens to be Health and Social Services and this sacred department that nobody is supposed to ask any questions about because it’s the health and well-being of the public. We shouldn’t go there, we’re looking after people. Just because we’re doing that, shouldn’t stop us from asking questions about where is the accountability, where is the transparency and who is responsible for managing these budgets when year in and year out budgets are brought to this House and are approved by Members of this House that are woefully inadequate.
I just wanted to get that out there again, Mr. Chairman, that that is not appropriate. It’s not appropriate for any government to knowingly be doing that. It shouldn’t happen and we just continually are allowed to operate like that and it just doesn’t make much sense to me.
Again, managing, you know, if you put yourself in the position of manager that’s managing under that regime, do you think you’re going to care if you’re over budget? Do you think you’re going to care if you approve something you shouldn’t approve? Do you think you’re going to care? The sky is the limit. What we have to do again is fund the operations appropriately and manage within those confines, not continually come back to this House time and time again for more money. It’s getting old, Mr. Chairman. We can continue, continue and continue to talk about it, but at some point in time somebody is going to have to start making some decisions across the way there and get us to a point where we’re approving real, accurate budgets for the Department of Health and Social Services. Today we’re not, as evidenced by this supp again. Thank you, Mr. Chairman.
Minister of Finance.
Thank you, Mr. Chairman. In terms of Health being off limits and questions being discouraged, I would suggest that if we checked Hansard, speaking as a Minister of Health for five years, my recollection, as it is today, is just in this House, on a constant basis, the Health Minister tends to top the questions in this House on an ongoing basis. It doesn’t matter which Minister you pick, which Assembly you pick.
We have a circumstance. We are talking about how do we budget. The debate is, do you budget on actual or do you budget on estimates. The Member talks about accountabilities and you want to be able to have some oversight, and I’m indicating to the Member and to this House again, in the past over time, budgeting on estimates has been determined to be not the most efficient way if you want to have clear accountability, if you want to have precision in the money being required. There’s money to do your operation. Over time budgets have increased, but there’s not the automatic increase. There’s been a request by Cabinet, by the FMB, I think by Members over time that when they spend the money, let them come back and we will look at giving them money to cover that off based on actual. We’re not going to just take it on word that they estimate that they need a million but they’re only going to spend three-quarters and then we have to figure out how we get the other $250,000 back.
If there’s a decision as a government or as a Legislature that we’re going to change our budgeting processes, all departments will come forward with your best estimate on how much it’s going to cost you do to business and what you’re going to need to do business. I would suggest there would be some significant potential for fiscal creep in all areas. That’s a discussion that can be had.
The Members speak about accountability. The supplementary appropriation process, we have to be able to come back and defend what those costs are and be able to demonstrate how we spent the money and what drove those costs in any given year. Thank you.
Mr. Chairman, when these appropriations are brought before the House, there is the opportunity for the Minister and for the government to defend those costs, but certainly they aren’t met with the same rigor that they would be met with through the business planning process and the main estimates process in the House under full light. They just appear here as one line item, and the government can try to defend it the best way they can, but it doesn’t lend itself to providing Members of this House the best opportunity to question the expenditures of this government.
While I’ve got the floor, Mr. Chairman, I just want to go back on something I said. I maybe said managers in the Department of Health didn’t care how much money they spent. I know they care. I know they’re out there working as hard as they can on behalf of the people of the Northwest Territories. What I’m saying is they are operating in a system where there is no ceiling, there is no cap. There’s nothing there. The sky is the limit, because, at the end of the day when the department can come back to the House, whether it’s just because it’s the Department of Health and Social Services or not, and seek millions and millions of dollars at the drop of a hat, to me that’s just not appropriate. You know, from time to time it might be okay, but this is becoming like a broken record, Mr. Chairman.
Again, I’d like to see a plan on trying to remedy it. The Minister and I spoke about this earlier during this sitting of the House. The Minister came before a standing committee 18 months ago with this nice glossy plan on how she was going to get deficits back to zero at Stanton and other health authorities across the Northwest Territories. Here it is 18 months later, we’re talking about the same things and nothing was done. That plan never saw the light of day even though it was presented to committee, and the committee left there saying the government is going to start to tackle the spending issues of Health and Social Services, we’re going to start budgeting accordingly and we’re going to take action.
Mr. Chairman, all I hear about the action is they are going to start charging patients to park at the hospital, they’re going to start charging patients in the room for television and phone services. They are going to start nickel and diming people to try to get the deficit under control. Mr. Chairman, that is just not going to work. It’s not appropriate. Our residents deserve much better than what they’re getting. Thank you, Mr. Chairman.
Mr. Chairman, I would have to disagree with the Member. I believe, from all my experience, that the quality of health care in the Northwest Territories, in my opinion, is second to none in the country. We have benefits, we have access, we have programs that other jurisdictions could only dream about and wished they had. The issue and the challenge... And there’s not a jurisdiction in this country, there’s not a jurisdiction in the world that is not dealing with the pressure of escalating health care costs. With us, we’re talking Health and Social Services, $300-and-some million. It’s about 30 percent of our budget.
Most other jurisdictions when you...(inaudible)...off the social services piece, the health piece alone is in the 40 percent-plus range. We have pressures that are not going to go away. If the Member has specific recommendations how he thinks we can take millions of dollars out of the health system, as Finance Minister, I’ll buy him dinner and he can tell me how we can do this in a way that we can stand here and tell the people that there is a way that we can extract millions of dollars out of the health care system and maintain all our programs like supp health or any other program, but we can still deal with the money and those pressures. I would be grateful to the Member if he could give us those specifics so he could help us in our budgeting processes. Thank you.
Were on page 7, supplementary health programs, not previously authorized, $6.801 million. Mr. Abernethy.
Thank you, Mr. Chair. Just for the record with respect to the health care system in the Northwest Territories, I agree with everything the Minister just said. I believe we have a fantastic health care system in the Northwest Territories. I also believe we are under significant challenges. Could we be better? Absolutely. Could we be doing more in the small communities? Please, yes, let’s do that. But we have a pretty good health care system in the Northwest Territories when we compare it to other jurisdictions.
I think what you’re sensing here is some frustration in the fact that we, as Regular Members, are trying to get a sense and an understanding of how this department is going to move forward to control certain things. Yes, the Foundation for Change is underway. I believe the Foundation for Change is going to identify a lot of improvements that can be made to the system to help us retain or maximize the use of our money, but we’re talking here today about medical travel. Medical travel will be addressed under Foundation for Change. What we’re talking about is how we’re accounting for it. The department keeps coming back and asking us to approve a supp, approve a supp, approve a supp. To Ms. Bisaro’s point, we know the baseline budget for medical travel is more than we’re putting in the books. We know that. Do we have to increase the budget for medical travel by $3.6 million? No, because I think putting a cap on it and trying to control it as much as we can, you need to put a cap lower than what the department is telling us they need, so let’s increase the budget for medical travel; maybe not by $3.6 million, but maybe by $2.5 million. They are going to have to come back for a supp, but if we put a cap on it at a reasonable level, we can get the Minister to work on the department to control those costs.
I understand the Minister’s of Finance point about not putting a cap on it and leaving it at the amount we have on it and do the same thing. I think I’m saying the same thing, but I’m just saying it’s pretty clear that the budget we put in there is not even close. Let’s try to get it a little bit closer to where we need to be, and let’s continue to get the Minister to put pressure on the department to control those costs, and let’s get done with the Foundation for Change. Let’s get some results out of that thing.
My colleague is right; there’s a little frustration on this side about the pace. It’s a beast. It’s a beast. Health is a beast and we need to rein it in as much as we can and we need to see some results. Please expedite Foundation for Change, increase the budget in this section a bit; not the full $3.6 million, but a bit. That way we won’t be asking for as large a supp every year. It seems pretty simple to me.
Minister Miltenberger.
I appreciate the Member’s comments and we do over time look at base budgets. We don’t just keep them pegged at last century’s costs or that type of thing. When we look, the Health budget has grown since 1999. It’s doubled. With the THSSI money from the feds, part of which was dedicated to medical travel, there is going to be a bump-up in this coming fiscal year.
In keeping with the Member’s comments, recognizing that the cost drivers are going to be there, some of the biggest being on an upward climb. For example, just the cost of fuel. Then the demand.
I appreciate the Member’s comments and our intent is to be as realistic as possible. We would like to minimize our coming back for supps. We would like to be able to budget exactly. But it has proven to be with the beast, as the Member said, an ongoing challenge. We are going to be, in fact, looking to those suggestions and, in fact, have made some enhancements for the coming year.
Mr. Abernethy. Ms. Bisaro.
Thank you, Mr. Chairman. I’m trying to understand the philosophy and the rationale for the budgeting here. The Minister advised that they budget on actuals. I’m looking at figures provided to back up this request. I’m looking at an actual deficit in 2008-2009 of almost $2.8 million. Yet it would seem that in 2009-2010 we did not bump up our actual expenditures, because we’re still short by $3.6 million. So from $2.8 million to $3.6 million, that’s $800,000. That’s not bad, but I would like to know, I guess, from the Minister if he could tell me what we budgeted in 2009-2010 for medical travel compared to 2008-2009.
Mr. Miltenberger.
Thank you, Mr. Chairman. I don’t have that specific piece of information before me. I can commit to get it for the Member.
I would be interested in seeing those two numbers, because I really have a hard time believing that we need $3.6 million. We have a $3.6 million shortfall if we’re budgeting from actual, because in the previous year we had a deficit of almost $2.8 million. Just a comment.
Comment. Next I have Mr. Ramsay.
Thank you, Mr. Chairman. Maybe I could get the Minister to make reservations for dinner for him and I sometime. I’ve got a number of things that immediately come to mind when we’re talking about health and social services and ways that things could be improved upon. I would never say that we should be pulling millions of dollars out of the system. My belief is we have to be putting more money into the system. We have to be budgeting accordingly. That I believe fully in.
I also believe, like my colleagues, that I would stack our system up against any system in the country. That’s not really the problem. The problem that I see and the way that I think we could fix things immediately is if we take a look at the eight existing authorities. When you’re trying to manage anything, the more moving parts you have it only stands to reason that it’s going to cost you more money, there’s going to be duplication. This is exactly where the government needs to start when it comes to managing and maximizing each and every dollar that we have earmarked for health care here in this Territory. We could still have boards out there that could be advisory boards rather than management boards. We could move them towards an advisory capacity and that would, in my mind, save us a tremendous amount of money on an annual basis. Start there.
The other thing is efficiencies. We really need to get a handle on missed medical appointments and the cost that missed medical appointments are having on our system, whether it’s for surgeries or for somebody who has the flu and misses an appointment downtown at one of our clinics or at the health centre. That costs money. Every time somebody misses an appointment it costs money. It got me thinking: Why don’t we have more of a concerted effort by staff at our health facilities to be calling people a day or two before their scheduled appointment just as a reminder? When I go to the dentist they’re making me appointments for months out and sure enough a couple days before I have that dentist appointment, they’re on the phone calling me and leaving me messages reminding me that I have an appointment. I think that in itself will save us a tremendous amount of money. Time is money, especially when you’re dealing with doctors and health care professionals. We can’t afford to be having hundreds of missed appointments on an annual basis at one clinic. We just can’t afford that.
The other thing too -- and I had a discussion with Ms. Lee about this the other day -- is on bulk purchasing. I know the Minister says we’re out in front of this, we’re spearheading our involvement with the western provinces, but the information that I have is that Alberta and British Columbia have already signed a deal. They’re already doing something together. There’s this New West Partnership between Alberta, British Columbia and Saskatchewan where they’re looking at bulk purchasing. The Minister says we’ve signed an MOU. I asked her the other day if we’re involved in this are we actually today making purchases under that arrangement, bulk purchases under that arrangement to help our escalating costs. The Minister was very evasive when it came to answering that question. She said, oh, we’re involved, we’re doing all these great things. The question was: Are we actually making a difference by bulk purchasing medical supplies and goods? She didn’t have an answer for that.
There are four ideas. The Minister wants some ideas, I’ve given him four. I can give him more when he books that reservation for dinner.
Yes, maybe if we could just remind Members we can get back to the discussion before us where we’re dealing with the supplementary appropriation and this particular area dealing with medical travel. We’re talking about something much broader than that. If we could keep our discussions to the item that’s before us. Mr. Miltenberger.
Mr. Minister.
Thank you, Mr. Chairman. If the Member for Kam Lake tells me what his favourite restaurant is, we can have that dinner, but I would suggest based on the things I’m anticipating, he’s going to be breaking new ground.
The issue of board reform, hesitant as I am to use that word in this Assembly, is probably something that is going to carry on to the life of the next government.
One of the main points of the consolidated clinic here in Yellowknife was to deal with the 14 or 18 percent of missed appointments that are, as the Member has indicated, costly and very inefficient.
Bulk purchasing, the Minister has indicated that we signed on this month. I would imagine we’ll be seeing the benefit of that very shortly.
There are other things we could talk about. The other one that most immediately comes to mind is, of course, greater use of telehealth that we’ve seen, as well, that’s now underway in the communities.
I will buy the Member dinner if he can come up with things that we have not yet considered. Otherwise, we’ll probably have to arm wrestle for the bill.
Just to remind the Members that we’re on page 7, Department of Health and Social Services, operations expenditures, supplementary health programs, not previously authorized, $6.801 million.
