Debates of February 17, 2015 (day 60)

Thank you, Madam Chair. I’m happy to go with whatever the committee wishes. Thanks to the Member for his comments. We too are really looking forward to moving forward and completing the construction of the long-term care facility and the health centre in Norman Wells. We believe it’s going to bring a new and important service to the residents of the Sahtu, which I believe they have wanted for a really long time. It’s also building upon our elders in our communities, which is creating more beds in the Northwest Territories for long-term care.

The Member is absolutely right; this will create employment opportunities and we have to do it right. I and others share the belief that if we really want to have some continuity in those communities in that long-term care centre, we’ve got to train local people to do local work. We’ve already started. We’ve actually sent out advertisements to all the communities in the Sahtu outlining the personal support worker training that is going to be facilitated in the Sahtu, in Norman Wells in particular, but for residents from anywhere in the Sahtu who have an interest in coming to Norman Wells to be personal support workers. That training includes all sorts of different things. Medical terminology, health care, basic support, WHMIS, food security, food safety, everything they will need in order to provide the personal support to the residents in that long-term care facility. So we too are very, very excited and I look forward to seeing that roll out and get a lot of people in the Sahtu trained so that we can get a lot of people in the Sahtu employed, which I think is something that we all want to see.

The Member did talk an awful lot about addictions and treatment facilities and the Member did talk a little bit about the residential school survivors program and the difficulty that people in the Sahtu have identified as a result of that program slowly shutting down. I have asked the department to engage with the federal government to find out what, if any, transition plans they have with respect to rolling that program out over time. Those conversations, actually the feds have engaged us in those conversations and we are starting to have a little bit of conversation about what their transition plan is. Having said that, the individuals in the Northwest Territories who happen to be residential school survivors do have the ability to access all of the programs and services we offer here in the Northwest Territories and we do have a continuum of support for individuals with addiction issues, for one, or mental health issues, as well, including the community counsellors and mental health addictions.

I do hear the Member’s concern about the continuity and the fact that we had some turnover in that area, and that is an area that is proving continual. As I mentioned to the Member, Mr. Blake, earlier today in question period, we’re going to have work with leadership across the territory to find ways to encourage young people to start pursuing these careers if we want to have long-term continuity, but a number of things need to be done.

Right now all of the residents in the Northwest Territories can take advantage of our addictions programs that we have contracted out in the South that are facility-based with a limitation, and the limitation is, and I know the Member is frustrated by this, and I’m frustrated, but we do have to understand that the facilities can say no to individuals with criminal records and they do from time to time. Depending on the criminal record a person has, they may not allow a particular individual to come into their facility. An example is somebody with sexual violence would probably not be accepted into a unisex facility. This can leave some of our residents out of the facility-based option, which is why we continue to work with community-based counseling.

We’ve got matrix programs expanding across the Northwest Territories that can offer treatment in communities. It’s still a 42-day program but it’s a community program and basically on more of, for lack of a better term, an outpatient basis as opposed to an in-patient. There are options, but I think it’s clear that we have to work with committee and we have to work with Members to explore this gap where there isn’t a treatment facility option because of the person’s history. It might mean that we find an on-the-land option. We need to explore this, and I’m happy to work with committee and talk with committee about these different options. But there are a number of things happening around addictions. We have a multitude of programs. It is a very wide spectrum. It’s following the recommendations from the Minister’s Forum almost exactly, and we are continuing to make progress in that area.

Today I did talk about the on-the-land programs which are moving in the right direction. As we continue to move forward with partners outside of the GNWT or Aboriginal governments, funding partners, hopefully, we will see huge opportunity to expand these. The beautiful thing about these programs is they are designed by the communities for the communities. The communities know what their needs are and if they need us to offer some clinical support, we can do that. If they want us to participate in that way, we can do that. But we’re also providing them the money to make it happen. I wish it was double, triple, but it isn’t. That’s why we’re looking at philanthropic partners.

I think I got most of it.

Thank you, Minister Abernethy. General comments. Next I have Ms. Bisaro.

Thank you, Madam Chair. I have a number of issues. There always are a huge number of issues with this department and most are comments. I don’t need the Minister to respond. I will try and ask my questions when I get to the page on detail.

I want to start off with the issue of continuing care. We did get a report from the department, from the Minister, but it did not commit to an action plan, and that’s a concern for me. There doesn’t seem to be, at least not that we’ve seen on paper, a cohesive, coordinated effort towards care for our seniors. From what I can gather, the mentality seems to be let’s have them age in place, and I’m supportive of that, but I am very concerned about facilities that are not being built in some communities and Yellowknife is one. The Minister is well aware of my concerns about the need for Avens to get their project going in the spring, and I know that the Minister is working and the department is working on that with Avens.

The child and family services system has had some revision and the Minister has kept us up to date on that for which I think committee is grateful. I understand there is some legislation coming forward and I look forward to the details in that legislation.

Concern about chronic disease. We’ve mentioned this, I think, probably every year running. Chronic disease is one of the biggest drains on our budget, I think. I will have some questions around the closing of the diabetes clinic here in Yellowknife and what we are doing both in Yellowknife and in all of our communities to try and tackle the huge issue of diabetes. There was, I think, some analysis that was going to be done, and I will be asking some questions about that.

A concern for me is that we haven’t managed yet to figure out how to provide supplementary health benefits for people who are working but don’t get any supplementary health benefit coverage. We have indigent coverage, but there is a group of people, and a fairly small number, but there are people within the Northwest Territories who don’t have any supplementary health benefit coverage at all, and that is a concern. The last time I asked the answer was basically, well, it’s a large amount of money and we don’t have the money from within to fund it. I can accept that answer but it doesn’t make me feel any better. We still ought to be planning to cover those people who are not covered.

The Day Shelter in Yellowknife and in other communities falls under this department. There was going to be an analysis, I think, of the Day Shelter in Yellowknife, and I haven’t seen that, I don’t believe. I do know that the City of Yellowknife has put a fair amount of money into that Day Shelter. I think they just recently advised us at a recent meeting that they had increased the amount of money that they have put into the Yellowknife Day Shelter. That concerns me and that, albeit it’s in my community, the majority of the people using that Day Shelter are not from my community, and I think the territorial government ought to be funding a larger portion of that Day Shelter cost.

The Medical Travel Policy has been under review for quite some time. I have concerns about if we are ever going to see the results of that review.

A couple more. The Midwifery Program. I have to mention the Midwifery Program, and I believe the Minister’s remarks talk about exploring opportunities to advance the design of a territorial program in 2015-2016. I appreciate that we, the royal we, the government is moving as fast as possible to get midwifery established in more communities, but this community of Yellowknife had a very successful Midwifery Program a number of years ago and it has pretty much dropped off the face of the earth and there has been very little mention in anything from the department or from the Minister about reinstating the Midwifery Program in Yellowknife, and that’s a huge concern for me and for many constituents.

Mental health and addictions services, it’s another large portion of the budget. Mr. Yakeleya has talked about one aspect of it. It covers many things. I think my concern is that we don’t have enough services to deal with the people that need to be dealt with, and I’m not sure, it’s a big problem for the department. I don’t know quite how we can better service our residents, but people who need counselling for mental health issues often don’t get it and there’s a long waiting list, and/or they don’t have the services available in their community. Certainly the services at Stanton are not optimum and there is very little opportunity, from what I understand, for people needing assistance with their mental health issues to get the service and to get the programs through the hospital. It’s an area that is a concern and I’m not too sure that we’re going to find an answer. Certainly not today. But I just want to say that it’s one of the issues within this department that is a big problem for me.

I’ll leave it at that. I will have questions when we get to detail.

Thank you, Ms. Bisaro. Ms. Bisaro indicated she was going to make comments and she did not need a response from the Minister, so if she is agreed, I will move on to the next person for general comments, and that would be Mr. Blake.

Thank you, Madam Chair. I just have a few comments here and maybe a couple of questions. Over the last few years here, since the last government, they shut down the long-term care in Aklavik, and there’s a high demand in our communities of my riding. Right now a lot of the elders have to go to Inuvik for long-term care and the majority of our elders want to stay in our communities when they get to that age. Their families are in the community and can visit them on a daily basis; whereas, when they’re in the regional centre, they’re lucky if their family sees them once a month or every other weekend. It’s very stressful, especially on the elders.

Also, nursing, once again in Tsiigehtchic there’s an ongoing issue. Hopefully we can come to some sort of terms here, whether it’s a licenced practical nurse, you know the community really needs something full time. We can’t rely on services once or twice a week. We have a number of emergencies, most of the times it’s during the weekend. The community, you could tell, is very uncomfortable during freeze-up and breakup because we do have a nurse on hand 24 hours a day. That service in the community is really needed.

Also, we just spoke earlier today, but I’d like to bring it up anyway. On-the-land treatment programs, my colleague mentioned it a little earlier today. Over the last few years there have been a lot of people dealing with residential school issues and, you know, it seems that just when we’ve brought the issue back up there’s no support for those people moving forward. You know, a lot of times it takes time to overcome a lot of issues and we need to be there for our residents and we need programs. You know, once a year is just not adequate. We need something at least every three months. There are a lot of people in our territory that need assistance. I didn’t ask the Minister the question earlier, but I’d like to know exactly how many people are actually going south for treatment. I don’t think the numbers are very high compared to what we had here in the territory.

Also, home care workers in the communities of Tsiigehtchic and Fort McPherson, especially Fort McPherson where we have the largest number of elders in my riding. It’s in the neighbourhood of 200 elders over the age of 60. There’s a big demand there but we only have one person working at the moment. It’s pretty clear that we need at least two people on a daily basis to assist there. For now those are the only general comments that I have. Thank you, Madam Chair.

Thank you, Mr. Blake. Minister Abernethy.

Thank you, Madam Chair. I appreciate the Member’s comments and suggestions and questions. The Member did talk about the shutdown of the long-term care facility in Aklavik. The facility in Aklavik was a supported living facility, and I understand that the Housing Corp has actually constructed an independent living unit to replace that facility. In working with the Housing Corp, we’ve actually ensured that these new facilities the Housing Corp is building to support our residents and needs throughout the Northwest Territories, including Aklavik, is actually program space where we can have our home support workers and other professionals come in and actually support our residents that are living in those facilities.

But I agree with the Member, we want our residents to stay in communities for as long as possible, which is why we need to continue to move forward with Our Elders, Our Communities and find ways to ensure that the residents can stay in their communities, preferably in their homes. I’ve had an opportunity to talk to a lot of seniors, and most of the people I’ve talked to would like to stay in their homes as long as possible. Unfortunately, we know they can’t. They may have to move to independent living where they can have some general supports – and that’s what the Housing Corp is so wonderfully providing at this point – and then, unfortunately, they might need additional support, which means they might have to go to a long-term care facility like the one in Inuvik or the one we’re building in Norman Wells or the one we’ve finished building in Behchoko or the one that’s here in Yellowknife or Inuvik or Smith or Hay River or some of the other communities. But I do hear the Member and I’m always open to suggestions on how we can support our residents who live in the communities and support them to live there as long as physically possible.

I did hear the Member say in Fort McPherson there are a lot of elders and he feels that they need some additional support and one position may not be enough. We can commit to doing a little bit of a sort of load assessment at Fort McPherson. I’m not familiar with the details in Fort McPherson.

I will say that some of these shortfalls, or some of these perceived shortfalls, we’ll be in a better position to deal with once we’ve moved to one health and social services system. We’ll be able to work together and move resources where they need and be a lot more flexible than we are now. So we’re very excited to have the support of committee as we move forward to go to a more integrated, collaborative system that’s going to help us address some of these issues, including the issues around nursing services in Tsiigehtchic. As we have a more collaborative, integrated system that’s focused on the clients as opposed to the system itself, once we’ve fixed the structure we’ll be in a lot more flexible position to actually start addressing some of these real challenges that we see.

I have committed to come in with the Member to visit Tsiigehtchic again and talk to the residents and we’ll have an opportunity to discuss what the community would like, recognizing that there may be options that may not be a nurse. We did go to Alaska and meet with a number of individuals who provided some really unique programming, and one of the solutions they came up with is a community-based representative who is trained in specific skills who can provide some of those up-front services. That might also help us with some of the continuity of services and ensuring that we have a longer range of services. I don’t know what the solution is, but our ears are open and we’re looking forward to having those discussions.

The online training programs, we have talked about that at length today, and those programs are going to be delivered by the Gwich’in. Every Gwich’in community – Aklavik, Fort McPherson, Tsiigehtchic – I think there’s going to be one more out there, as well, and we’re looking to partner with other philanthropic organizations to help bring more money in so that more of these programs can be delivered. But at this time we have the money, the $1.2 million that we have distributed to the different Aboriginal governments around the Northwest Territories, and as I said before, they know what they want. They know what they believe is going to help their people and add the most benefit. We’re very supportive of them, and if they need us for technical or clinical expertise, we’re there.

How many people in treatment facilities in the Northwest Territories? We’ve contracted with four and at any given time there are probably 12 residents of the Northwest Territories in treatment. It seems to be fairly consistent. It hasn’t changed much in the last number of years. Even with the expedited process, people are able to get in quicker, but the average number of individuals who have identified that they’re ready to seek residential treatment is one of our continuums, one of our program areas, it’s about 12 at any given time. Thank you.

Thank you, Minister Abernethy. Next on the list I have Mr. Dolynny.

Thank you, Madam Chair. I’d like to welcome the Minister and the Department of Health here today. In preparation for today I had to look back almost 364 days ago as to what I said on this department back then, and back then the Minister was in power in his position for 232 days. So, it was more of a reflection of a short period in office and I tried to recant and re-evaluate some of the overarching issues of the day and apply them to now, which is around 597 days later in office, as to where we’ve gone with this department. In that respect, I’ll try to make comparisons within that year and how we’re looking forward. So, today my comments will be general in nature and won’t require any type of response.

Back then I did mention that we were in a very unique position to reposition our Department of Health, given the nature and the gravity of the situation within our responsiveness and our effectiveness at delivering the quality care that we could do. Now, granted, by all accounts our accessing of health care in the Northwest Territories and the quality of that care is generally comparable to the rest of Canada. So I think, in essence, we’ve got to give some good marks with respect to the delivery. With that, I want to make sure that is loud and clear.

But to note, still to this day, after as many days as we’ve been here as Members of the Legislative Assembly and given some of us here with unique perspectives who sit on the standing committee who actually evaluate health and put health pretty high on what we do on a daily basis. We’re still, to this day, not doing well in certain key categories. There are still some real disparities between how Aboriginal people are dealt with and non-Aboriginal people are dealt with, still today. Even given everything we’re trying to do that’s positive and we still rank among the highest in Canada for smoking rates, binge drinking and suicide, and I have not seen those statistics go down during this term. When it comes to chronic diseases such as diabetes and cancers, many of these are on the rise and some of the statistics that we’re having brought to us for the Northwest Territories put us in a position where we should be asking why the numbers are so high and what are we doing to bring those numbers down. On top of that, our hospital admissions for preventable illnesses, we’re still the third highest in Canada and that ranking to three years ago is still as valid as it is today. Our injury rates are still 10 times the national average.

So when I look at these key determinants, I’m asking myself where have we gone as a government, where do we go with the Department of Health? Now I know that there are many, many challenges that we face in the Northwest Territories that are hurdles to deliver this quality of care that we’re all trying to achieve. For example, we have probably as much competition to recruit and retain our professionals as any other jurisdiction in Canada, but I think we’re doing a relatively good job. Could we do better? I think we can, but I think for the most part we’re not doing too bad, but we still have to face those challenges.

We still have the rising costs of drugs to deal with and we’ve been waiting for this pharmaceutical strategy, which was being deemed as kind of a panacea of a catch-all to deal with this. But yet, without seeing any type of framework on the table that we can take publicly, it makes it very difficult to see the resolve in that thinking.

Of course, our technology that we have in the Northwest Territories, albeit when we open up new hospitals we put new technology in these new hospitals, these new health centres. But as a general rule, our technology is aging and you have to replace that technology at a rate to which it keeps up with the disease and preventative illness that we’re seeing. I still think we’re going to be hitting a crux in the road here sooner than later for some of our smaller health centres and some of our regional hospitals that require a much needed upgrade in medical equipment and I don’t believe the money is there or will be there when the time comes.

Finally, we do have a lot of health and social challenges associated with our aging population. Let’s face it, none of us are getting younger, we’re all getting older and that’s just a fact of life. I look at it from not only as a legislator in this room, I look at this as even a health care professional myself and I try to evaluate what are we doing in concrete terms dealing with our aging population. I still don’t see that silver lining. Of course, there haves been reports out there. I’ve read the action plans and some of these initiatives, but it’s almost throwing rice at a freight train. This entity is coming full on, we know those age categories are going to hit us soon, and yet it seems we’re still not dealing with the issue and the root cause of what we’re doing to make those significant investment and changes in the future.

Notwithstanding, I know that the Minister is working feverishly hard, trying to create a new governance model for the delivery of care and I don’t want to get into details about that just before committee. I have been supportive, I’ve publicly been supportive and I will continue to be supportive because I think it is a good thing that the Minister and department are embarking on. However, I don’t believe, again, I don’t believe that is the catch-all that is going to correct all our woes when it comes to making things better. I still think there are going to be cracks in our system because we’re not prepared to look at some of those areas while we’re trying to change governance. I’m still, to this day, not understanding why it is that our accounting systems differ in our authorities that we have in our system. Now, I know through a governance system this should be in line, but the question is why did we allow it to get to that level and why couldn’t we have fixed it?

I don’t think we’re dedicating the right quality and risk management to these different authorities so that we’re standardizing our delivery of care across the board. Now again, a single governance model should correct that. But I need to see the workings, the different levers of this in action before we get to that stage, and that is still a missing determinant as we move forward.

Again, when it comes to reporting, if you can’t measure what you deliver, then how are you supposed to make change? Again, we’re told the governance model should make reporting standards a lot more efficient and effective, but yet we’re still missing a number of these determinants for whatever reason. We don’t have the numbers; we don’t have large enough numbers to report on. So we’ve got to come up with almost a made-in-the-North program where we’re actually looking at those health care determinants to evaluate how effective our delivery is and how effective that we’re able to maintain standards equal or on par to the rest of Canada. It shouldn’t be a nicety. This should be a right. Every Northerner should have the same right as any other Canadian, and I’m not quite sure we’re there. I know we’re making effort. I don’t want to give the illusion that the department is on their heels or dragging their heels on it, but we’re still not there.

When I started this position a number of years ago, it was funny because I look at our budget and back then we were spending 26 percent or 26 cents of our budget dollar on health, given the full budget. When you look at national averages, most provincial jurisdictions are spending up to 40 cents, or 40 percent of their budget on health. Every key economist in Canada four years ago clearly indicated with the rising age of population growth and the pressures of population growth and expenditures, that every jurisdiction in Canada would see budgets around 50 percent of their dollars spent on health. Three years later I’m looking at our budget and I’m thinking, you know what – this is the first time where I’ll say, “you know what” – we’re not spending enough. This is not true for every department I talk to, but for this particular department, although we’re seeing a $14.9 million increase of 3.8 percent, I’ll agree with that. We’ve got to spend more money on health. We’re not there. The current budget right now, if you look at my quick calculation, about 25 percent. So in three years we’ve actually regressed by almost a percent in terms of total budget, overall budget we spend on health. Again, as I said, that’s nowhere near national average, which is close to 40 percent, and nowhere near the predictable average of 50 percent.

Now I know we’ve got Cabinet Ministers over there going well, Daryl, you know, we spend all this money in housing and everything else. So if you add up all the things we do from income assistance, we do 50 percent of our budget in health. We have to compare apples to apples when we deal with that from across the system. Again, I don’t believe we’re there.

So, the observations that I have here are mostly just comments. I will have more specifics as we get into detail. I just want to leave you with this and leave the department with this. I mean, I applaud the work that’s being done, given the minimal amount of finances that we give this department. I’m impressed that you’re able to deliver the quality of care, given the limited resources that I think health receives as a general rule. Now, I’m not saying this is impoverished, but I’m seeing that if we were able to give this department a little bit more money in the future, and I’m hoping we can. I’m thinking we can do some great things because, at the end of the day, it’s about people, it’s about quality of life and it’s about the delivery of a promise, and that promise is good health. Thank you.

Thank you, Mr. Dolynny. Mr. Dolynny clearly indicated that he did not… Mr. Abernethy.

Thank you, Madam Chair. I appreciate the comments from the Member. I mean, we’ve had many of these discussions in committee and many of the things I’ve heard Members say today are things that I’ve also said and I share many of his opinions on this. We have a lot of work to do, but I think good things are happening.

I agree with the Member that the transition to one system isn’t the final solution, but it’s an important, integral part of improving services in the Northwest Territories. But it by itself will not help us improve the health results for residents of the Northwest Territories. There are many things that we need to do.

The Member did talk a little bit about some of the accounting systems and why they’re different, and they shouldn’t be and we are bringing them in line. The authorities are working to come onto a similar platform as far as the accounting systems they use. This is being rolled in, obviously, as part of the transition, but we’re not waiting for that to finish, we’re doing that work now. I don’t know if you’ve noticed. The document in front of you today looks a lot different than it looked last year, and one of the reasons it looks so different is a significant portion of the system funding that we have in the health and social services systems in the authorities. The authorities report financially, based on direction from the department on different indicators that you’d see or different criteria that are identified within CIHI. So this new structure that you see in your book today provides more detail on how the authorities are actually spending their money than we’ve seen before. This new structure also aligns with the national reporting structure defined by the Canadian Institute for Health Information, so CIHI. So we’re coming in line with what the authorities are doing and have their reporting, which is going to make it easier in the future. I say that only because as I’ve gone through this document it’s quite a bit different than the last time and it gets a little confusing, but we’ve tried really hard to lay it out as if we had done this in previous years.

Just so we’re clear, the authorities were already aligned internally with CIHI for their financial reporting; however, financials had previously been repackaged by the department when we were reporting them, which seemed like a redundant exercise and a little confusing. We feel that there is more transparency on how the money is spent and how it’s seen within the new information in front of you and we hope and we believe this is going to help facilitate improved accountability and analysis. It might be a little confusing as we go through it today, but it should be better in future years.

A couple other things. I mean, we have put in the 32 indicators for health performance here in the Northwest Territories. That’s just come into effect. We’re going to start having year after year after year data which is going to help us focus our attention to where it needs to be focused. We’re also always part of CIHI reporting and we have the information available as well.

The authorities, in recognition that the transition of health is coming, like I said, we’re not waiting. The authorities are actually working on getting on the same quality assurance system so that they can start providing reports on their quality assurance and improving quality within their facilities and their communities using the same types of criteria, information and analysis.

One area where we know there are some inconsistencies, and I thank the Member for bringing it up, is in some of our Aboriginal health results, but I do have to say these kinds of population health indicators don’t really respond to interventions in the short term. They do take a while for many of these interventions. Much of the work that has been initiated by committee and by the government, they do take a bit of time to actually see long-term results, and you’re not necessarily going to see them in 232 days or 535 days, but you should start to see them start to be rolled out and start to be effective.

We are getting these things out, and I do want to thank committee for all their support in the years as we’ve brought forward these initiatives, and the committee has brought forward initiatives. We’ve started to roll them out and we will start to see results on them.

Back to the Aboriginal health, I think we should all be really proud of the Aboriginal health and community wellness division. The work that they’re doing is groundbreaking. We’ve been recognized by other jurisdictions for being a real leader in this area. The work we’re starting around things like cultural competence is in line with best practices and recommendations from recent reports. One recent report was the First Nations second class treatment, and the author of that report is actually going to come to our wellness gathering and is going to be one of our keynote speakers. The Aboriginal health and community wellness is taking a real strong leadership role in getting the cultural competencies out there and trying to improve results for a significant 50-plus percent of our population here in the Northwest Territories.

Once again, thanks to the Member for his comments. I appreciate them. I look forward to getting into detail. I’m glad he brought up the accountability structure stuff so we had an opportunity to talk a little bit about why this document is different. We did share a letter with committee, but I’ve got to admit, when I went through this the first time it was like, um, what? But go through it a couple of times and it makes a little bit more sense. I did warn you. I wrote a letter.

Thank you, Minister Abernethy. For general comments, next on my list I have Mr. Menicoche.

Thank you very much, Madam Chair. Just an opportunity to do some general comments myself. I think I spoke earlier in the House, too, about the mental health workers and a retention strategy for keeping them in our very small communities. I believe it’s important because it has an impact on the residents. I spoke most particularly about Fort Liard, especially when there are times of distress or their lives have been upset. In the past, our mental health workers haven’t been there. I do have to say, like any other situation, staff have been going to Fort Liard to assist them at the moment, but it’s about consistency when you’re dealing with a mental health worker, somebody that you recognize, you develop a working relationship, you open up with them more, and that’s the kind of service that our smallest communities should have as well.

Speaking about accessible services, I just wanted to return about nursing for Wrigley. Currently, the situation is that the current lay dispenser is retiring soon and here’s an opportunity to really consider about returning a nursing station or nursing to the community of Wrigley. The Minister has got to bear in mind, too, that as the oilfields around the Sahtu get developed in a year or a couple years there will be increased impact to the communities due to development, and I think that’s how in the early ‘80s we got two nursing positions only because there was going to be a significant gas pipeline built up the North and at that time government felt the need to stem any potential impacts. They had two and then one nursing position there. I’d like to continue to keep that on the books and keep that high on my agenda as the MLA for that region, that the department has got to keep considering and finding an opportunity to return nursing to the community of Wrigley.

The medical travel. I and my constituents are awaiting the medical travel review. It’s very important work that they’re doing to review it and, in fact, they were, I think, in Fort Simpson the first two weeks in January, and I was quite excited because I thought they’d be doing exit interviews, people that had just returned from medical travel and/or opportunity for a public discussion. They did go to the community of Trout Lake, but I didn’t see that they offered any public session or rolling out how they were going to review medical travel in the community of Fort Simpson. I actually got some people quite excited that had medical travel concerns that they were able to speak to somebody. But I wasn’t informed about how the department wants to review medical travel and what stage it’s at, and I certainly hope it’s not almost complete, because the people do want to have an opportunity to speak and share their experiences and even offer suggestions of how it can be improved. I think a lot of people that are concerned with medical travel always, you know, yes, there are some negative experiences, but also they say that my experience can actually save medical travel budget money if they had listened to me or if they had done other ways of getting medical knowledge to the client.

In one particular case, it’s about the client had actually went on a medical travel, jumped on the plane in Fort Simpson to Yellowknife, to the doctor’s office, and the doctor said, okay, here’s the results of your tests, and then were planning some further treatments and/or examinations later. Then that person flew back to Fort Simpson. I’m sure all throughout this North this kind of experience is common. There’s probably something to be said about the practitioner or the doctor dealing with the client personally, but in our communities we do have teleconferencing and that kind of stuff. Perhaps we can move towards that, especially if it’s just about informing about test results. The test results in this case were positive, but if they’re negative perhaps you have to see them in person, but I don’t know how you would make that call. But it’s something that should be looked at, and like I said, that’s just one issue and I’m hoping that people in my communities are able to share their experiences and offer their suggestions as well.

I also spoke in the House about the new medevac contract and about enhancing the times to get to the communities, and I’m pleased that the Minister said there is a commitment. I think it was, like, 120 minutes to get to a community. I would certainly like to restore the confidence of the medevac system to the communities. With that, I will conclude my general comments.

Thank you, Mr. Menicoche. Minister Abernethy.

Thank you, Madam Chair. I appreciate the Member’s comments. We did talk this afternoon during question period about the mental health workers and some of the stress that the individuals that exist in the communities are experiencing. I will just add to what I said earlier today, that for individuals, our employees, who may be under stress or experiencing some levels of difficulty as a result of their daily jobs, we do have programs like the Employee and Family Assistance Program and I would encourage the Member, as I would encourage all Members, to remind their constituents of this program and encourage them to utilize it, if and when they’re in stress. I did say it earlier today, some of the backfill and some of the temporary coverage, when we move to a single system those types of things will be easier to deal with because we’ll have a larger pool to select individuals. So, it’s just another advantage of a more integrated, collaborative system here in the Northwest Territories for the 43,000 residents that we have.

I do hear the Member about the nursing situation in Wrigley. We’re committed to providing first responder training but we’ve also got Med-Response that can help the practitioners. I hear that the practitioner’s leaving, so obviously we’re going to need to work with the current authority to ensure that they’re doing some planning around how they hope to fill that position and possibly training somebody from the community, or trying to recruit somebody from the community.

I do also appreciate the Member’s comments on medical travel, and I agree. Things like test results and other things, we should be able to find a better way to do it, and I think we’re getting there and we’re starting to see some progress, but it’s going to take a lot of individuals to agree, practitioners as well as patients. So, we do have some work to do there, but I do believe we’re starting to see some better results.

Just for the record, around medical travel, the Standing Committee on Social Programs did review the draft revised Medical Travel Policy and they gave us a bunch of comments that we’re going through. We are hoping that that policy will be effective, or go live during this session, barring any unforeseen circumstances. On top of that, that policy is part, and we’ve gone through a number of presentations, the policy is the foundation on which all these components of medical travel hang on. Currently, as the Member has talked about, there is some public engagement on the patient support, the escorts component of medical travel, and this began, actually, in December 2014 and consultations have been held in Hay River, Tuktoyaktuk, Inuvik, Behchoko and the Larga House in Edmonton where a number of our residents go. This stakeholder engagement on patient supports is on track and its completion date is set for April 2015. This will give us the tools we need to actually revise the escort policy. So, as of January 16th we actually had over 123 people who have engaged in one-on-one interviews and different focus groups. Yellowknife, Fort Good Hope and Trout Lake will be engaged before the current engagement process is over. So, groups and programs that have been engaged to date are Stanton medical travel, seniors, community and our Aboriginal leaders, Nursing Leadership Forum has been asked, the Medical Directors Forum has been engaged and others have been recommended by different department leadership. We anticipate finishing the escort portion, the investigation portion shortly.

We’re also anticipating doing a second one on benefits and eligibility engagement. We believe this is going to start in July. So we’re following the timeline that was originally given to committee on that and every effort will be made to select communities different than the ones we went to last time. When we go into communities, we want on-road, we want off-road, we want small, rural, we want large populations, we want smaller populations. We’re trying to get a diverse group as we go out on these community visits so we’re going to go with the benefits and eligibility in July. We’re also going to do, which I think is a really important part, the appeals process in 2015-16. So we’ll have the vast majority of the Medical Travel Policy and its components done in the life of this government. There will still be some that will continue on.

With respect to medevacs – two hours, depending on weather – weather is the one condition that we cannot control, but with the new contract starting April 1st, we are two hours into small communities in the Northwest Territories, barring anything that the weather throws at us. I want, like the Member, to restore confidence to our residents in the Medical Travel Program and the new medical contract we have, in addition to supports provided by Med-Response, I believe will go a long way to restoring that confidence. I know there is a loss of confidence in some of the Deh Cho communities and I’m looking forward to travelling with the Member to the Deh Cho communities this spring and hopefully we’ll have an opportunity to talk about all of these things.

Thank you, Minister Abernethy. Next on the list for general comments I have Mr. Moses.

Thank you, Madam Chair. I would just like to welcome the Minister and his staff joining us today. I think you could tell by some of the discussions and correspondence from some of the Members here that there is still a lot of concern in this department, but before we get into some of the questions, I guess concerns that I might have, I just want to commend the department on the work that they’ve been doing with standing committee over the last three years and four months in terms of the onset of this government.

Over that period of time we’ve developed an Anti-Poverty Strategy, given some good input into that, the Mental Health and Addictions Action Plan and the action plan to transform child and family services which is huge, it’s really big. I think that’s going to really affect the safety and the health and well-being of our children in the Northwest Territories that are being apprehended and looking at where they’re going. The Early Childhood Development Action Plan, which is looking at investing in our people at an early age so that one day, hopefully, we’ll have a new generation of healthy, educated people, which will reach one of our goals of this Assembly, which is to have a goal of healthy, educated people free from poverty, Madam Chair.

I commend the work that the department has been doing in moving forward on the governance structure. I think that will bring everything in order, in terms of all the departments and the way we do business in this department with the Department of Health. Programs and services will take the best practices from a certain region and try to apply it throughout all the Northwest Territories and all the regions. The work that’s been going into prevention and promotion, you know, it’s something that standing committee has been very supportive of and has been pursuing and has been trying to invest in right at the onset of this government. Obviously, the legislation that we’ve been dealing with over the last three years has been very critical in how we do business within this House and within the government.

With that said, there’s been a lot of good work that standing committee as well as Members that have come to standing committee and the department have been doing in moving forward to build that foundation that will not only guide the remainder of this government but for future governments, the 18th, the 19th. These action plans should, hopefully, like you said, won’t have results right away but you will see them in a few years. The system that we currently have is very complex.

The Minister and I’m sure the staff know that, you know, having all these authorities and the way we do business, the cultural aspect of it and the traditions that some of our people practice make it a complex system, and there are many challenges and barriers as we move forward. I’m just saying that I know there’s a lot of challenges and barriers and one of those is trying to make residents of the Northwest Territories more accountable in living a healthier lifestyle. That’s where we get into the prevention and promotion and want to try to get that onset and look at how we do that.

As I said in my reply to the budget address yesterday, you know, we have some of the best programs and services in all of Canada and it’s getting to the point where we’re making our residents rely on government programs and services. That’s where we’re seeing this increased budget, $1.6 billion for about 43,800 people in the Northwest Territories, which is very high and it continues to build.

With that, Madam Chair, this department, from our first budget of this 17th Legislative Assembly, 2012-2013, to the budget we’re going to be looking at passing in this sitting has increased in the life of this Assembly almost $57 million and that’s an increase of 16.3 percent. Again, we see it here with an increase in this budget of $14.9 million from last year. Under the direction of government, we were all supposed to go through a fiscal restraint policy and look at where we can see funding. However, like I said, we get residents that rely on our programs and services, and as a result, we’re more reactive than proactive. We tend to put more money into these programs rather than looking at prevention and promotion, trying to keep people out of the health care system, and I think that’s got to be another priority. I know some of the work that the Aboriginal health division is doing is taking that stance of looking at how do we do prevention and promotion in a better way, especially with the chronic disease management and care.

At the onset of the 17th Legislative Assembly, when we met with all the deputy ministers, one of the things that were highlighted was that our biggest cost driver within this government is mental health and addictions. I think every Member on this side of the House that has made general comments has mentioned mental health and addictions, and we’re following the same Mental Health Act. I know there are discussion papers out there. I think it really needs to be the priority. If we want to cut down the cost in this area, the Mental Health Act needs to be a priority. It’s a huge act. Since its ascension in 1987, it hasn’t had any significant changes to it. It’s good to see that we’re going to be modernizing it and getting it up to date.

In terms of mental health and addictions, we have the on-the-land training program; we have Mental Health First Aid; we have those four contracts we do down south. What we don’t have and what we need is the follow-up. When these people come out of the programs, we need a support system there that can contact these 12 people at any one time, or the ones that do come out of care and treatment, to see how they are doing, but not only the follow-up there but the support system while they’re in treatment down south. In some cases we might get residents that go down to treatment and might be into a culture that they might not even be used to. They might be going down for alcohol treatment but they might be with people who have stronger addictions. I think that’s something that we need to look at and take into consideration. I’m looking at my time here and it’s running short.

Some other concerns that I have is last week we talked with the Premier on Third-Party Accountability Framework, not-for-profit organizations that do work on behalf of government. This goes back to program duplication. We may be running programs. There might be some non-profit organizations that are running programs. Let them run the programs. Let’s support them with the services and resources that we need. Why do we have to duplicate it and make things more complicated for residents?

With the time remaining that I have, the big one is the child and family resources. I think that, when I talked to child protection workers, one thing that they mentioned to me is that they need more money to do the work that they’re doing, which is huge.

The other thing that I have a concern with is the Early Childhood Development Initiative. This is the department that really wanted to go ahead and take the lead on that with the more critical years of early childhood development between zero and three, two being the most critical of those years getting them ready for school, and we wanted this department to take the lead on that.

However, this department has been doing a great job on the Anti-Poverty Strategy and taking the lead on that. I commend them for that.

Chronic disease management is always a big one and oral health. Oral health and speech pathology go hand in hand. Every time we’ve gone through these operation budget practices or where we are approving the budget, oral health has always come up, and I know that’s a challenge for the department to move forward on.

With the governance structure, early on at the beginning of this government, members from the Beaufort-Delta met with the then-Minister of Health to talk about creating an advisory council that would give suggestions, recommendations to our health authority in the Beaufort-Delta. We are going into the last few months and hopefully we’ll even see it become a reality. So, it just kind of goes to show how our government works. It does take a long time and making the necessary amendments to certain legislation and bills.

I’m seeing if there’s anything that I didn’t forget here that I wanted to bring up. With that, I just want to make comments that, as a standing committee, we do go through all these action plans, all these reports, correspondence with a fine comb. We look at it in detail and look at how we can make the best possible legislation, best possible programs for residents of the North.

Just for the record, I want to just state that in 2014-15 the standing committee did bring in four motions directly related to this department that were defeated. One was on oral health care, which is still a concern for many residents of the North. One is for the child and family resources programs and services which, like I said, I heard loud and clear from child protection workers that they need money. That was defeated in the tune of $1.2 million. Another one for the Mental Health and Addictions Action Plan, which is our biggest cost driver. We tried to invest $2 million to implement that plan; that got defeated. As we go through the budget, we’ll see there has been an increase in that budget. The last one was for early childhood development, as I said the critical years for our youth and our children, in the tune of $2 million to help with our employees that do those services or those people that do services on behalf of government. That was also defeated in the tune of $2 million.

There are lots of concerns. Like I said, this is a complex government. I see that my time has run out. I don’t really need a response. As we go into detail, I’ll ask some more specific questions. I do commend the work that the department has done, working with committee, and commend the work that committee has done in getting to this budget as well. Thank you, Madam Chair.

Thank you, Mr. Moses. Minister Abernethy.

Thanks, Madam Chair. I thank the Member for his comments. I’m not going to go into too much detail, just a couple points.

The Mental Health Act is a priority. We really wanted to get that done in the life of this government. But, as the Member said, it’s huge. It’s a big piece of legislation. It’s an incredibly important piece of legislation. In addition to all the other pieces of legislation that are happening here in the government and all the other work that is being done, I don’t believe we’re going to be able to get it done. I know we’re not going to be able to get it done in time to table in this session and probably won’t be ready in the May/June session as well. But I still believe the work that’s being done on that act needs to get out and people still need to see it. Recognizing that it probably won’t be ready until after May/June, I’m hoping to table it in our fall sitting as a tabled document, which will allow people to look at it and review it over the election period, so that when we come back into the Assembly or, rather, when the 18th Assembly comes in, the Members of the 18th Assembly have a piece of legislation that is, for the most part, ready to go and could be ready for first, second and third reading early in the life of the next Assembly. I think we all would have preferred to get it done, but just the amount of work that it’s taking to get this legislation out there, given the huge amount of interest from people across the Northwest Territories, I don’t believe it’s going to be done.

The Member did talk about some of the motions that were defeated. We are making progress in many of those areas, in particular the oral health area. We’ve actually been able to attain some of the money from the Territorial Health Investment Fund that we’re going to be able to utilize to develop a comprehensive oral health strategy, so we’re making progress there.

We continue to move forward on ECB and supporting the family committees, healthy family programs in the communities. We’re continuing to make progress there.

Even without additional money, the department has been incredibly creative and has been making progress in many of these areas just by living and working in an incredibly fiscally tight environment where there aren’t a lot of financial resources available to chase new programs. We’re looking at doing more with what we have and we’re looking to utilize our dollars more effectively and for better results, rather than just increasing the dollars that we’re spending.

Thank you, Mr. Abernethy. General comments. Next on the list I have Mr. Nadli.

Thank you, Madam Chair. I want to make a couple of general comments. I wanted to begin by highlighting that one sector of the population is vulnerable as we consider them and that’s the aging population of the elders that live throughout the NWT. Just having at least a perspective for where elders exist in communities. For the most part, they’ve lived a life, perhaps a long life, being accomplished in terms of a career, various work and various experiences. They have seen many changes. They’ve also, at the same time, seen their children grow up and now they’re experiencing their grandchildren grow up. Those are the golden years. Those are the years that are supposed to be stress-free, comfortable life, almost sailing, I guess, in a wondrous state. But the reality is that we don’t have a situation like that up north. The elders, for the most part, are living in communities in terms of trying to maintain their own home. Sometimes they’re struggling with the cost of living. They’re living on a fixed income. At the same time, the circumstances are that they have their grandchildren to take care of. It’s just the way it is in communities.

I wanted to begin by saying that because I think that there has to be some attention drawn to that reality and we need to deal with it, whether it’s at the local level, whether it’s at the regional level or coming from headquarters, but it’s a real issue that I think has to be addressed throughout this department.

At the other spectrum of the population that’s vulnerable are the sick people that remain in hospitals because we simply don’t have the facilities. There could be a need for special care and we don’t have it. The other option is we send them down south to be separated from their families or their siblings or their relatives, and we just don’t have those specialized care facilities up here in the North. So we have to house them, perhaps in a hospital, and try to do the best we can. That’s a challenge that we face.

There’s still a need for us to try to maintain at least the basic services that we’ve been carrying this far. You know, the diabetes program, because diabetes is one area that really, for some reason, affects Northerners, especially First Nations people. Sadly, you see some people that lose their limbs because the awareness is not there or the services of care and prevention are not there. The reality is that some people are just simply in a circumstance where they find that they’re at the end of the road and they have to take drastic measures like amputating, perhaps their limbs, because there’s just neglect.

Other areas like mental health and addictions, it’s sad that that whole issue still remains a big issue. It confronts us on a daily scale and it’s a matter that we need to accept, it’s a reality and we cannot deny that it exists. We can’t live in denial. We have to admit that it’s part of living, but at the same time it’s a matter that we seriously have to try to address the best that we can.

An unfortunate reality, too, is that we don’t have a treatment centre in existence and we’re trying to come up with programs such as the on-the-land programs. We need to take steps to ensure that those are succeeding as best as we can.

Another area that I wanted to highlight is the Home Care Program. Why I say that is because we have an aging population where most elders want to remain in their community or their homes. I thought the Home Care Program at some point would see a mixture of local people that can qualify to work with elders through the health care system at the local level. At the same time, they also have perhaps a person from the outside, or local that decides to become a registered nurse, or a nurse practitioner that is well experienced. They can work with local people and operate as a unit and work within the community to provide health care services to the elderly and the sick people that make the choice to be home. If we could achieve that, then it’s almost an effort of filling at least some parts of decentralization where we have a program that could be set up. You have local people, you have registered professionals or registered nurses that work with the local people and you’re delivering a program at the local level. For me, that’s almost like an element of decentralization. I’m kind of disappointed that we haven’t highlighted perhaps a program as much as we should and could.

In that same breath, too, with the onset of some new facilities and infrastructure in my riding, we still have this idea of trying to decide the fate of old infrastructure, like the old health care centre in Fort Providence needs to be decided. We don’t know what’s going to happen to that, but the bigger opportunity that I found was that from taking a perspective that we have a new building, you know, we’re going to move out of the old building. What I thought would be interesting is trying to do things differently. One example is to enhance the Home Care Program, but the unfortunate signals right now are that the status quo is going to be the same. We’re going to basically do the same as we’ve done for a long time and nothing is going to change. We’ll just have a new building.

There are some remaining concerns that health care could be delivered in the smaller communities. There’s been an effort in trying to deliver these programs where people live, especially elders, and there have been discussions in terms of trying to bring the health care services as close to the people as we can, and if it’s in the small communities, we need to work with the local leadership in trying to make that possible.

There’s been discussion in terms of governance in terms of perhaps moving to a centralized model of trying to amalgamate and try to pull things together. I see the rationale in terms of cost efficiencies through trying to make things more manageable, more economical, more financially frugal so that we have more resources. I think we need to be reminded, especially with a majority of First Nations that are on the receiving end of programs and services related to health, but the fundamental block in all of this is the fiduciary obligations of First Nations that do receive health care services from the government. The original relationship was between First Nations and the Government of Canada, and as responsibilities are taken on, there has been an effort to devolve responsibilities to territories, to provinces, and in this instance here in the North we have some First Nations groups trying to negotiate self-government regimes and models so that they can make decisions by themselves.

At the same time, and parallel to that, the system that we have is founded on that, that the fundamental relationship of First Nations and the Government of Canada has changed fundamentally so that those programs and services are delivered now by the GNWT. How that’s going to change in terms of if we come to a centralized model of health delivery, I don’t know, and perhaps that’s something that you need to maybe discuss at some point and contemplate in terms of how it is that we will try not to affect any constitutional obligations that we have to First Nations. Mahsi.

Thank you, Mr. Nadli. Minister Abernethy.

Thank you, Madam Chair. The Member did start off by talking about an aging population. Once again, I appreciate the Member’s comments.

We are doing a number of things. We do have Our Elders, Our Communities, and we’re building on basically four major pillars within that document and we’re developing action plans around each of those areas. One of them is home and community care, and I hear the Member’s concerns and he doesn’t feel that anything is changing. I will say that the facility that is being built in Providence today is a larger building than had been there previously and there’s opportunity for expansion and growth. So it may not happen today, but that does not mean it’s not going to happen. The facility has some room for further discussion.

The other areas that are pillars under this framework are palliative care; we’re building some actions around that, the long-term care facilities development review, identifying where facilities need to be built in the future, as well as caregiver supports. So there are a number of things happening there and I do hear the Member’s concerns about home care. We will talk to the authority and work with them to articulate some of the things that are being done around home care in the region.

The Member has talked a little bit about the one system, and just for clarity, this is not a centralized model. This is a territorial model including input from all regions, communities and also, to be clear, it’s not about saving money. We’ve been very clear all along this is not about saving money. This is about improving care of all residents in the Northwest Territories. We do anticipate that there will be an opportunity to control spending and focus money where it needs to be, but it isn’t about saving money, it is about improving care.

Just to be clear, health was transferred to the GNWT by the federal government in 1998, and what we’re trying to do today is to improve the service that we have now, the services that are currently being delivered by the GNWT so that we can provide better results to our residents. Obviously, and absolutely, we respect that some First Nations may seek to negotiate other arrangements in the future, and this doesn’t change that. This is about putting something in place today based on the fact that the GNWT currently has the responsibility and it does not hinder or change the ability for other Aboriginal governments to draw down some of those responsibilities in the future. It is not intended to create a structure that that cannot happen in, but it is intended to create a structure that meets the current needs of the residents of the Northwest Territories in the most efficient way and gives us the greatest degree of flexibility to meet the needs of all of our people. We will continue to have conversations with Aboriginal governments who wish to draw down those authorities and those responsibilities, and we will certainly work with them on that.

The old health centres. There are a number of them in the Northwest Territories. Once we move into our new facilities we will go through the process of analyzing whether we have any additional need for them, and if we don’t we will be giving those facilities to Public Works and Services who will be doing their needs assessments on all those facilities and looking for ways to dispose of those facilities if no need is identified by Health and Social Services. They will be working with communities to explore all options for use of those facilities. I know the people of Fort Providence, the different governments in Fort Providence have approached the government already, indicating that they have some really creative ideas, and I know that Public Works and Services is certainly open to having discussions around those particular areas.

Diabetes. We’re doing a number of things around diabetes as part of our chronic disease work. Projects like the NWT BETTER where it provides tools for doctors and nurses and patients to prevent chronic disease in areas like diabetes through lifestyle changes. We’re also, and I’ve mentioned it in the House, I believe it was in the October session, that we’re rolling out new approved clinical guidelines around diabetes which is new, and it’s going to be an important tool for all health practitioners in the Northwest Territories when they’re dealing with residents who may be at risk. We’re making sure that all of our targeted programs are available to all Health and Social Services authorities across the Northwest Territories and we are establishing an effective territorial program which is part of the new strategic plan for the system.

There are a number of things going on in the areas that the Member has been talking about and we look forward to continuing to work with committee as we roll these out.

Thank you, Minister Abernethy. For general comments, next on the list I have Mr. Bouchard.

Thank you, Madam Chair. Most of the comments have been made. I guess I just wanted to make a few comments relative to Hay River. Obviously, we’re excited about the new health centre coming on board this coming year. We’re excited to see the Midwifery Program being implemented. One thing that’s really helped me recently as an MLA is the system navigator and the go-to person to a lot of the issues that some of my constituents have been having. It seems like we’ve been getting a lot of success that way. At least people getting contacted and being connected with the department. I’m not sure how the system works as far as dealing with individual people, but sometimes people feel like they’ve been left out or not communicated with, and through the system navigator it seems like we’ve been able to get responses to people right away. Maybe not exactly where they want to be on a list for surgery or a list of when they’re going to get their special examinations or whatever, but at least they know exactly where they stand.

I know we’ve been working on a cancer navigator or looking at that. I think that’s going forward. I think that’s a way to deal with the public a lot more. I mean, that’s probably a good percentage of our job in the fact that we see a lot of concerns from different people on the system and how they deal with them, especially ones that are from people from the communities feel like a lot of times they have to come to Yellowknife or to Edmonton and where they sit on the list and when that would be expected.

Those people that have been travelling, I’ve been hearing lots of good things about the two homes that we have in Yellowknife and in Edmonton. Even speaking to a constituent this afternoon, one constituent was pleased. He was just in Edmonton and he was very pleased with the service and responsiveness that he got while staying there. I’ve heard that several times, so I just wanted to pass that on to the department.

Several Members have talked about on-the-land programs, and we’ve heard this concern in Hay River. I’m just not sure if the department is waiting for a proponent to drive some of these programs or is the department going forward and looking for proponents in different regions. That would be a concern of mine. I’m not sure if we have a proponent in Hay River that would necessarily be taking an on-the-land program, but would the department be looking at ways of implementing that through somebody or through different organizations and bodies?

There have been quite a few people talking about the closure of the addictions facility on the Hay River Reserve. Obviously, we’re concerned about that. A lot of people, when it did close, had an explanation from the department where it was but the department was looking for other opportunities for that facility. It’s a beautiful facility. It’s a great asset the GNWT owns, and we should be using that asset and getting that back into the inventory, and I’m assuming it’s going to be in our health system to benefit that. I think Members have spoken, whether it’s a diabetes clinic or mental health, that type of stuff. We need to use that asset that we have on Nats'ejee K'eh to the maximum. For it to sit there empty is a complete waste.

Speaking of the mental health, we’ve been hearing issues recently in the Hay River area now that we’re getting more successful identifying some of the problems that we have in our communities related to mental health, we’re having wait-lists. We’re having people having to wait a long period of time. Some of that is maybe because I’m not sure if we really have enough staff in that area or if we’re not willing to pay overtime, but I mean, it’s definitely an issue that’s out there. If those wait times are getting longer and longer there are a lot of people that are in pain and suffering through this mental health stuff, so I think we need to address that where we’re seeing long wait times in communities such as Hay River.

I know we’ve talked with the Minister and I know the Minister has been to Hay River to talk about the one health authority. Obviously, we have some strong interest in that. I think we want to see some representation from the region and from different people other than just one individual, our public administrator, who is doing a good job, but I think the community wants to be able to contact several people or get kind of a group or a regional concept of what we want to do with our authority. I think that part of it is very positive. Obviously, the big question mark is how do we plan to move forward with the Hay River Health Authority and its staff obviously protecting their interests but also being able to create this one authority, and obviously the staff not being GNWT is an issue going forward. I think the Minister is well aware of that, and we need to assess the complete cost to that.

Those are my main issues with the Department of Health right now, and I’ll leave it at that.

Thank you, Mr. Bouchard. Minister Abernethy.

Thank you, Madam Chair. Thanks to the Member for his comments. I too am very excited about the opening of the Hay River hospital. I know that the Members did have an opportunity to tour that facility last summer and got to see the size and the scope of that particular building and the amazing things that are going to be going on there, including midwifery, in Hay River. We will be able to support births. I believe we might even have some births anticipated for this month. That’s fantastic news that we’ve been able to make that progress.

I really appreciate the Member’s comments on the system navigator. We’ve been getting a lot of really positive comments and feedback from residents from across the territory who have had the opportunity to benefit from the support from the system navigator and we are very excited about that particular position.

The cancer care coordinator position that is being developed is actually currently out for competition and we’re hoping that it will be filled soon. We thought we had been there a couple times. We thought we had it filled a couple times and then staffing issues have gotten in the way. It’s kind of frustrating but we believe we’re going to get it staffed soon.

On-the-land programming, we’ve actually been going to different Aboriginal governments and organizations in the Northwest Territories seeking their input and asking them to get engaged. We’ve had pretty much all the Aboriginal governments here in the Northwest Territories engaged. In the South Slave we contacted, for example, the Dehcho and the Metis Nation.

Nats'ejee K'eh, you’re right; sitting empty is a waste. Tomorrow and Thursday Chief Fabian is holding a conference in that facility to start identifying some of the things they’d like to do and what other ideas might exist for that facility. We’re really looking forward to their feedback, once they get out of there. We’ve had some ideas in the past, but at the end of the day we want to make sure that we’re cooperating and working with Chief Fabian and K’atlodeeche. We’re really looking forward to seeing what they have to say.

Mental health wait times, I’d love to talk to the Member about that, maybe not in this particular setting because it’s not something that I’m actually aware that there’s mental health waiting lists in Hay River. I’d like to get a little bit more detail and try to understand what’s going on there a little bit, so maybe the Member and I can have a conversation afterwards.

With the health transformation, and I’ve said it once and I’m happy to say it again, once the legislation passes, recognizing that we want to make sure that we continue to get input from people as we move forward, our intent is to put in interim wellness committees in the communities, including Hay River, so that it won’t be just a public administrator, and when the system goes live in 2016, at that point official committees will be established. We’re hoping to have some interim committees in the life of this government, assuming that the legislation passes, and then we are intending to have the official committees, including a wellness committee in Hay River, established in April 2016.

I hear the Member loud and clear and I heard the residents of Hay River loud and clear and I heard the staff of the Hay River Health and Social Services Authority loud and clear. There’s real interest for them to come into the public service, but we need to make sure we do it right. As we have done with all other governments, as we’ve transitioned them into the GNWT, we are going to work closely with their bargaining unit. We’re going to work closely with the Hay River Health and Social Services Authority. We’re also going to work really closely with superann to ensure that, when we’re ready to bring them over, we have a full idea of what the costs are going to be, the full cost implications and the staff are aware clearly of what the benefits and challenges of coming into this system are. We want to make sure that everybody is informed and is part of the solution as we move forward. Thank you, Madam Chair.

Thank you, Mr. Abernethy. Department of Health and Social Services, general comments. Mr. Hawkins.

Thank you, Madam Chair. I just want to touch on a few subjects, a little bit of repeat from my other colleagues, but I do think it’s important to further lend strength and emphasize in certain areas. I’ll certainly bounce around here on a few subjects.

One of the issues I’ve raised repeatedly over the years is a seniors charter. I have yet to see any development of it. I had the former Minister express an interest in it, and I certainly hope the department eventually finds time in something like this. We always seem to talk the talk about how important our seniors are, and many of our health benefits are geared towards ensuring they’re targeted to a quality of life for our seniors in their golden years. I would certainly stand with anyone and certainly stand against any decriers of saying that the Northwest Territories doesn’t offer some of the best benefits, but I would say that the problem with offering good benefits is somebody always wants more, and the challenge, of course, of meeting those needs is always high. We conversely know that we put such a high priority on our seniors’ care, physical and mental well-being that it is an important value. What we offer today I think needs to not only be matched but superseded because we do care and we’re the type of jurisdiction that puts it as the highest priority.

I, like my other colleagues, wanted to sort of emphasize a little further on the options for treatment programs here in the Northwest Territories. I look forward to the day of hearing that we’re going to find a residential treatment program up and running. I’ve watched people, even as of recently, deal with their struggles and knowing that their options of fighting for weeks on end, months on end of trying to be stable enough so they can be sent out and wait for that opportunity. It’s really disheartening in watching this. I know there is no magic wand. If there was, it would be certainly worth a fortune by all means. It would certainly change the face of addictions the way it is. I know it’s a real struggle, watching people with these things. It’s just day in and day out. I have yet to meet a single person who ever said they wanted this. It’s such a terrible burden of these addictions where it is what keeps people down and moving forward. I don’t necessarily feel that the government pays enough attention to it. On the street you would ask people to talk on three or four issues in the Northwest Territories and it’s always up there as one of the most important issues of the day, yet I know things happen behind the scenes. I’ll be clear about that. I do know that, but it is still one of the absolute most important problems in the North, and yet, as I said, we don’t have a residential treatment program for addictions. I think that that’s something that we have to strive towards.

During the letting of the most recent medevac contract just prior to officially becoming implemented, I would say that one of the issues I was trying to raise about is the programming that they now offer in the new contract which is called CAMTS. It has really added financially, this particular program. I really wish the MLAs could have been in the early stages of the discussion with it. Even the director of the medical care at the Edmonton medevac facility felt it was asking a little much. It was very difficult for them at their location, which houses STARS air ambulance and is the receiver of all these medevacs to the Edmonton area. They felt it was an impossible challenge even for them to keep the credentials on a day in and day out basis. Our jurisdiction, which really I think mathematically, if I may define it this way, has approximately a medevac a day. I know it’s not exactly like that, but to illustrate the purpose, they felt that it was very small in comparison to the need of it and would add significantly to the costs to the medevac contract.

It’s easy to say we want the best care for all of our loved ones, and of course, when it’s your loved one, we always want the absolute best care. But we always have to say that if this is where we’re going, what next? We should be flying full C-130s fully loaded with doctors and nurses and medical equipment? I mean, where does it end? That’s the problem. I just worry that it’s a little sort of the old proverbial horse has left the barn situation here. To my knowledge, there was no early discussion before the contract went out for RFP. The only time we could raise it was during it, which the Minister didn’t want to talk about it, and I understand why he didn’t. I understand I’m not fooled by the engagement of the Fairness Commissioner. I’m prepared or don’t want to waste his time by saying I know what you’re going to say by saying you didn’t do it, couldn’t talk about. But I do say that it does add a fair bit of expense to the larger portion of the program.

Now, Mr. Chair, I see we’ve done some seat shuffling. We talk about how important the Mental Health Act is. It’s not to be treated as criticism that people are to be offended by, but it’s funny how much time we all keep saying that it’s so important. If it’s that important, why aren’t the resources being put towards it? I hear from almost every single Member how important the Mental Health Act is. I hear it in the public. I was in Fort Smith talking to somebody; I was in Hay River talking to somebody not that long ago; I talked to somebody in one of the other communities about it. Everyone seems to know how important this act is and the update. I’ve worked with, sort of, in some ways or in other various ways, some families presently going through the challenges through these problems associated with the lack of power, lack of direction, lack of innovation in the current act. I think the staff at Stanton Hospital has done an incredible job on working with what they’ve got, but the challenges before them of working with the current act is that it lacks the ability to do the things we need to do. The problem that really becomes extremely frustrating is that everybody seems to know what the problems are, and I just wish we wouldn’t talk about how big the act is or how many few days left we have in the Assembly or, oh, it will be the next transition document. It’s these types of things that really define a legacy of work done or work not done. As I said in the beginning, it’s not to be treated as a criticism, but I really wish the resources were asked for. I don’t see anyone stopping any of those dollars being forwarded or supported in any way. Is it a matter of hiring another writer? Is it a legislative writer or those types of things? I don’t know anybody who wouldn’t support that. If somebody just spent 10 minutes with one of these families, and I have, to talk about the challenges these families have with the current act, you’d be certainly hard pressed not to feel terrible about the way the situation presently is.

To add insult to injury, if that wasn’t enough, I wish we had stabilized psychiatric care at our hospital, I wish we had more care, I wish we didn’t have to use locums, I wish we could find a way. I’m not sure what the right way is. I can tell you what I think needs to be done, but often we hear we can’t hire anyone so we have to hire locums that come in and out and learn about the patient every time they come in, then the new doctor comes in and adjusts the medication, modifies it and then it’s back to re-introducing the problem, getting to know folks, trusting folks. It’s a real stress point for the families and I really do try to imagine for the person who needs the help.

I am reminded of a recent case of a particular family and the RCMP picked up this family member because of an incident. I was very thankful, certainly the family was very thankful, the fact that the RCMP recognized that this person’s issue had more to do with mental health and ability than it was a legal problem and they should be dropped off at the RCMP station, press charges, et cetera, and how the story goes. I would say to the RCMP, I appreciate that we do have members out there recognizing that, but the system itself is bound by certain problems.

I see my time is grinding away very fast. It’s funny how fast it goes when you’re on the clock and how slow it goes when you are listening to somebody else. I am going to use every second of it up. No time unused.

I would certainly like to go back and point out that I have often heard about on-the-land programs. I have yet to see the details of how those work in a positive way. It’s really designed, certainly in talking to people about spiritual health and mental wellness, but it’s really not for folks with addictions.

I will end with that and by just saying I don’t think we can do enough with addictions, enough in the sense of enough resources. I would certainly support more work towards the Mental Health Act and any way to get that done. Mr. Chairman, my time is up but I just wanted to emphasize how important those two particular subjects are to me. Thank you.

Thank you, Mr. Hawkins. Minister Abernethy.

Thanks, Mr. Chair. Thank you to the Member for his comments. I have to say I’m not exactly sure what the Member is talking about when he refers to a seniors charter. Maybe after sitting today we could get together and he can explain to me what specifically he is referring to. I remember a lot, but clearly I can’t remember everything so I’m not 100 percent sure what he’s talking about.

I do agree with the Member that there’s a lot of good work being done around elders and seniors and I do agree that more needs to be done, as well, which is why we are working on a number of those strategies that I articulated previously and we are going to continue to do that work.

We have a really good relationship right now with the NWT Seniors’ Society and the other NWT-based seniors’ societies. We are meeting with them on a regular basis, or as much as we can to make sure they are included and involved in any of the work we are doing and offering insight from their perspective, which I think is critical.

The Member talked about the frustration that individuals are having around long delays in getting them into residential care for addictions. I’m sure it’s true, but I do find that rather frustrating because we have gone to a 24-hour referral process and we can actually get individuals referred into treatment within 24 hours. So I would strongly encourage the Member if he knows people who are having some real problems there, we can refer them to the system navigator. They can go to you or a health practitioner. If they go to a health practitioner, that health care practitioner can make a referral to the territorial director and we can have a turnaround time in 24 hours. We have seen some fantastic success in this and I will acknowledge that not everybody seems to be aware that we have made that change. We have tried to tell people and tried to get that information out there. I am going to continue to say it, and I strongly encourage all of you to say it to your constituents and residents, so that we can get rid of this delay that individuals are experiencing and get them where they need to be. Right now we have contracts with four residential treatment programs that have a huge range and variety of programs within each of them that are really giving quality results to our residents of the Northwest Territories. So, please, let’s all work together to make sure that our residents know about this referral process. If they are having difficulties, let’s get them referred to the system navigator who can help them work through the system.

The medevac program, CAMTS, it stands for Commission on Accreditation on Medical Transport Systems. Although there was a significant cost to the air ambulance services, we are confident that the CAMTS is actually in minor financial impact on the overall contract. CAMTS itself did not result in a significant cost increase.

I will say, and I met with the individuals in Edmonton who are running the facility at the Edmonton International Airport. I did have a conversation with them around CAMTS. They did indicate that they don’t use CAMTS, but they did say that for a jurisdiction like us that is smaller, it is a reasonable, accredited national program that would be appropriate for a government our size. In fact, Alberta was part of our screening and evaluation committee and they strongly recommended CAMTS. As part of the assessment team, we did have a lot of confidence in their history, in their knowledge and their ability to direct us, a small jurisdiction, to an accreditation program that ensured the safety of our residents who happen to be using air ambulance services. So, we’re comfortable with CAMTS. We believe that it’s given us some certainty around the services being provided, and the successful proponent was able to meet those conditions.

The Mental Health Act, I agree. I sure would have loved to have seen this act done in the life of this government, but it is a huge amount of work. I know the Member doesn’t want me to say it again, but it is a huge amount of work. It’s essentially a new act. The old act was so outdated and so no longer effective, it is not effective.

We had extensive feedback from the consultation process, and we also received a significant amount of input from the Standing Committee on Social Programs that clearly has a strong passion for this piece of legislation and also wants to see it. We have a team on this constantly, trying to ensure that every piece of input that was provided to us is analyzed and considered fully. But recognizing that it is essentially a new act and that we do have a set number of days, we have to have the legislation done in time so it can go through a 120-day process. In order to do it right, to make sure that we get the legislation that truly will benefit the residents of the Northwest Territories, we don’t feel we’re going to be able to have it done in the May/June session, which is why I intend to table it in the fall session so that at least it’s out there – because it will be done long before then – so that residents of the Northwest Territories can begin looking at it and discussing it, which will only help enhance that piece of legislation moving into the life of the 18th Assembly. I’m optimistic that we’ll continue to get strong feedback. But I, like the Member, want to see this done and it needs to be done, and the sooner we can get it done, the better. But recognizing the realities of time and the amount of input that was provided, we’re not going to have it done for May/June.

I totally agree with the Member on stabilized psychiatric care. Absolutely, we struggle. We know that there are pressures and we’re constantly looking for ways to recruit and retain in that area and continue to enhance those services. But we continue to have relatively high turnover. We’re always looking for some thoughts and advice on how to improve this area, and we’re open to any opportunity within our fiscal reality.

On-the-land programs, the Member talked about evidence. A lot of the on-the-land programs are based on community wisdom. There’s a lot of Canadian literature that supports these types of on-the-land programs for improved mental health. For example, Australian literature supports improved physical as well as mental health through the use of on-the-land programs.

To answer the Member’s long-term question about are we getting benefit, we are actually developing evaluation programs for these on-the-land programs to make sure that we can monitor them and evaluate them and have long-term data that can come to this House to help us make informed decisions on how to continue to evolve and improve on-the-land programs in the future. Thank you, Mr. Chairman.

Thank you, Minister Abernethy. Mr. Hawkins.

Thanks, Mr. Chairman. I won’t spend more than, say, two minutes. I just wanted to make sure I mentioned something about naturopaths and I would certainly like to see further development of that. Maybe the Minister can speak to that.

The other two subjects are midwifery. I’m glad to see it’s expanding through the Northwest Territories and I will certainly agree that any support that could happen and we can be part of, I’d like to see that. But I also think there’s a glaring gap in the capital region on the need of that particular program, and I certainly wouldn’t mind just hearing a quick snapshot of where that path will go.

The last area I just wanted to make sure I got on the record, I guess I probably won’t do the page-by-page on these particular questions, is that children with disabilities, often diagnosing some of the disabilities usually has to wait. In some cases parents will tell me it’s through the school and education system. They get the school to help identify it and send to through the right path or coordinator to help identify these things. Everybody will say – and they’re right – that early diagnosis can help to good stabilization, growing correct pathways and helping people. A good example of that is early diagnosis of autism, for example, and to better treatment. There is speech and language and other opportunities. I mean, it just goes on and on, early diagnosis.

Like I said, I just wanted to get those three areas on the record quickly, but if the Minister could speak to those three particular areas of concern and interest that I have, I would appreciate it very much. Thank you.

Thank you, Mr. Hawkins. Minister Abernethy.

Thank you, Mr. Chair. It’s already had its second reading and it’s in front of committee, is the Health Professions Act. The Health Professions Act will give us the ability to create regulations to basically licence health professionals like naturopaths in the Northwest Territories. We have four priorities in that area. Recognizing how increasingly popular naturopaths are, naturopaths are actually fourth on the list. I put on the list for something to be done with the other three immediately after the legislation passes.

It will take a while once the legislation passes and is concluded, but we have been talking to the naturopaths and they are aware that the work is being done, and we will certainly be engaging them as we create regulation around that.

Midwives, there are two midwife positions in Fort Smith, two midwife positions in Hay River. We’re excited because there will actually be some births in Hay River as a result of a midwifery support program. The current budget calls for a Midwifery Program to begin rolling out in Beaufort-Delta in ’15-16, but I’ve written a letter to committee, seeking some advice and guidance and possibly going to a territorial program first, rather than going with Inuvik. Realities on the needs from midwives in Beaufort-Delta has changed since we originally came up with the plan to go there, so we’re looking at a territorial program possibly based out of Yellowknife but would also provide midwifery services in Yellowknife. We want to do that planning in ’15-16.

The children with disabilities, I agree with the Member, obviously, with any condition, not just disabilities. But early diagnosis is always going to give us better results. So, we’re constantly working with different professionals to create opportunities or create tools that will help do early diagnosis. We do have to rely an awful lot on some of the work that’s being done in southern jurisdictions where they have more money and more expertise that we can rely on, so we tend to work with a number of southern jurisdictions on those.

Thank you, Mr. Abernethy. I have nobody else on the list. Is it agreed to go to detail?

Agreed.

We’ll defer the department summary on page 183. Page 184, Department of Health and Social Services, revenue summary. Questions? Mr. Dolynny.

Thank you, Mr. Chair. Just a couple quick questions on this activity on the revenue. As the Minister is aware, we’re currently doing the Health and Social Services Professions Act. This act is currently in committee and I’m sure will be coming back to the House. That said, with the potential regulation of a number of new professions that will be affected in this fiscal year, I’m surprised to see that the amount of professional licensing fees has remained the same from the revised of last year to this year.

Does the department not consider the fact that there will be a lift in registration fees when that act passes? Thank you.

Thank you, Mr. Dolynny. Minister Abernethy.

Thank you, Mr. Chair. When and if the legislation passes, we’ll begin the process of actually creating the regulations which will allow us to license those professions. The numbers of professions, actually, individuals who fall into these professions is quite low, so there may be an increase but there won’t be a significant increase in the 2015-2016 fiscal year. We might start to see slightly larger numbers in years after that, once it’s actually been in place for an entire year. There may be a small increase, but the licensing fees are not huge either. There may be a slight increase and there’s room for adjustment once we have a better take on what those might be.

I would agree; the numbers in question are not huge. We’re talking about $180,000, but it’s the principle behind it. The fact that even when the act, hopefully, that will pass in the House and the regulations to follow soon after, they will probably – and again, I don’t have the numbers in front of me – be at least 50 to 70 health professionals that are affected by that legislation to which it will have a fee anywhere from $200 to $500. Again, it would happen, I would assume, during this calendar year. I’ll refrain from beating that one down a little bit more and I’ll definitely ask those questions later on when we review the budget cycle again.

With respect to the reciprocal billing, the two line entries that we have on this activity, both of them are for medical services for both hospital services and specialist physician services for Nunavut. There are about, collectively, it looks like about $12.8 million. If memory serves me right, they’re in the public accounts. There was a bit of an issue with respect to this amount of money always being in escrow, which means that we’re always waiting for the Government of Nunavut to pay its bill. What has the department done to bring the payment program in line so that this government here is not carrying services, paying for services, and then we’re waiting for 60, 90 days, 180 days for money? What is the department doing to mitigate that?

I remember in the 16th Assembly there were a lot of questions around this, and at that time we didn’t have solid agreements with Nunavut on what the actual costs are being, but we do have solid reciprocal billing agreements with Nunavut which clearly articulate the cost of the services and which services there are costs associated with, and we do collect the money. There are some delays. For instance, Stanton is behind about five months at this time on billings, and this is often as a result of capacity within Stanton. Receivables at year end are for services in that year to Nunavut and some of which are not invoiced to the end of the year, so there are some times where it’s a little late because we bill right to the end of the year and then we have to send invoices which are usually after the end of the year. There are a few delays, but we do collect the dollars that are owed to us. Some of the situations where money was outstanding, that was a number of years ago before these reciprocal billing agreements were really hard and fast and we had worked out some of these issues with Nunavut, but we do get the money.

We do get the money. That’s a clearly broad response to a question which I believe needs some due consideration. If we’ve just heard correctly, if we’re five months behind in billing on a rolling average of money, again, I’m not going to do all the math here, but I know if it is around $7 million and if that rolling average is five months, I would venture to say that the amount of interest that we’re being held accountable with the taxpayers having to leverage, would be around $350,000. It becomes a significant amount of money over the course of the year if the taxpayer of the NWT is required to finance reciprocal billing that’s that far in arrears.

Again, to the question, what is the average billing time? Is it five months now or are we making headway of maybe collecting these monies within a 30 or 60 day period?

We have a year to actually bill. We don’t actually have to send the bills until a year has expired, but they have to go within that year. As far as the amount of times, 30, 60, 90 days it’s taking Nunavut to pay us, I can get the department to look into that and get that answer back to you.

I’d appreciate if we can get that level of detail. Again, interest compounded daily, monthly, yearly adds up, especially when you’re dealing with potentially over $11 million, $12 million. Again, public accounts has shown us that that rolling average went down for a couple years and now it’s back up there. Again, I think it was around $7 million. I encourage the department to keep a handle on that because that’s a cost. It’s a cost we don’t talk about. It’s a cost that’s a burden to the taxpayer.

To the question, though, in terms of zero-based budgeting and looking at forecasting for the 2015-16 Main Estimates, I notice that for all reciprocal billings except for the specialist physicians in Nunavut have remained the same. It’s the same as the revised estimates of 2014. More importantly, they’re all zeros. They’re all averaged up to a whole number, which I find that odd if we’re doing a budget purpose that we wouldn’t have the actual revised estimates as a whole number like that. Can we get some explanation why we’re just seeing literally, really, a rounded up number when really we should be, especially for revised estimates, we should be seeing some decimal points, some dollars and cents there rather than a very wholesome number.

Thank you, Mr. Dolynny. I’ll go to Ms. Mathison.

Thank you, Mr. Chair. The Member will notice that between ’14-15 opening mains and ’14-15 revised mains there was an increase to the budget, and that was based on additional non-residents accessing our system that we, based on our tracking of the financials during the year, recognized that there was going to be additional revenue coming in there. Because there are fluctuations in residents accessing the system, we don’t necessarily have the ability to forecast who is going to be accessing in future years, so we based the ’15-16 Main Estimates on what we were seeing in ’14-15. Yes, they are estimates for whole numbers because we can’t get more precise than that, really, without clear estimates.

That’s fair. I needed to ask that question because it does stand out a little bit more bluntly than some of the other numbers that we have in this budget. With that, no further questions.

Thank you, Mr. Dolynny. Committee, we’re on page 184, revenue summary, information item. Questions?