Thank you. We will continue with that after a brief break.
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Thank you. Minister Abernethy, for the record, would you please introduce your witnesses again?
Thank you, Madam Chair. On my left is the director of Finance, Jeannie Mathison. On my right is the deputy minister, Debbie DeLancey.
Great, thank you. Good job. Yesterday when we left off we were on page 189 and that was administrative and support services, operations expenditure summary, $82.464 million. Agreed? Mr. Dolynny.
Thank you, Madam Chair. We know very well that with this activity there have been some changes with respect to how this has been arranged for this year, and I know the director is part of that and a responsibility of more the broad system of planning. With that, we know that before committee, and I know we’re talking about the new governance model where we should hope to streamline a lot of our administrative components throughout our authorities and, as mentioned in the House by the Minister, there may not be perceived savings. So, I guess, to the first question.
Will we not at least see some savings in design with respect to more efficiencies or more streamlining of services, quicker reporting and better financial services management? Do we not forecast maybe some degree of savings if and when I guess this governance model comes into full effect? Thank you.
Thank you, Mr. Dolynny. Minister Abernethy.
Yes, Madam Chair, we do believe that there will be opportunities to get some economies of scale and reduce some expenditures in some areas, but the overall price of delivering health care in the Northwest Territories continues to climb. We’re not going to turn patients away and the cost continues to climb. So we don’t see an overall savings in this activity, but we do see an opportunity to save in certain areas, have some economies of scale, control future growth of expenditures and make sure that we’re getting maximum benefit for all the dollars that we’re spending within the system. So, yes to everything the Member has just said.
I appreciate the Minister’s reply to that. As also mentioned, and in keeping the overarching issue, the directorate is in mind when I’m asking this question, the question of the performance indicators. Again, we have a national agreement to maintain and report on 32 of these so-called comparables, national comparables across Canada. Does the Minister foresee that that will be in full effect during this fiscal year and will this reporting be available publicly by residents? Thank you.
Thank you, Mr. Dolynny. Ms. DeLancey.
Thank you, Madam Chair. The 32 performance indicators have been adapted for our system and they’ve been based on best practices nationally, but some of them are unique to our system. We have published and we are implementing them, but we do not expect to be able to report on all 32 in the first year because some of them do require us to establish reporting mechanisms with the authorities. Some of them require us to compile baseline information. So our first year report will indicate what activity and when we can start doing annual reporting on all 32 of those indicators. Thank you.
Thank you, Ms. DeLancey. Minister Abernethy.
Thank you, Madam Chair. In addition to the 32 indicators, which are the GNWT indicators, we also do continue and contribute data to other organizations like CIHI that is doing national reporting. Our data is included there where it doesn’t actually identify… When the numbers are too small, they don’t put it in, but where the numbers are enough, they report on those and we contribute regularly to those organizations.
Thank you, Minister Abernethy. Mr. Dolynny.
Thank you, Madam Chair. I appreciate the Minister and deputy minister’s response. So it appears that we’re going to have more of a hybrid year, given the fact that some indicators will be available, some aren’t. Now I know how CIHI works and how they report. They report it as system-wide indicators and they’ll actually do facility indicators such as the Stanton Hospital. The differential information, that is available publicly. So if I wanted to gauge how well my hospital was versus the territory. I’m certain these parameters would be available for the public and that’s, I guess, the purpose of it here.
The way CIHI reports, there appears in their last edition there was only about, I think, eight performance measures for the Stanton facility and there were a lot more performance indicators for the NWT territorial, as the system-wide indicators. I guess to the question, can we get an explanation why the disparity? Why wouldn’t those indicators be relatively the same, and if so, are we going to see improvement this year and moving forward in terms of getting a better range? I’m hearing the fact that we’re working on getting more baseline. I get it, but I’m looking if we’ve got 25 reportable parameters at the facility, will we have 25 reportable parameters as an NWT system-wide parameter as well? Thank you.
Just to confirm, the Member is talking about the CIHI at this point?
Thank you, Mr. Abernethy. For clarification, Mr. Dolynny.
Yes, Madam Chair. I’m referring to the CIHI, which they have, again, 32 national base indicators which we are, from what I’m informed, we do participate with.
Thank you, Mr. Dolynny. Minister Abernethy.
Thank you, Madam Chair. CIHI is fairly structured in how they report information and they request information from us on all their indicators, and we provide them every piece of detail that we can. Then they go through their analysis process and present their information. They present it in different categories such as hospital-based categories as well as a territorial category. Some information at a territory level, our numbers are such that they can be recorded. Whereas maybe at a hospital level, if they’re too small then they’d be self-identifying so that they may not be reportable. They have some really stringent criteria on what degree of number they will put forward and what degree of number they won’t. That’s where some of the discrepancy, if any, may exist. But we will continue to provide CIHI with their data on a regular basis. They’re an important institution, important organization for helping all jurisdictions in Canada make evidence-based decisions, and we will continue to contribute data to them and everything they ask for. If we can provide it, we will.
Thank you, Mr. Abernethy. Ms. Bisaro.
Thank you, Madam Chair. I have a number of questions on this section. As the Minister mentioned yesterday, this department has changed considerably in the way it’s laid out, so if I bring up something on the wrong page, please, whoever, let me know and I’ll put it on the right page when we get there.
This section, if I read the text right, includes health services administration in Inuvik. I’d like to start by asking the Minister, when we talked about business plans there was a concern, and there’s been a concern for a number of years, but we talked about, basically, health card fraud and that Members feel and residents feel that there are people who are using our health care system when they’re not actually living here. When we inquired during business plans, I think we were advised that the Audit Bureau was going to be looking into this situation and to determine whether or not we are being as diligent as a government as we should be and ensuring that people are not taking advantage of our health care system when they don’t live here. I’d like to know from the Minister if that was done and have we established any kind of a different proof of residence criteria or protocol?
Thank you, Ms. Bisaro. Minister Abernethy.
Thank you, Madam Chair. It’s my understanding that that review by the auditors here in the Northwest Territories was done in 2008, and they made a number of recommendations. Most of them, I believe, we actually did incorporate into the health care cards here in the Northwest Territories.
We share the Member’s concerns. We want to make sure that our residents’ information is secure. We’ve had lots of conversations about some of the recent incidents around health care cards with the Information and Privacy Commissioner. She’s made a number of recommendations and we’re certainly looking at implementing, where appropriate, where reasonable and where possible. For some of the details on some of the specifics around the NWT health care cards, I will go to the deputy minister.
Thank you, Minister Abernethy. Ms. DeLancey.
Thank you, Madam Chair. Some of the recommendations that we did implement were more frequent renewals of health care cards, so we did a major renewal a couple of years ago. There are more stringent requirements for proof of residency. A number of checks and balances have been put into place. As well, health services administration does monitor, so whenever a card is lost or there is an unusual amount of activity in southern facilities on a file, then there is closer monitoring. We have implemented most of the Audit Bureau’s recommendations.
Thank you, Ms. DeLancey. Ms. Bisaro.
Thanks, Madam Chair. I guess I’m just a little confused, because we discussed this, I think it was September of 2014, and it was a recommendation of committee at that time, and you guys are talking about 2008. I’m just not quite too sure. I appreciate that that work was done but that was, what, seven years ago now, and I thought there was going to be some work done in the last six months or so. But I will leave that at that.
There is, I believe it’s in the section that it would be covered, the contract for the air ambulance medical travel contract. There was a huge increase in the annual cost of that contract. I’d like to know, first of all, where it is in this budget, where it shows up, and secondly, can I get an explanation as to why it’s going to cost us I think it’s $4 million more each year for the next five or 10 years, five years?
Thank you, Ms. Bisaro. Minister Abernethy.
Thank you, Madam Chair. With respect to the first question on the health care cards, the Member did mention an audit that was done, and the audit that was done by the Audit Bureau here in the Northwest Territories, or the review, was actually 2008, and that’s what we thought she was talking about. But there was some discussion between myself and committee about some of the concerns out there with respect to security of health care cards more recently. As a result of those concerns and the recent incident where health care cards were inadvertently mailed to the wrong addresses, we have put in a number of protocols to ensure that doesn’t happen again. It did happen again, so we have made a few more tweaks to it and now, actually, those documents need to be reviewed by several more people than they used to have to be reviewed by, including people within the department for a solid double check so that we don’t have this happen again.
With respect to the air ambulance contract, it’s in the supp health section of this budget. It’s not in this section. I’d be happy to answer that question now. I believe it’s gone up by $3.5 million, and it’s in a different section of this budget.
I’ll try to remember when we get there what section that was. Mr. Dolynny talked a bit about the governance and I had the same question why there doesn’t seem to be any indication in the budget that we’re going to be saving some money in terms of the amalgamation of health authorities into one. I would have thought there would have been some efficiencies and some savings due to economies of scale. I can appreciate the Minister’s remark that health costs keep going up. Absolutely they do. But, I guess, can we anticipate, then, that once this amalgamated system is in place, and I would think that it’s going to take probably a year for that to happen, so I’m looking forward to the budget for ’16-17. Can we anticipate that there wouldn’t be an increase in the overall budget because of the amalgamation of the health boards?
Just to be clear, we are talking about the ’15-16 budget, as the Member indicated, and the health transformation will not occur during this fiscal year. Much of the work is going to be done. The actual rollout of the transformed health system will begin April 1, 2016, and it may take a bit of time to realize some of the savings in some of the specific areas where those savings might occur. It would probably be a little premature to say whether or not we will see an increase in the budget in ’16 and ’17 or whether we’d see a decrease in the budget in ’16 and ’17. We are doing the work now that’s going to help articulate where we can get some of these program area savings and we will certainly be sharing that information with Members as that work is concluded.
Thanks to the Minister. That’s what I was trying to get at. I mean, a budget is an estimate document, and I was hoping that the Minister could give me an idea whether in ’16-17 the department is anticipating any savings.
There are two acts which will be coming into force in the next little while, certainly within this next budget year. Maybe I should ask the question first. Should I be asking about costs associated with legislation that’s going to be implemented here, or does it come elsewhere?
It could be here. A lot of those costs will be in the directorate.
I figured it depended on the act. Probably the one that’s going to be the most expensive is the Health Information Act. I would like to know where that’s reflected in this budget. Thank you.
The increased cost as a result of the Health Information Act is in this budget, the 2014-2015 budget, which means it’s also in the 2015-16 budget. For the detail, Ms. DeLancey.
Thank you, Mr. Abernethy. Ms. DeLancey.
Thank you, Madam Chair. As the Minister noted, we received forced growth in the 2014-2015 budget, so you won’t see it as an increase for 2015-16. The funding we received for the Health Information Act included funding for two positions, which is ongoing. There were one-time costs associated with developing policy guidelines and a training manual of $111,000 which is actually sunsetted out of the 2015-16 budget. Thank you.
Thank you, Ms. DeLancey. Ms. Bisaro.
Thank you, Madam Chair. The other piece of legislation is the Health and Social Services Professions Act. It’s anticipated to be in place during this budget year, so there’s also anticipated to be some costs around that. So where is that reflected? Thank you.
Thank you, Ms. Bisaro. Minister Abernethy.
Thank you, Madam Chair. We don’t see a significant increase in any cost. Most of the work is going to be done by staff who are employed by the department. There might be some slight increase in some contracts, lawyer time, which we work with the Department of Justice on so there shouldn’t be significant need for additional money to conclude or do that ongoing work. We have the staff already.
Thank you, Minister Abernethy. Administrative and support services, operations expenditure summary, $82.464 million. Ms. Bisaro.
Thanks, Madam Chair. I have one more question here and it has to do with the Medical Travel Policy. It seems we have been amending this policy for quite some time. I know the department has been working very hard on it and has been doing a lot of consultation and investigation and so on. I would like an update on where that’s at. The other half of this question is once we do put a new policy into place, is it going to create some efficiencies and save us some money or, because it’s a new policy, is it going to expand our costs and are we expecting an increase in medical travel due to the policy? Thank you.
Thank you, Ms. Bisaro. Could I direct you to page 215 of the budget for Health? If you think it fits better under policy, then it does, but I just wanted to mention that on 215 under supplementary health programs, medical travel is listed there. But if it’s on policy I will refer the question to the Minister. Minister Abernethy.
Thanks, Madam Chair. I am happy to answer the question now. We did send the draft Medical Travel Policy to the Standing Committee on Social Programs to provide us with input. We are just tweaking it right now at which point we’ll be sending it to the executive for final consideration. At the same time, we are also working on the individual pillars that fall under the Medical Travel Policy and right now we’re actually doing the work on patients, supports and escorts that began in 2014, December. Our consultants have travelled to communities like Hay River, Inuvik, Tuk and Behchoko. They’ve gone to the Larga House. There have also been a number of stakeholder engagement meetings on the patients, supports and escorts. It’s on track to be completed in April 2015. As of the middle of January, we had over 123 people who have engaged in one-on-one interviews and focus groups. Yellowknife, Fort Good Hope and Trout Lake are still on a plan to be engaged before the current engagement process is over.
As we’ve said all along, once the Medical Travel Policy is done we are going to start working on these pillars. So patient supports is the first one we’re working on and in July 2015 we are planning to begin the work on benefits and eligibility and start the engagement around that and in 2015-16 we also want to get to the new medical travel appeal process so we can have all those new policies done.
I don’t believe that it’s going to save money. I believe its cost neutral but it’s about getting the best results for the patients and making sure they have the supports they need when they are travelling. We don’t anticipate an increase. We believe we can do better with the dollars we have by having appropriate programs in place.
Thank you, Minister Abernethy. Administrative and support services, operations expenditure summary, $82.464 million.
Agreed.
Agreed. Thank you. Page 190, administrative and support services, grants, contributions and transfers, total contributions, $43.887 million. Mr. Dolynny.
Thank you, Madam Chair. I’m pleased to see that the French language services. We finally have allocations in many of our departments. It’s good to see that we’re living up to our legal obligation in Canada. That said, I know through a lot of reporting and a lot of feedback we’ve received over the years where we talk about where our policies fail, where our processes don’t meet the expectations of our clients, barriers to patients, especially accessing services quickly and efficiently and people who fall through the cracks. These were terminologies that were very widespread in a lot of system reviews we had in the Department of Health. The one thing that I feel we may have not covered in trying to mitigate these cracks in our process is the issue of having proper first-language services throughout all our communities. This has been brought up by many Members, having proper translation in all our official languages where clients come into our facilities who need that extra help to understand what their ailments are and get that proper communication. We know there are barriers. That is undisputable. The question is: What is this department planning to do this year to help move that file forward? Thank you.
Thank you, Mr. Dolynny. Minister Abernethy.
