Thank you, Madam Chair. The Department of Health and Social Services does recognize the importance of language and culture in all aspects of daily lives throughout the Northwest Territories. In many of the small communities, it is indeed a struggle to recruit and retain health care providers in any language. We do strive to offer services in all official languages here in the Northwest Territories.
However, because of capacity issues, this is obviously sometimes quite difficult. We have a multi-lingual website which offers a range of information in all official languages here in the Northwest Territories. We continue to post more information to this website in the Aboriginal languages all the time and we will continue to do so.
The department is also working with the departments of Education, Culture and Employment and Human Resources to implement the strategic plan on French language services and communications, which is one of the reasons you see some of the increases in front of you today.
By way of example, the Stanton Territorial Health Authority has an Aboriginal languages division that coordinates some language services within the facility here in Yellowknife. The regional health and social services authorities do have limited numbers of bilingual employees within their facilities, within their communities; however, they also have a list of interpreters and translators that they have under contract and who can provide services when required.
We also have a toll-free Helpline which offers services in other languages through an interpretation service. I believe it’s called CanTalk. However, they do have some limited ability to facilitate services in some of the Aboriginal languages. So there are a number of things we are trying to do to ensure our residents are receiving the services they need and that language services are available. In our health centres when we have individuals who do speak the language, we do provide them with bilingual bonuses so they can help us in communicating with people who are maybe unilingual as well.
So there are a number of things going on. Thank you, Madam Chair.
I will try not to sound blunt here. I’ve heard this song and dance before and so have many Members of the House. It’s not as if I am displeased, knowing we are striving and dealing with capacity issues and trying to find individuals and work on cross-departmental solutions. The fact remains is we’re still not able to provide that level of primary first-language service in a lot of our communities.
What I haven’t heard the Minister indicate is we are using technology. By technology, I mean just the simple fact of having an app with easy pictures, body parts where the pain is in conjunction with the people who may speak the language, simple tools and mechanics could be used to help diagnose and explain what the health system can do for that patient rather than nothing. I can’t expect a patient who doesn’t understand English coming into a scenario where at least we have some tools at the health centre, other than pointing them to a website. Is the department working on using technology? I’m not just talking in the bigger forum in terms of medical records and telehealth – I mean, those are big processes – but I’m talking about in the hands of the people who could be user-friendly, live in a world of app-friendly technology, and I know there have been language apps that have been designed. Have there been language apps designed for mental and health related issues? That can act as a segue between what the patient needs and what we can deliver at a health care level.
So again, the question is technology, are we there? Thank you.
I’ll just re-state again we are using CanTalk, which is technology. But I agree with what the Member is saying completely and Education, Culture and Employment is working with a number of the Aboriginal governments to create actual apps for things that can be used on iPhones and iPads around languages and to help people do exactly what the Member is talking about.
We’re currently working with a number of the different Aboriginal organizations and language groups in the Northwest Territories to help provide translation around medical terminology. When that’s done it would be a great opportunity to work with Education, Culture and Employment and the different language groups to get that information included within their language apps. We will certainly pursue that. That is a fantastic idea and I do thank the Member.
Thank you. Just as a question because it sounds like there is some work happening behind the scenes with ECE. How much of this budget is going to be allocated to translation services specifically for technology enhancements or changes so that we can use very app-friendly devices and applications? What is the budget, where is it in our main estimates and how much is it?
Thank you. We don’t have a specific budget for creating or utilizing or creating opportunities around technology. We would have to look within our budget and see what categories might be useable or might be possible to use for that particular project and we will do that. We will look at the budgets that we have. We have a very, very small budget for Aboriginal languages. There’s a lot more money for French languages in here as a result of the recent court case. But it’s a good idea. We will certainly look within our budget and see what categories would allow us to do this work.
Thank you, Minister Abernethy. Administrative and support services, Ms. Bisaro.
Thanks, Madam Chair. I just have one question here. It has to do with the amounts for the health and social service authorities funding. The amount has increased from ‘14-15 revised estimates to the main estimates for this year ‘15-16 and that’s all well and good. I appreciate that costs have increased. Over the years we have had considerable conversations about the expenses and the expenditures incurred by various health and social service authorities. There have been three or four authorities that regularly overspend their budgets and there have been great discussions about why they overspend. We approve supplementary appropriations to assist them to, you know, we approve the money for them to over-expend their budget basically. So I’d like to know at this point with this budget, did these amounts for the various health and social services authorities, do they meet the expenditures that these authorities are going to encounter over this ’15-16 year, or are we anticipating again that we will have authorities who are going to be in the hole at the end of the year? Thank you.
Thank you, Ms. Bisaro. Minister Abernethy.
Thanks, Madam Chair. These are numbers based on budgets provided by the individual authorities, but the Member is correct, we have run deficits in the health authorities in the past. Just for the record, a number of the areas for increase in this particular area include the service centre costs as well as the Microsoft licensing costs, some Collective Agreement costs and other costs that are associated with the health and social services authority funding in the area of administrative support. You’ll notice, as we go through this binder, there’s going to be several areas where money is needed to flow to the authorities that is consistent with the way the new reporting structure is. But at this point, if past predicts future, there’s a good chance that we will continue to see some deficits in the authorities until we do a fundamental fix on the system, which is what we’re in the process of doing now.
Thanks to the Minister. That was going to be my next question, I guess. You know, we’ve talked for many years, since I’ve been here, about the need to have the authorities, basically get them the money that they need in order to run their programs and to determine how much money they need. So that fix was supposed to have been coming probably four years ago now or five years ago now. So, to the Minister, when he says that the fix is coming, does this mean that we’ve changed the way that we fund the authorities? He also said that these budgets come from the authorities. So I’m guessing maybe we haven’t changed the way we fund them if we’re just giving them the money that they’re asking for. But is the fix the governance? Is that what he’s referencing? Or is the fix a difference in the way that we fund them and how we fund them and what we fund them for? Thank you.
Thank you. As we move forward to an integrated health and social services system here in the Northwest Territories to improve services for the residents of the Northwest Territories, we will be developing a new funding model that will fund the one authority, and once we have done that and we are able to work as a system we’ll start to see where some of the cost drivers and demands are, which will help us articulate where we need to spend money in a way that it doesn’t currently tell us because there are, in fact, eight significantly different authorities and decisions are being made in ways that are not necessarily consistent with each of the authorities. So once we move to one system we’ll have a far greater ability to monitor, track and determine what the true costs of the system are. At this point as we move forward, these changes are based on no increase as a result of the changes, but we will have a new funding model. We will fund in new ways. That information, as its developed, as we move forward, we’ll certainly be sharing with committee.
Thanks to the Minister for the clarification. I understand it better now and I have no further questions. Thank you.
Thank you. Mr. Moses.
Thank you, Madam Chair I have questions along similar lines with the deficits and the accumulated deficits. Just listening to the Minister respond to Ms. Bisaro’s questions, I guess as we’re moving towards one authority, how is the department going to work in terms of the accumulated deficits? When you look at the public accounts records, we have Stanton accumulated at over $15 million and the Beaufort-Delta, which did a good job last year, they had a surplus, finally, after a long time, but this year they have another deficit of about $2.5 million and now it’s accumulated back up to almost $8.5 million. So when you add all those up it’s going to be a big accumulated deficit, especially under this one authority. How does the department plan on addressing this accumulated deficit and do these authorities need to try to get a hold of that before we move into the one authority system? Thank you.
Thank you, Mr. Moses. Minister Abernethy.
Thank you, Madam Chair. The individual deficits will become the Territorial Health Authority deficit. It will be one deficit. The Members have asked a number of questions about cost savings and there will be, in certain program areas, an opportunity to save money, which we’ll be able to roll back into the system and we’ll be able to use that to start paying off some of the deficit. We figure it’s about a five-year transition period. We should be able to start knocking that deficit really down.
On top of that, we’ll also be able to really dig into where all the key indicators or the key drivers are, and then we’ll be able to have discussion with committee about how to fund those key drivers appropriately over the long term. Through the savings, we anticipate we might see, in particular, is we believe we’ll be able to start working on that deficit over probably about a five, five-plus year process.
Thank you. Just looking at how some of these authorities run and the services and programs that each authority provides in the communities, especially in the communities when you might just have one nurse who might get a call-out at seven o’clock at night. I just want to know what the department is doing in terms of their overtime policy, which could be one of our biggest cost drivers throughout all authorities. The callbacks, overtime, people getting sick and other individuals filling in. What is the department doing in terms of their overtime policy and whether they’re going to make a strong stance against this overtime policy to ensure that we’ve got employees that might not be abusing the overtime policy? Thank you, Madam Chair.
I’m glad the Member’s actually brought this up. Our human resources are significantly the largest driver of costs in the health care system. Our employees are highly trained and compensated accordingly, and there are significant costs there. Overtime is a massive deal. I’ve asked the department, and they’ve already begun the work on doing a complete analysis of overtime usage throughout the Northwest Territories in different authorities. They’ve actually started that work now to help us figure out what, if any, areas are driving overtime to greater degrees than other areas. Trying to dig in to figure out why some areas have higher overtime usage than others. What is driving that is that one region maybe has some health issues that another region doesn’t. So we’re doing that analysis now and I’d be happy to share that information with committee.
Overtime is actually the rate at which it’s paid and all those things are all part of the UNW Collective Agreement. So, I mean, we don’t have a policy on overtime, it’s determined by the terms and conditions of employment. In our communities and in our organizations, if people are sick, we call people in. If there’s a call in the community, we bring people in because we need to be able to provide that care. It’s where it might be being abused that we need to find and address and we’re doing that work now.
I’m glad the Minister talked about the indicators. The questions that I asked the Minister of Human Resources earlier during question period was some of these areas of undue stress and the amount that our Employee and Family Assistance Program is being utilized. Would the department look at these type of indicators to see which departments in either of the authorities we might be seeing some of our employees taking stress leave or taking mental health stress leave and see which areas we need to provide more services for our employees in that area? I know it could be because of management. It could be because of working conditions. I think Member Yakeleya brought in and tabled some photos of the health centre in one of the communities. Those aren’t good working conditions and I want to see where we need to put our resources in terms of where our employees are taking time off work because of stress and possibly other health conditions, and I think that would be a good indicator in where we need to put our resources so we can support our employees and our staff.
There are many reasons why there could be high rates of overtime in a community and the impacts of that overtime are certainly something that we need to be conscious and aware of on our staff, and we do have a Collective Agreement that articulates clearly how much time a person put in. There are mandatory rest periods and all these other things to ensure people are getting the down time that they need.
But the Member is right. Once we’re doing this work, depending on where we see the high rates of overtime, it should be able to help us focus in and start asking questions about why, what’s going on, are staff getting the supports they need? It’s going to help us with all of those questions. But I would suggest that, at the same time, there may be communities where there’s no overtime where the same level of concerns for employees would exist regardless of whether there’s overtime or whether there’s not. I know, through my employment with the GNWT, that sometimes overtime is not telling you what you think it’s telling you. So, we would have to analyze them closely.
Just for clarification and just why some of our employees are not going to work and why some are missing work and why some are going on stress leave and why some are maybe sick all the time is another area that I think we need to look into, because when people are sick and people are getting stress leave we’re still paying them and we’re also paying for somebody to fill in their position. So, those are indicators that we really need to address and look at and how to fix those. I think, as we move into this one system, we’ll be able to identify those a lot more. Just more of a comment. I just wanted to let the Minister and his staff know that it’s something we’ve also got to look at. Thank you, Madam Chair. No further questions.
Thank you, Mr. Moses. More of a comment there, I didn’t hear a question.
Administrative and support services, grants, contributions and transfers, total contributions, $43.887 million.
Agreed.
Agreed. Thank you. Administrative and support services, active positions on page 191.
Agreed.
Agreed. Thank you. Health and Social Services, ambulatory care services, operations expenditure summary, $60.154 million. Mr. Dolynny.
Thank you, Madam Chair. This is a relatively new section for committee. This is probably the first time committee has had a chance to digest the way it’s been categorized and some of the new, I guess, descriptions within this activity summary, so I’ll start off with this. To the department: What was the rationalization for doing it? What was the desired outcome? Then, in responding to that, maybe if I could get a breakdown in terms of physicians outside the NWT and specialty clinics, sorry, physicians outside the NWT and out-of-town hospitals. If I could get more of a descriptor than we have here before the House. Thank you.
Thank you very much, Mr. Dolynny. Minister Abernethy.
Thank you, Madam Chair. As I indicated yesterday, a significant portion of the system funding within the Department of Health and Social Services is actually for the authorities. So, recognizing that the authorities report on criteria and categories that were created by CIHI and the department didn’t, we have moved to a system where our reporting system that’s in front of you now mirrors what’s coming from the authorities and is consistent with CIHI, and this is one of the categories that existed. In previous budgets these dollars would have been in one of the sections where it said “transfers to authorities” and was a whack of cash but not a lot of detail. We feel that this system actually gives Members as well as the public more details into some of the specific areas that are actually where dollars are being spent within the system. So, it’s a matter of reporting in a consistent way between the authorities to the department and giving the Members the information they need so that they can ask the questions that I think are quite relevant.
When it comes to out-of-territory hospitals and physicians outside the Northwest Territories, this covers services that are actually occurring for our residents outside of the Northwest Territories. We’ve heard a lot of talk about this in previous budget discussions where we’ve come for supp funding or whatnot for our residents who are receiving services outside of the Northwest Territories and we have an obligation to pay. That’s basically what these are and it’s based on service agreements but we’ve also got reciprocal billing agreements with every jurisdiction in the country.
We know that the Department of Health has, under contract, nursing care or, I guess, nursing helper services in some of the jurisdictions down south, especially at the University of Alberta Hospital, where these individuals help patients who are brought down from the Northwest Territories who are in need of help to explain what’s happening to them, making sure that they’re coordinated with loved ones, et cetera. Where does that budget fit into here with respect to that service we provide?
That actually falls under the out-of-territory hospitals expenses.
What would the budget be for that service?
I don’t have the specific details. I will commit to getting that information for the Member, but it’s my understanding that it’s about $300,000, but I’ll get the exact number for our Member and committee.
I’ll take the Minister up on his offer there.
Now, with respect to that service delivery, as indicated earlier, there was some discrepancy in terms of when these nurses were available on call. There were hurdles in our system, and the Minister is very much aware of this. It happened to one of my residents here, where these nurses are basically Monday to Friday, nine to five, and we all know that emergencies and medevacs are 24 hours a day, seven days a week.
Has the department mitigated that philosophy of just a Monday to Friday availability of service and do we have this now, indeed, as a 24-hour service for those patients who are medevaced and who need that assistance when they arrive in Edmonton?
We do see this as a challenge and it is something that we want to fix. I agree with what the Member is saying. We actually have begun negotiations some time ago with the Government of Alberta in order to increase the amount of coverage that is being provided by these northern support nurses that happen to be in Alberta. Unfortunately, those negotiations have temporarily ceased as Alberta is going full forward into their budget process as well. We anticipate those discussions will continue once their budget is concluded.
I’m encouraged by what I’m hearing and I’m hoping that the Minister will notify Members and committee if and when we have that as a 24 hour service for our residents.
Statistics that were given to us last year indicated that the no-show rate for family physicians was a whopping 13.8 percent. That means 13.8 residents out of 100 were missing their family doctor visits. I see here speciality clinics are now a separate category, and with speciality clinics it usually goes hand in hand with a lot more expensive services. Do we know what our no-show rates are for our speciality clinics?
The Member is correct; the speciality clinics portion is mostly the speciality clinics located out of Stanton. Stanton does track that information but I just don’t have it at my fingertips, so I will commit to getting it to the Member in committee.
I’ll accept that offer from the Minister. The number, aside in terms of what that percentage is, is notwithstanding and we’ll get that number later as promised. The question is we know that there’s a cost to no-show rates. What is the department doing specifically to the speciality clinics in order to mitigate and lessen the burden on our health care system on narrowing the gap of no-show rates?
I agree with the Member. There is a significant cost to no-show rates both in productivity as well as frustration for those individuals who are on waiting lists. To talk about some of the detailed work that is being done, I will go to the deputy.
Thank you, Mr. Abernethy. Deputy Minister DeLancey.
Stanton has done a lot of work on this and we’ve had many discussions with them. One of the issues with no-show rates is there are a number of factors. It’s not always just that somebody fails to show. What we’ve determined is that some of the reasons there are no-show rates at the speciality clinics and at Stanton have to do with people being ill, with weather delays, with, again, because we have some communication challenges among our eight authorities with people not getting the information, as well as people coming to town and then having concerns or second thoughts or needing support. There is no one solution that will address no-show rates. Stanton is trying to do more in terms of better communication to make sure that patients are aware, have their travel, know when they have to be here, make sure that they’re getting calls ahead of time to remind them to make sure that all the advance work is done. But it’s not something that always evidenced is noncompliance or where it’s really appropriate to have a punitive response. It’s a pretty complex issue. Stanton is putting a number of things in place to try to reduce the no-show rates.
Thank you, Ms. DeLancey. Mr. Dolynny.
Thank you, Madam Chair. I understand it’s a daunting task, but I think in terms of no-show rates, I only need to lean in to make reference to my own personal dentist. I can tell you that I get no less than two or three reminders within 24 hours of my appointment, and I would feel very bad if I missed that appointment. I’m not sure if we’re doing that at the same level as we probably could be, as simple as notifying people of an appointment. To that, I’ll get a response, but I’d like to make reference to a great idea I heard from you, Madam Chair, that you brought into the House probably about two years ago. I love the idea where if you miss an appointment such as a specialty clinic or a specialty service, even a regular family physician clinic, that we submit a phantom bill to the patient and say, look, you know what, we’re sorry you missed this appointment; however, this cost taxpayers X dollars. It would somewhat shame the patient to make them understand that there was a huge cost implication. But quite frankly, I think the message would be loud and clear and I don’t think you’d have to do that service for very long before people would realize it. Again, I’m trying to lower the number of no-shows. I’m trying to save the department money so they can spend that on other programs, so to those questions.
Thank you, Mr. Dolynny. Minister Abernethy.
Actually, Stanton already did consider this. They explored it and there were a couple concerns that they raised. Number one, it’s not particularly culturally sensitive. It also doesn’t really articulate or recognize the fact that sometimes people are missing appointments for reasons beyond their control such as medical travel, flight delays. A lot of the people utilizing the speciality clinic are coming in from other communities to receive those services. Also, in a time of fiscal restraint and being prudent with our dollars, there is also a cost to it, a cost that has to come from somewhere, and Stanton would have to take that from program delivery, so they chose not to move forward with that.
They are looking at ways to find better communication. As the Member said, I mean, I get the calls from the dentist too. I don’t ever miss dentist appointments, and I might have missed a doctor’s appointment or two in my life. I appreciate the calls. I know many people do. They’re obviously looking for ways to enhance their ability to communicate with residents, recognizing that not all the residents are in Yellowknife, not all the residents have cell phones, some of them don’t even have e-mails. It can be complicated but we’re trying to rectify it.
Thank you, Mr. Abernethy. Next on the list I have Mr. Moses.
Thank you, Madam Chair. Just following up in some of the areas that Mr. Dolynny was speaking to in terms of services outside the NWT. Has a study been done or do we have data showing what our most frequent visits are or services that are being provided from Alberta, for instance, to our residents? In terms of cost efficiency, do we have the opportunity to see where we’re spending all those dollars and rather than continue to spend those dollars and send our services down south, that it would be more appropriate if we purchased a piece of equipment and take it somewhere, say, centrally located as here in Yellowknife? Do we have the data to kind of confirm that’s something that we should be doing?
Thank you, Mr. Moses. Minister Abernethy.
Thank you, Madam Chair. I’m really happy the Member has actually brought that up. Our chief clinical advisor has actually started doing that work already and it will help us do exactly what the Member is saying. If we find that we have repeat business going down for one particular procedure, it may prove to be far more efficient for us to do that procedure here in the Northwest Territories. There have been some procedures that we have been able to bring some locums in to do in the Northwest Territories to help us reduce costs just based on that type of information.
I hear a lot of people talk about MRIs. How many people are we sending out for MRIs on a regular basis, and when are we going to hit that magic point where it’s actually more appropriate for us to have an MRI machine here in the Northwest Territories than fly them out? We might be there but we don’t know until we have concluded. She says we’re not there. I still say we might be there but we won’t know until this analysis is fully done. But when we do cross that line, that’s the data that’s going to help us say yes, it’s time for machine X to be located here in the Northwest Territories. Apparently, it’s not MRIs just yet, but we’ve got to be approaching that line.
I’m glad to hear that that analysis is being undertaken and I think that there will be cost savings and also in terms of time for the patient, rather than have to go all the way down to Edmonton that they can actually come to Yellowknife. I know we got an e-mail not too long ago from the Minister in terms of a sonographer, in terms of breaking down in Inuvik and the amount of ultrasounds that patients might need was about four or five a week. Any update on that? I know in the e-mail it had mentioned that there is a shortage across Canada, but is there an update on when that’s going to be rectified? Thank you, Mr. Chairman.
