Just going back to the first part where, you know, individuals who can’t see individuals. The Med-Response team has highly competent professionals and the CHRs and the CHWs in the communities will articulate what they see. I believe they’ll err on the side of caution, which is the expectation. We don’t want to put people at risk. So if individuals are in need of medical detox and the doctor on the line determines it’s necessary, they’ll come in.
With respect to how long medical detox would be required for, it’s going to depend on medical direction. When they’re in either Inuvik or Yellowknife, a physician will be involved in the file, likely one of the hospitalists in the building, and they will assess when a person is officially medically detoxed. Where they go from there is somewhat dependent on the individuals but also on the doctors. If the doctors believe that somebody might need a psych consult, they would bring in psychologists and other professionals to have those conversations with the patient. If the patient has completed the medical detox and they decide that they’re ready for treatment, we have an expedited referral process to get them into a treatment facility in the Northwest Territories.
But treatment facilities won’t work for everybody. It isn’t what everybody wants, which is why we have continuum of care options or support options for persons with addictions. They can go back to the community and engage with counsellors, they can use a Matrix program, they can use one of the on-the-land programs that are being offered by a number of the Aboriginal governments in the Northwest Territories. There are lots of different options.
As far as the specifics around the psych situations in emerg, I’m not a doctor so I don’t know the exact steps that would be followed, but I’ll see if I can get some additional information for the Member on those steps.
I agree, not everybody wants to go to treatment, but in some cases not everybody wants the help. But as caring community members, caring families, friends, they see it.
With that, I’ll just lead up into what our current Mental Health Act talks about in terms of, I guess, the substitute consent giver part in here and it’s under the Personal Directives Act. I know that some Members were concerned about the wait times that some community members have to go to treatment, and in some cases the person doesn’t want to go. But under this one act, the Personal Directives Act, it talks about who can consent on behalf of the person. It’s a child of the patient, a parent of the patient, a brother or sister of the patient, or any other relative of the patient, even a friend of the patient. So, anybody can actually give the consent through the process to do it. I think something on the news was talking this morning about four months or two months of waiting time to get counselling and when the treatment is really needed.
Are the Minister and his department informing people throughout the Northwest Territories whose family members or even people in the community are suffering that they have the right under our current Mental Health Act to proceed and get them the treatment that they want? It’s involuntary psychiatric assessment and also involuntary admission. Is the Minister making residents of the Northwest Territories aware of that provision in our Mental Health Act we’re using for residents of the Northwest Territories right now? Thank you, Mr. Chair.
The information that the Member has provided still is dependent on the ability of the individual to provide consent themselves. The person has the right to provide. If they’re capable, they’re the ones you go to for consent. If they’re not capable or they’re under the age of majority, then you can go to others. But you can’t walk in and say, I’m their brother, I will override this person’s human rights and consent for them to go to treatment or into a psych unit. There still has to be a decision from a practitioner whether or not that person is actually capable of providing consent themselves. Maybe I’ll go to the deputy for a little bit more clarification.
Thank you, Minister Abernethy. Deputy DeLancey.
Thank you, Mr. Chair. Just to add to what the Minister has said, many medical professionals will exercise extreme rigour and what they consider to be due diligence before they would be prepared to make the call that a patient was not able to make his or her own decisions. So, it’s not simply a matter of saying I think so and so person should be referred. There are a lot more steps and a lot more legal barriers than that to it.
Thank you, Ms. DeLancey. Mr. Moses.
Last question. Just in terms of that, to make that assessment from a medical practitioner, I think that’s why that time after withdrawal, that time for observation to look at the patient, keep them in the hospital for 24, 48, 72 hours, which also can be done within this act, to see what other psychiatric assessments might need to be done on this patient, and then in terms of medical practitioners, you know, communities that don’t have nurses, how many psychiatrists or medical practitioners do we have in the Northwest right now that can actually do that kind of diagnosis?
Thank you, Mr. Moses. Minister Abernethy.
Thank you, Mr. Chairman. Medical physicians, family practitioners are actually trained to provide this assessment, as well, so if they’re working with somebody who’s in a medical detox and it’s determined that the person is now fit and they have concluded their medical detox, they can choose to discharge them or offer them other options that might be appropriate for them given their current situation. If they think the person has some psychiatric problems, they can refer them to a psychiatrist.
There are two positons at Stanton by way of example, but we’ve also got distant psychiatry and a number of other programs, locum psychiatrists in the Beaufort-Delta. At the end of the day, I mean, the doctor, as the deputy minister said, will make a ruling based on their knowledge, skills and ability and their knowledge of the programs and services that exist. If anything, one of the things that we do need to do better as a government is make sure that people, including MLAs, including doctors, including nurses, including private citizens are more aware of the programs that we offer and understand we have an expedited referral process, and understand the Matrix programs that are out there, and understand that community counsellors have a role and have many skills. We all need to get together and promote the message as best we can.
Thank you, Minister Abernethy. Mr. Moses, your time is up.
Committee, we are on page 211, nursing inpatient services, operations expenditure summary, $35.470 million. Does committee agree?
Agreed.
Page 212, nursing inpatient services, grants, contributions and transfers, contributions, $35.470 million. Does committee agree?
Agreed.
Page 215, supplementary health programs, operations expenditure summary, $32.361 million. Ms. Bisaro.
Thanks, Mr. Chair. I have a couple of questions here. I raised it in my opening comments but I want to ask the Minister, and it goes to supplementary health benefits for what we, unfortunately, call the working poor. Those people who are working who do not have their own supplementary health coverage either through their work or they can’t afford to buy it. They’re not indigent. They are working and they wish to continue to work. I’d like to know from the Minister if there are any plans anywhere in this next fiscal year to look at providing supplementary health benefits for this small group of residents. Although they may be small, it’s a gap within our system that has existed for a very long time and needs to be fixed.
Thank you, Ms. Bisaro. Minister Abernethy.
Thank you, Mr. Chair. This wasn’t actually an area that was identified as a priority during the Caucus discussions for the 17th Legislative Assembly. We do have a number of priorities we’re working on and, unfortunately, the department doesn’t have the surge capacity, and there are no positions without assigned duties. Everybody within the department has got a number of assigned duties. The department has some allocation for unanticipated contract work but this, obviously, is minimal. Delivering on the department’s ambitious strategic plan with proposed timelines requires full use of the department’s resources, including our staff, who are our most valuable resource.
Inevitably, new projects arise, and I understand the Members recently have indicated that they would like us to move on supplementary health benefits for the working poor. This is additional work in the department. I think this is something that does need to be done. There was a lot of discussion in the 16th Legislative Assembly, and I still think there’s room for some significant improvements. We know, based on some estimates that were done, that the projected cost for coverage for the working poor through supplementary health benefits is going to be estimated to be about $4.3 million. That doesn’t mean it doesn’t need to be done and work doesn’t need to be done around this area, but my recommendation is that we include this in our transition planning and make it a priority for the 18th Legislative Assembly.
It’s unfortunate. I’ve heard a lot since we started this session, an awful lot about, well, it wasn’t a priority at the beginning of the 17th so we can’t do anything about it, and that’s starting to wear on me a lot. I appreciate that the department has a lot of work to do and that they are doing a lot of work, and I know that they have staff who are working very hard, and I appreciate that staff are doing good work, and I wish that to be known. But there are an awful lot of things which suddenly seem to be not a priority and there are an awful lot of things which suddenly seem to want to be pushed off to the 18th Assembly, and there are still a lot of months left in this 17th Assembly. I’m struggling with the attitude which seems to be getting more and more prevalent that we can’t do it because we’re in the last year and we’ve got to put things off to the 18th.
The figure that the Minister mentioned of some $4 million-plus, that’s not the number that I remember from the working group that went through a very extensive review of supplementary health benefits. I don’t remember that it was that huge a number. It was actually reasonably minimal if I recall. We may be talking apples and oranges when we talk about costs, so I’ll just leave that one at that, but I would hope that, I guess to the Minister but also to all Ministers, that just because it wasn’t identified as a priority doesn’t mean that it shouldn’t be done. I appreciate that the Minister wants to get it done. I appreciate that he’s willing to put a priority on it for transition, but I still think we have residents who are not being treated fairly.
I will ask a question. I will ask a different question. Thank you for indulging me.
I asked this earlier and I’m now on the right page so I am going to ask it again. The air ambulance contract that was recently signed was a very large increase in cost from the previous contract that we had for the air ambulance contract. I guess what I would like to know is at the outset what is it in this new contract, what benefits are we gaining that are worth the $4.5 million or $5 million increase that we are having to bear?
Just going back to the first part of the comment before the question, the $4.3 million estimate was based on the numbers obtained from the NWT Bureau of Statistics by the Supplementary Health Benefits Working Group in 2010, and it’s been updated for new information. But $4.3 million is the estimate, which, as a note, is a significant amount of money in these fiscally challenging times. I do believe, and I think many Members believe, that this is an area that needs some work, and I would like to see that work done, which is why I’d like to make it a priority for the transition document.
With respect to the air ambulance, the providers actually have higher end aircraft that can get into the short runways throughout the Northwest Territories. We have expedited the turnaround time or, rather, the contractors have expedited the turnaround time to some of the smaller communities to two hours from four hours. The current 23-year-old aircrafts will be replaced with four newer ones, more advanced aircraft, all enhanced with dual stretchers so that they can carry more people for increased system efficiencies, improved avionics and systems such as enhanced vision systems that allow pilots to see more clearly in adverse weather conditions such as fog, which is hopefully going to help us reduce those times, and there’s new medical equipment on these airplanes from the old medical equipment that was on them that was getting dated. Significant enhancements in the aircraft as well as the technology on those planes to ensure quicker turnaround for our residents in some of our smaller communities.
I will say also through the Med-Response program, we have actually started to see some sharing of services. The Med-Response, the airplanes are actually able to pick up other people on return flights and actually maximize some of their flight times and get some efficiencies by recognizing that there are other things happening in the territory at the same time. I have some details that I’ll be able to share with committee when we go live with the Med-Response program.
Thanks to the Minister. I’m pleased to hear that we’re getting a little more efficient. Maybe that means we’re going to save money, ha ha. I guess I have to ask, the Minister mentioned new planes and new equipment and so on, and it may be a little crass in this question, but are we paying the contractor to upgrade their equipment? Thank you.
These were all requirements in the RFP to meet modern safety requirements, but also medically responsible requirements in order to provide safe transportation of our residents.
Thanks. One last question in this section and it has to do with the extended health benefits figure. It hasn’t increased, I see, but there was an increase… Actually, it went down from ’13-14 actuals to ’14-15 estimates. It stayed the same in the ’15-16 estimates. It’s my understanding that that area includes costs for seniors’ health benefits, our seniors are increasing and as our seniors increase we know that there’s going to be a bigger drain on our health system. So I’m surprised to see that there is no change in the estimate from this current budget year to next year. So can I ask why? Thank you.
Thanks. The Member is exactly right. There are increasing numbers of seniors in the Northwest Territories and we are actually projecting increased costs to our already existing budget but we’re in the process of trying to monitor that and figure out what those costs are so that we can project them effectively given that we have a growing population. I imagine at some point, once we get a better grasp of what those future costs are going to be, we will be coming back to the FMB as well as to committee.
Thank you. So the Minister is coming back. I presume he means coming back for a supp, coming back for more money. If we know this now why is it not in the budget? Thank you.
Thank you. At this point I don’t anticipate a supp. I anticipate the department will be coming back through the business planning process for ’16-17. We’ll have a better idea of what those increased costs or future increased costs may be.
That’s okay. Thanks, Mr. Chair.
Thank you. Mr. Bromley.
Thank you, Mr. Chairman. Just a follow-up. We know that seniors are increasing. I know that the Minister has the stats, 6 percent or something. We know that the costs are going to be there. I think that’s typically how the departments adjust their budgets when we know that those costs are going to be there. Why wouldn’t you do that in this case?
Thank you, Mr. Bromley. Minister Abernethy.
Thank you, Mr. Chair. This is actually the first year that we’ve actually started to see some impact in this particular area. The budgets have always been sufficient. We are starting to see some real pressure, but in order to make a forced growth submission we actually have to have some statistics showing the actual increase of costs over a little bit of time, but until this year we haven’t had those challenges. We’re starting to see it now, so we’re going to make a forced growth case for it.
Thank you. I guess we’ll watch the supps. Just on the medical travel, what’s the explanation for the $3 million decrease previous year and this year and the $5 million increase between this year and the one year under discussion here?
I’m going to go to the director of finance, Jeannie, on that.
Thank you, Mr. Abernethy. Ms. Mathison.
Thank you, Mr. Chair. In ’13-14 we received supplementary funding for the Medical Travel Program and that is the explanation for the change there.
Thank you, Ms. Mathison. I believe the second part of that question was, again, the explanation of the increase in the ’14-15 to ’16-15. Ms. Mathison.
Thank you, Mr. Chair. The explanation for the increase between ’14-15 and ’15-16 is $3.5 million for the air ambulance and an additional $1.5 million increase to reflect increased costs of air flights and boarding home costs.
Thank you, Ms. Mathison. Mr. Bromley.
Thank you, Mr. Chair. Again, this is part of the budgeting process I don’t always understand. We got the supplement in ’13-14. I don’t think we told people no in ’14-15 this year. So, I assume that if it’s going to be $19 million, it will be coming out of some other budget. So any comments on that would be appreciated.
Just for efficiency I’ll throw in one more here. The Minister knows we’ve been working since the first day of the 16th Assembly on increasing the efficiency of medical travel costs. The stat was 50 percent of medical travel patients were on the streets an hour after they arrived at Stanton and got released. All those sorts of things. We’ve been dealing with this call forwarding, or whatever it’s called, on-call business. What efficiencies have we realized, and if we haven’t, maybe it’s just improved service, which I realize is part of the equation. When are we going to see those efficiencies as we’re now in our eighth year of discussing? Thank you.
Thank you, Mr. Bromley. Minister Abernethy.
Thank you, Mr. Chair. Yesterday I actually talked in some detail about the medical travel modernization, and the Medical Travel Policy has gone to the Standing Committee on Social Programs who has given it back to us with a number of comments and whatnot. We’ve started to make those changes and we’re going to be submitting that to Cabinet for consideration. Once it’s approved, we will have the foundation document, which is the base Medical Travel Policy. Of that, based on discussions I’ve had with committee earlier, there’s going to be a number of pillars that connect on to that Medical Travel Policy.
Currently, we’ve actually begun some of that work and we have a public engagement process underway on patient supports or escorts. This began in December 2014 and the group that’s doing that work have been around the Northwest Territories. What we wanted to do is we wanted to get them into large communities, small communities, on road, off road, air only, those types of things. So far they’ve gone to Hay River, Tuk, Inuvik, Behchoko, and they’ve also visited staff as well as residents or patients of ours that are visiting the Larga House. We anticipate the stakeholder engagement around this component will be done at the end of April. Just as a note, as of January 16th they had actually had some one-on-one engagements with over 123 people. They’re also reviewing all the information that we have collected over the years. Yellowknife, Fort Good Hope and Trout Lake will be engaged before the current engagement process is over.
It’s anticipated that the next one we’ll be working on is benefits eligibility. That engagement is going to begin in July and we wanted to do the medical travel appeal engagement in 2015-2016. We’re hoping to have this work done, like I said, the engagement done towards the end of April. These will help inform those other areas to make specific policy around those particular components of the Medical Travel Policy.
For the money I’ll go to the director of finance.
Thank you, Minister Abernethy. Ms. Mathison.
Thank you, Mr. Chair. The preference, really, I guess, because there’s been some fluctuation in the expenditures in this program area for a number of years, the preference from Finance has been for us to come forward for a supp request once we can show justification within the year. So that is how we continue to move forward. Even the funding that’s in the ’15-16 budget is actually a one-time increase and we do have to come back and re-substantiate that again next year.
Thank you, Ms. Mathison. Mr. Bromley.
Thank you, Mr. Chair. I guess that means that will be happening the year following. I appreciated the Minister’s response, although I couldn’t hear an answer to whether we’re ever going to realize some efficiencies from the massive amounts of work and investment that we put into approving our medical travel.
I saw lots of activity, I heard about lots of activity, but I didn’t hear a response to when are we going to realize some efficiency. We’ve invested hugely in putting teleconferencing into every community and training. We’ve been sure they’re being used and so on. We’ve got doctors on call 24/7 and we’ve got the diagnostic imaging and electronic communications of those. Huge, huge things, I would think, to increase our efficiencies there. I’m not seeing it translated here. I did hear a lot of activity from the Minister but I didn’t hear the sorts of things I’m mentioning that we’ve been investing in big time, electronic data records and so on, is being realized through improved efficiencies and, hopefully, some reduced costs. I’ll just throw that out there, and if the Minister has additional, I’d welcome. Thank you.
Thank you, Mr. Bromley. Minister Abernethy.
Thank you. I know the Member and all Members have expressed frustrations around medical travel in the past. I too have expressed significant frustration around medical travel. I think you’d be hard pressed to find somebody who hasn’t.
Part of the problem that we’ve had around medical travel is the clarity around it. It doesn’t seem to meet some of the people’s needs. With these changes that are coming forward, it will be more clear. We’ll clearly articulate it so it’s understood and applied consistently across the Territories. That in and of itself will reduce some of the complications that we have, but it doesn’t mean that less people are necessarily going to use it. But the points you made of the telehealth and whatnot, those types of things, we are seeing some results but we also continue to have many other reasons that people are coming out on medical travel.
I would like to point out that we did a soft launch of Med-Response and this is one of the initiatives we said we believe we are going to see some real positive results. We did a soft launch in November and we’re looking at going live next week with a full hard launch on Med-Response. Since their soft launch, and this was up to January 15th, they coordinated 312 clinical consults from all authorities, 152 which were NWT air ambulance flights. They tracked nine calls that were initially requested in air ambulance dispatch, but after the conversation the work through Med-Response and the coordinator response didn’t actually result in a medical travel or an air ambulance call.
We’ve actually been able to already coordinate at least one aircraft to pick up two patients from different communities both going to Edmonton and return them on the same aircraft, getting some economies of scale by utilizing the same plane for more than one person. These are the types of things we know we will start to see more of as we go for a full hard launch on Med-Response. This is just one of the areas that we’re making progress and we’re starting to see some results. I’m looking forward to seeing how this plays out over time and whether or not there are even more opportunities to get some economies of scale and opportunities to control some of our future expenditures in areas like this. So, there are good things happening.
Thank you, Mr. Abernethy. We are on page 215, supplementary health programs, operations expenditure summary, $32.361 million. Agreed?
Agreed.
Thank you, committee. Page 216, supplementary health programs, grants, contributions and transfers, total contributions, $21.890 million. Does committee agree?
Agreed.
