Thank you, Minister Abernethy. Carrying on with questions on pages 38 and 39, administrative and support services, Mr. Moses.
Thank you, Mr. Chair. I just want to make a couple of comments. In the past I’ve made comments about some medical equipment. I think I’ve asked questions and made some statements in the House about when this department purchases new equipment, they send a lot of patients down south for specialized care, specialized appointments or checkups. I am trying to remember back, but I think the Minister mentioned that they were already in the process of looking at how many appointments where we send people down south and the cost-effectiveness of it and whether or not there’s a trend for dialysis or cancer treatment or some other area. Since you are creating a new stand-alone hospital, maybe we should get an update, and if he recognizes any of these trends, maybe we could start doing those kinds of appointments here in Yellowknife, at the very least, rather than sending our patients down south. Thank you, Mr. Chair.
Thank you, Mr. Moses. Minister Abernethy.
Thank you, Mr. Chair. We are always looking at the numbers and the costs of sending people south versus finding ways to keep them here in the North. We are doing ongoing analysis. We haven’t been able to identify anything appropriate as an immediate move to the Northwest Territories at this point in time. But in the construction and design of Stanton, we didn’t want to limit ourselves to the future. So there is room within the proposed build that would fit something like an MRI, as an example. In the plan of the new building, there is a section that is designated for where we put the addition on to house an MRI should we reach that point. We may well reach that point. The numbers are changing all the time and some day we might reach it, but we’re not there yet.
We have an immediate need to expand things like dialysis here in Yellowknife where there is a significant number of residents who require dialysis. We are working with the Stanton Foundation. I would like to applaud the Stanton Foundation, who is currently out fundraising for four new dialysis machines that could be put in this new hospital. When that happens, we will have to seek some operating dollars. We are on top of trying to monitor trends to ensure we have the ability to provide acute care services for all residents of the Northwest Territories.
In terms of the medical equipment, it kind of goes to what my colleague Mr. Bouchard mentioned as well. We do get a lot of medical travel which has also been a topic of hot discussion in the House. Whether or not we can put some equipment into the regions, for instance, seeing what we might be able to get up in Inuvik. With the cost of travel and adding an escort on to that, the costs doubled bringing people down, whether it’s a first appointment of follow-up or checkup appointments. Maybe it’s a possibility to see what inventory we have in the communities and if we can start putting that type of equipment in the communities. Thank you, Mr. Chair.
The line the Member is referring to is the medical equipment biomedical evergreening. Much of this can be quite small, Mr. Chair. Some of it is small machines, some larger machines. Some of it is diagnostic machines and some are more complex. We are always looking for ways to bring the services as close to our residents as possible. We have to acknowledge that it’s not just machines but specialty expertise, specialty employees who come to us who have particular training who sometimes have to come to these machines. It’s a little difficult to talk about this category with respect to machines because the nature of these machines is so varied, so significant, but we are always looking for ways to bring these services closer.
You will note that there is a portable ultrasound on this page and that is intended to go to Inuvik and help improve some of the X-ray services they are providing up there.
That is leading into my next question with the portable ultrasound machines in Inuvik, Simpson and Smith. It seems like it’s a very important piece of equipment in terms of detecting any kind of disease or disorders that can be life threatening.
Can the Minister tell me how many communities have these portable ultrasound machines and why we’re not getting them into more of the communities, especially the regional centres? On top of that, do we have people staffed and trained to operate these machines? Thank you, Mr. Chair.
The portable ultrasounds is in response to a policy that was put forward in 2006 by the Canadian Association of Emergency Physicians. There are new national standards for emergency rooms and these portable ultrasounds will be going into emergency rooms. We’ve already got the one we need here in Yellowknife and we’re looking at Inuvik, Fort Smith, Simpson – Was it Simpson? – Hay River, my apologies, to be in – you’re right, Simpson – the emergency units. They do require some specialty training that we’re not in a position to ensure that our community health nurses throughout the Northwest Territories have, so they won’t be going into the community health centres at this point.
Just looking at some of our regional centres, does Hay River also have one and does Norman Wells have one? Do these regional centres have the staff trained to utilize these portable ultrasound machines? Thank you.
There will be one in Hay River. It’s incorporated into the new build as part of the plan there. There will be one in that community. At this time there isn’t one scheduled or planned to be in Norman Wells, given the nature and degree or scope of that particular facility.
Just to follow up, do we have the people who are qualified because of the new standards, who are trained, and do we have the adequate staff to use these in the communities? Thank you.
You forget to answer a question and you get everybody coming at you from all sides. Yes, the training is incorporated. I apologize for missing that. Sorry.
Thank you, Mr. Abernethy. Continuing on with questions, pages 38 and 39, administrative and support services for the Department of Health, I have Mr. Hawkins.
Thank you, Mr. Chair. I’m going to maybe touch base on some of the earlier questions, only more so for clarity and so I can get the fullness of the detail provided.
First off let me say that I want to applaud the decision-makers on going forward with the new building. Part of the issue I had was I was speaking with two of the bidders when it came to three preferred folks to make a final proposal. Two of them told me it would be a lot cheaper and a lot faster to build a new building. I know a lot of emotion is probably attached to Stanton, and rightly so, but I think it’s important to ask ourselves was it the right choice, and I think it is at this particular time. I also find it really interesting, the clause of the old building will not become a burden on the territorial government or the taxpayer and I think that that was quite an interesting initiative that certainly years down the road that it’s going to play out in a way that I certainly hope it will, but the idea of having the proponent manage, take all the risk and the GNWT shares in some revenues, it’s really an interesting concept. So I hope in 34 years or whenever that contract is done that they look back and say that that decision wasn’t just a good one, it was an incredible one. Like anything, only time will tell.
My first area of questioning is going to be in the area somewhat as Mr. Moses had just pointed out. I’m curious about what new services are being identified. I did hear the Minister say about they’re thinking ahead with things like space for an MRI if that becomes the issue of the day that we need to now offer that service. I also heard him say the possibility of allowing more room for dialysis machines.
Can he maybe speak to the types of programs the hospital will be in a position to expand towards on day one? New changes that is. I’m not talking about floor space and an ER that’s bigger than it was before. What I’m talking about is what will be new and what is it preparing for. I’d like to know what programs we’ll offer new, as well as the staffing component that must have been examined when they considered this, because no designer worth their salt would have just drawn a hospital and said okay, we’ll figure it out from here. They would have had to have known exactly what program areas we needed and where we were going and they also need to know the complement of the staff required in this. So, that said, I look forward to that first set of questions. Thank you.
Thank you, Mr. Hawkins. Mr. Abernethy.
Thank you, Mr. Chair. We’ve been clear that this isn’t about adding any new services to the Stanton footprint at this point in time. It is a replacement of all the in-patient beds through newly constructed single patient rooms. There is a new larger emergency department allowing for more appropriate flow, patient engagement, things to help us address decontamination, isolation, those types of things. There is also a new larger medical laboratory with space for diagnostic imaging. We aren’t planning an MRI in there, but we have asked that the ability to add a footprint for an MRI be incorporated into the site design and the plans so there’s room for the MRI.
We’re incorporating into the building enhanced medical technology to modernize some of the hospital operations. We’re looking at, in this facility, sort of trying to build upon where we started in the existing Stanton where space became a giant issue, things like a chemo suite that will be in the new hospital. So it’s not a new service, but it will be done in a far better way and the area will actually be truly designed for the purpose and the intent. The same is true of the dialysis. There will be an area designed for dialysis that was designed as a dialysis unit as opposed to a room that a wall was knocked down and a dialysis unit was tossed in there.
So it’s planning about flow, it’s planning about the services, and the units will have room for some level of expansion over the 30 years of the life of the building, or the life of our contract with BHP.
Thank you. Anything new almost sounded exactly as what’s been said before. So, I guess there’s really nothing new per se.
What is the change to our complement of the staffing levels that we will experience in the new facility? Could the Minister, maybe not this present second per se, give me the exact number, but what’s the ballpark number we’re working with at Stanton and what is the ballpark staffing complement number we’ll need for the updated facility? Thank you.
We don’t want to get into the same situation we had in Hay River where there was a lot of early projections without the thorough analysis. Once again, we’re not adding new functions, but recognizing that the building is larger and that we’re designing units that are actually going to be focused on patient care and have a better layout, better flow, we anticipate that there will be increases in positions over the 30-year life of that particular facility. Over 30 years it could be anywhere from 50 to 100, but on day one I couldn’t tell you what those numbers are going to be. We need to do more analysis and we are in the process of doing that work today.
It was reported on CBC North, and I thought it was an interesting comment, and not just a plug for CBC North on at six o’clock with Randy Henderson – Randy can thank me later; I’m waiting for his Tweet – that said, in all seriousness, the Ontario Auditor General had pointed out performance problems with the contractor as basically the lead of this initiative. I mean, in essence it really talked about probably cost creep, although I haven’t had a chance to read the report, I certainly will be looking towards it later on. In essence, the performance of these two hospitals that were built in Ontario went well and above the original cost scope and predicted budget and of course it looked like, from the story that I read, that the size of the hospital was compromised probably in a manner to keep the costs from growing well beyond reach.
That said, has the department had a chance to go through these Auditor General reports? I mean, these contractors would have, of course, put their best case forward by saying oh, we’re the greatest contractor, we can build hospitals day in and day out any day of the week and deliver a great product, but if they have a history of running into cost overruns and there’s lack of oversight on the performance of these particular contracts, how does the department plan to mitigate this? It’s easy to say, well, that’s Public Works’ problem, but ultimately it’s somebody’s problem and it runs through the Department of Health who is asking for money. Thank you.
Thank you. The Department of Finance has taken the lead on the financing of this particular project as well as some of the monitoring and overseeing.
I do know, without question, that the staff of the Department of Finance did review those audits that were done in other jurisdictions because we wanted to make sure that we did not relive or redo the same mistakes that were done in other jurisdictions, which goes to the comment the Minister of Finance made later about some of the overseeing that’s being done on this particular project, some of the checks and balances that have been put in place.
We also do know, and if you read that report on CBC further, that one of the recommendations that came out of that particular report was a hard and fast cap on the construction costs, which is something that we’ve built into our contract. So we actually have a hard and fast construction cost cap on the facility construction itself so that the build won’t cost more money than we anticipated, but it’s going to take, as the Member was saying, a thorough analysis, constant checks and balances. The Minister has already committed to keeping committee informed about progress, steps, checks and balances. It is important for us to read those reports, those Auditor General reports from other jurisdictions so that we can be as informed as possible to make sure that we don’t relive those mistakes made in other jurisdictions.
Just as a final note, we also know that there have been hospital projects similar to ours where there has been a great deal of success without those cost creeps or other problems. I would say those jurisdictions have also learned from the mistakes of others to make sure that we get what we ask for, what we’re paying for over the short and long term.
Thank you very much. Sorry to compare the two projects, but of course the Inuvik-Tuk Highway had a hard number, as well, and we’re having a hard time swallowing that one too. So I fully agree and think it’s fair that if we change the scope midway through where circumstances beyond control gives us the chance, but again, those are things we’ll have to deal with, or somebody will have to deal with as time goes on.
The only thing I want to say is I want to reiterate the two comments I made at the very beginning of the statement, which were the new building, I’m very glad with that process. It’s the one I wanted. I was worried we would get a renovation while patients were trying to be served. I thought from the start it was impractical.
The last part I want to point out is that the old building will have a service life. It’s an iconic figure in this community and certainly the territory and it would be a shame to see it bulldozed over, so I’m glad to hear that it will have a life beyond the opening of the new hospital, a life that doesn’t carry any risk on the GNWT.
My understanding is Minister Miltenberger may have had a role in playing that no risk part in, so if he did, I hope he’s still here as an MLA serving in 30 years to evaluate the contract to see if it worked out. I have no doubt he’ll be here in another 30 years if given the chance, assuming his wife lets him. Of course, that probably means Mrs. Groenewegen will be wanting to keep running too.
In all seriousness, the new building is excellent news. The old building risk taken off is fantastic.
Thank you, Mr. Hawkins. Committee, we’re on pages 38 and 39 of your capital estimates. Administrative and support services, infrastructure investments, $44.134 million. Does committee agree?
Agreed.
Pages 40 and 41, community health programs, infrastructure investments. Mr. Hawkins.
Thank you, Mr. Chair. I’m not going to belabour this section very long. I just need to clarify a particular thing under the extended care 18-bed facility being anticipated to be here in Yellowknife. One of the particular issues that has arisen is the competitiveness of these opportunities.
Can I get the Minister’s commitment to this House that it will be a competitive tender process whether is it developed through a partnership with Avens or it’s developed as a government project or some other way? The point is, I want to ensure that this extended care facility is an open and competitive contract, our contractors can be involved in it and at least take a shot. I hear, time and time again, that although they don’t like it when they lose – make no mistake, they don’t like it – the fact is, they like it even less if they don’t get to be involved in the bid.
Thank you, Mr. Hawkins. Minister Abernethy.
Thank you, Mr. Chair. The extended care facility is going to be an important facility here in Yellowknife. We need to get this approved so that we can have the 18 level 5 beds that are currently in the Stanton building but will no longer be in the Stanton building. As far as construction, Public Works and Services will be the lead on the procurement of that particular facility, so I’m not really in a positon to say anything at this point on how they’ll proceed.
I will say that there has been some interest expressed in this building already. By way of example, Avens has indicated they would maybe like to enter into a partnership where that extended facility can help them move forward with the construction of a long-term care facility. We’ve indicated that that’s something we’re open to, but obviously before any decisions can be made on that, a solid business case would be required. First things first though. We need to get the project approved so that we can ensure that there are the 18 level 5 extended care beds available in Yellowknife for the day that the current Stanton closes and the new Stanton opens.
I guess I go to the Minister and, hopefully, maybe if he doesn’t want to answer, maybe the other Minister will answer it, or somebody will take responsibility for it, which is: Who can confirm or commit to the House that there will be a competitive process in this particular initiative?
Like I said, there has been some interest expressed by Avens to utilize that facility or utilize that opportunity to help them move forward with the expansion of their long-term care facility in Yellowknife. We’ve indicated we’re open to that discussion. If that is something that comes to fruition, obviously it might change our ability to do an open competition as Avens would be the builders and not necessarily us, so I can’t commit on behalf of Avens on how they intend to move forward with the procurement.
If that does not work, we will certainly want to have an open and transparent process to ensure that we get the best building we can for the dollars that we have available.
I hear the Minister but I worry he’s not hearing me. The issue is it’s not about Avens and if the government decides to contract directly with Avens for services for the extended care level 5 beds. Albeit it’s not as if it’s a competitive market in the city where we’ve got 50 seniors’ agencies scrambling at the door saying we want a chance. We really have one. Sorry; two. I should say it this way. You have Avens and you have the Government of the Northwest Territories. You have one or the other who wants to take on the challenge.
That isn’t the issue, and I want to be very clear, but the problem really boils simply down to the fact that if the government is now offsetting its, sort of, problem with this one by finding a partner who’s willing to carry the weight or the crux of the issue and follow through on the success of it, that’s great. But the fact is we’re giving them the money, government money, public money, taxpayer money, and they’re going about it in a way that probably creates great frustration in the community. I can’t say they will. I want to stress that. I can’t say they won’t. I don’t know. But I can tell you, when you are in business, be it in Yellowknife or anywhere in the Northwest Territories, and the government gives, I stress by way of example, $10 million for another group to build a facility that will then come up with a long-term contract, they see that still as government money. If the government enters into a $10 million, $20 million, $30 million project by way of contracting spaces, beds, leasing, whatever, they still see that as government money used to pay for that whole facility.
If any agency enters into sole-source agreement, they just see it as, de facto, the government has chosen to steer or redirect government taxpayer money without a competitive process, and that’s what I’m trying to avoid. I’m trying to see that we have a competitive process. Yellowknife is the one market community where we have a competitive community. It’s not as if it’s in Fort McPherson where you may only have one or two people who can do these types of things, or you’re in maybe Fort Simpson where, again, you’re very limited on your options and choices. The everyday citizen sees it as government money going through. It’s not the issue of Avens being the partner or the deliverer of the solution. It’s about how we get the construction portion and component of it, and that is a great concern. We have construction companies in the city that have more than enough skills and competence to do that, and that’s the type of assurance we need. I’m sorry to go on at length, but I need to ensure that it’s explained very well where the issue lay. It doesn’t lie with Avens.
The final thing I’ll say on this area is that if any agency wants to enter into a contract with the Northwest Territories government, I mean, essentially they do it at their own choice. We could put in our agreement with them that they have to have a competitive process on that. That’s a choice we can make how they do that. To say that, well, it’s up to them, actually I disagree. If they want to provide the service, which I certainly hope they do, because I believe they do a darn good job at it, we can say at the beginning that you have to be competitive and that is the minimum expectation we have in that area.
I know we have a lot of contractors. We even have some formally of Hay River who would like to be involved in this initiative and opportunity just to bid. I’m looking for some type of assurance I can go back to the folks in this community who own construction businesses who want to play a role in this, because these opportunities don’t come along very often.
Obviously, the procurement will be led by Public Works and Services, but moving forward from a Health and Social Services perspective, whether we’re partnering with somebody like Avens or looking for other opportunities, we must ensure a cost-effective business case and we must go with the most appropriate development delivery based on value for money.
I agree with the Member; transparency is necessary and having the ability to have an open and fair process is important. I take the Member’s point around having a proviso in there that even if we do work with somebody else that it has to be open and fair is important. I will certainly share that information with the Minister of Public Works and Services. I’m pretty sure he heard it.
I thank the Minister for that answer. Is there any commitment that we can get that that will be the process followed?
It’s a little difficult for me to make a commitment to bind future governments in this particular case since the procurement won’t actually happen until the life of the 18th Assembly. But as I said, I will certainly share that information. The department has the information. I’m sure the Department of Public Works and Services has heard what the Member is looking for. I will commit to ensure that that information is shared.
Thank you, Mr. Abernethy. Mr. Hawkins. Okay, next I have Mr. Bromley.
Thank you, Madam Chair. I welcome the Minister and staff here. I would just like to get some definition or characterization, so I’m using the right terms, of things like extended care versus long-term care, maybe a level of care. Could I get just a crash course on a few of those terms? Thank you.
Thank you, Mr. Bromley. Minister Abernethy.
Thank you, Madam Chair. I am happy to do so. Extended care facilities are what we refer to as level 5 and provides services to residents with complex medical needs who require 24-hour nursing care and a range of supports from other health care professionals. An example of this would be a resident who is on a ventilator who requires care from a registered nurse and a respiratory therapist. These residents’ medical needs may become quickly unstable.
Long-term care facilities, which we refer to as level 3 and 4, provides services to residents with more stable medical needs that require access to 24-hour nursing and health care professionals to assist with personal care and daily activities. An example would be residents with dementia who require a safe and secure environment 24/7.
Within completion of the operational plan and functional program, it was determined that 18 beds is the optimum level for staffing level of level 5. So that would be 16 extended care beds, one palliative bed and one respite bed in the extended care facility that we’re talking about today. Thank you, Madam Chair.
Could I get an inventory by those categories for, say, existing ones for Yellowknife, Hay River and Fort Smith?
We have the 10 extended care beds at Stanton currently and other than the Dementia Facility... Sorry, that’s it for extended care. So, 10 extended care in the Northwest Territories at this point in time.
For long-term care beds, we have eight in the Tlicho, 22 in the Beaufort-Delta in the Inuvik Hospital, none in Norman Wells at this point in time, 26 in Fort Smith, 25 in Hay River, 17 in Fort Simpson, 28 in Aven Manor and 28 in the Dementia Facility. Then at the hospital we have 10 extended care. So there are 151 long-term care beds and then 10 extended care beds. With the construction of the facility in Behchoko, there will be 18 long-term care beds and we will have 18 long-term care beds in Norman Wells, so we are moving those numbers up as we speak.
I think the Minister can see that there is a huge gap in the capital where we’ve known for years that the rate of increase is much higher than anywhere else in the Northwest Territories. I appreciate the commitments I am hearing him make to the extent that he can for trying to get after those, but even this 18-bed facility on anywhere near a comparative basis leaves Yellowknife in the dust. I would recommend that the department sit down and start bringing some fairness to this equation and start thinking on the scale that the data clearly shows is required. That’s a comment.
I agree with the Member; we need to make sure we are getting in front of this and we are working very closely with Avens to find some solutions. We are exploring a number of different financing options that are available. They have expressed an interest in a partnership opportunity in the extended care which would help leverage moving forward with the 60 beds they want to provide here in Yellowknife. I know they’re working with the Housing Corp to talk about the renovations of the existing facility once they have a facility to move people in.
This isn’t just a Yellowknife problem, I’m sure the Member will acknowledge. The Beaufort-Delta, by way of an example, is incredibly tight as well. We are actually out for RFP right now. I think it’s going to close next week, looking for someone to help us do the facilities planned for the Northwest Territories to help us figure out where we need facilities and how to move forward.
Having said that, I acknowledge that there is an immediate need in Yellowknife and I am working with Avens right now to get them into the capital planning process. We need a business plan; we need some cost estimates; we need to understand the O and M costs; and we are hoping, assuming that none of these other options like the extended care work out, to still work closely with them to get them into the capital planning process as quickly as possible.
Thanks to the Minister for those comments. The other gap that is out there is that there are many seniors, because of their income levels, who would never be able to get into these facilities that we are imagining.
What role does the Minister see government playing in the small Northwest Territories economy at working to provide private facilities or encouraging private facilities? Those who have the financial resources, families who have financial resources can have an option to support their elders with the care that they need, but they are unlikely to get the same support from a government institution. Thank you.
A couple of things. Your income doesn’t really affect your ability to access government funded long-term care facilities in the Northwest Territories or extended care. So it doesn’t matter if you make a ton of money or have no money, it’s based on need. So I’m not sure I understand that particular question. Hopefully the Member will be able to help me understand where he’s going with that.
On the other side, there is nothing stopping a private business from opening up a long-term care facility and charging whatever they feel an appropriate market rent or market fee would be to do that. There’s nothing stopping anybody from doing that. Having said that, I absolutely acknowledge that there aren’t any, which means there may be some barrier out there to dissuade some individuals who are interested in opening a privately run long-term care facility with no government money.
As part of the review that I’ve asked to be done, I’ve asked them to do some analysis around that component, as well, to see whether or not some policy changes are required to help create some incentive or remove potential restrictions or barriers that private enterprise might see for opening up and running their own private long-term care facilities and charging whatever they feel is a reasonable market price. So, that is to be included in the review so that if there are barriers, we can find a way to work with private enterprise to create some economic opportunities and see some additional non-government funded beds here in the Northwest Territories.
That sounds good, Madam Chair. I would be happy to provide the Minister with some examples. I’m sure he’s aware of them, but I’ll refresh his memory for people who are not able to get into facilities because of an income barrier. I will leave it at that. Thank you.
Thank you, Mr. Bromley. Anything to respond, Mr. Abernethy?
Pardon?
Do you have a response to that? Okay, thank you. Health and Social Services, community health programs, infrastructure investments, $16.343 million.
Agreed.
Thank you. Now we’ll turn to page 37, total infrastructure investments, Health and Social Services, $60.477 million.
Agreed.
