Thank you, Mr. Dolynny. To the motion. Mr. Nadli.
Thank you, Mr. Speaker. I’d like to thank the mover and the seconder for putting forward this motion. I support this motion.
One of the things that I kind of thought about, and hopefully this never happens, or perhaps maybe it actually has happened, is that the thought of an elder who has to be transported from another community and that elder is unilingual and is brought to a foreign place and that elder is left to their own vices, to fend for themselves to talk their way into a cab and to get to the hospital. You know, I would never want to see a circumstance like that, especially with an elder from a small community. Hopefully it doesn’t happen.
This motion ensures that likely in the future that those situations will not happen. That a lot of the policies and initiatives that this government puts forth we need to be culturally sensitive in terms of understanding the culture of businesspeople. At the same time, there are things that are needed, especially for elders, and this motion basically presents that.
So, with that, I support this motion. Mahsi.
Thank you, Mr. Nadli. To the motion. Ms. Bisaro.
Thank you, Mr. Speaker. My comments will be brief. I appreciate the mover and the seconder for bringing the motion forward. As a member of the Standing Committee on Social Programs, I was party to an update from the department last month on what they are doing in regard to the Medical Travel Policy. As I understand it and remember from that update, they are in the process of developing recommendations around non-medical escorts. So my preference is to wait for that recommendation and that work to come from the department.
I agree with most of what is in the suggested motion, but I can’t say that I agree with absolutely everything. One of the conditions that is being suggested for a non-medical escort gives me some pause. I do agree, certainly, with consistent application of any policy, that’s an absolute, and I do agree with monitoring and evaluation of any policy, in this case the Medical Travel Policy.
So that said, I do not wish to vote against the motion, but I will be abstaining. Thank you.
Thank you, Ms. Bisaro. To the motion. Mr. Moses.
Thank you, Mr. Speaker. I’d like to thank the Members for bringing this motion forward. Medical travel is a big issue throughout the Northwest Territories, and as my colleague mentioned, standing committee did get a briefing last month as well as on Monday, October 5. The Minister did table a document, NWT Medical Travel Program, Patient Escort Supports Report on What We’ve Heard and it is mentioned that they are working on their recommendations that were developed out of that report.
We all know that medical travel, as we go through our business plans, averages out to over $30 million a year. Now the escort portion is over $5 million and when we break it down that’s over 13,000 medical travel patients every year. So we’ve got to find ways to do things better that can cut our costs, whether it’s providing more services to the regions, or ensuring that people get the proper treatment when they do go out, because I’m sure a lot of these costs are travel that’s repeated over and over.
With the report, I know there have been some concerns and some discussions talked about staff turnover as well as capacity issues in the regions and there’s nothing that we can do about that. All we can do is continue to provide support and try to help our patients get the right programs, the right treatment, the right services that they need. I know there’s been an appeals process that has been discussed and that the department is working on it. I know, as I mentioned at the onset of my comments, that this is something that we’ve been working on for the life of this government.
What else we’ve been hearing is that some cases, when it’s not approved, people are just paying for their own escorts and that is something that needs to be addressed, whether it’s an afterwards appeal process to get remuneration on the hotel, airfare costs, per diems for people who need assistance. So the first part of the motion that was brought before us in the House, I do believe it’s being worked on. During our presentation to standing committee, as well, if you look at the document that was tabled on Monday, it says they are working on a lot of recommendations in there. Whether this motion will speed up the process, as I mentioned there are capacity issues, staff turnover, that’s going to reflect that.
The second part of the motion here is to apply throughout all the regions, and recently over the summer we passed Bill 44, the Health Administrations Act, that’s going to assist in transformation throughout the Northwest Territories. They’re going to provide better services to regions that are having some of those issues with medical travel, as well as all health and social service concerns in terms of services and programs provided to residents. However, due to the fact that this medical travel concern is something that we’ve been talking about, the Auditor General has brought it up and standing committee is trying to stay on top of it, among the many other emerging priorities throughout the life of this government. I will support the motion just on the fact that it is still important and I’ve got to show my support of the importance that medical travel and the escorts for our most vulnerable, our youth, our elders and those who are described in the motion.
I do understand and I do think that the department is working on it right now. There are challenges. Whether or not this motion is going to speed up the process, I have to have faith in our departments and when the governance and system transformation comes through I think it’s also going to reflect on the services that are lacking in some of our regions that don’t have these services currently.
So I thank the mover and the seconder for bringing the motion forward and I will support it based on the fact that it is an important issue and we’ve got to protect our residents of the Northwest Territories. Thank you.
Thank you, Mr. Moses. To the motion, Mr. Bromley.
Thank you, Mr. Speaker. I will be supporting the motion and I’d like to offer comments that might be classified or categorized as tentative support.
The motion calls for immediately introducing a policy change to ensure access to non-medical escorts for the patients with particular issues. Then again on the last furthermore that the government produce the report to these recommended actions for consideration by the House by February 2016, that’s almost five months from now. We know that this is being worked on since 2011. So I think that’s a healthy opportunity to help the interim or the new government to do its work and provide its response.
We did begin this work in the 16th Assembly and we’re somewhat frustrated that we didn’t make more progress there. It’s gone for the life of this Assembly and I know that the department is actively working on it. This is the message: please get it done.
Consistently applied is the second ask here. That’s something that I think everybody in the House can support and I certainly do.
The mechanism, calling for a mechanism for monitoring and evaluation, again, that’s a no-brainer. We need to do that with all of our policies, and this one in particular, as already noted by my colleagues, is a very significant policy for our residents and a very expensive policy. So we need to make sure that we stretch our dollars as much as we can. I know, in fact, that we have done a considerable amount of work on the Medical Travel Policy. We are working on this 24/7, on-call process, where doctors can be reached 24/7 by a community nurse. We know that we’re working on getting Electronic Medical Records in place so there’s accurate and ready information on patients to help assess their situation. We’ve established Telehealth with equipment and skills in every community in the Northwest Territories so we can create images of patients in their community immediately and with immediate results, and through our IT they can be transferred to the appropriate doctor or professional, again, for immediate consideration and evaluation. All those things should be helpful.
So, finally, I guess, I would note, I think it’s already been noted very straightforwardly, the more dollars we put into this the less dollars there will be for actual health care, so it’s a fine balance and there will always be a tension. It’s not an easy one to do but I think, you know, we’ve been at this for five years at least and we should be able to see some vast improvements. I’d like to see that summarized in place and presented to committee by February of ’16, as called for in this motion. I’ll be supporting it, and thanks to the mover and seconder. Mahsi.
Thank you, Mr. Bromley. Mr. Menicoche, to the motion.
Thank you very much, Mr. Speaker. I rise today, I’ll be supporting that motion. One of the things is that Members on this side of the House have been awaiting the review of the Medical Travel Policy and I’m sure the Minister will have heard that during his travels to all our constituencies that people raise concerns about medical travel. Even though this motion is quite specific and it may seem costly and expensive, but it’s just about that frustration of our people moving around and it’s another symbol that Members on this side of the House cannot wait for that review. But I think for me it only serves to let government know we’ve got to get this work done. We all know elections are coming and I’m sure that all the Members who will be running again as MLAs will certainly hear medical travel being heard.
Once again, the motion calls for three months’ time to start working on it. I know the bureaucracy is not running for re-election, so I would just let them know as they continue to work on the medical travel review that this particular portion be included as well. Thank you, Mr. Speaker.
Thank you, Mr. Menicoche. To the motion. Mr. Abernethy.
Thank you, Mr. Speaker. I would like to thank the mover and seconder for bringing this motion to the floor for this important conversation around medical travel. I clearly hear the Members as well as I clearly hear the residents of the Northwest Territories.
Medical travel is an essential component of our health care system, one that affects each and every one of us, every resident, at some point in their lives. As a result, it’s a subject about which many people feel quite passionate, as we’ve heard today, and hold incredibly strong opinions. We all want to know that support is there to ensure that we can access service when needed.
Frequently our residents are forced to access health care services in difficult situations, often when they’re ill or they’re in pain and they’re facing difficult diagnosis, when both parents are needed to support the treatment of young children or when our elders, who may not be fluent in English or familiar with the city they’re going to, need help getting around. At these times we want to know that our loved ones are not alone, and as a system we want to be compassionate, but the reality is that we need to balance that compassion with affordability because medical travel is a major cost pressure for our system.
Last year we spent $16 million to provide this service and about one-third of that went to cover non-medical escorts. Our medical travel budget is routinely overspent. Utilization rates are slowly increasing as we face an increase in chronic disease and our ability to contain these costs is impeded by uncontrollable factors like rising airfares. Another pressure is that the federal funding that we have counted on for many years to help us in this area is declining and will cease to exist completely after next fiscal year.
As a government, we strive to find a balance between supporting our residents and keeping our system affordable. This isn’t always easy, especially when we are faced with other competing pressures like demands for improved mental health and addictions services. The changes proposed in the motion, to provide guidance on the situations in which patients should have access to a non-medical escort, are almost identical to what is in the policy today. Our current policy clearly spells out criteria for approval of a non-medical escort that mirror very closely what is proposed in the motion. The challenge is not drafting policy guidelines; the challenge lies in the application and interpretation of those guidelines.
The Medical Travel Policy requires the referring health care provider to make the recommendation whether a patient or a client meets the criteria to be eligible for a non-medical escort. Determining when a patient`s physical limitations or need for an interpreter mean an escort demands careful consideration of many factors, including the nature of the medical condition, the duration of the required travel and whether the final destination is Yellowknife, Inuvik, Edmonton or elsewhere, the patient’s previous experience and personal desires, to name just a few. This is a judgment that is best made by a health care provider in consultation with the patient and the patient’s family members.
I frequently receive appeals from Members of this Assembly or the public who feel that they require a non-medical escort and ask me to intervene in the decision-making process or to overrule the recommendation of their health care provider. Mr. Speaker, let me state clearly that I have not, and I will not, second-guess the advice of health care practitioners in our system. None of us wants a system where decisions about access to medically necessary services are based on politics. This would undermine the public trust in the fairness and equity of our system and would not be consistent with the principles of the Canada Health Act.
Mr. Speaker, I’ll close by saying I recognize that our Medical Travel Program is not perfect. As Members of this House are aware, the department is working with Stanton Health and Social Services to improve the program. We have just completed consultation with stakeholders across the Northwest Territories on how to improve our policy around non-medical escorts. We recently put in an appeal process for anyone who doesn’t agree with a decision made under the policy. That’s a new resource that we have and I believe that the improvements the Members are seeking with this motion are already in process, and for that reason, and in addition to it being a recommendation to Cabinet, Cabinet will be abstaining.
I would just like to point out one additional thing, Mr. Speaker, and it’s one concern I have with this particular motion that’s in front of us. While I recognize that motions are recommendations and aren’t necessarily binding, it is obviously common convention that a government doesn’t make decisions for future governments. With respect to this motion in front of us today, upon dissolution all requests for documents and responses actually die in the life of this government. So this is actually recommending that the next government do something which will die on the floor. But I would like to say, even though the motion dies on the floor and the requirement for a response dies with the dissolution of this government, I want to give the Members an indication that the department is working on this file and they’ve heard you clearly and they know that we need to make improvements in medical travel, and the next government, I hope they’re as passionate about medical travel as the Members are in this House. Maybe this motion will be brought forward again so that there can be an appropriate response, but the department is working on this and is committed to getting it right. Thank you, Mr. Speaker.
Thank you, Mr. Abernethy. To the motion. Mrs. Groenewegen.
Thank you, Mr. Speaker. I’ll be abstaining from voting on the motion for a couple of reasons. Number one, the work that’s outlined in here is already underway. We’ve already been briefed in Standing Committee on Social Programs on the review of the Medical Travel Policy. So, reference to the Auditor General and the report and all that, it’s already happening.
To the issue of us determining who should get a non-medical escort, it’s taking that decision out of the hands of the medical professionals and I don’t think that’s our role. So I’ll be abstaining from voting on the motion. Thank you, Mr. Speaker.
Thank you, Mrs. Groenewegen. To the motion. Mr. Yakeleya, closing remarks.
Thank you, colleagues, for allowing this motion to be brought forward and have your views on it. I certainly know that this motion here, as Mr. Abernethy so eloquently laid out, is going to die. This motion may die here in this Assembly but this issue is still alive and will be still alive in our communities, with our elders that come and talk to us. I have a list of people who have e-mailed me on their experience with the Medical Travel Policy. It may sound that there’s not an issue, but in our small communities and our larger centres, regional centres, it’s an issue, so I hope that our constituents are listening all across the North.
We have a communication gap, big time, with the Medical Travel Policy. I want to let them know that since 2011, four years ago, the Auditor General – the Auditor General – stated clearly, “We’ve got a problem here.” It’s only now, at the dying end of this Assembly, that the Minister is saying we’re going to fix it, be patient with us. For one thousand four hundred some-odd days we had to let people go through this and…(inaudible)…their experiences, especially the elders. Shame on this government for allowing senior people, elders…and I witnessed personally elders in our community travelling without an escort. Shame on them. Shame on them. Our most precious persons in our community.
You know what? This motion says to the government we’re not going to take it. Give some flexibility to our people in the health centre. We’re not asking them. But there should be some common sense questions, common sense questions by the health practitioners, and some of them are not always nice people. I know that.
I’m really wanting to thank the people here to look at this issue here. People have cancer. They need to have someone to look after them, to care. That’s just common sense.
I know that there are lots of dollars spent on it. But we’re in the Sahtu. We’ve got to fly. We don’t have these large centres where we can just jump in a car and go and drive over there with a bunch of family members. Come on. Build us a highway and then maybe.
But I want to say that this motion is passionate, and I want to say that I look forward to the next government and this government looking forward to seeing what we can do to change it. We’ve got to change it now. There aren’t many elders left in our regions here.
Thank you, Mr. Yakeleya. The Member has asked for a recorded vote. All those in favour, please stand. Madam Clerk.
Mr. Yakeleya, Mr. Menicoche, Mr. Blake, Mr. Dolynny, Mr. Bouchard, Mr. Nadli, Mr. Hawkins, Mr. Moses, Mr. Bromley.
All those opposed, please stand. All those abstaining, please stand.
Mr. Abernethy, Mr. Miltenberger, Mr. McLeod - Yellowknife South, Mr. Lafferty, Mr. Ramsay, Mr. McLeod - Inuvik Twin Lakes, Mrs. Groenewegen, Ms. Bisaro.
Thank you, Madam Clerk. In favour, nine; opposed, zero; abstentions, nine. The motion is carried.
---Carried
Thank you, Mr. Speaker. I move, seconded by the honourable Member for Great Slave Lake, that Bill 72, Supplementary Appropriation Act (Operations Expenditures), No. 2, 2015-2016, be read for the first time.
Thank you, Mr. Miltenberger. The motion is in order. To the motion.
Question.
Question has been called. The motion is carried.
---Carried
Bill 72 has had first reading.
Mr. Speaker, I move, seconded by the honourable Member for Great Slave Lake, that Bill 72, Supplementary Appropriation Act (Operations Expenditures), No. 2, 2015-2016, be read for the second time.
This bill makes necessary supplementary appropriations for operations expenditures for the Government of the Northwest Territories for the 2015-2016 fiscal year.
Thank you, Mr. Miltenberger. The motion is in order. To the principle of the bill.
Question.
Question has been called. The motion is carried.
---Carried
Bill 72 has had second reading.
By the authority given to me as Speaker by Motion 10-17(5), I hereby authorize the House to sit beyond the daily hour of adjournment to consider business before the House.
Item 20, consideration in Committee of the Whole of bills and other Matters: Bill 54, An Act to Amend the Forest Management Act; Bill 55, Mental Health Act; Minister’s Statement 221-17(5), Sessional Statement; Committee Report 25-17(5), Report on the Review of Bill 55: Mental Health Act, with Mrs. Groenewegen in the chair.
I’d like to call Committee of the Whole to order. What is the wish of the committee today? Ms. Bisaro.
Thank you, Madam Chair. We would like to deal with Bill 55, Mental Health Act, and Committee Report 25-17(5), Report on the Review of Bill 55, Mental Health Act.
Thank you, Ms. Bisaro. Is committee agreed?
Agreed.
Thank you. We’ll take a break.
---SHORT RECESS
Thank you, committee. We’ll start with Bill 55, Mental Health Act. Committee has agreed to consider Bill 55, Mental Health Act. I’ll go to the Minister responsible for opening remarks. Mr. Abernethy.
I am pleased to be here to discuss Bill 55, Mental Health Act. The development of this bill has been the result of significant time and effort by the department, and would not have been possible without input and contributions from members of the Standing Committee on Social Programs, the public and front-line workers.
The primary purpose of Bill 55 is to ensure that those suffering from mental illness receive appropriate mental health care and treatment as soon as possible and in the least restrictive manner.
This legislation will modernize our current mental health framework while, at the same time, recognizing the unique needs and challenges of the Northwest Territories. It will better protect the rights of patients and those acting on their behalf, with the importance of culture and community at its core.
While the bill will address many gaps in our current mental health system, we know that the work does not end here.
I would like to take this opportunity to thank the members of the Standing Committee on Social Programs, community members and front-line workers for their significant contribution to the development of this bill.
I would be pleased to answer any questions Members may have. Thank you.
Thank you, Minister Abernethy. I will go to the chair responsible for Social Programs, the committee that considered the bill, Mr. Moses.
Thank you, Mr. Chair. As mentioned earlier during our review, when we read our document on Bill 55, there was a long consultation process. We had about 17 written submissions and we visited nine communities. We opened up our discussion on August 24th with the Minister. I appreciate the Minister and his department with the work that he did with committee over the length of this bill.
As we proceed, I believe committee members may have other questions for the Minister as we proceed with Bill 55. Thank you, Mr. Chair.
Thank you, Mr. Moses. Mr. Minister, do you have witnesses you’d like to bring into the House?
I do, Mr. Chair.
Thank you, Minister. Sergeant-at-Arms, please escort the witnesses into the Chamber.
Thank you, Mr. Chair. On my right is Debbie DeLancey, the deputy minister of Health and Social Services. On my left, Thomas Dorian, who is legal counsel.
Thank you, Minister Abernethy. Committee, we’ll go to general comments on Bill 55. General comments. Mr. Dolynny.
Thank you, Mr. Chairman. I’d like to welcome the department and the Minister here today. As this has been a very long and a very swift journey to have this bill before the House, I do want to commend the Minister and his department for getting this bill near the end of our term and I want to thank the department for assisting committee as we went from community to community to discuss the intricacies of this bill.
I guess, first and foremost – and some of this stuff may sound familiar to the department here – as I said in the clause-by-clause review, I believe what we have before is a very action-rich and a very resource-poor bill before us and what I mean by that is the fact that we’ve got a lot of new actions in order to deal with mental illness in the Northwest Territories, many of those which I support as a Member who has had the pleasure of going literally line-by-line and community-by-community to make that evaluation.
Where I feel that it is resource poor, although we have heard some indications that there will be some money invested in this, that money will pale in comparison to what really is needed to make this bill fully and truly effective. I want to just be cautious as we go through this bill and hopefully approve it here today, that the department has a big undertaking to try to get the much-needed resources. The Minister has his colleagues sitting across from us here; we have the Finance Minister here. You’re going to have to find some money, Mr. Minister, otherwise this bill won’t be as effective as we may think it is and it’s going to require some infrastructure, it’s going to require some human resources and it’s going to require a lot of community involvement.
So I do challenge the Minister to do the necessary lobbying. I know we’re going to be finishing up session here in a day or so. I know the Minister acts in his capacity up until the next Assembly is sworn in. So I’m hoping that during that period of time that we’re able to put the tools together to kind of put the necessary action items together to make sure that, again, if this bill goes through, that we’re going to have to start on that venture.
Things that I’ve noticed as we went through this act and taking this act on the road and trying to dabble in a little bit into my own medical background as a pharmacist is that – and I’m just going to say something here – according to statistics from the Centre for Addiction and Mental Health, at least 20 percent of people with mental illness also have a substance abuse problem. So there’s a clear correlation, and I’ll explain more about where this number comes from and what it means to this act, but there’s a clear indication as we investigate more and more in Canada that there is a commonality between addictions and mental health. Again, when you look at the overall aspect of this act, addictions are relatively silent. I think there’s going to be a bit of a wall there when we start rolling this out, and I’ll tell you that in a second.
What we’re seeing is that with the new paradigm shift in treatment is integrating the treatment of both mental health and addiction as being treated together. A lot of the studies coming out now that have some of the best outcomes when we treat mental health and addictions as one. Now, where this puts the residents of the Northwest Territories in a bit of a predicament is that our addictions treatment facilities are down south and that’s going be causing a problem and you heard time and time again and even some of the recommendations is the fact that we strongly encourage addictions treatment programs need to come back to home row.
I know the Minister is very adamant that through cost efficiencies and trying to save money, economies of scale, that it’s not possible. But the health care system is saying we need to work together with addictions, we have to find ways to find solutions. There are many studies here. There are a number of studies I can provide to the Minister and the department later to back up the information that I’m talking about, but as the Minister always says, these are silos and there are silos now with mental health and addiction service across Canada.
Many organizations, many jurisdictions, many provinces have seen that and, again, this act is silent on that. The growing trend right now in the provinces is integrated diagnosis and treatment initiatives. These are going hand in hand, and again, many of the new paradigms in terms of treatment are showing that these integrated diagnosis treatment programs are starting to roll out across the provinces and even at a provincial level – I’ll pick Alberta, for example – addiction counsellors are being cross-trained to do mental health work and mental health counsellors are being cross-trained to do addiction work. So it’s happening in other provinces. In fact, it’s gone even further that even a province like Ontario, that Minister of Health made an integrating mental health and addictions services as one of his four goals in the strategic 10-year plan. So they’ve noticed the fact that this is important to them as well. I know we’re not Ontario, but we need to look at what’s leading the charge across Canada when it comes to the flexibility of treatment options and integrated services.
So I’ll leave it at that particular point, Mr. Chair, and again, because this act is relatively silent on addictions, I just wanted to point out some of the recent trends that we’re seeing across Canada and some of the silence that we have pursuant to this act.
One of the last things I want to talk about is the fact that, yes, there is a triggering mechanism of a five-year review of this act, and I’m very thankful that it is. I think it was well received across the communities and I applaud the government for including it. Not every legislation has a triggering clause and I’m glad we have one in this one. So, kudos to the department for allowing that to happen. However, as I’ve said before in committee, in public settings, I don’t think we need to wait for that five-year review before we initiate that trigger. I think we’re going to slowly find out, once this act and if this act comes online, that we’re going to probably have to do some massaging of this act sooner than later and we all know how the speed of government happens sometimes and I don’t want to fall victim to that trend. We waited over 30 years for this to happen, so let’s not become victims of our own demise.
Let’s make sure that we are proactive by design and I strongly encourage the department to look at it early on in the life of the 18th once this thing comes online. I would include even up to a year, up to two years after we go live with this that it comes up for formal review and a full public consultation process. Hopefully by then the stuff I talked about earlier with integration of addictions might be able to be incorporated with mental health within the paradigms of one act.
I will conclude saying thank you very much for allowing me to speak and I do want to thank my colleagues. This was the last act that we had the pleasure of travelling together. You get to know your fellow counterparts quite intimately, I guess, sometimes when you’re doing road community travel. But this is a great group from the Social Programs committee. They’re enriched with plenty of rigor and I just want to say, for the record, it was a pleasure working with them and we’ve got a great chair that leads us down that path. Thank you.
