Yes. I understand the Member's question. As the Member may know, we are currently doing a mini-review of medical travel that will be done by the end of March, and it is looking at the question of escorts. It's looking at why escorts are sometimes approved and sometimes they are not approved until the appeal. It's also looking at things such as the knowledge base that medical staff have for recommending escorts. That is an issue that we are aware that we need to provide more clarity on, and we hope to be able to do that by the end of March. That's the intention. Thank you.
Thank you. Member for Thebacha.
Thank you, Mr. Chair. I'm looking at page 180. Just for clarity, Mr. Chair, the Fort Smith Health Centre would come under community clinics and health centres? Am I correct?
Thank you. Minister.
Thank you, Mr. Chair. I'll ask Ms. Mathison to confirm that. Thank you.
Ms. Mathison.
Thank you, Mr. Chair. Yes. Thank you.
Member.
My question is: community clinics and health centres, the budget went down. That's all the small communities, and I guess we're not considered a hospital. We're considered a health centre. The budget went down by almost $2 million. I'm just wondering, especially now that we've been through a pandemic and are still in a pandemic, why would budgets go down in community clinics and health centres? Thank you, Mr. Chair.
Thank you. Minister.
Thank you. What I see here is that this budget has some fluctuation in it. In the current fiscal year, it bumped up because of COVID restart money. That's why it's at $79,841,000 for this year. We're not anticipating, or at least not budgeting, for the COVID money for the next fiscal year because that hasn't been firmed up yet. There is no reduction in services. This does not represent any loss of nursing positions or other services to community clinics and health centres. It's puzzling to me about why that budget is a little bit smaller than it was in the actuals, but also in the main estimates for 2020-2021. I'll ask Ms. Mathison if she can explain that for us. Thank you.
Thank you. Ms. Mathison.
Thank you, Mr. Chair. The adjustment down in 2021-2022 is as a result of a change in the budget for amortization, which is to explain the use of the facilities. It's the depreciation on the assets that are being used in the delivery of these programs. Thank you, Mr. Chair.
Thank you. Member.
Mr. Chair, I'm wondering about the Fort Smith clinic. There are a few things that I feel that are not there that we had before. I know that they are trying to get a speech therapist; I know that for sure. We used to always have a dietician. We don't have one anymore. A dietician is very important. We have lots of seniors in the community, and the population at large. I'm just wondering about the dietician. The other area that I want to make sure is stabilized in the Fort Smith Health Centre is the lab services. We had full lab services there, and I know that we are going to be doing the blood work again. With everything else in there, we have to have very stabilized lab services. We come from a fairly large community. We're one of the four, maybe the smallest of the four, but I just feel that we have to make sure that people have to be able to go there and have the proper lab services and not have to come over here to Yellowknife just for some of the lab services that were offered before. That's very costly. I just want to know the answers to some of those questions. Thank you, Mr. Chair.
Thank you. Minister.
Thank you, Mr. Chair. This budget is at a very high level, so it doesn't speak specifically to what's going on in Fort Smith, and I don't have that detail with me. That would really be part of the Northwest Territories Health and Social Services Authority budget, to say what money was being spent in the specific areas that the Member asked about. We have spoken in the House before about Fort Smith lab services, and there is a switch from laboratory services to point-of-care tests. That transition is well under way, so almost all of the services that the Fort Smith lab had previously, it will have again. I think that some of the positions that are vacant are vacant because it's difficult to recruit people to those positions. It's not because we don't want Fort Smith to have them.
Those are my general answers. As I say, this budget is really at a very high level, so it's hard to provide that drill-down to the Fort Smith Health Centre in particular. One way you could do that is to take it into question period and ask me those questions there, and that would prompt me to get that level of detail to offer. Thank you.
Thank you. Member.
I'll turn to page 181, then, and go to Health and Social Services Authority funding. That went up by $22 million, so my question is for clarity. Everybody is equal in the territory, and we all expect the same services everywhere. I know it's very difficult. You can't have a large hospital in a small community, but it seems like we're always making sure that the Health and Social Services Authority funding, it went up by $22 million. It puzzles me how these budgets are presented because I just feel like it could be done more simply, so that we all understand very easily because I'm very good at numbers. Then there are hospital services over here, and then there is the Health and Social Services Authority. I just want more clarity, Mr. Chair. Thank you, Mr. Chair.
Thank you. Minister.
Thank you. Just to say, again, this is a very high-level budget, so it does not have Fort Smith-specific information in it. What I want to say is that the budget for the current fiscal year was subject to a supplementary appropriation for $21.4 million that had to do with the dialysis unit expansion in Hay River; mental health and addictions funding; safe restart funding; Child and Family Services, this was hiring some additional staff in that area; also, the child and youth care counsellor. Those are very general numbers. I do not know if Ms. Mathison can offer anything more specific, but could you please call on her, Mr. Chair?
Thank you. Ms. Mathison.
Thank you, Mr. Chair. The line that she is speaking to, on page 81, the Health and Social Services funding that showed the increase there of over $15 million, that is to reflect all of the programs in this activity. For example, it's showing increased funding for Child and Family Services, for child and youth care counsellors; we have forced growth for supplies in here; we have additional funding for the authority, Health and Social Services Authority in general to appropriately staff 24/7 operations. There is a wide variety of reasons why that increase there is $15 million for this year, some of which is likely allocated by the NTHSSA to Fort Smith for the health centre and for the staff there. However, yes, as the Minister said, we don't have that level of detail here with us today. Thank you, Mr. Chair.
Thank you. Member.
[Microphone turned off] ...questions.
Thank you. Questions? Member for Yellowknife North.
Thank you, Mr. Chair. Yes. I just want to start with a general comment of: I recognize main estimates are largely set by the Department of Finance and how they are set out, but this is $337 million on three pages, which makes it larger than any department. Maybe just ECE total department budget is there. I know that the reason for that is not really intentional; it's a Finance thing and how the department is organized. I think probably a look needs to be done and, when we table the budget, some more information on how we are spending $337 million be provided both to MLAs and the public because it can be very difficult to understand. Starting with the big picture, can I have an update of what the projected deficit for the NTHSSA will be this year, this fiscal? Thank you, Mr. Chair.
Thank you, Member. Minister.
Thank you, Mr. Chair. I am not sure that I have a projected deficit yet. I do not know that they have done their budget. I think they are waiting for us to finish our budget. The last figure I have for the deficit was $120,700,000. Thank you.
Thank you. Member.
Thank you, Mr. Chair. I understand there are some plans to run a deficit-reduction plan. Are we expecting that this main estimates that we are looking it for 2021-2022 will actually add to the deficit, or are we now budgeting enough that the deficit will essentially stop? I am not expecting us to pay off the $120 million, but is it going to get bigger this fiscal, as well? Thank you.
Thank you. Minister.
Yes. Thank you. Based on the budget for this fiscal year, which had a deficit budget, the NTHSSA had a deficit projected for this fiscal year, then I am going to say that we are going to continue to grow the deficit for the time being. What we are trying to do is to reduce the size of that deficit to zero through the health system sustainability plan, which we have spoken about here, so what we are trying to do is understand the drivers that are adding to the deficit and address those and reduce them, obviously, so we get to a point where we are not budgeting with deficits for the health authorities. Thank you.
Thank you. Member.
Thank you, Mr. Chair. Admittedly, my understanding of why the health authority is able to run a deficit in the first place is not fully understood. Are there any plans to simply not allow them to run a deficit and then, if they needed to, come back through a supplementary appropriation process so that there is a little bit more ongoing tracking to this House? When they wrack up debt, it's not like it's a different debt; it's still the GNWT being held, and I think, at one point, we are probably going to have a conversation about whether that $120 million of debt is written off and brought into the GNWT. I do not really see the point in making them pay it off. I would like them to get to zero and adding to it. Is it possible, or is there a reason that health authorities have to be able to run deficits and we cannot simply let them rely on the supplementary appropriation process like every other department? Thank you, Mr. Chair.
Thank you. Minister.
Yes. Thank you. I will start this, and then I will turn it over to Ms. Mathison. We have a very generous set of core services that are offered by our health authorities, and we need to ensure that we can continue those services now that we have them offered to our residents. We cannot say to people, "You could be out of work in March because we think that we will be out of money by then." The real question facing the health authorities is: what is the scope of our core services and what are the extras? Are we going to continue to fund all of the extras and continue adding to our deficit, or are we going to limit services? Are we going to ask people to pay for services? How are we going to manage the drivers on our health spending, which are substantial for us and all across Canada, which is why you hear news stories all the time about the Premier is negotiating with the federal government for an increased Canada Health Transfer. I, personally, am not a budget person. I do not see a way of reducing the deficit to zero and then working with supplementary appropriations when these are now all core services that we are funding. However, that is an amateur view, and Jeannie Mathison is a professional, so we should hear from her.
Ms. Mathison.
Thank you. No pressure. To the Member's question around whether or not it would be appropriate to address the shortfalls through supplementary appropriation, I would suggest that the answer would be: supplementary appropriations are meant for unknown, uncertain, like in a given year, and authorities have been experiencing these deficits for some time now and that is the reason why they are budgeting for them. We do come forward on behalf of the authority in instances where they have budgeted, and we can very clearly articulate where they have overspent their budget. For example, medical travel, we typically come forward for that because we can very clearly lay out what they had budgeted and what was to be spent and then forecast; similarly, with adult southern placements, for example. In those cases, yes, the department does support the authority in going for supplementary funding, but generally, we are at the state of still not understanding all of the drivers of the deficit. Until we are at that point, we cannot address those funding shortfalls. Thank you, Mr. Chair.
Thank you. Member.
Thank, Mr. Chair. Yes. I guess that makes sense to me. We are not going to cut off core services anytime, but we have a yearly fund of fires to supplementary appropriation, which can range from $4- to $50 million and have large fluctuations. I think probably there is some room to have that conversation later. However, I wanted to switch to, I believe this is the funding for the Office of the Public Guardian. Can I get a clarification of whether there has been an increase to the Office of the Public Guardian? I note the department has a goal of decreasing the wait list for the number of people for guardianship. There is also some talk of reforming the act. Some people with disabilities do not presently qualify for guardianship, and they probably should. I think there is quite a bit of work and that this backlog has been a long time coming. Have we increased the budget for the Office of the Public Guardian somewhere in this $337 million? Thank you, Mr. Chair.
Thank you, Member. Minister.
Yes, thank you. The Office of the Public Guardian is actually in adult support services, and the staff there is the public guardian and an assistant. I don't think there is a budget increase, other than through the collective agreement, for this office in this fiscal year, but I will just turn to Ms. Mathison for additional information. Thank you.
Thank you. Ms. Mathison.
Thank you, Mr. Chair. No, there is no increase for the Office of the Public Guardian in this budget. Thank you.
Thank you. Member.
Thank you, Mr. Chair. I would like to see an increase for the Office the Public Guardian, but I guess I am even more concerned in looking at the business plan. We have asked them to do quite a bit of work, and they are already backlogged in getting people into guardianship. Is the department, somewhere else in this budget, providing policy support to that office so that they are not tasked with decreasing their wait list and completely reforming public guardianship? Are we providing policy support? Thank you, Mr. Chair.
Thank you. Minister.
Thank you. I think that they were doing intake through contract services. I don't know if that's still the case, because that detail isn't on this page, but let me ask Ms. Mathison if that is the case. The Deputy Minister... [Microphone turned off]
Thank you. Deputy Minister.
