The NWT department of Health and Social Services (HSS) is well on its way to achieving its long list of deliverables for improving healthcare across the territory, but high costs of care and higher-than-average health issues continue to be a burden on the system.
The department recently released its annual report reflecting on the state of service delivery and health in the NWT 25 years after the devolution of authority to the territorial government.
The highly detailed report was candid in the department’s shortcomings, which ranked fewer than its successes in this second year of the ongoing five-year strategic plan.
According to the report, HSS was successful in completing or being on track with 40 of 45 priority actions identified to improve the health of the population, which include improving child and family services, the health status of the population, innovations to service delivery, ensuring patient safety and system quality, and measuring and reporting outcomes.
While the percentage of people reporting “very good” or “excellent” health has risen slightly from the year previous to 54 per cent, with numbers of smokers and dangerous drinkers falling, the NWT still ranks highest in Canada for smoking rates, binge drinking and suicide.
Mortality rates for infants and preventable illnesses continue to be among the highest in the country, along with the rate of injury hospitalizations, which are twice the national average. Though incidents of tuberculosis have dropped, cases of MSRA (superbugs) sharply increased in the NWT along with sexually transmitted infections.
The rates of chronic disease, such as diabetes and cancer, are also on the rise. Forty per cent of admissions to NWT hospitals continue to be related to chronic diseases that could be prevented or better managed.
HSS has joined with the Canadian Foundation for Healthcare Improvement to complete a set of pilot projects to find better ways of managing chronic diseases, focusing on diabetes, mental health and renal care (kidney health).
There is currently no standardized support system for remote communities in the NWT to ensure health practitioners have a single point of contact when they need assistance with urgent clinical support.
In response, HSS has begun to implement a new service called Med-Response, which will give healthcare workers a single number to call for 24-hour emergency support access to a practitioner and air ambulance service.
Work is also underway to integrate the medical record system across the board, including the digitization of x-rays viewable in other provinces within 35 minutes, and the creation of a territory-wide Electronic Medical Record (EMR) system, allowing information on patients to be shared easily and quickly between clinical providers.
System-wide renovations are in effect, seeing $36 million in upgrades and retrofits across the territory, from long-term care facilities to health centres, and over 17 per cent of biomedical equipment replaced at the end of its life cycle.
Work on establishing a pharmaceutical strategy to manage the use of prescription drugs across the territory is still on the books, but has been delayed.
A major key to unlocking future success within the department is the new funding arrangement with Health Canada for community-based wellness programs, which allow communities to receive multi-year funding for self-designed wellness programs developed through local consultations.
Several communities have already completed their wellness plans, and it is anticipated that every community in the NWT will have done so by the end of the 2013-14 fiscal year.
The planning is being done under a new division of HSS identified for Aboriginal Health and Community Wellness, whose team works with community groups and Aboriginal governments on identifying their priorities.
Cutting back the deficit
The department spent $372 million in 2012-13, with over $247 million (or 66 per cent) going directly to the regional authorities.
Every authority reported a deficit last year, totalling $5.8 million for the total department. Added to previous deficits, the current accumulated deficit is now $19.1 million.
Human resources continue to be the most significant cost to the department, making up 67 per cent of total expenditures.
Medical travel is also a significant cost-driver for the system, totalling $30.7 million in 2012-13, though $12.4 million was paid for by third parties. Last year, HSS also spent almost $19 million on placements for Northerners in southern facilities unavailable in the NWT, a number that increased by 18 per cent from the year previous.
In order to cut costs, HSS is looking to distance health provision where possible. The Stanton health authority recently partnered with the department of psychiatry at Dalhousie University to provide tele-psychiatry to patients in need of psychiatric care.
Use of telehealth is also on the rise. The number of residents served by telephone increased from 1,614 in 2011-12 to 1,951 in 2012-13. HSS intends to increase the number of residents served by 5 per cent each year.
More children than ever before (87.5 per cent) are receiving social services in their home communities, along with those receiving home care. Those able to stay in their home communities for home care have increased from 1,973 to 2,071 in the last year.
Still, there have been delays in implementing a comprehensive and modern medical travel policy and program, and no-shows for appointments continue to be a problem. Though numbers of missed appointments decreased for specialists, no-shows for nurse practitioners and family physicians have increased.
2012-13 Operating Budgets by Authority
Beaufort Delta Health and Social Services Authority
Population: 7,000 across Aklavik, Fort McPherson, Inuvik, Paulatuk, Sachs Harbour, Tsiigehtchic, Tuktoyaktuk and Ulukhaktok.
Dehcho Health and Social Services Authority
Population: 3,400 across Fort Simpson, Fort Liard, Fort Providence, Fort Simpson, Hay River Reserve, Jean Marie River, Kakisa, Trout Lake and Wrigley.
Fort Smith Health and Social Services Authority
Hay River Health and Social Services Authority
Population: 3,800 in Enterprise and Hay River.
Sahtu Health and Social Services Authority
Population: 2,700 across Colville Lake, Dèlìne, Fort Good Hope, Norman Wells and Tulita.
Tlicho Community Services Agency
Population: 3,000 across Behchokò? Gamètì, Wekweètì and Whatì.
Yellowknife Health and Social Services Authority
Population: 20,900 across Dettah, Fort Resolution, ?utselk’e, N’Dilo and Yellowknife.
Stanton Territorial Health Authority (Yellowknife)
Population: It serves the entire territory, along with residents of the Kitikmeot region in Nunavut.