EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
At that healing centre they had a foundation of Inuit culture, language and beliefs. They had Inuit employees who worked at the healing centre and it was fully utilized by our government.
I heard that we did spend quite a bit of money.
Once it was closed, the employees were laid off.
Now I hear that there’s another centre that has been opened and will be utilized by Nunavut.
I have two questions that I would like to ask at this time, Mr. Chairman.
Have those people who were employed at the old healing centre been rehired by the new centre considering their experience? The clientele are specifically Inuit.
Does the new centre have the same Inuit culture and beliefs as its foundation?
My apologies; I don’t have all the numbers of positions. I do know that some of the staff did return and it’s under the direction of a board.
There could have been some staff not available, whatever the case may be, but there have been some rehires.
Again, part of my question was in regard to the new centre and I do know that it’s not under your responsibility.
Since we’re going to be using that new centre, are you satisfied with the foundation and if they will be using the Inuit culture and beliefs as the foundation of their organization?
I agree with the member. It’s very important to have culturally grounded healing, especially with people that are going through treatment or addictions or counselling that’s needed in that manner. It’s very important.
There’s a strong recognition more and more so, not just from Inuit but also other First Nations and other indigenous people across the country, that there is a need to have that grounded base of healing within your cultural parameters.
We’re still working with the facility that’s in Ontario.
I was just informed that there were discussions even this morning still. From the way I understand it, it’s just open to women right now.
We’re looking at how we can roll out more treatment availability to all of our residents.
I know I’ve had discussions with Natan Obed, the President of ITK, where he has brought up in presentations that there are no treatment facilities in any of the Inuit regions across the country.
I know the federal minister is very aware of that. When she was here a few weeks ago, it was a topic of discussion that I had with her on not just accessing more Inuit culturally relevant facilities but also looking at the potential of locating facilities in the territory with Inuit trained counsellors. Thank you, Mr. Chairman.
I have a question on page H-6 regarding various services.
There often is a discussion, for example, about medical professionals coming into our community for a very brief time and not everyone who wishes to be examined is seen.
I can use an example about my daughter’s two daughters who have been waiting two years to see an eye specialist without success. That’s just an example.
What are you doing to possibly extend the specialized medical personnel travelling to the communities?
What is your department doing about the special travel, be it dental services, eye care, or other types of services?
The member brings again a very important initiative that I wanted us to focus on very diligently, especially the specialized services for kids’ oral health.
I know the member is talking about the eye care team and a number of different specialists going into the communities.
We take a very close look at the waiting lists as they occur and examine ways on how to increase visits.
There is a mandatory amount of days in our contracts that the majority of specialists, specifically with eye care and dental care, have to spend in a community.
Our first objective, obviously, is to make sure that they’re maintaining that level of their contract.
I know the member is aware that a few years back where the federal government had contributed some access funds for kids’ oral health where a number of people from his community were flown down to a facility in Manitoba to receive the oral care that they needed.
There are a number of different communications that we have amongst ourselves on waiting lists and to see how we can tackle that.
In addition there are also opportunities for partnership with the federal government on specific initiatives.
Going to another subject, we try to be prudent about spending money.
One thing I usually bring up is the telehealth services where patients can be diagnosed and it seems like we’re not utilizing it enough.
Is it because it’s too expensive or we don’t have enough equipment to operate telehealth?
Maybe I just don’t know about it, but I don’t hear anyone saying that we’re fully utilizing telehealth.
Can you give us an update on what’s happening with that?
I was hoping somebody was going to ask me this question.
Telehealth is, I think, a perfect example of how we can provide better level of care for our residents without the necessity of travelling.
There are a number of different initiatives that are currently ongoing.
Some of the things that I’m really excited about is we have actually put out new infrastructure across the territory in almost all of the communities.
We’re still waiting for a few communities, but we have new cameras for ear, nose, throat and skin conditions that have been involved in all community health centres and training is ongoing.
One of the other exciting initiatives that have been undertaken is telehealth equipment in all the mental health offices in the community health centres specifically for mental health so that there’s no scheduling conflict for telepsychiatry and a number of different initiatives.
Are we doing everything that we can with the infrastructure that we have? No.
I’m the first and I’m totally open. I believe that we can utilize the telehealth technology in more expanded roles.
It’s something I know the director in charge of telehealth and I’m sure is hopefully listening and happy to hear that I’m a very supportive proponent of initiatives that they’re undertaking.
In addition to that we’re continuously putting business cases forward to be able to expand the service delivery through telehealth. I look forward to championing those business cases moving forward so that we can really take a look at a more solid benefit.
Just some statistics from April 1 to the end of November last year, there were 737 clinical sessions.
That’s not just somebody communicating from the health centre of somebody on medical travel maybe here to have a baby or something. Those are clinical sessions, which is equivalent to 4,000 hours of telehealth. Statistically we are increasing our use.
I believe, a couple of years ago when I was asking that question, it was up around the 2,500-hour range.
There are increased uses expanding on the infrastructure and I look forward to more enhancements to the program.
It’s not really under the health care service delivery, but I have asked this question on more than one occasion.
To remind you, Mr. Minister, we had a doctor in Pond Inlet who was the same doctor for the High Arctic, Clyde River, and I don’t know if Igloolik was involved, but Clyde River was one of the communities.
She had to leave for some reason and has not been replaced.
Since I became an MLA, I have been asking repeated questions about how we can be more prudent with our expenditures.
Since we don’t have a doctor, we have to send patients out of the community to be provided a service that they require.
It would be a cost-saving measure to have that doctor there. There are accommodations for that position.
Has your department considered possibly getting a resident doctor up in Pond Inlet or if you could possibly look at relocating one of the doctors to the High Arctic?
I haven’t been around long enough, I guess, to remember a physician travelling through the High Arctic.
The member probably knows a lot more about it than I do.
One of the initiatives that I am proud of that we’re undertaking is the nurse practitioner which has offset in Pond Inlet, as an example, 570 physician appointments just in one year.
The higher level of care that a nurse practitioner can provide offsets a lot of needed physician appointments.
I know that doesn’t really answer the member’s question. I do know that that will be a component of the model of care review that we’re doing as well, making sure that the right care is being provided at the right place by the right person.
That is something that will be examined.
I am very excited about the nurse practitioner that we have highlighted in the member’s community of Pond Inlet, and I look forward to more continued success on that program across the territory.
Welcome, Minister Hickes, Ms. Stockley, and Ms. Kabloona.
My first question has to do with mental health workers or psychiatrists.
Have they all been trained through the Uqaqatigiilluk! (Talk About It!) initiative?
They wouldn’t need that type of training through ASIST.
Just to clarify, they are actually trained at a higher level already where they wouldn’t need that lower level of training.
Chairman (Mr. Mikkungwak) (interpretation) Thank you very much.
Maybe I will ask it this way.
Are the mental health workers able to provide training on the Uqaqatigiilluk! suicide prevention initiative?
Chairman (interpretation): Thank you very much. Minister Hickes.
Some of them are trainers and more of them are becoming trainers right now. I believe there are 15, if I recall the number correctly, that are in a trainer program.
I also thank the minister for the clarification.
We would like to see more training made available to Nunavummiut.
Mr. Enook already spoke about telehealth diagnosis.
Last week in your opening comments you mentioned that psychiatrists are going to be providing more services to Nunavummiut through telehealth.
When will this be initiated? I don’t know where the psychiatrists are situated. How would they be utilized?
That technology is already being used for telepsychiatry.
It’s an ongoing initiative that we’re looking at growing more and more.
We have relationships with a number of southern institutions already, Sick Kids in Toronto as an example, where we have a good relationship accessing telepsychiatry sessions out of there.
There are additional facilities that we are looking at growing and increasing access to.
A number of different reasons, one it addresses some of the backlog that we have with our mental health workers on the clinical psychiatry side of things.
It just provides more access to our residents without the need for travel.
I’m on page 129 of the business plan.
Under Mental Health and Additions it was $24 million last year and you’re now asking for $26,986,000. It is increasing in the following years.
I appreciate the mental health programs that they are budgeting for, but how can it be improved in our communities?
Sometimes people’s health conditions don’t seem to change even after they see a mental health nurse and some of the clients think they need more help.
How are you planning to improve this in the future?
That’s going to be the focus of the 18 new positions that we are applying for under this budget.
We want to make sure that there’s more peer support at the community level where these workers are local people that are working that would be able to help people identify additional programming that they may need through self-identification in addition to clinical expertise identifying different programs that are available.
Again, if somebody feels that they’re not getting the level of care, if they have questions about their care, they can contact the clinician that they’re working with or they can also contact our patient relations office, which can get a professional to look at their file to adjust any methods or access to programming.
Chairman (Mr. Akoak): Mr. Joanasie.
Perhaps I’ll move on to something else.
He also mentioned the patient relations office for clients or when people ask for different services from their department. They can contact the patient relations office if they have an issue.
Mr. Mikkungwak also mentioned this. When people approach me, I just direct them to that office.
How has the operations of the patient relations office been to date?
Are they short-staffed?
Hon. George Hickes: Thank you, Mr. Chairman. It’s another question that I sincerely appreciate.
We do have three PYs under our patient relations right now, of which two are filled, but with the amount of volume that I keep sending them, I’m sure they’re going to be looking at applying for additional positions some time pretty soon.
We do have other languages. We have English and French right now. We do utilize other health care staff to provide Inuit language support.
The third position where we’ve got somebody targeted for and I’m really hoping that we can make it work out that has some clinical background as well as Inuktitut speaking.
I also thank him.
Some people are probably angry when they call the patient relations office.
How do they work with other people? Because anger does not help anybody, it won’t solve anything. If they’re in a bad situation and they’re too angry when they approach the patient relations office, has this been a concern at any time?
I was just conferring just to clarify part of my response.
A lot of times while the situation might bring a lot of passion to, the staff at the patient relations office very clearly and very early in the discussion is advocating for the patient to be able to make sure that they can understand and just help them navigate through the health care system.
There’s not a lot of anger that’s generated to them the majority of time.
It may start off that way, but they’re very good at calming the situation down.
Like the member states, acting in anger is not conducive to moving things forward in a way where people can get the services that they need.
It’s to identify an issue and to work with the patient and the health care system and team to make sure that the patient is getting the level of care that they need and deserve. That’s what our role is as the department, to make sure that people are getting the level of care that they need.
There are candid and I’m sure there will always be differing opinions on what level of service that somebody needs, but in general they work very well advocating on the patient’s behalf to make sure that the situation is resolved to the satisfaction of all parties involved.
Mr. Joanasie (interpretation): Thank you, Mr. Chairman. I also thank him.
If Nunavummiut had a complaint or problem with the level of service provided by the Department of Health, it’s not only the patient relations office that they approach. There are employees at the Tammaativvik Boarding Home and at the hospital.
Perhaps you should set up peer support. Sometimes nurses are approached at work if there was a complaint about them.
How can you get the residents in the communities, for example, to re-channel their anger and harness it for the better in the future?
I really appreciate the member’s question because I just remember seeing something even recently where it’s a national and probably an international issue of health care providers. The way they’re treated by patients in some circumstances is very worrying.
I’m sure the member and most members have noticed signage in health facilities in general on how important it is that there’s zero tolerance for disrespect and violence. We want to make sure that our staff are there… .
They’re there to try to help the patients or ourselves as circumstances arise.
We want to make sure that they’re treated with respect.
We work very hard in our cultural competency within our health care providers so that they can understand where some of this passion and maybe some of the anger come from and can work with the person in a way to alleviate their concerns.
Most people, I have found in life in general, but more specifically maybe in health, just want to be listened to with respect.
Whatever the issue that they’re going through, they want somebody to listen to them with sincerity and respect.
If people do that, it tends to tone any type of aggression down.
Health care staff, probably better than most, understand that and that is part of their everyday life to make sure that they’re dealing with the patients with respect and professionalism.
You answered my question.
Representing my constituency, they want to be treated exactly the same way by their health care staff or service providers.
Cultural differences can be a barrier, but before we become too far apart culturally, how can the community and health care providers get closer together? We all want to see the relationship improve.
I’m just commenting on that on behalf of my constituency because I hear it from them.
Respect has to go both ways.
Moving on to another area, in your business plan on page 129, the budget for medical travel has not changed.
What do you think about that? Do you feel the amount is enough or if it’s not going to be enough, what will be the reason for you to ask for another supplementary appropriation this year?
With medical travel it’s an as-needed expense, so it’s difficult to project until latter parts of the year on how much is actually being utilized.
That being said, the member is correct.
Last year there was a business case that was approved through the Financial Management Board of a $5 million increase to medical travel.
Again this year we are budgeted for around $64 million.
We’re projecting for this fiscal year to go to $73 million.
That’s, again, an argument we will have to bring forward in a business case for next year to look at either increasing the budget for it.
In addition, I think more importantly, is to identify ways to bring more efficiencies. Again, that’s going be a large direction with the medical travel review to hopefully identify further efficiencies that can offset some of the increase in travel.
I’m sure you track the number of patients who use the medical travel budget. Can that $64 million be broken down? It’s getting close to $64 million.
Is there any way you can break it down into medical travel patients and monies spent on escorts? Is there a breakdown of the two that distinguishes the amount spent on patients and the amount spent on escorts?
I know that in the 2015-16 fiscal year there were over 28,000 scheduled airline tickets that were booked and over 1,800 medical evacuations, or medevacs, like I had mentioned, at a cost of over $70 million.
I don’t have the number breakdown in front of me for escorts versus medical patient travel.
Again, it’s a continuous challenge that we have. I get challenged for not providing enough escorts and then I get challenged for spending too much on medical travel.
It’s a lose-lose scenario if you’re sitting in my seat, but at the same time we have to do what is best for the client. That is the focus of not just the review, but the focus of the department.
We don’t look for reasons to say no, but when we say yes, it has to fit within the parameters of the policy or through the individual circumstances to go through the appeal process to provide an escort.
As long as our elders have proper medical escorts, then the money is well spent. That is just a comment.
I’ll stop here.
The minister had 80 minutes of questions already, so he may want to make a break. We will take a 10-minute break.
>> Committee recessed at 17:53 and resumed at 18:06
Chairman: Welcome back to the meeting. We’re on page H-6.
The questions I was going to ask were asked. I just have a few questions, but I may have more questions later on.
The first question I have is that health centres have certain furniture and equipment. Who is responsible for them? Is it the health centre administration or the people responsible for maintaining them?
I would like to know who is responsible for that.
It would depend on what the equipment was. Some equipment has maintenance contracts associated with the purchase of them, but generally it’s the nurse in charge or the regional executive director that would continuously monitor any equipment or furniture needs to determine whether something would need to be replaced or repaired or could continue on the lifecycle.
Mr. Qirngnuq (interpretation): Thank you, Mr. Chairman. The reason I’m asking that question is after Christmas festivities in our community, some people were going home and there was a snowmobile accident. It was an adult with children and an elderly person had broken a leg or something.
It was in the middle of the night and there was nobody in the health centre at that time.
Emergency workers would have something like a stretcher. They don’t have anything like that in the community. Who would be responsible for something like that?
It’s a real challenge in some communities where we don’t have vehicles or the ability like an ambulance service to be able to go pick up residents.
I know on some occasions the RCMP attempts to assist.
Some communities do have an ambulance service where they have funded through the hamlet or municipality the purchase of a used ambulance and stretcher and of trained staff. Those are pretty few and far between.
I’m not sure how to answer the member’s question.
Even if there was a stretcher in the facility, which is my understanding that all of health centres have stretchers in them, to be able to go to the health centre, grab a stretcher and go back to the scene, there might be... .
I’m not sure if the volunteer fire department would have some initial first aid training and that type of thing where they can provide some type of splint support to get somebody to the health centre.
It’s an ongoing challenge across the territory and there’s no simple solution.
That is one of my concerns because it may happen again.
We don’t want it to happen again. It would be good if we had trained people that could handle things like that.
That’s a general comment.
The other question I would like to ask is on duty travel.
Is this treated like medical travel by health officials?
What committee or person decides on this kind of medical travel?
I would like clarification on this question.
If I understood the question, whenever somebody is travelling for medical purposes, if they don’t have an escort where they arrive first, if they were to be flying to Iqaluit as an example, there would be people from the boarding home that would pick them up unless they’re ambulatory, which they would be picked up by an ambulance.
What level of transportation would be provided would depend on where they’re going.
I’ll ask a question in English so that I can get a clear answer.
Who makes the schedule for medical travel patients?
Whenever somebody is travelling for medical purposes, they would work with the medical travel coordinator at the health centre.
In addition, we have a medical travel office that looks after some of the bookings as well, but it’s all coordinated with somebody local.
You didn’t understand me.
If a person is going to go to a health centre in the community, I’ll use myself as an example. I get into the health centre and I ask, “Can I get some help?”
Then they tell me, “The schedule is full right now. Can you come back at another time?”
Even though the rules have been changed this past spring and we don’t need to make appointments anymore or if you come in as a walk-in, does that mean you can do so without making an appointment?
That’s my question. Can people just walk in to receive treatment? That’s my question, Mr. Chairman.
Thank you for clarifying that question to the member.
Whenever somebody goes in, depending upon the staffing of the health centre, there are going to be different options as far as scheduling patients in and triaging people as they walk in.
The staffing would determine a lot of the parameters on how long in advance you would have to schedule an appointment or if you walk in off the street, they would take you in almost like an emergency room type thing where they would triage your need and evaluate whether you need to be seen immediately or whether you need to be seen later that day or whether it’s something that can wait.
There would be medical personnel triaging or deciding how urgent your level of care need is.
With regard to whether it would be scheduled appointments or to walk in off the street, sometimes in some communities we have challenges with staffing to make sure we have the full complement on duty, so that would dictate some of them.