EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
The department is also recognizing that we also need to increase other medical professionals, not just in nursing. It is going to be looking at human resource plan in this upcoming year to make sure we include that we have trouble recruiting for ultrasound, individuals, lab techs, and those fields.
Hopefully the strategies we develop will incorporate a lot of those, and not just doctors and nurses.
I thank Ms. Keenainak for that answer.
As she stated, she works closely with Arctic College so maybe can you give us an update on the number of Nunavut nurses expected to graduate from our nursing program this year and whether any or all of them will come to work for the government of Nunavut?
Chairman: Thank you. Minister Ell, do you want Ms. Keenainak to respond?
Hon. Monica Ell: Yes, Mr. Chairman.
Chairman: Ms. Keenainak
Ms. Keenainak: Thank you, Mr. Chairman. Currently, there are 20 students registered in the nursing program; nine are beneficiaries. Five students are in first year; two of which are beneficiaries.
Ten students are in second year; six are beneficiaries. Three students in third year; no beneficiaries in that. Two students are in fourth year; with one beneficiary.
The department is also sponsoring a long-term northerner to take that nursing program as well so we are encouraging that program.
We hope that all of the nurses will work for the Department of Health at the end of their studies.
The way it has been operating, the students are asked what section of the health centre or hospital they would be interested in, whether it’s acute care or if it’s home care or a different part, and then we talk to them to see what capacity we have and then place them in the health facility with the department of health.
There’s rumour that graduated nurses from our nursing program have trouble getting on as a nurse with the Government of Nunavut. Can the minister clarify whether that is true or not?
If one of the nurse graduates passes the national exam and is ready for employment, will the Government of Nunavut hire him or her as a nurse upon graduation and upon passing the national exam?
When they graduate and when they pass their national exam, the Nunavut government does want to hire them.
I thank the minister for making that clear.
I’m happy and glad that we will hire them as soon as they are done.
On a different matter, recently the reports have focused on medical travel clients being sent to the southern health centres only to find that their appointments have not been booked.
I know of this happening twice in constituency of Arviat. It was in the media that this older couple went down four times and all four times the appointments were not booked.
Recently, a few weeks ago, a different older fellow got shipped down to Winnipeg, and the same thing happened. He got to Winnipeg and he had no appointment. Not only is it bad for the elders to do that.
There is a whole lot of money that is being thrown out the window.
What efforts are being made to address this lack coordination and unnecessary expense?
Yes, that is an issue across Nunavut.
It’s an issue of coordination and communication between the health centre, the referral sites in Ottawa, as well as medical travel. It’s a number of office and individuals, in terms of coordination. We flagged that as an issue.
There was a recent workshop in Rankin Inlet where Health Canada, WSCC, medical travel folks in the departments, and we also had a senior management meeting at the beginning of April where we also brought in all the senior managers from all the regions to talk about medical travel.
That is something that we are going to be working on, in terms of making sure that there is better coordination between all the individuals and people that are involved in that.
I’m aware that Member Rumbolt has identified that as well in previous sittings.
We’re striving to work on that and the minister had committed to doing a review on the medical travel policy, but we’ve also included the case managements, as well as the referral system on that to try and deal with some those issues that you’ve identified.
Can the minister indicate if this a manpower issue or a communication issue?
Minister Ell.  Hon. Monica Ell: Thank you, Mr. Chairman.
It could be both. It could be the manpower and the communication. It could be one or the other or both.
Chairman: Mr. Savikataaq.  Mr. Savikataaq: Thank you, Mr. Chairman.
That’s an unexpected response because you’re just stating now that you have no idea why there is a problem and why clients are being sent to the south and not getting treatment. Can you just elaborate a bit more?
We can’t really answer that question without having specific cases.
It’s a case-by-case basis.
I can’t say that this person had an appointment and missed it because of this reason when another patient could have a different reason for having an appointment that might have been cancelled for some reason.
Mr. Chairman, I can’t answer that. Thank you.
You would think that someone in the health profession, maybe at the nursing station, would call down and say, “So and so is leaving. Does he or she have an appointment to go to when they get to the medical facility?”
Something as basic as that is not being done.
Can you please just clarify whether someone at least makes a phone call to say, “So and so is coming to Winnipeg or Ottawa or wherever for an appointment.
Do they have an appointment?”
As part of the study that we’re going to be doing into why these happen, it will definitely be included.
I take it, then, until the study is complete that patients will keep unnecessarily being sent to the south for appointments they don’t have.
I’ll have Ms. Keenainak answer that question.
The amount of volume that we deal with in terms of medical travel is quite high. I think that the majority of medical travel appointments do go okay.
There are some cases where there are issues of coordination, as you have indicated, but I think we recognize that that does happen periodically and that’s why we’re trying to do the review and trying to streamline some of the processes so that kinds of things will be minimized.
We will not completely eliminate issues like that, but we hope that we will be able to minimize them in the future.
I’m not in the health profession at all, but until you have studied this problem and figured out what the problem, wouldn’t a good interim solution be just have the nurse-in-charge call the facility where the client is going and check the day before the patient leaves to see if there’s actually an appointment?
Yes, they do always make checks, but we can’t tell you that on a specific day, a specific nurse did so and so or a specific patient did that on that specific day.
We do have a grievance system where these could be dealt with, what we call Patient Relations.
The individuals could go to those and check it to see what caused them to have miscommunication.
I can’t specifically tell the member a specific case.
Next on the list, Mr. Enook.
Good afternoon, minister and your staff.
I think we’re on page H-4. Can you confirm whether we’re on that page?
I don’t have the Inuktitut copy. I figure that human resources are included in here.
If I am out of order, please rule me out of order.
Yesterday, it was confusing as to what specific terminology would be used about mental health nurses and psychiatric nurses.
What level of education would a mental health worker need?
Hon. Monica Ell (interpretation): If you’re talking about community mental health then they could have less of an education but a professional would need to have a professional education.
Chairman: Thank you. Mr. Enook.
If I was a person with an illness of the mind and would like to be treated, would I be a hard person to treat?
Secondly, we talked about psychiatric nurse, a mind doctor, so to speak. I’m trying to determine what the differences are between a mental health worker and a psychiatric nurse? Is there a difference?
I do not have the job descriptions in front of me, but a psychiatric nurse is a profession.
They need to have professional requirements and the person that would be working with them in the community would be called a community health worker to support the psychiatric nurse.
The community mental health worker would not be required to have certificates or diplomas.
They could be hired from the community and trained with a psychiatric nurse with on-the-job training.
Let me try to frame my question like this; why must all communities have both of these two positions?
Today the psychiatric nurses aren’t hired from the communities, and they’re not local residents.
They are usually professionals.
We have more of those mental health workers in the communities. This is the way we look at them.
However, in the future perhaps they may be able to obtain training in the field of psychiatric nursing so that they could deal with people with mental health issues whose lives are affected by illnesses of the mind.
We are looking at the cooperation of those two positions as being desirable for the future.
I respect job opportunities. However, I am also aware that we should not be throwing money around just to have somebody working in a health centre.
Perhaps I should ask, in relation to the first priorities, like the psychiatric nurses that we need more money to be throwing into this field because they can really do something with people with mental illnesses. Are we utilizing our resources wisely? Are you saying that both positions needed to be in the community, the psychiatric nurse and his or her assistant?
At the present time, there are already psychiatric nurses in the communities, there are also community health workers in the communities, just not in every single community.
I said yesterday, I talked about community health workers and that there are community health committees in many communities and they are able to provide advice in other areas.
We hear in larger communities we do know that people talk about trauma in relation jealous rages. People have gone through the court systems where couples have trouble.
There need to be those kinds of professionals that deal with these kinds of extreme cases and they could also utilize advice from communities’ committees that know the community very well.
The Hon, Member, do you believe in that? You have more education than me…if you really believe this from the heart, it’s okay.
If you guys figure that you are spending money wisely, so be it. I am not going to say that you are wasting your money. However, Mr. Chairman, may I now move on to some other subject?
I think it is in here, like general policies. Where are we?
If I could ask a different question, Mr. Chairman, in reference to what I have stated previously, any questions that I have asked earlier this winter, I would like to go back to the travel policy.
I know that you will be reviewing it and that you will be coming with a golden rule in relation to medical travel.
However, in reference to the unilingual Inuit and I am aware and happy that whenever possible I hope that you can answer me in Inuktitut, too, by the way so that those who do not speak English or use English as a second language can understand.
I’d like to ask in reference to whoever will be going on medical travel and do not speak English or are not fluent in English…
Can he ask that question when we get to H-5, so that we could go more smoothly as we are on page H-4.
Chairman: Thank you. We are on H-4. Development of Legislation and Policy Directorate.
Continuing on my line of questioning that I have asked policy that I wanted to ask about before I was interrupted, the first question I have it seems that it is applied differently.
Let me; therefore, ask again who has the final say in terms how the total policy should be interpreted.
In relation to the policy on medical travel, only a policy… . Which one are you talking about? Are you talking about the medical travel policy?
I didn’t want to speak in English but for clarity’s sake. (interpretation ends) I’m talking about your escort travel policy. (interpretation) I’m talking about medical travel escort policy.
Hon. Jeannie Ugyuk (interpretation): The question from the Member for Tununiq, once we go to the next page he should ask the question when we get to that particular item.
Right now we’re on H-4, page 98 and 99, and your question is on page 103. You’re getting into healthcare services delivery. We should follow the pages as we’re going.
Chairman: Thank you. Health. Branch Summary.
Directorate. Development of Legislation and Policy.
I think that’s where Mr. Enook is. Mr. Enook.
Mr. Enook: Thank you for that ruling once again. I shall try and continue. (interpretation) I shall try to continue. When you are a unilingual Inuktitut speaking and can’t speak English, and you have to go to the hospital…Let me rephrase this.
Who has the final say as to if that patient is eligible for an escort or not?
The policy that was set last in June 27, 2013, we’ve been referring to it. The Medical Travel Patient Policy states that anybody can complain if their travel didn’t go the way they wanted. If that person was going to need an escort and they were not treated properly, they can complain to that group that we have been talking about.
Medical travel escorts are approved by the regional directors. The regional directors have the final say. If patients have a complaint about their request for an escort, they can go to the regional director and they can complain to the regional director.
If that doesn’t satisfy the client, they would have to be provided with a response in less than 10 days.
If the patient is not satisfied with the response of the regional director, then the matter would be referred to the deputy minister and the deputy minister would have the final say.
If the person is refused an escort, if anyone is going out for medical is refused an escort, can that person go through the entire complaints procedure?
Can that all be dealt with before that patient has to travel to the south?
Yes, we would want to settle the matter before the patient has to travel.
To make it absolutely clear and so that my fellow unilingual Inuktitut-speaking people will know, what you’re saying is that it would be good if the system ran like that. It sounds like it may not run like that all the time.
I don’t have a magic scope that will help me see into the future.
I can’t say that that will not happen. We don’t want things like that to happen. We want to have good expectations of these things not happening.
I don’t have a magic scope that will help me see into the future either, but we have actually witnessed it.
Things become clear, things become near, and we can see them without a scope.
I have seen it.
Let me ask it this way, Mr. Chairman. With respect to any patient who has to go to the hospital who can’t speak English, what are the criteria for getting that person an escort?
The policy that was approved on June 27 has sections in it that refer to different circumstances.
If the intended destination of the medical travel patient has no interpreter, then they would require an escort.
We all have different dialects.
For example, Sanikiluaq people have their own dialect. A lot of times, we can’t understand what people from Sanikiluaq are saying.
For cases like that, if there’s not going to be an interpreter down there, he or she can get an escort.
If the patient is too young, the person has mental problems or physical problems that they need help, or they need help getting medication, or going to the doctor, then they would qualify for an escort.
Let me request a clarification on this.
So anybody who cannot speak English has to go to the hospital, can they bring an escort that they will not use as a translator or interpreter?
For example, if the patient is below the age of majority and the escort needed to sign papers on behalf of the parents or if the patient needs a translator in the hospital where they are going then they can bring a translator; however, if the person sent as an escort for the intention of him or her being the translator then they would have to be the translator down there.
Maybe you did not understand my question. Let me make it clearer.
Let’s say an elder who cannot speak English has to go to the hospital here in Iqaluit or in Ottawa; can he bring an escort even though that escort will not be the translator because there are already interpreter-translators both here in Iqaluit and in Ottawa?
I cannot say yes or no to that.
People have different reasons for going to the doctor.
If that elder had to leave and the escort has to help with the doctor visit, the escort has to know what procedures will be done to the patient.
The patient can have a translator in the hospital destination or the escort can act as an interpreter as well.
We cannot say right off the bat whether a patient going to the doctor will need an escort or not. It is all different circumstances.
Let me ask this question.
In your policies it states that there are interpreters in the regional centers in the hospitals of the regions and also down south; therefore, because of that, they do not need to bring a translator to go to a hospital, and, if that is the case, it does not seem to be necessary to bring escorts that speak English because there are already translators in the regional health centres so then the escort can just be an escort.
Some destination doctors do not have translators. For example, Yellowknife does not have an Inuktitut translator on staff so they have to bring their own escort/translator.
What about going to Iqaluit?
There are interpreters here in Iqaluit.
For example, if I was coming from Pond Inlet and I’m going to Iqaluit for medical and if I’m able to have an escort is it ok if my escort speaks English or Inuktitut? They do not have to really speak English or Inuktitut?
If the person going on medical travel only speaks Inuktitut and has to get some medical advice, they have to have an interpreter.
Even though there are interpreters at the final destination, the escort has to know how to speak English.
Chairman: Mr. Enook
It seems like you are breaking your own policy; you say that if that individual is going to Iqaluit for medical treatment and they already have interpreters over here in Iqaluit… it seems like your policy states that you have to have an English-speaking escort.
There are a lot of people that go for medical treatment in various locations.
We cannot really tell because it is a case-by-case basis.
Wouldn’t it be better, Ms. Minister, if it goes case-by-case, wouldn’t it be better if you did not have a policy at all?
There have to be guidelines to act as a framework.
It’s on business plan, page 99, for 2013-14.
It’s on business plan, page 99, the very first bullet.
Chairman: The very first bullet I have is “Complete and implement the health services strategic plan based on the health care gap analysis…” Is that what you are on?
Mr. Mikkungwak: Yes, Mr. Chairman.
Hon. Monica Ell (interpretation): George Hickes asked that same question; my response was that we have not finished the strategic plan.
Yes, it was asked.
As a member from a different community, all of the Members of the Legislative represent different communities and our communities have different populations.
How are you going to be doing the strategic plan? You deal with patients and to make sure that the people that get medical attention are looked after properly.
We are planning, at this time because they are going to be dealing with the strategic plan in six months.
We are also continuing to do the strategic plan.
My follow up to that response is in regard to my community; in the last several years we had forced growth due to industry. Was that taken into consideration regarding this matter?
That will be part of the consideration.
Mr. Mikkungwak: Thank you, Mr. Chairman. I thank the minister for the response.
Moving along on the very last bullet there, on the particular priorities again, considering revisions to the Nunavut nursing recruitment and retention strategy; I understand one of my colleagues did ask a question in reference to this, but my question is, with be what revisions will be occurring, will that be based on quality of services to Nunavummiut or will that be based on number of people served in Nunavut?
We are looking at both.
Mr. Mikkungwak
Mr. Mikkungwak: Thank you very much, Mr. Chairman, and thank you for the answer.
In reference to professionalism provided to the medically healed Nunavummiut, how will the professionalism aspect be looked into further?
I would like to ask Ms. Keenainak to answer the question.
As part of the strategic planning for the department, one of the things we’re looking at is quality assurance, and that is looking at clinical standards particularly for nurses.
The Registered Nurses Association from the NWT and Nunavut just recently met here. I’m hoping that we will be able to work with them a little bit closer, because they’re the ones that actually licenses the nurses.
Those are the kinds of things that we’re looking at in terms of clinical practice for nurses. Doctors have their own College of Medicine as well.
Mr. Mikkungwak (interpretation): Thank you, Mr. Chairman. I thank Ms. Keenainak for the answer.
My follow-up to that question will be is how often are the evaluations done that the nurses within our territory are providing professionalism to their clients?
I’ll ask Ms. Keenainak to answer that question.
The Government of Nunavut has the performance management system, and ideally, the performance evaluation should be done on an annual basis, taking a look at their job description and also their work plan. If there were areas of concern, those have been done more frequently. It depends on case by case, but the performance management is about once a year.
Mr. Mikkungwak: Thank you, Mr. Chairman. I thank Ms. Keenainak for the answer.
The reason why I asked that was a number of my constituents have been filing complaints and I believe I can address those matters with the department.
Moving on, that middle bullet there, the one just above that, Office of Public Relations, has the department taken into consideration of possibly expanding the employee staff level or will it be status quo?
Right now, the Office of Patient Relations that was announced last year on July 12, 2013, has three patient relations positions: one in Cambridge Bay; and two in Iqaluit, which are staffed by beneficiaries.
This office has not been in operation for one year as of yet. There are no plans at this time to change it.
On your priorities for 2014-15, review and revise the Extended Health Benefits Policy. Do they foresee substantial changes, or is that part of legislation?
The review will focus on four areas:
Administrative efficiencies, such as updating claim forms, applications, and better communications of the program;
Accommodation and meal allowance rates;
Clearer definitions of chronic conditions benefits; and
Incorporation of health benefits for non-aboriginal social assistance clients, such as emergency dental, medical travel, and medical supplies and equipment.
As well, health has completed a jurisdictional scan to ensure that Nunavut’s Extended Health Benefits are comparable to other Canadian jurisdictions.
Mr. Mikkungwak: Thank you, Mr. Chairman. Thank you for the answer.
Looking at their 2015-16 priorities under the same section again, begin legislative process to introduce health-specific privacy legislation. Do they foresee in the near future a specific health problem?
I will ask Ms. Keenainak to answer the question.
The Nunavut Information Privacy Commissioner actually recommended to the Government of Nunavut that we introduce health-specific legislation because of the complicated issues around personal health information.
The jurisdictional scan that we have done shows that other Canadian jurisdictions have it, and the NWT has it as well.
We are hoping to strengthen privacy issues around health-related information, over and above the age of legislation.
That is the purpose of this one.
Right now, one issue that came up around electronic health records, we did work with the commissioner and introduced security and privacy directive as part of the project.
Chairman: Thank you. Please keep in mind that we have translators who need to keep up.