EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
Hon. George Hickes: Thanks again, Mr. Chairman and members.
I am pleased to present the Department of Health’s main estimates for fiscal year 2017-18.
As I had mentioned, I have with me Deputy Minister Colleen Stockley and Associate Deputy Minister Karen Kabloona.
For the 2017-18 fiscal year the Department of Health requests a budget of $353.39 million.
This represents an increase of $12.1 million, or 3.43 percent, from the previous fiscal year.
It also means the creation of 26 new positions.
The main estimates and business plan before you today will ensure clinical expertise and facilities are available to all Nunavummiut; continue the expansion of our mental health and addictions services; commence in the development of a territorial action plan for suicide prevention through the Quality of Life Secretariat; and as always, to deliver those services in an effective and efficient matter.
Mental Health Services
Mr. Chairman and members, the department continues to maintain a focus upon resources at the community level.
Health is progressing through the second phase of our mental health programming and services program which will help to expand mental health and addictions services across Nunavut.
Specifically Health is seeking 18 new mental health and addictions workers in 2017-18.
These are community-based positions that will provide direct mental health and addictions services to individuals and families across the territory.
The intent remains to expand and standardize community-based mental health and addiction treatment options which include medical detoxification, counselling and day programming, social-emotional learning programming for children and youth, readiness for substance abuse treatment programming, mental health monitoring and case management, treatment referrals, and peer support.
Mr. Chairman and members, in addition, the department will also aim to offer alternative service delivery options and approaches to enhanced services by increasing access to psychiatrist sessions via telehealth.
Public Health Nurse Capacity
Mr. Chairman, the Department of Health is committed to strengthening public health nursing in Nunavut.
It is recognized that strong public health programming and public health nurses are effective in both preventing illness and subsequently decreasing demands on community health centres.
Capitalizing on the enhanced capacity of new public health nurses in Arviat and Gjoa Haven delivered in the fiscal year 2016-17, Health is proposing to add two new public health nurses in Naujaat and Kugluktuk in fiscal year 2017-18 at a cost of $312,000.
Quality of Life Secretariat
Mr. Chairman and members, the Quality of Life Secretariat was created to coordinate the GN’s implementation of the Nunavut Suicide Prevention Strategy and to provide overall management support and leadership in suicide prevention.
In March 2016 the one-year suicide prevention action plan, Resiliency Within, was released to continue implementation of the jury’s recommendations, build on the successes of the previous action plan, and engage stakeholders in the development of a longer term action plan to address suicide prevention in the territory.
Health is proposing a dedicated and coordinated approach to the GN’s suicide prevention initiatives through establishment of the Quality of Life Secretariat.
The Quality of Life Secretariat will have a focus on:
Strategic planning, leadership, and coordination for the GN’s suicide prevention initiatives, plans, and strategies;
Management of a grants and contributions program for community-led solutions called Upigivagitsi Grants and Contributions Program; and
Management of a grants and contributions program specifically providing core funding for the Embrace Life Council and the Kamatsiaqtut Help Line.
Mr. Chairman and members, the department is seeking $6.63 million in funding to support the Quality of Life Secretariat.
This is inclusive of six new positions, $4.22 million in grants and contributions resources, and $1.45 million in new operational funding.
Model of Care
Mr. Chairman and members, there are ongoing complex challenges to delivering health care in Nunavut, including changing demographics and expectations, fiscal constraints, and a vast territory to serve.
As you all know, there is a need to review, assess, and modernize the current model of care to best suit Nunavummiut and to ensure that the right care is being delivered at the right time by the right provider in the right place.
The purpose of the Model of Care Program Enhancement project is to examine operational processes, focus on primary health care principles, provide timely access to services, and reduce overall health service delivery costs by improving program integration.
Mr. Chairman and members, this will help to improve patient experience through seamless program integration, equitable and timely access to comprehensive health care services.
The initial assessment phase of the project is currently ongoing.
Health is seeking $655,000 in 2017-18 to facilitate the second planning and implementation phase of the Model of Care Program Enhancement project.
Nurse Mentorship Program
Mr. Chairman and members, a key goal for Health is to develop a competent, sufficient, stable, appropriate, and well-supported workforce, particularly amongst the complement of nursing health care professionals.
Health is faced with chronic nursing shortages and requires an aggressive and strategic hiring plan to increase the number of potential candidates who are eligible to apply for nursing positions in Nunavut.
The department is seeking $1.17 million to fund the development of a nurse mentorship program. This will include funding to support Nunavut Arctic College nursing graduates through a one-year mentorship program.
A high-quality mentorship program is fundamental to the provision of safe, quality nursing care and to the integration and retention of these Nunavut-trained nurses.
Transfer of Elders’ Homes
Mr. Chairman, with a core mandate to facilitate the care of elders within the territory, the GN intends to consolidate all residential long-term care programming for seniors under the Department of Health.
As the initial step in this initiative, effective April 1, 2017, the responsibility for Nunavut’s three elders’ homes in each of Iqaluit, Arviat, and Baker Lake will be transferred from the Department of Family Services to the Department of Health.
Mr. Chairman, operational funding for these three elders’ homes amounting to just over $3 million will be transferred from Family Services to Health and will be used for service contracts and agreements to operate the facilities.
An additional $200,000 in capital funding from Family Services for minor capital maintenance projects will accompany operational funding transfer.
Mr. Chairman and members, as indicated, a priority for the department in the coming year is to enhance service provision to the most vulnerable of our population.
The department is continuing to work on long-term care solutions for our aging population, to help those requiring treatment by mental health specialists, to ensuring that the appropriate and efficient mix of services are provided to all Nunavummiut by an increasingly strong, competent, and complete complement of health care professionals.
Mr. Chairman and members, while we may face many unique challenges brought on by our geography, demographics, technological constraints and added expense, it is important to recognize the advances which we have made on behalf of all Nunavummiut.
I fully acknowledge that there will always remain more work to do and more positive outcomes to realize, but is through our collaborative efforts that we will continue to strengthen the foundation of our health care system and achieve our common mandate to the benefit of all in our territory.
In closing, our aim remains to provide the best possible health care services to the population of Nunavut.
We are committed in the development of a well-governed, integrated, collaborative, and quality health care system that is innovative and responsive to the needs of all Nunavummiut.
The department envisions and champions a health care system that empowers Nunavummiut to live healthy lives and is supported by a health system that embraces Inuit societal values.
Mr. Chairman, this concludes my opening comments. Qujannamiik.
Koana. Merci. Thank you.
Mr. Chairman, the Members of the Standing Committee on Government Estimates and Operations have reviewed the 2017-18 main estimates and business plan of the Department of Health.
The standing committee notes that the 2017-18 operations and maintenance budget for the Department of Health is approximately $353 million, which represents nearly one-quarter, 23 percent, and the largest share, of the government’s total operations and maintenance budget for 2017-18.
Despite an increase of over $12 million from the Department of Health’s 2016-17 budget, history has shown that costs for health care service delivery in Nunavut consistently exceed approved budget allocations. It is anticipated that supplementary appropriations for additional funding for the department will be brought forward as they have been in the past.
Mr. Chairman, the standing committee recognizes that the minister and his officials continue to negotiate with Health Canada in ongoing efforts to secure adequate federal funding with which to address health care needs across the territory. Members support the minister in his efforts to address the unique challenges of providing health services across Nunavut’s enormous geographic expanse, with limited and expensive transportation options and within the unique social, economic and demographic circumstances of our northern communities.
Mr. Chairman, the standing committee notes that in addition to providing basic health care and medical services for all Nunavummiut, the Department of Health also administers a number of focused health programs with specified federal funding, such as the Non-Insured Health Benefits Program for Inuit residents.
Mr. Chairman, the standing committee notes that a number of new positions will be added to the department in 2017-18.
However, members continue to express concern that many of the department’s current positions remain unfilled. The standing committee appreciates that there are significant challenges in staffing full-time health care positions and encourages the department in its efforts to recruit and retain full-time health professionals, especially in such positions as community-based nurse practitioners and public health nurses.
Members further encourage the department in its efforts to ensure that medical professionals hired from outside of the territory receive appropriate orientation and mentorship as well as ongoing cultural awareness and sensitivity training. The standing committee encourages the minister to work closely with his counterparts to ensure that the lack of housing is not a barrier to the successful recruitment and retention of health care professionals.
The standing committee supports the department’s ongoing efforts to increase resources and staff in such areas as mental health. Members look forward to receiving regular updates on initiatives which will address addictions treatment and programming at the community level as well as coordinated efforts related to suicide prevention activities and promoting healthy lifestyles.
Mr. Chairman, members appreciate that the department’s focus on updating its model of care is intended to improve the overall quality of health care and patient experience.
Mr. Chairman, over the years the department has made significant investments in such technology as the telehealth system. During his appearance before the standing committee to review his draft main estimates for 2017-18, the minister indicated that telehealth use will be expanded in all Nunavut communities within the current fiscal year.
Mr. Chairman, members have raised concerns about situations faced by medical clients who are sent out of Nunavut and away from their families to receive care. In particular the quality of services provided at out-of-territory boarding homes has been an ongoing issue.
Members have requested on numerous occasions that greater oversight be applied to ensure that contractual obligations are being met.
In addition, concerns have been expressed regarding the lack of Inuit language and other culturally appropriate services which are contracted to facilities outside of the territory.
Mr. Chairman, there is a growing need for long-term care services across the territory. The standing committee notes that the responsibility for elders facilities will be consolidated under the Department of Health following the transfer of three elders’ homes from the Department of Family Services.
Committee members look forward to receiving further information on the department’s long-term plans to support Nunavut’s growing elder population and updates on what steps are being taken to ensure that ongoing improvements along the continuum of care.
Mr. Chairman, health-related initiatives at the community level can be greatly enhanced with the support and participation of Health Committees of Council. The committee notes that 2017-18 funding allocations for health committees remain unchanged from previous years.
It was noted that additional support for Health Committees of Council could assist them in becoming more effective in undertaking the important role of promoting the health and well-being of their communities.
Seeing none, we will now proceed to the page-by-page review of the departmental estimates starting on page H-4.
Before we start, (interpretation) I just want to remind the minister and staff that we have to work through interpreters. Do not talk too fast so that everybody in Nunavut will understand you. Inuit smile, even if you don’t have any teeth.
Thank you. (interpretation ends) Health.
Directorate. Mr. Paul Okalik.
Mr. Okalik (interpretation): Thank you, Mr. Chairman. Welcome to all the witnesses. I don’t envy the department, but I’m glad that they are here to try to help.
I have some questions under Directorate. There was an inquiry conducted concerning someone who died here in Iqaluit.
I would first like to ask if this inquiry was fully carried out and depending on your answer, I will want to ask more questions.
I am fully aware that some questions can’t be answered immediately, but I want to hear more details about this issue first of all.
I didn’t catch the question
itself. I understand you’re talking about a coroner’s inquiry that was recently discussed, I’m assuming, in the media.
I think I know which one you’re talking about. Could the member clarify the question, please?
Chairman: Mr. Okalik, for clarification.
Yes, that is what I was referring to, the coroner’s report to the Department of Health. Have you reviewed that coroner’s report and what are your plans in regard to the recommendations?
Hon. George Hickes: Thank you, Mr. Chairman. I thank the member for clarifying that.
Mr. Chairman, I guess for all the viewing public, whenever an occurrence like this happens, it’s heartbreaking. I know members of the family under this specific instance and it’s a very difficult topic.
When I was first made aware of the coroner’s report coming out, I read it myself and some of the recommendations.
I do know officials within the staff are looking over the report with detail, looking into the circumstances surrounding the specific incident, and I know the media has been looking for comments from me as well.
There’s very little that I can talk about at this time with specifics to that case until the department has completed their review.
The majority of the recommendations from my first glance looked pretty straightforward, that there are obviously some gaps in the care provided in this instance.
We are looking at the specific details that led to this unfortunate incident, and my sincerest condolences to the family and to all the people that were friends of that person and for the family.
I thank the minister for having that reviewed.
When do you think that your department will be able to address the recommendations from the coroner’s report? I’m sure you’re working on that and we will be expecting it. When will the situation be corrected for all of Nunavut?
I would like the minister to explain as to when the recommendations will be implemented.
Chairman: Minster Hickes.
Hon. George Hickes: Thank you, Mr. Chairman. Just for the sake of the public and for all members here, we don’t wait to react to reports such as this.
When I look at the recommendations from the coroner’s report, there are a number of initiatives that the Department of Health has already been undertaking.
A quality assurance committee is being put together. We’re in the process of staffing, I believe there are three positions under that, to make sure that for one, through our model of care, we’re setting processes for our health care professionals to follow that are easily identified.
In the chair’s opening comments he talked about some of the orientations. That’s another thing that we have already identified that there’s a need to do a better job of orientating new and casual nurses and health are professionals to the territory.
With regard to specifically quality assurance, those steps are already being undertaken.
With regard to a specific date on when I’ll be able to respond with the report and recommendations, I can’t give that now. We just got the report earlier this week and I know it’s a very fresh, passionate and sensitive topic.
I know myself and I know my officials within the department want to make sure that we give that report its due diligence and make sure that any findings that we deliver after... . Within our report, like I said, there are a number of them that are already being actioned, but we will have further information in the fairly near future. I can’t commit to a date, Mr. Chairman.
I know this is a very touchy issue, so I’ll try to be patient and wait in regard to this.
You mentioned some programs and services. Looking at the business plan on page 121 at the top, it states that they will provide more training on cultural orientation for their staff and that they will provide that support in the offices.
Perhaps you can tell us when this plan will be completed.
I would like to ask that question because it’s included in the business plan.
Hon. George Hickes: Thank you, Mr. Chairman. Sorry for the delay. I was just confirming a couple of the details.
We are currently developing a standardized employee and clinical orientation program.
Like I had mentioned earlier, we recognize that there is a gap when new frontline workers come to the territory and it can be a challenge. They may have clinical expertise, but when you’re dealing with the public in Nunavut, there are certain cultural implications, practices, and considerations that need to be made and must be made for health care professionals coming to the territory.
We currently do have the employee orientation module building that cultural competency. It is being helped in the delivery by the Department of Culture and Heritage.
We currently do have seven trainers that are being trained right now.
We’re looking at working within our own human resources department on developing the recruitment marketing strategy that will allow us to be able to provide better education during the recruitment process itself.
It’s one thing to get employees here and then provide that orientation, but we want to make sure that potential employees that are looking at employment opportunities in Nunavut also know what they’re getting into before they get here, even before the orientation happens.
There are a number of steps that we’re taking, but it is also in conjunction with partners like the Department of Culture and Heritage, in addition to the Canadian Foundation for Healthcare Improvement, which is the basis of the orientation.
I know that if anyone is going to work in Nunavut, they should be aware of our culture because it’s unique.
Some people have very good patience, but patients know what they’re feeling when they go see the doctor.
Although they may be invisible, we know what the ailments are. I want the doctors and nurses orientated about that.
When are you going to be completing the orientation program for the new staff?
I appreciate that question. The first class of training that we’re looking at doing is in a little over a month from now in April.
One of the things that I really want to highlight under this is that when we bring up medical health professionals, the cultural component is very important, but in addition to the health competency component of it, there are practices, policies, and procedures in place that our health care professionals must follow. When there are gaps in that and when there is maybe a lack of understanding, that’s when situations arise that put people at risk.
That is a very strong component that we want to make sure that our health care professionals understand their roles and responsibilities, if there are any differences in Nunavut compared to other jurisdictions they may have worked in.
Like the member says, when somebody goes into a health centre, they’re expecting to be treated with care and dignity. Our goal is to make sure that that is being provided all the time.
Are there gaps?
People are human, but we need to decrease and make sure that those gaps are more infrequent. We want to make sure that the quality of care is second to none.
We can’t provide all levels of care in this territory, but we can get that early prognosis or that early visit and get it done right so that people know where their next level of care or where the next practice that they would need to participate in, in their own health care.
Following the business plan on page 121, fourth bullet, it states that they want to “ensure maximum beneficiary representation in the workforce.”
What’s the status of it now?
How many Inuit nurses are there now, and how are we going to train Nunavut Inuit to become physicians?
That’s what I would like to ask.
Unfortunately I don’t have the data specific to nurses, but we have set the target of 96 Inuit hired in 2016-17 and to date 73 Inuit have been hired in the targeted positions. We are trending above year-to-date estimates.
I just want to highlight some of the initiatives that we have taken.
We have been taking advantage of some of the new hiring practices that the government has put out for restricted competitions.
We have been very successful in bringing some of our long-term casual employees into indeterminate positions through that process.
There are a number of initiatives that the Department of Health has undertaken to increase Inuit employment and also to make sure that we’re not only meeting our targets but even the opportunity to beat those targets.
I will want to hear more in the future how many Inuit nurses we will have. I didn’t hear how you will recruit Inuit to become doctors and what kinds of training programs you plan for doctors. We would like to see Inuit doctors trained in the future who know their fellow Inuit.
What are your plans in regard to this issue?
Although I can’t control what line of work our graduates want to go into, I strongly recommend a health care field.
Some of the issues that we talk about, and recent media has highlighted, is the need for more Inuktitut-speaking medical professionals across the territory.
I strongly encourage our graduates to consider post-secondary education in the health field.
More specifically to the member’s question, it may not be so much Inuit hiring of physicians, but we do have partnerships with Memorial University to look at… . We bring in resident doctors or people that are in their training at the end.
We’ve already had, I believe, 27 physicians come through the territory in the last few years and we’ve had three sign on to indeterminate contracts so far just from that.