EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
We’re on page H-6. (interpretation ends) Hon. Minister, (interpretation) at this time, I will give you an opportunity to provide responses to the earlier questions from yesterday so that we can all hear the information.
You have the opportunity now before we proceed. (interpretation ends) Hon. Minister.
Yes, we couldn’t provide the information yesterday members enquired about and we stated we would look into them.
First of all, with respect to the High Arctic and Repulse Bay medical travel delays and specialist visits to the communities where people can’t make appointments, what we can respond with on this issue is that we concur with the need for longer visitation periods so that all who need it are seen.
We will start planning the extensions, but I doubt that it will be done right away as we need to do more research to make these improvements.
We also heard yesterday about the Repulse Bay patients who are bumped off due to the airline focusing on freight delivery and not passengers, so we will meet with the airline companies and stress the importance of this service and try to have regular meetings. We will now work on that.
Another question was raised about the boarding homes where medical patients board in during their travel. They have to comply with regulations. Any boarding home has to comply with specific legislative requirements.
Further, if any patient were to be injured in the boarding home, our department has to be immediately notified. The regulations are primarily geared towards health and safety practices to protect the patients at the boarding facilities and they are inspected for compliance.
Yes, these meetings aren’t on a daily basis, but we will be looking at setting regular meetings, perhaps four times a year when inspections occur. That is what we have now planned.
Another concern was raised regarding mental health workers and whether they receive adequate training. The training fund was depleted. However, we are aware of the need to train more of our employees.
That is another plan we will work towards, a training plan for the mental health workers. We will use what are called in English (interpretation ends) training ladders (interpretation) to progress them through Arctic College.
We will plan this through Arctic College because we know that we need to conduct more training in this field.
Another question was related to the time period that doctors and specialists spend in the communities. From what I understand, 1,340 days was spent in Nunavut to date within this calendar year.
This is the total number of days they spend in all communities in Nunavut and as far as I am aware, this figure is also not adequate for our needs. We will need to revisit this in the future.
Another question was raised about the Non-Insured Health Benefits Program for aboriginal people and we know people are tired of waiting for this change as we try to complete our work, but we do know that it is a complex situation as this program is specific to non-insured people.
Additionally, this program is operated by another level of government, so we have to review this in a different vein. We also know it will increase the costs to this government, which is why it requires careful scrutiny. We have yet to finish this work, but we will continue to work towards that in the immediate future.
These are the main questions we couldn’t respond to, but I know there will be many questions from my colleagues.
Chairman (interpretation): I am also quite grateful for your department’s quick turnaround to the questions raised by the members yesterday and for your responses to them.
It is now easier to understand. On behalf of the members who raised those questions, I thank you as they will now be able to review these responses.
We will move on. We are on H-6.
I guess I’ll carry on from where I was in question period today.
Mr. Chairman, I realize I brought this topic up under H-4, but I would like to revisit it under the Health Care Service Delivery page because I believe it has an impact.
From the response to the written question that I had given the department to the minister in the last session, I spoke yesterday about 10 positions on internal assignment, of which almost three-quarters of them were quite senior positions.
I had mention yesterday on how it was a concern of mine that so many senior officials within the department were on an acting basis.
One of the concerns that I’ve got regarding the health care service delivery is that whenever there is an acting position, it creates a domino effect for the position below them.
If somebody moves up to fill an acting position, that position is empty.
If I take this under the numbers that I have in front of me of 10 positions in acting, really, there are at least 20 positions that are impacted, which creates even more work for the fellow staff at the lower level that report to these positions. Their work obligations are a lot higher.
I would just like to ask the minister: how many of these acting positions have been posted in the last six months?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) We post regularly, so I don’t have all that detail with me, but I know that we do have about 1,000 employees and 10 positions on transfer assignment. Yes, that’s too many.
Comparing the numbers, it’s a challenge and we are working with the Department of Finance to make sure that we fill up those positions that need to be filled.
We understand that it creates additional challenges when we aren’t able to staff up, so we are working with the Department of Finance on those areas. (interpretation) Thank you, Mr. Chairman.
I’m sure some of us come from the public service and I myself have worked in director positions in an acting capacity and I know, at that time, you’re dealing with a director’s position, it’s different than dealing, in my circumstance, it was policy.
When you’re a policy analyst or even a senior policy analyst, the directorship is still a different skill set that is needed.
What concerns me the most out of these is there are so many senior positions. There are at least six directors and ADM of operations. These are very senior positions within the department.
There is the territorial director of mental health and addictions.
You can’t take a mental health worker and all of a sudden assume that they’ve got the ability to direct the division. The executive director of Iqaluit health services, depending upon the position of where the individual came from, doesn’t necessarily give them the skill set to manage the Iqaluit health services across our whole city.
It brings a lot of concerns.
I would like to see a little bit more action on filling the positions and backfilling the positions underneath if the people that are in the acting capacity do end up with the indeterminate position.
It is more of a comment, Mr. Chairman. Maybe I will allow the minister to respond to that before I go to my next question.
Chairman (interpretation): Thank you. (interpretation ends) If you want, Hon. Minister.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I fully agree with my colleague that we need to create more stability and permanency within our workforce.
It is not that we are not trying. I have met with the federal minister. I have met with Canada’s Mental Health Association, for example.
We are trying to do what we can to find the best people for all the positions that we need in here in our territory. That will continue.
I appreciate my colleague’s concern and I share that very much.
I hope that within the coming year, we will be in a better position and that those indeterminate positions will be filled. (interpretation) Thank you, Mr. Chairman.
Chairman (interpretation): Thank you, Minister Okalik. Mr. Hickes.
Mr. Hickes: Thank you, Mr. Chairman. I look forward to seeing some progress in that avenue.
Mr. Chairman, I would like to go back to one of the questions from my colleague, Ms. Angnakak, who is travelling today, regarding patient relations office.
I think I understood where she was kind of going on the tracking process of completion.
Thinking about it overnight kind of made me wonder.
I understand that they are tracking the amount of calls and the purpose of the calls, but I’m wondering if they are tracking the successful completion or if there is a call where the patient was unsatisfied, satisfied, or very satisfied. I’m wondering if they’re rating that tracking.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) We haven’t had the capacity to survey our callers yet, but I think we track the successful results in some way.
We can get that information, perhaps. (interpretation) Thank you, Mr. Chairman.
I am sure Ms. Angnakak, myself, and the rest of the committee members will look forward to that information.
I had a question regarding some of the responses yesterday from the minister to my colleague, Mr. Rumbolt. If he doesn’t mind, I’ll elaborate a little bit on it.
In one of his responses to the 24/7 additional health care professionals, he stated that they are not looking at increasing more PYs, but looking at adjusting their hours to accommodate the level of care that they are providing now.
From my information, when we were looking at the allocation of the new PYs that are being applied for, I have listed 27 positions in health centres. Maybe if the minister could elaborate on which statement is correct.
Chairman (interpretation): Thank you, Mr. Hickes. Minister Okalik.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) As I said, the additional PYs will definitely assist us in delivering better services throughout our territory.
The nurse practitioners in numerous communities will assist in reducing the burden faced by our health care workers throughout the territory.
It has been very successful in Pond Inlet.
It will help us in relieving some of the stress faced by our nurses in those communities.
In terms of 24/7 care, we do offer it now. The nurses have regular hours from 8:30 to 5:00, but they are always on call and they designate a person who will be on call after hours, so they are on 24/7 for emergency cases.
I want to be clear on that. We are trying to work on adjusting the hours where they are busiest so that it reduces the overtime that they may face for the coming year.
That will take a bit of time, as negotiations with the union will be required on that. (interpretation) Thank you, Mr. Chairman.
Just to clarify the statement that you said that you’re not looking at increasing more PYs, you are looking at increasing PYs under this pilot program that was done in Pond Inlet.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) The pilot project in Pond Inlet was to look at improving services and diagnostic skill sets through nurse practitioners and that was very successful.
We are spreading it to the other communities so that we have those additional tools that will allow us to diagnose patients quicker and this will increase our capacity throughout the communities.
It’s not increasing the hours; it’s just providing us with an additional tool to assist the nurses on the ground. (interpretation) Thank you, Mr. Chairman.
With these 27 positions in the health centres across the territory, again I’m going to use that word I don’t like, Mr. Chairman, assume that you’ve had discussions with the Nunavut Housing Corporation on staff housing availability across the communities for these positions.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) From what I understand, there are five additional PYs for psychiatric nursing in Qikiqtarjuaq, Kimmirut, Iqaluit, and a shared position in Grise Fiord and Resolute Bay, one community wellness worker here in Iqaluit, and 22 positions in Cambridge Bay for residential treatment.
Those are the 27 I believe my colleague is referring to. (interpretation) Thank you, Mr. Chairman.
I sincerely thank the minister for clarifying that for my information, but maybe he could elaborate on the discussions regarding staff housing allocations that are going to be needed for these positions in the communities.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) From what I understand, a lot of these positions are there already and some housing has been provided to them already. I think that the issue of housing has been addressed. (interpretation) Thank you, Mr. Chairman.
Just to go back to a response from Mr. Rumbolt again yesterday, he had asked a question regarding, and I’ll quote from the Blues, “…I wonder if you can explain why your department needs another $5.56 million in order to provide a service that you’re already providing.”
In the response, the minister is quoted as saying, “Those are more monies that may be needed to deliver the service.”
I have been in this position for a little over a year now, but I don’t think we approve monies too often that may be needed.
Maybe if the minister could elaborate a little bit more on the need of those dollars.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I thank my colleague for that question because we’re trying to stay ahead of the curve.
My colleague may be aware that on average, the Department of Health requests an additional supplementary appropriation of about $20 million a year, on average pretty much.
We’re trying to get ahead of the curve and look at our actual spending on overtime and other things that we face throughout the year. We’re trying to stay ahead and hopefully we may have less or hopefully none for a supplementary appropriation in the coming year.
We’re trying to stay ahead and actually ask for the money that we may need for the coming year. (interpretation) Thank you, Mr. Chairman.
I know I have gone on rants before in this legislature on the need of coming back for supplementary appropriations from all departments, but I have specified the Department of Health in the past.
I still have a question regarding the dollar amount.
If it’s anticipated that there is that much overtime being used or needed on an annual basis, why aren’t more PYs designated to offset the positions so that you’re not having to have staff work so much overtime?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) We try our best and hire as many nurses as we can.
With this budget, it will assist us in hiring additional support for nursing which will definitely help us in relieving some pressures.
As I said, we are looking at reducing overtime, but that requires more discussion with the union so that we can reduce the amount of overtime.
We are looking at innovative ways to try and adjust our ways in reducing the dollars that are expended at Health. (interpretation) Thank you, Mr. Chairman.
If the Chairman will allow me a little bit of flexibility here, as the minister brought up supplementary appropriations, I realize it’s not under this budget line.
Is there an anticipated supplementary appropriation that is going to be coming to the House from the Department of Health?
Chairman (interpretation): Thank you, Mr. Hickes. (interpretation ends) Hon. Minister, it is your discretion.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I just want to ask: are we projecting for next year or this past year?
I just want clarification. (interpretation) Thank you, Mr. Chairman.
Chairman (interpretation): Thank you. (interpretation ends) Clarification please, Mr. Hickes.
Mr. Hickes: It’s both years.
Chairman (interpretation): Thank you. (interpretation ends) Minister Okalik, your discretion.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) There will be a request for this past year, but as I said, we are trying to keep the numbers as low as possible for the coming year by planning ahead.
That’s what we are trying to do and we are trying to avoid supplementary appropriations hopefully for the coming year. (interpretation) Thank you, Mr. Chairman.
I’m going to jump now to the same page that Ms. Angnakak brought up yesterday in the appendix A-IV-2, Detail of Projects Funded under Third-Party Agreements. The very first header under that is the Health Portfolio Wellness Contribution Agreement.
According to the main estimates, this amount will be decreased for 2015-16 despite an increase in the revised estimates amount from 2014-15 of almost $9 million.
How is this amount of federal funding provided for this program determined?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) From what I understand, on April 1, 2012, Health entered into a five-year funding agreement with the First Nations and Inuit Health Branch of Health Canada for community-based wellness programs.
Communities have been and are provided with the opportunity to access multiyear funding for community wellness programs upon receipt of their community cluster plans and further proposals.
Funding from Health Canada (Northern Region) totals $87.5 million over five years.
Under this agreement, Health has the ability to move unspent funds from one fiscal year to the next until March 31, 2017.
At the outset of the agreement, the funding was broken down to approximately $17 million per year. However, various budget adjustments have been made throughout the year.
In addition, as Health has the ability to carry forward funds, the total yearly amount expended may be higher or lower upon the amount that may be estimated.
This accounts for the differences between 2014-15 and 2015-16, as presented, on the Health Portfolio Wellness Contribution Agreement line under H-8.
That’s what I have so far. (interpretation) Thank you, Mr. Chairman.
Chairman (interpretation): Thank you, Minister. Mr. Hickes.
I appreciate that response and I’m pretty sure I understand, but maybe just for clarification, the main estimates in 2014-15 estimated a little over $19 million coming in under that and the revised estimates came up to a little over $26.5 million.
Those are monies that were expended that fell under the criteria of this fund, so the federal government funded it.
Hon. Paul Okalik: Yes. (interpretation) Thank you, Mr. Chairman.
Chairman (interpretation): Thank you. (interpretation ends) Yes, Mr. Hickes, go ahead.
Mr. Hickes: Short and sweet. Thank you.
If only my questions were so short sometimes.
Mr. Chairman, I would like to touch on the Medical Transportation Division. Since the 2014-15 budget, the amount hasn’t really increased or decreased and yet, I know that in this House, we have talked about a number of different initiatives, the CT scanner, telehealth, to offset some of the medical travel.
What steps have been taken to better predict the cost in this area, and how are some of those initiatives working if we’re not seeing the budget amount decrease?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) The benefit of the CT scanner is that it allows us to get an earlier diagnosis and allows us to provide earlier treatment in a lot of cases. It may not reduce the amount of travel, but it allows us to diagnose earlier, which might also increase travel to Ottawa, for example, to get proper treatment for the patient.
That’s probably why you don’t see a lot of reduction in travel there because we’re actually just improving our services.
The earlier we treat diagnosis, the better the result for both the patient and our department. (interpretation) Thank you, Mr. Chairman.
Mr. Hickes: Thank you, Mr. Chairman. I’m pretty sure I know some of this information, but maybe if the minister could… .
I’m going to talk specifically about cancer identification and early treatment.
It has been brought up a number of times in the legislature here that too often, our residents, by the time they find out they have cancer, it’s too late to treat in a manner other than extending their life on a short-term basis and it’s too late to eliminate the cancer in their bodies.
What steps is the Department of Health taking in early identification of cancer?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) The CT scanner has definitely assisted us in providing an earlier diagnosis. For example, we will probably have sent about 300 patients to Ottawa for the same type of test.
We have done about 1,300 tests here in Iqaluit, for example, which allows us to diagnose earlier and easier in our territory.
It definitely has helped us in providing a better service for those who may be at risk. (interpretation) Thank you, Mr. Chairman.
One of the priorities in the business plan, and sorry I don’t have my page open to it, but in the 2015-16 portion of the priorities in the business plan, it speaks to developing and “pilot a primary care model at the Qikiqtani General Hospital.”
Can you describe what kind of model is currently in place at the hospital, and how a primary care model will change the current way services are delivered for Iqalummiut?
Hon. Paul Okalik: We’re just trying to locate the page at this time. (interpretation) I’m sorry.
Thank you, Mr. Chairman. (interpretation ends) What we are planning to do is to assign a team to each patient, which will allow for continuum of care. If one of those team members cannot attend to the patient, at least an additional person will be able to assist in caring for that individual that requires treatment or some medical work. (interpretation) Thank you, Mr. Chairman.
That partially answered my question, I guess, but I’ll leave it at that for now, Mr. Chairman.
I’ve got another question that I would like to get to.
On page 110 of the business plan, it talks about the budget for Hospital and Physician Services increasing from $71.7 million to $75.5 million.
Have the costs for services increased under this category or are more services being delivered?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) As I said in my opening comments, the CT scanner, for example, has been a very useful tool for our hospital and we will need additional resources to support it like a scheduler and additional technicians to work the scanner, so this budget reflects that. (interpretation) Thank you, Mr. Chairman.
Chairman: Qujannamiik, Hon. Minister. (interpretation) Mr. Hickes, you have noticed that your time has run out.
I will recognize other people for now and I will get back to you.
I’m going to go to another member.
I also will hand over the Chair at some point so I could ask one question, but I want to ask a question.
Some people say “tarraqtuutiit” in Inuktitut for the CT scan, but you say that it is quite useful.
I would like to ask this question. Because it is based in Iqaluit, perhaps there will be one in the Rankin Inlet Health Centre or the Cambridge Bay Health Centre. Are you having that in your plans in the future?
I wanted to ask that question.
I realize that we all know the usefulness of it and how it could be used in other communities.
We are looking into that, but right now, we are also looking at it in terms of Iqaluit only.
Mr. Sammurtok (interpretation): I don’t think they want to hear my question.
What I want to ask about is the (interpretation ends) home care providers. (interpretation) In our community, I sometimes listen to the radio and hear about the facility and that has now closed.
I want to know if this program is successful throughout Nunavut. That is what I want a response on.
Yes, this program has provided a benefit to our department and we haven’t identified it as a concern as we are quite satisfied with the operation of this program, as it provides tremendous benefit to people with disabilities and elders. This program has been successful.
I want to move to a different item.
With respect to our elders, yesterday, you were reading a statement where I believe you stated that there are possibly 30 elders in Nunavut still waiting for this.
In Rankin Inlet, while you were speaking, I wrote down a few notes with a (interpretation ends) rough estimate. (interpretation) I believe we have at least seven or more elders who require assistance.
What plans does your department have for the Kivalliq regional (interpretation ends) elders care facility?