EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
There are rates that are set by the Non-Insured Health Benefits which mainly pay for all of the costs of Nunavutmiut, mostly those clients who are taking advantage of these boarding homes.
The rates are set by the federal committee, which includes NTI, Health and Social Services, and the federal government and they do differ from region to region.
Our finance official may have the record here, but that’s not for her to provide. I can provide you with more details in a number of ways, but I’m going to try and see if our finance officer has information on that.
When our clients are housed in hotels, it’s due to overflow at the boarding facility.
The boarding facility is actually responsible for making the arrangements with the hotels, so we in turn actually still fund the boarding facility at the same rate and the boarding facility is responsible for the payment of any hotel costs for the overflow clients at this time.
So we pay at the same rate.
So if you are funding a boarding home for all of the monies and the boarding home is responsible for providing the hotels, are we 100 percent sure that hotels are getting paid by the boarding home or is that the responsibility of this government?
That would be an agreement between the boarding home and the hotel facility, and we don’t monitor that.
It’s a little bit confusing. If hotels are used and you are waiting for the boarding home to pay them, I’m just wondering: have you ever heard of any cases where hotels were not being paid by the boarding homes when they were used to house medical patients?
I have never received any complaints from a hotel that they have not been paid by a boarding home.
I want to go back to one of the comments that Mr. Curley mentioned where he had said that alcoholism wasn’t an illness. It’s my understanding that alcoholism is an illness.
Hon. Tagak Curley: My Point of Order is this: I never said it was an illness. If I said it in Inuktitut, I apologize. You may have misunderstood.
What I said was the regional hospitals and health centres are not set up here as mental facilities. These are a different set of facilities. Where he got that idea, I just have no idea.
Mr. Elliott, to the Point of Order.
Mr. Elliott: Thank you, Mr. Chairman. In terms of what came through and what I was listening to in the interpretation, it sounded like he had said that the health centres and facilities were for illnesses and people with illnesses. That was my point and wanted clarification.
To me, he has given clarification that it is considered an illness. That’s all I was looking for, Mr. Chairman.
I did offer him to read the Mental Health Strategy, which is really quite professionally done, I say again, very involved, and treats mental illness as a very serious issue that the Nunavut government has to look at. If you are reading it, I know it’s prepared by doctors and certified by them because it’s quite specific in some cases.
We’re lacking services in that regard and therefore, one of the components often mentioned is that we need to have treatment centres.
It’s all over the place, but our Mental Health Division is now trying to focus on establishing these centres so that we can become part of the ongoing services provided and responded to as a result of the Mental Health Strategy that was tabled in 2002. So we’re working towards that and I say again that the cabinet is supportive of that, but they left it, that this year will be the development year so we have our plans properly and documents in place so that there is no room for confusion.
To the Point of Order, I find Mr. Curley’s explanation of his Point of Order is clarified.
Thank you, Mr. Curley. Recently on February 23, there was an article written in the Nunatsiaq News. It was entitled, “New scheme irks Nunavut pharmacists.”
I was wondering if the minister could explain what’s actually happening with the new way in which his department will be handling medical supplies, pills, and medication for clients.
Mr. Chairman, I have not had an opportunity to read the article. It has been alluded to me that there was one, but the information I have is that it wasn’t meant to be accurate, it wasn’t meant to be fair, nor did it ask any of the government officials whether or not the information in the story that they were creating was actually factual or not.
I think it was the opinion of one person or the journalist in question about what’s happening.
We do have a plan. As a result, the pharmacy program is part of medical services. We cannot do without it.
Health centres depend on supplies. We have partners throughout Nunavut that we have engaged, at least three retailers in the territory. They are important partners and their services will continue.
There is also a regulatory side at the national level. Some is related to pandemic stuff that is critical.
Therefore, some of these supplies cannot be obtained from the retailer because the federal government is responsible. For instance, for H1N1, all of the provinces had to buy in bulk and the federal government was responsible for buying them directly on a cost shared basis.
These pandemic related drug supplies will be purchased continually through the national pandemic plan as well as the territorial pandemic plan.
Also, let’s not forget we have maybe 25 different health facilities in Nunavut. They require a stock in their local supplies so that patients, our clients, are not just given Tylenol medication.
According to standards applied, they require at least a five-day supply at all times in case of emergencies.
There are also educational services required that have to be conducted by technicians. Who best should hire those technicians?
These are not new; these have been in place for a number of years now. It’s important that our technicians fully understand federal, national, and territorial regulations.
For further information, I’ll have Madam Voth explain exactly what’s going on.
We did, Mr. Chairman, about two weeks ago, invite the shareholders of the two regional corporations and their personnel to meet with our departmental officials through my deputy minister.
They went out excited, there were happy, and there were no disagreements whatsoever.
That was confirmed to me when I met with them, by all places, at the restaurant. They were quite excited and happy about it, including their presidents and their chief executive officers.
Yes, the department is looking at various different delivery models for the pharmaceutical program. We are in internal consultations as well.
We don’t really have a strategy to report here to the committee today. I would like to say that what we would be working towards would be a business case. It would go forward through the Department of Finance’s estimates process in the fall.
The minister must have anticipated my question coming because he was talking about who better would be to hire and put these people in place than the GN employees.
But the article actually mentioned about the Iqaluit-based territorial drug distribution supervisor, three pharmacy technicians in Iqaluit, one pharmacy technician in Rankin Inlet and Cambridge Bay.
Are those positions and those PYs what we are approving here today? Like you said, the strategy and the plan won’t be in place until September.
Will that be in next year’s fiscal budget or is it in this budget this year?
The new model that we’re examining for the pharmaceutical program is not in the 2011-12 budget.
We are looking at developing a business case that would go forward through the estimates process for the 2012-13 budget.
We’re working in a multiple number of years; I believe it is 2012-13.
That helps too.
In terms of when I read the article, it seemed like it was going to be happening right away, but I guess it would be status quo from now until that next budget.
Could I have the question repeated, please?
One of the things that I was asking was with the way that the pharmaceutical products are being distributed and handled, nothing will be changing until the 2012-13 fiscal year.
I believe the strategy would go forward in the business case that would be delivered in the fall, so that would be for the fiscal year of 2012-13.
We are not asking for any new funding for a new model for this year; we are continuing the status quo as far as I know.
Again, when I read the article for the first time, I thought, “Oh, jeez. We just finished the Auditor General’s report on the HR and it takes 318 days to fill a position. You better start advertising now.
That way, positions are filled by the time the program rolls out.”
That was all of the questions I had, Mr. Chairman.
On the summary activity under H-7, someone was asking about when there is overflow in the boarding home, in transit, some patients have to stay at a hotel.
My question is pertaining to that specific concern.
How much are these people paid for meals at the hotel?
I would assume that they are given money for meals; breakfast, lunch, and supper.
How can the minister assure me that there is, in fact, enough money for the patient to eat at the hotel?
If the minister has the information, how much money do you give these patients staying at the hotel because of the overflow in boarding homes?
The clients who would be staying overnight in the hotels would be brought back to the boarding home for their meals, and I would like to clarify… .
Chairman: Go ahead, Ms. Voth first and then Minister Curley.
Ms. Voth: I would like to clarify that this is under the NIHB program, which is a Vote 4, so the costs do not fall under the treatment area of the Vote 1.
I just wanted to make that clarification as well, that it’s a Health Canada program and it’s funded through the Vote 4 funds.
Now Minister Curley.
Hon. Tagak Curley: Like we indicated, the boarding home arranges for the overflow of individuals and they are responsible for the meals as set at certain rates.
So they advise the hotel, “For breakfast, it’s this amount, lunch for this amount and that amount.”
When the patient does have a meal, they charge it but if they exceed it, they have to pay the difference.
If you want that rate, we can provide it as we don’t have it with us at the moment.
How much is this amount and how much is that amount in terms of dollars?
I don’t think he has that information, but I think he said that he was going to get that information to you, but go ahead, Minister Curley.
Hon. Tagak Curley: No, I think I did respond that I said we don’t have that information.
That’s the way it works in the Kivalliq. Whether it’s different in the Kitikmeot, I’m not sure, but we will get that information provided.
They do have a set amount for breakfast and we will provide that information.
I’ll say it again, we shall provide it.
I would imagine the hon. minister would provide the information to all of the MLAs here in this Committee of the Whole.
Hon. Tagak Curley: We shall provide it to the committee, which we are responsible for responding to the question.
Ms. Ugyuk: We’re under Public Health?
Chairman: We are under Treatment.
Ms. Ugyuk: Treatment?
You guys are looking at implementing a plan or something for a new treatment centre for addictions. Do you guys know where it will be?
The plan for the treatment centre is still under review.
We have an RFP out for expression of interest.
I understand that that closed in mid-February. We’re creating the plan.
We don’t actually have solid plans in place of where the treatment facilities will be.
We are working on that plan and that RFP process is providing the information to develop that plan.
I just want to remind the members that we are on Bill 1, which is operations and maintenance and not on capital.
Mr. Tapardjuk (interpretation): Thank you, Mr. Speaker… Mr. Chairman. I apologize.
On page 136 of the business plan, in the Home Care Program, which I believe is for disabled people at home who require assistance day to day, there will be a review of the program to be completed by March 31, 2011.
Maybe I can get clarification about the review. What exactly will be the subject of this review? Is the consideration towards lowering the number of home care recipients?
Is it about the capacity? Perhaps, Mr. Chairman, after receiving more information on this review, I can ask more questions.
As we know, the Home Care Program is basically more of a Vote 4 funding, with a small amount of funding coming from the territorial government.
Yes, we are looking at the service level and the capacity.
We cannot put a home care worker in each community as permanent; it is on a needs basis. Once a client is assessed and if they need home care service, we assign a home care worker to serve the client on an as and when needed basis, so it’s not permanent.
We just don’t have permanent home care people if there is no need for home care service in any particular community.
I thank the witness.
It’s written that there will be a review conducted on this program. It’s apparent that a report will be presented after the review is complete.
It has caused some problematic issues, such as why home care workers have to be able to speak in English.
The majority of people requiring care are usually elders no longer capable of looking after themselves.
The elders have requested that the home care workers should be older, be able to communicate with the elder, and be able to listen to their concerns.
We were informed afterwards that if a person wanted to work as a home care worker, then they have to be able to speak in English in order to qualify as a worker for these elders.
The reason why it is needed that a home care worker be bilingual is because there are forms that need to be filled out.
There are still instructions and national standards that have to be followed, so that is why it is needed to have preferably a bilingual home care worker.
Yes, in my opinion, I believe that this requires further review since the focus should be on the wishes of our elders who require care.
The requirement to be bilingual should be secondary to the needs of our elders.
The people who require care should be our priority, as people who may not speak English are usually more capable, especially in relation to life experiences.
They know that the elders need care and the home care workers are alone for extended periods looking after them.
When this program is being reviewed, this aspect has to be reconsidered.
Hon. Tagak Curley: Thank you. (interpretation) With respect to some of our responsibilities, it would be better to view them as a whole and not to segregate them when asking questions about them.
We have students taking courses, such as those in the Nursing Program, who are increasing in number and we want to see it succeed so that we can have more nurses.
We currently have students taking one-year, two-year, and three-year programs, with some students taking a four-year program.
As these students graduate, they will definitely be an asset.
With respect to home care, you don’t just care for a person.
If the patient has an illness, you have to be able to recognize the symptoms.
As an example, doctors usually check up on the patients, especially if the sickness wasn’t diagnosed at an earlier stage.
We have heard many cases about this.
The elders we are discussing can have debilitating illness or physical frailties which force them to have home care workers, assisted by nurses.
So it’s generally easier to accommodate when the worker is bilingual.
If the worker is an Inuk, then they should be able to converse in English.
On top of this, we also have national standards related to home care nurses.
They require licences and if they didn’t require these qualifications, we wouldn’t be so adamant about these workers also being nurses.
That is why the requirement for bilingual home care workers is there.
However, the number of home care nurses is increasing, so we will eventually have the majority of workers who would be able to speak in Inuktitut providing this care.
Once everyone has agreed to a common understanding… . Further, what the people who require home care have asked for are workers who can talk to the patients so that it makes their job easier.
It’s obvious that when you conduct your review, as per your stated business plan, that you will report back on the how changes will be made.
However, I have a concern that applies to our current situation.
In just a short while, it may not be as critical down the road. Those of us who are bilingual are also getting older and when we require care, we have the option to speak either language.
The people whom I am concerned about are those who require care today.
It looks as if this will be subject to a review and once completed, we will see a report in this House down the road on this matter.
That was just a comment there.
My question is on page 135 of the business plan.
Under Treatment, in the Mental Health section, there is a $2 million increase over last year that the department is asking for. I was wondering if the minister could explain exactly what is happening with that, whether there are new PYs being offered or new programs being offered.
The $2 million has to do with increases that we’re experiencing today in the out-of-territory residential program as it relates to mental health clients.
We do have a portion of the residential care program that’s in social services and then also in the mental health, so we put that under Treatment.
That $2 million are the costs that we’re experiencing today in the residential care program.
For patients who are being sent out, are there specific locations that are determined and only those can be used or are there exceptions?
I’m assuming there are service contracts or something that has to be set up, but are there only specific ones that they can go to?
We actually have an RFP process that we have gone through for the second time. We would like to make it an annual process. I understand that CGS is setting it up already for the third year.
Through the RFP process, we ask for interest in providing the residential care services and then what kind of services can they provide. So then we have a panel of people who review the submissions from the proponents and then they are either added to the listing of residential care facilities that we use or they’re not.
For my next question, I wanted to go back to the main estimates on page H-9, the summary of grants and contributions under Treatment. The line item is Maternal Health Strategy.
There is $170,000 allocated for that strategy.
I was wondering if the minister could explain what that strategy is going to be about.
The strategy for the midwifery program… .
We have been delivering a program in Cambridge Bay since September of 2010. We have a curriculum that reflects both Inuit cultural values as well as Canadian and international midwifery standards.
The contribution portion of the $170,000 will be in place to run the Midwifery Education Program.
So the money actually goes for training to have more midwives in the territory.
Total Operations and Maintenance, to be Voted. $164,650,000.
Chairman: We will move on to H-8.
Under this branch summary, there are activities about health insurance programs, territorial health insurance programs, supplementary health benefits, and also vital statistics.
My question is pertaining to vital statistics.
Mr. Chairman, the Vital Statistics Division manages and administers the Health Insurance Program, as well as recording and administering information related to births, deaths, and marriages.
Page 139 of the business plan, Mr. Speaker, indicates that one of your department’s priorities for 2011-12 will be to “Review the Vital Statistics Act for possible amendment.”
The question is this, Mr. Chairman: what kinds of issues have resulted in the plan to review this legislation?
I understand that the Vital Statistics Program has not had a review for a number of years and I believe it is prudent to review policies within Health and Social Services periodically.
We want to do a review of the Vital Statistics Program, but I’m not aware of an urgent issue right now that is causing us to initiate the review.
I have a difficult time getting information from Vital Statistics as it is.
I hope that people like me will be able to use the local health centre to get the information once they’re in place.
Anybody want to respond to it?
Anybody else got questions on Health Insurance Programs?
Mr. Tapardjuk (interpretation): Yes, with respect to the Non-Insured Health Benefits program, it seems that the funding won’t increase for the 2011-12 fiscal year. Furthermore, with the shared responsibility of the regional Inuit associations, I believe they have an opportunity to discuss certain parts of the program.
Additionally, with respect to funding allocations through the Non-Insured Health Benefits program, it looks as if the funding won’t be increased in this fiscal year.
Can the minister explain how the Non-Insured Health Benefits will support the patients?
We’ve had dialogue with the federal government regarding this program. The last agreement we came to had a four-year life. I don’t have the actual end date, but it is a lot faster now.
I believe that for the last fiscal year, there was about $2 million set aside specifically for medical travel, including lodging and some of the particulars that you mentioned.
The medical travel portion is the largest amount of money we spend, but again, there are other services we provide, such as the Territorial Health System Sustainability Initiative and the THAF program. We were allocated an extra $10 million specifically for medical travel, which will end in the fiscal year.
This was a one-time federal grant to assist us with medical expenditures.
It’s quite obvious that we will face more difficulties down the road, but we are in continuing dialogue with the federal government. As our population is increasing, they would have to increase the funding specifically for medical travel.
But I want to assure the member who is asking the questions, Mr. Chairman, that we will not be letting this program fall between the federal government and the NTI partners that also sit on this program administration committee.
I just wanted to ask for a bit of an update. One of the things in the Auditor General’s report was, in terms of the expenses and giving money back through the uninsured health benefits, the Department of Health and Social Services wasn’t reporting back fast enough or there were names that were wrong or misspelled.
The last time you gave us an update, the department was actually doing a better job, and so more money was being recovered.
Is that still on track and are records being kept better?
Yes, actually our costs under the program of NIHB have actually escalated up to $26 million, I understand, for last year. I would expect that that would be the same for this fiscal year that’s ending.
It is a demand-driven program as well.
We do provide forecasts to Health Canada on where we think that the program will come in at the end of the year, but this is their program, so it is demand driven, and they keep a close eye on what the costs are.
In terms of demand driven, does that mean that there is no actual cap on it?
We begin the year with an initial contribution agreement with Health Canada.
When our forecasts show that we think it’s going to be higher than the contribution agreement, then we request to have an amendment to the contribution agreement from Health Canada.
We work very closely with them with regard to the forecasts, where we will come in at the end of the year.
We are concerned as well with the escalating costs within the NIHB program. As I spoke to earlier to the committee, we are working on a joint project with Health Canada to gain an understanding and analyze the reasons why we are sending people south, which is one of the biggest costs, of course, under the program.
I don’t have any more names on my list here.
We will go to Health and Social Services. Branch Summary. Health Insurance Programs.
Total Operations and Maintenance, to be Voted. $53,155,000.
Chairman: We will go back to page H-3. Department Summary. Health and Social Services.
Detail of Expenditures. Total Operations and Maintenance, to be Voted. $296,988,000.
Chairman: I would like to thank Minister Curley, Ms. Downe, and Ms. Voth for appearing here before the committee.