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Yes, I am ready to begin with my opening comments, if that is okay with you.
First of all, I am proud that you are now the Deputy Chairperson of the Committee of the Whole.
Mr. Chairman, I am pleased to take this opportunity today to present the 2011-12 main estimates and business plan for the Department of Health and Social Services.
Mr. Chairman, the 2011-12 operations and maintenance budget for Health and Social Services is again the result of tough decisions during which the department had to balance financial reality with the health and social service needs of Nunavutmiut.
However, I can assure the members that we remain committed to supporting and sustaining an effective and efficient publicly funded health care and social services system without a reduction in quality of care.
The proposed 2011-12 operations and maintenance budget is $296,998,000.
This is a net increase of $32,571,000 over our 2010-11 main estimates of $264,417. Some of the more significant increases are as follows:
As of April 1, the department is requesting $10,677,000 for increased costs experienced in the Out-of-Territory Hospital Program.
Canada’s national health insurance system is designed to ensure that all Canadian residents have reasonable access to medically necessary hospital services on a prepaid basis.
All jurisdictions currently participate in a reciprocal billing arrangement which guarantees cost recovery for services delivered to clients from other jurisdictions.
My department has experienced both increased volume and cost pressures in this program and requires additional budget.
Residential Care
The requested increase for residential care in-patient services is $6,840,000. Treatment for mental health disorders requires highly specialized staff and a safe residential setting. A residential setting allows for both therapeutic intervention and recovery for the client, as well as safety for the family.
My department faces both increased volume and cost pressures for this program as well.
Medical travel
The department is requesting $5,474,000 for increased costs experienced in the medical travel programs; both scheduled medical travel as well as emergency air ambulance.
During the past several years, the department has controlled costs through negotiated contracts with the airlines, increased facilities and physician services, and through the provision of telehealth services, which has enabled health care providers and clients to meet in real time over large distances in Nunavut.
While helping to mitigate the cost increases, medical travel is still driven by many factors, including birth rates, population demographics, contract and price increases, and pandemics.
There is an increase of TB in the Baffin region.
Out-of-Territory Physician Services  Out-of-territory physician services, like out-of-territory hospital services, are client driven.
The department ensures that all residents have access to medically necessary physician services on a prepaid basis.
Annual jurisdictional rate increases are averaging approximately 4 percent per year and the department has not had an adjustment for more than four years.
The requested increase for this program is $3,332,000.
Nunavut Physician Services
Providing an adequate number of physicians is critical to maintaining stability in the supply of physician services and guaranteeing Nunavutmiut access to necessary medical services.
The Nunavut system of health centres run by community health nurses is dependent on adequate physician resources to support the nurses so that they can stay in Nunavut.
In Iqaluit, the physicians provide primary care, run the hospital, and provide sophisticated medical services to the population of Nunavut.
The department requires an increase to the Nunavut Physician Services program of $2,146,000.
Child and Family Services Act Review
The department is requesting an additional $900,000 in 2011-12 to continue the comprehensive review of the Child and Family Services Act as set out in Tamapta, with the intention of introducing new legislation within this term of government.
Changes to the Act will ensure that Nunavut’s children and youth are provided with appropriate and responsive services.
Supplementary Health Benefits
The supplementary health benefits program is designed to provide assistance to eligible persons in Nunavut who require health insurance services beyond those covered by the Nunavut Health Care Plan.
Improving the overall standard of living in Nunavut in regard to health and well-being is a priority of this government.
The department expects the new website with detailed information on supplementary health benefits to be operating in March 2011.
Once the site is live, we expect increased use of this program.
The department is requesting an additional budget of $811,000 for supplementary health benefits.
Laboratory Services
Additional funding of $682,000 is required to manage laboratory services.
Lab tests are one of the few essential diagnostic tools that clinicians use to determine the type and severity of many illnesses.
Volumes tend to fluctuate based on outbreaks of certain infectious diseases, such as tuberculosis.
School Breakfast Program
My department is the lead in a project to enhance and support the breakfast programs in our communities.
This initiative will be implemented in partnership with the interdepartmental Poverty Reduction Working Group.
New funding of $665,000 is required.
Reducing the effects of poverty on those most at risk, including our youth, is one of the priorities set out in Tamapta.
Food Insecurity
Food insecurity is a crisis in Nunavut that cannot be addressed by Health and Social Services alone.
Many factors affect food insecurity and a collaborative and comprehensive approach is needed.
The Quality of Life Committee and Anti-Poverty Secretariat have agreed that food security is a critical priority in Nunavut and new funding of $494,000 is required to begin work on this important initiative.
Maternal and Newborn Care
The Midwifery Profession Act and supporting regulations are now in place.
In June 2009, the department released the Maternal and Newborn Health Care Strategy, which sets out the action plan to integrate new maternal and midwifery services into the health system and enhance prenatal care and parenting skills.
The department requires $560,000 to support the implementation of this strategy.
Mr. Chairman, with the approval of the additional funding of $32,571,000 added to the base of the department’s budget, this will certainly help to address the increased expenditures the department has been experiencing over the years.
It will also ensure that the department will be able to continue to provide essential care and treatment to our most vulnerable residents in our territory.
Over the course of the coming year, my department will continue to protect and improve the health of Nunavutmiut in order to ensure that individuals, families, and communities are leading healthy lives.
Meeting the growing needs and expectations of Nunavutmiut while balancing my department’s fiscal reality will be challenging.
This committee’s continued support is essential to the advancement of our work.
We will be responding to your questions at the appropriate time, Mr. Chairman.
Just prior to requesting that the witnesses be brought to the witness table, I would like to direct a question regarding the information on page 2 of the English version. In your opening comments, you stated that the figure for that item is $264,417.
I wish to ask if this is indeed the correct amount or if you wish to revise the figure that is currently on record.
Can you clarify that for us, Minister Curley?
Hon. Tagak Curley (interpretation): Thank you. I didn’t realize that I made a $2 figure.
On page 2, the amount that we are requesting is actually $264,417,000.
Minister Curley, do you have witnesses that you wish to bring to the table?
Hon. Tagak Curley (interpretation): Yes and I will introduce them once we go down to the witness table.
Chairman (interpretation): Members, do you agree to bring in the witnesses?
Sergeant-at-Arms, could you escort the witnesses in, please.
Minister Curley, please introduce your witnesses for the record.
To my right, I am very pleased to introduce Deputy Minister Alex Campbell, and this is going to be his last appearance before the Committee of the Whole for he will be relocating in the middle of March. He has worked very hard and we are sorry to see him go.
I am pleased that he is here to appear before the committee.
Also, to my left is Executive Director of Corporate Services Debora Voth.
Welcome, Deputy Minister Alex Campbell.
Since this is your last appearance before the Committee of the Whole, I’m sure that there will be a lot of questions for you.
I also welcome you, Debora Voth, to the Committee of the Whole. I’m sure that you will be of assistance to the minister.
Perhaps the Co-Chair of the Standing Committee on Social Wellness has opening comments.
Members of the Standing Committee on Social Wellness have reviewed the 2011-12 main estimates and business plan of the Department of Health and Social Services and I am pleased to provide you with opening comments.
The standing committee notes that the 2011-12 operations and maintenance budget for Health and Social Services is $296,988,000.
While this amount is $32.5 million more than the 2010-11 main estimates that were approved in this House a year ago, the proposed budget is only just over $4 million more than the department’s revised 2010-11 O&M budget which includes amounts allocated through supplementary appropriations.
Members note that supplementary appropriations for the Department of Health and Social Services continue to be brought forward by the government, with the most recent one approved just last week being over $12 million.
Mr. Chairman, given the department’s ongoing pattern of over-expenditure, the standing committee is of the view that the department’s projected budget for 2011-12 is very much an estimate.
The committee recognizes that the Department of Health and Social Services faces a number of challenges in providing consistent and high quality health care across the territory.
A number of factors that drive costs upwards are not entirely under the department’s control, such as costs for fees, treatment, and services, many of which are provided out of territory, the unforeseen costs of health outbreaks, and the cost of meeting necessary staffing requirements.
Mr. Chairman, the committee also recognizes that the basic formulas used to determine base funding for health and social services needs in the North are inadequate to start with.
Our unique characteristics, such as population size, the geographic expanse covered by our territory, and the linguistic and social challenges, are simply not taken into account by financial formulas based on statistics and in competition with other jurisdictions across Canada.
Our unique position has been recognized to some extent by additional federal funding, such as the Territorial Health System Sustainability Initiative, which provides additional funds under the Territorial Health Access Fund and the Territorial Medical Travel Fund.
These additional funds are not guaranteed to continue indefinitely. The standing committee will support the minister in any efforts to access additional and sustained federal funding for health and social services across Nunavut.
The standing committee is, however, of the view there are a number of areas where our government could do more towards planning for costs and controlling costs.
For example, over 30 percent of Health and Social Services staff positions are consistently vacant, resulting in expensive agency contracts and inefficient financial management practices, such as transferring amounts originally budgeted for compensation and benefits to contract services.
The standing committee will be closely monitoring the success of initiatives such as the revised pharmacy program, the development of electronic health records, and the management of the Non-Insured Health Benefits contract, as these are areas where significant cost savings could be achieved over time.
The standing committee recommends that the department refocus its efforts on filling full-time positions on a timely basis and continue to work with partners, such as Nunavut Arctic College and other departments, to help train and qualify Nunavummiut for jobs and careers in the health and social services fields.
Committee members anticipate receiving detailed information on the number of graduates from Nunavut Arctic College health career programs who have been employed by the department in recent years.
The standing committee fully supports initiatives such as the Nursing Program, including the newly proposed licensed practical nurse course, as well as the Midwifery Program, which will provide more maternal and midwifery services closer to homes and families.
Members were pleased to hear of the recent agreement to bring family medicine residents from Memorial University to train and practice at the Qikiqtani General Hospital.
It is promising to note that physicians under this contract will remain to practice in Nunavut under a return-of-service agreement.
Mr. Chairman, the standing committee notes that the department is looking at reviewing its service delivery models and members look forward to the future scrutiny of proposed changes to program delivery practices.
Committee members stress the need to incorporate more Inuit Qaujimajatuqangit and Inuit societal values into the way that programs and services are delivered.
Mr. Chairman, the standing committee has previously noted that a number of GN departments have shared or overlapping responsibilities.
In some communities, social workers are caught between their legislated responsibilities for child welfare and their assumed duties as probation officers, which put additional stresses on a job which is already very demanding.
Committee members have further noted that issues relating to elder abuse often seem to be lost between departmental mandates and recommend that the minister work with his departmental colleagues to further strengthen support and protection mechanisms for Nunavut’s elders.
Mr. Chairman, the standing committee recognizes that one of the department’s key initiatives for 2011-12 continues to be the comprehensive review of the Child and Family Services Act, with the introduction of new legislation in the future.
While the care and welfare of Nunavut’s children is the primary focus of the legislation, members have suggested that issues relating to elders and Inuit societal values also be integrated into the review.
Committee members recognize that the Department of Executive and Intergovernmental Affairs’ Social Advocacy Office is also working towards addressing issues of concern relating to the more vulnerable groups in Nunavut society.
The committee encourages the minister to work closely with his colleagues, especially the Minister of Executive and Intergovernmental Affairs, as the consultation process unfolds.
As members will note, the copy of the opening comments that I have been reading are kind of out of date because one of the concerns and one of the examples that the committee was going to use was the role of the child advocate’s office or the child and youth representative and how that group would work together, and this had been addressed in the Budget Address today where Minister Peterson said, and I quote, “… we are advancing towards the establishment of an independent child and youth representative.”
Mr. Chairman, following the dissolution of the divisional health boards, community health committees called Committees of Council were established under municipal authorities and funded by the Government of Nunavut.
The standing committee encourages the minister in his efforts to strengthen the role of these committees and to consider ways in which they may support the effective delivery of health care services at the community level.
Mr. Chairman, it is clear that the cost of medical travel is one of the most expensive expenditure areas for the Department of Health and Social Services.
Standing committee members were interested to learn that a significant percentage of medical travel costs, nearly 40 percent, are accounted for by travel and accommodation of escorts to support medical clients.
While the committee is of the view that appropriate levels of support must be provided to individuals who need to travel far from their home and culture to receive care, members also recognize that the current levels of expenditure are unsustainable.
The standing committee recommends that the Medical Client Travel Policy be reviewed accordingly.
Members are also aware that levels of expectation from both clients and the families of Nunavut clients receiving health care continue to rise.
While it is noted that the Department of Health and Social Services has made many efforts to meet the demand, standing committee members are of the view that a new dialogue needs to take place to identify what levels of service are acceptable and reasonable.
Mr. Chairman, the standing committee is pleased to note that the Department of Health and Social Services has taken steps to ensure that Nunavummiut who are not covered by existing health insurance plans are able to access the necessary health benefits.
Members encourage the minister and his officials to ensure that the relevant information is made accessible to the public as soon as possible.
Members look forward to the unveiling of the department’s new website.
Members encourage the department to use these systems to analyze and communicate trends in the health status of our population to effectively plan resource and program delivery.
For example, with the passing of the government’s Tobacco Damages and Health Care Costs Recovery Act, reliable historical statistics in such areas as lung cancer, heart disease, and respiratory disease will be necessary to support legal actions to recover the relevant health care costs.
In addition, members urge the department to analyze information specific to medical travel costs in order to better anticipate and plan for trends in this area.
Mr. Chairman, access to nutritious food is a critical component of maintaining a healthy lifestyle.
Members were pleased to note that the department continues to focus resources on addressing food insecurity.
Committee members look forward to further scrutiny of the new federal Nutrition North Canada Program, which will have a profound impact on the ability of Nunavummiut to afford good and nutritious food.
Mr. Chairman, as I noted at the beginning of my comments, the standing committee is concerned that the proposed budget for the Department of Health and Social Services for 2011-12 is not a realistic one.
The committee supports the minister in his efforts to improve financial management within his department and encourages him to take the necessary steps to control expenditures.
I suggest to members that wherever possible you ask your detailed questions during the page-by-page review. Are there any general comments to the opening comments?
My question to the minister is in regard to medical travel.
As he indicated in his opening statement, up to 40 percent of the cost of medical travel is for escorts and their accommodation.
I have heard complaints in both Kimmirut and Cape Dorset where people say that certain people get escorts that don’t need them and in other cases, they need escorts and they don’t receive them.
I know of one case in Cape Dorset where this gentleman, who is over 55 years old but was capable of travelling on his own, didn’t need it as far as the language barrier, but the nurse said that he was entitled to an escort because he was over the age of 55.
So my question is if you’re over the age of 55, you are entitled to an escort through medical travel.
Minister Curley, do you wish to respond?
I think the preamble that the member just outlined is true that there are different ways of applying medical travel.
Like my colleague from CGS, I’m not in tune with the day-to-day decisions that are made by the managers, but each region appears to operate differently in applying the provisions of medical travel and escort policies that we have.
I suppose it’s sometimes a judgment call by the local nurses as well as the other health care individuals.
The rules are clear and why they are applied differently is something that I don’t immediately have a response to.
It could be true that some managers would like to oblige strictly based on the age, not necessarily, as he’s indicated, on the basis of whether or not the client in question is unilingual or not.
It differs from region to region and that is why we have ongoing departmental reviews.
We have not formalized a formal review yet, but I think, during the course of the last four years that it has been operating, it may be time and I have indicated to my officials that it is something that we’re going to have to do before too long.
I appreciate your answer on this one.
I guess the biggest issue now is if somebody figures that they should be entitled to an escort and they’re not, who they can go to? Obviously the head nurse is the one who makes the decision in the community.
Who can they go to and complain about that?
Alex Campbell.
Mr. Campbell (interpretation): Thank you, Mr. Chairman. (interpretation ends) I thank the member for that question.
Just to restate what the minister indicated earlier, the current policy on client travel is that elders who are unilingual who are 60 years of age and over automatically qualify for an escort, so I just wanted to clarify that as well, unless that particular elder says, “I don’t want an escort.”
Chairman: Qujannamiik, Deputy Minister Campbell.
For the deputy minister, basically what I asked is if they have an issue with it and they won’t allow them an escort, who they can complain to.
Chairman (interpretation): Thank you, Mr. Schell. (interpretation ends) Deputy Minister Campbell.
There is an appeals process there. The office of the regional director of the region is in Pangnirtung.
They appeal to the regional director for an escort if they are denied an escort and that’s supposed to be the final appeal.
The practice has been that people appeal to me directly and also to the minister on an ongoing basis. So it’s just a matter of the implementation and the enforcement of the policy itself.
Chairman: Qujannamiik, Deputy Minister Campbell. (interpretation) Do you still have questions, Mr. Schell?
In your main estimates, the estimates are going up by $32 million.
Every year, we always have supplementary appropriations brought in by the health department. Do you really think that this $32 million is going to cover you this year without having to come to supplementary appropriations?
We will try and answer the question.
I think it will likely be in more than one part because the whole budgeting process of the government is really quite, in a way, very involved.
It goes through various stages throughout the year and all of the departments normally put forth their spending targets for the coming year.
Knowing very well the guidelines with respect to the target set by the Department of Finance and the FMB allows all of the other departments to compete for that pot of money.
Therefore, our department, which is probably the largest public expenditure department in terms of services and critical services, is normally, I think, the most underfunded at the end of the process, not as a result of our choice.
We have normally, historically now, budgeted pretty close, accurately, but it’s normally cut back by close to the amount that you indicated, $32 million or so, and that pot of money has historically been set aside by the FMB and the Department of Finance as a contingency.
Instead of directly applying it to our request to meet the actual budget we submitted, that percentage is normally reduced close to that amount and Finance, through the budget process, sets it aside especially for the health care contingency, but we know there is a condition to that.
We have to apply through the supplementary estimate process.