EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
That is the emphasis I think that we need to direct our energy to in this department. We need to focus again on providing good quality care services to grassroots community levels and that is where the energy should be. I repeat that we need to look at providing support where we do good service and addressing the concerns that we are not doing too well in.
That is the direction that I have envisioned for the organization this year.
I believe earlier this year, there was a story where a consultant had concluded that social workers were under-staffed and under-funded and so on.
In view of that, I believe that that report has not been tabled in this House.
Could the minister maybe consider tabling that provision of the report if it has not already been tabled?
And could the minister respond to the House that if, in fact, social workers are under-funded, and short of personnel and obviously resources to do their jobs, what steps the minister has taken to ensure that this fact has been taken care of.
First of all, just to acknowledge the report that he makes reference to, the report was produced by the Superintendent of Child Welfare, and I don’t know if I’ve tabled that report in the House or not, but in that interview, there are a number of areas that were expressed.
What have we done since that? I’ve directed my officials to review the functions of all social workers across Nunavut. I’ve also asked that their jobs be reviewed in terms of the compensation that is paid to social workers.
The other area that I’ve also asked internally is to look at how we do business. Part of that is that for every social worker, there are a number of functions that they carry out. We may need to look at whether those functions carried out, such as probation, best fit with social workers.
At the same time, I’ve asked for a review of the allocation of social workers by community. Since 1999, that has not been reviewed and it’s an area again that we need to look at in addressing some of the workloads of our social workers.
Again, I go back to emphasizing and focusing our energies in areas we do well, but in also paying attention and addressing where we’re not doing too well, and that includes the functions and the workload of our social workers, or any position.
So since that time, there has been progress internally to start that process. The job descriptions have been evaluated through Human Resources as an example, but it’s broader, it will take a bit of time and it will involve not just issues here but across the territory by community.
I appreciate the minister’s direction to address some of the problems that have been identified.
I know I can tell you that social workers in our communities will certainly appreciate the direction. I fully want to encourage that you do so, continue to do so. They need more resources than probably more than any other social services that we obtain.
I just wanted to, Mr. Chairman, try and reconcile the two areas that I said I thought were conflicting. I’m not going to put any blame on the government or anything, but when I looked at the statement, you said major population centres enjoy a whole lot more services, whether that was facility-wise, or what not, or services-wise, I’m not sure.
The communities should also enjoy the medical services, or health services, and social services, if at all possible, to the extent as they are enjoyed by the larger communities.
Having said that, I just wanted to remind the minister and her staff that when I read some of the Inuuqatigiitiarniq Healthy Communities Objectives, there is one on the first page, I believe the third bullet on the right, by 2020 Nunavut is a place where, and I quote, “Health and social conditions and indicators are at or better than the Canadian average.”
When I read statements like the smaller communities should not expect to enjoy what major communities enjoy, it concerns me. I’m going to leave it at that.
So I don’t want the smaller communities to feel that they are going to have to settle for second best in terms of medical health services or social programs. So I just want that to be clear so that I don’t confuse anyone.
Mr. Chairman, I’m going to leave my comments and questions here. I will have more questions with transportation and medical issues.
I don’t think there was a question there, but minister, if you want to respond to that, go ahead.
I recognize the member’s concern and it’s certainly not our intention to do that, but to also recognize that it’s not possible to have every community have the same level of service across the board.
The comment there was just to acknowledge that there is a difference, but the aim will be to provide the best care and service as possible. We do recognize in some areas, the communities’ staffing, we have not kept pace with the growth of each centre and to also start addressing our energies and resources to those priorities of each community.
So I would just like to acknowledge the member’s comments.
On page H-7, I would like to ask a question in regard to the Nunavut Arctic College and it’s delivery of midwifery-based options to improve community continuity of maternity care services in remote Nunavut communities.
In 2005-06, it was at 150 and now it’s at 326.
The issue of midwifery was going to be started in 2003 in Arviat and it never got off the ground. You stated that it would be moved to Rankin Inlet. Is that why there’s an increase for this year?
During 2005-06, we did identify $150,000 and from what I understand of that program, it was to design the Midwifery Training Program. That involved working with agencies, women’s groups, and the elders in designing the Midwifery Training Program.
The increase in the amount was an enhancement to start the delivery of that particular program. This is a training program and not necessarily the midwifery service offered through the health centres such as the Rankin Inlet Health Centre.
Mr. Alagalak (interpretation): Mr. Chairman, what about the plans that were initiated in the 2003 Midwifery Training Program in Arviat?
You probably said that because you didn’t know about the plans to have that Midwifery Training Program in Arviat. We were just waiting for the program to get started and then, all of a sudden, we heard that it was moved to Rankin Inlet.
It shouldn’t be in one community, it should be in more than one community in order for the communities to benefit.
What would I say to the people now because you didn’t make any mention of the plan that was originally slated for Arviat.
A couple points: the training program that has been offered through Nunavut Arctic College is to train individuals to become midwives.
The next step from that process is to use those skilled people to provide midwifery services in communities. And the whole idea about providing health care closer to home, this would be an example of providing that service closer to home.
So the individuals being trained would be able to go back to their home communities and provide midwifery services. That’s our intention for down the road.
I don’t know all of the details of what went on in 2003 and prior to, but I have asked staff to research some of those concerns that Mr. Alagalak has raised.
And one thing I should also note that I believe in this budget, there are two maternal care workers allocated for the community of Arviat.
Mr. Alagalak (interpretation): Well, we were not informed. We were not told that after their training, they would go back to their communities and practice midwifery.
It does alleviate some of the concerns we have, but they even had struck a committee and I’m sure that they were looking forward to have those training programs available.
We have a large population in Arviat now and Arviat has the highest birthrate in Nunavut.
I don’t think that we should just leave it at that, and there are a lot of women who would like to take midwifery-based programs.
I can now give a little bit more information to the people of Arviat and I’m sure that in the upcoming years we will see these types of programs be made available.
We are on H-5, H-6, and H-7.
I thank the minister and her officials for coming again today.
I wanted to ask the minister about telehealth. As the minister probably recalls, before she was the minister, we had quite a long discussion in the House about the cost of telehealth, the benefits, and how it worked. I think the previous minister might have even made a commitment to update us on how the telehealth system is working.
So my first question to the minister on telehealth, and it’s also described on the business plan on page H-14 and it’s part of the main estimates on page H-5: can the minister tell us today: what is the status of the telehealth network across Nunavut?
Currently, all Nunavut communities are connected to the telehealth network and it’s used for education, clinical activities, some visitation, and administration. So there’s some of that. Those are the type of activities that are currently being applied towards the telehealth system.
The telehealth improved the quality of providing health care advice to clients that are providing that service in the communities. We are looking at further utilization of the telehealth system with our health centres.
We need to work towards more utilization of it.
As it is right now, about 25 percent of the telehealth system is used for clinical activities.
I have a constituent, a family in Cambridge Bay who have a relative in a homecare facility outside of the territory.
I believe the health department is using the telehealth for the family to stay in touch with the individual.
It works to a certain extent, but it is very trying on the family because the individual is in the out-of-territory facility, there is no family, and you can’t touch or hug each other.
It’s very difficult for the family and for him because there is a lot of crying and tears.
It is one way to stay in touch with relatives.
I don’t think it will totally eliminate the need to have some family interaction.
I believe your department offers one visit per year for a family to visit an out-of-territory relative.
That’s just a comment there. Could the minister give us an idea of what the total cost of establishing the telehealth system ended up being? I know figures were tossed around last year but we never did get a final figure.
Could the minister give us a number there please? Thank you, Mr. Chairman.
Internally, we funded $3.5 million and the rest was covered through the federal government.
Could you give us a final total cost figure on the telehealth, and then also give us an indication if the money from the federal government has been received to help pay for the telehealth system?
The total investment to establish the telehealth system in Nunavut cost $10.1 million.
Could the minister tell us how the Department of Health is evaluating the telehealth system to measure its effectiveness in Nunavut?
In my former hat, I had made a commitment to members that we would evaluate the system, and that is still in the works.
We’re looking at having that report completed by some time this summer.
It is important to remember here that we needed to get the system up and running before we can evaluate it; get it up and running, then use the system, and then evaluate it.
So that work is under way and we’re looking at sometime probably in this summer to complete the report.
Some of the things that I mentioned earlier, it’s used for education purposes. We can connect 15 health centres at once with the telehealth system, and some clinical activities and some visitation from people in hospitals and whatnot to their home communities.
In terms of the report itself, that won’t be done until some time this summer.
Mr. Peterson: Thank you, Mr. Chairman. I thank the minister for that information.
Will the minister commit to providing the Members of the House with a copy of that report as soon as it’s available?
I will commit to providing that report.
Can the minister also tell us: do other departments in the Government of Nunavut have access to the telehealth system in terms of using it for their communications purposes between the regions and perhaps out of the territory?
I understand other departments have access to the telehealth system, but again, health services would have priority in using that system.
It’s probably a good idea that it is made available to other departments, as and when they need it, with health being the priority of course.
The business plan on page H-14, it shows that the telehealth budget, Information Technology has decreased by almost $700,000.
Can the minister explain why there is a decrease?
The difference, the decrease of $692,000, was a result of the transfer, the budget for PYs, one from each region; and a decrease in the equipment budget by $500,000.
On business plan, page H-16, the priority for 2006-07 is further implementation of the e-Health Plan. Can the minister tell us again what the e-Health Plan is and how it relates to the telehealth network?
The e-Health Initiative, the department is focusing on implementing distance development that will allow us to track a number of types of service.
One example would be medical travel. Another one would be in the area of pharmacy lab services. It is a bit different than the telehealth system in that this e-Health Initiative is systems development internally for tracking and reporting our inventory or our usage, say, as an example, of medical travel.
It’s probably a good idea to track medical travel given the high costs over the years. It spiralled out of control I think for awhile there, and we have to get that under control.
On page H-15 of the business plan, priorities for 2005-06, it says that the e-Health Plan is complete; implementation has begun for the first two of four phases.
Can the minister explain what the four phases are and then update us on the implementation of the first two phases?
From what I understand, the report on the e-Health Initiative is completed. The implementation has yet to start.
Could the minister expand a little bit more?
The plan says that it is completed, but there are four phases. Could you give us some detail as to what the four phases are? Again, it says right in your own business plan that implementation has begun for the first two phases.
So I’m taking that that work has begun if you are stating that in your business plan.
I think, for clarification, the report was done. The implementation of the system has not begun. The system still needs to be developed.
So I will ask my deputy to respond to what those four phases are of this initiative.
Mr. Ramsden.
Mr. Ramsden: Thank you, Mr. Chairman.
Implementation, as it’s stated in the plan, speaks to implementing or getting the plan itself done.
So the very first phase was a detailed mapping out of all of the processes of care that go on in all of the areas of the department.
The second phase identifies the systems that we want to get developed first. And so those are the ones that the minister spoke of briefly; a system to track lab results and have them available for care providers; a system to track children in care; a system to track drug distribution in the health centres and prescriptions for patients.
So when we say implementation there, we have identified the system needs. And this year, within probably a month, we will go out and look for the actual systems that exist that we can consider buying.
Chairman: Thank you, Mr. Ramsden.
I thank the minister and Mr. Ramsden for that information.
The government tabled a list of contracts last November and in that list of contracts was a listed contract for almost $660,000 for the Digital Health Care Solutions and the money was to develop the e-Health Program. Could you give us an update on what exactly Digital Health Care Solutions did in terms of developing the e-Health Program?
I’m going to ask the deputy to speak to the details of that report.
Chairman: Thank you. Mr. Ramsden.
Mr. Ramsden: Mr. Chairman, we used that company to help us develop the e-Health Strategy and the plans so they are the people that have actually worked with our staff to lay out all of the ideas, essentially the division, for what the e-Health System would look like over time.
So they have met with our staff, they have met with Health Infoway, which is the federal funding partner that’s involved in this. They provided much of the expertise to help pull that plan together.
I thank Mr. Ramsden.
Could he give me a bit more clarity: when do you expect the e-Health Program to be fully implemented?
Do they expect it to be implemented in 2006-07?
I guess there’s further implementation of the e-Health Plan. It doesn’t give an indication that it would be fully implemented. Could the minister tell us if it will be fully implemented?
I don’t know exactly when it will be fully implemented. Development of systems takes time. I would say that in the next five to ten years, we would have a full system for Nunavut related to health and social services.
At the same time, as we move forward in the recommendations of developing these systems to track information and whatnot, the system development will also require any financial investments depending on how we are doing internally, or when we require additional funding to develop those systems.
So that will all, again, depend on the phases that we are going through to fully implement any systems development for the Department of Health.
It’s not cheap; it will take time, resources, and staff to develop this system.
It is something that we are exploring and looking at: what those models or system could look like in trying to improve on various programs.
Can the minister tell us that this plan that Digital Health Care Solutions developed in conjunction with the Department of Health; in the course of developing that program, did they prepare a cost benefit analysis to show that by investing this much money this year, and maybe some more money in the subsequent years in the long term, the minister said five to ten years, leave that $5 million in this whole program, are we going to save $100 million, or $50 million.
Is that part of the planning?
I said earlier that the plan is done on what those pieces would look like. I’m being a bit cautious in that I don’t want to move forward in the full implementation because we have not cost out what financial impacts this will have in developing a system for Health and Social Services. We need to slow down a bit and look at exactly what is affordable, in light of all the other priorities within the Department of Health.
At this point in time, I’d like to focus my resources and energy in improving other areas of the department, and slowing down a bit in the movement of developing systems.
Systems are there to allow us means to report and track information better.
At the same time, it is a fine balancing act internally with the resources that we have to also look at areas that are in need of attention, such as social workers, or whatnot.
I’ve asked my staff where we are at and to really focus the energy and resources where it is most needed at this point in time, and to slow down on internal systems development and focus on the areas where we need to focus in providing the frontline service to community level grassroots, and so on.
The cost analysis is not done at this point in time. We’ll eventually keep the file moving, but at this point in time, my priority and emphasis in directing my resources and energy is to improve the quality of care and services that Health and Social Services provides on a daily basis.
I thank the minister for that explanation.
I agree to some degree that they should focus on the people and not on internally. At the same time, over the years, since 1999, the cost of running the Department of Health has grown quite high; well over $200 million now.
If we can find ways to make the Department of Health more efficient; the tracking of expenditures and medical travel and all those things; because we are in a unique area of Canada where we are so large; 26 communities that are totally reliant on airlines, and we are talking about telehealth.
We have to find ways and systems to help make us more efficient so that we can save money by eliminating inefficiencies, then we will have more money available to direct into the medical services to help our residents up here.
I think we are in the situation where it’s not very likely that we are going to keep getting more and more money from the federal government. We can’t suck money out of all the other departments to support health.
We need to find ways to make it more cost efficient, and work with what we have and still deliver a high standard and quality of health services to the people that we represent.
So I urge the minister not to give up on finding efficiencies and programs to make the department more efficient, but to find that balance where you can become more efficient, at the same time, deliver the health services that we need in Nunavut.
I don’t think I’m alone in stating that Health is probably the most important government department.
I’m sure a lot of the ministers would disagree, but the Health Department touches everybody in the communities, so we have to find ways to make it work for everybody.
Not just to give more money, let’s find out where we can save money so we can direct it again to providing medical services for the people that need that kind of help.
I didn’t hear a question there, but Madame Minister; if you want to respond to that, go ahead.
Thank you for the comment from Mr. Peterson.
I agree, we need to keep moving forward in developing systems. We are focusing on systems development where I think it makes the most sense in providing quality healthcare services to Nunavummiut such as lab results, clinic scheduling systems, and pharmacy information.
And I think that’s where we need to look at investing some of our resources in providing healthcare services to Nunavummiut, but at the same time, I also have to look at all the other priorities and pressure points the Department of Health is under in the areas of social work.
I also recognize that yes; we need to report our budgets.
We need to report on our expenditures and so on. The system cannot focus all it’s energies in sacrifice of quality of care of services to Nunavummiut. It is a fine balancing act and that is the approach I am taking in trying to focus the resources that we have within the Department of Health.
I take the member’s comments and advice and will continue to try and improve systems without sacrificing the services in other areas for Nunavummiut.
We’re on page H-5, 6, and 7.
I can’t find what I mentioned yesterday or on other occasions under the business plan; international nurses.
Can the minister update us about if this will go ahead or what is the status of the international nurses at this time?
The information related to international nurses, we continued with that process of recruiting our international nurses and finalizing the orientation and the exams that the nurses have undertaken.
They wrote their Registered Nurses Association exams last week, I believe it was on February 10. The results are not with us at this point in time. Once that information is completed, then we’ll look at the next steps and respond to those.
At the same time, I’ve asked to look at and evaluate how we’re doing in our recruitment efforts and I’ve also asked that we also look at further efforts at recruiting nurses within Canada.
Until we give ourselves the time to evaluate the recruitment of the international nurses, so that’s kind of where we are at this point in time.
At the same time, the Department of Health has invested a lot of energy into developing training programs in various areas such as social work, maternal midwifery, and so on.
One of the things I have directed my staff to look at is also some recruitment strategy in place for the graduates that will be coming out of those programs such as mental health and so on.
It doesn’t make any sense to me to invest training money and then not have a hiring plan in place to hire those people that graduate.
So I would like the department and I have directed my staff to look at bridging and completing that circle in the hiring.