EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
If there are any people out there listening that are interested in pursuing a health profession, Memorial University’s physician training there gives some direct access to be able to practise in Nunavut through some great partnerships; previously with the federal government, now funded from within the Government of Nunavut but working with Memorial University.
This summer we’re planning a health focused summer camp for Inuit youth to take a look at different professions within the health care industry so that as people are finishing and choosing their courses in high school, they can see some of the opportunities for employment and how they can contribute to the betterment of their community and the territory going forward.
That’s a very interesting initiative that I believe the member asking the question was a part of setting up.
I can visualize a number of things in what training they want to offer in northern Ontario. They have set aside seats for an aboriginal peoples’ training program to encourage further training for aboriginal people to become doctors.
If we can focus on Inuit-specific programs, make them available, and have an agreement with a university, can the minister commit to reviewing this so that we can have this training program specifically for Inuit?
Can the minister commit to reviewing this kind of program?
It is something that is already being explored with the Northern Ontario School of Medicine.
They are assisting with the health profession camp this summer.
There are already links that are being made that would give us the ability to enhance and promote additional partnerships with facilities or organizations such as that.
I will want to hear more about this in the future because it’s very interesting.
Also, looking at the business plan on page 121, the last two bullets, “Introduce an interim suicide prevention action plan” and “Engage partners and stakeholders,” I would like an update on that and what your plans are for the future.
I thank the member allowing us to continue focus on this very important issue.
When I took on this portfolio and the associated responsibility of suicide prevention, we all realized what an important matter it is across the territory.
We also realized that the Resiliency one-year action plan was a short-term band-aid, if you want to call it that.
There are a number of initiatives that it allowed us to focus on the Quality of Life Secretariat and have that created.
It’s the first time that money has been specifically allocated to suicide prevention and there are a number of ongoing initiatives.
To be honest, it’s such a live file that just to bring all members up to date, if the Chairman would allow, I would appreciate it if my associate deputy minister could finalize the response with that.
Ms. Kabloona.
Ms. Kabloona (interpretation): Thank you, Mr. Chairman. (interpretation ends) The Quality of Life Secretariat has been very actively working with Nunavut Tunngavik Incorporated, the RCMP “V” Division, and the Embrace Life Council on the implementation of Resiliency Within.
We’re very happy with the progress on that.
We are continuing to work on the development of a long-term action plan. A number of initiatives are identified in the business plan before the House today, including the continued work of the secretariat and a significant grants and contributions program for ongoing support for the Embrace Life Council and the Kamatsiaqtut Help Line.
It was mentioned that the federal government has committed funding for mental health programs.
Will this funding be accessed this year to provide programming?
With the Canadian Health Transfer and the Health Accord funding that was fairly recently announced by the federal government, because it’s based on per capita funding, there is actually very little monetary impact that it has.
What there is over the period of the next 10 years will help us maybe supplement some of the programs we’re doing, but it’s not enough to actually initiate any new programming.
In my opinion with the new mental health and addictions positions that we’re looking at funding for in this budget, in addition to the plans that we have going forward to bring more community-led initiatives regarding mental health, I believe that what little we are getting will assist us in providing those objectives.
I just really want to emphasize that when we’re talking about mental health, there are mental health nurses, there are mental health counsellors, there are a number of different initiatives that we’re putting across the territory that these new positions will enable us to be able to move on to our next phase of planning on service delivery across the territory at the community level.
Mr. Okalik (interpretation): Yes, I’m not the only one who wants to ask questions. My colleagues will want to ask questions, so I’ll stop here for now.
I fully support them in their initiatives. We would like to provide more support.
I’ll stop there for now as other members want to ask questions. I’ll ask more questions on other areas.
Mr. Alexander Sammurtok (interpretation): Thank you, Mr. Chairman. (interpretation ends) There is a vacancy of a director in the Kivalliq region.
There is a director from the Qikiqtaaluk health board that travels through once in a while.
When are you guys filling out that position of a director?
If you will indulge me for just a moment, please.
Thank you, Mr. Chairman. I apologize for the delay on the question.
The latest information that I have on the executive director position in Rankin Inlet is showing paperwork pending.
What that tells me is that it’s in the staffing process right now.
I could follow up with the member on the specifics of where we are in our staffing process, but I don’t have that level of detail with me today.
Yes, I would like to get updated information in regard to that.
There is also a vacant position for the nurse in charge at the Kivalliq Health Centre. When will that position be filled?
Again I apologize for the delay.
I don’t have the actual position of the nurse, but I do know that there were three nurses hired in Rankin Inlet as of December 31, 2016.
It doesn’t state in my documents whether one of those was the nurse in charge.
From my understanding, the nurse in charge is just an acting nurse in charge.
I would like to get follow-up information in regard to when that position will be filled permanently.
If you will allow me, Mr. Chairman, I’ll go on to another question.
There is a transient centre in Churchill, Manitoba. What is the cost of operating that transient centre?
Hon. George Hickes: If the Chairman will indulge me just a moment, please, I’m looking for that level of detail.
Thank you and I apologize, Mr. Chairman.
When we’re looking at actual costs to the department, we’re looking at in the 2015-16 fiscal year under $700,000 after NIHB recoveries.
During the year how much is that building being used for the (interpretation) residents of Kivalliq?
In 2015-16 the number of nights used was 4,326 out of a possible 9,490 and there are 26 beds in the facility.
Mr. Sammurtok (interpretation): Thank you, Mr. Chairman. (interpretation ends) Concerns were constantly raised about the services provided under various contracts held by the Department of Health for such programs as medical boarding homes, emergency medical travel, and scheduled medical travel.
What process has your department followed to ensure that services, conditions, and other obligations are being properly provided by the different contractors?
It seems to be an ongoing challenge with some facilities to make sure that the monitoring is being adhered to, not from our end, but to make sure that when we bring forward recommendations and again, when I speak to any issues at any boarding homes, I have always strongly recommended that if members are aware of different scenarios or situations, they direct their clients to the patient relations office to make sure that we’re aware of any issues.
I did want to make sure that people are aware that we collaborate very closely with Health Canada on this, as the NIHB program is very involved with the boarding home, medical travel, and necessary doctor visits outside the territory.
We work with Health Canada to develop the monitoring process for the boarding homes, which typically includes annual visits, client surveys, and monthly teleconferences with service providers.
We do operational audits of maintenance logs and confirmation of annual jurisdictional health and safety inspections.
The most recent meeting with the Government of Canada’s NIHB program took place as recently as November of 2016.
We do have monitoring feedback.
It is provided through informal visits from health staff and we do those two to three times a year and senior departmental staff visiting boarding home facilities when they are on duty travel, including myself.
When I’m travelling in an area where there’s a boarding home, I make sure I go in and visit.
There are also discharge planners in Edmonton, Ottawa, Yellowknife, Winnipeg, and Churchill that follow up with clients and report any issues brought to their attention.
Of the various, different contracts held by the Department of Health for services such as medical boarding homes, emergency medical travel, and scheduled medical travel, how many will be renewed or put out to tender in the upcoming fiscal year?
I would have to confirm with some documents, but it is my recollection that there are no agreements that are up for renewal at this time in this fiscal year.
In Mr. Joanasie’s opening comments on page 1 he talked a little about the history of the health department consistently exceeding approved budget allocations and always needing supplementary appropriations at the end of the year.
Considering that we’re near the end of this fiscal year, does the department know if they will be coming forward with a supplementary appropriation and, if so, how much it will be?
Chairman: Thank you. Minister Hickes.
The member brings up a question that I myself have brought up when I was sitting beside him a little over a year ago.
Upon sitting in this chair now where I realize some of the uncontrollable factors that are associated with certain aspects of our health care delivery, specifically medical travel, mental health contracts, agency nurses, and physician contracts, there are overages and we will be coming forward with a supplementary appropriation this fiscal year.
I had anticipated it being a lot less than it is. Due to a number of contributing factors, I’m going to say, in the last three to four months, it has skyrocketed. I’ll use that term bluntly.
Our supplementary appropriation request this year will be $29 million.
If we add the $29 million he just mentioned to the previous year’s budget, you’re coming up to approximately $375 million that this department will spend on health in this current year.
In the minister’s opening comments he talked about his budget for the next fiscal year being $353 million and within that he’s hiring 26 new employees.
How confident is your department that in the upcoming year you will be able to fulfill your obligations within the budget that you will have?
The member is very correct in his numbers. One of the things that even I didn’t realize until I started going to some of my FPT meetings when I talked to some of my colleagues across the country, in the chairman’s opening comments, he mentioned that the Department of Health takes up 23 percent of Nunavut’s budget.
In a lot of jurisdictions across the country it’s closer to 40 percent. In a lot of respects we’re doing very well with the money that we have.
One of the concerns that I have brought up is the budgeting process itself. When we take a look at historical expenditures specifically in the categories that I mentioned earlier that are not really controllable such as medical travel or mental services, that’s one of the larger increases we’ve had that will be coming forward in the supplementary appropriation.
It shows that we’re doing a good job in providing the level of care that people are coming to expect.
The challenge that we have as a government overall is when there are increases across one department, it puts a challenge across the entire government to fiscally balance increases.
Thus the necessity of coming forward with supplementary appropriations when we can see with more accurate data on what our year-to-date figures are going to look like.
We’ve got budgeted for medical travel. I believe it’s $64 million to $65 million and we’re coming in at $73 million. We haven’t been at the $64 million level, I think, for three fiscal years.
We have been spending more than that every year.
Are we budgeted properly for it? I believe not, but at the same time we have to realize other priorities and other needs across the territory from other government departments.
It does put the onus on the Department of Health to have to come forward with a supplementary appropriation.
We do make up some of the difference. It could have been a bigger request coming forward.
We have found a number of efficiencies in other areas where we have offset some of those smaller surpluses to take a look at making sure that some of those surpluses that we’re experiencing now are where we’re funding those 26 new positions from.
When we talk about going forward, we are taking steps. We are doing a review of medical travel.
We have Territorial Health Investment Fund arrangements with the federal government to help offset some of those costs.
I believe this fiscal year upcoming it’s only $3.4 million out of our Territorial Health Investment Fund from the feds. Last year it was $5.5 million.
The year before it was $8.8 million, I believe.
When you’re looking at decreasing assistance coming from some our partners, it puts more pressure on the government’s coffers to be able to maintain the level of care that we’re obligated to provide.
Although I myself have sat in your chair and questioned the validity of having to have a repeat offender like Health coming back for supplementary appropriations, unfortunately at this time there are no other options available to me.
Again along budgeting, the department has a history of a lot of vacancies throughout.
I’m just wondering: what role do vacancies play within your budget?
How do you use vacancies in your budget? Do you budget as a full staff contingency or do you do up your budgets with the anticipation that not all jobs will be filled?
I appreciate that question for a couple of different reasons.
For one, we do budget as if we’re filled and most of that money is used to offset casual employment.
I’m just going off the top of my head, so without going through my notes here, it’s over 400 vacancies that we have and over 300 of those are filled with casuals. Those monies are being used.
In addition to that, when we’re looking at casual nursing, although we have been doing a better job in hiring more indeterminate nurses, which reduces our costs and stabilizes our budget, almost one-third of our nurses are casual nurses where we do have to rely upon higher costs associated with agencies and different factors that play into that.
Just to answer the question in a nutshell and I apologize for rambling on, Mr. Chairman, but we do budget for all of our positions as if they’re filled.
Also in the minister’s opening comments he talked about the 26 new positions.
Given the fact with your history of having a lot of vacancies in the department, how confident is your department that you will fill all of these 26 positions within the next year?
Actually some of them we already have using our current dollars we have filled with casuals. Once we get approval for these indeterminate positions, we will be able to move those positions out to competition. Hopefully some of the people that are in their positions would apply for them and receive the indeterminate positions.
Just using the six Quality of Life positions as an example, we’ve got two of the positions filled with internal transfers right now and the rest of them are on CSAs currently.
When we’re talking about the mental health and addictions staff that we want to roll out to the communities, we want to be very aggressive in our recruiting and we will work very closely with HR to make sure that those competitions go out as fast as they can once we get approval for these funds.
When we’re talking about the public health nurses going to Naujaat and Kugluktuk, again, those are very key positions that we can work within our own HR division when we’re talking about nursing positions where we have more control over the hiring process.
We do and we will continue to work very closely with the department of HR to make sure that we get these positions filled as fast as possible because the member is right, any delays in filling these positions slows down what our goals are of providing health care from our business plan and from what we’re looking at doing across the territory.
I thank the member for giving me an opportunity to talk about that.
On page 2 of the minister’s opening comments he talked about 18 of the 26 positions being for new mental health and addictions workers.
He goes on to state that there are community-based positions.
Is he able to enlighten us today on which communities these positions will be going to?
When the business case was developed, it was to locate 18 positions over 17 different communities spread over three regions.
In June of last year the Department of Health began the process of redesigning the model of community-based addiction and mental health programming and treatment, again based on a coroner’s inquest that came in at that time, the Mental Health Act consultations, and the learning from the United for Life summit on suicide prevention, all of which suggested the necessity to reconsider the health model.
Right now, out of the total 78 mental health and addictions related positions throughout the territory, of which 73 are filled by Department of Health employees, the number of filled positions could potentially be higher as the figure doesn’t account for agency staff.
The planning process to implement this model is just in the final stages right now and that’s when we will look at exactly which communities that these positions are going to be targeted for.
We know the number of positions that we’re going for and we know we want to spread them out over a number of communities across all three regions, but I don’t have community-specific numbers at this time.
Again on page 4 you talked about six positions for the Quality of Life Secretariat.
Are you able to tell us where these positions will be located?
All those positions are located here in Iqaluit, but they do work with community wellness coordinators and other societies and organizations at the community level to assist the rolling out of programming.
It’s a centralized department here in Iqaluit.
My final question, again, is on all these positions that are being created.
How does your department feel about the adequacy of obtaining housing for all these positions?
One of the things with the community-based mental health and addictions workers specific to those 18 positions is we’re hoping to hire local, so we’re hoping housing won’t be an issue with those positions.
With regard to any additional positions, as all the members in this House and most of the people know, public housing is a continual challenge in some communities more than others, but in general the bulk of the positions that I’m applying for funding for on behalf of the department is hoping to be local hiring where housing should not be an issue.
Ms. Angnakak: Thank you, Mr. Chairman, and welcome. Good afternoon.
I wanted to start off talking about the 18 new mental health and addictions workers.
Is that a combined position, mental health and addictions, or are we talking about two like a position for mental health and another position for addictions?
It is for both.
When you’re counselling for mental health and addictions, it goes hand in hand in some cases, but they’re trained in both categories, if you want to call it that.
It’s a mental health and addictions counsellor.
It says 18.
We have more than 18 communities.
Can you provide us with a brief overview?
Is every community going to get mental health and addictions workers eventually and, if so, when will that happen?
Right now all communities in the territory do have mental health and addictions staffing.
We’re looking at enhancing it. Right now there are positions. Like I had mentioned earlier, there are 78 positions right now.
We’re looking at enhancing the programming available to mental health and addictions counselling.
One of the things that we recognized, again just going back to Member Rumbolt’s question on our supplementary appropriation, one of the categories that we went over substantially is our mental health and addictions.
We’re hoping that having more access to counselling will help alleviate some of those cost overruns, but at the same time people are recognizing more and more out in the public.
There is more and more awareness on mental health issues and people are seeking help and it’s putting a strain on the system. That’s where we want to make sure that we’re adequately staffing that component to be able to provide a consistent level of care across the territory.
Can the minister tell us out of all the reasons you can think of for visiting the health centre or hospital, are mental and addictions one of the most common reason why somebody would go to a health centre?
Acute care is the most common need for visiting a health centre or hospital in the territory, but it is a growing number when people are seeking out mental health services.
On page 2 of your opening comments you talk about these community-based positions and you also describe what you expect them to do, for example, “standardize community-based mental health and addiction treatment options.”
You said that the communities all have mental health and addictions workers already in place.
Are these services, including “medical detoxification, counselling and day programming, social-emotional learning programming for children and youth,” is this all in place right now?
Yes, I will put a little asterisk. It is to varying degrees and that’s what we’re looking at helping to stabilize with some of these positions.
Most of the community mental health workers right now are like psychiatric nurses or mental health nurses or children and youth outreach workers.
We’re trying to provide more at the community level to bring more peer support workers into place, people that understand the community, the people in the community, readiness for treatment programming, day treatment, on-the-land programming, family healing, aftercare if they do go away and they come back to make sure that they don’t step back into some of their old habits.
It’s providing a more consistent level of care across the territory.
That sounds very good, that we have a lot of the services in place, yet our addiction rates are so high.
When I think about medical detoxification, for example, that’s a pretty serious thing to be going through.
Are you saying that communities and nurses are... ? I don’t know how to say it. It’s something quite big.
Again, are nurses having to deal with this at the community level?
Is that working all right?
Are we seeing good results?
Again, there’s a lot of dependence. It depends on what they’re recovering from. There are different drugs out there, whether it be alcohol.
The staff that are in the communities are able to deal with it to a degree.
If it goes beyond their scope of expectation of what they can provide, that’s when we look at sending people out to other facilities for residential treatment or more aggressive treatment.
I just want to ask one more question about additions before I go on to something else.
Do you have the stats for the number of people from Nunavut that have gone away on referrals for addiction treatment and have come back and relapsed?
If you don’t, why don’t you track that? That’s a lot of money being spent and a lot of money being spent outside of Nunavut.
We don’t have that tracking right now.
While I do understand the value that it would bring, it’s not like somebody steps off the plane and they relapse right away.