EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
Welcome, Mr. Ma. Does the Chair of the Committee on Social Wellness have comments?
Ms. Ugyuk (interpretation): Thank you, Mr. Chairman. (interpretation ends) Members of the Standing Committee on Social Wellness have reviewed the 2013-14 main estimates and business plan of the Department of Health.
The standing committee notes that the 2013-14 operations and maintenance budget for health is $280,427,000, which takes into account the transfer of social services to the newly created Department of Family Services.
With respect to the transfer of the Social Services Division to the Department of Family Services as of April 1, 2013, committee members have expressed some concerns with respect to the transition process and what efforts are being made to ensure that no clients or staff members ‘fall through the cracks’ when it comes to redirecting requests for service and information.
Members encourage Department of Health officials to work closely with Department of Family Services officials in this regard.
Committee members further encourage the government to more effectively use the positions of community-based government liaison officers (GLOs) to provide assistance to community residents in accessing services and support from the appropriate departments as well as in communicating policies and procedures related to service delivery for the public.
While the proposed 2013-14 budget for the Department of Health does represent a relatively minor increase over the restated main estimates for 2012-13 that were approved in this House a year ago, members are aware that the nature of service delivery in the health care field is driven by various demands which can be unpredictable and costly.
The department has brought forward supplementary appropriations on a consistent basis over past years, with this year being no exception.
However, the committee anticipates that with the department’s revised mandate, Department of Health officials will be able to focus their efforts more efficiently and economically than ever before.
Mr. Chairman, Nunavut’s unique population characteristics and geography, as well as the linguistic and cultural aspects of health service delivery lead to significant cost drivers when it comes to delivering services.
While the federal government has recognized the impact of costs related to delivering health services in the north by providing additional funding through such initiatives as the Territorial Health System Sustainability Initiative for medical travel and other services, the funding agreement has already been extended twice and is set to expire in 2014.
The standing committee strongly supports the minister’s efforts to guarantee the permanence of such federal funding to ensure the ongoing delivery of adequate health care and medical services across Nunavut for the foreseeable future.
The standing committee recognizes the department’s efforts to improve the delivery of health care services with the addition of a number of staff positions, such as administrative assistants, new nursing positions in the Kivalliq region, therapy assistants, and a new biomedical technologist position.
The committee appreciates that many challenges are faced in maintaining staffing levels, especially for nurses and physicians, and encourages the department in its efforts to improve recruitment in these areas.
In addition, the committee remains supportive of the department’s initiatives within Nunavut Arctic College’s health careers program and encourages Nunavummiut to consider pursuing training and education in these areas.
Mr. Chairman, the standing committee continues to support the department’s investments in initiatives, such as the Interoperable Electronic Health Records Program, and anticipates that once the system is fully implemented, it will allow for improved analysis and planning for public health initiatives, as well as in addressing specific health care issues.
Committee members have noted that mental health problems continue to lie at the root of many other social and health issues.
While the committee recognizes that mental health worker positions remain within the Department of Health, it will be important to maintain ongoing communications with social workers working within the new Department of Family Services to provide the full range of client support.
Members fully support the ongoing implementation of actions and initiatives to address the issue of suicide in our communities.
The committee recognizes that a review of the Mental Health Act is anticipated for the upcoming fiscal year and will be monitoring the consultation phase closely.
Issues relating to addiction and substance abuse are also of great concern across Nunavut.
Committee members continue to support the concept of culturally relevant, community-based programs and encourage the minister to work with his officials to continue providing programs such as the one delivered in Cambridge Bay last year.
Mr. Chairman, members have noted that a number of Tamapta commitments, including plans for a Nunavut-based treatment facility, have not yet been brought forward and may not come to pass within the term of this Assembly.
Members have noted that the new correctional centre in Rankin Inlet has been called a healing centre, which gives a somewhat misleading view of the kinds of programs that are being delivered at that facility, and encourage the government to push forward on its original plan for a territorial treatment facility.
Mr. Chairman, medical travel is one of the most expensive expenditure areas for the Department of Health and the government as a whole.
The standing committee recognizes that there is often no other option than to fly clients to regional centres or to other jurisdictions to receive the necessary care and services. Concerns continue to be raised regarding the policies relating to medical travel and the provision of escorts.
With social services client travel being addressed under the mandate of the Department of Family Services, the committee encourages the minister to revise the Department of Health’s medical client travel policies accordingly and to clearly communicate any changes to health professionals, service providers, and the public.
Members further note that the department has yet to introduce its new “Patient Relations Process” by which medical clients can bring forward complaints or concerns and have them addressed.
Members encourage the minister to introduce the new process publicly and at the earliest opportunity.
As the members are well aware of Rules 77(1) and (2), I want to remind members to leave your questions until we get to the page-by-page review of the departmental estimates, please.
Do members have any general comments pertaining to the opening remarks from the minister?
On page 2 of the Hon. Minister Peterson’s opening comments, under “The department will also continue to work on:”, bullet No. 3, “possible revisions to the Nunavut Nursing Recruitment and Retention Strategy;”.
I am hoping this will address our reliance on recruiting agency nurses from the south.
I don’t have any other comment except that I hope this will address this.
Perhaps when we review the department’s branch summary page by page, then I may come up with a question.
I have no other names for general comments.
So therefore, we will now proceed to the page-by-page review of the departmental estimates starting with page H-4.
Total Operations and Maintenance, to be Voted. $23,373,000.
I just have a few general questions before I get into some specifics.
I wonder if the minister can give us: what is the current status of scheduled medical travel contracts for each region of Nunavut?
Mr. Chairman, I believe we have just signed medical travel contracts with all the airlines. The scheduled airline contracts have been signed and medevac contracts have all been signed.
I think they’re in place for another one to two years.
Under these medical contracts, have there been any changes?
Are we seeing different providers for the medical contracts or are we going with the same ones that have provided it in the past?
Mr. Chairman, I believe we’re using the same medical travel airlines that we have used in past years.
The routes have changed a little bit, but we are essentially using the same airlines.
What is the current status of the emergency medical travel contracts for each region of Nunavut?
Mr. Chairman, we have contracts in place with air ambulance contract vendors in each region.
The same question as before is: are we still going with the same carriers or the same airlines that provided the same service in the past?
The only air ambulance provider that has changed was in the Kitikmeot.
It’s my understanding that the contracts for the medical boarding homes are being reviewed or reissued at this time.
Can the minister update us today on the boarding home contracts in Yellowknife, Edmonton, Winnipeg, and Ottawa?
The current situation with the contract in Ottawa is that the contract is in place. I think, in Winnipeg, there was an RFP that was put out.
I can check on the date. There was an RFP put out for the provision of operating that facility. In Edmonton and Yellowknife, I believe the contracts are in place.
The department’s three regional facilities in Iqaluit, Rankin Inlet, and Cambridge Bay have all been operational for some time now. Have you seen any reduction in the cost for travel and treatment as a direct result of services being offered in the regional centres?
I thank Mr. Rumbolt for the question, a very difficult question to answer.
We are making some changes in the Baffin.
We’re now expanding or renovating the Qikiqtani General Hospital so that we can bring people from the outlying communities to Iqaluit for more sophisticated diagnoses and if we have to, we will send them to the south.
In the Kitikmeot, the health centre there can only provide a certain level of service.
As I mentioned in question period, we don’t have an adequate number of doctors and nurses to provide specialized services through the housing and the boarding home there.
In Rankin Inlet, I believe the health centre there is providing some outpatient service, but again, if we can’t provide specialized services, we have to send folks down south.
As we have mentioned in previous years, a lot of the medical travel is demand driven.
If we have to send people outside Nunavut for very sophisticated diagnoses, it becomes quite costly because bed nights are expensive in hospitals and doctors charge more. It is costly, but a lot of it is demand driven.
One of the department’s priorities for 2012-13 was to use the findings from its review of the Client Travel Policy to establish consistent guidelines in the area of medical travel, and that is on page 90 of the business plan. Did this review also examine the roles and expectations of escorts for medical clients and, if so, what kinds of issues were addressed?
We found that a lot of the issues with the Client Travel Policy were behavioural.
In other words, people would not show up for the travel or they missed their appointments. When people miss their appointments, it creates a domino effect in terms of rescheduling appointments and rescheduling air travel.
That was one of the major issues we found.
In some cases, medical clients who are sent out for treatment end up spending long periods of time in the hospital.
Can the minister describe what expectations exist for the escort of these patients, and will these expectations be listed under the revised guidelines?
The expectations are fairly general.
The escort has to be there with the patient that they are accompanying, assist them to go to their appointments, and be there to assist with translation/interpretation.
It is very general.
Some medical clients, especially our elders, who may end up in the south be in an unfamiliar environment and not understanding the languages being spoken around them increases their need for escort support.
Can the minister describe what consideration is given to provide adequate escort services for those medical clients, such as our elders, who are most in need?
The primary services when the elders are unilingual and over the age 60, we do provide an escort unless they don’t specifically require an escort.
A lot of it would be a factor of age with the level of service we provide.
For anyone who has been an escort for an elderly parent or relative in the hospital, they will know that it can be a very tiring and exhausting experience.
Can the minister indicate whether any consideration has been given to provide relief support to those escorts who end up spending days and sometimes weeks at the side of their ailing relatives?
I know it can be very challenging for an escort if they have to be in the hospital for a patient from eight in the morning until midnight and they probably need some relief.
We can accommodate people in terms of they can switch them out with another escort after four weeks.
If we know up front or soon into the escort service for a particular patient that a second escort is required to relieve an individual who is in that situation eight until midnight, for example, if we know that early on, then we can review it and look at how we can assist with a second escort.
Three of my next questions are kind of along the topic that I was discussing, but they tie into different departments under this budget item, so I’ll ask them under Directorate because it involves support and the Client Travel Policy.
Funding for medical travel, accommodations, and escorts for beneficiary clients is provided through the Non-Insured Health Benefits Program.
Can the minister indicate what discussions have taken place with respect to funding available to provide adequate escort services for medical clients?
Mr. Chairman, it’s always ongoing with non-insured health benefits; we have quarterly meetings with Health Canada.
I have Mr. Enook.
I have a variety of questions and I assume they are going to be under H-4. If they’re not under that page, you can provide me with direction.
Under the minister’s opening statement on page 2, the department is going to be dealing with, and the last bullet states, “planning and possibly expanding mental health service capacity outside of Iqaluit.”
As Nunavummiut, can we get clarification on this?
I will have additional questions later.
If I understand him correctly, we’re expanding our mental health services in Iqaluit through the Akausisarvik facility that we hope will be open in April.
We’re looking at using the existing facility in Rankin Inlet.
Our staff is reviewing the possibility of a facility there and we’re also looking at an existing facility in Cambridge Bay.
I thank Minister Peterson for his response. The need to help people with mental health issues is becoming more apparent within Nunavut and outside Nunavut as well.
If they have concerns regarding mental health patients, I think it should be considered one of the most important issues because sickness affects the whole family, but mental health affects most as well.
Additionally, once I joined this House upon my election, I have continually heard it mentioned that it has to be considered one of the most important issues.
However, nothing seems to be planned to meet this challenge.
As an example, many employees periodically visit our communities for short periods with brief examinations of their clients and then they leave again. I doubt that this is a best practice scenario when we are talking about services provided to our mental health patients. To analogize, when dentists go into a community, they extract their set amount of teeth and then they leave the community.
I see this in the same vein, even though I think this is an extremely important matter.
I imagine that there is some sort of strategy to deal with this issue.
For example, after a two-year period, how many employees has Nunavut hired as mental health workers?
Mr. Chairman, we don’t have specific numbers on PYs.
I do know where we can get that information, but I just don’t have it here right now.
We have made some significant investments in mental health over the last couple of fiscal years, and we are doing an investment in Akausisarvik.
In this budget, we’re looking at seven new PYs. I recall mental health workers last year.
We were talking 12 mental health workers last year, using grads from some of the Nunavut Arctic College courses and programs.
We are making investments. We do recognize that mental health is a high priority for the Government of Nunavut.
We are making those investments. Unfortunately, we just can’t make huge investments all at one time. There is just not enough funding, but we are making steps in the right direction.
I want some clarification. The minister states that they are moving in the right direction.
I like that answer, but what things are getting better? Is it because we are getting more PYs under this present provision? Are the communities getting more employees?
How do you tell the communities that you can now have a mental health worker?
Is there a law or policy in place saying, for example, that Pond Inlet is in a situation and now they need a mental health worker?
Is there a policy in place?
I thank Mr. Enook for his concern in this area and I appreciate the question.
It’s a difficult question to answer.
As I answered earlier, it is a high priority for the government and for the Government of Nunavut.
We are making steps. We are reviewing the Mental Health Act. We have the Mental Health Framework for Action.
We created the new PYs in the last budget.
We are expanding Akausisarvik, as I had mentioned, and the other facilities. We are making steps in the right direction. The challenge is staffing, of course.
With staffing, housing is a factor. You don’t always have housing for the positions you want to staff.
We’re working on that.
I know, in the Kivalliq region, there were some issues. This fiscal year, we transferred our mental health director from the Kitikmeot down to the Kivalliq region and she’s making great progress down there, increasing the mental health worker capacity down there without destabilizing the Kitikmeot.
It is a challenge, but we are working on it.
Again, it comes down to budget availability, housing, other infrastructure, but we’re putting in place these policies, the Acts, and the framework.
I think that will help us, plus the research that we’re doing in this whole area will support our future requests for mental health resources.
Maybe I’m not clear with my question.
When we apply for a job, there is usually a job description and certain educational requirements. If we meet the criteria, then we can apply for a certain position.
My earlier question was: for example, in Pond Inlet, how do you determine that there’s a need for a medical health worker?
Is it based on our population or the fact that we have adequate nurses or maybe is it based on lack of housing?
What are the foundations that can state, “Yes, these communities need mental health workers.”?
Also, I want to remind the minister what I have always stated.
Since 1999, there are vacant government buildings in Pond Inlet.
Even though no one ever mentions lack of housing, there’s an issue in Pond Inlet.
There are a lot of housing units in Pond Inlet that have never been utilized.
On what basis do they determine that a certain community needs a mental health worker?
I thank Mr. Enook for clarifying his question.
Again, housing is an issue in all communities, but the Government of Nunavut has… .
I’m not the housing minister, so I don’t want to say too many things there about how they decide.
It is a priority ranking process where the departments meet and determine which positions within the government or within the communities are the priorities for housing.
Certain positions, I guess, in some of the communities are higher ranking than mental health workers.
I totally don’t understand his comments.
He’s saying that the government departments meet and determine which positions are given priority for housing.
I’m trying to ask: how is it determined that a community needs a mental health worker?
Maybe someone can rephrase that question because I have no idea as to how I could clarify my question.
Mr. Chairman, I believe every community has at least one mental health worker or mental health PY. Again, it’s a priority ranking system.
I think nurses and teachers, for example, will have a very high priority in terms of provision of housing.
At this particular moment, I’m not sure how high a rank the mental health position is in the community.
Perhaps our time here is limited, and the employee whom the minister states works as a mental health worker doesn’t even reside in Pond Inlet. We share the worker with several other communities or perhaps we will lose that position.
I totally disagree with the minister or perhaps we totally misunderstand each other. I will leave it for the time being and use other avenues to pursue it further to come to an understanding.
However, Mr. Chairman, if you will bear with me further, I have another question regarding a separate issue.
Mr. Rumbolt’s line of questioning included references to medical escorts.
Mr. Chairman, I believe it was last year when I raised questions or made comments about the issue in the House regarding patients on medical travel who require medical escorts. That it is largely clearly written.
The one and seemingly most important thing is terminal patients with cancer.
It states within the policy that as long as you are able to walk and can speak or write in English, you don’t require a medical escort.
When terminal patients with cancer have to go on medical travel, they are already burdened mentally with their sickness, but they have to travel.
I was urged to speak to this issue by a fellow resident who was in that situation and it is unfortunate that the person has now passed on without any progress on what he asked me to convey.
However, he did pass along some thoughts and questions that he felt should be voiced or considered for others who may experience the same thing he was undergoing. He stated that whenever he left for medical treatment, he was always alone and he stated that he was always worried about the news that he had to face alone.
Based on the policy we followed at the time, our own government policy criteria stated that this patient wasn’t sick enough to qualify for an escort, yet the patient himself was mentally anguished and extremely worried all on his lonesome.
At the time when I raised these questions, I wonder if any consideration has been placed on this issue.
I’m sorry for your constituent and that he has passed on.
We never like to lose a loved one or a friend in our communities.
I completely understand how challenging and difficult it is for people to have to go down to the cities.
I escorted a guy down last week to Edmonton, a young guy who is 16, but he hadn’t been down to Edmonton for a couple of years, so it was an eye-opener.
Mr. Chairman, usually, if a client is medically incapacitated or the client has a mental or physical condition that he or she is not able to travel unassisted or when the escort needs to participate in the client’s treatment program, there is an escort approved.
Maybe this is the bottleneck where our problems arise, particularly with medically terminal patients who have cancer.
Some patients with cancer don’t look at all unhealthy and look capable.
Even though their body seems fine, their mental state is in turmoil as they are worried about their illness and scared of what the doctor’s prognosis will be.
Although the medical travel to the south itself is stressful enough, they also must face this enormous problem individually with no support.
Even with all of the challenges of being sickly, it is the mental turmoil and stress that I imagine is the more difficult aspect to deal with, if you were to be in that person’s shoes.
That is what I tried to raise in my questioning.
This is an actual situation that occurred, yet the response I receive is that only if certain criteria are met will that person be able to be provided a medical escort.
As per my previous line of questioning, can’t the department revisit this policy and include extraneous circumstances aside from the criteria?