EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
I didn’t know you had regional offices for Qikiqtaaluk; $731,000, given to regional offices to be distributed throughout that region?
We do have offices in Baker Lake, and in Igloolik. In the Kivalliq the grants and contributions that are listed there basically pertain to community library operations in the Kivalliq.
That’s what that contribution is for, because it’s specific to libraries within the Kivalliq region that’s why it’s listed there.
Any grants and contributions that are specific to regions are listed, but if it’s for all of Nunavut, all of Nunavummiut to apply, it is in the headquarters budget.
Chairman: Thank you, Mr. Kolot.
So those specific ones that are listed in the regions are in fact continuing. If they are continuing on an annual basis how can we tell if it’s an increment on an annual basis?
Mr. Kolot: Thank you, Mr. Chairman. As all members of this Assembly know that 2007-08 estimates represents the status quo. There have been no increases reflected in any grants and contribution categories.
It is our intention to proceed with supplementary requests later this year, but for this budget, it simply represents the status quo, as directed by the Financial Management Board.
Mr. Tootoo: Thank you, Mr. Chairman. I just want to get a clarification of the amounts that my colleague was asking about, the grants and contributions that are administered out of the headquarters.
Would those have been included in the document that was tabled yesterday in the House that shows all of the grants and contributions for the department?
Hon. Louis Tapardjuk: I will get David Kolot to respond to that.
Culture, Language, Elders and Youth. Department Summary. Detail of Expenditure.
Hon. Louis Tapardjuk (interpretation): Yes. The money that we have for our department has not increased but what we want to do is still a little bit more.
I would like to thank the Members of the Legislature for agreeing to the budget for our department.
I thank your staff.
I would now like to ask Minister Aglukkaq of Health and Social Services to make her opening remarks.
Bill 01 – Appropriation (Operations & Maintenance) Act, 2007-08 – Consideration in Committee – Health and Social Services
Thank you for this opportunity to present the 2007-08 Main Estimates and Business Plan for the Department of Health and Social Services to the Committee of the Whole.
We have made some difficult choices in the 2007-08 Operations and Maintenance budget for the department. We had to balance the financial limitations faced by the government as a whole with the real health and social service needs of Nunavummiut.
Mr. Chairman, our goal for 2007-08 is to deliver effective, quality programs and services that meet national standards. Nunavummiut need and deserve a basic, reliable health and social services system that not only responds to illness but supports wellness and provides health protection.
We can achieve this only if we strengthen our financial management capacity so that we can make effective, efficient and responsible use of public funds.
Over the coming months we will be transferring the payment processing functions to the Department of Finance. Our Finance Division will then be in a position to focus on budget development, financial projections, and training of the program managers.
We will also strengthen our health protection capacities through the development of a Public Health Strategy for Nunavut.
Through research, consultation and workshops, we will create a practical plan for addressing the unique circumstances of Nunavummiut.
In undertaking its day-to-day work, the department will take into consideration the work done before not just by our own staff but also by others such as the Health Integration Initiative involving Nunavut Tunngavik, Health Canada, and the Government of Nunavut.
We will support the efforts of other government departments in implementing community based measures for preventing violence against women.
With our small and dispersed populations, it’s not possible or reasonable to offer Nunavummiut the full spectrum of health and social services that people in big cities take for granted.
We will be hard-pressed in 2007-08 to follow through with our plans to modestly expand patient and other services in the regional centres.
We are fortunate to have good partnerships with out-of-territory agencies and institutions. We will nurture these relationships over the coming year so that Nunavummiut can continue to access those services that we are unable to offer here.
We can and will continue to deliver primary healthcare services such as homecare, health protection, and environmental health.
Thanks to the amended Pharmacy Act, our Nurse Practitioners will be able to practice to their full scope.
We are using technology to help us avoid costs and improve the patient’s experience. For example, the fetal fibronectin test can confirm if labour is truly under way. This test alone meant 45 medevacs were avoided, and 45 families did not have their lives disrupted unnecessarily.
We also use telehealth and visiting specialists to make best use of our limited financial and human resources.
There will be times where our healthcare providers must do what the patient needs rather than what the patient or his family wants simply because the system can’t afford to do otherwise.
That is a reality of healthcare today not just in Nunavut, but across Canada.
The Department of Health and Social Services recognizes that we need to improve our recruitment and retention of staff especially nurses and physicians.
It is in everyone’s best interest to have a stable and qualified workforce for both social and health services.
We now offer a wide range of training opportunities to our nursing staff. We will also be making improvements to the physician package.
Over the next three years we hope to employ a greater number of Nunavut graduates of post-secondary programs in health and social service professions. Over the long haul, having a home-grown northern workforce is the best way to stabilize our system of care.
My department is already making contact with potential graduates with a view toward making job offers to those who want a career with the Government of Nunavut.
Mr. Chairman, for fiscal year 2007-08, the Department of Health and Social Services is seeking a total of $225,622,000 for operations and maintenance expenditures.
This is a slight decrease from the 2006-07 revised estimates.
Mr. Chairman, Thank you for the opportunity to make these opening remarks to the Committee of the Whole.
I welcome any questions you may have with respect to the 2007-08 main estimates for operations and maintenance for the Department of Health and Social Services.
Does the Co-Chair of the Standing Committee on Health and Social Services have comments?
Members of the Standing Committee on Health and Education have reviewed the main estimates and business plan of the Department of Health and Social Services for the 2007-08 fiscal year and I am pleased to provide you with opening comments.
The standing committee notes that the operations and maintenance budget for Health and Social Services for the 2007-08 fiscal year is $225,622,000, which is very close to the amount allocated in 2006-07.
Given the department’s past history of over-expenditures, the committee urges the minister to ensure that her department keeps close control over its spending in the upcoming year in order to remain within budget.
Mr. Chairman, over a year ago, the Baffin Regional Hospital lost its accreditation status. Although the Department of Health and Social Services was originally given 18 months to meet the set standards for regaining its accreditation, the committee has now been given to understand that the department is working with the Canadian Council on Health Services Accreditation to develop new accreditation standards for Nunavut.
Members hope that this process will not delay the department’s progress in ensuring that services at the Baffin Regional Hospital and all other regional health facilities meet national standards of service and care.
The department is proposing another increase in departmental positions for 2007-08, although it appears that hiring for a number of jobs has been put on hold.
At the same time, the Government of Nunavut’s own employment statistics show that as of September 30, 2006, the department was only able to fill 67 percent of its positions, down from 73 percent a year before and down from 80 percent two years before.
One job that has not yet been filled is the position of the Client Services Coordinator.
This position was created nearly two years ago in response to the members’ request for an individual to be able to assist Members of the Legislative Assembly and their constituents in addressing complaints about service delivered by the department or its contracted service providers.
Last year, Members of this House approved the department’s 2006-07 business plan, which clearly committed to filling this position.
To date, the position has not been advertised.
Although it receives less emphasis in this year’s business plan compared to previous years, the standing committee looks forward to reviewing initiatives resulting from the department’s recent Care Closer to Home Strategy.
The committee consistently supported the department’s long-term objective to train and hire more Nunavummiut to work in the health care field.
However, members are disappointed that the number of beneficiaries filling positions at our regional and community facilities is not increasing.
The standing committee encourages the minister in her efforts to provide training, certification, and employment opportunities for more Nunavummiut to enter the health care field.
The nursing shortage, in particular, continues to be a major concern across Nunavut as it is in the rest of Canada.
The committee urges the minister to continue to work with her officials to ensure that there are full-time nursing staff in all of Nunavut’s communities.
It has become apparent that focusing efforts and limited resources on recruiting international nurses has not been as successful as anticipated. The standing committee believes that more effort and resources should be directed to employing full-time Canadian nurses.
The standing committee recommends that the minister work with her counterpart in Education to provide better financial support to Nunavummiut who are training to become nursing professionals.
It is vital that these individuals are able to focus on their studies without undue financial stress and that they are assured of a place within Nunavut’s health care system as soon as they successfully complete their program.
If extra support can be provided for internationally recruited nurses to pass their Canadian nursing exams while being employed by the department, the standing committee believes that we can do the same for our very own Nunavut-trained nurses.
The standing committee is pleased with the progress towards opening 24-hour continuing care facilities in Nunavut.
This was a commitment that all members agreed to at our Arviat full caucus retreat. While members have noted that the department’s business plan states that local training programs are underway for staffing at the Gjoa Haven Continuing Care Facility, it is not clear whether similar training programs are planned for the upcoming continuing care facility in Igloolik.
The department’s business plan focuses on the role to be played by the community-based health committees of Council.
Members agree that community-based health committees are in a prime position to provide appropriate guidance and direction with respect to the various wellness programs accessed by communities, especially if they are provided with adequate training and resources.
At the same time, members believe that Nunavut needs a territory-wide coordinated approach to a number of health issues such as suicide prevention, substance abuse and domestic violence.
The committee looks forward to reviewing the department’s plans for implementing its Community Wellness Strategy, as referenced in the department’s recently tabled Health Integration Initiative document.
Given the holistic approach suggested by the Community Wellness Strategy, it is not clear to the committee why the department’s business plan indicates that a new addictions strategy will be independently developed in the upcoming year, especially since the department tabled a Nunavut addictions and mental health strategy in 2002.
Mr. Chairman, members of the standing committee continue to have serious concerns regarding the implementation of the department’s medical client travel policy.
Members have also noted ongoing problems with the administration of the travel coordination services for the Baffin region.
The committee would welcome a government decision to relocate these positions back to Iqaluit.
The committee looks forward to an update of what has been done to improve medical travel services for Nunavummiut.
Members encourage the minister to work with her department to ensure that clear information about medical travel is made available to all clients, escorts, and health professionals.
In a recent exchange of correspondence with the minister, the committee was pleased to receive information on a number of these issues and looks forward to receiving the remainder of the information that we requested in the near future.
That concludes my opening remarks. I anticipate that individual members will also have questions and comments as we proceed. (interpretation) Thank you, Mr. Chairman.
I’m very concerned with the direction that the department seems to be going over the last three years. Three years ago the Standing Committee on Government Operations, at public hearings with the Auditor General, were told by government officials that the department was finally going to be in the black.
Since that time, the minister had indicated last week that they’re looking at little over $10 million over budget for this fiscal year.
And this is after we’ve already bumped up the base budget that was under funded by a little over $20 million. There’s some extra funding in there to deal with the accreditation issues at the hospital. I think it was a little over $2 million more added in there.
The department, after six years, with all of the problems, we believed at the time that we adjusted the base budget to adequately reflect the needs of the department.
It just seems to have gone totally out of control again.
In the minister’s opening comments, she talks about a stable, qualified workforce.
I have concerns, too … it seems like a very high turnover rate in the senior officials at the department. Is that one of the problems why things aren’t being monitored?
What type of financial and management controls is the department putting in place to watch their spending?
One of the things she also mentioned in her opening comments with this latest transfer of payment, the bill payment staff going over to the Department of Finance, is that they could focus on proper budget development, financial projections, and training programs.
But I think the issue is what kind of responsibility or accountability is out there if we pass the budget, and there is a budget for each area that is being monitored and managed to work within.
I’ve heard comments from all over this territory from different people saying they’ve heard that some people said, “Don’t worry about the budget; just go ahead.”
To me that’s not acceptable.
It seems like since the beginning of our government in 1999, is always like the health says people get sick and we can’t tell them that we’re not going to fly them out as an excuse to hide behind to just burn money.
We need to be assured that there is some accountability as to how the department spends its money. It seems like there is no accountability. Just go back and say we need more for medical travel.
Are there accurate reflections in the budget? I think the budget that we have in front of us today is unrealistic.
They have for medical travel, I think it is the same amount as last year and already they’re over from last year.
In some cases maybe they’re...we know we’re going to go over in that area and no one’s going to say no to that so we’ll just under-budget in that area and if we do go over budget again we’ll just come back to a supplementary again and we get more money.
I have very serious concerns over the financials controls in the department; why things seem to get out of hand.
It is just a continual revolving door of senior staff that are there.
I know that has to lead to some problems of monitoring and making sure that people know what they’re doing.
It seems like they take one step forward and then three steps backwards.
I have a lot of concerns in this area and I will be asking the minister and officials, when they’re in the witness table, a lot of question on that.
Some of the things that the Members of this House have voted on in the past and have been told they’re going to happen aren’t happening. We hear now that accreditation ….we’re told give us eighteen months and $2 million and we’ll get it fixed.
And now a year into it, it’s not going to happen for another year so that’s 24 months, and maybe we’ll be ready by then. They’re changing the standards.
What was the big rush to get that on then? It doesn’t make sense.
Another thing that I am very concerned about, as the co-chair mentioned in his opening comments, the fact that the majority of concerns from MLAs here from their constituents are health related whether dealing with the staff at a health facility, or medical travel, or whatever.
It is just the nature of the beast in that area that there are always concerns that are brought to our attention.
Over the last few years we’ve worked to try to find a way to help alleviate that problem because every time when we try to ask about it here in the House it always no we can’t talk about that because it’s a person’s private, confidential information.
For a couple of years now we have been told that the solution to this is we’re going to hire a client services specialist or coordinator and then we find out that this position hasn’t even been advertised.
This Assembly last year approved the funding for that position.
When we approved the department’s main estimates I would assume that it was approved by Cabinet too before it came in, and they are looking for a very good explanation from the minister why they didn’t even bother to advertise for that position.
Just look at what has been going on here for the last week and a half. How many concerns have been brought up that are health related; of individuals having concerns and they have nobody to go to.
We have told our constituents to raise their concerns with our client services coordinator.
Are these just words to make us sound good?
We make a decision on something and we expect that some direction be given and that commitments made on behalf of the government and the Assembly are not just words.
They are actually commitments and actions and things have been done for it. What is the use of us being here to approve something if it is not going to be acted on?
Another thing that I know has been a big push for the department over the last few years was the Care Closer to Home Strategy. That seems to have fallen right off the radar now.
I will be looking to find out exactly why that has happened.
In her opening comments, she also said that the health department recognizes we need to improve our recruitment and retention of staff.
Are they just recognizing that now?
How many years has this been going on?
We have a contract in place with a consulting firm to hire international nurses.
As the co-chair indicated, it hasn’t been very successful.
Issues were brought up in the past and I know of cases where there were nurses living in communities with their partner who wanted to work there but couldn’t because that position was being held for someone else that wasn’t there yet, for an international nurse.
“Well we can’t give you a job there because we are holding that for somebody.” Here is somebody that is living in a community and wants to work but can’t.
My time is up so I will ask some questions when we get there.
I also want to raise some concerns that I have. It is one of the biggest departments and it is very essential. The health centres, nursing stations, all over the Keewatin, we understand it is an essential service.
The staff go through very difficult times.
As I stated, when I was under their care, there are physicians out there who work really hard and look after their clients very well. I would like to congratulate them and recognize them.
There are some good people out there but I know there is room for improvement.
We hear all kinds of concerns from our constituents as a Member of the Legislative Assembly. I don’t want to talk with them directly so I direct them to the minister. I feel I would be interfering with their work.
What I wanted to say was we hear about people who are leaving the north because rent is way too high.
I believe that is true because according to the present government policy we know that people in government staff housing, not just the medical staff, but people who were in government housing go to public housing because it costs way too much to rent a government staff house.
I think there is a surplus even in Rankin because Inuit are starting to go to public housing units.
What I want to say is that the essential services in the government, for example. Even if it costs one quarter more, they have to be provided housing even if they’re subsidized higher, because it is an essential service.
I’m saying this because it is very difficult to attract nurses to come and work, and it’s getting harder to get doctors to come to the communities.
When we are dealing with the Housing Corporation, if possible, nobody wants to pay rent but nowadays nothing is free.
I think the government policy has to review the essential services for nurses and doctors.
If it will help to retain nurses and doctors to stay longer, then that policy will have to be changed.
I wanted to bring that up.
Mr. Chairman, in the Keewatin, I’m not sure if the health centre in Rankin Inlet is a regional centre because when it opened almost a year and a half ago there were so many beds, and those beds have never been used.
We feel like people who have heart problems should be kept overnight.
Sometimes where they might require 24 hour care, even at 4:00 or 5:00 in the morning, there was an elder who tried walking home from the health centre.
Those are the things that need to be fixed, so I will be raising questions as to why those beds can’t be used in Rankin Inlet.
More than once an elder told me they were having a heart problem. He had to call an ambulance because the health centre wouldn’t answer and the taxi wouldn’t come. Once he got a response from the ambulance, the driver, who was a fire chief, my colleague knows, they were told not to do that.
Once there was an investigation he had to be medivaced to Winnipeg.
So, I want to tell the minister that the standards will have to be improved.
I also want to bring up the Winnipeg Boarding Home.
My colleague from Rankin Inlet is aware that there are a number of problems that will have to be dealt with. Sometimes Inuit who are there don’t feel too welcome. There are problems with food.
So, I will be bringing those issues up too.
During the development of the Kivalliq Centre there was to be a boarding home. We still haven’t heard anything.
What is the status of the boarding home? Will the federal government fund it? Or are you in the process of negotiations?
So, I will be asking questions with regards to those issues.
Let us be very careful. There are medical personnel; nurses and doctors who work very well and they should be recognized.
Lastly, Mr. Chairman, every year in Rankin Inlet, there is an annual Christmas party and it is becoming very popular. The medical staff holds a Christmas party with the elders.
People enjoy it.
Maybe if every community was like that there would be a lot less problems. As Members of the Legislative Assembly we fully support this. The nurses really enjoy eating with the elders and providing service to them.
I would like to apologize for going ahead of myself there.