EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
We must see a shift from a cute care services to health promotion and prevention of all illnesses, we need to enhance community base initiatives that utilize or integrate Inuit Qaujimajatuqangit with contemporary knowledge, modern science, community wisdom and local solutions.
Integrated and comprehensive prevention and promotion efforts are required.
In Nunavut Mr. Chairperson we require a modern information technology system.
Nunavut comprises 24% of Canada’s land mass as you all know we are require to deliver services in 26 widely disbursed communities.
Through technology we have an opportunity for creative responses service delivery, education of health professionals and learning from each other.
We must also provide the opportunity for quality care, cost effectiveness and very timely service delivered over vast distances.
The technologies of tele-health applications will realize the substantial financial savings over time.
Mr. Chairperson heavy demands will be placed on available financial resources of the department and of this government by an increasing population a focus on integrated prevention and promotion efforts acquisition of new diagnostic tool and acute care services.
The challenges we face in department of health and social services are extensive, we are building a confident, professional integrated team that will deliver the very best service for the residents of Nunavut within the available resources.
I trust this assembly will look favourably on the budget that I’m about to present, the health and social services budget is divided into 2 main categories operation and maintenance or O&M and Capital.
On our operation and maintenance Mr. Chairperson the budget for the department is detailed on pages 10-3 which indicates on our total operation and maintenance budget is 117 million and 427 thousand dollars.
Our original budget request was based on a detailed analysis of the requirement to provide enhance service to the residents of Nunavut.
The reduction from the original request was based on the realities on the amount of funds available to all departments and to the government of Nunavut as a whole.
We will try to minimize the impacts on service delivery to best of our ability, while living within the allocated amount, however this may result in a budget that requires significance increase over time.
The operation and maintenance budget is divided as for the pie graph in page 10-3, you will note that the primary acute programs account for 50% or 59.8 million of the budget.
These programs are currently delivered by the 3 regional health and social services boards and additional 27.7% or 33.2 million is allocated to the health care insurance which in reality, Mr. Chairperson, are also primary in acute care expenses generated outside of Nunavut by the Iqaluit hospital and by pay for service doctors, these are paid by our government under the health care insurance program.
The directorate of the department is currently composed of 15 positions out of a plan total staff compliment of 72 and 40% current staff are Inuit.
All of the expenses are associated with these position including such as a travel, office supplies, computers, telephones, are within 10.6% or 2.6 million allocations.
We also included in the directorates from program delivery expenses which are delivered directly from Headquarters.
Community health programs at 8.2% or 9.7 million and children’s programs, Mr. Chairperson , at 3.5% or 4.2 million round out the total operations and maintenance budget.
Mr. Chairperson, the department of health and social services has a small capital budget totalling 2.188 million, there are number of capital projects in fall within this budget and he will provide more detail about those as we progress.
The Department of Health and Social Services is working with the department of finance in the construction of the health centre in Arviat this year.
This project is being finance as a P3 project and it will not be reflected in our capital budget.
Mr. Chairperson and Honourable members this concludes the formal part of my presentation today, we’ll be please to answer any question you may have about the budget for the department of health and social services.
I will also welcome your comments on how we can work together to build a stronger health and social services in Nunavut.
>>applause
Chairperson (interpretation): Thank you , Minister of Health and Social Services.
I will now ask a representative of the standing committee to give us their report of their review of the budget.
Jobie, who will read the report?
Mr. Nutarak (interpretation): Peter Kattuk will read the report.
Chairperson (interpretation): Sorry , please repeat that.
Mr. Nutarak (interpretation): Mr. Kattuk will read.
Chairperson (interpretation): Okay, Mr. Kattuk , go ahead.
Report of the Standing Committee on Culture, Education and Health on the 1999/2000 Main Estimates for The Department of Health and Social Services
Mr. Kattuk (interpretation): Thank you Mr. Chairperson , I will read a part of it in English and Mr. O'Brien will conclude.
The Honourable Ed Picco, Minister of Health and Social Services and departmental officials met with the Standing Committee on April 29, 1999.
The Minister spoke very openly about the challenges facing his Department and the opportunities that some of the new technology and training may provide in meeting the needs of communities.
The Standing Committee also appreciated the preparation by the Minister and his Department, which was evident at our meeting.
The Standing Committee had a very dynamic dialogue with the Minister and looks forward to talking about these issues in the future.
Business Plan/ Operations/ Programs
The Department of Health and Social Services has an O&M Budget of $117,400,000 of which $75,000,000 in contributions to the Health Boards to deliver programs, which includes $15 million for medical travel.
The Need for an Inuit Nurse Training Program
A most compelling issue for the Members of the Standing Committee, is the need for Inuit nurses in Nunavut.
The Minister outlined the departmental concerns regarding the high turnover of community nurses and the difficulties in recruiting nurses from the south.
This will be compounded now that a number of southern jurisdictions have recently announced nurse hiring increases .
To the Members, the heavy workload on a few community nurses, particularly where the full complement of nurses are not available [vacancy rates range from 22 to 42%] is more than a concern.
It is a crisis in the communities.
The lack of Inuit nurses also means that Inuit cannot receive health care in their own language, opportunities for health promotion and prevention are missed, Inuit traditional knowledge cannot be fully incorporated into our health delivery system and a lack of stability in many communities.
Members were advised that at this time, there is only one Inuit nurse in Nunavut, who recently began nursing in Arviat.
At the Health Board level, only 3% of the professional staff are filled by Inuit.
The Minister laid out a plan to fix part of this situation, which the Members fully support.
He noted that in recent years, a partnership model had been set up with Dalhousie University School of Nursing which would see students in an Arctic College Program able to obtain a two and a half year diploma or a full four year nursing degree.
A number of students have already completed a pre-nursing year with Arctic College and could begin a nursing a program in September, if it were to be offered.
However, there is no budget at this time for this critically important program.
As noted above in our meetings with Education, Standing Committee Members believe that Nunavut students must be encouraged to move into the areas in which there are jobs – there are several hundred nursing and health related positions, all of which are well-paid professional positions in all of our communities.
There is no point talking about Article 23 and Inuit employment in government positions in the Health area unless proper training programs are being provided.
It took thirty years of NTEP type programs to get 34% Inuit Teachers and 4 out of 42 Inuit Principles.
Thirty years ago, Dr. Percy declared the need for an Inuit Nursing Program – think where Nunavut would be now if it had been properly initiated.
The Government has to start somewhere if we hope to see Inuit health professionals in Nunavut, and it should start now.
This Department has a detailed plan, they are ready to go and they need our support.
A long term commitment is required, if we are to see it through.
The Standing Committee also encouraged the Minister to travel to Ottawa to try to obtain more funding for our health care system and to invite federal officials to the North to see for themselves, the impact on our communities, of too few health dollars and too few nurses and doctors.
Members offered to come too, if this would help.
The Minister noted that he had recently met with Hon. Allan Rock, the federal Minister of Health and had raised these issues, including the need for funding for an Inuit nursing program.
Members commended the Minister’s efforts in this regard.
Mr. Kattuk: I will give Mr. O'Brien the recommendations to read.
Chairperson (interpretation): Thank you, Mr. Mr. Kattuk for reading the report.
Mr. O'Brien: Thank you, Mr. Chairperson, the recommendations are as follows;
That as a first priority, if additional resources can be found, the programs identified by the Department of Health and Social Services for Inuit nurse training be implemented in this fiscal year.
Cabinet Decision to Abolish the Regional Health Boards
The Standing Committee appreciated very much the briefing that the Department provided to us on the matter of the dissolution …
Chairperson (interpretation): Excuse me I might be wrong but I think we are supposed to vote on each recommendation as we move along?
…no? Sorry , please continue.
Mr. O'Brien: The Standing Committee appreciated very much the briefing that the Department provided to us on the matter of the dissolution of the Regional Health Boards and District Education Councils.
This provided a lot of important background information to the Members, which we understand had been delivered to the Cabinet and to the Chairs and to Executive Directors of the Regional Health Boards and District Education Councils.
Nevertheless, Members still have questions and they felt that the people in the communities will have questions too.
As noted above with respect to Education, while the opportunity to save money and have more accountability to elected officials is clearly one that Members support, the Standing Committee was concerned at the lack of an operational or implementation plan.
There were small charts projecting savings, but no details on how those numbers were generated.
There were assurances that no current employees of the Regional Health Boards would lose their jobs and that everyone would be provided other opportunities within the Department, but no plan was presented showing how this would happen and whether these positions would remain in their current communities.
There will be more accountability to the elected Minister, but no complaints procedure was presented.
Members wondered if the department will create an ombudsman type of person to co-ordinate and streamline complaints to the Minister.
Members noted that smaller communities would need someone local to whom they can send information regarding their concerns.
While it was noted that the Community Health Councils would have more of a role to play, no information was presented on what that role would be or what additional support would be provided to enable them to carry out this expanded role.
Who will take the initiative to create these councils if they don’t currently exist?
How do Interagency committees fit in?
What will be the checks and balances in this new system, for individuals and communities with respect to their Community Health Councils and the Department? How does this affect the Departments commitment to decentralization?
What positions will now go to Pangnirtung?
The Minister stated that an outside person would begin working with the Department and the Boards to develop the transition plan and that the Minister would bring it back to the Standing Committee in September.
The Standing Committee looks forward to receiving the draft legislation and reviewing more complete plans at that time.
That the Government of Nunavut provide a detailed implementation plan to the Standing Committee, which includes information on: how the Regional Health Boards will be phased out, specifics on the cost savings of abolishing the Boards, staffing plans for the current employees, complaints procedure to the Minister, support for the Community health councils and projected impact on communities where the Board offices are currently located.
That the Government of Nunavut develop a communication package for communities and Nunavummiut, including radio, TV, written materials and visits by the Minister to communities and meetings, such as the Kitikmeot Leaders’ Forum; and
That any savings realized from abolishing Regional Health Boards be retained by the Department of Health and Social Services.
Tele-medicine
The Minister presented some interesting information on tele-health facilities.
These are currently in the communities of Iqaluit, Pond Inlet and Cape Dorset.
They allow patients to come into the facility in Pond Inlet and be “seen” via technology and satellites, by a doctor in Iqaluit or even Ottawa.
It was noted that in a one-week period, of 15 people who might have been referred to Iqaluit by the community nurse, only 3 still had to come to Iqaluit after being “seen” by the Doctor through tele-medicine.
Therefore, the Government saved the travel and accommodation costs of sending these people to Iqaluit, and the people were saved the trouble of leaving their community and family.
Departmental officials noted that tele-health facilities are quite expensive, (over $300,000 each), but they can pay for themselves over a short period of years by saving money as outlined above.
They may also be a vehicle to provide other services, such as psychiatric counselling or supervision of probation and parole.
The Standing Committee members were interested to see how this technology works and intend to follow-up to the invitation to visit the Iqaluit hospital to see it in operation.
In light of the difficulties in getting Doctors to move to smaller communities in Nunavut, this may be an alternative.
Members noted that there are sometimes difficulties with the technology, and it may be wise to wait until the satellite technology and linking is improved.
However, Members look forward to receiving more information on the benefits and disadvantages of these facilities, and how these facilities might be paid for in the future
Capital Plan - Financing Capital for New Health Facilities – P3
Standing Committee members welcomed the Department’s plan to conduct an audit of what health facilities and equipment were currently in each community, along with an assessment of what shape they are in.
All Departments should do this type of capital audit.
However, Members noted that the Department really had no capital plan for this fiscal year - only one capital project of $12,000 for the Gjoa Haven Health Centre.
Over the past year, Members have heard various discussions about planned health facilities in the regional centres and the possibilities of P3 financing.
Members raised questions to the Minister about P3 financing, but did not receive much information.
While innovative ways are needed to finance new health facilities, Members are concerned about moving forward with P3 financing before knowing more about the pros and cons.
Where will the operating dollars come for the O&M of these facilities?
That the Government of Nunavut provide a full briefing to the Standing Committee on P3 financing, as it may be applied to health facilities, including a frank discussion about the pros and cons of P3 financing as compared to alternative or conventional methods.
Mr. O'Brien: Thank you Mr. Chairperson, that concludes the report.
I do have 5 committee motions.
Continue with your motions.
Committee Motion 24 – 1 (2): Inuit Nurses Training
Mr. O'Brien: Motion 1; I move that as a first priority, if additional resources can be found, the programs identified by the Department of Health and Social Services for Inuit nurse training be implemented in this fiscal year.
Seconder to the motion?
… sorry, I am told there is no need for a seconder.
Those in favour ?
Committee Motion 25 – 1 (2): Implementation Plan for Abolishing Boards
Mr. O'Brien: I move that this committee recommends that the Government of Nunavut provide a detailed implementation plan to the Standing Committee, which includes information on: how the Regional Health Boards will be phased out, specifics on the cost savings of abolishing the Boards, staffing plans for the current employees, complaints procedure to the Minister, support for the Community health councils and projected impact on communities where the Board offices are currently located.
None opposed.
Carried .
Committee Motions 26 – 1 (2): Communication Package for Communities
Mr. O'Brien : I move that this committee recommends that the Government of Nunavut develop a communication package for communities and Nunavummiut, including radio, TV, written materials and visits by the Minister to communities and meetings, such as the Kitikmeot Leaders’ Forum.
I don't see anyone opposed. motion carried.
Committee Motion 27 – 1 (2): Savings Retained by Department
Mr. O'Brien: I move that this committee recommends that any savings realised from abolishing Regional Health Boards be retained by the Department of Health and Social Services.
To the fourth motion.
Mr. Puqiqnak : Can I hear the motion again?
Chairperson (interpretation): Please read your motion again, slowly.
Chairperson (interpretation): Understand now?
Comments ?
Motion carried.
5th motion. Mr. O'Brien.
Committee Motion 28 – 1 (2): P3 Financing
Mr. O'Brien: I move that that the Government of Nunavut provide a full briefing to the Standing Committee on P3 financing, as it may be applied to health facilities, including a frank discussion about the pros and cons of P3 financing as compared to alternative or conventional methods.
Chairperson (interpretation): Thank you Mr. O'Brien, to the fifth motion.
All in favour ?
opposed?
That was the last motion.
The Minister of Health and Social Services can now take the witness chair.
He can also bring in his officials.
Hon. Ed Picco: Nakurmiik Itsivautaaq.
Thank you Mr. Chairperson with me today is on my left Rosemary Cooper the assistant deputy minister of the department and on my right is Mr. Ken MacRury who is the deputy minister of the department, thank you Mr. Chairperson.
Chairperson: Thank you Mr. Picco.
Mr. Iqaqrialu: Thank you Mr. Minister.
I think that I was supposed to ask you to introduce your officials, but you were ahead of me so I thank you.
Are there any general questions the minister and his officials are now in the witness table.
You can now ask your questions or if you have general comments, regarding the departments.
Main estimates, Mr. McLean I don’t want to make mistake on your name this time, go ahead Mr. McLean.
Mr. McLean: Qujannamiik Uqaqtii.
Just in general comments that I want to make in health and social services.
We all know that in health care professionals and what I’d like to call the care givers in our communities, are over worked, underpaid and under appreciated.
I’m sure the current minister has a plan to help out with our care givers in our communities.
And other things I would like to bring up is, over the years, we all complain about health care and the lack of it and social workers things like that, but the biggest more biggest issues that come up in my community and it’s probably a tragedy is the early detection of cancer.
There’s no way that the any of the cancer affect especially my community can be detected early enough that we can save these individuals and there’s quite a few tragedies in the last 5 or 6 years in my community where it was detected too late.
I’m not blaming this on health care professional, when it gets to a certain situation where it’s terminal and can’t be prevented than it’s just agonizing, so I’m sure the minister will be trying to work around that situation, where you know ,cancers various of forms of lung cancer and other cancers can be detected earlier and treated.
And still to this day most of us living in remote communities away from hospitals have no way of finding out if we do carry a cancer ourselves, so I think this have to addressed and seriously looked at.
Chronic care facilities for elders’ I don’t know other than one community in my region that I live in that has a chronic care facility we hear the statistic about our population is 50% under 20 but we do have an ageing population like other regions in Canada with the elders and it’s to the point now where we have no facilities in certain communities.
In the smaller communities that we can care for our elders when they get into the chronic care stage and I’m sure the ministers’ had to deal with that in his personal life with dealing with the chronic care elder’s.
So, I’m sure the minister will be dealing with that over the next few year’s.
In my election campaign when I went door to door and talking with the various people in my community, there was a genuine concern there that there’s not enough traditional knowledge and older Inuit people being used for family counselling, suicide prevention, and just all around counselling, because in most communities there’s a government building or a nursing station people that are in just stress and have to go to a public building and make appointments to see people.
So I’m sure the minister and I know his mandate was to use more IQ in dealing with the family problems and situation.
I’m hoping that this will be fast track and in the long run it’ll probably be more helpful in cost effective to use traditional knowledge in regards to suicide prevention and the family counselling.
Capital projects we talk about, we hear about hospitals and regional centres and 3 of them are planned.
I’m kind of hoping that the department has a full plan in place along with the minister of finance on how were going to staff these facilities, cause I heard 1 figure is being addressed in Rankin Inlet was 50 jobs with a hospital comes 50 jobs.
Well to me I’m hoping that if they build these facilities in the regions that they’re going to repatriate the dollars.
And if the plan isn’t repatriate these dollars for health care facilities, where’s the money going to come from I certainly hope it’s not going to come from the decentralization budgets that were negotiated couple of years ago.
Another concern, comment is the cost of prescription drugs in Nunavut I think it’s three times national average, I could be incorrect there, but that’s a price I got and availability of them, I know in my community I was called by a health care professional saying that there's a shortage of pharmaceutical drugs for the community.
So, I’m sure the minister will deal with that.
Thank you Mr. Chairperson, I know you will address these issues and concerns and it’s just a general comments I don’t really require answers at this time, but if you’re going to write me answers like last time with quick response I’d appreciate it very much.
Chairperson (interpretation): Thank you. Minster of Health & Social Services.
Hon. Ed Picco: Thank you Mr. Chairperson.
Mr. McLean has made some very good observation and the general commencing.
To start off by telling the Members how pleased I am today I will be able to sit here as a Minister of health and at the first…I think we have some translation problems, so I’ll just stop now.
Chairperson: (interpretation): …as usual the technical equipment isn’t working now.
Mr. Picco: …1,2,12,1,2,1,2…
Chairperson (interpretation): There we go.
Hon. Ed Picco: Tusaava?
Tusaava?