EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
The department is under incredible financial pressure in a number of areas. One of them is pointed out in the minister’s opening remarks and that has to do with the compensation and benefits.
One of the perceptions, for example, is the department has a vacancy rate of over 30 percent. I think it’s around the order of about 38 percent.
The perception is that if you have a vacancy of 38 percent, then the department should be saving money. However, what happens is we still have to deliver the services. To deliver the services at the 38 percent vacancy rate, it actually costs more money.
That’s one of the pressures that we’re under.
Also, we spoke a little bit about the out-of-territory hospitals.
For example, in the out-of-territory hospitals, in-patient rates have increased steadily each fiscal year at about 3.5 to 5 percent.
Outpatient rates have increased to 41 percent over 2007-08 to 2009-2010.
Those are incredible rate increases.
What is happening in the south is there are incredible pressures within the other jurisdictions to ensure that services they deliver to other provinces and other territories, patients from out of province, that they actually recover full costs.
We are finding that they are paying more and more attention and making sure that the rates that they charge to us reflect what it actually costs for them to deliver those services.
Another example is between the years 2001 and 2006. We also have volume pressures between those two years. Referrals to Ottawa increased by 63 percent, while population growth was only 11 percent.
We have population growth, but that is not the only pressure that we have on health and social services. We also have actual usage by each individual member of the population has increased.
That’s a 63 percent increase in referrals. At the same time, there was an 11 to 18 percent increase in the population.
Referrals to Ottawa have increased by 7 percent in 2007 and 9 percent in 2008. We are facing incredible pressures in health and social services.
Chairman: Thank you, Ms. Voth.
You still got some?
Mr. Elliott: Thank you, Mr. Chairman. I guess there was some confusion.
I can appreciate what the minister is saying in terms of being able to pin down certain costs and whatnot, and then the minister said as well that the costs are increasing. That’s why I actually asked the question that I never got an answer to.
How realistic is the budget if you keep telling us, and you just went on about how the costs are going up, there is an increase in usage of the department’s resources and there is a $10 million decrease in what the department is asking for.
I just wanted to ask again: how realistic is that if, in previous years, you have been asking for more and more money as the year goes on?
You just got done saying that the costs are going up and now the budget is actually $10 million less than it was before.
How can you justify that?
The question that has been asked is quite significant for the department. Over the past nine years, we have continually gone back to FMB to ask for supplementary funding. The member is absolutely correct.
We have been projecting, as best as we can, realistic projections through the course of the year.
To answer the question that you raised, we have increasing pressures for the health system to deliver its mandate. We certainly could do with more money in delivering our mandate.
However, we do appreciate that we also have to work within our own government and FMB processes, cabinet processes.
As the minister indicated earlier, we are provided with targets that we need to work under as a department. We have tried very hard to live within those targets on an annual basis.
As the member will also appreciate, the Auditor General has noted in her report that the department should stop coming to the government after the fact to ask for this money.
For this past year, we have tried to forecast more realistic amounts to the end of March, hence we went to FMB and the Legislative Assembly prior to year-end to try and overcome the over-expenditure and not to spend the allocation that is not there for us. In other words, we shouldn’t be breaking the Financial Administration Act to deliver these services.
We do have a number of strategies as well that one of the members mentioned that are on the books right now. We’re a bit behind in implementing some of those plans.
Once we start implementing some of those plans, some of the results will start coming in.
As an example, with the nurse recruitment and retention process, we are already starting to see some improvements to our hiring of agency nurses.
It’s coming down this fiscal year. Hopefully we’re not going to experience any increase of cost there and hopefully that will come down at least $4 million this year.
We have hired 61 nurses in total since the strategy started, but at the same time, there have been 25 resignations through that process, so over 30 nurses have been the net difference to the system.
We are trying to live within our means, but it’s certainly very difficult to live within those means given the challenges that the minister and Madam Voth mentioned earlier.
As an administrator, yes, certainly, there is not enough there. We would like to see a lot more as a department. At the same time, we need to work as a team with the rest of the government in trying to handle some of our financial pressures.
It must be hard trying to balance the needs of people’s health in Nunavut.
My next question goes along with some of the stuff the Auditor General’s office has been saying and you had alluded to it a bit in your answer, Mr. Campbell.
Now that you have the budget that you are putting forward and working with, what steps are being taking to ensure that the department’s proposed expenditures for 2010-11 stay within those budget guidelines?
I know taking into effect what Mr. Curley said about you can’t pin down some cost, but there must be some type of a plan in place to stay within your budget and if you could explain that, it would be greatly appreciated.
Hon. Tagak Curley: Thank you. I will have Alex respond to the budget management.
About this time every year, I do send out a directive to the senior management staff, a directive that has fiscal management restraints, financial management items that I want the senior management to adhere to.
I would go through our regular administrative stuff. Travel, for instance, is easy to tackle, as well to curtail travel, to watch the overtime and things like that. I go through a list of things that we need to curtail.
I also say that we shouldn’t be hiring agency nurses, we shouldn’t be hiring contractors, and we shouldn’t be hiring consultants.
So I say all of those things to the senior management.
I have pushed back on the variance reports that we do get on a quarterly basis, challenging the numbers that are provided to me on a regular basis with the support of the executive director from corporate services. I try to put the onus on management to manage within the allocation that has been provided to the department.
So there are a number of fiscal management tools that I try to implement in the department.
When somebody has a bright idea to do on an initiative, I always ask for a business case before we even consider the proposed letter executive management level.
We are doing our prudence in trying to manage within that framework.
I should say that my finance staff are projecting a shortfall for next year already. We haven’t even started April 1 and we’re already projecting some expenditure patterns that are going to be tough to handle in the next fiscal year.
With that, as I said, there are a number of things that we can do as well, like we can delay some of our hiring, but again, we’re at about 38 percent vacancy right now and it’s very difficult to manage the department without people working in those positions.
I guess in a roundabout way, I’m just suggesting that it’s tough to continue to manage the department given the fiscal climate.
I just wanted to get some background too in terms of the motion that was put forward in the House back in November by Mr. Okalik and seconded by the minister with the Territorial Health System Sustainability Initiative fund.
I know the federal government announced in their budget a two-year window where we’re kind of safe for the time being.
Has your department heard back anymore as to when do negotiations start with that? Is it a possibility that it’s going to be cut back next year?
Do you have any of that information or have you been in contact with the federal government on that?
Is that for Mr. Campbell or the minister?
Yes, our team, at the moment, as we speak, is in Ottawa trying to nail down the three-party or four-party deal with the federal government. We pretty well have a clear understanding what our share will likely be out of the two-year program that the federal government extended. Before I get into the details, I think it’s appropriate to thank all of the members for their support.
That definitely puts pressure on the federal government.
My colleague, the Minister of Finance, did his share of lobbying. I know the Premier did with the Prime Minister, as well as the Deputy Premier had a direct lobbying meeting with the Minister of Indian Affairs some time this winter in Yukon.
I would like to acknowledge all of the members and my colleagues who did a great job in lobbying the federal government.
I think even though we’re short of a five-year agreement, at least two years, we have a bit of a breathing space. During that time, we’re going to continue to put pressure on the federal government and hope that maybe we will see a different way or a different program established.
I know we certainly would like to continue to discuss infrastructure requirements of the health facilities for Nunavut. That will be the cabinet’s responsibility with my input into the whole thing.
I would like Alex to go through some of the territorial health sustainability initiative.
We had our deputy ministers’ conference call on Friday, the deputy ministers of the Yukon, Northwest Territories, and me, to map out and reinforce the fact that there shouldn’t be any funding changes to the way the allocation was managed before.
Nunavut’s share of the $60 million would be about $14.5 million per year.
So it’s $10 million for medical travel and $4.3 million for what we call task initiatives.
So that is going to be our position going into the federal government, that we’re going to stick to our heels and dig in our heels, and hopefully have the same funding arrangement.
The other thing that I should mention is that we do have other federal funding dollars that we rely on as well under public health. They are roughly around $13 million to $14 million and we negotiate those amounts every year. So that also goes a long ways to addressing some of those expenditures in partnership with Health Canada that we talked about earlier, Vote 4 funding.
We tried to also manage some of our challenges by partnering with the federal government on these initiatives. Thank you, Mr. Chairman.
One of the other questions I have is: will you be bringing forward another supplemental appropriation request in this session?
Hon. Tagak Curley: Mr. Chairman, I will have Debora Voth respond to that.
Chairman: Go ahead, Ms. Voth.
Yes, Health and Social Services is coming forward with another supplementary appropriation for this session.
The majority of the supplementary request has to do with the treatment costs for H1N1. In the session this past late fall/early winter, we came forward for the immunization program. At that time, we realized we would have to come forward for the one time.
What we wanted to do was identify one-time costs that we did not feel would be carried forward into the next year.
That would be the vaccination supplementary appropriation and now the H1N1 that wasn’t carried forward into our funding pressures for next year.
We also have an additional dollar amount that we now have more information to make better estimates.
We made our estimates in December, where we would come in at the end of March, and now we have adjusted those and feel that we will, in order to pay our bills, need more supplementary appropriations.
Any more questions, Mr. Elliott?
There was a mention of medical travel. When will the regional medical contracts come up for renewal?
Hon. Tagak Curley: Thank you, Mr. Chairman, for the question.
My understanding is that they will be up for renewal next year.
We have one more year due for the life of the medical travel contracts for various airlines in Nunavut.
I’m wondering too, in terms of the status for the boarding home contracts for Yellowknife, Edmonton, Winnipeg, and Ottawa, if I could get an update on those.
I’ll have Mr. Campbell go through those projects.
For the Yellowknife boarding home, we do have a new facility there that is slated for official opening some time at the end of April.
It’s already operational right now, so we do have a long-term commitment for that operation in Yellowknife.
The one in Edmonton, the contract itself for that one is coming up soon. What we have done is we have extended that contract for up to a year. We’re going to be reviewing some of that extension and see how long we can operate that.
We also extended the one in Winnipeg for another year.
I also want to welcome the Hon. Minister Curley, also Ms. Voth as well as Mr. Alex Campbell.
It’s hard to try to lay this all out, the whole complication of cost allocation and as well as priorities for the government as well as the departmental priorities themselves.
I appreciate the fact that, and listening to your opening comments, as well as responses to my colleagues’ remarks to your opening comments, it was good hear that there is an understanding of the difficulty of providing as much as we can to all Nunavummiut.
As I have said in the past numerous times, your department deals with the most difficult and sensitive issues that affect people’s lives.
All departments in all areas do, but health and social services, I personally think, has the most impact on daily activities next to education.
In regard to your opening remarks, on page 3, the first paragraph, you noted that you did have to make tough decisions in which you had to balance financial reality with the needs of Nunavummiut.
The minister states, “I can assure all members that we remain committed to supporting and sustaining an effective and efficient publicly funded health care and social services system without a reduction in quality of care.”
With the cutbacks last fiscal year and the foreseeable does not seem so bright as well, I was glad to hear the Deputy Minister, Mr. Alex Campbell, stating a response to an earlier comment that they’re looking to hope to reduce some of the costs incurred by the department by using agency nurses.
One of the things that struck me was quality of care.
It’s known in all of Nunavut, as well as in Baker Lake in particular, that constituents have expressed concern that there is no continuity in quality of service from agency nurses as a result of the numerous, repeated turnover of nurses coming and going, that they don’t provide consistent services.
We understand the challenges that this faces the department in terms of having permanent nurses versus providing any service.
What I want to say basically is that I’m sure there will be other members asking some questions in regard to the page-by-page.
It is also known that with not any foreseeable increase in dollars coming, I would like to express the severity and the seriousness that we should try to implement immediate nursing retention in order to avoid agency nurses so that we have people who want to be in the north.
That would provide some consistency, familiarity with elders, familiarity with some illnesses, familiarity with babies’ needs, and familiarity with special needs.
I think that’s very critical.
I have had one constituent come and share two different diagnoses from two different nurses. She tried to address, as a mother, her issues about her baby’s concerns, a mother knowing how to take care of her child, knowing what the issues are. She was given two different diagnoses.
Each time she tried to address them both with the two different agency nurses, she was, for a lack of a better word other than in her own words, spoken down to and given a big, whole array of education as to how to care for her child while her child is sick.
This was in the same week.
She tried to address it in a diplomatic way. “I just want my daughter to get quality of service here right now.
Rather than you trying to educate me on how to do this, can you just do your job and assess my child?”
She was rather embarrassed and shocked about that because she felt offended that this person in a position of authority, in her eyes, who has the special authority and special power over providing a quality of service or a need, it was almost like she had her hands slapped just for wanting to address the consistency and quality of service.
Now, with that, I have had the delight of using agency nurses and I’m very thankful for the service that I got for my immediate concerns.
It actually took me two tries to get through to one of the nurses to get a quality of service.
I went back to the health centre twice in one day to see and get the same service with two different results.
I think that what it comes down to is quality of service and quality of care. I think that’s the one thing that we always like to do as legislators as well as the minister of the department is to provide quality of service and care.
I can honestly attest to say that I admire how you guys have been juggling the difficulty of how you administer the departments and the priorities. It’s not easy listening to all of this because as legislators and public officials, we are bombarded daily by concerns.
It’s our job to do that and it’s our job to scrutinize the government, but it’s also our job to support the departments and also to provide some input.
I really like the dialogue that the department is opening up with and I think that we should stay focused on the issue that quality of care and quality of life is something that should be first and foremost in all areas in Nunavut.
I just want to commend the department for their willingness to hear and listen, but as well, I look forward to seeing a reduction in agency nurses and having permanent nurses.
I just wanted to share that with you and thank you for the opportunity, Mr. Chairman.
I don’t think there was any question there and I have nobody else on the list for general comments.
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. $22,989,000.
Chairman: We will move on to H-5. Branch Summary.
Health and Social Services. Social Services. Total Operations and Maintenance, to be Voted. $36,434,000.
Mr. Elliott, go ahead
Mr. Elliott: I’m sorry, I must have been sleeping.
Could we go back to H-4?
I have some questions on that one, but we kind of jumped over it very quickly, if everyone is in agreement.
Chairman: I’m going to have to ask the committee because that has already been agreed to. So it’s up to the committee if they want to go back to that.
Does the committee agree that we go back to H-4?
Chairman: Let’s go back to H-4 then.
So I can go?
Last year, you published a set of guidelines for Nunavummiut who wish to bring forward complaints or concerns about health and social services.
To date, how many concerns and complaints have been brought to the attention of senior management officials, and what steps were taken to address and resolve them?
I think it’s important that we provide the stats on that. I will try to do it region by region.
Even as we speak, I had one today. I don’t know whether I will include these in the stats or not.
At one point, when you were in my office, I recall telling you that I had one call at three o’clock in the morning.
What would the president do when he receives… I am kidding.
Three o’clock in the morning, there was a complaint. I do get calls at home and the most shocking one was at three o’clock in the morning.
I think it’s very important to address that issue because not only are we concerned with the statistics but we are interested in responding to the patient care and I thank Moses for raising some of these points.
I share with my officials at all times that our health care workers should be sensitive and that they need more training in that area, and we’ve got to do better in that area.
I want to acknowledge that we take these complaints seriously and I believe there is a two-way approach to this whole issue, not just the health care worker but also the patient’s right to be treated fairly.
In order to provide justice to the question, I will have to take the question as notice because we don’t have the stats with us on this right now.
When you get the information, you will just update the members on that.
I was going to say that I don’t think we can take questions as notice in Committee of the Whole, but as long as the minister has committed, could he give me a timeline as to when we might be… is he going to table these annually or is this something he’s going to give to us internally?
I suppose, Mr. Chairman, we could do it whichever way works best or preferred by members.
Obviously, we don’t have a mandated complaints requirement to table them by way of law, but voluntarily, we will certainly and I will agree to table any information I can during this session. It’s a matter of getting our officials to put it together and we will have that information practically as soon as possible.
In the business plan on H-3, one of the objectives of your department is to work on a privacy policy framework. I have just noticed over the past year working as an MLA: will this framework provide MLAs with some sort of guidance as to how they can best provide support and assistance to the constituents without infringing upon their private rights?
I think this is a very sensitive and very important area that the privacy of patients is really quite critical and I really don’t think that we can play around with it politically or make it a conveniently politically correct way, I don’t think there’s such a thing as that.
I noted that the Privacy Commissioner’s report was very cautious even though that some members took her report that she had no problem with issuing privacy-related H1N1 issues or listing communities publicly.
The department was very cautious in issuing numbers at that time. I’m not trying to revisit that, but I just want to let you know that in view of the fact that we have small population in some communities, we didn’t want to treat them as separately from larger communities. Therefore, we took the safe side on that one.
I believe, in my interpretation, the Privacy Commissioner was quite cautious that a small community like Whale Cove would probably have concerns whereas in Yellowknife, you can have a little more insulation with protecting individuals from patients being revealed as to who has that particular kind of illness.
So having said that, Mr. Chairman, what I’m saying is that I don’t think we can link the politicians with the right to privacy when we deal with the privacy rights of individuals medically.
So we will take the cautious side on this one and continue to work on what we commit to do.
I think it was more related to how much you reveal when certain illnesses or pandemic kind of illnesses are occurring, should you have a cap on numbers that you’re safe to release or whatnot and that kind of stuff.
We’re working on a number of parameters on this one, so it’s not as straightforward as it appears to be, but we want to remain on the cautious side in favour of the patients’ rights to privacy.
I appreciate the minister’s answer, but my point is I was hoping that the minister could commit that while they’re talking about the privacy policy framework to again not include in the formal process as to this is what our role is but provide us with some guidance as MLAs in terms of how to do our job effectively so we don’t actually cross that line.
If you guys are reviewing it and you’re coming up with a privacy policy now, why not include us?