EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
Our Premier was at the premiers’ meetings in January. All the premiers from all the provinces and territories were there and most of them expressed their concerns.
I indicated earlier that the health ministers from most of the provinces and territories were tasked with having to hold a couple of meetings to get together and discuss how this unilateral action affects us and how we can approach Ottawa to perhaps back off or find another way to help us with funding.
Mr. Curley: Thank you. Mr. Chairman, I certainly agree with the minister.
I think all the Members of the House have a very important obligation and responsibility to say to the federal government that we need help with respect to medical and public health services in Nunavut.
I appreciate the minister indicating that the territorial formula financing transfer itself is really not enough because the concept of doing business and services up here is staggeringly misunderstood, I think, by the federal government.
I think it’s my responsibility as a member of Nunavut that the federal government has not only just an obligation to provide services on an ongoing basis but they also have a fiduciary responsibility for Inuit people, despite the fact that they are providing some 30-some-odd million dollars for non-insured health programs.
It is not enough. It is outdated. The cost of doing business, including energy infrastructure, is really staggeringly dangerously high.
I think, when you look at the energy prices picking up now, all the facilities are going to be tabbed with the price.
So I would like to continue to give the minister the full support and encourage all members that, not only the finance minister but our own MP as well, it is important to me that she is a member of the federal cabinet and also an MP from Nunavut.
I think sometimes she misunderstood the staggering nature of the costs of health.
The minister needs help from all of us that the federal government has to live up to its obligations not only to provide some level of service but to look at this part of the north that hasn’t got any means of reducing costs because we’re limited to flying patients in and out of communities.
I would like to certainly encourage the minister to continue to advocate strongly that we cannot just depend on the Prime Minister’s announcement of 6 percent a year and hope that by the end of 2016, we would have better health financing for Nunavut.
Can the minister indicate to me that support from this Assembly is important?
I certainly appreciate Mr. Curley’s support and endorsement of the health department.
I know he did a lot of work in that capacity as the former minister.
I remember a few years ago, while I was the Minister of Finance and Mr. Ma was the Deputy Minister of Finance, I made a prediction. I could see the costs going up on the health side and it is very expensive.
Minister Curley would have to come back to us all the time for supplementary bills. I predicted by 2020, there will only be two departments in the Government of Nunavut: the Department of Health and the Department of Finance, one to incur the bills to provide health care to our residents and the other department to pay the bills, and then eventually there will only be one department. That’s the way it’s going because the health care costs in Nunavut are rising.
We have so many challenges up here that other jurisdictions don’t have to provide an adequate level of health care to our residents.
We struggle every day to find the resources to help people.
We hear from MLAs quite often and individuals via emails about the provision of the same type or level of treatment and health care that folks elsewhere in Canada get.
Yes, to your answer.
If I can get support from all the MLAs and all ministers in this House, it would send a strong message when I’m talking to my counterparts across Canada.
Mr. Curley: Thank you. I have one last point with respect to that.
I appreciate the Prime Minister has come up here, and so on, and I think he certainly needs to be informed better about the serious situation that we face with the costs of health care in Nunavut.
Also, I think that we cannot take for granted that our MP, who is also the Minister of Health federally, Leona Aglukkaq, understands the whole degree of costs of delivering health care and medical for Nunavutmiut.
I think it’s also our responsibility, each one of us, that we can’t just be expecting programs and everything else to increase in our communities without getting some federal help. We’ve just simply got to get more federal attention.
I think the situation that we’re facing cannot wait until 2017 because the costs are going up.
The air transportation is definitely going to go up now that the driving force of the costs of the airlines we’re dependent on for patients is going up, indicators, and they are not going down.
So to me, we’re facing a very serious situation.
I certainly encourage the minister again to continue to forecast and submit those forecasts to the federal minister continually because it’s one of the major, critical issues that we’re facing.
I will certainly give you all of my support if you need it somehow.
Although I didn’t hear any questions in the comments, I would like to ask Minister Peterson if he wishes to comment on that.
I thank Mr. Curley for those comments.
Mr. Chairman, the Department of Health and Social Services really is a very special department.
It’s unique from other government departments because it actually is a department that touches every one of us in Nunavut daily or almost daily.
Everybody knows someone who is sick or has died or is in care. It touches us all. So we all want the best health care for our relatives, friends, and neighbours.
When we hear that someone is sick or is being medevaced, that’s one of the most terrifying sounds when you hear a medevac jet taking off at two o’clock in the morning from your community because you know somebody is in great danger.
I think there are going to be some positive things happening in the future. I won’t say they’re all doom and gloom. We are making some inroads in addressing some of the concerns that we’re talking about daily.
We are looking at initiatives to expand our health facilities in Nunavut.
I said earlier that we’re trying to train more Nunavummiut to get into health professions and that alone will help bring down the costs.
So there are some positive initiatives on the horizon, but the health care costs are very expensive and I don’t believe that they’re going to actually really go down because we have changing demographics in Nunavut and Canada and with the different structural arrangements that we have in Canada, the costs will continue to rise.
Thank you, Mr. Curley, for your comments and support.
We’re on page H-4. Health and Social Services. Branch Summary.
Directorate. Total Operations and Maintenance. $21,310,000.
Your 2012-13 draft business plan indicates on page 131 that your department’s Client Travel Policy has been reviewed and one of your priorities for 2012-13 will be to incorporate findings from that review to establish consistent guidelines and strengthen coordination of medical travel.
Do you anticipate that this initiative will result in cost savings for the department?
Mr. Chairman, I’m going to have my Executive Director, Debora Voth, respond to that question.
Chairman: Thank you, Minister Peterson. Ms. Voth.
Ms. Voth: Thank you, Mr. Chairman. We anticipate that we will be finished with the review of the Client Travel Policy at the end of March.
The current status is we have gone out and consulted clients in multiple boarding homes and boarding facilities that are actually accessing the medical travel system.
We have consulted key informants within the Department of Health and Social Services that work within the medical travel system on a daily basis. We have also done a fairly comprehensive cross-jurisdictional review.
So what we’re doing right now is we’re gathering that information and we’re just taking a look at the picture of what are the current benefits that are provided within our current Client Travel Policy and what is the information that we’re getting in from our consultation process.
At this time, we can’t say that it would be a cost reduction or a cost increase, but we should know more at the end of March.
When the report is complete, will you commit to tabling the Client Travel Policy in the House?
I can’t make that commitment at this time.
We will try again. H-4.
Total Operations and Maintenance. $21,310,000.
Chairman (interpretation): Thank you. (interpretation ends) Page H-5. Branch Summary.
Health and Social Services. Social Services. Total Operations and Maintenance. $47,463,000.
Firstly, I want to ask this question. In your opening comments, there was a reference to the Department of Health and Social Services increasing costs for travel and transportation. The figure under social services totals an increase of $4.34 million for transportation costs.
This was a figure I wanted to ask about. What exactly is the purpose for this increased cost, Mr. Chairman? Is it for air travel and transportation costs associated with social services?
My executive director of corporate services would like to answer that question.
The total cost of $4.3 million is addressing two areas of shortfall that we’re experiencing today for travel and transportation.
It’s not for additional services per se, but it’s to fund a deficit that we have been experiencing for the last number of years.
Previously, we were able to cover off this deficit through surpluses that we had experienced in compensation and benefits.
The costs under this program are for social services. Examples of client and family travel that would not fall under medical travel would be, for example, a child or a permanent ward on adoption pre-placement visits with potential adoptive parents.
Also, when a child is living in a residential care facility outside their home community, a family member may visit this child twice a year. An adult in residential care may have one family member visit them once per year.
If no foster placement is available in the child’s home community, the child is sent to the nearest community with an available foster placement.
The second portion of this request of $4.3 million is for costs that the department is experiencing for relocation travel, for the increase in casual nurses and casual social workers.
So each casual professional generates costs for travel, such as a roundtrip ticket, taxis, travel per diems, accommodation, and excess baggage.
Indeed, it seems apparent that when the draft legislation for the Child and Family Services Act is being reviewed, I’m just imagining that things may change, at least this particular part.
It has been clarified in my mind, but just below that, there’s wording to that effect. Excuse me.
It’s not related to social services but health centres, so let me ask a different question, Mr. Chairman.
Social services used to be administered by the municipality in Cape Dorset for many years, but it was eventually transferred back to the Nunavut government. How much additional funding was required to fulfill this social service to Cape Dorset after the hamlet no longer undertook the provision of that service under contract?
Let me first get that clarified, Mr. Chairman.
The funding was already in the CGS budget, so we just transferred it and the amount was $300,000.
Another matter close to this area is residential care, which is $4.1 million. You referred to residential care in your opening comments. Is this for residents requiring care at home or in a care centre?
It states in the English version of the plan that they will be drafting a residential care strategy in the 2011-12 fiscal year.
I imagine we will be given a vision of how the department plans on meeting these challenges via their strategy.
Additionally, we have been notified that it may not be completed in the fiscal year.
Now, where exactly does this strategy fit into? Has it been vetted as to what else is missing or what requires further study? What barrier or problem exists that this has to be revisited for further review, especially for people who require residential care?
What is the problem causing this need for review?
Let me start with that question. Thank you, Mr. Chairman.
I’ll ask my deputy minister to answer that question.
As part of the Child and Family Services Act review, we recognize that residential care is a big component of social services and rather than doing that component separately, because we are doing an overall review of the Act, we thought it would be easier if we just tie it together. So that’s what we’re going to do now. We will just tie this in as part of the overall review of the Act rather than have it as a separate component.
Chairman: Thank you, Mr. Ma. Mr. Tapardjuk.
Further to that point, when we speak about care required outside of Nunavut, particularly physically disabled people or other people who require daily care, can you clarify whether or not social services has contracted out care centres outside Nunavut? For instance, how many Nunavummiut with physical disabilities are currently in the care of institutions or centres in the south?
I would like to get an answer to that, please, Mr. Chairman.
I apologize for the delay. For 2011-12, the number of children and youth in out-of-territory placements is 64.
For 2011-12, for adults and elders in out-of-territory residential placements, the number is 84.
The facilities in Gjoa Haven and Igloolik constructed by the government to provide facilities to residents with physical disabilities requiring daily or all-day care are up and running.
Has this lessened the number of residents requiring care outside of Nunavut?
Additionally, what type of vision do we have for our future needs in Nunavut?
An example is: if a facility was created in Iqaluit, would we have to repatriate residents to Iqaluit from outside of Nunavut?
I would first like to get an idea of what type of plan or strategy they have with respect to the people who require residential care currently being housed outside.
Mr. Chairman, I recall in September 2004, a Full Caucus Retreat in Arviat where we discussed the importance of continuing care facilities and I recall that we wanted to build a continuing care facility in every community in Nunavut.
Here we are, almost eight years later, and there are only two continuing care facilities.
I believe each one can only accommodate 10, so it’s a total of 20 clients. We need to do more work in that area. They are 24/7 facilities and I believe they’re making tremendous use of the facilities and promoting them.
Are we on page H-5?
The Branch Summary under Social Services talks about children and vulnerable adults who may require protection or other specialized services. Some of the key areas are child protection, adoption, and violence in communities. The minister also stated in his opening comments that $4.1 million will be required for residential care.
Furthermore, those of us who sit here are aware of the Tamapta Mandate, which is the current foundation of this government and the members here.
The past Auditor General, Sheila Fraser, spoke to the issue of people at risk. Whether they are personally at risk or their children are at risk, they all require more assistance. How can we provide them with more assistance?
The statement made by the former Auditor General pertaining to Nunavut’s social issues related to how many smaller communities in particular don’t even have a social service worker. I believe that is the term in Inuktitut.
Communities don’t have social workers. Where one exists in the smaller communities, the social worker is not always present in their home community as they are responsible for several communities. The social worker rotates amongst their communities, spending several weeks or a month in each community, and then they go to the other community.
Once the social worker has moved on to another community, the people at risk are left with no services or assistance and they are left in a position of risk. When the social worker leaves the people they have just visited, the community with no social worker is now at risk.
Following the recommendation of Sheila Fraser that all members here supported, my question to the minister is: how many communities in Nunavut have an existing social worker working full time in their community?
I would like a response to the question I just asked.
Hon. Keith Peterson: Thank you, Mr. Chairman. I again apologize for the delay.
My accountant was adding up the numbers. The number is 18 out of 25 that have permanent social workers in the communities. Thank you.
Mr. Ningark (interpretation): Thank you, Mr. Chairman. Now that raises another question.
With the 25 communities currently in Nunavut, you just stated that 18 communities have full-time social service workers. Does it mean that these 18 communities have full-time social workers who stay in their community all year long and don’t have to visit other communities? Perhaps the only time social workers would leave their community would be when they go on holiday.
That is my secondary question. So these 18 social workers you noted don’t have any other communities they are responsible for.
Hon. Keith Peterson: Thank you, Mr. Chairman. I believe, being GN positions, they would be entitled to some time off for vacations and other leave, but they would be covered by other social workers.
Mr. Ningark (interpretation): Thank you, Mr. Chairman. With regard to these 18 positions and if we look at the seven remaining communities that don’t have a full-time social worker but have local community workers, such as wellness coordinators, income support workers, health workers, can they not deal with these children and families at risk or wherever there are cases of family violence?
Can they not look after the guardianship of these children at risk? Do they not have the ability to do that?
Again, I’m only talking about the communities that don’t have social service workers because when they are requesting assistance and they don’t get it, the violence in the community seems to grow bigger and it becomes very difficult to try to stop it. If we look at the government’s Tamapta Mandate, we speak about healthy communities and healthy families, and that we will be self-sufficient in looking after ourselves. This is something that they refer to back and forth and that it is the foundation of the GN.
One of the recommendations of the Auditor General regarding Nunavut and social services was that every community needs a social worker. Have you put together a recruitment plan to ensure that all the communities get social services, especially while we are Members of the Third Assembly?
Hon. Keith Peterson: Thank you, Mr. Chairman. I thank Mr. Ningark for his comments and concerns. Just to clarify, the 18 we’re referring to is actually communities.
So there are 18 communities with social workers. We are very concerned about the OAG’s report and recommendations, and we have put a major push to hire social workers for all the communities in Nunavut to address precisely the concerns that Mr. Ningark has raised with us here.
Mr. Chairman, I’m going to ask my deputy to provide some further information and clarity on exactly what our department is doing to recruit and place social workers in communities. Thank you, Mr. Chairman.
Chairman: Thank you, Minister Peterson. Mr. Ma.
Mr. Ma: Thank you, Mr. Chairman. As the minister indicated, we made a concerted effort just before Christmas and it has been ongoing during the last several months to get a community social services worker in every community.
By and large, in every community, we will have a social worker by the end of the fiscal year.
I do want to say that there is one caveat and that caveat is that in some communities, the challenge is having staff housing units for those people.
That’s something that I have to commend the Nunavut Housing Corporation for working with us very closely on. That’s what has allowed us to hire almost a CSSW in every community.
We have 41 positions on our org chart and we have all of those positions filled right now either by indeterminate, casual, contract, or agency. As a result of the recruitment efforts, we have 16 new CSSWs.
They will be starting in the next few days and that will replace currently seven casual and agency staff.
Our plan is we want to orient all of them. We will likely do the orientation out of Iqaluit.
So we can assure the member that we have taken the OAG’s concerns very seriously and we have made a very concerted effort in that regard. I do want to commend my executive director of social services for the fine efforts that she has made in this regard and the human resources team both within my department and within the Department of Human Resources.
Chairman: Thank you, Mr. Ma. Mr. Ningark.
Did the hon. minister indicate that there are 18 communities without the service of a social worker, yes?
Just to clarify, it’s 18 communities with social workers.
In the jurisdiction where there’s a high level of violence against women and children, I don’t think we can think or talk about… .
We’re not about to compromise in our communities, especially in the small communities, where there are no social workers.
We need the services now and we ask the government of this day, “Please, for God’s sake, provide the communities with social workers,” especially where people have to face, almost on a daily basis, the distasteful violence, especially the people who are in a vulnerable home like elders, youth, and women.
Will the minister commit to ensuring, during this life of the Third Assembly, that each and every community, as recommended by the Auditor General, will have a social worker?
I thank Mr. Ningark for his heartfelt comments. I understand perfectly where he is coming from.
I have the greatest respect for the former Auditor General of Canada, Sheila Fraser. She did a tremendous amount of work on behalf of our territory.
She personally came here to make her final public hearing precisely on this issue related to children, youth, and family programs and services in Nunavut.
That was one of her key recommendations. This government takes OAG recommendations very seriously.
We will commit to doing our very best to make sure every community has a social worker going forward.
I have Mr. Oshutapik.
I would like to speak to the issue, but you may correct me if you feel it’s outside of our review mandate.
We are talking about capital purchases related to social services.
This item is one many communities wish for and it’s not just our community that is requesting this. I pondered this capital purchases idea as we were debating the social services estimates.
Improving the existing child welfare system is a priority of my fellow residents because of the fact that the system is causing problems related to child welfare.
Whenever the social workers find a case, their western methodology of social services is the antithesis of the Inuit way of resolving issues.
The way they conduct their practices is alien.
Since the majority of Nunavut communities have mainly Inuit residents, the whole child welfare system is one of removal.
The whole precept of removal is a western corporate mentality, where the social worker, upon finding a case, will work to remove the children. The removal of children is not the way to resolve issues.
This is especially important when we’re talking about the budget estimates and I wanted to bring this matter up, Mr. Chairman.
I am of the belief that this system needs overhauling and incorporation of the principles of Inuit Qaujimajatuqangit, especially since this government keeps maintaining the importance of traditional knowledge in government operations. With respect to child protection, why do we keep throwing out Inuit practices?
All we see in the communities is the break-up of the family, the tearing down of family ties, as we have seen children who have restriction orders and they’re not allowed to see their parents. Parents discipline or scold their children and the social worker breaks up the family over that.
This is why I believe the legislation needs to be revised in this regard and that is what I wanted to speak to while we’re talking about budget estimates.