EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
Mr. Chairman, the standing committee recognizes that in addition to basic health care coverage for all Nunavummiut, the Department of Health also administers a number of federal funding programs such as the Non-Insured Health Benefits Program, which helps to cover costs relating to travel, food, and accommodation for beneficiary clients who are required to travel away from home to receive medical treatment and care.
NIHB also covers various costs relating to dental care, vision care, and pharmaceuticals for beneficiaries.
The standing committee notes that high pharmacy costs raise concerns for many Nunavummiut and encourages the minister to work with his provincial and territorial counterparts in their efforts to address the cost of pharmacy products across Canada.
The standing committee supports the department’s ongoing efforts to increase resources and staff in such areas as mental health, public health, and long-term care.
Members recognize that additional resources allocated to quality improvement are intended to address the need for changes to the delivery of services at the community and regional levels as well as improving the overall quality of health care and patient experience.
The standing committee encourages the minister to provide timely updates on any proposed changes to service delivery that may directly impact medical clients, their families, and the communities they live in.
While the standing committee recognizes that many of the approximately 60 new positions to be added to the department in 2016-17 will provide much-needed services to Nunavummiut, it must be noted that a great many of the department’s current positions remain vacant to date.
The Standing Committee on Social Wellness continues to encourage the department to focus on the recruitment, training, and retention of health workers, especially at the community level.
Members further encourage the department in its efforts to ensure that medical professionals hired from outside of the territory receive appropriate orientation and ongoing cultural awareness and sensitivity training.
Mr. Chairman, over the years, the department has made significant investments in such technology as the telehealth system and diagnostic equipment such as a CT scanner and updated X-ray and ultrasound machines.
The standing committee encourages the department to monitor the effectiveness of these investments in providing a greater level of service at home and reducing medical travel costs with a view to acquiring additional equipment in the future, such as dialysis machines, which would permit more Nunavummiut to receive medical services in Nunavut closer to their families and communities.
Members of the standing committee have raised concerns about the number of medical clients who are sent out of Nunavut and away from their families to receive care.
While it is recognized that, for certain types of care, the required type or level of services is not always available within Nunavut, members encourage the minister and his staff to work more closely with community groups and organizations to address local needs and support local efforts to provide support and programming.
The standing committee was pleased to note the department’s plans to address long-term care needs in the community of Baker Lake.
Committee members look forward to receiving further information on the department’s long-term plans to support Nunavut’s growing elder population in all of Nunavut’s communities.
At the other end of the population spectrum, the standing committee notes that the Department of Health is proposing to introduce a number of initiatives focusing on children and youth, such as programs in the areas of emotional and social development as well as ongoing oral health programming.
Committee members strongly encourage departmental staff to work closely with school staff and DEAs to support students in addressing healthy lifestyles choices.
Mr. Chairman, health-related initiatives at the community level can be greatly enhanced with the support and participation of Health Committees of Council.
The committee notes that 2016-17 funding allocations for health committees will once again remain equal and unchanged across all communities.
More support could be provided to Health Committees of Council to assist them in becoming effective in undertaking the important role of promoting the health and well-being of their communities.
During the minister’s presentation of his draft 2016-17 main estimates budget to the standing committee, a commitment was made to provide information on the current status of contracted services with such entities as the Ottawa Health Services Network as well as contractors providing boarding home services and airline transportation.
The standing committee looks forward to receiving updates on the status of such contracted services.
You read well.
Before we proceed, I would like to remind members that if you have questions, you will have an opportunity to ask them during the page-by-page review even if they are in the Minister Okalik’s opening remarks.
Do my colleagues have any general comments?
If there are none, we will proceed.
Let us go to page H-4, but before we proceed, we haven’t met for a long time and I would like to remind you, as we’re in the Committee of the Whole, that according to Rule 77(1), you have 10 minutes to speak, and according to Rule 77(2), subject to the discretion of the Chair, a member may speak more than once to a matter under discussion but not until every member wishing to speak has spoken.
I suggest to members that whenever possible you ask your detailed questions during the page-by-page review and indicate which page you are referring to so that the minister and his officials will have a good idea where you’re commenting from.
We will proceed with our page-by-page review and we will first deal with the Department of Health.
Directorate Ms. Angnakak.
I almost said, “Mr. Speaker.”
One of the things that come to mind right away when we have the Department of Health before us is the motion that was passed last fall to establish a hospital board.
I think that the department was supposed to bring that into the House in the fall of 2015 and we haven’t seen anything.
I’m wondering if you can explain to us why it hasn’t come to the House and what the next steps are.
This is an ongoing process. I will have to look into this with my officials and we’re still planning towards that and it’s not complete yet.
We want to set it up properly for the new board.
Once we’re done, we will be able to take it to the House.
Just a reminder to the minister and officials, if you wish to discuss amongst yourselves, you have a mute button.
I think this is an issue that is something that I feel is very important. I think we’re the only jurisdiction without a board and according to that motion we all passed, this was supposed to be in place by the fall.
Why is there such a delay?
Why aren’t we where we are supposed to be?
We are still dealing with this today and we will carry on with it as per the motion and we will be establishing a board.
I don’t believe the minister answered my question.
What constitutes the delays? Why don’t we have a board in place now? What are the reasons?
We will be implementing this and we want to do it properly. Along with my officials, we’re going to have to review it very carefully before we can present it.
I still didn’t get an answer. I keep asking what the cause of the delay is. (interpretation ends) You’re in breach, really, of the motion and I think that’s kind of serious, so I am really hoping that you can provide us with … . Has the process even started?
Let’s start there. Has the process started to establish this board?
The process has not stopped.
As I have stated, we will create a health board.
We’re trying to do that as we were asked to do.
Can the minister tell us then when he expects this board to be in place?
Chairman (interpretation): Thank you, Ms. Angnakak. Don’t forget to mute your microphone if you’re going to have a discussion.
We are getting close to completion and we will create the board this year.
I’m just getting started.
The Department of Health repeatedly overspends the budget. Every year, supplementary appropriations are brought forward to account for over-expenditures. What efforts have been made to ensure that your budget for 2016-17 is realistic and that requests for supplementary appropriations in the upcoming fiscal year will be kept to a minimum?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) We’re always looking to improve, reduce, and create more efficiency.
As I stated in my opening comments, there are some areas that weren’t even budgeted like security and other areas that should have been budgeted that aren’t a part of our overall budget, so we’re including them.
That will have a reduction in supplementary appropriations for future years for sure.
I hope that we can prevent over-expenditures by doing more promotion throughout the communities.
Part of the budget is to create more public health employees so that we can prevent illnesses and reduce our overall cost on health care. (interpretation) Thank you, Mr. Chairman.
That is good to hear, which brings me to think about the Canada Health Accord and that expired in March of 2014. That provides stable funding for all Canadian jurisdictions.
Can you describe what discussions are underway with your federal, provincial, and territorial counterparts to ensure that we have adequate funding for health care in Nunavut?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I had the benefit of going to Vancouver with my colleagues and those discussions are very preliminary at this stage, so I can’t pinpoint when we can have a new accord in the future. (interpretation) Thank you, Mr. Chairman.
This funding expired 2014 in March, so what are we using now?
Is money still coming in even though it expired or how does that all work?
Can you explain it to us here in the House?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) Yes, the old agreement still continues with nominal increases each year. (interpretation) Thank you, Mr. Chairman.
Hopefully we will get a lot more than we usually do.
Your department plans to add 60 new PYs, even though you have difficulties, really, in filling current positions.
To what extent does your department’s consistent vacancy rate impact your departmental budget?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) We end up contracting and using casuals and some overtime for employees where there are vacancies. (interpretation) Thank you, Mr. Chairman.
Ms. Angnakak: According to your structural chart on page H-1 of the main estimates, 60 new positions will be added to the Health Care Delivery Branch, 17 new PYs in the Health Centre Division.
Which community health centres will receive these new positions and how will individuals be recruited or trained to fill those positions?
Chairman (interpretation): Thank you, Ms. Angnakak. (interpretation ends) I think there were two or three questions there.
If you want to answer them individually, fine, or however you want to answer it. (interpretation) Thank you. Minister Okalik.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I can answer some part of it in terms of the interpreter/translators.
All the Kivalliq will get full-time interpreter/translators, which has been casual, so a lot of those are partially filled already.
It’s a matter of making them indeterminate so that they can have the benefits and security of a job. (interpretation) Thank you, Mr. Chairman.
Ms. Angnakak: Well, that’s great news to hear because I think that’s exactly the way we’re supposed to be going.
In fact, I do want to tell you that the problems that I brought up to you about the lack of interpreters at the hospital here, I think that you have addressed those problems very well.
I am happy to see that as well.
I want to get into a little bit about concerns about the status of various contracts that are held by the Department of Health for services such as the medical boarding homes, emergency medical travel, and scheduled medical travel.
What processes does your department follow to ensure that services, conditions, and other obligations are being properly provided for by the different contractors?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) We do meet with the contractors that deliver those services to our clients.
It always helps to learn from the clients on the issues they may be facing. We appreciate the feedback and then we introduce them for improvements to these contractors.
Please, if you have issues, continue to let us know so that we can improve the services with the contractors. (interpretation) Thank you, Mr. Chairman.
Before I proceed, Ms. Angnakak, I know that you really want to ask questions and it’s interesting, but please keep the interpreters in mind because they need to keep up with you and that goes for all of us.
We have to go through the interpreters, so we should keep that in mind, as they are assisting us.
Ms. Angnakak (interpretation): Thank you. (interpretation ends) Yes, I’ll try to slow down.
I get so excited when Health is before us. My goodness me, what great opportunities here.
When we’re talking about different contracts that the Department of Health has for services such as the one like the boarding homes and that, how many will be renewed or put out for tendering in the upcoming fiscal year?
I’ll try to slow down.
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I’ll answer slowly to try to assist my colleague in normalizing the speed and tone.
The Winnipeg boarding home, for example, their term is ending this May, I believe, and the possibility of an extension for another year.
The Edmonton boarding home will be up next, next year. The term will be up in 2017.
The Iqaluit boarding home will be due up in March of 2020. The Ottawa Larga Boarding Home will be March 2028. The Yellowknife boarding home is also October 2028.
Those are the boarding home contracts that we currently work with the federal government on. (interpretation) Thank you, Mr. Chairman.
From those contracts that you spoke of, what is usual term? Are they all the same?
Do they all have a five-year term with a five-year extension or 20-year terms? What are the terms?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) Some of them are shorter and depending on the contractor as well, so each case is different.
We also make sure that they’re following the terms of the contract by meeting regularly with these contractors.
They are challenging at times, but we try to work with them. (interpretation) Thank you, Mr. Chairman.
Which contract is the longest contract?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) The longest contracts are with Ottawa Larga and with Yellowknife as well.
Those are contracts that we work out, with the federal government providing the funds, and we work out the terms with the contractors. (interpretation) Thank you, Mr. Chairman.
I’m on 111 in your business plan and you talk about “a comprehensive training and development strategy to address both technical and soft skill gaps in the workforce.”
I would like to know more information about the soft skill gaps in the workforce. What does that mean? Which PYs would fall into that category?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) I believe this is more in line with the recommendations of the review that took place.
There needs to be more cultural awareness for our employees, so we look forward to providing this training along with ongoing training for our health care professionals to support their work. (interpretation) Thank you, Mr. Chairman.
Again just above that, you talk about “umbrella legislation to allow the regulation of multiple health professions currently not regulated in Nunavut.”
Can you explain what you mean by that? When do you expect this legislation to come our way?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) There are some professionals that aren’t regulated currently like chiropractors and other professions that provide support services for health care.
I look forward to working on this and hopefully, next year, we will be in a position to introduce legislation. (interpretation) Thank you, Mr. Chairman
We’re on page H-4.
First of all, I would like to ask a question on the opening comments where it speaks to three positions that they want to create under the (interpretation ends) quality improvement program. (interpretation) I believe it was in response to the review that was conducted by Ms. Katherine Peterson.
I would like to know what the roles or duties these three positions will be performing. What kind of jobs will they actually be doing?
The three researchers who carried out the study further stated that these supervisors need more monitoring to ensure they’re working properly. We will be adding those three PYs. One of them will be a researcher to monitor their work.
In the recommendations, it stated that there should be a full-time chief nursing officer position.
That is under recommendation 2. Is that included in the three PYs that you are requesting?
We already have a chief nursing officer in place.
I would also like to thank the department for their efforts in implementing the recommendations from the report.
Let me move to another topic. This issue was partially referred to in a previous question about the contract last month, when the airline companies appeared before the Full Caucus.
We directed questions on the contract with the government. One representative from Canadian North responded that the contract had been extended, that contract held by the Department of Health. What is the final date of closure for this contract?
Can we get that information? Further, are you in negotiations with the companies?
I will stop there for now.
We added a year to the extension of the contract to allow more time for other airline companies to apply, as currently, it would have been comprised of the existing carriers. In looking at the outside world, there are not many airline companies operating in Nunavut, but it was to allow more companies to submit bids by adding an extra year up to August 2017, when the tender will open to the public.
We have heard via the news media through print and the web that a new airline was established just recently that will fly from Iqaluit to Ottawa and east to Halifax and it is called Sarvaq Aviation.
Has this company been included in the discussions about the contract to see if a cheaper price can be submitted for the contract and whether they would be interested?
I, too, am quite pleased that another airline will be available, perhaps leading to a better price. However, this contract is still in force and it will open for public tender in 2017. I would encourage all airlines who wish to bid, if they have the appropriate aircraft, to submit their bids and we will be open to all submissions.
I would like to get back to Ms. Angnakak’s line of questioning where she spoke of renewal of contracts.
In particular, the Inuit Kivalliq Centre in Winnipeg, I believe it was discussed that the contract will be renewed or extended in May. I would like to know what the status of this contract is.
This contract is in the interim period and we may have to extend it for another year based on the operational requirements of the companies.
They have to work together to try to resolve these issues, so we will most likely wait on this by extending it another year.
Mr. Sammurtok, are you finished?
First of all, I would like to ask the minister for clarification with regard to the opening comments on page 2, second paragraph.
It states, “This year, we are asking for four new nurse practitioners for the communities of Arviat, Baker Lake, Coral Harbour, and Naujaat.”
Will there be four new nurse practitioners in those four communities or will there be one for each of the four communities?
Yes, the four communities will each get a nurse specializing in prescription drugs, able to fill out prescriptions and provide more information on the patients, as they have more authority than regular nurses.
We had a pilot project in the past, which provided many benefits and that is why we are trying to expand it to other communities.
It is evident now that it’s going to be very beneficial for Baker Lake. Last year and this year, we’ve had a shortage of nurses in Baker Lake. Even before I came here, we had a shortage of nurses and they could only see patients in emergency cases.
I don’t know what it is like right now, but we had a shortage of nurses.
In your opening comments, it states that in all of the Kivalliq communities as well as Sanikiluaq, there are a total of 12.8 positions. I would like to get clarification.
Are the current employees going to be considered first? I refer to the people currently working there who are not indeterminate but in largely casual positions.
To date, they have been hired as casuals and we want to hire them as full-time employees. I know that they will be able to apply for the full-time, indeterminate positions.
I want clarification on your opening comments on page 3. Earlier on, you stated that “Absent in Baker Lake is a home and community care program.”
I was looking at the six positions that your department wants to create, which will provide a lot of assistance to the community.
This includes building “care plans for clients, improving access to treatment and reducing wait times.”
With respect to these six positions that serve the entire region, do they have to be nurses or are they mainly administrative staff supporting the department?
If you can understand, I wonder if you can elaborate a bit further on the six positions.
Perhaps the manager will be a nurse. However, the other employees will be trained and we would prefer them to be Inuit from the communities, as they tend to hold these positions. They will receive training and assist the nurses.
Also just underneath that one, there is another paragraph I want clarification on. Obviously, in 10 communities in Nunavut, we require security measures to ensure our health care workers are working in a safe environment.
It is obvious that would help.
Have you done any studies related to smaller communities? It seems obvious that smaller communities facing emergencies or injuries have difficulties trying to move patients through the doors. Sometimes in an emergency, in a smaller community, when you are transporting patients or an injured person, it was difficult to enter.
Is this not a concern?
The communities we have focused on face particular challenges, such as break-ins of health centres and vandalism, which we want to cut off. We believe having security in the health centres will lower these incidents.
Health centre equipment and operating our health centres is very expensive, so we have to protect them.
Do you have any questions on that page?
I will ask my next question in English for clarity. (interpretation ends) One of the priorities in your 2016-17 draft business plan is to “Introduce the revised Extended Health Benefits policy.”
Can you describe some of the changes to the policy and explain how they will benefit eligible Nunavutmiut?
Hon. Paul Okalik (interpretation): Thank you, Mr. Chairman. (interpretation ends) We are planning to introduce this new policy this fiscal year. I can’t identify exactly when, but we will. (interpretation) Thank you, Mr. Chairman.
Mr. Mikkungwak (interpretation): Once the revised Extended Health Benefits Policy is completed, will regular members be able to see a copy of that policy?
He said, “Absolutely.”
Mr. Mikkungwak (interpretation): Yes, now I understand, absolutely, of course.
(interpretation ends) The need for health-specific privacy legislation, (interpretation) as it seems obvious that within the health department, when we deal with medical cases, there are confidentiality issues, as legislation exists to protect privacy.