EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
It seems there is just one person running the whole thing and patients are just not happy.
The end of the contract is just too far off in my opinion, but it should be reviewed properly.
The other matter is airlines in the Kivalliq. We are served by just one airline, Calm Air.
There is no other airline and this predicament puts us in a very bad spot, especially for medical travel patients. It takes them a long time to get back home because often there is no space available.
With only one airline, it is especially bad in early spring. In summer and into the fall there are many tourists that go to Churchill.
Again, there is just one airplane that covers the entire route between Winnipeg, Churchill, and Rankin Inlet and it can’t keep up with the demand.
Has that contract been extended by a year as well?
Yes, I believe I had answered that in an earlier question.
The contract was extended up until the end of August of 2018.
That being said, there is work ongoing already with the Department of Community and Government Services, as well as we’re looking at aviation expertise to get involved in a discussion on the best practices for the best type of procurement model for this type of a contract to make sure that… .
Again, it’s a highly used service. We want to make sure for one that we are getting the best value as well as the best service.
Currently, as the member stated, there have been some issues. We do work very closely with airlines to make sure that they’re adhering to their contract conditions.
Medical travel patients are supposed to get priority.
There are issues with weather and mechanical delays that can contribute to unforeseen circumstances.
We do work very closely and we’re going to continue to work very closely with all of our contract partners that provide this type of service to us to make sure that there is recognition of the importance of medical travel patients.
It is not just an inconvenience alone; it adds additional costs to the Department of Health when people aren’t able to fly home when they’re finished with their appointments.
There are additional costs with accommodations and meal expenses that contribute to the addition of costs to the Department of Health.
It’s a big concern of ours.
People have approached me on a number of occasions because they are put up in a hotel when the Winnipeg boarding home is too full.
When they are put up in a hotel, they get $30 meal tickets for one day. I think it’s $30 or not more than $35 per day for meals.
That $35 is not enough to have breakfast, lunch, and supper.
Can that be increased? They end up paying money out of their own pockets because their meal tickets are only $35.
With the issue as far as over-accommodation of the boarding home itself, they are under a contracted obligation to provide secondary boarding and typically they look at hotels that are close to the facility.
There are a number of different hotels that they use that are in very close proximity to the boarding home.
The preferred model of providing meals is that the boarding home does provide transportation back to the boarding home for any provision of any meals.
With regard to the specific amount, I would have to look into actually who sets that amount a little bit different, whether it’s part of the contract or whether it’s part of negotiations with Non-Insured Health Benefits, or if it’s just under the contractor’s estimation of what it costs to provide food at the facility.
I do want to emphasize that any medical travel patients that are travelling are more than welcome to take advantage of the transportation of the boarding home to go back for meals and other food and visiting.
This issue has been raised many times. Patients have been having problems with the drivers of the boarding home.
I urge the minister to review this very carefully and in detail to find ways to improve services for the patients that require transportation to and from their appointments.
I wanted to ask some questions again and I think this is the time to hear about OHSNI.
I asked you a couple of oral questions in the House, I think it was the last sitting, but I would like you to, perhaps, talk a little bit about first of all, just for the benefit of everybody watching, what is the role of OHSNI and if you can also talk about the other regions and what kind of set-up they have as well.
With regard to the services provided by OHSNI out of Ontario, it’s a very broad level of service that they provide.
It goes right from case management of the actual medical, following the medical appointments and the procedures that are necessary for patients as they travel through the health care system in Ontario.
They assist the navigation of that. They have interpretive services that are available. They also provide some I guess you call it in-patient care at Larga on an as-needed basis.
In addition they have been very cooperative.
I met with the chair of the board and the executive director of OHSNI when I was in Ottawa earlier this year, shortly after taking on the portfolio of Health.
It gave me an opportunity to kind of understand how important of a role that they play in providing health care to Nunavummiut from this region going through the Ontario health care system.
They provide counselling to our patients that are going down there and, like I said, patient navigation through the health care system and almost any other support that may come up as needed.
To kind of put it bluntly with regard to the other two regions, I wish we did have a one-contact service provider that was able to provide all those services.
We kind of have to piecemeal it together, if you want to call it that, in the other regions where we work with the jurisdiction that they travel to, in Alberta and Manitoba, to take advantage of resources that are available there.
Again, where some of the gaps can occur and I have spoken about it here a few times now on interpretive services of making sure that medical terminology is something that’s very important in properly communicating to unilingual residents of the territory or even just for people with English as a second language to be able to understand the procedures that they’re undergoing, the medications that they need to adhere to the conditions of, and especially the aftercare.
When people come home, it’s a very important step in their care to make sure what’s expected of them and their family when they return home to make sure all the healing can take place.
I don’t believe I quite got what the other regions have.
I know you said that you wish you had an OHSNI type of contract, but what are you working with right now?
Just as an example, one of the topics that have come up to my level a few times is access to counselling.
If somebody is going down for cancer care or very serious issues, access to counselling has been a very critical component of understanding what they’re going through and helping the family adjust to some of the dire news that people receive.
I’m just using this as one example.
We would undertake participation with counselling services within that jurisdiction, either through CancerCare Manitoba or through Alberta cancer care, and just provide the interpretive service to be able to access those types of services in that jurisdiction.
Where OHSNI coordinates that and helps people navigate it through, they will help direct the services to the client.
We do have to rely upon, in the other jurisdictions, the model of care that’s in that case management system in that jurisdiction to make sure that people are accessing the point.
It’s a little bit more difficult. You’re not having somebody telling you what’s available all the steps of the way through. It puts a little bit more onus on the family and the patient to be able to access the services that they desire.
That’s what I meant by that.
When you say you would arrange counselling and all of that for somebody, are you talking about your department?
You have somebody within the department that’s working with… .
Is there an equivalent to Larga in Winnipeg?
I’m just trying to get a better understanding of what the procedure is.
Just to clarify, for accessing counselling in the territory, you go through the region that the patient is travelling from. Once they’re in a southern jurisdiction, we would have to rely upon the services that are being provided there.
Again, the client or the patient and the family have to undertake a little bit more onus on themselves to access or request those types of services. They’re available. It’s just somebody’s not going to always tell you all the way through all of your appointments and steps of what exactly is available.
It may take a little bit of enquiry, “Who can I talk to? What’s my next step?” You may have to ask some questions on your own and take a little bit of initiative.
It’s kind of a surprise to me that you wouldn’t have put an RFP out for a similar service like that in the other regions, which brings me to the question of OHSNI.
When I ask about OHSNI, it’s very difficult to figure out how they got set up.
I have never seen a call or a request for proposal. They don’t seem to be anywhere, yet we are using them.
Would OHSNI then fit under the NNI Policy?
All government contracts are NNI applicable.
I guess in the case of OHSNI as an example, if there was a submission or proposal from a northern-based group or an organization, they didn’t meet the cost or the parameters of the RFP.
I think there might be some interest from some Inuit firms to deliver the same kind of service, but it was just unknown of how… .
Is this a contract that’s going to be coming up soon for renewal or how long is this contract for?
Right now the contract comes up on April 1, 2021.
There is one extension that is available. When I talk about contracting and procurement, as following all with the procurement rules, we make sure we go with the best proponent.
That being said, when you’re looking at the amount of travel out of this region versus the other two regions, to submit a business case such as OHSNI in the other two jurisdictions, somebody would have to really take a look at the numbers.
Once you’re committing to providing that level of service, which I’m very pleased with the level of service that OHSNI provides, would the volume in the other two regions sustain an organization to provide that level of service?
That’s something that we are exploring all the time of taking a look at what we can do in the other regions to be able to provide an equivalent level of care. We want to make sure that during our medical travel review, we are looking at the other two regions to see how we can accommodate them.
Yes, I think it is worthwhile to look at that.
When I go to Ottawa, I like to go visit the hospitals and Larga, and we all like to make those kinds of rounds to see our fellow Nunavummiut.
It was always a mystery to me about what happens when people go down for nothing because either they don’t have an appointment or whatever the other reason is.
I guess I should ask you: is OHSNI responsible for setting up appointments with doctors down there?
They’re not responsible for it, but they do assist.
Whenever we coordinate medical travel, especially if people need to see different specialists or need different appointments, we try very diligently to make sure that we’re piggybacking appointments.
That being said, it does happen where people have gone down for appointments and there is conflicting information or maybe the appointment didn’t exist as Medical Travel had understood.
The MEDITECH software that we have been utilizing on case management to be able to track people from across the territory as it’s being rolled out, as I had mentioned in an earlier response, has streamlined that process and has reduced errors noticeably.
It is something that through our Medical Travel Policy review, we’re going to continue to look for efficiencies and identify stronger ways and methods to make sure that appointment schedules are very clear to the people that are travelling and as well, notification is far enough in advance so people can accommodate their schedule.
We do our best as a department if people have conflicting schedules where we do our best to accommodate with our partners in the south.
I’m going to switch gears, as one MLA always used to say.
I would like to talk about long-term care. We often talk about elders, especially lately.
As you know, I’m very much involved in a project here with the Sailivik Society. We have talked about it endlessly.
One thing that I would like to find out more information on is Nunavummiut who aren’t necessarily elders but have to stay down south because their needs can’t be met here through assisted living or maybe long-term care, but they’re not elders.
How many Nunavummiut have to be in the south because they can’t receive that type of care here?
It’s challenging to answer that question because there are some instances where Health is involved in providing care in a facility down south, but typically the responsibility is to Family Services to provide that level of care, so I wouldn’t have access to those numbers.
Maybe she could coordinate with me and the Minister for Family Services to get a more accurate, detailed response.
Ms. Angnakak: Thank you. In your business plan under long-term care you have a little over $7.7 million. Is that in or out-of-territory costs?
That is in-territory.
One of the things, as you know, I have been frustrated with, really, is the whole issue of the hospital management board.
I think the House, everybody stood up and we all agreed that we wanted to have a comprehensive review of the merits and benefits of establishing a board of management.
I don’t really understand why there seems to be so much reluctance to release the findings.
I really believe that it sends a wrong message to simply ignore the will of the Legislative Assembly and not release those documents. In fact, as we know, you seconded the motion and I’m wondering if you would change your mind on that.
I strongly disagree with the member that we haven’t followed through with the will of that motion. The wording on that was “to undertake a comprehensive review of the merits and benefits of establishing a board of management for the Qikiqtani General Hospital and report on its considerations and findings to the House.”
I realize we haven’t tabled a report on that and I did offer and the offer is still open to sit down with the member and discuss all the different levels of how we considered it, but I strongly disagree that we haven’t… .
If anything, I believe we have taken a solid step forward in the creation of a board of management at the QGH to occur at some point in the future.
With the board governance model that we’re looking at right now, we want to make sure that we have community engagement linkages to the local community health and wellness committees.
The allocation of resources that are necessary to put up an advisory board are sincere and they are going to be occurring in the very near future.
We also want to make sure that we’re not putting the government or the Department of Health itself at risk or our patients at risk.
It’s not as simple as adding a board of management to a facility like that; to make sure that we’re providing consistent care across the territory for one and for two, to make sure that the accountability that ends at me, I’m responsible for it.
I understand a board of management works in larger jurisdictions and I believe it can and will work here, but we’re not quite ready for that step right now.
I think the Department of Health is taking a very serious step forward in the process of getting to that point by creating the depth through an advisory board that will have an impact on the direction of the QGH in particular.
I guess I would disagree with you. I don’t think the department has proven anything that they have done to this House because there was a motion passed and it specifically said specific documentation that we’re looking for, but we haven’t seen it.
Like you said, you haven’t tabled it.
I think personally an advisory board, in my mind, with no authority would be a waste of time. Maybe we should wait until a proper management board could be established. Maybe we should wait to find out from the department why a management board can’t be established right now.
We don’t have the information that you are looking at. We don’t have it here.
All we know is that we passed a motion and this motion was supported by everybody here. All we have heard from the department is that “Oh, no, we can’t do that. We have to have an advisory board.”
We don’t know why. You haven’t provided that information to us.
Maybe you are right. Maybe you’re absolutely right and we shouldn’t be having a management board or maybe we’re right. We don’t know that because we haven’t got that information.
That’s what we’re looking for from you, is to provide that information.
Hon. George Hickes: Thank you, Mr. Chairman. I appreciate the member’s passion behind this topic.
Again, I just want to reiterate that the motion clearly stated it was to undertake a comprehensive review of the merits.
It wasn’t to put in a board of management. It did not state that in the motion. A private member’s bill cannot force the government to undertake different expenditures.
It was to come back with the merits and we saw the merits. That’s why we came back with the creation and the suggestion of the creation that got approved through cabinet to create an advisory board.
The invitation is totally open to the member to sit down with me to go over the pros and cons of the five different models that we examined.
We have the information in a number of different pieces in a number of different ways. It’s not set up in a report.
When we’re dealing with the structure and formal processes that need to be followed to make sure that a report gets provided, I’m taking away capacity from people that are working on a number of different initiatives and I feel that it wasn’t a prudent use of time for those people to be used to put in the formal report.
I’m totally open to sharing the findings.
If the member keeps pursuing this and she still agrees after the sharing of information with her and any other of my colleagues around the table that want further information on this topic, I would be more than happy to sit down and explore, again taking resources away from their duties and the department to satisfy the member’s need for a report.
We may be getting just a bit out of what we’re trying to do today, discussions.
I think we will have to pursue this through another means.
I would like to know a little bit more about the dental plan that we have in Nunavut.
Recently I have been dealing with a constituent who has several children and two of them need dental work with a dental surgeon.
One was approved and the other one wasn’t.
They were told that in order for the other child, who is only a couple of years older than the first, needed their own personal insurance.
Now I’m becoming very confused over what’s going on. What are the criteria?
When a dentist refers a child to the dental surgeon, can the child be only looked after if the parents have personal insurance for such things?
I’m surprised to hear that.
I would very much appreciate, outside the House, if the member could give me some further details and connect me with that parent.
NIHB has committed, through the children’s oral health project, to provide oral health promotion, prevention, and basic treatment initiatives for children zero to nine years of age.
In addition, through NIHB coverage, they would be covered for additional treatments on an as-needed basis.
We do work with dentist offices here in Iqaluit and through contracted services throughout the rest of the territory.
The criteria do come out of NIHB where the billings for dental treatment are paid from, but as far as the details on why one child would be accepted than another, I would be curious to know the circumstances around that.
If the minister would remember, I did bring it to your attention last week and I also phoned the hospital or your patient relations office because I was told to do that. I did that as well. I’ve had no response from them.
Today when I phoned the parent to see what follow-up has been done on their behalf, they said, “Nothing,” and they’re very angry about it and they don’t understand why one child would be favoured over the other one.
For them the rules changed.
In fact the mother said, “Well, I’ll go back to the dentist and get a referral.” The surgeon said, “It doesn’t matter.
I have it on the file that your son won’t be seen unless you have personal insurance.” I thought that was a very odd way to be dealing with Nunavummiut here.
It’s the same one.
I think that’s all from me right now.
I do recall that conversation now and it was being looked into and I’ll have staff follow up with that immediately.
Mr. Alexander Sammurtok (interpretation): Thank you, Mr. Chairman. (interpretation ends) I would like to ask a couple questions.
When a patient or client makes a phone call to the health centre, they’re referred to the nurse on call, indicating that there’s a long list of other patients that are required to be looked at.
Why would a community like Rankin Inlet, when there are about five or maybe six nurses, be referred to a nurse on call?
When we’re dealing with after-hours care, it’s always a challenge. Our nurses are expected to work a full day of work and then be on call throughout evening hours and sometimes for extended days where it can put a lot of stress and challenge on the system itself.
With regard to the member’s specific community in Rankin Inlet, it would depend on the circumstances of what the patient is calling in for.
With specifics to the provision of care, that is the one of the things with the model of care review we’re doing right now that we’re undertaking to ensure that when we’re considering what care is expected to be provided, we’re looking at a number of different initiatives; staggering hours in some of our communities at the health centres to be able to give nurses staggered shifts. We’re looking at potentially extended hours in some to meet the community’s individual needs.
Again, when I go back to provision of health care in general, we want the engagement of the community and we want to be able to provide the same level of care across the territory. There may need to be some customization in certain communities to be able to provide that care consistently.
It’s not for in-patients that are trying to make an appointment after-hours. It’s between 8:30 in the morning until 5:00 in the afternoon when the nurses are at work during those times, and then they are referred to a nurse on call.
I can’t understand that at all. Would you explain that a little more clearly to me, please?
I will have to look into the specifics of it, of the scheduling process that is used in Rankin Inlet.
I don’t like to assume anything and we all know what could happen then.
The nurse on call may be the most consistently available to talk to in case somebody needs to have an immediate telephone triage on how urgent their need to actually get physical care. The nurses that are in the hospital are busy doing other duties and they may not be near a phone consistently.
It’s something that, again, I have to look into the details of how they structure it in Rankin Inlet, but to me that would be a pretty safe guesstimate on my part of why they would direct calls to the nurse on call because there would be somebody there that’s available to take a call.
On another topic, when a physician makes an appointment with a client and the southern physician or the doctor requests that the patient go down south for treatment with an escort, who decides in Nunavut, in the community that the patient can’t have an escort, especially when they’re going down for an operation?
I wouldn’t want to put the onus on an individual. It is the policy itself that dictates whether people would have an approved escort.
There may be instances and I know of instances where the doctor recommends an escort for the patient, but depending upon the medical procedure that is being undertaken, they may not necessarily need one.