EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
With the department’s new CT scanner finally becoming operational at the Qikiqtani General Hospital, members anticipate that there will be long-term cost savings as fewer medical clients will have to travel out of the territory for diagnostic tests.
Members encourage the department to maintain its efforts in recruiting and training health workers both at the community level and at the regional health centres.
Members fully support the department’s initiatives to ensure quality of care at all community health centres and to achieve full-time staffing and continuity of service across all communities.
Mr. Chairman, Nunavut’s unique population characteristics and geography as well as the linguistic and cultural aspects of health service delivery are significant cost drivers when it comes to delivering health services to Nunavut residents.
In recent years, the federal government recognized the financial impacts related to delivering health services in the North and provided additional funding through such programs as the Territorial Health System Sustainability Initiative.
The standing committee strongly supports the minister’s efforts to work with her territorial counterparts to again access additional federal funding to address specific health care and medical service needs across the northern territories.
The committee further encourages the department to work collaboratively with representatives from the community-level and well as from the federal level to address specific health issue needs with funding, resources, and other supports.
The standing committee recognizes the department’s ongoing efforts to improve the administration of health care services with initiatives such as the Patient Relations Office, the Interoperable Electronic Health Records System, and amending policies relating to medical travel.
Members encourage the minister to closely monitor developments in these areas especially as they relate to concerns regarding rights, responsibilities and privacy.
Mr. Chairman, the standing committee fully supports the department’s initiatives in the areas of long term care and support for elders and individuals with chronic illnesses.
Members further encourage the department to address issues facing Nunavummiut with disabilities, including improved wheelchair accessibility for medical travel clients and providing additional support for parents with disabled children including those suffering from illnesses such as autism.
Members note that a review of the Extended Health Benefits Program will be conducted in the upcoming fiscal year and look forward to updates in this area.
Mr. Chairman, the standing committee has noted that mental health and substance abuse problems are often at the root of many other social and health issues.
Members support the concept of culturally relevant, community-based programs being delivered in Nunavut’s communities and encourage the department’s plans to focus on mental health and addictions during the 2014-15 fiscal year.
Mr. Chairman, the issue of food security is a growing concern across Nunavut.
Members strongly encourage the minister to work with her ministerial colleagues and community-based groups to address this concern.
Funding and support for breakfast programs in schools, parenting, life skills and nutrition programs for pre-natal mothers and families, and supporting healthy food choices by both retailers and consumers can go a long way towards promoting good health and well-being across the territory.
Chairman: Before we proceed, I would like to remind members of the following: 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 just have a couple of questions regarding the opening comments from the minister.
On her second page it talks about focusing resources on three different bullet points. With regard to the last bullet point of performing a needs assessment for enhancing long-term care services, there are $30,000 budgeted for. Is that a community by community assessment, or is that regional or territorial?
We are looking at Nunavut-wide perspective.
I have repeatedly brought up the topic of looking at care and services being provided in the territory.
Will this assessment identify needs from a territorial standpoint? Will this include looking at facility needs across the territory?
Hon. Monica Ell (interpretation): Thank you, Mr. Chairman. (interpretation ends) Health is planning for a needs assessment to determine how best to meet the long-term care needs of Nunavummiut, having gauged a territorial lead for long-term care planning. The assessment will include care delivery model, such as community and in-home support model for support of living and residential programs.
The results of the assessment will help inform future strategic planning and development.
I thank the minister for that response. Also on the same page right underneath that it talks about the department will also continue work on…It’s got four bullet points, but specifically I’d like to ask about the middle two - long-term care of $5.3 million.
How much of those dollars are being anticipated to be spent outside of the territory?
Hon. Monica Ell (interpretation): Those funds are for the facilities in Nunavut, mainly for Gjoa Haven and Igloolik.
Thank you for that, Minister Ell.
With the third bullet, Mental Health and Addictions of $17.3 million, the same question.
This mental health issue will be directed to my deputy minister, if possible.
That’s currently we provide within the territory. We do have mental health positions in the regions.
We are starting to have some psychiatric nurses in some of the communities, which we’ll have territorially. That also includes Akausisarvik here in the facility. We also have a facility in Cambridge Bay, which we been using the money to kind of operate.
Long-term-wise, it’s not in this particular time, but we’re also in this particular plan, but we’re also looking at one in Rankin Inlet.
Mr. Hickes: Thank you for that response.
I just wanted to let you know as well that I recently met with the City Council of Iqaluit and they had a number of good things to say about the psychology services improvement in Iqaluit.
With regard to Vote 4/5 funding for specific activities that you mentioned towards the bottom of the first page of your opening comments, you talk about $49.6 million in fiscal 2014-15. Are there dollars included in that from the previous Territorial Health System Sustainability Initiative?
Hon. Monica Ell: No.
From what I understand, funding for that initiative expired on March 31 of this year.
Have there been discussions with your federal counterparts to revisit and have those dollars being put back into our health care system?
Hon. Monica El: Thank you, Mr. Chairman.
For the TC funding the federal government announced, we are still waiting to hear the details of that announcement and we’re expecting to hear the details later this fall.
Next on my list is Mr. Enook.
If my question is not appropriate, you will advise me.
I have a question on the opening comments.
Be welcome, hon. minister and your staff.
If I could be provided with an answer… .
I have a lot of paper here.
In the opening comments, it is stated that there will be 13.5 PYs.
I’m not specifically asking too much.
My question is; there are two of them, but they’re not specifically directed to that.
It’s directed to mental health workers and to psychiatric nurses. What’s the difference between these two professions?
In English, they look different. In Inuktitut, how else can we distinguish between them?
If they’re able to be distinguished, how do you base your decision as to what community should have which of which of these different kinds of health professionals?
I thank my fellow MLA for the question.
The Inuktitut terminology for these, we would need to use what we have heard so far, that they deal with minds.
The psychiatric nurse relates to having a higher, more professional specialized education for those that are required to see doctors, but the mental health worker is more of a support person to the other, real professional “mind-dealer” in the Inuktitut sense.
However, they do work in support of each other in relation to the severity of what the mental illness of a person would be and what the mental illness of the person would be.
I would like to be working with the terminology people in terms of whether there does need to be better terminology for those professionals.
My question is what do you use to provide mental health workers or psychiatrists to be brought to the community? How do you figure that you need those kinds of people?
Hon. Monica Ell (interpretation): Thank you, Mr. Chairman. .
At this time, what we have in place is in each community to have a psychiatric nurse and their mental health worker assistant to make sure that all of the communities to have those mental health workers and psychiatric nurses.
I would like to get some more clarification; are the psychiatric nurse and the mental health worker two different positions?
Are you trying to get all the communities to have a mental health nurse and a psychiatric nurse?
How do you make sure that you get those two positions in each community?
I am unsure what his last questions was.
Psychiatric nurses have more education than mental health workers because people in the communities have more knowledge about their community and they can be taught by a psychiatric nurse to have a mental health worker. Mental health workers know what kind of help people need in the communities.
What we want to have in each community is a mental health worker and a psychiatric nurse.
If there’s more work to do in a community, there can be more than two people.
The mental health workers can get more training on what to do from the psychiatric nurse.
Do I understand that all the communities in Nunavut will have a psychiatric nurse and a mental health worker? Are you trying to get a mental health worker and a psychiatric nurse in all of the communities?
That’s what we want to do. This is the long-term goal that we have as a department.
It has to be agreed to by the financial management board and the Members of the Legislative Assembly.
That’s the plan that; we have to have those two positions in each community if possible, Thank you, Mr. Chairman. .
I am happy to hear the plans that you have for the Department of Health.
At the present time, do you have a policy in place or do you have a goal in place to provide those two positions to each community and what you want for each community?
I would like my deputy minister to respond to the question.
There’s a policy in place, but it needs changes.
It’s called the Mental Health Act and it’s an old Act. We’re going to make amendments to that Act.
I think it was in 2002 that there was a framework for action implementation plan.
The Nunavut Suicide Prevention Strategy was also provided by the cabinet.
We’re going to be reviewing it this year before March 31 to see what kind of amendments have to be provided.
Maybe my question was not clear and that’s why I didn’t get a proper response.
My question was: how do you figure that a community needs a psychiatrist or mental health nurse or psychiatric nurse?
What is your basis for getting a mental health nurse or what criteria do you have to provide a community with a psychiatric nurse or a mental health nurse?
I’ll give this question to my deputy minister again.
I’m sorry if I didn’t understand your question properly.
We work with the communities. We work with the regional offices, such as the Kivalliq region, and we work with the director of mental health to figure out which communities will get a psychiatric nurse or a mental health nurse.
They’re all called health and community wellness committees. We work with them to decide which communities need those positions.
I don’t know if that answered your question or not.
Lastly, I’m beginning to understand.
Do you work with the community wellness committee in each community and who do they report to, to say that we need a psychiatric nurse or a mental health nurse?
Who do they talk to when they want those positions?
They would tell us that this community needs those psychiatric or mental health nurses. They would encourage us that we need those two positions.
My department will do the planning along with the Financial Management Board so that we can request some funding from the Financial Management Board and our request would go to the Members of the Legislative Assembly for approval.
With respect to the hon. minister’s report, it states that there would be $6 million in the Medical Travel Program and $9 million in the Out-of-Territory Hospital Program.
I would like to ask that question. That $9 million for the Out-of-Territory Hospital Program, Mr. Chairman, I would like clarification on the $9 million for the Out-of-Territory Hospital Program. Is that the whole amount?
It’s for services that we cannot provide, but it could be provided for the out-of-territory hospitals. According to where they come from, for instance, if they live in Winnipeg, Ottawa, Yellowknife, Churchill, or Edmonton, that $9 million is for those.
This will be my last one, I think.
It states that you used $2 million in the Pharmacy Program. I know it’s not just for pills.
It also states that you have been overspending in that department or in that budget line.
Mr. Chairman, I have asked the minister and I have stated in the past, have you ever investigated to see if there has been any mismanagement of the Pharmacy Program, for example, the puffers?
Also, there are other things that we don’t know about that have been abused.
Have you looked into the Pharmacy Program to make sure it’s being managed properly? Have you looked into it at all?
We have been very concerned about it.
Hon. Monica Ell (interpretation): Thank you, Mr. Chairman. (interpretation ends) Health funds a short-term supply of prescribed pharmaceuticals to cover the time it takes prescribed pharmaceuticals to arrive in the mail to clients who do not have access to privately run pharmacies in remote communities. This is for those that have pharmacies in the health centres. I would like to ask my deputy to have further clarification.
Mr. Enook: Thank you, Mr. Chairman. .
Before you respond to my question; you said something that I didn’t ask about.
I’m trying to ask this instead; we have been very concerned about the pharmacy program.
Pills that are no longer under the prescription for the patient, they keep sending them to the patient even though they are not supposed to be taking that kind of medication anyway and they just bring them back.
Someone has to pay for that medication.
All medication have a cost. We ask: Can you look into this? Have you done nothing on the matter?
I would like my deputy minister to respond to that.
Ms. Keenainak (interpretation): Thank you, Mr. Chairman. (interpretation ends) The department does have a territorial pharmacy position, but it has been vacant for awhile.
That’s one of the things that we need to recruit for.
This particular budget item is only for, as the minister indicated, in the health facilities just to tie you over until you get your medication.
The department does not pay for….like, for regular prescription they are either funded by the NIHB program or an employee’s medical insurance company.
Right now, we don’t have the mechanism, but once we recruit the territorial coordinator issues like that should be looked at.
We are skidding a little bit off track. We are on 2014-15 proposed budget. We can stick to that.
Mr. Enook: Mr. Chairman (interpretation) I thought we would be able to ask general questions.
If I am off track, I apologize.
I would like some clarification on what my fellow MLA was trying to ask about.
In regard to the $9 million stated for the out-of-territory hospital program; in that program, does that include the medical boarding home?
Is that included in the $9 million? That’s my first question.
Hon. Monica Ell (interpretation): Thank you, Mr. Chairman. No, that program is not within this $9 million.
Mr. Mapsalak (interpretation): Thank you, Mr. Chairman. . Do I understand that out-of-territory medical patients are not paid out of this $9 million program?
Chairman: Thank you. Minister Ell.
Hon. Monica Ell (interpretation): Thank you, Mr. Chairman. No, you were asking if the medical boarding homes were paid out of the out-of-territory hospital program, and they are not.
When we are working on the main estimates, I will ask more questions about this.
I have another question that has to do with your opening comments. Just below what I was asking about.
You informed us at one point that you have a new CT scanner in Iqaluit. That was welcome news that there is one now in Nunavut. Many patients have to travel south for that kind of diagnosis.
They literally become southerners because they have to wait for such a long time to get on the CT scanner list. So Health is seeking $891,000 to start the program.
Is the CT scanner being utilized now for the people of Nunavut?
Hon. Monica Ell (interpretation): Yes, the CT scanner was installed in Iqaluit. You can, basically, look inside the whole body.
It has been utilized since the beginning of this year at the Qikiqtani General Hospital. The $891,000 is to be used for the future operation of this scanner. There are other things called X-rays in the communities, so we can set up X-ray programs in the communities.
Chairman: Thank you. Mr. Mapsalak.
Mr. Mapsalak (interpretation): Thank you, minister for the response.
It’s great that there is one like that here in Nunavut.
When will it be available for all the people of Nunavut? I should ask for if it’s for patients in Nunavut. If that’s the case, when will be used for patients in Nunavut.
Before I respond to that, let me explain.
The $891,000 is just for the operation of the CT scanner in Iqaluit. That’s it. The actual CT scanner that can look inside your whole body, the plan is to have it available for all of Nunavut patients to come to Iqaluit and be scanned.
However, right now if you’re in the Keewatin, Winnipeg is closer. For emergency cases, they will continue to use Winnipeg because it’s closer and they’ll get there sooner. That’s the way it is set up for the interim.
My first question is related to the $6 million in medical travel increase.
I know that historically you’ve been experiencing budget shortfalls. I am wondering if you feel that the increase of $6 million in regard to medical travel is enough to meet the needs.
When we were planning the budget and looking at the historical budget documents, using those, that’s how we planned for our budget. We don’t know what the future holds. We don’t know what the future holds.
We don’t know if there were going to be more medical travel patients that need to fly out. We don’t know at this point. We won’t know if it’s going to be enough or not enough.
Chairman: Ms. Angnakak.
I’m losing my earpiece here.
Thank you for that answer. I hope that you can come up with ways of trying to make sure that we’re not going over budget.
I also look at the $700,000 in the Physician Services Program. Is the increase because we need more doctors or is the cost of hiring doctors going up?
Chairman: Minister Ell.
Chairman: Thank you. Ms. Keenainak.
It’s a combination of both, the fee that doctors are giving are growing higher as well as the fact that we are increasing specialist physician visits rather than the patients going down south. That’s part of the reason why there was an increase in physician service fees.
Thank you for that answer. Just going into the second page of your opening comments, mental health and addictions, the funding increases of $1.7 [million], you talk about “this is for awareness and understanding of mental health issues and addictions, and focusing on providing culturally appropriate wellness information.” Can you elaborate on how these funds will be used using perhaps some specific examples?
Hon. Monica Ell (interpretation): This is a federally run program. I’ll hand this over to my deputy minister to answer.
Ms. Keenainak: Thank you, Mr. Chairman. This is federal money that the department has been able to access and they have flagged mental health and addictions as one of their priorities. So that is supplementing the funding that we currently have.
This funding has also helped fund up to March 31 of the Cambridge Bay Mental Health Transition House. We have been able to staff that facility in Cambridge Bay where we have been able to repatriate some patients from southern institutions. There has also been a reduction in the number of medevacs that we’ve had to send out because they have been able to be seen at the mental health facility in Cambridge Bay, as an example.
I’m just going down the page here now. On page 2 of your opening comments, you talk about tobacco reduction, including the implementation of a reduction framework. What age groups do you target when you’re addressing this area?
We’re targeting all age groups.
How often does your department, who work in this area, go into the schools and work in the schools, and what kind of initiatives have you implemented?
The youth action teams have been established in several communities and are being promoted in all communities. The department’s health promotion specialist for schools is working with the schools, in the schools, and the Department of Education to integrate tobacco reduction into the curriculum, and other school programming.
Just one last question on the opening comments. When you talked about the Cambridge Bay facility for addictions treatment.
I know it’s a pilot project, but how well is that working so far? What can you tell us about that? I understand it’s early days.
The Cambridge Bay facility has been working quite well in the community.
Right now they have been able to bring some people back from out-of-territory into that facility.
So we repatriated some patients to the facility. They’re taking in in-patients. And also they have beds there, and are also taking in-patients.
I believe it’s doing well.
I thank the minister and her assistant who created an excellent opening address.
My first question relates to the opening address where it states that the Department of Health’s O&M will be increasing to $18.5 million compared to the previous year. Some of their responsibilities have been handed over to some other department. Why is there such a big increase in this of $18 million?
It’s in my opening statement so the increase is representative of the $6 million is for transportation of medical services and the $9 million was for out-of-territory hospital costs, and the other costs are for pharmaceutical supplies.
What we did have to hand over some responsibilities to the Department of Family Services. We used to be called Health and Social Services so we needed to hand over some of those responsibilities over to Family Services. Some of the funding went to Family Services.
More on the same page in the second part of the first page, I have a question in relation to the delivery of fostering of wellness in the communities, which is $6.1 million for Family Services. Is that for all the communities?
It is related to that particular program. One of the community wellness groups requested further funding relating to food and other things. This funding is for those kinds of community programs.
Mr. Mikkungwak (interpretation): Thank you very much, Mr. Chairman. Thank you for that answer.
At the bottom of the page, mental health and addictions, according to the way it’s written, it will be providing culturally appropriate wellness information to the tune of $1.7 million. Could they elaborate on the breakdown? What proportion of that $1.7 million will be directed for Inuit specific areas?
I will hand this over to my deputy minister. Thank you.
This $1.7 million is from the federal government. We have a funding agreement as to how it will be used.
The federal government specifies how they want the money they provide to us to be utilized.