EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
We actually just started this project in the fall and we’re running full bore.  As the minister has indicated, we actually have a consultant on site now.
She’s got, I think, about 30 or 40 years experience on this. So in my view, she is the right person.
Definitely, to start bending the cost curve, as the minister said, we need to start getting the information together. I guess the thing that we realized in doing this is we have tied in both the health management information system project and the electronic health record project that are managed with two different project leads into a steering committee that I chair. I was going to say something else; I have lost my train of thought on that.
So I would hope that by the latter part of this fiscal year, early in the next fiscal year, we will start producing some reports. We’re going to test drive some of them for a bit and that should then start helping us making good, sound financial decisions, but also get clinical decisions in terms of where we need dedicated resources. This also would help us somewhat in our case with the feds as well.
So it’s a fairly ambitious program and like I said, we’re very much in the early stages of this.
On page 91 of the business plan, in one of the priorities for 2012-13, so we’re coming up to the last month of that fiscal year, one of the bullets on page 91 was “Begin to phase in implementation for the Office of the Auditor General cost-recovery recommendations.” The status was that “The department has begun implementing these recommendations. Processes and procedures have been developed to ensure the department is able to bill third party insurers, including NIHB and other jurisdictions.”
I’m wondering if we could get an update on what has happened with that priority over the past year, whether the government has been successful in collecting more of the third party money that’s out there and not necessarily being brought back to the territories.
Hopefully that might mean, when the Minister of Finance comes before us, that the supp might be smaller than what it should be.
I thank Mr. Elliott for his question and comment. As most Members of this House can appreciate, it’s not an easy job to be the Minister of Finance and then be the Minister of Health and Social Services.
The Minister of Finance is concerned about where the funding is coming from and we’re always trying to encourage departments to manage their appropriated funds properly so that we can report back to the House.
As I indicated in my opening comments, we’re coming back soon with another supp bill for additional funding. I have been pressing the department very hard on being more diligent in drilling down, as I call it when I’m talking to them, to find out what’s driving the costs. A lot of the costs are demand-driven.
People have to be medevaced or there’s medical travel. We have to get people to the appropriate medical facilities. There is that.
With respect to the Office of the Auditor General’s report, we are working on that. Part of what we’re doing is, as Mr. Ma had commented, we have this lady who is working with us on this program to help us identify costs.
So we’re hoping to shortly be in a position to review it. The interoperable health record is also going to help us.
We are, of course, continuing to stress throughout the department and across Nunavut the importance for all of our managers or anybody who is making decisions on funding to be cognizant of our policies and be very careful with respect to spending public money unnecessarily. There is an element of prudence coming into the Department of Health.
It’s demand-driven, but we recognize that there is only so much funding available. We have to, as the expression goes, “stretch our dollars.”
Chairman (interpretation): Thank you, Minister Peterson. (interpretation ends) Mr. Elliott, your time is up. I’ll move on to the next person.
I just have a couple of very quick questions.
Mr. Chairman, where all of the communities where the populations are growing every year, I would like to know what process or criteria the Department of Health uses to determine the number of nurses required in any given community and how often each community’s needs are reviewed.
Hon. Keith Peterson: Thank you, Mr. Chairman. I thank Mr. Rumbolt for his question.
With respect to the nurses, again it gets down to having good information on the community and this is where some of the work that this lady is doing for us will help and also the health records.
I think they believe the current ratio is one nurse per 300 in population in the community.
We try to keep it in that range. That’s when the ratio gets a little out of whack. One nurse to 400, we would certainly be really serious about getting another nurse into the community.
That’s what we’re doing through the main estimates. We are trying to get approval for three nurses in the communities. Thank you, Mr. Chairman.
Chairman (interpretation): Thank you, Minister Peterson. Mr. Rumbolt.
Mr. Rumbolt: Thank you, Mr. Chairman. I would like to thank the minister and his officials for their responses.
In your opening comments, you mentioned that there was $600,000 to increase the staffing compliment of community health nurses of three-nurse stations to four-nurse stations in three communities in the Kivalliq region. Can you update us today which communities will be getting the additional nurse?
The three communities are Coral Harbour, Repulse Bay, and Sanikiluaq.
Chairman (interpretation): Thank you, Minister Peterson. (interpretation ends) Mr. Rumbolt, you make me feel great with that question.
I have no further questions. Thank you.
Mr. Ningark: Thank you, Mr. Chairman. I need your guidance here. I wanted to ask about Nunavut nursing recruitment and retention.
I would like to know which summary, H-4 or H-5, because both summaries’ introductions are very similar in nature. I need your guidance, please.
Chairman (interpretation): Thank you, Mr. Ningark. (interpretation ends) You can proceed with the question that you want to ask as it is part of the branch. (interpretation) Thank you. Mr. Ningark.
In the minister’s opening comments, he talked about the Nunavut Nursing Recruitment and Retention Strategy.
In my reply at that particular time, I indicated to you, I believe, that I wanted to ask about our reliance on agency nurses.
I’m wondering if the Nunavut Nursing Recruitment and Retention Strategy will be looking at how we can retain and recruit nurses from Nunavut and reduce the dependency on agency nurses that we hire from the south.
Hon. Keith Peterson: Thank you, Mr Chairman.
The Nunavut Nursing Recruitment and Retention Strategy was intended to assist us to decrease our dependency on agency nurses. In the early years, it appeared to be having some impact in reducing the reliance.
In fact, in 2011, we were down to a little over $5 million, but now we’re turning back up again. In 2013, we’re over $10 million for the cost. Casual nurses have gone up in the corresponding time.
We are analyzing the information that we have available on that to see what the issue is there.
We are hoping that we can continue to recruit indeterminate nurses, but it seems to be a bit of a trend where indeterminate nurses will… .
I don’t know what the phrase would be, but they will want to become casual nurses because casual nurses get more travel in and out of their communities. There seems to be fewer benefits for indeterminate nurses. So we are looking at that to see what the concerns are of indeterminate nurses.
Obviously, if we can recruit and retain indeterminate nurses, then we would have a lesser dependency on agency nurses and casual nurses in Nunavut.
At the same time, across Canada, there continues to be a shortage of nurses, so we are in a very competitive environment for nurses. We have to compete with other jurisdictions.
Nurses can, to a large degree, pick and choose where they want to go. That’s why we have this Nunavut Nursing Recruitment and Retention Strategy.
We are completing a review and the deputy minister can update Member Ningark, if he wishes, on the strategy and the review that we’re undertaking or nearing completion.
If there are additional questions, then we can try to answer them.
Mr. Ningark
Now I can see there are some improvements within the Department of Health, especially in the area of public health.
Now, in the minister’s opening remarks, he talked about possible revisions to the Nunavut Nursing Recruitment and Retention [Strategy]. What is wrong with the current Nunavut Nursing Recruitment and Retention [Strategy]?
Do we need to change it or amend it in order to work for our needs within the jurisdiction?
As the Minister of Health and Social Services, I have been quite concerned for the last year about the increasing costs for nursing in Nunavut; indeterminate nurses, agency nurses, and casual nurses. As I indicated in my earlier answer to Mr. Ningark, although the strategy had an initial positive influence on the use of agency nurses, the trend in the last couple of years is an increase.
We have indeterminate nurses who all want to become casual nurses.
My deputy minister has felt my wrath a few times over the last seven or eight months about the cost.
I know it’s not sustainable. So he’s completing a review.
I have asked him just a few seconds ago here if he could comment and I asked him to be perfectly blunt with the Committee of the Whole.
Mr. Chairman, if you will allow me, I would like to have Deputy Minister Ma to respond in detail to Mr. Ningark’s question.
Chairman (interpretation): Thank you, Minister Peterson. (interpretation ends) Actually, I was kind of looking for consensus from Mr. Ningark. However, I do appreciate your request.
Mr. Ma, I will allow you to add.  Mr. Ma: Thank you, Mr. Chairman.
This is now reminding me of my Finance days where I was asked to be brutally frank and lay it out the way it is.
By way of background, the Nunavut Nursing Recruitment and Retention Strategy was something that was brought forward in the Second Assembly. I might have the dates wrong, but it’s around 2007 to 2008. It was a five-year strategy which expires in about 27 days, I think it is.
So as a result of that, we did a review this year.
We struck a group of working officials. They have made their recommendations to me in a report. I have not looked at the report.
However, having said that, I can comment on very specific things, without seeing the report, that have impacted our ability to roll out the strategy as successfully, I think, as people would have hoped. One of the ambitions at the time, and this is just the way it worked out, was that whatever the strategy cost us within government, it would be funded with savings in other areas.
Quite honestly, that never transpired.
If you look at the minister’s opening comments, I think he alludes to the fact, but maybe it’s somewhere else. Yes, I think it is in his opening comments. He alludes to the fact that we’re asking for $1 million in this year’s budget to cover off existing shortfalls in the Nunavut Nursing Recruitment and Retention Strategy.
So that is a fund right there that has not worked out as well because we obviously didn’t achieve those cost savings.
Second of all, he mentioned the fact that we’re in direct competition with other jurisdictions in Canada for a limited pool of nurses that are getting long in the ears and I have to be careful because I’m getting long in the ears as well.
My colleagues and I spent quite a bit of time in Toronto in December talking about this impending change in the workforce.
We also now are in the period of opportunity, the way I see it.
We have a new collective agreement with the Nunavut Employees Union.
We can discuss things that we wouldn’t be able to talk about before because we were in what’s called a “statutory freeze.”
For example, the ministers talked quite a bit about nurses that are becoming part time.
One of the things a lot of nurses have indicated to us is job sharing.
We’ve had some initial discussions both with the union and our colleagues at the Department of Human Resources.
We obviously have to change our existing Human Resources Manual to accommodate some of these changes that we want to move forward on.
Other things that we’re looking at are changes in the work hours and obviously, that requires a discussion with the union.
For example, there’s no reason that says we have to be open from nine to five.
In fact, I would say society has changed even here in Nunavut and maybe we should be open from seven to seven.
I don’t know, but those are discussions that we can have.
That allows our nurses some flex time. It allows our clients the opportunity to come in at a time more suitable for them as well.
Maybe we will open through the lunch hour as well. So those are some of the things that we’re talking about.
We know that the package between agency nurses, casuals, and determinates is a bit out of whack right now; we need to bring that in line.
So that’s just to give you a flavour of what we’re looking at. Not to say that the original strategy was flawed, it just didn’t turn out the way that people had hoped.
So this is a good time for us to step back and say, “Okay, what can we do that’s better, that’s actually going to make this work?”
I should maybe end by saying that about one-third of our workforce is nurses, so this is critical in terms of how successful we are in terms of our fiscal viability within the department.
So it’s a bit of a long-winded answer, Mr. Chairman, but hopefully that gives Member Ningark some flavour of what we’re working on.
Mr. Ningark: Thank you, Mr. Chairman. I thank the minister. Through the hon. minister, I thank his deputy for the answer.
Now, once the strategy is drafted and implemented, I’m wondering if there is a possibility we can hope for a further increase in training for health care professionals, especially community nurses, within the near future.
Chairman (interpretation): Thank you, Mr. Ningark. Minister Peterson.
Mr. Chairman, health training is always a high priority within our department. Of course, we support and encourage nursing students, whether they’re in Nunavut or at an institution in the south for training.
Of course, we would welcome them to come back and go work for the Government of Nunavut because there is a good chance that they will live within the communities of Nunavut.
Training is always a top priority, whether it’s for nurses or other health professionals in Nunavut. Even in our management ranks, we’re offering health management training type programs with an organization called Red River College.
There’s health administration. So it’s not just about the health practitioners; it’s also about offering training to our health administrators throughout Nunavut. Thank you, Mr. Chairman.
Chairman (interpretation): Thank you, Minister Peterson. Mr. Ningark.
Mr. Ningark: Again I would like to thank the hon. minister through you, Mr. Chairman.
As a politician, I believe in our graduates, whether different careers are pursued through different channels and different opportunities. I know that it’s hard to retain the trainees when they graduate. So long as they find a job placement, whether here in the territory, in the NWT, Yukon, or wherever within the public sector, I think we’re doing pretty well.
It’s just a comment. Thank you.
Chairman (interpretation): Thank you, Mr. Ningark. I didn’t hear a question.
I have no other names on my list for H-4. (interpretation ends) Health. Branch Summary. (interpretation) We’re under Directorate.
Mr. Enook (interpretation): Thank you, Mr. Chairman. This was a question I asked earlier about billing. I would like direction from you, Mr. Chairman, if I can proceed with that question.
Chairman (interpretation): Mr. Enook, you have an opportunity to ask your question since you had your hand up. You may proceed if your question is under Directorate.
I made reference earlier and I’m sure that your department knows about it. It’s with regard to prescription pills or prescribed equipment that are no longer required by the patients.
I was talking about checks and balances earlier. For example, I’m always prescribed some pills and I don’t require those anymore. If I brought them back to the nursing station, what happens now?
Are they kept in the pharmacy or the health centre? Are they kept for some other purpose or for another client who requires those prescription pills?
Hon. Keith Peterson: Thank you, Chairman.
I’ve had conversations with the assistant deputy minister on exactly that issue and I would like her to provide the information that Mr. Enook is seeking.
In trying to answer the question, there could be two parts to that.
When there is a prescription that is provided to a client and it is filled at the health centre, they would be filling what they think is the need of the client. So you might fill a two-week or one-month supply, then the question is: if the client feels better and does not feel the need to complete that prescription for some reason, what happens to the remaining pills?
I think the health centres would be asking those clients to bring them back and they would destroy them.
It’s not good practice for people to keep unused and/or later outdated prescriptions in their homes. There is a service that drugstores would provide in that regard to bring in old medication.
If you are thinking about the ordering that the health centres do, we provide an inventory of drugs that are commonly prescribed and they’re held within a secure cupboard within the pharmacy or within the health centre, and then distributed based on the dosage of the prescription provided.
Mr. Enook (interpretation): No, maybe I wasn’t clear enough and I apologize.
Maybe it was me.
What I was trying to say, just as an example, is if I went to the pharmacy in Iqaluit here and I was given a prescription by a doctor, I would bring those pills to the health centre when I no longer required them. I would tell the nurse that my doctor told me that I don’t require these anymore and I haven’t even opened the vial.
What happens to those unused prescription pills?
Do they become part of the inventory of the health centre or are they returned to either of the two pharmacies here in Iqaluit?
Practice would tell you that any prescription that has gone out to a person would not be returned and put into an inventory.
If they were no longer needed, they should be taken and just destroyed. There would be no putting it back into the supply.
If the pharmacy keeps sending me up to four prescriptions and I haven’t needed them for a long time, the government just keeps paying for those unused pills that are being put in the garbage, Mr. Chairman.
That would be a question for the physician that is prescribing those, but why would the physician continue to prescribe medication that a client no longer needs? That would be the issue that we would want to address.
Thank you for your response. Trust me, it does happen.
We use a lot of money for those types of incidents.
I could have a one-on-one discussion with you on that.
If you would give me direction, Mr. Chairman, I have questions about health centre visits in the communities.
Your questions would be under Treatment if you’re talking about health centre visits.
Mr. Enook: Thank you, Mr. Chairman. (interpretation) That’s it for now.
On page 92 of the business plan in the priorities for 2013-14, one of the bullets is to “Develop and implement a Patient Relations process to assist in responding to and resolving complaints related to health care delivery.” Is there an individual who is spearheading this initiative or is it a branch within your department?
There are a number of people involved in this initiative. I’m not sure how I can respond to it.
The Department of Health and Social Services has made a number of attempts over the last several years to address the complaints process.
Obviously, the system that was put in place four years ago didn’t achieve the desired results. I know my predecessor and now I have received a lot of complaints as ministers directly. Of course, I have to redirect them to my deputy and they end up getting redirected within the department.
To address that, we thought we would call it a patient relations process, where we would put an individual right in the department with headquarters who would coordinate and it would just be the patient first.
We do have two individuals already working in the complaints area, but we’re identifying another individual to oversee it all and make sure that complaints, either to me or to the level that they come in to us, are identified and that the patient or individual who is initiating a complaint or concern will be contacted and they will track that issue or concern right through to completion.
Mr. Elliott: Thank you, Mr. Chairman. Do you anticipate that the transfer of the Social Services Division to the Department of Family Services will allow for improved budget management in 2013-14 and, if so, why?
Yes, I think that the government had responded to a question last week where the health department can focus on the health-related issues, acute care and primary care in all of the hospital and health centres in Nunavut.
If you have another department focusing primarily on the social service issues, they would have their own official, they would have their own corporate services, go through the budgetary processes, and they would have the controls in place.
I think the tendency in the health department right now, as I have recognized in the last year and a half in talking to my officials, is that sometimes the social services component of health is overshadowed by the health issues.
So if we have that focus, then we can make those priorities and we will be able to stay on top of the costs a little bit better, foster care payments or residential facility contracts, better coordination of negotiating the rates or fees that we pay out on residential care contracts.
Again, I think the travel will be a lot better. If it’s in that one department, we can have a centralized negotiating or contracting and procurement side that can look after a number of those areas.
I anticipate that there would be savings that will come from that.
Again, with the splitting of the two departments, we will have the Department of Health and we will have the Department of Family Services as of April 1. Since this is the directorate which is working on making sure there is a smooth transition with the separation of the two departments, I’m curious to find out if the minister could explain how the transition is going.
In speaking to some frontline workers, I know they’re a little concerned about and again, they have very specific questions in terms of capital and where their office is going to be and where they will actually be working out of as of April 1.
So if the minister could maybe explain today how the directorate is rolling out the separation of the two departments so that we can have a better understanding of how it’s… . Is there an implementation plan or is it set up in stages?
Mr. Chairman, when I reflect back on the Second Assembly, oftentimes we would sit and have our spring, winter, and fall sittings and oftentimes after sittings were concluded, we would be on our way home, only to get back to our ridings to find out that the government had restructured and they would do it over a weekend.
I might be fast-tracking a little bit, but it seemed like that.
There was no planning.
A new department would be created out of nowhere sort of thing, a new name, different things would be moved around, and that’s how things were done to a large degree.
In this government, we initiated and we’ve had a rather long process.
We have consulted with many people, government officials, some MLAs, ministers, and officials over the last year or year and a half. We have initiated some of the recommendations last summer.
With respect to the health department carving out a small component of the department, I think 68 positions are primarily the social services component.