EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
I would like to introduce my officials from the department. With me today I have Deputy Minister Colleen Stockley and Executive Director of Corporate Services Greg Babstock.
Mr. Chairman, the department has a number of capital projects planned to replace and renovate our aging health care facilities.
Currently 62 percent of the department’s community health centres are 20 years of age or older.
The construction of the new Arctic Bay Health Centre is on its last phase and is slated to be operational by 2017.
The community health centres in Sanikiluaq, Cape Dorset, and Qikiqtarjuaq have been identified for replacement after Arctic Bay is complete.
For 2017-18, Health is requesting $4.55 million for four capital projects.
The first capital project that requires continuing funding is the new Arctic Bay Community Health Centre.
The department is requesting $50,000 of capital funding for the closeout phase of this project.
The estimated total project cost is $27.7 million, including the detached five-plex staff housing unit that is currently being constructed by the Nunavut Housing Corporation and located next to the new health centre.
Mr. Chairman, ongoing planning and design for the new Sanikiluaq Community Health Centre is the second capital project that requires funding.
The department is presently looking to further enhance the design of new health centres to better meet the needs of the department and communities.
The department is requesting $1 million in capital funding for the design phase of the project.
The department anticipates a construction tender package will be issued late in the fall of 2017 to meet the summer 2018 sealift schedules.
In the coming fiscal years the department will be requesting an estimated $15 million in 2018-19 and $12.3 million in 2019-2020 for the first and second phases of construction.
The construction is expected to be completed by March 2020.
For the last two items in the capital plan, the department is requesting funding of $1.5 million for small capital and $2 million for ongoing lifecycle maintenance.
The small capital annual allocation is for the purchase and replacement of the department’s medical equipment, vehicles, and furniture.
I will provide you with a detailed listing of the equipment, vehicles, and furniture that we are planning to replace in 2017-18 once the list is finalized.
We have also set aside some contingency funding for emergency repairs during the winter months.
In closing, the department’s proposed capital plan for 2017-18 is in line with the Sivumut Abluqta Mandate of this government.
It is focused to ensure clinical facilities are available to Nunavummiut by replacing aging health care facilities, which provide essential services to Nunavummiut.
Mr. Chairman and committee, I thank you all for your support on these important projects and I welcome questions and comments from members.
I am pleased to provide opening comments on behalf of the Standing Committee on Government Estimates and Operations as the Committee of the Whole begins its consideration of the proposed 2017-18 Capital Estimates of the Department of Health.
Standing committee members note that the department’s proposed capital budget for 2017-18 is just over $4.5 million, which is the smallest capital budget requested by this department in a number of years.
The proposed capital estimates include funding for two infrastructure projects, one in its final stages, the new health centre in Arctic Bay, and one in its beginning stages, the design phase of the replacement health centre in the community of Sanikiluaq.
It is noted that the replacement health centre project that was planned to begin in Cape Dorset has been deferred due to potential power constraints while Cape Dorset’s high school replacement project gets underway.
Mr. Chairman, it has been noted that instead of including staff housing within the new health centre in Arctic Bay, a standalone five-plex housing unit is being constructed near the new community health centre.
Mr. Chairman, members of the standing committee were disappointed to note that the 2018-2022 five-year capital plan does not include any future projects to address pressing needs in the areas of mental health, rehabilitation, or elder care.
While members recognize that initiatives are underway to open additional long-term care beds in some communities, the committee encourages the minister to work with his staff to explore additional options in this area.
Members encourage the minister to work with his cabinet colleagues to develop a long-term infrastructure plan for providing care for our elders within Nunavut alongside programs, such as home care and the operation of assisted living facilities.
Mr. Chairman, the Department of Health’s proposed capital estimates also include two blocks of funding for minor capital and small capital projects.
In addition to the department’s current fleet of over 80 vehicles across the territory, the department’s small capital budget may include the purchase of new vehicles.
Committee members continue to have questions regarding policies and protocols governing the use of departmental vehicles for patient transportation and what types of situations are considered “medical emergencies” during which clients may be transported.
Information provided during the minister’s appearance before the committee did not clearly identify which items listed under small capital would be prioritized for purchase and, in some cases, whether items had already been purchased under the current fiscal year’s budget.
Mr. Chairman, the Department of Health’s capital budget includes a block of funding for ongoing lifecycle projects in its 2017-18 capital estimates.
Members fully support initiatives for purchasing specialized diagnostic equipment so that medical clients are not required to travel far away from home, often to other jurisdictions, in order to receive medical services.
While regular upgrading and replacement of medical equipment is certainly necessary, members raised some concerns with respect to the ongoing maintenance and repair of specialized equipment that is currently in use in community health centres.
Mr. Chairman, it has been noted that the use of the telehealth technology for service delivery across Nunavut has been a longstanding option for health care.
Members would appreciate an overview of how the telehealth system has been used since its installation as well as options that are being considered for expanding its potential as a diagnostic and treatment tool that could potentially reduce medical travel.
Mr. Chairman, that concludes my opening comments on the proposed 2017-18 Capital Estimates of the Department of Health.
The floor is now open for general comments. General comments.
Seeing none, we will now proceed to the page-by-page review of the departmental estimates starting on page H-3.
Health. Directorate. Total Capital Expenditures.
Mr. Mikkungwak: Thank you, Mr. Chairman. Welcome to the minister and officials. Good afternoon.
My first question here is, the three health centre projects recently completed in Repulse Bay, Arctic Bay, and Taloyoak were intended to be built using a common design as a cost-saving measure.
However, modifications to accommodate each project’s unique circumstances resulted in increased costs.
Will the new health centre projects for Sanikiluaq, Cape Dorset, and Qikiqtarjuaq also be based on a common design and, if so, how will you keep costs from increasing?
When we’re talking of common design when we’re building a health centre in any community, there are still some individual needs sometimes based upon the size of the community.
When we’re looking at a common design, there are certain elements of a health centre that are common.
It saves that process of the design work. There are still design expenditures or design costs associated with any type of infrastructure build.
Using the common design model reduces those costs; it doesn’t eliminate them.
It does have a factor of saving money than going back to a new design for every health centre in every community.
Housing for health centre staff has often been raised as an issue of concern.
Will new staff housing be built to accommodate staff at the new health centre in Sanikiluaq?
What specific factors led to the decision to proceed with the Sanikiluaq Health Centre Replacement Project in 2017-18?
Chairman: Minister Hickes.
It gives me a chance to clarify that the generation capacity of the community did not play a factor in that.
When we’re looking at the amount of construction that is going on in Cape Dorset specifically, which is what we intended to start with, there’s the Kenojuak Ashevak Cultural Centre being built, there’s a new school being built, and there’s a new power plant being built.
As a government, any time we’re looking at construction projects and developing infrastructure in communities, we want to make sure that we are able to utilize local labour content, as well as utilize local hotels, restaurants, and other components of the economy at a community level.
If we were to proceed with all of those projects at the same time in Cape Dorset, it was felt that the capacity of the community couldn’t be met with the needs of all of those projects going on simultaneously.
Therefore we went to the next project in line with regard to our priority list and that was Sanikiluaq.
I hope that explains that for the member.
What specific factors will determine when the department will proceed with the Qikiqtarjuaq Health Centre Replacement Project?
Whenever we’re looking at replacing infrastructure in the territory, it’s based upon priority of need first and the condition ratings of infrastructure.
When you go across the territory, like I had mentioned, over 60 percent of our health centres are over 20 years old. It’s not an easy endeavour to prioritize a need when the need is so great.
That being said, we do have limited infrastructure capital dollars as a territory and there are many competing interests.
Does that lessen the need?
No, but we do have to make sure that we take advantage of the knowledge from across the territory from all departments on all needs for Nunavummiut, not just health centres.
We do take that into consideration and we are working with the Department of Community and Government Services to replace these centres. Right now we are anticipating the Qikiqtarjuaq Health Centre to be completed by the year 2023.
I thank the minister for all the answers.
I know there are respective MLAs for these particular communities that I have been questioning, but I’m sort of leading to my community here.
Have any other communities been identified as requiring replacement or renovated health centres in the near future and, if so, which communities?
When we’re looking at replacing health centres, we’re just about complete with the project in Arctic Bay. Sanikiluaq, as mentioned in this budget request, is next in line with anticipation of Cape Dorset immediately after that and, like I just stated, with Qikiqtarjuaq after that one.
Right now, according to the list that we’ve got in priority replacement, the rest would be on the current capital planning cycle.
I’ll say in no particular order, but Baker Lake is one of the next three that are being anticipated in introducing to the capital planning process.
I guess his answer is sort of leading into my next question here.
I honestly believe, and if I do recall correctly, there was a study that was completed in 2004 at the Baker Lake Health Centre.
I’m fully aware there are not enough rooms for examinations and general services provided at the health centre due to the volume of traffic.
As I have made it very clear since I got elected, with an operating gold mine, forced growth, and whatnot, and with the influx of people within my community, it’s an unhealthy place to go to in my opinion.
There’s no space to move.
Even when we look at the two receptionists at our health centre, they’re in a very confined area and eye examinations are done in a hallway.
My next question here would be: will the department look at doing another study, either to renovate or enlarge the health centre in Baker Lake, and when would that occur?
Like I had mentioned with regard to the Baker Lake Health Centre specifically, it is outside of the capital planning process with regard to replacement, but it is very high on the priority list.
That would beg the question on the validity. If you’re looking at investing money into expanding a building, to me there is a need to replace it.
If we look at expanding, it may extend the lifecycle for a short period of time, but again with the limited infrastructure dollars that we have, we have to make sure that we’re spending the money properly.
I understand Baker Lake has grown dramatically in the last number of years and I applaud the staff for working in tight confines.
It’s a fairly common theme across the territory. We’ve got a lot of older buildings that were built without the anticipation of the population growth that has occurred across the territory.
Baker Lake is not alone in that circumstance and that’s why we’re endeavouring to build health centres as often and as frequently as we can get capital dollars to do it.
I’m not sure what else I can say.
I hear it very loud and clear that there are limited funds, so I guess that’s why I’m asking if there will be a feasibility study or planning study within the next year to determine if an expansion is more feasible or an entirely new community health centre should be constructed in Baker Lake.
I thank the member for bringing forward possible solutions.
When we do an evaluation of a facility along with Community and Government Services, we’re evaluating the lifespan of that type of infrastructure.
At this time for one, there’s no money allocated to a preplanning study on the Baker Lake facility, but like I had mentioned, it is ranked quite high on our replacement schedule.
I would question the need for doing a study such as that if we’re going to be replacing the facility in the fairly short term.
It depends on how you take that perspective of government lifecycles and capital cycles, but it’s not that far off on the horizon that we will be looking at Baker Lake.
I do understand there are limited funds and whatnot.
As the minister is fully aware, he has attended quite a number of federal counterpart meetings regarding infrastructure for aging health centres and possibly constructing new health centres or expanding.
How have those discussions been coming?
I still say I’m fairly new to the health file. I have participated in one provincial-territorial-federal meeting as recently as a couple of weeks ago and there were numerous discussions around the table.
Infrastructure didn’t come up as a specific topic, but I can assure the member that in sidebar discussions with the federal minister, I highlighted the need of our aging infrastructure and obviously she’s not able to commit to anything along those lines at this point.
Our Minister for Community and Government Services and our Premier continually lobby the federal government for infrastructure dollars.
I think we all recognize the infrastructure deficit that Nunavut exists in today. I think it’s getting more and more recognized across the country that to be able to provide services, specifically health services, is something that we have to address as aggressively as possible.
When we look at these preplanning dollars, is that sole sourced just from the government or is that a partnership with federal government funds?
I guess that will be my next question.
Those preplanning dollars go through Community and Government Services. I’ll speak to a generality, if I may.
I can’t speak to another department’s budget line, but when we’re looking at doing feasibility studies on health projects, for example, the feasibility study is done by, from what I anticipate most times, staff from Community and Government Services.
That may vary upon their capacity, availability, and the timelines associated with it.
As far as specific details on how that process works, it would probably be a question best asked of the Minister responsible for CGS Thank you.
When we’re looking at these health centres, the figures that we are currently looking at are new health centres, I believe.
I guess the next question is: when we look at enlarging a current health centre as opposed to renovating a current health centre, could the minister or the officials provide me with a ballpark figure of how much of a difference for those two particular items would be?
Mr. Chairman, when you’re talking of “hypotheticals” like that, it would have to again fall into the preplanning process of looking at comparables.
Again, when you’re dealing with facilities that are quite old in some communities, the actual value of renovating or putting an addition on to replacement, there are three very different scenarios.
On some you may, on a short term, be able to extend the lifespan of a building by five or maybe up to ten years in renovations. You’re dealing then with a new part of a building and then still have the existing building that may have any structural issues associated with that age.
When you’re looking at the value to dollar, in a lot of cases, with the state of a lot of the health centres that we have, it’s not worth to renovate or to put an addition on.
It’s much more economical to replace in most instances.
When we look at preplanning, I guess it’s pretty evident that I want a preplanning study for the community of Baker Lake to either replace it or enlarge it.
What process would our community have to do considering the fact that the current staff are in an extremely small nursing station and on top of that we have visiting doctors and additional professionals trying to work in that extremely small health centre for the size of my community?
That would be my next question.
I do understand where the member is trying to go with this.
Initially my concern would be, if we do a preplanning or feasibility study on something that we know needs replacing, what kind of value are we getting for that? In addition to that, then do we roll that out to every community that we know has a health centre more than 20 years old?
We know they need replacing at some point. When they were built, a lot of those facilities were built in an era where we didn’t have the energy efficiencies and the technologies of today’s where the O&M cost of maintaining facilities like that... .
If it’s something the member feels very strongly about, it’s something maybe he can propose in the next capital planning cycle to the Minister of Community and Government Services to add a project like that to the preplanning process, but as of now, that’s not in the current capital plan for us to be voting on today.
Mr. Mikkungwak: Thank you, Mr. Chairman. I thank the minister for his sound advice on that particular topic.
I’ll move on to something different here.
When we’re travelling as MLAs, I often come across this and I’m very aware that we have two regional health facilities, one in Rankin Inlet and one in Cambridge Bay.
The one that I come across quite often is the community of Rankin Inlet before I make it home.
I often come across a lot of medical travel clients coming from Winnipeg or vice versa going the other way.
A majority of them are elderly and some after having undergone surgery. Maybe this should be coming from my colleagues from Rankin Inlet to look after their other Kivalliq fellow people.
On the last trip I came across medical travel clients travelling from Baker Lake and Arviat and there was a major meeting occurring in Rankin Inlet. The plane was delayed and there were some weather issues, which I understand we really can’t control. Are there any considerations for a boarding home to be constructed within these two communities?
I guess initially I would like to preamble my response by thanking the member.
Through his own humility, he gave up his room for somebody who was stuck in that travel circumstance and I know he slept on a couch that night. I thank the member for looking after his constituents in such a selfless manner.
In response to the question, there has been a study of the need for boarding homes in Cambridge Bay and Rankin Inlet. That being said, the majority of the boarding homes that we utilize are contracted services.
When I spoke earlier of the need for infrastructure dollars, there are also economic development opportunities for third parties to take advantage of opportunities to either build or purchase or operate such facilities to be able to provide service to people that are travelling through regional hubs.
As of now, we don’t have anything like that on our capital planning cycle. It is a challenge. I understand that.
There are medical travel conditions and policies that are intended to alleviate people during medical travel. If they get stuck somewhere, there are hotel arrangements that are being made. If your stay is expected to be more than two hours, there are opportunities to get a day room through medical travel.
In a perfect world, if I had pot full of gold at the rainbow, I would love to build a boarding home in Rankin Inlet, but when you’re looking at the condition of our health centers across the territory, that’s not a contracted service that we can look at; boarding homes and structures of that nature are.
On my list of names...
...Mr. A. Sammurtok.
Mr. Alexander Sammurtok (interpretation): Thank you, Mr. Chairman. (interpretation ends) Has any consideration been given to having long-term care beds or palliative care beds in the Qikiqtani General Hospital or the Rankin Inlet Health Centre?
With regard to here in Iqaluit, there is a potential for two beds to be used for that purpose.
With regard to Rankin Inlet, I believe the member had asked me a question in question period last week.
When I did tour that facility, there are a lot of space restrictions.
Even when that facility was built way back when, I don’t think they totally projected the amount of use or what a hub Rankin Inlet would become. As of now, I’m not aware of any plans to transition any of those beds into long-term care beds.
When you’re doing preplanning, has there been any consideration for giving long-term care beds or palliative care beds for new health centres?
Hon. George Hickes: When we’re talking community health centres, they’re typically not staffed 24/7.
When you’re looking at adding palliative care or even long-term care, you’re looking at not only increased costs in different building codes when you’re having residential services provided in a health centre; there are also quite substantial staffing costs for putting limited beds.
We are still exploring different models right now. The responsibility for some of the long-term care services we are providing are through Family Services. In conjunction with that department, right now we’re doing an analysis of a perfect storm, I guess if you want to call it that, of what the proper size facility is for staffing requirements to be able to provide the best level of care for long-term residents, with some fiscal responsibility on identifying, in a perfect world, how much staff to how many beds to the size of the facility.
That review is ongoing right now. Myself, I’m very much looking forward to the results of that.
Your department’s 2015-16 capital estimates included a project to repurpose the former children’s group home in Rankin Inlet.
What is the current status of this project?
Hon. George Hickes: Thank you, Mr. Chairman. I thank the member for bringing that up.
In the proposed planning projects for 2017-18, the Department of Health has submitted a Rankin Inlet mental health transition facility.
When we looked at the existing facility, the cost to renovate exceeded... . Like I spoke earlier about when we were talking about getting value for our dollar, the results of that review were that it would be more economical to rebuild.
We’ve got that in our capital process under preplanning at this time.
As the minister and the rest of the members are well aware, I tabled a document in regard to having everybody, especially Health, look at it and consider it.
The cost would be even cheaper than renovating the old children’s group home.
I hope you had a serious talk about that.