EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
I would suggest that we introduce $75 per adults but I believe for children, before it was all encompassing and when you look at that, usually there will always be two people, either an escort or an individual.
I would suggest that it be introduced for adults only at this time until we can hopefully resolve this with Health Canada.
That’s what I would propose.
I’m sure the people out there will be happy to hear that.
My next question and I don’t know what kind of response I’m going to get but would they consider putting that rate retroactively to October 11, when it was changed by Health Canada.
My understanding is I don’t know if people were informed of this when the change happened.
The people I talked to were not aware that it had changed.
I’m just wondering if that’s something that would they commit to looking at that and seeing what the amounts would be and see if it’s something that is workable for the department.
The public was informed about that because there was a pamphlet that was in there with the billet cheque.
It was with the billet cheque.
I guess this kind of information was given out in 2004.
If it was given out once at the time of the change but if someone never took anyone in as a billet from before that change until sometime after, then they wouldn’t know.
That’s the point that I’m making.
I can appreciate the effort that the minister has indicated the department made to try and make people aware of the change but there were people out there that were not aware of the change and they didn’t find out until after.
So, again, I would just like to ask the minister if they would commit to taking a look at going back on that retro and if it is something that is feasible for the department to look at doing that.
I will get my Deputy Minister, Mr. Blais to respond to those questions.
We will take a look at this issue and do our best.
I’m not sure what the logistics are to reinstate this retro but we will certainly explore that and make every effort to address that and we will advise our minister and it will be her final decision on that.
I appreciate that and like I said, I asked if they would look at it.
I don’t know if it’s something that can be done or not.
I just want to reaffirm what I heard here today that the department would be reinstating the $75 fee for adults, effective today.
The minister will be reporting back to the members on the logistics to see if they can go back on that.
Hon. Levinia Brown (interpretation): Thank you and I will give the microphone over to Mr. Blais.
Mr. Blais: I would certainly love to do it as effective as of today.
I think what we would like to do is make sure that we have to go back and do I think a fair amount of work to reinstitute those rates.
So I would think that we will need at least a week or two to have that in effect.
Having said that, if we can do the retro, we will try and achieve that as well, but I would only commit to maybe, possibly within the next two weeks, to have that in full force.
We also have to notify the clients so that there’s the communication that has to be reinstituted as well.
We will be ringing the bell.
We can now resume.
I appreciate the logistical work to it, but I appreciate the commitment given by the minister and her staff on this, and we will probably, tomorrow, be giving notice of motion for that motion to give Health Canada a wake-up call that it costs a little bit more to live up here than it does to live in Southern Canada, and that needs to be recognized.
My next question here is under Contract Services that there’s a significant increase over the 2004/05 amounts, but the amount is similar to the one from the 2003/04 actuals.
I am just wondering if the minister or her staff can give us an explanation as to why that is and what Contract Services those are for.
In regards to the contract services, they were mainly for the nurses and the agency nurses that were utilized by our department.
Mr. Whitworth will be supplementing my response.
Chairman (interpretation): Thank you. Mr. Whitworth.
The change in the contracts mainly with two areas like the minister had said, the nursing agencies, we had finally recognized what they had cost us and adjusted the budget accordingly, and the second part was the new physician, we had received $3 million dollars in additional funding for the new physician and that was the main cost, between those two approximate cost were approximately $6 million.
How much of that was for agency nurses?
It was approximately $2.8 million increase.
That $2.8 million increase would bring the total out of the 17 to what?
Mr. Whitworth: Could you ask the member to repeat his question I didn’t hear his question, I though he just made a statement.
Mr. Tootoo: Mr. Chairman I was wondering with that $2.8 million increase over the previous years, what’s the total that’s been spent on agency nurses.
Mr. Chairman (interpretation): Mr. Whitworth.
Mr. Whitworth: The actually budget that we have in for this fiscal year is $4.2 or $4.3 million.
When these agency nurses come to the north to work, do they have to pay any portion of their travel?
Do they get a separate meal allowance?
Do they get accommodations provided to them?
Do they have to pay for any of that?
With the transportation, the transportations paid for by the department, but they pay for there meals.
I didn’t get the rest of the question, so I’ll give it to Mr. Whitworth.
What we’ve tried to do with agency nurses is to liken them to a Government of Nunavut employee if we hired an indeterminate or a casual staff.
So we try to treat them the same, because since I’ve come to the department, it’s been an issue which we’ve had dealings with the Union on the same issue with concerns, we’ve met with them and shown them, and documented to them that it’s not quite the case.
We have had brought the agency nurse usage and the benefit right in line with the Government of Nunavut employees as close as we can get them.
I think, I know that there is some money in the budget to try and attract a whole bunch of more nurses to Nunavut.
I think as long as there is this inequity, and I realize a lot of times these agency nurses are brought in when were in a bind, and we don’t have anyone.
But as long as there is an inequity there, if I was a nurse, I would rather stay as an agency nurse instead of becoming an indeterminate nurse working for the government because I can pick and choose where I want to go, for how long, and get flown out and back.
So I think this is something the department needs to take a look at, if it really wants to try and maintain stable and increase our health professionals, health care providers, especially nurses within Nunavut.
I’ll have Mr. Blais respond to the question.
I certainly have strong sentiments about agency nurses.
First of all whenever we have any type of temporary worker, on an ongoing basis that is not good quality of care.
That is not what any hospital or any jurisdiction would prefer.
For that reason when you look at the efforts being put right now to recruit up to a 100 nurses, internationally, I think the purpose is to try and achieve a more stable environment and reduce our dependency on out of territory nurses.
That is the objective.
That is what we are working on.
In that regard I believe that we have extended over 30 job offers, currently.
That will probably grow to above 50 within the next month or two.
Our objective is to hire nurses that will stay and live in Nunavut and to reduce our dependency.
That is about as short as an answer that I can provide at this time.
Mr. Tootoo, your time limit is over.
We are on Treatment Programs.
Mr. Kattuk: I have a little bit of a preamble.
As Sanikiluarmiut I still feel like we are in the 1950s because I remember when TB was on, I was concerned that time that there were patients that had to go out of the hospital and they just then have no seats in the airline, or something like that.
Also when you had to travel home they were put in cargo, cargo boxes or just lie down on the cargo boxes.
No seats.
I felt the same thing up to today; we are in the 21st century.
The reason why I am saying that our community is growing we have about 800 people in the community and there is more than one case who is at Winnipeg or Churchill by medivac or medical charter.
So my concern is that it also if I had questions also when you have a half an hour appointment with the doctor and then you had to wait at least a week, before you go home, so just for a half an hour appointment.
It gets tiring sometimes when you have to wait a week in a boarding home and your appointment was done five days ago.
So it is not sky services that we need as for Sanikiluarmiut.
My question is, are you looking at better services for my community so that we don’t have to wait that long in the boarding home.
Are you looking at providing more services to my community?
I will have Mr. Blais respond to that question.
I can certainly sympathize with the member’s comments because I have heard quite a few times similar problems from other communities as well.
Currently, we have a task group in place. We are currently renegotiating all of our contracts for out-of-territory service.
So the answer to your question is yes.
We are trying to improve the level of service to all of the communities or those traveling outside of the territory.
Also, we are looking at trying to arrange the appointments so people don’t have to stay five days in the boarding home as soon as their appointments are finished.
Hopefully the next day, they are traveling back to their community where possible.
We are also in the process of recruiting eight more physicians for the territory right now.
So, many of these appointments, if we had more family physicians, could be done here in Nunavut for a traveling family physician.
So there are series of initiatives over the next year or two that we will be putting in place to address many of the concerns you have expressed.
Mr. Kattuk: Yes also, when they are released from hospitals, when you talk with the travel agent in the boarding home, they say it’s already full and you are on the next flight.
That might be another five days, so that takes a long time.
Also, the airlines, I am scared of flying because when you fly there’s nowhere to go.
You can go anywhere when you are on the ground, but up in the air, there’s nowhere to go.
So single-engines, makes me worry when I am flying in a single-engine going back, not back, but engine doesn’t break, also the pilot can get sick and we don’t know when we will get sick or there were some times when the pilot is alone and when I fly with single-engine.
So are you looking at a better, I mean some people liked it, but myself, I am scared of flying in a single-engine, so what’s your situation looking at the airlines itself?
Are you looking at twin-engines or is it still with the single-engines?
Also, it’s small, especially with those disabled people.
We have 800 people in community, and of course we do have certain people in community and they have to go out regularly to hospitals.
So sometimes I think those people, they are not comfortable in the small planes.
So are we looking at bigger airplanes or airlines?
I would like this to be responded correctly, and adequately.
As he stated that he was scared, and I am quite sensitive to that.
I will get Mr. Blais to respond to his question. (interpretation ends) Yes, that will be twelve times, Mr. Peterson, I caught your message.
The Sanikiluaq medical charter flights have just been negotiated recently.
So all I can say is that we will have to look into this as to whether or not we could look at if there’s a possibility for us to have larger planes flying into that community.
So I know that we sent out a RFP recently, and based on what was submitted, we basically, I know I have awarded a contract or it a three-year, I know that it’s a three-year contract, is it?
So all I can say is that we will review with the provider, the people that have been given the contract, to see if we can make any changes at all.
That’s the best we can do at this point in time.
I would like to thank him for that answer.
In any way can I help with your negotiations, or is it done.
Yes, of course, if you would like to be involved, it’s your community and your constituency, it’s better to have the member involved with the officials who are dealing with the contracts.
It’s much better to have the member involved.
I’ll have Mr. Blais respond.
It is our hope to go Sanikiluaq very shortly in the next month or two.
So we’ll have an opportunity to talk more about this when we are there.
We will also follow up with the current provider who has been awarded the contract to see what can be done and hopefully at that time we’ll be able to provide you with more information.
I would like to touch on the issue of social workers.
I noticed in the past when social workers have to go out for holidays there is no replacement and nobody comes to the community to replace that person who has gone on holidays.
I’m glad about what has been done in the community.
When the social workers get in the community, in the local TV there is, if you any concerns or social concerns to go see that person.
They may not be qualified social workers that that person is told to see before she gets back to the community.
I’m glad that there is always somebody but sometimes people are uncomfortable with certain people or, I cannot word it now because when you have to see an RCMP for social concerns, it’s not comfortable for some people because on the local channel it says if you have a concern and want to see a social worker, you can go to the RCMP and talk to them about your problems.
Isn’t there a policy that social workers have to have certain qualifications to do social work?
Yes, I’m very glad that you have informed us of all these issues.
I would like this to be responded to adequately, so I’ll have Mr. Blais respond.
When I started about 21 months ago, one of the first things that I looked at was the whole issue of social work and why we were having so many difficulties at that time.
It was obvious that we had serious vacancies in all regions.
Since that time I know we’ve made significant progress and our hope is that in the foreseeable future to be able to have social workers to send as replacements when the communities when they on holidays.
So we can have a replacement type of strategy...
The second piece of the question is what is the qualification of social workers.
There are at least four categories of social workers and each of them requiring a certain level of knowledge, training and education.
When they are recruited they are recruited within those categories.
Mr. Kattuk (interpretation): I am finished.
I thank the minister again and her officials.
While we are on Treatment Programs I would just like to thank the minister for treating me the other night during the hockey game and it was very good treatment at that.
I went up to the Hospital here and had excellent treatment up there by the receiving nurse and the doctor.
They stitched my up very well and gave me a tetanus shot, so I am good for another ten years.
It is very reassuring to know that they have nurses and doctors who can provide emergency medical services.
I just wanted to follow upon the excellent lines of questions from my colleagues.
In particular, I am interested in Medical Transportation Centre concept that Mr. Blais has been talking about for the last year.
It was mentioned in the KPMG Medical Transportation Review Report.
I understand that there is an RFP going out this year.
I am wondering if Mr. Blais could give us a sense of where he thinks that Centre will be located.
What is the staff compliment will be and the types of hours that we’ll be seeing it operate?
As it relates to the location, I think looking at the technology requirements of this type of Medical Travel Centre.
Hopefully, in the RFP we will be seeking advice of those submitting proposals to ensure that they identify communities where they feel the support structures are in place to accommodate the kind of service that we will be expecting.
I don’t have a view on where that location might be, but I do know in looking at the some of the requirements that were identified in the KPMG Report, plus also the work that has been done by my staff to identify what’s required to run a very efficient, timely call centre.
It would be very difficult for me at this point to identify which community would be able to provide that level of support and infrastructure.
So it is going to be really dependent on that, where the location would be and prioritize to some extent.
So at this point I don’t have an answer to that other than I do have concerns in regards to the infrastructure capacity required.
That will have to be met by those submitting those proposals.
As far as the operations, I believe that we would be running a 24 hour, seven days a week service.
During the peak periods, we would certainly have more staff in the call centre; in the off hours we would have minimal staff to mostly coordinate medivacs and those kinds of services.
It is our hope as well, when we put in the call centre, that we will also have in place, because call centres have peaks and valleys, I am a paramedic by trade, so I am very familiar with this area of what we are trying to achieve anyway, that we would hope that we could put in also what I call a quality review process that would allow us to interview or direct the successful company to ensure that they interview maybe 10 percent of all clients who have experienced medical travel.
That would probably be done by phone, at least that’s my intent at this point in time for Nunavutmiut.
The second piece of that is that the people who provide the care to ensure that they are satisfied that when they do call the call centre that they have a quick response and everything is done and get their opinion.
Also the referral centres.
When we talked about patients getting lost and boarding homes, this would be another way that we could get all three major providers, including airlines, and get enough input so we could begin to make those changes and then process improvements that are required.
I would venture, based on my experience in other jurisdictions, then in the space of two or three years we would have I think a remarkable system.
So this is the intent, at least this is the vision that we are looking at right now.
I was reading on page 27 the KPMG report where the authors said managing the medical travel program requires a strict set of skills and expertise of the program is both complex and costly.
I recall that you met with the hamlet council in Cambridge Bay, and then you were at the KIA AGM in Kugluktuk last fall, and somewhere where you provided some figures.
You said there’s 20,00 airline tickets that your department issues every year, and 60,000 patient nights, I forgot, I didn’t catch the number of patients and escorts that you are dealing with, so I am thinking that’s a lot of people and tickets, and patient nights to handle.
And then you have three regions, you have to deal with three times zones, you have multiple boarding homes, you have hotels/motels you have to deal with, the hospitals, and you have airlines and charter companies.
So that comment that the authors made seems to start making sense.
You sound very optimistic at it within three years, but are you being overly optimist or do you really, truly believe that this is something that’s possible in Nunavut?
Chairman (interpretation): Thank you. Minister Brown.
I would like to try and respond to some of that.
Of course, in Nunavut, we have no choice of our medical services.
Sometimes we do have to go south for different things and different treatments and diagnostics.
However, in the Northwest Territories days, when it was Government of the Northwest Territories, we were totally ignored simply because when you come to equality at the west, how many hospitals did they have there?
They had maybe perhaps four, maybe perhaps five, but when you went to the east, how many did we have, there was none to compare except for this 52 year old hospital here in Iqaluit.
So by stating that, I am saying that we were neglected here in the east and in the central Arctic in those years.
It’s no wonder that the costs are escalating because the population is growing as well, and the 20,000 tickets that I mentioned, I think it’s fair to say that people, no matter who they are, they have to be treated.
If they have to go south to be treated, that’s the arrangement that we have with medical hospitals, with the medical people and the doctors do the referring.
And a lot of times, we are accused in Nunavut that we cost too much, but it’s not our fault that all of the money is flowing south, we just simply have no choice for Health and Social Services.
For example, we have absolutely no choice but to have a lot of surgeries being done in the south.
It costs a lot of money to have a bed down there per day.
They charge an enormous amount, but anyway before I go further, I think Mr. Blais can further add to this statement.
Before I conclude this statement, I would like to say that yes, I did apply a bandage to Mr. Keith Peterson on the night of the hockey, but then anybody can apply a bandage, it was just a simple, not even a procedure, but it was a simple thing to do and I thought it was right to go down and get a couple of bandages because he was playing hockey.
Chairman: Thank you. Mr. Blais.
I am very confident about the need for a Medical Travel Centre, and I am also confident that we can build a travel centre in Nunavut or contract it out, either way, and provide a much better service than what we provide now.
I just want to say as well that we do provide a good service currently.
It’s amazing that we can manage 23,000 airline tickets a year at 67,000 boarding home days.
That’s equivalent of hotel days, and that’s not counting private billets, and people who stay in homes in some of the communities.
So it’s quite a large number, and in total when we look at, we spend between out of territory care, which we pay the hospital and specialist and medical travel, in last year was $71 million, so the need for medical travel can not be more obvious any where in the country then Nunavut.
I think we have the capability and the possibility of putting that in place within the year, so again, we’re on target, January of next year is we hope that we can add that in place.
The other thing is that the medical travel center is key to achieving closer to home, it’s not just for medical travel, because if we want to look at using our new facilities in Nunavut, for example in Cambridge Bay regional health center, and Rankin, we have to begin how to manage the flow of patients to and from different communities and our current system really does not lend itself well into doing that.
And if we want to maximize the option to train people in Nunavut, to provide those services, I think the medical travel is the center piece or the pivotal point by which that will be achieved.
So, it’s medical travel outside of territory, but it’s about developing capacity in Nunavut, and using the medical travel to insure that occurs and any savings or resources can be redirected to areas like training and development.
I believe it’s quite achievable.
Madam Minister and Mr. Blais, I agree with you, if we could control cost and travel we can put funds back into medical treatment and programs and provide care closer to home.
I truly hope that it’s achievable within a year or two.
That leads me to another question I have, it’s been bothering me for a year, and it’s troubled my constituents, it’s the patient tracking aspect of the whole medical transportation. It’s where the patient heads south and they miss appointments, or the escorts go astray and the patient is left somewhere, and they don’t know how to get around at the airport or find a taxi, all that sort of stuff.
It causes a lot of stress and strain and additional grief for them, particular the elders.