EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
Minister, would you like to answer that?
The question that…. Nurses are able to. Both doctors and nurses are able to make decisions.
Was it directors of the regional departments? Would they be involved in any decision making?
Chairman (interpretation): Thank you. Ms. Brown.
Hon. Levinia Brown (interpretation): To my knowledge, no.
I’m just…. The point I’m trying to get on here is the experience factor when determining if a patient should be sent out on a medical evacuation.
Who is qualified to make that decision?
Is it a nurse?
An agency nurse comes up from down south, isn’t very experienced, does not know the north….
We have indeterminate nurses who are very experienced, know the communities, they know the north.
Is there a difference between those types of nurses, in terms of experience factor, in making the decision to send a person on a medical evacuation?
The nurses are able to make decisions on who has to go on emergency medivacs, and they do talk to doctors as well.
Chairman (interpretation): Thank you, Ms. Brown.
I asked this question the other day about the medical transportation centre.
Would the nurses and doctors have to go through the medical-travel centre before the decision was made to send a person down for a medical evacuation?
My deputy, Mr. Blais, will answer that question.
Chairman (interpretation): Mr. Blais.
The answer to that is, no.
Typically the decision to medevac a patient out-of-territory would be done at the local level by the nurse, or the doctor, or in consultation with a doctor.
The information, though, would be forwarded to the medical-travel centre to ensure that information is captured, as well as documented, so that we can maintain some form of statistics on the type of evacuation that is being performed, where they’re going, et cetera.
So, the decision rests with the local providers, basically.
I guess my concern is that you had to get a $10 million increase in the main estimates last year through a supplementary appropriation; your projections last year were incorrect.
For this year, your projections are at level with what the revised estimates were, and I’m wondering if you have sufficient controls in place to keep your transportation costs down or to control medical evacuation decisions.
This medical-travel centre initiative: is that going to save money?
We know that your department has had a 100 percent increase since 1999.
A lot of it is due to transportation costs.
That is something that we have to keep an eye on.
Chairman: I’m sure they’re doing their best to keep an eye on that figure, because sometimes we don’t know when there is a medevac coming or going.
It’s beyond the control of the health department.
Some people have to go on medevacs and some people don’t need to go, so it’s really out of their department’s control.
It is as the need arises.
Do you want to answer that?
The funding that you’re talking about…. Yes, there were a lot of medevacs last year, and it is beyond our control.
We cannot tell people not to be sick so that we can have more funding.
It is beyond our control and we do have to have emergency medical services.
With a lot of illnesses it is very very difficult, when viruses are spreading within the community.
Chairman (interpretation): Do you have any further questions?
I’m not disputing that we have to provide the best medical services that we can to our folks up here.
A lot of medevacs are authorized where the patient probably doesn’t need to be medevaced, and the cost of an average medevac can range between $12,000 to $18,000.
If you do that enough times…. That is why we’re up to $35 million and I think overall, Mr. Blais said the other day, $71 million.
That is a lot of medical travel.
If it keeps increasing at those exponential levels, in health, we’re going to have a serious problem on our hands within a couple of years.
So, we have to find any way possible to keep the costs down, especially for travel.
If that means that the nurses and doctors have to consult with each other to make sure that a medical evacuation is definitely required, then I think that’s how you’ll have to look at it.
Any responses?
I would like to thank my colleague for bringing these issues forward.
Mr. Peterson, any further questions?
Compensation and benefits: could you outline for us what the difference is between an agency nurse and a regular nurse?
What are the average costs for an agency nurse versus Nunavut having their own indeterminate nurses being placed in Nunavut?
I will direct this question to Eric Whitworth.
Chairman (interpretation): Mr. Whitworth.
Mr. Whitworth: Thank you, Mr. Chairman.
It is talking about a wide variety of analysis on the difference between indeterminate employees and agency nurses, and we have, I think, been fairly successful in the last six months to bring the costs of agency nurses down. In some cases there are certain agencies that the cost is very similar to our indeterminate nurses.
Our goal, naturally, is to fill all of our vacancies so that we are not dependent on southern providers.
Chairman: Thank you, Mr. Whitworth.
Any more, Mr. Peterson?
Could you give us a dollar figure?
What is the difference? What would be the average cost to retain an agency nurse in Nunavut, versus a regular nurse, at one of the health centres?
Mr. Whitworth.
In total, the average cost for an indeterminate nurse is approximately $100,000 a year; for an agency cost, it is costing us approximately $185,000.
It was costing us approximately $185,000 a year if you annualize our cost.
If you want to get specific on hourly rates, the hourly rates for an indeterminate is approximately $50 an hour, with benefits, and an agency nurse on average is costing us somewhere around…. It is down now to an average of about $70 an hour.
I should have been a doctor.
Recently, the Northwest Territories and Nunavut Nurses Association held a meeting here, and one of the things I read was that a lot of the nurses that come up to Nunavut are recruited but don’t know the full benefits or effects that they will be working for.
They do not know what environment they are going to be working in, and then, of course, it results in a high turnover.
What is the department of health doing to address that kind of turnover?
On the issue of retention, we are doing a lot of things currently.
We just completed a three-day workshop several weeks ago where we have identified a number of areas where we think we can improve the kinds of things that you have mentioned.
At the same time, we are looking at the retention side because our focus in Nunavut so far has been on recruitment.
We have done a pretty good job on recruiting; we have not done a great job of retention.
So, our focus in the next year would be to pay attention to how we can improve the retention of nurses and other health professionals in the fields.
It stands to reason that the health and social services department, on its own, cannot achieve that objective.
It requires the participation of communities, when people are coming into their communities. It requires the best support of hamlets or other organizations like the RCMP to ensure that we welcome staff into our communities. But also, when they are here, that we address their needs, that we provide the appropriate information about the communities that they are going into.
So, part of the movement that we have now: we have a retention and recruitment committee of 26 people.
Half of the committee members are made up of front-line staff, that is nurses, social workers, x-ray technicians.
Again, they are participating in trying to improve in those areas that were mentioned earlier, as well as trying to develop stategies to involve communities more in the retention aspect.
Last but not least, all the research that has been written over the last ten years for the case that it is really a community issue.
Communities have to be involved in the retention of health professionals.
I think this is where I think we have not done as great a job as maybe other provinces and territories.
So, that is our focus for the next year.
I am wondering, does the department have a formula that they use, or some mechanism to determine how many nurses should be in each community in Nunavut?
For example, Cambridge Bay: should there be four nurses there at all times, or should there be six, based on population?
Is there a formula that you guys utilize to help them make that decision?
I am not aware that there is a formula in Nunavut.
I know that there are formulas for hospitals and for various parts of Canada.
The basis on which we are operating currently, it has been historical more than anything else.
The funding formula, a formula for the ratio of health professionals, cannot only be based on nurses.
It also depends on the staff mix, whatever professionals are in that community, social workers, mental-health workers, or psychiatric nurses.
So, funding formulas can only be achieved up to a certain goal, but you always have to consider the total compliment of health professionals within the community.
If a community only has two nurses and one is on vacation or helping a patient on a medical evacuation, would there be a nurse that would come in and cover while those nurses are out of town?
Is there a mechanism you use to apply?
The mechanism normally that we have: we have some staff that are basically on call.
We also have…. Again, we use a lot of agency nurses in two of the three regions currently, to the order of about $6.5 million a year.
At this point in time, there is a minimum threshold that, typically, a health centre can operate at, regardless of the size.
We use agency nurses that are currently the primary support structure for relief.
Would there ever be a situation where a nursing centre, a health centre in a community would not have a nurse on duty?
Do they ever occur?
You are absolutely sure there are nurses there to treat the patients?
Chairman: Thank you, Mr. Peterson. Mr. Blais.
I don’t think anyone could ever provide that kind of guarantee, regardless.
The fact is that sometimes, when we do have outbreaks, and we have had serious outbreaks in many of our communities, we have come close to not being able to provide that service.
I can recall a time this winter where we flew a charter from Winnipeg with nurses and doctors; they were not able to land twice.
We can see where that is a possibility, and I guess this would be something that would be unpredictable or unusual.
For the most part, I think we tend to do very well.
It is not something that I am aware has occurred since I have been here.
We tend to be able to predict fairly accurately. But, in the event of a significant crisis, or anything of that nature in winter conditions, I would presume that would be a possibility, but that, again, is a hypothetical situation.
Mr Peterson.
Mr. Peterson: No more questions, Mr. Chairman.
Mr. Evyagotailak (interpretation): Thank you, Mr. Chairman.
I want to address the Minister of Health and Social Services.
I remember in Kugluktuk, in regards to medevacs, I remember one patient was supposed to arrive who did not have an escort.
This person who did not have an escort had problems on his own.
This person was on his own, and the spouse, who wanted to go on the medevac as an escort, wasn’t approved.
I would think that the $35 million is not too much when these patients, who request escorts, have to go.
Why is it that some of these patients don’t require escorts?
The next day when it comes to paying the bills there should be some funds aside to use for escorts.
I’m just helping out what Keith had to say.
Chairman (interpretation): If you could respond, Mr. Blais.
We feel very much for the patients who have to be sent out on emergency cases. But, there are different circumstances, and they do use different types of aircrafts.
So, there is a lot of factoring in there.
The patient has to have a room, and very likely they don’t have escorts to come with them because of a lack of room, or if the nurse is required to escort the patients.
And if there was an approval for an individual to have an escort, then they would be flown out the next day, if they were approved by the nurse or by the medical professionals.
It is taken by case by case and the different circumstances.
Chairman (interpretation): Mr. Evyagotailak.
Mr. Evyagotailak (interpretation): Thank you.
I think it could be very useful for you for the patients to have escorts, as I know the Lear Jets on the medevac do have rooms for escorts at times.
That’s all, thank you, Mr. Chairman.
I have a question regarding the social workers.
They have a very heavy responsibility, and the minister is well aware of that.
It seems today that they have taken on more additional responsibilities than they did 10 or 20 years ago.
Usually they deal with social issues, family counselling, youth and underage offenders.
They have a very heavy caseload that they have to deal with, and we are well aware of that.
In Rankin Inlet I heard an elder make a speech to hamlet council in regards to the concerns he or she had about young parents splitting up, and the children being taken into custody by social services. And, the concern that this elder had was that they were not using the elders as counsellors because, of course, it falls under the responsibility of the department of health’s social workers.
I believe that you can use the elders as counsellors.
If you look at the Department of Justice, for example, they have elders justice committees.
Is it possible for the department to return the services of these elders and to use them as counsellors?
We have to use the elders more, because they can help.
We cannot just rely on the legislations, and the regulations, and lawyers, and so on.
We cannot just focus on the southern techniques anymore.  We have to retain the services of the elders who are more than willing to provide the types of these services that will be required by your department.
Are you receptive to that idea?
That is a very excellent question, and it will definitely have to be considered by your department.
That is a very good comment made by the member because the elders are very helpful and they are very important.
I think, as the Department of Health and Social Services we feel that the elders have to have a place in our department or any other department.
We have to consider it because the elders are being more utilized by some departments.
So, we will look into it, and I will talk with my staff, and we will seriously think about the question that the member has….
And I thank the minister for the comment, and I would like to…. Because, the elders cry themselves when they are trying to help out the young children.
What we have to do is we have to try to give more love to the people that are hurt emotionally.
We have to have Nunavut ideas implemented into the departments of the government.
I know that this will be appreciated if we could start helping the elders or hiring elders to help out in some departments.
My question is that some children are adopted. They were too young, then they go out and get their child adopted.
Is that the work of the social workers?
We have people that are, when we are looking at adoptions, basically focused on that particular issue, and we have a director for adoptions as well, in the department.
Mr. Curley (interpretation): Yes, there was legislation that was…. I think it was the adoption law that was just legislated a while ago.
Is there…. I think there is an adoption commissioner.
I am not exactly sure how they operate.
Are they appointed by the department, or how are they chosen?
Who wants to answer?
Hon. Levinia Brown (interpretation): Yes, I am sorry, I did not see the light.
Yes, I feel that is way off, because there was custom adoption in place.
I’m not quite sure how to respond to that because I’m not quite sure how the system works right now.
Perhaps, if I could try to get the information for the member, and after I get some information I could have a better response.
The deputy minister said that there is a director in place for…. I heard a while ago that there is an adoptions commissioner in place, or a position in the community.
Are they working to comply with Inuit customs, and who appoints that commissioner, and how are they paid, too?
Not just for myself, but for the rest of the members, and the public could get some information.
Perhaps my deputy could respond to that.
I am not very familiar with this particular area but I know that typically, there are 38 adoptions commissioners.
Currently there are only 23 positions filled, and I believe they are working on filling the balance of that.
How they are appointed, or how they are paid, I can’t provide a good answer to that in this point in time.
Members have to get more information on the adoption commissioner and how they appoint him or her.
The minister should be making a minister’s statement on that.
Apparently, I heard that this individual was not paid.
I can’t divulge any names, but when there is an adoption, and the individual looks after this adoption, whether it might be one or two or three children, then they get paid per adoption.
If I was a commissioner of adoptions, I would try to get so many adoptions done.
I don’t think this payment system is adequate.
I heard that the payment is very, very small, just like in a quota system.
I don’t want it done that way.
If you don’t answer my question right now, it would be okay, but if you could make a minister’s statement or get us more information from your officials….
The commissioner was the person that wrote to me personally.
I think you understand what I’m talking about.
So, please consider that.
Would you like to respond to Mr. Curley’s question?
I will get some more information on the adoption commissioner.
As far as I know, the adoption commissioner, if she gets an adoption done, gets a $100 payment for one adoption.
I think there are nine in the Nunavut region that are adoption commissioners. I will get my deputy to elaborate on that.
Mr. Blais: Basically, it’s correct what the minister has just stated, that we do have 23 custom adoptions commissioners in Nunavut.
Currently there are nine appointments pending.
They’re paid for every custom adoption the commissioner completes. They’re paid $100 by the director of adoptions.
The piece that I’m not aware of is who appoints the commissioners.
And, I guess this is a part of what we’ll have to find out for the member.
Mr. Curley (interpretation): Yes, I would like to thank the deputy minister and the minister. But, I would like the government to consider if that individual, the adoptions commissioner, is paid only $100 per, I think they should look at the salary again.
Not to pay them sort of like a quota system, but the payment should be made in a different way.
The member is directing the department to look into that adoption commissioner.
Mr. Alagalak (interpretation): Thank you, Chairman.
Last year, Health Canada did some work on the diabetes study.
At this time there is no more money in this budget, but there was money for it last year in the amount of $102,000.
I suppose that they must know by now that there is something that should be done about it.
As far as I know, Health Canada did a study on this, and they went to the communities to consult them or to do surveys.
Have they found out the information, or has the funding run out from Health Canada, or has the Nunavut government received $102,000 at that time?
Has the study been done already? Is that why there is no more funding for that?
Chairman: Thank you, Mr. Alagalak.
I’m not sure exactly what stage the funding is at right now.
Perhaps I could respond by saying that I have to look into that information as to what the funding is going to be.
As soon as I find the information, I can respond back to the member on the study of diabetes in the north.
I think this is a very important thing. They have to find out that there would be some assistance for the Inuit people that never had diabetes before, and there is a whole lot of them are starting to get diabetes.
You hear about them every day.
The information that Health Canada did, we have to also read the information.
So, I will await the response from the minister.
If there are any reports on that study that was done on diabetes, perhaps if we can get the information as well.
My other question is on the same page.
In regards to contaminants, there was some funding available to the health department for contaminants. It was $100,000 in that contaminants program.
I know that there are a lot of contaminants in the north.
When they identify those contaminants in the community, they have to send it out to make sure that it’s not dangerous to your health.
I think there was some funding last year for contaminants, and there is none left for the coming year.
I will get Mr. Blais to respond to that question.
Mr. Blais: This was one-time funding we received from INAC last year.
Like many of the funding that we do receive, it doesn’t necessarily carry over from year to year.
I guess this is one of these times when it hasn’t done so.
Mr. Alagalak (interpretation): I would like to state again that if INAC only gives you a one-time, did you ask for more funding after that?
After the funding ran out?
I am sure that you will be seeking some money from them.
Mr. Blais: One thing I can say, Mr. Chairman, is that we’ve just finished the year as it relates to this area funding for the department, and I believe that the department is looking at submitting for additional resources for next year.
It takes a while for these types of projects to confirmed, sometimes three to four months.
So, at this point in time, I can say that the funding is finished for last year, but we can only hope that next year there will be some additional funding coming our way.
We are working on that at this point in time.
Health and social service branch and treatment programs, and the total operation and maintenance is $84,598,000.
Chairman (interpretation): Do you have any questions on H-12?
Health and social service department summary.
Total, operations and maintenance: $182,244,000.
I would like to thank you, Minister Brown, and your officials.
Yes, I would like to say thank you very much, and I have learned a lot these past couple of weeks, and I will try my best to have a good working relationship with everybody.
I appreciate my deputy, Mr. Bernie Blais.
I appreciate them very much.
And to my left, Eric Whitworth.
I appreciate you very much. And also, Victor Tootoo, our assistant deputy minister, I would like to thank him as well.
I am very comfortable with my staff, and I will be learning from them, because I am representing Nunavummiut and I will do my best.
Of course, this is very important to me because we have to have…. I cannot say we will be using less money because health issues are very important.
Once again, I would like to thank you very much.
Chairman (interpretation): Thank you for your patience.
James Arreak, would you like to Chair the Committee of the Whole for the next department.
Chairman (Mr. Arreak): Thank you.
Do you want to proceed with community and government services.
Chairman (interpretation): I would like to ask the Minister of Community and Government Services to do his opening comments.
I am delighted to be here today to address questions about the 2004-05 main estimates for the Department of Community and Government Services.
(Interpretation ends.) Community and Government Services was created to better serve the needs of Nunavummiut, communities, and departments within the Government of Nunavut.
We are building on the history and strengths of the two former departments.
We have kept “Inuit Qaujimajatuqangit” and the Inuit Employment Plan as strong considerations in the reorganization of the department and have protected jobs with no layoffs.
Community and Government Services has a budget of just under $133 million and staff in six regional and decentralized offices, including Iqaluit.
Their responsibilities impact the day-to-day activities of Nunavut communities and other departments within the Government of Nunavut.
Funding emphasis has been placed in those areas where the need is greatest.
I am pleased to say that even in this time of financial restraint, the impact on programs and contributions has been minimal.