EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
For example, the department continues to base its proposed budget for compensation and benefits as if all of its positions were filled on a full-time basis.
However, on average, over 30 percent of Health and Social Services staff positions are consistently vacant.
As the year progresses, contractors such as agency nurses are hired to work in positions which remain vacant, which in turn requires significant transfers within the budget from compensation and benefits to contracted services.
In some instances, actual costs have exceeded budgeted amounts which then lead to over-expenditures.
Practices such as this should be discouraged.
The standing committee encourages the department in its efforts to improve its budget planning process.
At the same time, it recognizes that a number of factors pose a challenge to successful budget planning, such as growth in the population, the rising costs of goods and services, and increased expectations from clients as well as unforeseen expenditures relating to health situations such as the recent H1N1 outbreak.
Mr. Chairman, staffing has been a continuous challenge for the Department of Health and Social Services.
The standing committee appreciates the efforts of the many Health and Social Services staff who end up doing the work of two or more people.
The standing committee is of the view that a more rigorous approach should be taken to determine service delivery models within the department and to allocate resources accordingly.
The department’s business plan does list a number of important strategies, such as the Public Health Strategy, Mental Health Strategy, Tobacco Reduction Strategy, and other initiatives which will focus resources on specific areas, such as maternal health, addictions, and health promotion.
However, the standing committee recommends that the minister work with his staff to develop an overarching strategic plan for the department as a whole.
Mr. Chairman, the standing committee has noted that a number of GN departments have shared or overlapping responsibilities which can lead to time-consuming, costly, and at times, confusing duplication of services.
For example, both the departments of Health and Social Services and Justice play a role in addressing domestic violence and situations of abuse.
The Department of Health and Social Services has developed its policy for family violence shelters whereas the Department of Justice continues its implementation of the Family Abuse Intervention Act.
Members encourage the minister to work with his colleague, the Minister of Justice, to ensure that such efforts are fully coordinated.
At the same time, the Department of Executive and Intergovernmental Affairs is proposing to focus on social safety net issues while social services delivery falls specifically under the mandate of the Department of Health and Social Services.
Committee members continue to have concerns that policies, initiatives, and programs directed towards vulnerable groups in Nunavut society are not well coordinated.
The committee encourages the minister to work closely with his colleagues, especially the Minister of Executive and Intergovernmental Affairs, on initiatives relating to children, families, and other socially vulnerable groups.
Mr. Chairman, as you will recall, following the October 2009 Full Caucus gathering, Members of the Legislative Assembly committed to developing new child and family services legislation as one of the key initiatives of this Assembly.
Members will be closely monitoring the development of this legislation.
Standing committee members have heard a number of concerns from constituents with respect to the practice of placing children in care outside of the territory, far away from their families and culture.
Concerns have also been noted with respect to adoption policies and procedures.
Mr. Chairman, following the dissolution of the divisional health boards, community health committees, called committees of council, were established under municipal authorities and funded by the Government of Nunavut.
These community-based committees of council can play an important role in promoting health and wellness.
However, for many such committees, their mandates remain unclear and there is a lack of guidance, support, and monitoring for their activities.
In addition, current levels of funding for such committees and the initiatives that they may wish to undertake remain limited. The standing committee encourages the minister in his efforts to strengthen the role of these committees.
Mr. Chairman, committee members recognize that a key element of success in the implementation and delivery of health programs is the incorporation and inclusion of Inuit culture and language.
This applies not only in the areas of terminology and programming but also in the training, recruitment, and retention of Inuit into the health professions.
Members are aware that significant funding for entry level courses such as the college foundation courses has been provided through the Territorial Health System Sustainability Initiative.
Members were pleased to note that the federal government has temporarily extended this funding for the next two years.
Mr. Chairman, the committee recognizes that social workers in Nunavut require a broad range of training and experience, as well as a certain level of cultural awareness and sensitivity.
The department has faced some difficulties in recruiting individuals who meet these criteria. Members urge the department to work with Nunavut Arctic College to support the appropriate training and qualification of Nunavummiut to work in these areas.
Nunavut Arctic College’s Nursing Program has seen some success in graduating nurses to date. The standing committee was pleased to note that the minister and his officials have given some consideration to implementing measures such as return of service contracts to ensure that Nunavut-trained nurses will work in the territory after their graduation.
Mr. Chairman, standing committee members continue to express concerns with a number of the department’s policies and practices and the inconsistent manner in which they appear to be implemented. Constituents continue to have problems with medical travel and accommodation.
It is not always clear to our residents what eligibility criteria are applied to travel, escorts, and accommodation. In addition, the families of Nunavut residents who are required to go out of the territory to receive medical services that are not available in Nunavut have expressed concerns over the lack of support and the level of stress faced by individuals so far from their home and culture while receiving care.
The standing committee is aware that the Department of Executive and Intergovernmental Affairs is reviewing a number of programs, including those related to supplementary health benefits, and looks forward to reviewing the results of this initiative.
Mr. Chairman, the standing committee supports departmental programs which focus on specific social health issues that are of concern across Nunavut, including nutrition issues, such as diabetes, fetal alcohol spectrum disorders, and sexual health, as well as programs to monitor and control the spread of communicable diseases such as tuberculosis or viral outbreaks such as H1N1.
Members were pleased with Nunavut’s overall response to the national threat of an H1N1 pandemic and congratulate the minister and his staff for the success in addressing this issue proactively.
Members would be interested in receiving a report of the final accounting of costs related to addressing exposure to the H1N1 virus across Nunavut as well as lessons learned from a broader pandemic preparedness perspective.
Mr. Chairman, the high cost of living in Nunavut’s communities is frequently demonstrated by the comparative prices for nutritious foods.
Committee members would be pleased to receive further details on departmental initiatives relating to specific nutrition issues, such as sodium or trans-fats.
Last year, the federal government released two reports concerning the Food Mail Program and has indicated it will continue to fund and review the program.
In December of 2009, the Premier tabled a copy of the Government of Nunavut’s response to those recommendations and members were pleased to note the government’s position on this issue.
Mr. Chairman, the committee recognizes the department’s ongoing need to invest in electronic health information systems for data collection, case management, and evaluation.
Members encourage the department to use these systems to analyze and communicate trends in the health status of our population to address specific health issues across the territory.
Members further urge the department to use the collected information to analyze and determine high cost areas in the delivery of health services and maximize the efficient use of our resources given the limited funds that we have.
Mr. Chairman, as I noted at the beginning of my comments, the standing committee is concerned that the proposed budget for the Department of Health and Social Services for 2010-11, which represents over one-fifth of the Government of Nunavut’s total operations and maintenance budget, will not be adequate.
The committee encourages the minister to continue in his efforts to improve financial management within his department and to take the necessary steps to control expenditures.
At the same time, Mr. Chairman, the standing committee is of the view that the federal government bears an important fiduciary responsibility to the people of Nunavut.
The standing committee was very pleased to note that the federal government has announced that it will be temporarily extending funding for the Territorial Health System Sustainability Initiative for another two years.
However, members urge the minister not to rest in his efforts to access additional and sustained federal funding for health and social services across Nunavut. The committee stands ready to support the minister in his efforts in this area.
I suggest to the members that wherever possible you ask your detailed questions during the page-by-page review of departmental estimates.
I would like to thank the minister for his opening comments. I would also like to thank the Chair. I think I called you Mr. Speaker earlier.
With respect to the community health committees, I believe that they fall under the mandate of hamlet councils.
The minister has stated that he would like to devolve more powers to the health committees so they may take on more social services and has expressed desire for his department to work more closely with them. I thank the minister for this. I hope this is realized now that we expect it to happen.
Referring back to the hon. minister’s opening comments on page 2, the last paragraph in English, (interpretation ends) “Every individual has a role to play in their own health and well-being.
And every community has a role to play in the health and well-being of its residents.
Community involvement in identifying and addressing health needs is crucial.”
We all agree.
“Community health committees are a key partner to my department’s success and we will work harder to strengthen, empower and further rely on their knowledge to guide our program development and service delivery.” (interpretation) I hope that this is realized while under the current minister, who I knew before he became the minister and who I regard as friend.
Mr. Curley used to say that when you go to a health centre, they just give you Tylenol and tell you to call in the morning.
The nurses have nothing but good intentions and are trying to help the patients as best as they can.
However, I have heard more than once and I’m sure that my colleagues have also been made aware about patients who have gone to the health centre thinking they need medical attention but told that they are well enough and in good health, only to find out later that they’re suffering from some terminal illness when it’s too late to do anything.
I know that there is commitment to address this as it says on page 2, the department is asking for our help as it serves us. Perhaps there is a need for better diagnostic equipment and techniques to catch these cases, especially cancer. If health centres in the communities of Nunavut were better equipped with diagnostic means, then this issue could be addressed properly.
The nurses would like to provide better service and the patients deserve that, but perhaps there are problems in communications because the patients sometimes feel that their needs aren’t being addressed properly.
I thank the minister for seeking solutions to these issues.
I also received two letters from my constituents and I have them here with me, although I’m not going to read them out. They both speak to the issues of medical care. I will provide copies to the minister at the end of this session.
I want copies of these letters sent to the proper complaint process, but I don’t know who to contact.
I apologize, Mr. Chairman, I received these letters very recently and I wanted to bring them up with the proper authorities. I would also like to speak to the minister personally on the matter.
I have no further comments to make in my statement. I wish to thank the minister and express my constituents and my support for him. These patients are seeking help when they go to the health centre and some of them for serious medical reasons.
During the page-by-page review, I will have further comments to make as they arise.
I don’t see any question there, so we will move to the next one. Mr. Arvaluk, please.
I thank Minister Curley for his opening comments.
Though you brought up most of the important and pressing issues, I would like to comment on your statement, especially the language on page 2, in the last three paragraphs, 3, 4, and 5.
I would like more recognition of the difficulties faced in trying to quit smoking.
I, fortunately, finally succeeded in quitting smoking, and that will be a year next month.
I found out recently that I have problems with my liver and I should have known better all along.
We don’t worry about such things in our youth but as we get older and have been smoking for 40 years like I have, we realize that things are bad for our bodies.
We were never informed about such risks.
We have always known as Inuit, we gather berries, leaves, roots, etcetera, so that our natural diet is good for our bodies.
However, we didn’t know that some of the store-bought food was unhealthy and that the stores don’t care at all but would rather make money. That is their purpose, to make money.
Many clearly know that some foods should not be processed that way, such as potato chips, Coke, and others that are extremely unhealthy, that cause tooth decay and many serious threats such as diabetes.
The makers of these products know of these things, but the products make such huge profits, so they keep marketing such products.
It is clear that these kinds of products are bad for our health.
Those of us who went to residential schools were taught that certain foods are bad for our health.
Along with the introduction of schools here, these products became available to us. Our parents, who knew nothing of any of this, readily adopted store-bought foods, which their children seem to prefer over traditional foods.
Upon my return from residential school, I started working. It was shocking to find younger Inuit children starting to lose their teeth and obesity was becoming a problem.
We, the older ones, still had all our teeth. What was abnormal was that the younger children were losing their teeth when it was only the elderly prone to this problem.
When these older folk were younger, they ate only healthy food and they never had obesity problems even though they ate plenty.
We fully support your efforts on reduction of tobacco use, as you state on page 2, but we would also like to see support for those who live in our communities to be able to make and afford healthy choices.
There is a spacious co-op warehouse in Pond Inlet.
Half of that warehouse is filled with junk food, such as pop and chips, and even before the next sealift season, all of it will be bought and consumed.
Pond Inlet has a small population of about 1,400, but they seem to prefer junk food since they are not aware of more nutritional alternatives.
I know that you said that people should have some responsibility for their health and that it is up to them to make healthy choices, but some people really don’t know that junk food is bad for their health.
We, especially you as the minister, must educate the public about healthy food choices and nutritional contents of food available in stores; information that we already know here.
Perhaps we could do this through an adult education program.
There have been home economics classes held in the past.
This approach could be used to teach nutrition to the public, to teach cooking, which foods are good for your physical and mental health. There are still people out there who don’t understand why their children are always so hyperactive when they themselves give junk food to the children to keep them from crying. Some parents don’t see the connection between hyperactivity and junk food.
We need to educate the public about the causes and effects of sugar.
Another brief comment I would like to make is concerning your opening statements on page 4, under Compensation and Benefits.
I understand that for the year 2010-11, $6.9 million will be spent on this budget item.
I understand that this is as per the agreement that was reached, but I also read from the committee report that you will have to use up 100 percent of these funds to qualify again for the next budget cycle. I would like this reviewed and changed.
In addition, under bullets 2, 3, and 4, especially bullets 2 and 4, there is an expectation from the public to see something done about TB patients who were sent down south to sanatoriums, especially children who were sent outside of Nunavut to Winnipeg and other major centres, and who came back having lost the ability to speak Inuktitut.
They came back strangers to their customs and families and having lost their taste for traditional foods.
I am very pleased to see that the department wants to do a comprehensive review of their child and family services.
Inuit children will hopefully not have to go outside of Nunavut when they can stay in Nunavut when help is available and wherever possible, send Inuit children to other Inuit communities.
I am very pleased and grateful for your opening comments.
Once we start the page-by-page review, I am sure we will all have a lot to say. I would like to thank the committee chairman for his opening comments. I would also like to thank John Ningark and Mr. Arvaluk for their clearly stated comments.
With respect to John Ningark’s question, I know that we will have opportunities for in-depth discussions as we work through the review, but yes, we would like to work closely with community health committees and I know that we have much work ahead of us.
We have devolved some of the responsibilities to the hamlet councils who have established these community health committees.
I would like to say that we are cognizant of the facts referred to in Mr. Arvaluk’s comments regarding nutrition and healthy living.
I believe that we can work closely together on this to reduce preventable health problems like these so that our nurses, who are always very busy, can focus on other pressing issues.
Alex Campbell and I are continuing to work on this issue. This coming year and up to April 1, we will be providing you with regular updates on our progress.
Arvaluk’s comments are taken to heart because we know we need more public education initiatives.
With respect to aboriginal health, I would also like to point out that there is additional funding from the federal government. Perhaps some of this funding can be used directly by health committees and we will look into that.
I understand now from James Arvaluk’s comments where some of the funding could go. Sometimes we have to wait a while for those programs’ dollars to actualize.
With respect to the funding process, I can tell you that annually, the budget process, and I think Arvaluk knows how the process works, takes a whole year to work through the cycle. Although we request for the largest funding, we don’t always get what we ask for.
Last year, in our proposal, we asked for more than what the actual budget line says. However, we have to allocate and share some of the funding with other departments. The funding is inadequate as it now stands.
We are forced to haggle and negotiate this particular $6.9 million for employee salary increases. All told, this translates to about a 5 percent increase for the entire public service starting on April 1.
We were told that this funding will not be disbursed all at once. In fact, the contribution agreement provided $4.5 million, but $2.4 million will have to come from my department at the expense of other programs and services. These are other increases elsewhere for sure.
I will conclude my remarks for now and as we go through the page-by-page review, Mr. Chairman, I am sure further questions will arise. Thank you.
I will just let you inform the members that we should be just asking direct questions on the opening comments. We have lots of time to go through page-by-page and come up with other questions. I only have one more member on my list, Mr. Elliott, and then we will go page-by-page on general comments.
My comments are sort of directed towards page 3 of the minister’s opening comments in the second paragraph where he said, “Mr. Chairman, the 2010-11 operations and maintenance budget for the department is the result of tough decisions during which the department had to balance financial reality with the health and social service needs of Nunavummiut.”
I just know in the past, the Department of Health and Social Services has repeatedly overspent its budget. Almost every year, supplemental appropriations have been brought forward.
From the statements made in Minister Peterson’s Budget Address, it sounds like with the H1N1, I guess the government’s reaction to that is there is going to be another supplement for that.
Your proposed budget for 2010-11 is significantly less than the revised budget for 2009-2010.
With what you are saying, do you think that the budget for 2010-11 is realistic?
I appreciate the question. I think that all of the members know that the health department is one of the most difficult aspects to pin down to the penny in view of the fact that medical care is not readily available in Nunavut as it is for most Canadians in other jurisdictions.
So that normally is the main cause, outpatient expenditures continue to rise and increase, particularly when health care or treatment is not available in Nunavut.
I think the member should also recognize the fact that out-of-territory services that we normally incur throughout various provinces, one area that I note that the committee has done much work on is the rising cost of these services.
For instance, year to year, the costs have continued to rise beyond Nunavut’s borders and therefore, these are one of the major contributing factors of increased costs.
I can have Debora Voth, with your permission, Mr. Chairman, to explain exactly why we have experienced such pressures.
I believe that we have done our homework but at the same time, we are very aware that each year, there are unplanned expenditures that’s to come upon the department and therefore, it’s one of the departments that’s very difficult to really pin down to a penny.
I would like Debora Voth to explain further some of the pressures and whether or not our budget is realistic. I think you will agree that most of the departments normally don’t get what they ask for. Budgets are normally capped at certain levels and the department then has to try to manage within that approved budget by the FMB.
Chairman: Mr. Aupaluktuq, go ahead.
I would like to advise the proceedings at this time, Mr. Chairman, that we seem to not have a quorum at the moment. I just want to raise that to your attention, sir.
Chairman: Yes, go ahead, Minister Curley.
Hon. Tagak Curley: Earlier, Mr. Chairman, I asked you to see if Debora Voth could respond to part of the question from Mr. Elliott.