EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
Looking at what is before us for the next fiscal year, I was thinking perhaps, you can talk a little bit about whether or not you feel that you are going to be seeking appropriation again.
I talked a little bit about it with the questions from the member from Sanikiluaq yesterday, that we are bringing forward quite a large supplementary appropriation this year.
I’ll reiterate and elaborate a little bit more here today.
As the budget process unfolds, as I had mentioned yesterday, in some jurisdictions up to 40 percent of that jurisdiction’s budget is directed to health.
In Nunavut, as the chairman of the committee mentioned in his opening comments, we’re at 23 percent. Now I don’t like using percentages per se as a comparison, but it does give you a good indication on the limitations we have within our current fiscal framework.
Now that being said, there are also challenges from the government overall. We need continued schools.
We have capital infrastructure deficits that some people estimate $6 billion to $7 billion across the territory. We have education as a high priority. Culture and Heritage and Environment, we have so many different competing departments for the same dollars.
As the Minister of Finance just stated in his Budget Address yesterday, we’re nearing $2 billion.
When I look at us having a budget of 23 percent of the territory’s budget when the national average is 38 percent, I think we’re doing quite well for what we’re doing.
Unless there are some dramatic changes in the budgetary process, I don’t anticipate not having Health come back for supplementary appropriation.
There are departments putting in business cases for projects every year.
We put in business cases that get denied as well. Some of them may help save money in the long run.
When you invest money now in certain projects, it looks at alleviating stresses like telehealth and the CAT scan that’s provided at the QGH right now.
It took a number of years before that got approved and then once it did, we’re already seeing impacts.
Investments in different technologies also have limitations. Bandwidth is a challenge across the territory.
When we’re talking about digital imaging, we do have more and more X-rays that are doing digital imagining. I believe it’s almost all of them now if I’m not mistaken. That is an investment in infrastructure, but it alleviates the need sometimes for medical travel because the doctors can get a clearer image immediately versus an X-ray being sent down.
Oftentimes erring on the side of caution, a medevac is needed.
There are a number of different initiatives that we are undertaking and there are initiatives that we’re going to continue to bring forward to the government as a whole and keep pushing some of our business cases down the road.
With current fiscal parameters and structure the way that is right now, I don’t foresee any time soon that the Department of Health will not be appearing before this legislature without a supplementary appropriation.
I think that’s why I’m asking you this today again because I want to know what the process is that you go through as a department.
On the other hand, you can see surpluses and yet on the other hand, you see somebody coming for appropriation.
How can we fix that as the Legislative Assembly?
What is it that we need to do to improve so that you do not have to come for appropriations all the time?
What needs to happen?
I’ll ask my other question afterwards.
Hon. George Hickes: Unfortunately the answer is quite simple.
Almost all of our overages are needs-based. We can estimate and project expenditures like medical travel, agency nurse costs, or physician contracting, but we don’t know really until we’re at a good chunk of the way through the year what the actual costs are.
It’s not a fault in the system per se.
Again, there may be some recognized and like I had mentioned yesterday with medical travel, we’re budgeted for $64 million. We haven’t been at $64 million in expenditures for a number of years. We did get an increase of $5 million last year, but we didn’t get an increase this year.
As I had mentioned yesterday, territorial health investment funding is on a depreciating manner, so it’s putting more and more pressure on the GN to look at offsetting those costs.
When we’re talking about controllable costs, like I had mentioned yesterday, we could have been coming in for a higher supplementary appropriation. We did have some small surpluses in some avenues or budget lines of our business that we used to offset what we could.
It still left us short and the bulk of that, like I said, is from uncontrollable costs.
There’s no easy answer. There’s no simple explanation to change it other than looking at more historical, actual costs and maybe looking at budget processing a little bit closer to those. Again, you could have a year where your expenditures are less, then we’re surplusing and that, and then we’re getting our knuckles rapped for that too.
There’s no easy answer.
I do want to commend my colleagues across the cabinet that we do work together to try to allocate the funds the best way that we can determine for the betterment of all Nunavummiut.
In just looking at the differences between the main estimates and actual expenditures over the years, they’re pretty well around the same, give or take $5 million or $6 million.
We have one of the things I guess that’s different in Nunavut compared to other jurisdictions, of course, is our medical travel, but we also have NIHB.
I’m wondering if you can give us a better understanding of what role NIHB has when it comes to the care… . If somebody has to fly to Ottawa for medical services, does NIHB play any role in that at all?
NIHB plays a big role. I believe last year we got approximately $35 million last year from NIHB and projecting $37 million to possibly $38 million this year.
They don’t cover the full costs of medical travel for Non-Insured Health Benefits; they cover a portion of it. It’s almost like a deductible. I guess you can say that if you’re talking from insurance words.
They reimburse us for prescription medication, medical supplies and equipment, dental services, also the reimbursements for dental and eyewear, and eye exams outside of the territory.
Like I said, there’s some reimbursement for part of the travel expenses.
We work with them with our boarding homes. They cover most of the cost of our boarding homes. Sometimes the agreements that we sign with some of the facilities are a little bit higher than what we’re reimbursed for, so it costs the government some money there.
The timing right now as a matter of fact it’s up for renewal effective April 1. We have been in negotiations for some time with Health Canada to address some of the issues that I’m bringing forward today.
We work very closely with Health Canada on establishing rates, boarding home rates for example. They play a big role in our being able to activate a boarding home.
The member from Rankin Inlet has brought up in the past and other members from the Kivalliq of having a boarding home in Rankin Inlet.
Those are all the types of discussions that we have with NIHB that we look at opportunities to fund and offset some of our expenses. At the end of the day it does still costs us money.
Does NIHB also cover the cost for long-term care in the south or that or is it just purely for medical?
I want to go on just to something else now and it’s to do with suicide prevention.
Often we hear about families when this horrible tragedy happens. I often heard that families feel that there’s no support for them after something like that has happened, for example, if a family member finds another family member and that picture and that thought stay in their head.
What are the plans for families to access more help right there? You can’t always wait a week or something.
Sometimes people need that help right after something like that has happened. I know often that family members band together and support each other and that’s good, but sometimes you need more than that. What are the secretariat’s plans to address the trauma that families go through immediately after something terrible like that has happened?
One of the toughest parts of my job is when I get those notices from a community that there has been a death in that manner.
The health centre is always involved right away. There are counsellors available immediately.
In some circumstances where the impact may be outside a small family unit is where we look at responding with a trauma response team. There are a number of different avenues for people to access counselling immediately and aftercare, not just face to face but also through telephone counselling as well.
There are existing resources available to assist families and residents of a community that are dealing with that type of trauma.
Yesterday I was asking questions, but I wasn’t done. Thank you very much, Mr. Chairman, for allowing me to ask another question.
In your 2017-18 business plan it states that you will do a study for 2017-18. The Department of Health will conduct an evaluation of capital infrastructure, departmental communications, and medical travel programs. With these evaluations that will occur, will the departmental staff be conducting them or will they be done by an entity outside the Department of Health?
Hon. George Hickes: Thank you, Mr. Chairman. With regard to infrastructure, there is collaboration with Community and Government Services when we’re doing an analysis of the existing infrastructure.
We also realize that as those analyses are being done, they are also prioritized as well to make sure that those especially with health and safety conditions that need to be addressed immediately receive a higher priority.
With regard to medical travel, we do have people in-house. The review has already started on that and I’m hoping that the timeline can be even accelerated a little bit.
To me, it’s one of our biggest cost drivers that we work very closely with Health Canada to make sure that we’re maximizing the effectiveness of our Medical Travel Policy.
Again, like I had mentioned earlier in an earlier response, we’ve gotten declining assistance for medical travel. We don’t get a lot of assistance from outside, so we’re covering the majority of the costs on this and it’s a huge cost driver for the department.
One of the things, when I got into this chair, is I wanted to make sure that that was an initial focus that we could look at immediately.
If anything, we have accelerated that priority with the medical travel.
We are continuing to go on with CGS on lifecycle analysis on our infrastructure.
Yes, I understand that response.
However, I would like to ask an additional question.
You will “Evaluate Medical Travel programs to ensure effective service delivery.”
Does this review have a deadline as to when it’s supposed to be done?
Is it going to be done within the year or in two months? Does the Department of Health have a deadline for this review?
I wouldn’t say there’s a deadline.
I know we do want to make sure that it will be within the fiscal year for sure, but I want it sooner rather than later.
It’s not like we’re waiting for a report to come up to examine efficiencies.
When I look at MEDITECH, the health records management system in itself, when I was visiting one of our health centres in a community, the medical travel person informed me that just that first week of rollout in that community saved five people’s travel.
We talk and we hear from our constituents, and I know I’ve gotten letters from some of you that are aware of constituents that have gone down to a medical appointment somewhere that didn’t exist, and then they get turned around and flown home.
For some people, especially those with mobility issues, that’s not a minor inconvenience.
Those are some of the things that we’re looking at right away that have had an impact.
We look at other technologies that can be used to avoid medical travel, digital imaging as an example, like I have used earlier. It seems to be a bit of trend here. I keep blowing my own opportunity for some of the ministers’ statements that I’m looking at putting out.
Not only with the Cambridge Bay seniors development, but there is respiratory assistance technology that some of you may have been made aware of.
During our tour of the renovated section of the hospital, the topic came up of equipment called CPAP. I can’t remember right now off the top of my head what it stands for, but it’s an assisted breathing apparatus that, when used with infants, avoids the necessity of having to intubate, which puts a tube down a newborn infant airway, which has all kinds of potential for harm, necessitates medevacs down, and extends the hospital stay.
Already we have invested in that equipment here in Iqaluit and also on some of our life flights as well.
Already that has had an impact in saving dollars and reducing medical travel costs.
It’s not like we’re waiting for a report to come out to act upon it. As things occur and as things mature, we’re initiating them right away.
The final report will probably have 90 percent of stuff that we’re doing, maybe with some minor tweaks on anticipated future improvements.
I don’t anticipate waiting for a report to come out to make any more adjustments to our medical travel.
The evaluation that you’re doing is a great opportunity to look at infrastructure as well.
The elders facility in Baker Lake was held by the Department of Family Services, which is being transferred to the Department of Health.
It is a very busy place.
The officials from the Department of Family Services visited the facility and they were considering how they could make it more affordable to run.
Since the responsibility is being taken over by the Department of Health, I want to make sure that some of your officials will go visit the Baker Lake elders facility to look at the operations and to see how it can be improved.
Some of the elders who I represent have explained to me that their rooms at the facility are too small.
It would be a good opportunity for officials from the Department of Health to go to the Martha Taliruq Centre in Baker Lake so that they can actually look at it and make considerations.
It has proper staff.
To move on to a different topic, you have staff in the communities.
In Baker Lake there is a worker that deals with babies and young people. Our dialects are different. In the Baffin region, what do they call it?
I’m talking about young boys or young kids. I’m asking about the staff. Some of them are not in indeterminate positions and have been in casual positions for two years now.
They don’t really have the job permanently, but they work there.
Is that the situation there?
I’m not familiar with the exact position that the member is talking about, but there could be a number of different reasons why somebody would be on a casual basis for extended periods of time.
Like I had mentioned yesterday in one of my responses, we have been very successful using restricted competitions to get people into indeterminate positions.
One of the challenges we have and when we’re dealing with, as one of the members asked yesterday, how we budget, do we budget for all of our positions?
Some of those monies are used in identified needs in communities where we provide casual positions that may be technically unfunded that we fund from within to deal with an identified need.
I would have to look at that specific position and maybe have a conversation with the member after on the specifics of that one, but in general there are ways that people do stay in casual positions for extended periods of time.
I can assure everyone here and everyone watching that that was an immediate focus of mine. I see my deputy minister nodding her head and she can assure everyone here that that was one of my first requests of the department, to deal with long-term casual staff and wherever possible to make sure that they were given an opportunity to enter into indeterminate employment with the Department of Health.
Earlier I asked a question and maybe I’ll translate it myself here.
Child and youth outreach workers within the communities... . I have been made aware that the employee in Baker Lake has now been in that casual position for two years. At the same time similarly, positions in other communities have been casuals even longer.
Listening to your response, I take it that the department will take a look at these casual positions. Will the department make a decision on having them become full-time employees? Thank you, Mr. Chairman.
Again I will just preface my response that it will depend upon whether those are funded positions or not.
That being said, it is the intention going forward to make sure that people that have been in long-term casual positions, whether it be through restricted competitions or open competitions or through direct appointments, we are picking them off; we’re making progress.
If the Chair will allow, I would like to go back to the member’s comment from before on having health staff visit the facility in Baker Lake. I just wanted to make sure the member was aware that we’re a step ahead of him.
We’ve had staff in there already from our transition team taking a look at the facility and making sure that the residents there are assessed to the level of care that they need. Thanks for the comment.
That’s very promising for the Martha Taliruq Centre, which has been long-standing and servicing the needs of the elders of Baker Lake and even some elders from nearby communities now.
It’s very promising to hear that health officials are taking keen insight into that particular centre.
Moving on, in your draft business plan one of the things that your department is looking at working on is model of care redesign.
When we look at model of care covers and how this new model will improve service delivery for staff of health, as we all know, staff from health departments are crucial, but at the same time when we look at health, there are clients and families.
As the department, you’re looking at a redesigned model of care.
I can elaborate a little bit. I know I touched on it a little bit yesterday and I thank the member for asking the question.
It gives me a chance to get a little bit more specific.
When we’re dealing with a territory as vast as Nunavut, providing consistent care across all the communities is a challenge.
When we’re looking at a formal model of care design, we want to make sure that people expect and receive the same level of care from one community to the next, from one region to the next, dealing with all the challenges that we do have in providing health care with the demographics, from the fiscal constraints, as I have alluded to.
One of the things that were identified is that there is a need to modernize the current model of care.
That’s why we went ahead to look at redesigning it. We want to make sure that people are getting the right care at the right place at the right time from the right person. There are a number of factors that go into that.
I’m not clinician, but I do happen to have one sitting beside me so.
Maybe if the Chair will indulge me and allow my deputy minister to elaborate a little bit more maybe from a clinical side of things on what specifics we’re looking at within the redesign of the model of care, I would appreciate it.
One of the things that we want to look at with regard to the model of care is what our care ratio is. That hasn’t been looked at for a very long time in terms of number of nurses versus number of people in the community. The communities have grown a lot over the last number of years.
Other questions that get raised when we look at a model of care are how could we use laypeople and how could we use people from the communities and train them in different ways to be able to provide services in the communities much the same way as we did with the children’s oral health coordinators. We had people who were interested from the community who came in and received training and now are performing a valuable service in their community.
Another thing that we have in mind to look is, is there a way to look at other health professionals such as licensed practical nurses, for example.
That’s a model that has been used in many other areas. We’re looking at if and how such a model could be used. We’re just in the beginning phase.
We have been to a number of communities or a consultant has been to a number of communities to talk with health staff.
Our first cut is to talk to the health staff and talk to the people who are working in the health centres to get their feedback and ideas.
We just had our first meeting with NTI earlier this week.
We’re really just getting going.
We will be coming out to the communities and asking for feedback and asking communities what is working well in your community and what is not working so well to really design a model of care based on evidence, best practices, and people working to the full scope of their abilities, licences, and training.
When we look at this redesigning of model of care, this would be my last question on this particular H-4 page here. I brought this up on my first year as an MLA for Baker Lake, even on my second year, third year, and today I ask this.
When you’re looking at redesigning your model of care, are you going to take into serious consideration of early detection of cancer screening?
Is that going to be one of the highlights on your redesign?
It will be a component of it, but overall when we look at early detection, especially with cancer, again that’s one of the priorities that I talked to my deputy minister about when I took on this portfolio. I really wanted to see some movement on screening.
There are a number of different initiatives specifically with cancer care that we’re exploring.
I’m not going to get into it at this moment.
I want to see how they progress as we move forward.
I do want to assure members that cancer screening is a key component moving forward to making sure that people are getting care early so that it doesn’t become as serious of an issue.
Next name on the list, Mr. Okalik.
First of all, I would like to thank the minister and his officials for responding to a question I brought up yesterday regarding the number of Inuit nurses we have employed.
It’s something that we would like to give more support to because we don’t have enough Inuit working in the department’s offices.
I would like to move on to another subject regarding the Igloolik incident.
I would first like to thank the Member for Aggu for asking the family of the man who was shot by the RCMP.
He was mentally challenged and he was shot by the RCMP.
His name was Felix.
He’s not with us anymore and he does need a representative.
I would like to look further into the coroner’s inquest.
There are over 20 recommendations and some of them are directed to the Department of Health.
First of all, one of the recommendations indicates that our government should give workshops to the RCMP and hold meetings in the communities.
Will that be implemented by the Department of Health?
My apologies, I have a tickle in my throat. If the Chair would indulge me, I’ll ask my deputy minister to respond to that.
We have received the coroner’s report and have been in discussion with the coroner to make sure we understand the recommendations and the reasoning behind it.
With regard to training our frontline staff, we want to make sure that our frontline staff are trained not only in recognizing issues with mental health and addictions, how to treat people, and to understand what’s going on with people with mental health and addictions, but to also be grounded in cultural considerations so that they understand the context of the behaviours and the illness that they’re dealing with.
We will continue to deal with mental health in the future.
We have to provide more support to people with mental health challenges and look for different options.
I’m going to keep asking questions on the recommendations that were made for the Department of Health.
The fifth recommendation states that if anyone is shot by the RCMP or if anyone has lost a family member, this individual and the family will have to be counselled.
Will the Department of Health make plans to implement this recommendation?
I apologize for earlier.