EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
I’m wondering how you as the minister react to that lobbying effort.
Obviously, if people feel that Health Committees aren’t working and they want the regional boards back, then there must be an issue somewhere.
If there is, what is your department doing to resolve the issue with allowing Health Committees or developing Health Committees to be more efficient and more effective in communicating the healthy needs and issues to your department?
The role of the Health Committee is one that we are continuing to develop and expand.
The role of each Health Committees’ functions in the communities, particularly around the whole issue of coming up with the development of wellness strategies for the communities around public health and prevention.
That is an ongoing effort from our department.
The challenge that we have is some of the Health Committees function under the municipalities and some of them function under the Health Department, so we’re working with each umbrella.
Recently, we’ve also written a letter to the President of the Nunavut Association of Municipalities and seeking their input on the roles in strengthening the terms of references around their roles.
At the same time the Health Integration Report speaks very clearly on the need for development of integrated services for Health and Social Services with partnerships at the community level.
And in those recommendations, it speaks to the development of Community Wellness Health Committees and we are working on that.
I believe they have a real strong role in identifying grassroots prevention initiatives, especially when we speak to keeping people healthy or developing healthy communities. What does that mean by community: they have a role in that. They have a role in advising staff, the health centre staff and social workers, on how we can better serve the community and so on.
So we are working towards that and the terms of reference, and the public health initiatives that we’re doing, the strategic planning will also look at the role of the committee at a broader level as well.
Can the minister tell us how many Health Committees of Council there are in Nunavut?
Every community has a Health Committee.
It’s good to know that every community has a committee.
I think in the past there were a few communities that hadn’t established those committees.
With that in mind, I would like to ask the minister how much funding the department provides to each Health Committee of Council to carry out their functions in the community.
Hon. Leona Aglukkaq: Thank you, Mr. Chairman. I believe the total administrative support we provide to the health committees is $200,000.
Chairman: Thank you, Minister Aglukkaq. Mr. Peterson.
That would mean that some communities aren’t getting as much as other communities.
I recall that Cambridge Bay is getting $10,000. How do you decide how much funding goes into each committee?
I’ll get Shirley to respond to the breakdown.
Ms. Alder.
Ms. Alder: Thank you, Mr. Chairman.
The department based the contributions to each community on population, as well as initiatives that we receive from the community. The larger communities, obviously, would receive larger amounts than the smaller communities.
Chairman: Thank you, Ms. Alder.
That’s good to know that they’re getting some funding out of the formula. Obviously, I think that most communities will want more funding, but recognize that there’s a short supply.
Going onto your priorities for 2007-08, one of your priorities is staff current essential positions with full-time staff.
One of my big issues in Cambridge Bay is the staffing of the regional health centre with doctors and nurses.
I don’t know if I am making any progress in terms of getting answers there. It seems to be a difficult thing for the department to complete.
I am wondering if you could update me on what your department is doing to recruit doctors for that facility in Cambridge Bay, and the nurses that go with that position. If you could clarify as well what are some of the issues that are affecting you in terms of preventing you from hiring these essential positions that you’re stating as a priority in your business plan?
In terms of our physician recruitment, just like with nursing there is a national shortage of doctors, as well as nurses in Canada. That’s the biggest obstacle for us.
Every jurisdiction is drawing on the same pool of professionals to recruit, and some jurisdictions have better packages than others to offer. Just last week Alberta enhanced their physician package by $1 billion. That’s our entire territorial capital budget for one program.
So that’s what we’re competing with.
In some of the challenges that we’re trying to address, we’ve enhanced the physician’s compensation for doctors. That’s in the supplementary bills that are before this House to try and attract more doctors in the north; not just in one community, but also throughout the north, as well as our nurses.
I have heard that housing is also an issue in Cambridge Bay; there is a shortage of housing. If that is the case, if you don’t have housing for doctors and nurses then how would you go about hiring full-time staff to work in that health facility?
I believe the Nunavut Housing Corporation is in some discussions regarding some housing. I don’t know if it’s completed yet, but the Nunavut Housing Corporation is tasked and mandated to negotiate housing for these positions.
Yes, I am aware of that, I am sure it is an issue right across Nunavut.
In my information, in Cambridge Bay, there is a need for 20 housing units. Currently, and for the last several years, and probably into the foreseeable future of it, we could have a critical shortage in Cambridge Bay.
If that’s the case, are you saying that the regional health facility is never going to have full-time staff? There’s supposed to be four doctors and, I think, 20 nurses. So are we never going to have the four doctors?
Are we always going to have one doctor and eight nurses?
Can I get an answer to bring some resolution to this ongoing question and answer session I have with various ministers in various departments?
I am going to ask the Assistant Deputy Minister of Operations to come and join me up here so we could speak to the regional facilities and staffing.
Do you want to just wait for a second?
Chairman: Sergeant-at-Arms, please escort the minister’s staff.
Minister Aglukkaq, for the record please introduce your staff.
To my left is Dave Richardson, the Assistant Deputy Minister of Operations.
Chairman: Mr. Richardson.
Mr. Richardson: Thank you, Mr. Chairman.
Recruitment for professional staff is a challenge to the territory. Cambridge Bay has the same challenge to recruit additional nursing staff and physicians to complete the full operation of the new facility.
The staff recruiting is part of our ongoing initiatives.
It is handled both at the regional level and territorially. The medical director is dealing with physician recruitment and has just undertaken a plan to strengthen the physician recruitment.
With respect to nursing we are working both with our own staff and with our contractor to fill the indeterminate positions as well as casual positions.
It is true that housing is a complication for us and being able to fill all of our vacancies. The facility has introduced some new programs but has not completed the recruitment for nursing in position.
Chairman: Thank you, Mr. Richardson.
I thank the minister and Mr. Richardson for that information.
Mr. Chairman, can the minister indicate or explain what her department has to do immediately to provide 100 percent staffing complement at that health centre, and I’m aware that there are supposed to be four doctors and possibly 20 nurses.
What has to happen immediately for you to be able to even contemplate staff in those positions?
I think some of the answer was given to that: the housing situation is one, the compensation to the positions that we have is another, and the challenge that we face in Canada, the shortage of nurses and doctors.
So I don’t believe it is a one-answer response.
There are a number of factors that we have to deal with in trying to recruit those positions, Thank you.
Further on in that priority statement there is a reference, “... to reduce the reliance on staffing through agencies.”
I’ve heard over the years, and I think we’re all aware of this, that it is probably more beneficial or financially beneficial for a nurse to be an agency nurse than it is to be an indeterminate nurse.
Indeterminate nurses, when they are hired they have to, if they’re in Government of Nunavut staff housing, if it’s available, they have to pay high rents. Whereas if an agency nurse comes in, the contractor provides the housing, but the contractor charges it all back to the Government of Nunavut in the first place.
So what measures are you going to take to reduce the reliance on staffing through agencies?
The first thing is train our own. We’ve been trying to train our own nurses for some time now.
We have a program in partnership with Dalhousie University, and we deliver the nursing program here. The top priority is to train Nunavummiut to take those jobs, continue to try and advertise for long-term nurses and casuals.
We’re also doing a request for proposals for agency nurses similar to the one that is offered in the Northwest Territories to try and reduce dependency on agency nurses.
The request for proposal... Dave is working on that today.
So those are initiatives that are underway currently to try and reduce the dependency on agency nurses.
Throughout all of Nunavut, we have probably a large number of nurses. Can you give us a rough breakdown between the indeterminate nurses and the agency nurses that are in the various health centres and hospitals throughout Nunavut?
I don’t have that, but I can provide that to the individual. I don’t have it in front of me. I’ll have to get my staff to collect that data.
I hope her staff is looking for that as we speak.
Could the minister provide an idea of what it costs to support one indeterminate nurse versus what it costs to hire one agency nurse?
I don’t have that information. Mr. Chairman, I can get that information for the member.
I hope your staff is working on it somewhere in the bowels of the Department of Health as we speak.
Does your department have any anecdotal evidence that the Government of Nunavut Staff Housing Policy is negatively affecting the current staff in terms of turnover and staff leaving because the cost of Government of Nunavut staff housing policy is imposing a higher cost on them to support their living needs?
I’m going to ask Ron to respond to that.
Chairman: Thank you, Minister Aglukkaq. Mr. Browne.
We’re not aware of any information that indicates that staff are leaving because of that.
There were some staff that left in December but when we looked into it they had other reasons for leaving.
So there is no clear indication that is a factor at this point in time.
Mr. Peterson: You’re giving me overtime?
Chairman: Sorry, I didn’t check the time.
Any questions? Health and Social Services. Branch Summary.
Directorate. Total Operations and Maintenance.
Just following up on what was raised in questioning.
What is, at present in the Nunavut Nurses Training, what is the present drop-out rate to date, starting with maybe when you started what was the drop-out rate and what is the drop-out rate today?
The Nursing Program is run by Nunavut Arctic College, the Minister of Education can probably provide that data. That data is within the Department of Education.
I will be asking the Minister of Education that, I guess, but if I was the Minister of Health I would be yelling at Department of Education everyday and the Premier asking them to improve the program.
I think the onus is on the minister, too, to know how successful her program is even though it is through the Arctic College, support and everything else, yelling at the minister on a daily basis.
Is there any talk between the Minister of Health, Education, and the cabinet leadership to review this very important nursing program, which is very important for Nunavut, as the minister indicated, to get our own nurses to alter or to improve the method that is being used right now to graduate more Inuit from Nunavut?
I can provide the member with the current numbers of students that are enrolled as of today.
In 2006, 29 students are enrolled in the program, plus an additional six in the access year before they actually start the program. We have an access year that we designed. So there are six in the access year and 29 currently enrolled
What we have tried to do is to speak to the students and talk about what options they have for employment with us, and communities they are interested in. In the summer months we provide employment to the students in the area in a nursing-type field, or assisting to try and place them into the field to keep them on and give them additional experience and exposure to the field, and so on.
I have a break-down of the information that’s available in terms of what financial assistance each student is given while they are in school for family and so on. I have the information because we do also provide housing to our students and that is subsidized housing.
We have that as well.
Within the Department of Health we have also established a scholarship program that we give to our students on an annual basis.
So we have collected all of that data to date to see what other areas that we can improve in.
Upon graduation we implemented a new initiative again to mentor our nurses for at least six months before they are placed in the field.
So those are what we have done internally, direct contact first and foremost to students to let them know that there will be jobs for them upon completion of their training. So there are a number of initiatives. In that way we’ve looked at ways of trying to provide additional support to our students.
Can the minister then give us some documents of that information some time later this winter or .
spring started today? It didn’t feel like it, Mr. Chairman … So that we could talk about it some time maybe in the spring session, if there’s going to be one, because we are not interested just to show that we have an interest.
We’re interested very much because we need to get in touch with our patients from Nunavut locally.
That is a very important part. It’s a necessity.
It’s not just a program to get more nurses.
In the NTEP Program, sometimes we have 12 enrolments for NTEP in Coral Harbour from years back, how will we run NTEP Program just for Coral Harbour … maybe it’s a couple from Chesterfield Inlet.
Are you running now regionally based nursing programs: 20 in Baffin, nine in the Kitikmeot, and how many more in the Kivalliq, under the same university degree program.
If not, why not? Is it the budget that’s the problem for nursing or the government is not giving you enough budget to run the program?
What’s your maximum number of entrants that you can accept?
These are a whole lot of questions but I don’t want to take up the House time with those details. I think those details should be given to us like the Nunavut Small Craft Harbours Report, kind of ten-pager, because we want to review these and encourage the government.
Look, some of these programs should have been done ten years ago under the Northwest Territories Government because traditionally teachers and nurses are underpaid. Traditionally, they were not important to the society.
Therefore, when they become important and they’re still not being paid very well at that time, then we realize we’re short of these people; teachers and nurses for our own people.
Realizing that, I think we’re going to have to make up and accelerate our training program for those nurses and work with the House here to get the best possible course of action to determine what our goals and objectives for these nurses are.
So can the minister then tell me if she will provide us some information in a document of where we are now and where we think we should be going?
I think for clarification in regard to this program, we need to deliver a program where there’s a hospital for practicum and training of our nurses and so on.
This is the reason we can’t deliver in any other community because there is only one hospital in the territory. So that program is offered here. Perhaps, 20 years from now or 15 years from now, we might be able to do that in Cambridge Bay or Rankin Inlet but as it is right now, it’s here.
If the member is asking about the program as it is to education and what we have available for participants or people interested in that, I will provide that information to the member.
Mr. Arvaluk. Thank you, Madame Minister. Thank you, Mr. Arvaluk.
Under Directorate, as the minister indicated earlier, their Finance Division falls in there. As I had indicated in my opening comments on Friday, I have some serious concerns with the department.
The first Health Minister we had in Nunavut was always saying they were under funded, which is why they were always in a deficit position.
Since then, we’ve boosted their base budget over $20 million, I believe. And now I hear again we’re going another $10 million over.
I guess my question to the minister, it says in their business plan under Finance: “... provide financial reporting and advice support to managers including functional advice to the three regions through the following activities; budget development, and financial control.”
What kinds of financial controls does the department have in place to monitor the actual spending that goes on through the actual department?
I’ll start and have Ron add to that.
The current processes and authorities that we operate under is the same as the other departments under the Financial Administration Act. We have the same authorities, payments, spending, that whole process.
I don’t know if Ron wants to elaborate on that.
The department prepares monthly financial statements and they bring financial challenges forth. There have been things that are very difficult for us to control.
The main cost increase over the last year or so has been medical travel. We have done some things to try to reduce the amount of medical travel such as establishing a mobile ultrasound service; establishing testing for false labour to reduce the medevacs, providing more rehab staff in Iqaluit to eliminate the need for travel outside for the rehab.
But, the volume and cost of medical travel because of the fuel price increases have continued to rise. The other major factor is the difficulty in recruiting staff and the higher cost of filling vacancies with agency staff.
Those things are tracked in our monthly financial statements, but being able to manage those major costs drivers is very difficult.
I know the agency nurse issue is something that has been talked about here earlier.
I think we would all agree that there is a need to have those positions filled with indeterminate nurses because they are cheaper for us. And then there is the whole idea that we need to train and generate our own nurses. Those types of things aren’t going to happen over night.
Even if you look at the last set of graduates of the Nursing Program, although I understand they finally have now all been employed, we had a graduate that had to work as a waitress in a restaurant because she couldn’t get a job, when they asked questions about it, well that they didn’t pass the certification and training, or their final test that they need nationally to be able to work. At the same time we have in some cases agency nurses filling in and working with an international nurse that hadn’t passed their test as well.
Can we have some assurances that in the future, where we can bring in an international nurse, and if they’re not qualified to work yet, because they haven’t passed their test, there is someone hired to work, so they have to work with someone; they can’t work by themselves.
Can we make sure that happens with our graduates, as well, so we don’t have them working in the restaurant; one of them even went to Alberta because they couldn’t get work. I know she’s back. Thank you, very much for reminding me of that, but the simple fact that they had to go some place else and we’re in such dire straits here of looking for nurses.
It seems like these are home-grown nurses that are told, “No, sorry, you have to wait,” but the international nurses that come in, “Oh, you guys don’t have to wait, and we’ll get someone to work with you so you could be there.” To me it’s like a double standard there.
I would just like to get a commitment out of the minister that something like that won’t happen again.
In the future that we take these young graduates under our wings and employ them right away, even though they can’t officially practice as nurse practitioners, until they pass their tests, but I am sure every single nurse out there would love to have someone working with them, even if they are just there to help them out.
Would the minister commit to that in the future?
We’ve committed to that. We’ve tried to make some improvements to the program and the HR division has been meeting with the students before they’re done to also find out what their interests are.
Some of them don’t want to stay; some of them want to go somewhere else. We accept that as well.
Internally the department has met with the students and are trying to be proactive in trying to find where they want to work when they’re done with training, and so on. We are addressing those very issues at this stage.
I am sure that all the future graduates will be very happy to hear that.
The next question is dealing with these transfers of the financial positions and you know they’re transferring all the payment functions out of finance. I am just wondering if the minister or her officials could indicate if they’ve had problems in that area of finance that needs to be beefed up.
Are there problems that have been identified there? Is that why they’re transferring those particular functions over to finance?
The transfer of those positions to finance is to address the concerns identified in the Auditor General’s Report the last few years.
The transfer of the payment process right now within the Department of Health takes up so much of our staff; just the pure volume of processing.
With this change the staff that are there will have time to do more trend analysis of our current patterns in our line item forecasting, to do more training of the staff at the community level and at the regional level, as well as here of the employees.
As it is right now, much of the energy is spent just processing payments and with the change, it will allow us to concentrate on other things within the department that are important in strengthening financial management.
I guess if I was looking at it and I guess I am looking at it from the outside and not the inside, it seems, historically, the problem has been the spending, not the payment with what’s been going on with the Department of Health, and the controls in place to monitor that.
Is the minister saying they’re too busy just paying bills rather than keeping track of where they sit with their budget?
Sorry. Minister Aglukkaq.
The time spent just on the volume of processing does not allow the staff to do analysis of the cost drivers of our programs such as medical travel and the data entering of it.
And we’ve processed to date 33,000 airline tickets and that’s from every health centre, every region, and that comes down to processing and payment.
So we want to be able to dedicate more of our staff time to do more analysis on the cost drivers to be able to forecast more in areas where we may be experiencing an outbreak of RSV or something, but that has been a real challenge for us.
The other area around that, we want to be able to get a handle on where we are with our line items earlier on, working with the team of staff in the regions and with the assistance of financing and processing those payments, we will have a better balance of financial management.
I guess the minister indicated earlier it’s like 17 PYs that they’re transferring out, or identified to transfer over to the Department of Finance from her department.