Debates of February 14, 2011 (day 38)

Thank you, committee. I’d like to call Committee of the Whole to order. In front of us today are tabled documents 4, 30, 38, 62, 75, 103, 133, 135; Bills 4, 14, 17, 20; and Ministers’ statements 65 and 88. What is the wish of committee? Mr. Beaulieu.

Tom Beaulieu

Tu Nedhe-Wiilideh

Thank you, Mr. Chairman. We will continue with Tabled Document 133-16(5), NWT Main Estimates, 2011-2012, with the Department of Health and Social Services and, hopefully, getting into the Department of Education, Culture and Employment today as well.

Thank you. Is committee agreed?

Agreed.

With that, we’ll take a short break and come back with the Tabled Document 133-16(5).

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I’d like to call Committee of the Whole back to order. Before going on break we agreed to do Tabled Document 133-16(5), NWT Main Estimates, 2011-2012, starting with the Department of Health and Social and then going to Education, if there’s time. Minister Lee, do you have witnesses that you’d like to bring into the Chamber?

Yes, please, Mr. Chairman.

Does committee agree to allow the witnesses into the Chamber?

Agreed.

Sergeant-at-Arms, can I please get you to escort the witnesses into the Chamber.

Thank you, Minister Lee. Can I please get you to introduce your witnesses for the record.

Thank you, Mr. Chairman. To my left I have the deputy minister of Health and Social Services, Paddy Meade, and to my right is Mr. Derek Elkin, director of finance. Thank you.

Thank you, Minister Lee. Welcome. When we left off we were on page 8-29. Mr. Bromley.

Thank you, Mr. Chair. I’d like to try and continue where I seem to recall I left off some days ago.

I want to just follow up a little bit on the training of our nurses, the Nurse Practitioners Program and the Introduction to Advanced Practice. I’m still looking on some clarity there. I guess the first one is we’ve heard from the Minister of ECE. Does the Department of Health and Social Services also agree that we need to continue to increase our use of nurse practitioners in the Northwest Territories?

Thank you, Mr. Bromley. Minister Lee.

Mr. Chairman, yes, there is a need and there is room for more nurse practitioners. We have vacant positions in some communities for NPs. We don’t have a vacancy in Yellowknife, but in regions and in communities. Thank you.

Mr. Chairman, what is its current state, contrasted with the immediately previous state, of our support from this department through ECE for the training of nurse practitioners?

Mr. Chairman, the investments that the department has been making through HR has stayed consistent over the last number of years. Thank you.

That is the past. I assume that is also the current. What is the planning for the future? Thank you.

Mr. Chairman, I think that is something that we are and we need to work on over the next month or two as we work toward the next business plan. As the stats have shown in the House, we have over the next three years 60 to 70 grads of nursing school coming out of Aurora College. We have other human resource needs. We have two long-term career centres being built, for example, and both, especially Sahtu, has shown their interest in training their local staff to work at the long-term care facilities. It is something we need to look at. We want to expand home care services and we need to look at training for home care services, workers to work in those jobs. It is something that we need to review. At the same time, we have fiscal pressure, but the priorities are to make sure that our training programs are meeting the needs of what the workplace needs are. I think we need to look at that. That is part of the review. Thank you.

Mr. Chairman, I would presume that the Minister’s earlier observations that we do need nurse practitioners and we will continue to push for increased use of them would enter into that review. Is the funding secure for the 2011-12 fiscal year? Thank you.

Mr. Chairman, we are funding until the end of 2012. We need to review our money, our program and training needs and work with Education and HR to see where we go from here. As the Members know, we will be reviewing in the next business plan cycle, which actually begins right after, as soon as the budget is over. We will be working toward that April, May, June and the Members will have a look at that. I think it is an area that needs a thorough review. Thank you.

Mr. Chairman, I want to turn quickly to the Introduction to Advanced Practice training at Aurora College. My understanding is that in the past, essentially all of the Bachelor of Nursing students were able to take the Introduction to Advanced Practice courtesy of the two departments’ support. Is that true? Is that continuing? Thank you.

Mr. Chairman, it is true. However, it is also my information that many of the employees have gone through that program and they don’t need to... There are less people who are in need of that program because once you take it, you are done. Thank you.

Mr. Chairman, I am having a hard time with finding any horse sense in that. Mr. Chairman, obviously we have a continuing intake of students. We have continuing revolving people in our communities. Could the Minister match those up for me somehow?

Mr. Chairman, I am going to ask the deputy minister to give more details on that. Thank you.

Thank you, Minister Lee. Ms. Meade.

Speaker: MS. MEADE

Mr. Chairman, historically that program was also used for people in our casual pool and required many of the programs or the people that we are now using -- locums, long-term casuals -- already have completed this program. We have actually had a reduced intake by interest level simply because people have this. Part of the review is who we need to target with this program to ensure that it is hitting the right people and also, as the Minister spoke before, where are the needs and how do we adjust what we are doing as far as northern teaching methods, given the pressures that we have and how fast we can focus on the various levels of nursing and the needs for those nurses. For example, for obstetrics practice and other areas in some of the change of practice, how do we upgrade and focus on that? We are having ongoing discussions with ECE and Aurora and that will be part of the review. On this, the AIP, I think it is a valuable program issue. What is the focus group now and how do we marry that up in the overall training? Thank you.

Thank you, Ms. Meade. Mr. Bromley.

Mr. Chairman, again, it seems a fairly straightforward thing to me. We have regular intakes of Bachelor of Nursing students. We are sending them out to communities. We need to make sure they have the training. I assume, within the deputy minister’s remarks, that will be assured and perhaps I can just get confirmation of that. Thank you.

Speaker: MS. MEADE

Mr. Chairman, I think the issue is practice ready and whether that program is actually geared to what is needed in the various communities and how much on-the-ground training needs to happen. This should not be unique to our program. It is a situation faced in western Canada that I am aware of. The issue of intro advanced practice, we have to assess what is actually required, given the way that our practice is changing. That is what I am talking about. It is not a guarantee for the program as it exists. It is a guarantee to say what do we need in the future, given where our graduates need to go and how we can best support and train them. Thank you.

Mr. Chairman, our deputy minister is really just providing the justification for a course tune-up. They are not taking the course and making sure that practice in remote and rural communities is provided. The bottom line is this is a highly valuable course. The instructors that have probably more experience than our remote and rural communities has a nurse in charge, et cetera, than anybody in the room here in the House have spoken to me about the value of this course. I am happy to trust the professionals there.

Another issue I would like to just touch on briefly is this House has called repeatedly for a milk subsidy and, to our chagrin, we have continually been refused that. The need doesn’t go away. The Minister of ECE provided a one-time program that has now fallen through the floor. It was nice to have that one-time program, but it still leaves resolution of this. Is the Minister working to get that in place through her work with ECE and what other resources she has at hand? Thank you.

Thank you, Mr. Bromley. Minister Lee.

Mr. Chairman, I have to go to weeks back when that file was more alive than it is now. I just haven’t had the latest update on that, but I do believe Education, Culture and Employment was spearheading that file. I could say to the Member, you know, frankly, that we are hard pressed to come with new initiatives. I know that should there be choices for the Member to make, he will put this on top of probably lots of other things.

From where I stand, we are under a $36 million deficit. We have restraint in place in every part of our program. There are lots of things that we would like to be able to do that we are not able to do. In all honesty, I have not been able to find money to give milk subsidy to our residents. Thank you.

Thank you, Minister Lee. Mr. Bromley, your time is up. I’ll go to the next person on the list, but before we do that I’ll just remind my colleagues in committee to keep our questions to the nature of the page that we’re on. The last bunch of questions that were asked were probably more appropriate for 8-17, which is health, human resources. So we’re on community health programs on page 8-29 and I’ll go to the next on my list, which is Mr. Ramsay.

David Ramsay

Kam Lake

Thanks, Mr. Chairman. I’m going to have to wait then, I guess, to benefit the process. I’ll just hold my questions. I was going to follow up on some questions my colleague Mr. Bromley had, but I’ll hold off until the other page. Thank you.

Thank you, Mr. Ramsay. The next person on my list is Mr. Yakeleya.

Norman Yakeleya

Sahtu

Mr. Chair, I want to ask the Minister about the diabetic program and the community programs for the Sahtu and the funding that’s going into our communities for diabetic educational prevention, treatment programs. Is the department increasing their funding as diabetes is increasing in my region and would we see a Sahtu home-grown diabetic program in the years to come? Right now our program is offered, I believe or I think, in Yellowknife and Inuvik and they’re administrating this program. Thank you.

Thank you, Mr. Yakeleya. Minister Lee.

Thank you, Mr. Chairman. There is no increase in our budget for I don’t think any program. Any of the new initiatives are very specific areas in the strategic investment community initiatives and that was outlined in our opening statement. This is a very status quo budget and that was made very clear by the Minister of Finance when he brought down the budget on day two of the session. But we do understand that delivering the diabetes program to our people is part of our core programming and we do that through our regional offices with the assistance from the knowledge that headquarters can provide. As well, in the Sahtu, as we have tried to do in other communities, I am aware that in the Sahtu we are using technology and telehealth to provide some programs in areas like diabetes support. As well, I am aware that in my travels to Sahtu communities that health care staff at the ground level are aware of speaking to and talking to the people and giving them support on chronic disease management and part of that is diabetes education. Thank you.

Norman Yakeleya

Sahtu

The point I wanted to make, again, reflects to the many priorities within health care, many priorities within this specific budget item we’re talking about and that health care is not quite equal across the North here and they’re doing their best. I know that some of the health centres have the technology to hook up with some of the other larger hospitals to look at issues such as diabetes. My point is, I’m hoping that this Minister, within the life of this government, makes some strong recommendations to look at the seriousness of diabetes in our small communities and makes some strong recommendations to have some strong programs in our communities. This is a very dangerous disease. It’s increasing every year more and more and we need to really put this issue at the forefront, like alcohol and drug programs, and have our own region take care of it. So I just wanted to say that.

I also wanted to say that I look forward to a day where we could have the Midwifery Program in our region. Right now we have it in Smith and Yellowknife and the people in Yellowknife are sending a petition around to have it here. Again, I’m looking forward to seeing where other regions can take advantage of it. We did have it at one time, now we no longer have it. Now we have new rules to follow and new technology that we have to learn. So I hope that the Minister can put in some strong recommendations to improve the Midwifery Program not only in Yellowknife and Fort Smith but also in our communities. It has a lot of cultural significance if that program moves ahead. I do support having one here in Yellowknife and one in Fort Smith, but let’s move out beyond that and hope that that’s in the long-term planning.

Mr. Chair, I wanted to ask the Minister about midwifery. What will it take to have that program in the books so the health boards can look at it? Now, I say that to support our families in our communities, because I’m afraid that these types of programs would be decentralized. If there’s a discussion about health boards maybe in the future being amalgamated into one super board, I fear that along with it some of the programs are also going to be amalgamated and we won’t see the programs we want in our region. So I want to ask the Minister is that type of discussion happening at her senior management level and also with government.

I’d like to finish this off with the support we need for the residential school survivors. It’s a huge issue. Our people in our correctional facilities talk about the residential school issues. People in our communities talk about the residential school issues. We have an interagency committee set up by this government under the direction of the Department of Education, Culture and Employment that deals with a vast array of residential school issues. This department is part of that interagency committee. In my communities, these issues are still alive and well. Last weekend I went to Tulita and sat with an elder and talked about this issue for about an hour. We just don’t seem to have the support there to deal with this type of issue. I was hoping that this Minister would go to the Government of Canada and press them hard on support in our communities, not for just one-time funding but ongoing funding. A lot of issues point to residential school and we’re not meeting or supporting our people to deal with those issues. I was hoping that the Department of Health would take a serious look at this, not from a statistical point of view or from a clinical but from a cultural point of view.

The Minister has supported a community in my riding to bring an elder into my riding. It took a long time, but we got the elder there and I want to thank her and her staff for working with my people to bring this elder in there. The elder talked and saw many people, Aboriginal and non-Aboriginal and they really appreciated it. That’s what I’ve been supporting all along, is having an alternative method to look at how we deal with issues such as residential school. I know that we can do something. It’s been proven successful in the last couple of days and the last week in the Sahtu by having this elder come into our communities. Again, I appreciate the Minister for making this happen. The people are happy they got to see this elder. There were quite a few people.

I want to just close with these being some of the concerns I’m going to raise with the Minister here.

Just in order of questions the way the Member raised it. On chronic disease management, which includes diabetes support, the Member asked if we were spending more money in the Sahtu. I answer that we’re not spending more money, but that is not to say we’re not doing the work, because that is part of our core business. The nurses and health care workers in our communities are equipped to help our people with managing chronic diseases, and diabetes is one of them. We use technology, if necessary, to support that. I am aware, in all of my travels in the Sahtu communities, that they have men clinic, women clinic, baby clinic, and then diabetes clinic. Those are all within the mandate of our health care professionals to do that every day. Diabetes management and chronic disease management is part of our Foundation for Change action plan. It is our priority.

The second thing is midwifery. We’ve had this discussion last week. We are working on a territory-wide strategy. I strongly support expansion of midwifery in communities. I think there is a strong case to be made to expand it to regional centres like Norman Wells, Fort Simpson, Hay River and Inuvik. I think we need to look at a less medical-oriented model. The one we are practicing right now is heavily doctor centred, to use a layperson’s language. We want to look at what Nunavut is doing, which is to use more traditional midwives. We have begun our work. With the opening of a new health centre and wellness centre in Norman Wells, I think there is an opportunity for us to look at the long-term view of working on a Midwifery Program for the Sahtu region. It will take careful planning and investment in resources. We need to train and find interested women who would be interested in doing that. It is something that I strongly believe in, especially for communities where there is just not a lot of help for pre- and post-natal support for mothers and babies.

The department is not engaged in thinking and talking about a super board. I realize that this topic has come up. We are reviewing the governance model. We will be talking to the committee on how to go forward from there. I can tell you, from working with the Joint Leadership Council and working with the chairs, we are working more toward how to work together as one unit. We come as two PAs and the health authority chairs, but we have worked really hard over the last year to work as one unit, work with each other, support each other and understand deeply that changes we make in one area and one authority and one region affects everybody else and we need to work together in making the changes for the benefit of the whole.

Residential school programming. I appreciate the Member’s comments on that. It is something that our department is involved in many ways, because our mental health and addictions programs and other aspects of programs that we deliver are directly or indirectly related to the impact of residential school. The huge summit that’s going to happen in Inuvik we are involved in working with the local communities to support the people that will be attending that residential school gathering, which will be a national gathering. I’m also aware that although it was slow in getting started, the federal program that’s available to support residential survivors is gaining ground. I was in Inuvik and talking to some of the Gwich’in leaders who are supporting residential school survivors. I think there is less intake than there should be. Even the Dene Nation leadership and other Aboriginal leaders have said that people are taking up that program more and more. I would encourage everybody to tap into that federal program. Obviously I am in regular contact with my federal counterpart and I’d be happy to advocate, and I do, on issues that are important and that the Member has raised.

Thank you, Ms. Lee. Reminding everybody that we’re on page 8-29, community health programs. Any more questions on page 8-29? Mr. Bromley.

Thank you, Mr. Chairman. Speaking briefly, I want to thank my colleague for raising those issues and especially the Minister’s response provided on the Midwifery Program. I think that’s a very key area and I can’t help but note that the Minister is giving quite different feedback now than perhaps in budgets past. I’m very happy to see that and appreciate that. I’m gathering that some work has been done to consolidate the view that there are benefits to those programs. Is that something the Minister would be prepared to share with us at some point in time?

Thank you, Mr. Bromley. Ms. Lee.

Thank you, Mr. Chairman. I’m assuming that the Member is referring to the Midwifery Program, and the Foundation for Change speaks to coming up with a territorial-wide strategy by the end of next fiscal year. It will take some work and, as I said in committee, we will bring stakeholders and we will review this program. I was just talking about the importance of expanding this, talking about that I personally believe and that is the direction that I am giving to the department, is that we need to look at not just what’s going on right now, which is very heavily medical-based midwifery programming in Yellowknife and Fort Smith where midwives depend very much on physicians, but what we have is the reality in Fort Simpson and Inuvik and Norman Wells is that we need to tap into a more traditional midwifery practice that is sort of similar to what Nunavut is doing. What they have there are registered midwives working with more traditional midwives, and that should be a model to look at. It’s more musing but that’s sort of the vision that I have for the Midwifery Program and we have some months to work on that. We don’t have anything right now to give to you, but I have no doubt that we’ll be working with the committee as we move forward on this. It will be a massive project to work out a territorial model.