Just, I guess, leave it as a comment that the presentations we’ve had it sounds like a lot of it should be fairly straightforward and perhaps to some degree there’s parts of it being implemented already. The technology is as simple as a phone or cell phone, where we have coverage. I guess I’m looking for efficiencies here. I like the model. I’m looking for complexity, but it seems pretty straightforward to me. I’m wondering where the bottlenecks are in implementing this. I realize it’s a new model, the tires need to be kicked and so on.
We’re certainly already maximizing, to the best of our ability, the use of the technology and the existing physician and nurse practitioner resources as far as the use of specialists that are now available to the other authorities and the review of everything from lab tests to X-ray results. We are continually challenging ourselves on the use of telehealth and that equipment. But the Territorial Service Network will be extremely complex. There is controversy amongst physicians. If I am a locum physician, part of my interest in coming here is I can make a lot of money on call. If I’m a physician who wants to come here -- and I’m talking about outside of Yellowknife -- and I want to come here, one of the deterrents is that I don’t want to be on call every second night or have a solo practice. We’re looking at how we actually move dispatch and clinic dispatch into our medevacs. We’re being pushed by this because of the pressures from other jurisdictions as well as our own complexities. We’re already doing as much as we can. I’m talking about a real change of delivery model that will take buy-in from all the providers and while we have seen some pieces of this... Australia’s medevac, some of the STARS ambulance use of dispatch, we’re borrowing all of that, we’ve just got interest from Ottawa on what’s called The Best Brains to come and help us share some of this because this has not been done in Canada before. We’re looking at Labrador and how they’re utilizing on call with physicians and nurse practitioners. We’re not using what we have now, but this really will be something that has not been done in Canada and certainly we want to make sure before we roll it out, that we’re not having unintended consequences. Even talking about what will initially be in the mix and how that impacts simple things like the calls to ER, who’s going to answer and how we marry that up with dispatch to a medevac, it actually is extremely complex to get it right. So we’re not not doing it, but that core piece is pretty complex.
Thank you, Ms. Meade. Mr. Bromley, your time is up. I could put you back on the list, if you wish. Otherwise I’ll go to next on my list, which is Mr. Ramsay.
Thank you, Mr. Chairman. Just a few questions. Sorry, I had to step out there. I understand there is going to be some more information coming forward on locum nurses in the Northwest Territories. Just a quick question: does the department know how many are currently being utilized in the Northwest Territories today?
Thank you, Mr. Ramsay. Ms. Meade.
That’s actually a daily, weekly event. In particular there are high seasons like in the summer where we had people on holidays, people for other reasons, you bring in a higher number of locums when we’re having trouble with recruitment in some areas. I know that a couple of authorities, Beaufort-Delta being one, had a higher percentage of locums and, in fact, a higher percentage of not even being able to fill at the locum level. I think the best way is to give you averages over the past time.
The use of locum nurses in the smaller communities is increasing and part of that is our own nurses who have been coming in, a lot of people, doctors as well, are at late in career. Also the locum pools that we’ve used historically are also end-of-career people and they tend to come in for longer. Newer nurses are coming in for shorter periods, so it increases the numbers. It’s things that we’re looking at as far as how we fill, recruit, and even use locums. We will include those numbers from an average. It doesn’t necessarily tell you on the ground, the community-by-community, but we will do our best to give you a picture of that.
One of the reasons I ask that question is because we have gone to a four-year degree program with our northern nursing students now and one of the concerns that I’ve heard is that there aren’t the jobs, the jobs aren’t posted. Even though we’ve got locums and we’re relying on agency nurses, the jobs aren’t being posted. They’re not out there. For new grads coming into the work scene, it’s a pretty scary sight when you’re graduating from a four-year Northern Nursing Program and there are no jobs to be had on paper. Then you see all these locum nurses and agency nurses working in the Northwest Territories. If I was a student, I’d be asking some questions, too, about what the government’s priorities are. Are they with the locum nurses or are they with our graduating northern nursing students? I think they should be with the northern nursing students.
I’d like to ask the Minister how the department is going to take the northern nursing grads and integrate them into this system. Are we going to make every effort to decline the amount of reliance there is on agency nurses in the Northwest Territories and how are we going to do that?
This issue about the new nurse grads is not unique to the NWT. The issue is whether the new nurse grads can actually practice in more independent or solo practice. A lot of jurisdictions are actually putting a lot more from the hospital side or delivery side training into that. We find that ourselves. A lot of the new nurses could come into Yellowknife where there’s a cohort around them. So what we’re doing is looking at how we can better support new nurses, new social workers to practice in the more remote areas.
The project I talked about earlier, the Territorial Support Network, I believe will also help that. We’re looking at whether we can have virtual mentors so that there’s somebody connected, again, through technology, to those new nurses so they can go out in a more isolated practice, and we’re having conversations with the CEOs around so what will it take to start to put these new nurses.
The problem is that Yellowknife is more stable and, while we had an issue there, we’ve been able to fill a lot of the permanent positions. It’s the more rural and remote positions that are difficult. We have to adjust how we’re going to support new grads in a more remote area through technology, through mentors, through supervisors that’s different than we have traditionally to be able to get them out there. Clearly, the focus is on trying to hire as many of our own because they will stay here.
I did ask the Minister to answer that question and I’ll perhaps ask some questions to the Minister during formal session when I can get some answers from the Minister on where exactly the game plan is to integrate northern nursing grads into the health care system here in the Northwest Territories. I appreciated the deputy minister’s response, but I want to hear it from the Minister and I’ll ask her when I get a chance sometime this week, hopefully.
I wanted to also ask a couple of questions about the new working protocol with the Government of Alberta, how our patients that are requiring service in Alberta are going to be taken back to the Northwest Territories sooner than has been the practice in the past. They would stay there until they recovered, but now we’re going to be recovering more patients here in the Northwest Territories. I don’t see a corresponding increase in the budget for allowing that to happen. I also don’t see a corresponding increase in the budget anywhere to look at the increased cost that it’s going to take for our medevac patients into Alberta. There’s, at the very minimum, ambulance costs that are going to be involved from the international into the city. There may even be helicopter service required. That’s $2,500 a shot. I’m just wondering how the department puts this into the budget, so that I can understand where it’s at here.
Thank you, Mr. Ramsay. I think that last question actually refers to the next section in the budget, but I’ll go to the Minister anyway.
Just for the record, after the deputy minister spoke I was going to go back to the Minister. I think she wanted to answer your first question but I skipped over her. So I apologize to the Minister for that and I’ll go to the Minister for a response on both questions, I imagine.
Thank you, Mr. Chairman. The first item about nurses and how we’re going to make it possible for them to work here, obviously, as a government we are committed and wanting to make sure that we hire and keep as many of our northern nurses as possible. One thing the nurses are actually doing, we have communicated to the nurses who have written to us, is that they should not, actually they should, it’s not a bad thing if there’s local nurses being hired because that means there are jobs there for them to take. Secondly, they wouldn’t be responding to jobs advertising for nurses positions. They wouldn’t be applying for those jobs upon graduation. They would be in a different stream, the Graduate Nurses Employment Program. So we are committed to doing that. Thirdly, I want to tell you that we are working with HR to have someone go in and talk to these nursing grads so that we can provide them with the information that they need about what the next step is in terms of finding jobs and have them stay here, because that’s what we want to do.
The second thing I want to say about medical travel... MLA Ramsay I think referred to two things. One is the 48-hour rapid repatriation policy that Alberta has administered. We’ve been working to adapt to that change. In the longer term the investment in facilities in Hay River and Norman Wells were in anticipation of what we know will come in future. All of the jurisdictions, especially Alberta, are under pressure and it’s important for us to be ready. So that is the medium and long term.
In the short term, the deputy minister is in daily contact with CEOs on a daily basis to make sure we are managing our beds properly and adequately and that we have a full picture in place every day with respect to the movement of patients.
Lastly, regarding the medical travel question about Edmonton airport, as the Member knows, the Premier of Alberta committed, and the mayor of Edmonton when he was here reconfirmed, that this airport is not going to close until we have a plan in place, and the quality council is working on coming up with the recommendations to the Premier. We are involved in that process and there will be a plan in place as to how we deal with the medevac of patients out of the international airport before the last runway closes.
With respect to what the extra costs are, we can’t put something that is not going to happen for a year or two, or even three years from now, in a budget. The health system responds to demands. We pay for what is required for patients to move around and between now and then, a lot of things could change. We hope to have more patients staying in the Territories. Alberta is going through their change. They are pushing patients out of Edmonton. They are revamping services in other places like Grande Prairie and such, so you know there is lots of moving parts there. The important thing is that our system is organic, it is a living system and it is our job everyday to respond to it and we do. Thank you.
Thank you, Minister Lee. Mr. Ramsay, your time is up. I can put you back on the list if you want, but for now I will go to the next Member on the list, which is Mr. Bromley.
Thank you, Mr. Chairman. I have a specific question here in the area of audiology services. This seems to be a perennial topic because we have had such problems delivering these services and I want to ask the Minister where we are at with this in the Northwest Territories, specifically with the positions we have here at Stanton and in the Yellowknife Social Services Authority, if any. Where in this budget are we addressing the gaps and filling them, knowing what we must know by now? Thank you.
Thank you, Mr. Bromley. Minister Lee.
Thank you, Mr. Chairman. The issue there is the challenge we have had in recruiting staff for that program. We had gone out with advertisements for competitions at least twice, I believe, and we were not able...were not successful in getting the trainee for the audiology aide, so that is where we are but we are committed to continue to work on that.
Do we have an audiologist position and is that filled at this time? Thank you.
We do have the position, but it is not filled. Thank you.
Are there any other audiology positions that we have and are they filled or are they vacant as well? Thank you.
As would be the case with other positions, we would use locums to fill those positions as there are no permanent ones. Thank you.
So just to be clear, I believe there is one audiologist position and one aide position; both are vacant and the audiologist is probably being served, it sounds like, by a locum. I am wondering what is that costing us compared to these positions should they be filled, if that is known, and how long have these positions been vacant. Thank you.
There are a couple of questions there that I need to get back to the Member on. I don’t know how long it has been vacant and I don’t know how much money it costs to use a locum as opposed to having our own. Thank you.
This sounds like a particularly difficult profession for finding qualified people in Canada. Perhaps that is the case. I know we spent a couple of hundred thousand dollars on this retention and recruitment, recruitment and retention website last year. Have we had any bites in the area of audiology or any return on that investment in this area?
I don’t know if we have had specific requests or information seeking that position, but I could undertake to try to get some stats on what kind of feedback we have received on practicenorth.ca website. Thank you.
The earlier questions on the audiologist and the costs and so on and how long they are vacant, I will look forward to that information and perhaps I could broaden my question, although I would welcome any specifics on the website business. I would appreciate any update on how that is working for us and if that has actually gained us some ground here. We will leave it at that, Mr. Chairman. Thank you.
Yes, I will get that information for him. Thank you.
Thank you Minister Lee. Next on our list is Mr. Abernethy.
Thank you, Mr. Chairman. I want to go back to the question I was asking earlier in the questions that Mr. Ramsay had been following up on. When I was talking earlier, I was talking about getting statistics on specifics and different things and not just agency nurse statistics but also our locum pool. I just want to confirm a couple of things so that we can make sure we get the right information when you are coming back to us with the locum pool. Does the Government of the Northwest Territories still maintain a pool, a locum pool of nurses that we use in our authorities but also in our departments? Once upon a time, the Department of Health and Social Services through Human Resources, was running nurses through IAP and other programs so that they could become part of our pool, our Government of the Northwest Territories relief pool, and we would hire those people to go out to the communities instead of using agencies. Is this still true?
Thank you, Mr. Abernethy. Deputy Minister Meade.
Thank you. We have a pool of relief casual nurses, mainly in Yellowknife but not limited to that. The term locum is usually when you have got longer coverage, so we have a pool for short term, but we have moved to developing and training our own casuals, not as it was when Human Resources was in the department but clearly still continues. So, yes, we have them.
I think we are combining and using terms and it is getting a little confusing for me. Relief nurses are an indeterminate nurse that has been hired by Stanton to provide backfill when nurses call in sick or are away on holidays, but they are permanent without guaranteed hours and they are indeterminate employees. That is one category. I would be curious what the utilization of them is.
There is the other category which is casuals, who have been offered training, IAP particular, so that we could hire them to go out and provide backfill in the communities when there isn’t somebody, a permanent nurse in a position, whether it is vacant or whether that nurse has gone on holidays. Once upon a time, we used to advertise. We used to bring people up from the South, we used to train them through IAP and then they would owe us a return of service. That is what the Government of the Northwest Territories casual relief pool was. Not indeterminate but no guaranteed hours, we would train them and they would owe us a period of time. We would also call those the community health nurse locum pool. I believe that still exists. Can you confirm that that exists on top of the relief work and our utilization of agency nurses?
Yes, and we can get a breakdown, as you requested earlier, but also beyond that, authorities find themselves with nurse shortages and they are looking at experienced nurses who may or may not have worked in the North; usually people that have been here or are now working in other jurisdictions or even retired, who are also coming up for longer locums. So that’s a whole other piece that I refer to as the locum pool.
Once upon a time any nurse working in a community health centre who was employed by the GNWT, and that included agency relief nurses or agency nurses as well, we required them to take or provide proof that they have equivalent to IAP. We also required every nurse who worked in a community health centre to have the IAP equivalent. Do we still require that of nurses, regardless of how or why we’re employing them, who are working in the community health centres to have that or its equivalent?
We’d certainly look at the equivalency because not everybody is trained with the numbers that we need. Our use of locums and casuals has increased. It’s the equivalency that we looked at but we can certainly clarify more information on that.
In clarifying that, I also want to see whether or not we require our term and indeterminate nurses working in community health centres to have IAP.
Another section within this particular division or area is physician services. I was interested, when the Minister was talking she referred to if we were running on physicians on sort of a territorial model rather than a regional or authority model. Is there any progress to going to that territorial model for physicians or are we still running it as an authority-based model?
I would say that there certainly is support from the medical directors’ forum. The issue is what’s the actual coverage need from what the new model will be. In general, at the JSMC there’s always fear when you make this kind of a change, because it gets misinterpreted as what does that really mean, will we lose doctor services? So we’re talking about a virtual pool, pooling all the resources and what the future model is. Part of that work is being done by the medical directors as far as the physician resource model numbers that are required and where. Is there 100 percent buy-in yet? No, but clearly we’ve got a lot of work developed in that area.
Thank you. Mrs. Groenewegen.
I move that we report progress.
I would like to thank the Minister and her witnesses and ask the Sergeant-at-Arms to escort the witnesses from the House.
Can I have the report of Committee of the Whole, please, Mr. Bromley.
Mr. Speaker, your committee has been considering Tabled Document 133-16(5), Northwest Territories Main Estimates, 2011-2012, and would like to report progress. Mr. Speaker, I move that the report of Committee of the Whole be concurred with. Mahsi.
Thank you, Mr. Bromley. A motion is on the floor. Do we have a seconder? The honourable Member for Tu Nedhe, Mr. Beaulieu.
---Carried
Orders of the day for Tuesday, February 8, 2011, at 1:30 p.m.:
Prayer
Ministers’ Statements
Members’ Statements
Returns to Oral Questions
Recognition of Visitors in the Gallery
Acknowledgements
Oral Questions
Written Questions
Returns to Written Questions
Replies to Opening Address
Replies to Budget Address
Petitions
Reports of Standing and Special Committees
Reports of Committees on the Review of Bills
Tabling of Documents
Notices of Motion
Notices of Motion for First Reading of Bills
Motions
First Reading of Bills
Second Reading of Bills
Consideration in Committee of the Whole of Bills and Other Matters
Tabled Document 4-16(5), Executive Summary of the Report of the Joint Review Panel for the Mackenzie Gas Project
Tabled Document 30-16(5), 2010 Review of Members’ Compensation and Benefits
Tabled Document 38-16(5), Supplementary Health Benefits - What We Heard
Tabled Document 62-16(5), Northern Voices, Northern Waters: NWT Water Stewardship Strategy
Tabled Document 75-16(5), Response to the Joint Review Panel for the Mackenzie Gas Project on the Federal and Territorial Governments’ Interim Response to “Foundation for a Sustainable Northern Future”
Tabled Document 103-16(5), GNWT Contracts over $5,000 Report, Year Ending March 31, 2010
Tabled Document 133-16(5), Northwest Territories Main Estimates, 2011-2012
Tabled Document 135-16(5), GNWT Response to CR 3-16(5): Report on the Review of the Child and Family Services Act
Bill 4, An Act to Amend the Social Assistance Act
Bill 14, An Act to Amend the Conflict of Interest Act
Bill 17, An Act to Amend the Income Tax Act
Bill 20, An Act to Amend the Evidence Act
Minister’s Statement 65-16(5), Devolution Agreement-in-Principle, Impact on Land Claims and Protection of Aboriginal Rights
Minister’s Statement 88-16(5), Sessional Statement
Report of Committee of the Whole
Third Reading of Bills
Orders of the Day
Thank you, Mr. Clerk. Accordingly, this House stands adjourned until Tuesday, February 8, 2011, at 1:30 p.m.
---ADJOURNMENT
The House adjourned at 6:12 p.m.
