Thank you, Mr. Moses. Mr. Abernethy.
Thank you, Madam… Holy cow! Thank you, Mr. Chair. You’re so different. When did that happen?
I can’t even remember what I was going to say. We don’t really have an update. I’ll get that information for the Member. I know we’re moving some of our people around, you know, to help backfill where possible and we’re looking at doing some staffing, but we don’t have a full answer for that. I’ll get that information for the Member.
I think the next question that I have in line deals with the ambulatory care services. On a couple of occasions during my term, we have had infants that were born in the Beaufort-Delta in the Inuvik Regional Hospital that were born with jaundice. I’ve asked twice in this House about BiliBlankets. I believe they only have one at the Inuvik Hospital. Should two babies that are born with jaundice happen to be born at the same time, one will be able to get the phototherapy that they need with the blanket, but the other one we’d have to send out on a medevac and those are thousands and thousands of dollars if compared to if we just purchased another blanket.
Can I get an update on whether or not the department has taken any action on this or, in fact, maybe you have an inventory on how many BiliBlankets we have throughout the Northwest Territories. Thank you, Mr. Chair.
We did bring that up to the Beaufort-Delta board and the public administrator and the staff at the Beaufort-Delta. They indicated that they actually felt they had an adequate supply of BiliBlankets and other tools they can use for individuals. But since that time, they’ve also put in this award-winning obstetrical program called MORE OB, which is changing the way they’re delivering some of the services in the Beaufort-Delta. It’s an amazing program. As a result of those changes, there didn’t seem to be a desire for them. They weren’t that interested in bringing in an additional BiliBlanket. But we will follow up with them again to see if anything has changed, and if they are looking at moving in that direction, then I’ll let you know.
I appreciate that, because I’ve heard it a couple times from local residents as well as residents from the small communities. Not just Inuvik but right across the Northwest Territories. I think we have to make sure we have an adequate supply should this happen.
Just moving forward, I was speaking with a physician on the plane ride coming back to Yellowknife and he was talking about this TED Talks and where this physician was talking about the use of remote technology. When we talk about ambulatory care services, a lot of it is very time sensitive, and actually trying to get into communities, whether it’s a blizzard or some of our remote communities maybe up in the coastal regions and with the work on the Mackenzie Valley Fibre Optic Link, has any work been done in terms of a study to look at how we can use the Mackenzie Valley Fibre Optic Link in terms of remote technology? In the TED Talks they talked about using robotics in medicine, so being able to perform not surgeries but performing medical procedures, or giving advice to some of our communities that might not have any nurses but have health care workers that might be able to do the services that are time sensitive and whether a medevac can get in there or not. Is there a study being done to see what kind of equipment we might need in some of these small, remote communities, especially now that this Fibre Optic Link will be up and running in 2016? If we get a planning study now, then it’s something that we can work on. It would cut down on travel costs, cut down on medevacs and also possibly save lives. Thank you, Mr. Chairman.
We’re quite excited about the Mackenzie Valley Fibre Optic Link. We believe it’s going to help enhance the services that we already have, and our first focus is to make sure that the tools that we have in place – EMR imaging, lab services – that we currently try to provide over the Internet are enhanced as a first priority and make sure we get maximum benefit out of those programs that we have. We also believe it’s going to support and help us with things like telehealth because we’ll have a better link and better time, better connection.
We also know and we’ve had an opportunity to look at some of the technology that’s in place in Alaska, which is really quite amazing. There are some really interesting things, and we continue to be in touch with Alaska. That would be our second priority after we make sure we’re getting maximum benefit out of our existing things.
But I will say that the doctors in the Northwest Territories are an amazing bunch of people and they really appreciate technology. I promise this literally every day they approach somebody and say, hey, this is something new. We try to incorporate as much as possible and where reasonable. Some of it’s beyond our current fiscal means and we will find a way; some of it is rather inexpensive and we can begin work on those things right away. So we continue to be open-minded and it’s for opportunities as they’re presented to us.
Thank you, Minister. Committee, we’re on page 193, ambulatory care services, operations expenditure summary, $60.154 million. Agreed?
Agreed.
Page 194, ambulatory care services, grants, contributions and transfers, $22.813 million. Agreed?
Agreed.
Page 197, community health programs, operations expenditure summary, $144.418 million. Ms. Bisaro.
Thank you, Mr. Chair. I have a couple questions here. I mentioned in my opening comments that I’m concerned about provision for seniors and the services and programs that we have for seniors. The department has produced at least one document about continuing care. I can’t remember the title now, of course it escapes me, but one of them was referenced I think at some point by the Minister as not being an action plan, which leads me to believe there is an action plan either coming or that there is one.
So in terms of services for seniors and continuing care for seniors, how we’re going to deal with our seniors, how we’re going to look after our seniors, is there an action plan for continuing care for seniors, and if so, is it made public? Thank you.
Thank you, Ms. Bisaro. Minister Abernethy.
Thank you, Mr. Chair. Seniors are an incredibly important part of our population. The aging population is a growing population here in the Northwest Territories, and we want to make sure that we’re there for them as much as possible and we’re providing supports for them as much as possible. We have our framework, which is Our Elders, Our Communities, which focuses on a number of pillars. We’re working on separate action items and action plans on a number of pillars, including an action plan around a facilities review identifying how we’re going to move forward with facilities here in the Northwest Territories over the next number of years. There are also actions and an action plan around palliative care as well as home care enhancement as well as supporting our seniors in our communities to stay in their communities as long as they can. So, there are a number of things happening.
We have a good relationship with the Seniors’ Society. We meet with them on a regular basis to ensure that they’re involved and providing input and insight into actions as we move forward. We provide a significant amount of money to the NWT Seniors’ Society so that they can undertake actions on their own, which we’re always excited to partner with them on those. So, there’s a number of things we’re doing to support seniors.
Thanks to the Minister. These issues or these pillars that the department is working on, can I get some sense of when they might be completed, when committee might have a chance to look at them and give some feedback? Thank you.
Mr. Chair, for the specific detail on the action items and what’s happening, when we hope to have some of them available, I will go to the deputy minister for that detail.
Thank you, Minister. Deputy Minister DeLancey.
Thank you, Mr. Chair. With respect to planning for long-term care facilities, I believe we had shared with committee the continuing care review that was completed that was based on demographic projections from the Bureau of Statistics. We are now working, actually, in partnership with Avens to update those projections to make sure that, as we support them in their Aven Pavilion project, we do have the most up-to-date projections and then that will inform our plan that we’ll finalize for the capital development of long-term care facilities.
With respect to standards for long-term care facilities, over the last couple of years we have approved continuing care standards. We have approved a long-term care staffing model and received forced growth funding to bring our existing long-term care facilities up to date. We are developing a Falls Prevention Strategy for our long-term care facilities. As the Minister noted, we are working on a palliative care action plan, planning for long-term care beds. We’ve worked with the Northwest Territories Housing Corporation to ensure that if they develop new independent living units there is provision for adult day programs. We continue to roll out training and what’s called a Supportive Pathways Approach, which is really the contemporary philosophy for how we should respect the wishes of elders that live in our facilities to make their own choices about what they do on a daily basis. It is a fairly new way of looking at things, so there’s a lot of training to be done in that. We’re working with authorities to roll out the new continuing care standards. We have a couple of authorities that are piloting some innovative approaches to working with elders in the community to delivering home care and foot care programs. We’re monitoring those pilots to see if there are things that can be extended into other regions. Thank you, Mr. Chair.
Thank you, Ms. DeLancey. Ms. Bisaro.
Thanks, Mr. Chair. Thanks to the deputy minister. I didn’t hear a time frame in there. I can understand why one wasn’t given. There’s a lot of work going on and I imagine they’re probably not quite too sure exactly what day it’s going to be finished. I will ask for a time frame if it’s possible and accept the answer if it’s not possible. I understand that.
I’d like to ask a question about chronic care, particularly about diabetes. It is one of the biggest chronic illnesses that we have to contend with, I guess, as a territory. I always get confused on this, but my understanding is that there was a diabetes clinic that was being held in Yellowknife and that was discontinued. What is in place now, whether it’s in Yellowknife or whether it’s in other communities, but what’s in place for people with diabetes to get educated, to basically be treated and learn how they have to handle their disease to get them to get to a point where they’re not a drain on our system? What do we have? Thank you.
Thank you, Ms. Bisaro. Minister Abernethy.
Thank you, Mr. Chair. As far as time frames are concerned, a number of the items that the deputy described are actually well in progress. Some of them have actually been concluded and others are going to take a bit more time. I will get the department to put together some estimates on timelines for the ones that are outstanding but also articulate which ones have already been done and which ones are currently in progress. I will get that to the Members as soon as I can.
The Stanton diabetes education program had a territorial focus and it was delivered in Stanton. The program did some visiting to communities and provided some other clinics. In 2011 the decision was made to transition the program to Yellowknife Health and Social Services as the work was more consistent with the primary care approach. In 2012-13 the Yellowknife Primary Care Clinic implemented some drop-in clinics around this particular area, and diabetes education programs provide services such as workshops. They do drop-in clinics. They do scheduled appointments. They provide some cooking workshops as well as fitness sessions in Yellowknife. Client services include foot care, which I know is a very popular program, as well as some motivational counselling to individuals who happen to have diabetes. The program is run by a team that includes an internist from Stanton, a primary care physician, an NP and an LPN and a dietitian. The program for Yellowknife is still there. It’s at Yellowknife instead of Stanton.
Do you have something else, Mr. Abernethy?
Thanks, Mr. Chair. I do want to just articulate quickly that Yellowknife is not the only place where this diabetes program has been going on. Hay River, Fort Smith and Inuvik offer a targeted diabetes education and care program through their authorities by teams of educators that include nurses, nurse practitioners, dietitians and physicians. The Tlicho Community Services Agency, in partnership with the Tlicho Government, is training local diabetes educators to work with their nurse practitioner who will work directly with people diagnosed with diabetes to learn how to manage their disease.
Funding from the Canadian Partnership Against Cancer has allowed us to adapt our BETTER project approach, which is a great program, and their tools for doctors and nurses and CHRs as well to work with patients to identify their risk and learn self-management techniques for a range of chronic conditions which do include diabetes. So there are a number of things that are happening in the area of diabetes.
I would like to go a little further and say that there are gaps. We know there are gaps. The lack of a territorial program, in my opinion, is a gap. The Joint Leadership Council and the authority CEOs have already identified this as a top priority. Once we actually move forward to a single system here in the Northwest Territories, we’re developing a territory-wide program to meet the needs of our residents and our people rather than fragmented approaches. Hopefully, we’ll be in a position where we can pool some funding to develop something that really meets the needs of our people across the entire territory. But at this point I would say the lack of consistency and regularity is certainly a gap and it’s a problem that we would like to address once we move to one authority.
Thank you, Minister. Next on my list I have Mr. Blake.
Thank you, Mr. Chair. I have three topics I’d like to talk to today. First under health centres, I know it’s an ongoing issue in Tsiigehtchic. If they can’t have a nurse, they’d like a licenced practical nurse there or some specialist in that community on a full-time basis. Many times, during the weekends especially, we get emergencies. It’s left up to our residents to respond to the majority or pretty much all of these incidents. So we are really putting our own residents in our community at risk here, having to deal with a lot of traumatic issues at times here.
Moving forward, we did get commitments in the past to have a licenced practical nurse in the community. I don’t see any policy or guidelines that are holding us back. Why can’t we do this as a pilot project? Thank you, Mr. Chair.
Thank you, Mr. Blake. Minister Abernethy.
Thanks, Mr. Chair. I have indicated that I’d be happy to go to Tsiigehtchic and have a conversation with the leadership to determine truly what it is that they are specifically asking for and what it is that they think will meet their needs. There are lots of potential options. We ask the question of what can an LPN do within their limited scope of practice, and an LPN scope of practice is significantly less, or it can be significantly less than an RN. What is it we are trying to accomplish? We have looked at other models from other jurisdictions like Alaska where they’ve taken local people and provided them with significant training so they can provide some services, get local people for local work, which is something we’ve heard constantly throughout the Northwest Territories. Let’s find ways to employ our people in our communities. There are opportunities, possibly a high level first responder might be more appropriate than a nurse or an LP in a community like Tsiigehtchic, recognizing that we have regular nurse visits on a weekly basis and for some periods of time they do stay for extended periods of time. I would like to have an opportunity to go in with my staff and have a detailed conversation with the community on what it is exactly they’re looking for and how we can best meet their needs, not committing that it will be an LPN or an RN because that may not be the position that benefits the community the most, but we will have that conversation.
The other thing I wanted to speak about was under the home care and home support services. A great program that was undertaken a number of years back but, you know, in Fort McPherson there’s a huge demand there and right now we only have one person that’s working there and we’re hoping to get another position there. With the demand there, it would make things a lot more suitable as to the amount of clients that they work with. Right now it seems that there’s an overload and the community would really like to have another position there. Thank you, Mr. Chair.
I’m not aware of the overload in Tsiigehtchic but I’ll certainly take that under consideration, sorry, in McPherson, and I’ll certainly have a conversation with the public administrator of the Beaufort-Delta Health and Social Services Authority to see if we can get that figured out.
The last thing I wanted to speak about is under the programs for residential care, specifically under the adults, because you know a number of our elders have to go to Inuvik for long-term care. Just recently one of our elders from one of the communities had to move to Inuvik because of illness and hasn’t been given much time actually. The sad thing about it is we’re actually billing this elder every month. You know, that person is really frustrated at the moment with not only having to deal with his illness but also being charged up to $800 a month to be staying at the long-term care.
The Member has recently brought that to my attention and we’re working with the Beaufort-Delta to figure out what’s going on with the details of the situation and we will be able to respond back to the Member shortly.
Thank you, Mr. Abernethy. Next on my list I have Mr. Dolynny. Sorry, Ms. Bisaro.
Mr. Chair, if you want to go to somebody else first, that’s fine.
Thank you, Ms. Bisaro. I’ll go to Mr. Dolynny.
Thank you, Mr. Chair. Thank you, Ms. Bisaro. I have two questions and both of them, really, come under the category of grants and contributions, especially contributions. The next page obviously breaks down that contribution in terms of the different types of funds and programs. One of particular interest to me is the mental health and addictions, which is at $1 million, and the unaligned healing, which is a $225,000. Sorry, mental health and addictions at $625,000 and unaligned healing at $1 million. Given the nature of the day when the majority of Members here spent a large part of our day talking about the importance of mental health and addictions, especially the mental health component, I find it odd that we actually are spending less money this year than last year. It’s not a lot less, but it’s about $150,000 less.
Can the Minister give us a rationale? Given what we’ve spoken to today, given the attitude of wanting to make change and do better and advance the agenda of mental health in a stigma-free Canada and a stigma-free North, you would think they’d be putting a bit more money, not taking away. What is the rationale for less investment this year? Thank you.
Thank you, Mr. Dolynny. Minister Abernethy.
Thank you, Mr. Chair, just to be clear, these are grants and contributions. There are dollars that are flowing out to other organizations such as the authorities but as well as other organizations for specific programming. This is in no way, shape or form indicative of the entire budget being spent on mental health and addictions by the Department of Health and Social Services. I believe that number is closer to $15.7 million. For some specifics I will go to the deputy minister.
Thank you, Minister Abernethy. Deputy Minister DeLancey.
Thank you, Mr. Chair. The apparent reduction is actually the result of a re-statement. Our complete budget for the On-the-Land Healing Fund is $1.2 million, so it’s actually slightly higher this year than it was last year. What we’ve done, though, is we’ve carved out $200,000, and that actually shows up under fees and payments. The reason for that being, in our consultations with Aboriginal governments when we ran our pilot programs, we realized that we needed to do some work with each of the Aboriginal governments to develop some common outcomes and a common evaluation framework, and there’s a desire on the part of Aboriginal governments to see that done, perhaps not by department staff but by an external consultant that they would have some ability to help select. So we’ve actually increased the budget slightly, so the $1 million is what’s rolled directly out to Aboriginal governments. The $200,000 that’s held behind is to work in partnership with them on some common evaluation, sharing best practices, program support, developing program standards and so on. Thank you, Mr. Chair.
Thank you, deputy minister. Mr. Dolynny.
Thank you, Mr. Chair. I do appreciate the rationale. Just from an optics point of view you can imagine the dismay, as a committee member who fights very hard, tooth and claw, for every dollar. When I see a number regress, we need to find clarification.
In that same breath, my question is if this is indeed monies that were put aside for outside contributions in the realm of mental health and addictions. We know that Nats’ejee K’eh in its operating years was receiving about $2 million a year for mental health and addictions programs. If I look at the combined number here for outside investment and funding, that number is now only about $1.6 million.
Can the Minister or department indicate, is my rationale sound? Did we spend $2 million before on mental health and addictions outside for program delivery and now we’re only spending $1.6 million combined? Thank you.
Thank you, Mr. Dolynny. Minister Abernethy.
Thank you, Mr. Chair. Some of those numbers that the Member is pulling together aren’t exactly right, but the Member is correct in the fact that there was a $2 million budget for Nats’ejee K’eh. We’re using that budget to cover the individuals that are going in our contracts with the four southern facilities. We figure it’ll take about a year to figure out what that price should balance out to. We figure the price for delivery in the southern facilities is about $1.2 million, which leaves about $800,000. We were planning to utilize those dollars for the mobile treatment program and we’ve been close and then it’s been stalled and then we’ve been close and then it’s been stalled and it’s been close and it’s been stalled on the mobile treatment program and we’re continuing to try to move forward on that, but the other part of that $2 million was intended to be going towards the mobile treatments.
So, if I’m following the money correctly and if I’ve heard correctly here today, about $800,000 has been put aside for mobile treatment, or at least the establishment of mobile treatment. Can the Minister indicate where that $800,000 is in this new budget structure?
On Page 197, under community mental health and addictions there’s a budget line of $15.24 million. That’s where those dollars are.
I think this also lends to the overall question that I think myself as a Member has in terms of how this new layout looks and, again, the details behind this layout. I’m going to ask, at a point in time, if the Minister would commit to giving us more of a breakdown so we can actually understand some of these large $60 million, $15 million, what they are all encompassing. Again, because of the fairly large change in format here, would the Minister commit to providing that breakdown for committee once the main estimates are completed?
I do acknowledge this is certainly more complex than it was before. This offers way more detail than the budget did in previous years. When we indicated to committee that we were going to be moving to a system that actually provided some consistency between the authorities and the department and was consistent with the CIHI definitions of different program areas, we did offer a briefing. We ran out of time. We’d be happy to come back and give committee a briefing on these new categories and how they relate. There is some certain crossover. Some of the money will fall into multiple areas for what appears to be a program area, depending on the definition of how those dollars are going to be spent.
I acknowledge it is far more complex. I will admit it took me probably three, four, almost five times reading through this with people who are smarter than I am around finances before I even started figuring it out. I acknowledge that this is difficult, but this is going to be better in the long run. I do apologize for the frustration in working through this new format.
I do appreciate where the Minister is coming from. If he’s frustrated, I can tell you that you times that by 10 and I think you’ll see where Members are today here. We applaud the work in trying to make things more detailed and more simplistic to match parameters, but given the format of today, it is posed to be very problematic.
Last question. Last year the subject of oral health became of great debate and it was around the sunset of a federal funding initiative on children’s oral health care to the tune of $468,000. At that time, committee felt very strongly that oral health was an initiative that should not fall off the table and that we recommended to have that amount reinstated into the budget. Sadly, as we all know, Cabinet declined that request and oral health, which was funded federally, did not receive the proper funding. To the question, how are we dealing with oral health? Where does it fall in the program delivery that we have before us and what’s the funding that we have set aside for children’s oral health care?
We are pleased to announce that we have actually been approved to receive $4.5 million in federal funding under the Territorial Health Investment Fund for the development and initiation of an NWT oral health strategy. Based on the March 2014 report Brushing Up On Oral Health, we have developed an ambitious action plan for the development of an evidence-based strategy to improve the oral health status of NWT residents, particularly with a focus on our children. That number can actually be found on page 221 of this document, and it’s under the title work performed on behalf of others, and it shows $4.333 million under Territorial Health Investment Fund. It’s the third from the bottom.
