Thank you, committee. Committee, page 204, community social programs, grants, contributions and transfers, total contributions, $26.249 million. Does committee agree?
Agreed.
Thank you, committee. Page 205, community social programs, active positions, information item. Any questions?
Agreed.
Thank you, committee. Page 207, diagnostic and therapeutic services, operations expenditure summary, $23.820 million. Mr. Yakeleya.
Mr. Chair, I want to ask the Minister on this page in regards to the therapeutic services to the regions, and I’ll speak for the Sahtu in regards to the speech-language specialist pathologist coming in. Is that program being utilized in the Sahtu? I understand that when a speech-language person comes into our region they’re well received by our people in that area. It seems like we need to have more of her or him come in to do some work with our students. Is there an evaluation as to being in our region that this is what they are finding, either to request more support or say we need a permanent type of specialist in our region?
Thank you, Mr. Yakeleya. Minister Abernethy.
Thank you, Mr. Chair. It still exists; it’s still ongoing. We have speech-language pathologists come into all the communities in the Sahtu on a regular basis, but they’re also providing follow-up services through telehealth and they’re partnering with the schools. So, it’s a great relationship that we have with Education, Culture and Employment and the individual district education authorities to actually help facilitate that. We’re very excited by that partnership and that relationship that we have there and we’re happy that we’re able to get it in.
The department is doing an evaluation of rehab services that we provide across the Northwest Territories which does actually include speech-language pathologists, so we will have more detail on that. It takes a bit of time to do these analyses, but when the report or the review is done, the information will certainly be shared with committee if they’re interested.
Thank you, Minister Abernethy. Committee, on page 207, diagnostic and therapeutic services, operations expenditure summary, $23.820 million. Does committee agree?
Agreed.
Thank you, committee. Committee, page 208, diagnostic and therapeutic services, grants, contributions and transfers, contributions, $22.820 million. Does committee agree?
Agreed.
Thank you. Committee, page 211, nursing, in-patient services. Ms. Bisaro.
Thank you, Mr. Chair. I’m not sure if this is where I can ask about midwifery but I couldn’t find where else it might be. This talks about pregnant people, so I’m hoping midwives fit in here. I understand that the Minister had some questions, I think, about this earlier and we are making some changes to the plans for this year, some changes in the Beau-Del. The Minister has advised that, I think, in ’15-16 we’re going to be looking at a territorial program. I think he also advised that it’s simply going to be planning in the 2015-16 year, and in the next breath he says, yes, but they’re going to be looking at providing some midwifery in Yellowknife. So I’m quite concerned that if we spend a year doing planning… I can understand doing planning for a territorial program. I’m having difficulty understanding why we can’t start recruiting for midwives in Yellowknife in the ’15-16 year. I haven’t heard anything that leads me to believe that that will be occurring in this next budget year. So I’d like to get a bit more of an explanation of why we need to plan for a year, why we can’t start instituting a Yellowknife Midwifery Program as we plan for the territorial program. Thank you.
Thank you, Ms. Bisaro. Minister Abernethy.
Thanks, Mr. Chair. In this budget it actually shows Midwifery Program, an increase of $964,000 which is intended to implement the Midwifery Program in the Beaufort-Delta. But as I’ve indicated previously, there have been some changes in the Beaufort-Delta and there is a desire by the Beaufort-Delta to move to a different model. They’ve put in a new MORE OB program for birthing babies, which is a revolutionary award-winning program. What the Beaufort-Delta is talking about now is putting in a nurse practitioner who will have midwifery responsibility and will be providing a regional program and working with the community health nurses.
So this money will still be used, assuming we get committee support, to create an NP midwife position in the Beaufort-Delta who will take on that role and become part of the maternal care team. So, that’s actually pretty exciting, but it is quite different than what was proposed before.
Originally the Midwifery Program in Yellowknife was going to begin planning in ’16-17. What we’re suggesting is, given the changes in the Beaufort-Delta, we begin that work in ’15-16. It is a different program. The Member had indicated previously that we had a midwifery program in Yellowknife, and I would just like to remind everybody that it was never funded and it was one person. We have learned through experience that one person does not make a midwifery program. We had a great person, a very committed person, but one person can’t be a midwifery program, given that it’s literally 24/7 care and response. The only thing one person will do is get burned out and be unable to perform the duties. It’s not healthy for them and it’s not healthy for their client. So there wasn’t a really effective program, although it was effective of the quality of the person we had. But it was also not sustainable; it was never funded.
What we’re talking about now is having a territorial program based out of Yellowknife, and that is a different model than having just a localized Yellowknife-based midwifery program. This program will also be able to facilitate midwifery or midwife-supported births here in Yellowknife and support clients in Yellowknife, but there will also be a territorial focus for those regions and communities in the Northwest Territories that do not have midwifery support now to provide the pre- and postnatal support, and support the community health nurses that are out there.
It is a little bit different. It will take a bit of time. I’m anticipating, if we get support, what we’d like to do is move forward with that planning and we could theoretically, and I think it’s quite conceivable, be in a position, after the design is done, to begin recruitment in the ’15-16 year. But recognizing that we do have some work to do and we are expediting this significantly and bringing it into Yellowknife and a territorial model, it will take some time to do that work. It’s different than any model that we’ve employed elsewhere. It’s not the Fort Smith model. It’s not the Hay River model. It’s not the Inuvik model. It’s going to be a new model that’s going to be supporting Yellowknife as well as those communities that do not have it. So we do need a bit of planning time and lead-up time, which is the discussion that I’m hoping to have with committee. But right now in this budget, you’ll notice that it’s $964,000 in Inuvik. That’s what was originally discussed in business plans. Since then, these changes have come about and we would like to move forward, with committee’s support, to expedite a territorial program based out of Yellowknife.
Thanks to the Minister for that explanation. I don’t disagree. I think what we’re ending up with is a different model in every sort of region and one that’s going to work for each region, and that’s a good thing because we certainly are quite different and require different services in our regions. So I can agree with the premise, but knowing how difficult it is to hire midwives and how long it has taken us to get midwives in both Fort Smith and Hay River and knowing that we’re going to have midwives here in Yellowknife, I would think at the same time that we’re doing planning we will be able to consider, the Minister says maybe this year, but I think as you’re doing the planning you should be going out and recruiting for midwives because it has taken, I’m sure the Minister knows, many months to get midwives in our other communities.
Maybe I should ask the question to the Minister. What’s the average time it has taken us to recruit a midwife? Thank you.
Mr. Chair, it has taken a while to recruit, while we’re still proving to be unsuccessful in Fort Smith and we continue to move there.
We can’t recruit midwives in Yellowknife without job descriptions. Given that it’s going to be a territorial model and the midwives are going to have some responsibility not just in Yellowknife but on a territorial level, it is going to require different job descriptions because the scope of work is going to be different. We need to have job descriptions. We need to outline and clarify what that scope of work is going to be and how it’s going to work so we can draft effective job descriptions so that they can be properly evaluated. All of this does take a little bit of time. To go out and do recruitment with no job descriptions, no position numbers and no description of work is not possible. Also, we won’t be able to tell the individuals we’re recruiting what their scope of work is.
What we can do and what we’re constantly doing is we’re out there promoting the role of midwives in the Northwest Territories and we’ll continue to do that. We’ll be out at recruitment fairs, encouraging midwives to look at the Northwest Territories. The information about where we’re going with the territorial program will be shared with as many midwives as we can find, so that when we are ready to recruit, hopefully there will already be some interest established to come to Yellowknife to provide midwifery support and services on a territorial level.
The Member is right; there are multiple models out there. As we move to a single authority there is going to be an opportunity to start having these different programs meld together, work together to provide a comprehensive service throughout the Northwest Territories recognizing that there are going to be some differences from community to community and region to region.
Thanks again to the Minister. I guess the next question I have to ask, then, is it sounds as though there won’t be a midwife who is assigned full time to the city of Yellowknife, so am I correct in that? If that’s the case, it sounds as though the service to Yellowknife residents in terms of midwifery is going to be somewhat reduced. Will there be, within this territorial program, a midwife who is basically assigned or a PY that is assigned to Yellowknife full time?
These are some of the questions that we still need to work out, but at the end of the day there will be a midwifery program in Yellowknife, there will be midwifery services provided in Yellowknife. Will there be one midwife who is designated 100 percent of their time to Yellowknife? It’s a little too early to say. It might be that they provide services to X number of clients in Yellowknife but they’re still supporting community health nurses in two or three communities. It’s difficult to say. That’s some of the work that we need to do, but the intent is to have a midwifery program in Yellowknife. How it works with the staff is yet to be determined.
Thank you, Minister Abernethy. Continuing on with nursing inpatient services, I have Mr. Bromley.
Thank you, Mr. Chair. I appreciated that exchange. Just a couple more questions on that. Obviously, the Minister knows the Yellowknife program was pulled because there were insufficient midwifes. One person could not do it. Ms. Bisaro was asking about one position. Obviously, we would need a team of midwives dedicated to Yellowknife, so I hope that will be a focus of the discussion when that’s appropriate. It sounds like it’s coming up soon.
I know the Minister is aware that there is a very committed bunch of midwifery, I’m not sure I would say activists as active in the promotion, and recognition of midwifery is an important role in this area. Will they be a part of the consultation that the Minister is contemplating here and what’s the timing on that?
Thank you, Mr. Bromley. Minister Abernethy.
Thanks, Mr. Chair. Just to go back in time, there was never any money budgeted for midwifery services. Yellowknife Health and Social Services chose to re-profile some of their internal funding and they created a Midwifery Program that was only funded for one position. I don’t believe one position makes a midwifery program. In fact, I would suggest it would be dangerous for the incumbent to have a one-incumbent-based midwifery program because they would get burnt out.
In the proposed design in the midwifery report it suggests that for a territorial program based out of Yellowknife there would probably have to be about eight midwives to ensure that Yellowknife has adequate coverage and that those midwives can also support community health nurses and other individuals in an education role and a support role as the community health nurses are dealing with pre- and postnatal support. It’s about working together, but it would have to be more than one, obviously, and the program in Yellowknife would be focused on providing a program and have the midwives work together to ensure that the women in Yellowknife who wish to use midwifery services are getting the support they need. It would have to be balanced with ensuring that we’re also providing that education and expertise through our midwives to other practitioners throughout.
We need to do some design and, absolutely, we will be discussing it with the individuals who have an interest here in Yellowknife, and there is a real strong advocacy group here in Yellowknife with a real passion for midwifery services. I’ve met with them. I feel the same way. We want to get this right.
This money that is for the budget now includes money for five positions in the Beaufort-Delta, and we’re looking at putting one position in the Beaufort-Delta and then using these dollars to help do the design and whatnot and getting ready to, hopefully, if we get that far, begin some staffing this year, but the program is going to have to be more than those positions.
Thanks to the Minister for that response. The other aspect of that was when. Just an alert to these people on when you might be approaching them so that they can do the prep necessary.
I guess related to that, I know there’s a midwifery program in Calgary. I know of a student there that’s from the NWT, although she moved south. Are we all over that campus, whatever it is, with the opportunities in the North to capture the opportunities to hire those graduates?
This is a ’15-16 budget so we would probably begin the outreach early in ’15-16, but it also depends whether or not we actually get support from committee to go in that direction. That outreach will begin, assuming the dots are there and the t’s are… I don’t even know what I’m talking about now. The i’s are dotted and the t’s are crossed. I knew I’d get there eventually. But we’ve got to do that and we need to get support from committee to change the direction we’re taking here.
If the Member remembers, we’re moving forward with a new Human Resource Strategic Plan and there’s an outreach component in that Human Resource Strategic Plan where we’re going to attempt to get out to colleges and schools where our northern students are pursuing medical or health-related careers and make sure that we keep in touch with them. Can I say that we’re in touch with that midwife student right now? I can’t say that at this time.
Thanks for the Minister’s response there. I’ll look forward to when he can give me a positive response to that question. When I say Yellowknife, I include Ndilo and Detah, obviously, and I’m happy to see that we’re moving towards a territorial approach.
My other questions were with respect to the psychiatric nursing unit at Stanton and the training that staff there have for physical restraint when it’s needed to deal with the potential for violence and injury. Are staff trained for physical restraint and how frequent are the incidents of violence in the psychiatric nursing unit at Stanton? I know some of us have spent a lot of time at the hospital recently and the code whites are a little more frequent. I was surprised. Maybe I’ll start with that.
The nurses that are located in the psych unit as well as in the emergency unit are trained in non-violent crisis intervention. There are a couple different parts to non-violent crisis intervention, but all the nurses that are in those units, from what I understand from Stanton, they have actually received the training. There are also refreshers on a regular basis. There’s a second level of training, and we’re actually working with the security providers in Stanton right now as well as the others to get some of our people, including some of the security staff into the second level of the NVCI certified instructor program. Unfortunately, it’s delivered in Toronto and it’s only delivered every couple of months. The next delivery is April 15th and we have staff going down as well as some of the security providers in the building going down for that second level, which is a little bit more intensive and requires some new and some additional restraint procedures, in April. We’ve got a number of people going down for that.
I think there was a second part of the question that I’ve blanked on there.
I was wondering about the frequency of incidents in the unit.
There are number of code whites that occur in Stanton on a fairly regular basis, and as a result of the most recent incidents of violence, I’ve requested that Stanton provide us with a copy of every code white incident report so that we can track them and get a bit of an idea of how often these code whites are occurring. Since we’ve done that, I think it was three weeks ago, I’ve seen three. But the three that I’ve seen have been fairly minor in nature with no injury or damage done. That does not minimize the importance of the issue. It’s starting to give us a good, clear picture of how many of these code whites are taking place. I’m happy to share that information with committee as we move forward trying to make fundamental improvements to the safety and security of our staff and patients within that facility.
Thanks to the Minister again. I appreciate the Minister taking the initiative to put those monitoring actions in place. I know the Minister is aware that there have been some very serious events in there and the emergency department with a few injuries that are both physical and mental and some longer lasting than others. Many believe that there is insufficient support from non-nursing staff, particularly security that people at the hospital, simply because they don’t have the training and the direction. What does the Minister have planned in the order of responding to those needs? Thank you.
Mr. Chair, as I have already indicated, some of the training that is ongoing around non-violent crisis intervention, security staff is involved. They are also involved in the second level of the non-violent crisis intervention training which actually has a larger component around some of the restraint protocols and how to do it safely and effectively.
Stanton has been working closely with the security agency. Effective Monday morning, there’s going to be different security officers in the facility with additional training from their current employers – one additional with a higher level of training in the emergency room. This is temporary. These are intended to be in there until we’ve actually concluded many of the different reviews that we’re doing around security, safety, space, environment, different things that can be done. We’ve had a specialty consultant come in and do a review of the facility both from a functional layout point of view but also reviewing our policies and procedures around safety and security. They’re going to be providing us with recommendations on that, but in the interim, we will have this staff member in there on Monday with a higher level of training.
Thank you, Minister Abernethy. Mr. Bromley, you’re time has expired, but if you need to get back on, please let me know. Continuing on with nursing inpatient services, I have Mr. Yakeleya.
Thank you, Mr. Chair. I want to ask the Minister on the status of the requests by the Deline leadership community support on a sort of respite care or palliative care bed units in their community. There was some discussion with the previous Minister. I’m not too sure if this Minister is up to… We had some meetings with the Minister on that request from Deline. They’re asking for a bed or so for that community. I haven’t heard. It’s pretty quiet from the department as to what’s being communicated. This is an ongoing issue with the community and the Minister. Can I get a very brief update? Thank you.
Thank you, Mr. Yakeleya. Minister Abernethy.
Thank you, Mr. Chair. At this point our priority is actually to provide training to our community health nurses so they have the knowledge, skills and ability they need to provide palliative care in the homes, so supporting individuals in their homes as opposed to moving them to a different facility or building. Once we’ve completed that training, we are able to provide palliative support in people’s homes. We’ll be able to assess the effectiveness of that and that will help inform any future direction which could include supporting some palliative beds in some communities throughout the Northwest Territories.
Mr. Chair, that’s very strange. We were going in one direction and the Minister is talking about going in the other direction, training nurses for palliative care. I thought we were moving along there. Was this supported by the community of Deline to say, okay, we’re going to go through some training, and training the nurses to provide palliative care to the community nurses? Something has gone a little wacko here. Can I get the department to respond to this?
Mr. Chair, our challenge in this fiscally tight environment that we are all currently in is the cost of putting infrastructure in place, which will spend a vast majority of its time empty, is difficult, but we hear the communities loud and clear, all communities in the Northwest Territories who wish to have their residents as they’re going through the dying process who wish to be in home. We want to be able to support them to stay in their homes, including communities such as Deline. We want to make sure that our staff have the knowledge, skills and ability that they require in order to put support for palliative care in communities. From there, we’ll be able to make a better assessment as to whether or not it’s time to move forward with palliative care beds, which there is a significant cost to.
We’re still interested in having conversations with Deline in trying to find solutions, but in both scenarios, we do have to start by ensuring our staff have the knowledge, skills and ability to provide palliative support. Then, without the knowledge, skills and ability to provide that support, it doesn’t provide any level of care for our residents. We need to make sure that training is there as a starting point.
Mr. Chair, I’m certainly disappointed in the response from the department and the staff here on raising their hopes through discussion with the people of Deline and the palliative care beds. The Minister certainly gave reasons why this request shouldn’t be honoured and is making a left when he should be going down the right lane. I’m very disappointed by the department’s response and justifying why they’re not going to take Deline requests seriously as it was duly noted in my notes and the Minister’s meetings with the leadership and people of Deline in regards to this request. It’s been an ongoing, long, substantive request by the people in Deline. Certainly the Health department pulled the plug on this one here. I don’t even want to have a response to my comments here. I’ll leave it at that.
Thank you, Mr. Yakeleya. The Minister is flagging me for a response. Minister Abernethy.
Mr. Chair, I’m sorry the Member is disappointed. We are still interested in discussions with the community. We’ll continue to move forward with the community. We also see an opportunity here, a possible opportunity with the Deline self-government to move forward on this initiative, but at the same time, we still need to make sure that people have the training they need to provide the programs that are required in palliative care.
Thank you, Mr. Abernethy. Continuing on with nursing inpatient services, I have Mr. Moses.
Thank you, Mr. Chair. I think there’s some good discussion. I’m going to focus mine around the psychiatric nursing unit at Stanton and also just for the whole territory, what kind of psychiatric services we have. It’s also mentioned, there’s a little paragraph that talks about the unit includes beds for withdrawal management. How many beds exactly are in that psychiatric unit and how many are allocated for withdrawal management? Thank you, Mr. Chair.
Thank you, Mr. Moses. Minister Abernethy.
Thank you, Mr. Chair We don’t have beds dedicated to withdrawal management anywhere in the Northwest Territories, but we have beds that can be used for withdrawal management. The beds at Stanton aren’t in the psych unit for withdrawal management. They’re actually in the medicine unit. I believe the unit is 12 to 18 beds, but I will confirm the number of beds in the medicine unit. When individuals need medical withdrawal in the Northwest Territories, we have beds in Inuvik and we have beds in Stanton that can be used for those purposes.
What are we doing for the small communities that just have health centres and specifically with the eight communities that don’t have nurses that can provide any kind of medical treatment for anybody that might be going through some withdrawals? Thank you, Mr. Chairman.
In the communities where there are health facilities, individuals can go to those health facilities and get referral and be brought in, through medical travel, to utilize the detox beds in either Inuvik or Yellowknife, whichever happens to be closer. For the smaller communities that don’t have nurses, we do have other types of professionals in those communities like CHRs, CHWs that we can have conversations with and they can get a doctor involved to make a referral so that an individual could come out and receive withdrawal management services in either Stanton or Inuvik, whichever happens to be closer.
Just in terms of putting this type of responsibility on the workers in the small communities to now assess what a person is going through, what kind of training are they getting in terms of knowing when to call a medevac or when to admit somebody into a health centre until they get the proper treatment that they do have?
Their responsibility is often they’re required to get in touch with Stanton emerg or Med-Response. Med-Response is actually the organization now that they’d call in to and would help do an assessment and diagnosis to determine the urgency of the situation. Med-Response, as you know, involves having physicians on the line, nurses on the line and other professionals on the line who could actually do that assessment, and they would determine whether or not a medevac is required for medical detox or whether it was something that could be facilitated through medical travel. But the Med-Response team has the expertise to make that diagnosis, and the CHRs and CHWs that are out there in the communities have training on basic information and how to share that information with our professionals.
I know we’re unique in the North in terms of barriers and challenges, especially when it comes to the remote communities. I just want to make reference to a news article on CBC, I don’t know how many years ago, but they were talking to a psychologist or psychiatric physician that talked about not being able to do a correct assessment because he couldn’t see the individual and talk to him, so I think there are some flaws in there. I just want to put that out there.
In terms of withdrawal management, do we have a policy right now in terms of how long do we keep an individual who’s going through withdrawals so they can get the medical observations to see if there’s anything further needed such as psychiatric assessment, or whether they need to go to a psychiatric ward after they’ve gone through the withdrawals, and any cases in where somebody is self-harming and goes to the emergency ward? What are the steps taken by the Stanton or even Inuvik Hospital to ensure the safety of the individual? I’ve seen odd cases where as soon as the person sobers up they’re allowed to leave and it’s contravening our current Mental Health Act that we are currently using right now. Thank you, Mr. Chair.
