Question has been called. All those in favour? All those opposed? Any think abstentions? The motion is carried.

---Carried

Reports of standing and special committees. Member for Kam Lake.

Thank you, Member for Kam Lake. The motion is in order. To the motion?

Thank you, Mr. Speaker. Mr. Speaker, I move, seconded by the Member for Great Slave, that Committee report 59-19(2), Standing Committee on Social Development Report on the Review of Bill 77: Nursing Profession Act, be received and adopted by the Assembly. Thank you, Mr. Speaker.

Reports of standing and special committees. Member for Kam Lake.

Introduction

Bill 77: Nursing Profession Act (Bill 77) received second reading on March 29, 2023, and was referred to the Standing Committee on Social Development (Committee) for review. Bill 77 repeals and replaces the Licensed Practical Nurses Act (Act), which has only had minor amendments since coming into force in 2004. It is intended to improve regulatory function by establishing a single regulatory framework for all nurses in the Northwest Territories (NWT). It will also standardize the assessment of credentials and oversight of nursing practices under one regulatory structure.

Bill 77 was developed through close collaboration with Registered Nurses Association of Northwest Territories and Nunavut (RNANTNU), which will be renamed the College and Association of Nurses of the Northwest Territories and Nunavut. Regulatory bodies of this kind have been established in other jurisdictions.

Bill 77 changes the following:

• Repeals the Licensed Practical Nurses Act and transfers the authority of RNANTNU;
• Establishes new nursing designations, scopes of practice, registers, and associated requirements for Licensed Practical Nurse, Registered Nurse Authorized Prescriber,
• Registered Psychiatric Nurse, and Registered Psychiatric Nurse Authorized Prescriber;
• Allows Registered Nurses and Registered Psychiatric Nurses who meet certain qualifications to order and interpret specific diagnostic and screening tests, make diagnoses, and prescribe specific medications;
• Updates the complaints and discipline process, including the appointment of a Complaints Officer;
• Adds a requirement for employers to report to RNANTNU if they terminate a nurse, or if the nurse chooses to resign instead of being terminated, due to unprofessional conduct;
• Adds by-law making powers to regulate the practice of nurses, including nurses who practice solely through virtual care; and
• Modernizes language.

Committee Considered Public Input

Committee sought public feedback on Bill 77 with a public notice and targeted engagement letters. Committee received written submissions from the Canadian Nurses Protective Society (CNPS), Scott Robinson RN, and RNANTNU which are appended to this report.

On May 10, 2023, Committee held a public hearing to review Bill 77. At that meeting, Committee heard remarks from the Minister of Health and Social Services and her staff, and they received oral comments from RNANTNU and the public. Committee thanks all these participants for their engagement.

One area of concern identified was the need to provide clarity and certainty with respect to the complaints process. Committee agreed with this concern. RNANTNU stressed the need to redact information in the complaints summary to protect client health and other sensitive information. In response, Committee stressed the importance of procedural fairness, specifically that nurses should receive full, unredacted copies of complaints made against them.

Committee also had concerns about how complaints regarding unprofessional conduct would be addressed by the new statutory officer created by Bill 77, and asked questions about complaints related to Cultural Safety competencies and standards of care for Indigenous residents and those living in small communities. The Minister referred to Living Well Together: Indigenous Cultural Awareness and Sensitivity Training for GNWT employees, and RNANTNU discussed existing standards of practice with respect to Cultural Safety during the public hearing. While these continuing Cultural Safety initiatives are important, Committee stressed the need for nurses to provide culturally safe care in the NWT. Committee was initially concerned about changes to the scope of practice, job descriptions, and change of pay for some nurses. For instance, Registered Psychiatric nurses will see major changes with Bill 77 because they will now be regulated in the NWT.

Committee also asked questions about whether the Government of the Northwest Territories was corresponding with Nunavut on amendments to the Act and heard that the territories were working together but not aligned legislatively. RNANTNU maintains it will be able to operate under the NWT and Nunavut's respective Acts governing the practice of nursing in both jurisdictions.

One area that CNPS and other members of the public identified was the need to provide clarity around insurance and protection, as well as the appeal mechanism for respondents ordered to pay costs during the complaints process. Committee shared these concerns.

After careful consideration, Committee supported six motions amending Bill 77. Three of these proposed amendments were the direct result of public engagement. Committee negotiated the exact wording with the GNWT. The other three proposed amendments were non-contentious: two corrections were made to French language clauses in the Act, and one was an agreed upon change regarding insurance and liability protection.

Committee Amended Six Clauses

Motion 1

Both Committee and the GNWT supported the submission made by CNPS to amend Clause 20 of Bill 77 by adding the words “liability insurance or protection” to paragraph 20(1)(t), striking out "liability insurance." A motion reflecting this change was drafted and passed at the clause-by-clause review.

Motions 2 and 4

While Committee noted the mechanism in place to appeal decisions, submissions during public engagement noted this would not apply to costs of investigations in situations where complaints were dismissed by the Board of Inquiry.

Two motions related to this issue were drafted. The first proposed that Bill 77 be amended by adding language “establishing the procedure to be followed in appeals of directions to pay the costs of investigations” after clause 20(1)(z.19). The second amended clause 67 by introducing substantial changes regarding an “Appeal of Direction to Pay Costs of Investigation” where a hearing was not required 67.1(1), concerning notice of direction 67.1(2), appeal 67.1(3), referral to the Board of Inquiry 67.1(4), and language clarifying an order as to costs 67.1(5). The Minister concurred with both motions, and they were passed at the clause-by-clause review.

Motion 3

Committee feels that it is procedurally fair for nurses to receive full, unredacted copies of complaints made against them. Committee also noted that while nurses are entitled to receive a copy of a complaint made against them under the Act, they may be unaware of this right.

The GNWT and RNANTNU remain concerned about protecting client health information, and redacting potentially vexatious material from complaints, and therefore prefer to provide summaries of complaints.

After negotiation with the GNWT, a motion was drafted concerning “notice of right to receive copy of complaint” which proposed to amend clause 56(5) by adding “(5.1) A summary of a complaint provided under paragraph (2)(a) or (5)(a) must include a statement advising the respondent of the right to receive a copy of the complaint under paragraph (2)(b) or (5)(b) on request.” The Minister concurred with the motion, and it was passed at the clause-by-clause review.

Motions 5 and 6

Committee agreed to support the GNWT's recommendation to correct the French versions of clause 70, under the heading “Renvoi à une commission d'enquête” and 119(3), by striking out "qui n'est pas un médecin" and substituting "qui est un médecin." Two motions reflecting these amendments were drafted and passed at the clause-byclause review.

Conclusion

On May 31, 2023, Committee held a clause-by-clause review.iv Committee passed the motions to report Bill 77, as amended, to the Legislative Assembly as ready for consideration in Committee of the Whole. In the House on June 1, Bill 77, Nursing Profession Act, was orally reported as ready. On June 2, Bill 77 was cited in the Orders of the Day as one of the items under Consideration in Committee of the Whole of Bills and Other Matters.

This concludes Standing Committee on Social Development's review of Bill 77: Nursing Profession Act.

Question has been called. All those in favour? All those opposed? Any abstentions? The motion is carried.

---Carried

Thank you, Member for Kam Lake. The motion is in order. To the motion?

Thank you, Mr. Speaker. Mr. Speaker, your Standing Committee on Social Development is pleased to provide its Report on the Review of Bill 77: Nursing Profession Act.

Mr. Speaker, I move, seconded by the Member for Great Slave, that Committee report 59-19(2), Standing Committee on Social Development Report on the Review of Bill 77: Nursing Profession Act, be deemed read and printed in Hansard in its entirety. Thank you, Mr. Speaker.

Reports of standing and special committees. Member for Kam Lake.

Introduction

Bill 80: Dental Hygienists Profession Statutes Amendment Act (Bill 80) received second reading on March 30, 2023, and was referred to the Standing Committee on Social Development (Committee) for review. Bill 80 is a private member's bill, sponsored by the Member for Kam Lake, to amend the Health and Social Services Professions Act and the Dental Auxiliaries Act. This Bill proposes to provide dental hygienists with the option to work independently of a dentist. Specifically, Bill 80:

• • • Will require the Minister of Health and Social Services to recommend to the Commissioner regulations under the Health and Social Services Professions Act, on or before March 31, 2024;
    • Designate the profession of dental hygienists as a profession, effective April 1, 2024;
    • Transfer the regulation of dental hygienists from the Dental Auxiliaries Act to the Health and Social Services Professions Act, effective April 1, 2024; and
    • Replace gender specific language in the Dental Auxiliaries Act with gender neutral language.

This report outlines key events leading up to the introduction of Bill 80; describes Committee's engagement with the public; and summarizes stakeholders' positions and Committee's decisions on key issues.

Committee Welcomes Improvements to Oral Healthcare

The purpose of Bill 80 is to permit dental hygienists to work independently of a dentist. Currently, under the Dental Auxiliaries Act, all dental hygienists working in the NWT must be supervised by a dentist. Section 6 of the Dental Auxiliaries Act reads:

6. No dental hygienist shall practice dental hygiene except under the direction and control of a dentist who assumes direct professional responsibility for the patients in respect of whom the services are being provided.

On May 12, 2023, Committee held a public hearing on Bill 80. Committee heard comments focused on the important role of oral health in preventative healthcare, and its significance within the overall health of individuals. Members expressed concern with the current state of oral healthcare delivery across the NWT, especially in small communities and regional centres. Members also voiced concern about the lack of equitable access to preventative oral healthcare across the NWT. Committee agreed unanimously with the intent of Bill 80 and all Members agreed to support it.

While the Department of Health and Social Services (the Department) did not present at the public hearing, Committee did meet with the Minister to discuss the Department's concerns with the Bill. Committee also exchanged correspondence with the Minister to try reaching consensus on an agreeable timeline for when the proposed changes within Bill 80 will take effect.

The Minister stated that the estimated timeline for the Department to complete the work within Bill 80 would take up to four years to complete. The Department also sent draft motions to amend Bill 80 with the dates of July 31, 2027, and August 1, 2027, as the dates of enactment for professional designation of dental hygienists, as well as the date for the creation of dental hygienist regulations, respectively.

However, Committee did not agree with the proposed amendments from the Department and advanced motions with a more aggressive timeline to implement the regulatory work.

AMENDING BILL 80's TIMELINES

Committee held a clause-by-clause review with the Member for Kam Lake on August 10, 2023. Committee engaged with the Member for Kam Lake on a compromised date of enactment on the Bill's proposed timelines. Committee then passed two motions to amend the Bill's timelines for when dental hygienists become a designated profession, and the date by which the Department shall establish dental hygienist regulations.

Originally, clauses 1 and 2 of Bill 80 read:

1. (1) The Health and Social Services Professions Act is amended by this section.

(2) Section 5 is repealed and the following is substituted:

5. (1) The Commissioner in Executive Council may, by order, designate professions to which this Act applies.

(2) The profession of dental hygienists is designated as a profession to which this Act applies, effective April 1, 2024.

Additionally, the original wording for Clause 3 read:

(3) The following is added after section 67: 67.1. (1) The Minister shall, on or before March 31, 2024, recommend to the Commissioner regulations under section 67 to regulate the practice of dental hygienists.

(2) Before recommending regulations under subsection (1), the Minister shall consult with

a) Indigenous governments;

b) the Canadian Dental Hygienists Association; and

c) dental hygienists actively practicing in the Northwest Territories.

Committee proposed two motions to amend the timelines (included in Appendix 1). These amendments will extend the timelines proposed in the Bill to December 1, 2025, and November 30, 2025, respectively giving the Department more time to enact the proposed legislative changes. Committee believes these amendments, which will come into force approximately halfway through the 20th Assembly, will be a sufficient timeline for the Department.

On August 10, 2023, at the clause-by-clause reading of Bill 80, the Member for Kam Lake, sponsoring Member of the Bill concurred with these amendments.

Committee Considered Public Input

Committee sought public feedback on Bill 80 with a public notice and targeted engagement letters. Committee received written submissions from:

- Ms. Nadja Lennie;

- Ms. Ashley Morine; and

- Hon. Julie Green, Minister of Health and Social Services.

All written submissions are included in Appendix 2 to this report.

Moreover, during the public hearing on Bill 80, Committee heard remarks from the Member for Kam Lake, along with Mr. Todd Orvitz, CAO of the Inuvialuit Regional Corporation, and Ms. Nadja Lennie, owner of Fireside Denture Clinic. Committee thanks Mr. Orvitz and Ms. Lennie for their engagement. Their participation helped inform Committee discussions on key issues for future consideration.

Committee Recommends Urgency in Oral Preventive Care

Committee strongly agrees with the Member for Kam Lake's concerns about the lacking areas of oral healthcare delivery within the NWT. Committee supports the intent of Bill 80 and acknowledges that the Department has stated its support of the Bill's intent as well. Committee considers oral healthcare as an urgent matter that must be addressed by the Department sooner, rather than later. While the amended Bill sets fall 2025 as the deadline for a new designation and regulations for dental hygienists, the Department should aim to complete this work even sooner.

In addition, during the public hearing on Bill 80 the CEO of the Inuvialuit Regional Corporation (IRC) stated that their organization had recently established a Memorandum of Understanding with the Northwest Territories Health and Social Services Authority (NTHSSA) enabling IRC to employ their own practicing dental hygienist under the direction and control of the NTHSSA's contracted oversight dentist. Committee believes this type of arrangement is a great interim option to increase access to oral preventive care while the department works on designating dental hygienists a profession and creating accompanying regulations. Committee would like to see similar types of agreements as that between the IRC and the NTHSSA be established with other communities and organizations that deliver health services. Therefore, Committee recommends the following:

Recommendation 1: The Standing Committee on Social Development recommends that the Department of Health and Social Services increase efforts to improve oral preventative care in communities. This work should include:

• • • Providing interim options for dental hygienists to work independently of a dentist prior to fall 2025; and
    • Ensuring Indigenous Governments and other organizations that deliver health services are aware of other options to provide oral preventive healthcare.

CONCLUSION

On August 10, 2023, Committee held a clause-by-clause review. Committee passed a motion to report Bill 80, as amended, to the Legislative Assembly as ready for consideration in Committee of the Whole.

This concludes the Standing Committee on Social Development's review of Bill 80: Dental Hygienists Profession Statutes Amendment Act. Typically, Committee includes a recommendation in each report requesting a response from government within 120 days. The recommendation is then moved as a motion in the House and Cabinet is required to respond. However, since the 19th Legislative Assembly will dissolve in less than 120 days, Committee has decided to leave out this recommendation and requests that the government provide a public response to this report, even of a preliminary nature, before the beginning of the 20th Assembly.

Question has been called. All those in favour? All those opposed? Any abstentions? The motion is carried. Bill 80 is deemed read.

---Carried.