Marsi cho, Mr. Speaker. Committee wishes to consider Tabled Document 286-19(2), Main Estimates 2021-2022, Department of Health and Social Services. Marsi cho, Mr. Chair.

Thank you. Does committee agree?

Thank you, committee. We will take a short recess.

---SHORT RECESS

I will call Committee of the Whole to order. We will continue on with health and social programs. Minister, do you have witnesses to bring back in?

Thank you, Mr. Chair. Yes, I do.

Sergeant-at-Arms, will you escort the witnesses in, please? Minister, would you like to reintroduce your witnesses?

Thank you, Mr. Chair. With us today is Deputy Minister Bruce Cooper and Director of Finance Jeannie Mathison.

Thank you. Committee, we will continue on with health and social programs, beginning on page 179 with information on page 183. Questions? Member for Inuvik Twin Lakes.

Thank you, Mr. Chair. My questions are regarding the line item under Child and Family Services. There is an increase of $4 million. I know that it is probably due to the increased staffing that we see, but is there any work being done in that department for collaboration with Aboriginal governments on them taking over, or assuming parts, or a planning process, to children in care, assuming that part of the department? Thank you.

Thank you, Member. Minister.

Thank you, Mr. Chair. I want to make sure I am on the right page. Could the Member please say which page she is referring to?

Member.

One-eighty.

One-eighty?

Thank you. As the Member said, we have hired a number of additional staff in Child and Family Services to improve services to families who need additional support. That is reflected in the budget here. With respect to Indigenous governments creating their own regime for taking care of Child and Family Services, we are very supportive of that. We are prepared to collaborate with Indigenous government organizations and the federal government to make that happen. It's federal legislation that enables this to happen, and the federal government has announced funding available to Indigenous government organizations to pay for the cost of engaging in this process. Thank you.

Thank you, Minister. Member.

Thank you, Mr. Chair. My question was: is there dedicated staff within this funding to have that engagement in this budget with Indigenous governments, especially the ones who are saying they want to do this? Thank you, Mr. Chair.

Thank you, Member. Minister.

Thank you, Mr. Chair. At this point, we have expressions of interest from two Indigenous government organizations, and the lead on that is the territorial director of Child and Family Services. It's my understanding that, at this point, there isn't a need for additional staff, but we certainly don't want to hold up the process. The legislation provides timing for coming up with agreements once the negotiations officially start. If it turns out that we are not adequately staffed, we would certainly address that with a supplementary, if necessary. Thank you.

Thank you. Member.

Thank you, Mr. Chair. Going on to the next area, I am going to go into is the hospital services. It's more so within the whole hospital wellness, mental health, addictions. In this budget here, I'm looking at community mental health. I'm looking at all of these different areas. Hospital services, $142 million. I know this has been raised in the House over and over again. There are issues with medical travel navigation. There are issues with Indigenous patients not trusting the service. They are not getting the answers. They are not getting the direction that they need. They are not getting the support that they need to navigate through our healthcare system. Is there any place in this budget to have Indigenous patient advocates or people in the department to navigate our residents through? Thank you, Mr. Chair.

Thank you, Member. Minister.

Thank you. I will just say that the hospital services budget is spread through several different categories in this budget, and this particular one is about in-patients. That is what the Minister is referring to in terms of Indigenous navigators. We do have people in navigator positions at this point. There is a question about whether it would be a good idea to have more people in this position, and that is something that we are interested in exploring further.

That may or may not be connected to medical travel. What I mean by that is that, in a separate review of medical travel, which is in a different section, we are looking at the escort policy. The patient navigator may supplement that or assist patients as they come to all of the hospitals, no matter where they come from, but we are not really at a stage yet to say exactly what is going to be offered and where. This is one of the areas that the department is working on. Mr. Chair, I would like the deputy minister to continue on with this answer, please.

Thank you. Mr. Cooper.

Thank you. Member.

Thank you, Mr. Chair. I know I have raised it in the House, and I know we have health navigators who know where, if you need an application, you go here; if you need this, you go here; and you phone them and you know that. However, a lot of our elders and a lot of people who are coming into our hospitals from the small communities, Indigenous people, even within Yellowknife facility, that's a scary facility; even for somebody coming out of Inuvik, that's a scary facility. It's a big facility. You can get lost in there. That's more of a comment.

We keep talking about how, in order to bridge this gap between cultural safety and cultural awareness by having Indigenous nurses trained and hired; we talk about it for the teachers. This is not happening. There must be a way that we bridge that gap to have Indigenous nurses as pathfinders in these hospitals, as somewhere where people can feel safe and trust that they will help them. Indigenous people, I have found, even with my time, is that they don't like to ask questions. They don't want to push people. They don't want to bother anybody, and then you wonder why a lot of our people have cancer, and they wait too long and these types of things. Like I said, that's more of a comment.

I want to move down into the family violence prevention. I'm looking here, since 2019-2020, there is $4.020 million, and then, in the 2020-2021, there was $4.174 million; it hasn't really changed much. It's $4.178 in this main estimates. I know we just recently got the intimate violence report. I am just wondering if there is a response within this department, if there's money or there's staffing allocated, in this family violence prevention, or if it's mixed between different departments. I guess it's up to the Minister to explain that, to address this issue within the territory. We know it's one of the highest in Canada, in the Northwest Territories, of family violence, and these are the ones that are reported. There are many that go unreported. I'm just wondering, in this budget, how are they planning on addressing that? Thank you, Mr. Chair.

Thank you, Member. Minister.

Thank you. I am going to give two kinds of answers here. The first is specifically to family violence shelters. That's what this line item is for. In 2019-2020, there were new standards adopted for family violence shelters and a new funding model. While it looks like it hasn't gone up much, it actually did go up just right before the numbers that are in this budget. This pot of money is spent on the five shelters that we have in the NWT.

In terms of family violence prevention, that issue is really a whole-of-government issue. Health and Social Services has started to have conversations with Executive and Indigenous Affairs, where the women's secretariat is, and with Justice and other departments that deal with family violence, to talk about a whole-of-government approach to reducing those numbers. That would be a more strategic approach. What you are looking at in the budget here is the frontline approach. Thank you.

Thank you, Minister. We will now go to Mr. Norn.

Thank you, Mr. Chair. Just looking at page 180 on Child and Family Services, just in regards to my riding, I know that social workers, child protection workers, have a very, very tough job. I commend those guys because I understand there are very high turnover rates on that just because of the mere stress of the job. I know that, in one of my communities, in Deninu Kue, there was recently a change in staffing that left a position open. I am just wondering if that position was going to be filled in Deninu Kue. Thank you, Mr. Chair.

Thank you, Mr. Norn. Minister.

Thank you, Mr. Chair. This budget is at a very high level. It represents spending in big categories and not at the regional or health centre level. I don't have a specific answer to the Member's question. I will say that we do not contemplate eliminating any positions anywhere, so if there is a vacancy, then I am going to say that it will be filled. Thank you.

Thank you, Minister. Member.

Thank you, Mr. Chair. Thank you. That was good to hear. I mentioned in my Member's statement earlier that there are a lot of service gaps, and we try to make sure that we are always keeping on top of it and making sure that we don't have vacancies for extended periods of time because that means that our residents will go without some valuable services. Forgive me, too, that I have kind of inserted myself here right in the middle of this. If I am being repetitive here, my apologies. The other part of my question here: is the Department of Health and Social Services, in terms of mental health supports, are they working with the department of education and schools to promote mental health services and helping get mental health supports for students? Thank you, Mr. Chair.

Thank you, Member. Minister.

Thank you, Mr. Chair. The child and youth care counsellors program is a joint initiative of Education, Culture and Employment and the Department of Health and Social Services. It's a four-year phased-in project. In the next fiscal year, the one that starts April 1^st, these positions will be available in the South Slave. That's the last year of the four-year implementation in the South Slave, is the target there. That means that there will be counselling positions that are trained to a different standard than the current school counsellors, who will be available to help children and youth, whether they are in school or not in school, and they are available year-round. They're only tied to the school schedule. That is a program that we have on the go right now, and I'll just, through you, Mr. Chair, ask the deputy minister if he wants to add anything further to that. Thank you.

Thank you. Deputy Minister.

Thank you. Member.

Thank you, Mr. Chair. That's really good to hear. One of the biggest things I notice, especially when you have one department working on any sort of initiative, there always tend to be things lost in translation, so I'm glad there is some sort of agreement there to make sure that there are some clear lines and clear responsibilities because anytime there is something missed, then the whole think kind of runs amok. I'm glad to hear that there is some collaboration. Right now, even in times of COVID, mental health is a real issue now, and we have to make sure that we keep on top of it and not be so knee-jerky. I think it's really important that we keep on top of this. Just moving along a little bit, Mr. Chair, am I allowed to ask questions on page 181?

Yes.

There's a line here, medical professional development. I'm not sure exactly what that is. Can the Minister just describe what those funds are for for professional development? Thank you, Mr. Chair.

Thank you. Minister.

Thank you, Mr. Chair. The only information I have here is the description on the page that it is a grant to the NWT Medical Association for the professional development of eligible NWT physicians, so I'll ask the deputy minister if he can provide some additional information on this. Thank you.

Thank you. Deputy Minister.

Thank you. Member.

Thank you, Mr. Chair. Where I'm going with this is: one of the biggest things, in terms of medical treatment and medical services for our small communities, and I guess for all our communities in the territory, is that, if you want to effectively treat somebody or offer them the best service you can, you have to fully understand what their culture is like and what cultures are like in small communities and understand that. I think that would make a lot of our medical professionals better practitioners and help them hone their craft. It's a little tougher if you just insert somebody from the South and put them in, say, a small community and they don't quite understand kind of the ins and outs of that. My next question is: I don't know if this has been asked, but has there been more work done on cultural sensitivity and cross-cultural training in their department? Thank you.

Thank you. Member. Minister.

Thank you, Mr. Chair. Yes, the department has been working on cultural safety initiatives since the 2013-2014 fiscal year, and what we have focused on, to define what we're talking about with cultural safety, is initiatives that are designed to address inequities experienced by Indigenous residents when accessing our health services, to improve early childhood development indicators, enable seniors to age in place, and increase the number of mental health and addiction program supports. What we want is: we recognize that, because of historic factors, Indigenous people may not be accessing the healthcare system as much as they need to. The Mental Wellness and Addictions Recovery plan addresses this issue, and the specific Caring for Our People Action Plan sets out how we're going to accomplish cultural safety within our healthcare system.

There were a number of pilot activities that the department carried out to try and understand what worked best. They did 13 of these, and they have now finished with their pilot phase and are developing a framework on cultural competency which will be introduced in the Legislative Assembly once it has been endorsed by the NTHSSA leadership council. This is really, in my opinion, well on its way to being embedded in the everyday work of the department that people take this training and they learn about the operating environment from a cultural point of view. What we are looking for as a result of this is that more staff are trained in cultural competency and that patients express greater satisfaction with the services that they have received. When those numbers start to go up, we'll know that we have started to meet our targets in this area. Thank you.

Thank you. Member.

Thank you, Mr. Chair. Thank you for that response. I'll just finish up with a short comment. I think we need to start collaborating more, working with our Indigenous governments and working at the community level. Yes, I support my colleague from Inuvik Twin Lakes on having kind of those buffers to help bridge those cultural gaps, and I'm hoping we see some more work done in that area. Mahsi cho, Mr. Chair.

Thank you, Member. I'll take that as a comment. Next, we'll go to Mr. Bonnetrouge.

Mahsi, Mr. Chair. I'm sure the Minister is well aware of my concerns about the local health centre and the staff issues there. Many of my people, my community members, have complained to me about the goings-on within the health centres. They are questioning the competencies and experience of staff, particularly nurse practitioners, the nurses, within the health centre. I'm wondering if there is a bare minimum of qualifications required to work in a small health centre. I wonder if the Minister could enlighten me on that. Mahsi.

Thank you, Member. Minister.

Thank you, Mr. Chair. I want to express some concern about us identifying people who are working in small communities in a limited number of jobs. I don't think it's fair for us to discuss their competence or qualifications in this forum. They are not here to defend themselves. We don't have the level of detail, because this is a high-level departmental budget, to provide that level of information. We have standards for health professionals, standards of education and experience that they have to meet, and there are also professional qualifications that are set out by the Registered Nurses Association and the NWT medical association. This is an area in which we want to provide qualified care, obviously, but I'm not going to be able to discuss the qualifications of people who work in the Member's community. Thank you.

Thank you, Minister. Yes, and if we could, keep the questions to the line items and to the budget itself. This is not a forum to name people, especially in the smaller communities where everybody knows everybody. Mr. Bonnetrouge.

Thank you for that, so I will dispense with my line of questioning in this area here. We had concerns that there was no communication with the community at all from any of the workers there, whether it be nurse practitioner, social services, community. There is no interaction with the community whatsoever. Anyways, so that is leading to a lot of problems there. I am just wondering on the next page, page 181, the Child and Family Services items there, I know they have a group out of Yellowknife who provides that service. I am just wondering if there is any future look into having First Nations take over a file like this in the communities. Mahsi.

Thank you, Member. Minister.

Yes.Thank you, Mr. Chair. The Assembly of First Nations worked with the federal government to develop a child and family services law that became law in January of 2020, and this provides for sovereignty of First Nations to provide child and family services care. We, the Department of Health and Social Services in the NWT, fully endorse this law and the sovereignty of First Nations to provide this care, and we are more than happy to collaborate with them and with the federal government in having communities take this jurisdiction on and provide child and family services care that meets both the national requirements and local expectations. As I mentioned to the Member for Inuvik Twin Lakes, two jurisdictions have expressed an interest in taking this area on, and the federal government does have money to assist these jurisdictions with capacity to negotiate and create their own regime. This is an area that we are very interested in seeing develop over the next few years. Thank you.

Thank you, Minister. Member.

[Microphone turned off] ...questions.

As there are no further questions, please turn to page 180. Health and Social Services, health and social programs, operations expenditure summary, 2021-2022 Main Estimates, $337,150,000. Does the committee agree?

Thank you. Long-term and continuing care services, beginning on page 184, with information items on page 187. Questions? Ms. Semmler.

Thank you, Mr. Chair. Just looking at the program detail, homecare and support services, it's very obvious we have gone from, in the 2020-2021, $11 million, and then it increased to $20 million, and it is remaining status quo. I know that they were talking about putting more home support workers, more hours into home support workers in the communities. Is that what that money is, or what is in that extra $10 million?

Thank you, Member. Minister.

Yes. Thank you. Yes, the Member is correct. The biggest portion of this increase, $8.4 million, comes from the First Nations and Inuit Home and Community Care funding from the federal government, and it's reflected in various categories through this budget. One million dollars is for staff to pay for unfunded elements of the collective agreement in this area. We also have a very innovative program going with Aurora College where we are doing some workforce planning with them to train people to work in long-term care as personal support workers and nurses, and so we are collaborating with Aurora College and providing some funding for that. We are also addressing again a staff funding shortfall at Avens, so that comes out to $11.3 million. Thank you.

Thank you, Minister. Member.

Thank you, Mr. Chair. Within that homecare and support services, and I see that there is long-term care and supported living, the Minister has said that there is training with the college. Within the department, is there staff looking at addressing the issue with the job descriptions where a lot of Aboriginal people who are taking Aurora College are finding they are hitting a barrier when they do not have the one year of experience as to entering after they have just finished taking the personal support worker and have been working in their practicum within these facilities? Thank you, Mr. Chair.

Thank you, Member. Minister.

Yes. Thank you, Mr. Chair. I would like to refer this question to the deputy minister. Thank you.

Deputy Minister.

Thank you. Member.

Yes. Thank you. Also looking at long-term care and supported living, my colleague and I, we had discussed this, and we have heard the stories over the past year. I addressed it, I think it was in the fall time, and I addressed it in the spring time sitting, that a lot of our elders are in long-term care. I know we have opened it up so some of them can have one visitor and things like that. Within this fund, within this budget, is there extra funding in there or are there COVID dollars that the Minister is accessing to try to get extra community staff or support so that some of the elders who are in our long-term care are not being left alone? Because we have heard the stories of the families. I have seen the pictures of people visiting outside the window. We are lucky in Inuvik that it's ground level, and they could stand outside the window. That is not the case for most long-term cares, so I am just wondering if there is, in this budget here, because it is ongoing. We are losing our elders, and our elders are lonely in these facilities. Is there money in this budget for extra staffing or some safety mechanisms to try to have them be able to see more family and visit or things like that? Thank you, Mr. Chair.

Thank you. Minister.

Yes. Thank you. This is really a heartbreaking situation for elders. They tend to have a smaller social circle as they age, and COVID, of course, has made that even smaller. This is really not a budgetary issue. This is an issue of public health, and what I have heard the Chief Public Health Officer say is that, when most of the population has received a second dose of COVID-19 vaccine, it will be possible to relax internal restrictions, internal in the NWT, and that may include things like visiting long-term care centres. Right now, that does not happen because it is considered to be too risky. That is why there is only one designated person who goes in. In terms of this budget generally, this budget does not provide for spending related to COVID because we do not have any money that is related to COVID that goes beyond the end of this fiscal year. However, if the situation drags on and it looks like finances are an issue, I think that we would certainly revisit this area.

Thank you, Minister. Member.

Yes. Thank you, Mr. Chair. Okay. No, I just wanted to make sure. We look at and see the homecare. We see long-term care. When you're in a community the size of mine, you see people working in long-term care, going from house to house. They would have different jobs. They have different circles, and then they have family circles. They take precaution to go in. I get that the CPHO has put these rules in place to protect our most vulnerable elders, but on the other hand, I also think there's some mechanism in there for maybe some extra support for that so that people are able to do the things that the staff are doing to go in and visit and have that. It's almost been a year, Mr. Chair, and I'm looking at this budget. I don't know if that's going to have anything to do with it, but if there's money in there for extra PPE or anything like that for family members and maybe some, if they want to have more family to see them, a space where people can go in and meet individually so that it's more regularly, if that's going to cost more? I don't know. Thank you, Mr. Speaker.

Thank you, Member. Minister.

Thank you. I think for me, I'm really waiting to get to the point where most people have had their second shot, and we have a better understanding of not only of our immunity, but whether the vaccine is effective in stopping the transmission of COVID so that we can return to life as normal, in so many ways, and especially in this way. What I can say is that, while nothing is planned now, this time last year, nothing was planned either. We can change our minds and come back and meet the needs that we see through a supplementary appropriation. Thank you.

Thank you, Minister. Member.

Thank you to the Minister for that, and this is more just, the last is just a comment. We've heard really good success of uptake of vaccine in our small communities, which is great. We don't have that for our regional centres, and that's where our long-term cares are. That just extends that time. Being in the regional centre, I do know a lot of people that are hesitant to even get the first or second, like to even get vaccinated. I think that poses the issue, and that's why I'm raising it because our small communities are getting vaccinated at high rates than our regional centres. Thank you. It's more of a comment. Thank you.

Thank you, Member. Minister, would you like to comment?

Sure. The month of March is going to be a very big month for first doses, if required; second doses, for sure. There will be vaccines available in just about every community in the NWT. I'm really hoping that, by the end of March, we will have good uptake in the regional centres. I know that there are various people and organizations, like Hotii ts'eeda, even the NWT Association of Communities, who are really promoting getting vaccinated, and I appreciate those efforts. I think that all of us who are working from an evidence-based decision-making point of view need to encourage vaccination. It is the single best thing that the person can do for themselves, even the Queen said so. Thank you.

Thank you, Minister. Member.

No further questions. Thank you.

Ms. Nokleby.

Thank you, Mr. Chair. I just wanted to start by saying I'm glad to see the increase in funding to the seniors fund. I think that's always worthwhile and just hope that there's also a mandate for a push alongside of that to ensure that the services are expanding out into the communities and are not just Yellowknife-focused, especially with additional money. I did notice that the respite fund -- maybe I could just first ask: there's a bit of a bounce around in numbers there, and perhaps, maybe the Minister of the department can speak to why the actuals were so low in 2019-2020 versus the revised estimates for last year and then, of course, the proposed estimates? Thank you.

Thank you, Member. Minister.

Thank you, Mr. Chair. I'd like to refer this question to the director of finance. Thank you.

Director.

Thank you. Member.

Thank you, Mr. Chair. I'm really glad to hear it's not disappeared for the upcoming year. When I look at the disabilities fund and then the respite fund, as well, just being a little less and such, I'm just wondering, as we see a change in how long-term care facilities are looked at as a result of COVID and then, as well, our mandate and priority to age in place, I'm just wondering if the department is tracking potential trends in keeping seniors at home or people with disabilities at home as opposed to group home situations and whether or not we're going to have to increase funding in these areas to support organizations doing that? Thank you.

Minister.

Yes. Thank you. We recently completed a long-term care bed study, and for that, we used 10 years of data that tracked what age people were when they went into long-term care and what level of acuity they were at in terms of service need. We have a pretty good idea of when people need to move out of their independent living. We also, of course, provide homecare throughout the NWT, so there are metrics about how many people require homecare and what kinds of services they need. For more detail, though, I'll ask, Mr. Chair, if I can refer this question onto the deputy minister.

Deputy Minister.

Thank you. Member.

Thank you, Mr. Chair. I'm really glad to hear all of that and would welcome, at any point, more information on that and to have feedback, et cetera, as well. One of the things that I remember discussing when I was campaigning was the idea or trying to come up with ways of increasing Indigenous businesses in small communities. Also, I was thinking around the lines of keeping elders at home, as well. Is there a potential or has the department considered creating small businesses in communities where there is like a small boarding home or such that the development corporation takes on and runs and then the department contracts the services for the care for the elders to that group? There's a business creation program. Then there could also be a training component for local youth and young adults that, then, they can learn to take care of their elders, which is a skillset that can then be transferred throughout Canada if they do decide they don't want to stay in the North. I just think this is an area where we really are going to have to think outside the box, and it's always been a story that, when I've travelled through the North and into communities, that's really heartbreaking because you hear it time and again. A good friend just recently lost his father who spent the last few years in Norman Wells when the family was in Tulita. I just wonder if that's an area, perhaps, maybe the department is interested in looking at, is sort of an Indigenous-run, small boarding home for supportive care? Thank you.

Thank you. Minister.

Yes. Thank you. The reason that the long-term care is offered in regional centres is that we need some efficiencies in the number of beds and the number of staff for the 24/7 responsibility, so it's turned out that, in the smaller communities, we just can't get to that economy of scale to provide for full supportive living, which would include nursing care as well as care aides. In terms of whether there has been any discussion to create a business or training component to situate in small communities, I am not aware of that, but I will ask the deputy minister if he is. Thank you.

Thank you. Deputy Minister.

Thank you. Member.

Thank you, Mr. Chair. I am glad to hear that, too. I get that there is a certain degree of technical expertise that is required for certain types of facilities. However, even if it's a matter of a senior who has a dilapidated home and, therefore, now they are getting moved out of it into a long-term care facility, if they don't need a large degree of care, I don't see why we can't have a lesser, sort of, care worker or lesser-educated care worker there to help them. That's great, and I look forward to learning more about the paid caregiver pilot program. It never made sense to me that we make people go out to work so that their family member can then have someone else come in that the government then pays for to look after them. Glad to hear that. My last questions are just around the active positions. I noted that we have gone up four positions, and I am reading it right today if I wasn't yesterday. It's all-in headquarters. My question would be: are these all administrative functions for the department or administrative roles that do need to be in one place, as we've said, or are some of these employees actual care and support workers for patients or long-term people? Thank you.

Thank you. Minister.

Thank you, Mr. Chair. These four positions are funded under the First Nations and Inuit Home and Community Care funding. The first is a senior nursing consultant. The second is a project manager. There are two health planners in continuing care. All of these positions are located at headquarters where the rest of our policy functions are located. Thank you.

Thank you. Member.

Thank you, Mr. Chair. I will just get in one last plug to always try to put some of those positions out in the communities if we can and work on our mandate priority. Thank you.

Thank you. Member.