Thank you, Madam Speaker.
Extend work on cultural safety throughout government
The importance of cultural safety extends beyond addictions services. Committee wants to see work to understand, enhance, and measure cultural safety applied to other areas at the health authorities and in the GNWT. The department should outline how it will build on its most recent cultural safety action plan, Caring for Our People, in the months and years ahead. Committee therefore recommends:
Recommendation 6
That the Government of the Northwest Territories conduct a whole-of-government review of cultural safety in all standards and policies associated with GNWT programs and services and provide a timeline for implementation. This review should identify barriers to cultural safety to inform efforts to remove or reduce identified barriers.
Prioritize revised hiring practices
The work plan aims to revise hiring practices for addictions positions that formally recognized the value of Indigenous qualifications by 2023-2024 fourth quarter. Members believe this work should be completed sooner.
Work on job descriptions and hiring practices should have already been underway before the work plan was developed. The Department of Finance's Indigenous Recruitment and Retention Action Plan contains five action items to increase Indigenous representation at all departments and agencies, including at the health authorities. That plan was launched almost one year ago, in November 2021. The department and health authorities should collaborate with the Department of Finance to expedite this work plan commitment. Committee therefore recommends:
Recommendation 7
That the Department of Health and Social Services and health and social services authorities, in collaboration with the Department of Finance, prioritize their commitment to revise hiring practices for addictions positions to recognize the value of Indigenous qualifications. Committee further recommends the timeline for this work to be moved up by six months, to the second quarter of 2023-2024.
Incorporate Indigenous knowledge into standards of practice
While the work plan commits to revising the hiring process to recognize the value of Indigenous qualifications, it does not explicitly extend that logic beyond the hiring phase and specifically to standards of practice. Western medical standards create barriers to cultural safety for Indigenous residents. They make it harder for Indigenous people to gain accreditations to become healthcare providers within the system. They also distort the measurement of outcomes. Indigenous people lead different lives than non-Indigenous people. The desired healthcare outcomes for Indigenous people do not always match those defined by Western standards.
Indigenous standards of practice are also a matter of rights. Article 24.1 of the United Nations Declaration on the Rights of Indigenous Peoples declare that "Indigenous peoples have the right to their traditional medicines and to maintain their health practices." Committee therefore recommends:
Recommendation 8
That the Department of Health and Social Services and health and social services authorities review and adjust standards of practice to recognize the value of Indigenous knowledge and provide a timeline for implementation.
Set up mechanism for staff-identified changes
To complement the work plan's top-down, holistic approach, committee proposes a bottom-up mechanism for healthcare staff to identify improvements. This will empower frontline staff to develop, implement, and communicate creative solutions in real time while the larger policy approach is in development.
Committee is not aware of any such mechanism, available system-wide, to drive bottom-up change. Frontline workers have an important perspective on the challenges in service delivery. They may be able to propose out-of-the-box solutions not conceived elsewhere. Committee therefore recommends:
Recommendation 9
That the Department of Health and Social Services and health and social services authorities set up a distinct method for frontline staff to identify barriers to care and cultural safety or propose better practices and policies on an ongoing basis and provide a timeline for implementation.
Reach those at risk who do not use addictions services
A key concern for committee is overcoming barriers to risk at each individual who does not access addictions services. The Auditor highlighted the need to gather data from individuals who are not service users. Committee believes the work plan can go farther to reach at-risk individuals and therefore recommends:
Recommendation 10
That the Department of Health and Social Services collect and analyze data from residents who do not use GNWT addictions prevention and recovery services, to identify creative ways to remove barriers and make services more culturally safe and provide a timeline for implementation.
Secure federal support to set up healing centres in the NWT.
Members have heard repeated cries for one or more in-territory healing centres. Right now, Northerners who want to access facility-based addictions treatments must leave the NWT to receive this service. Neither the audit nor the work plan provide a determination on whether the NWT should set up in-territory healing centres. The auditor noted that the lack of in-territory facilities could create barriers for some clients, including those concerned that southern treatment may not reflect their culture. However, the auditor stopped short of recommending a healing centre. The work plan is silent on the matter.
By contrast, the Truth and Reconciliation Commission's Call to Action No. 21 is quite clear. It states: "We call upon the federal government to provide sustainable funding for existing and new aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority."
The federal government recently made good on this Call to Action for Nunavut. Canada is providing nearly $50 million to support up to 75 percent of the construction costs for the Nunavut Recovery Centre. Nunavut's centre will be based on Inuit cultural practices and provide a range of treatment and healing interventions. Canada will also provide $10 million in ongoing annual operating support.
Between Call to Action No. 21 and Nunavut's recent precedent, committee believes it's time for the GNWT to secure federal support for one or more healing centres in the territory. This should include immediate access to detox centres in each region. Committee therefore recommends:
Recommendation 11
That the Government of the Northwest Territories, in collaboration with Indigenous governments, pursue federal funding to help set up healing centres in the Northwest Territories.
Strengthen the follow-up process
Present performance measures and regular reporting
Committee wants to ensure that the department demonstrates its progress towards achieving the work plan's expected results. One potential risk, in this regard, lies in the lack of disclosure on performance measures. The work plan that the department presented at the October 6th public briefing contained activity measures to describe what work would be done. The work plan also included high-level statements on expected results. But missing were specific performance results that are easily measurable.
Committee is aware that the auditor required the department to comply with word count limits. More detailed aspects of the work plan, like performance measures, may not have fit within the publishing constraints. Committee wants to see performance measures and regular public reporting on progress towards associated targets. Committee therefore recommends:
Recommendation 12
That the Department of Health and Social Services present performance measures for each activity in the Addictions Prevention and Recovery Work Plan and provide a timeline for implementation. The department should report on progress with:
- A web-based tracker, similar to ECE's Action Plan to Improve Student Outcomes Progress Tracker, on a quarterly basis; and
- A public briefing at committee, in spring or summer 2023 before the 19th Assembly ends.
Madam Speaker, I would like to pass the final reading of this report back to the MLA for Yellowknife North. Thank you.