Question Period Note: Medical transportation and counselling in Nunavut

• We know that medical transportation is necessary to ensure individuals in Nunavut have access to the health services they need. We are supporting that.

• The territorial government receives funding to run its health system through various transfer payments, and for a portion of the medical transportation costs for Inuit residents.

• In 2020-21, Indigenous Services Canada is allocating $64.7 million, which includes an increase of up to $20.2 million from 2019-20, to the Government of Nunavut to directly support medical transportation through a co-payment approach on flight costs.

Health services in the North
The responsibility for delivering health services is shared by the federal and provincial/territorial and Indigenous governments, including the provision of mental health services. The federal government supports First Nations and Inuit community mental wellness through a number of programs and services. Specifically, through the First Nations and Inuit Health Branch, ISC supports and funds mental wellness programs and services in five key areas: community based mental wellness services; the Indian Residential Schools Resolution Health Support Program; the Non-Insured Health Benefits Program Mental Health Counselling Benefit; the First Nations and Inuit Hope for Wellness Helpline; Jordan’s Principle and the Inuit Child First Initiative.
Since 2017, the Government of Canada has contributed $228.1 million over 10 years in Nunavut in the community-led Nunavut Wellness Agreement. Furthermore, Budget 2019 announced an additional investment of $50 million over 10 years to renew and expand the reach of Inuit Tapiriit Kanatami’s National Inuit Suicide Prevention Strategy.
A Memorandum of Understanding outlining the roles and responsibilities of ISC, the Government of Nunavut, and Nunavut Tunngavik Incorporated for both the construction of the Nunavut Recovery Centre and its ongoing operations was signed by all three parties on October 2, 2020.
Medical transportation in Nunavut
Nunavut is a vast territory made up of 25 small and isolated communities, none of which are connected by roads. Approximately 85% of the population is Inuit. Each community has a small health centre, but there is only one hospital in the Territory, located in Iqaluit, which provides services to residents of the Qikiqtani (Baffin) Region of eastern Nunavut. Because of these realities, the Government of Nunavut relies heavily on medical transportation to support residents in accessing health services within and outside of the Territory.
The Non-Insured Health Benefits Program provides a suite of medically necessary goods and services to eligible First Nations and Inuit clients. In Nunavut, these benefits are administered directly by Indigenous Services Canada, as well as via a contribution agreement with the Government of Nunavut. That agreement includes funding for medical transportation, such as accommodations, meals, and air travel. In 2019-21, the value of this agreement was $45.4 million.
Since its creation in 1999, the Government of Nunavut has charged a co-payment of $125 per direction for all air travel for residents requiring medically necessary services not available in their home communities. This co-payment, which the Non-Insured Health Benefits Program reimburses for Inuit residents, applies to all forms of air transportation, whether a $2,000 scheduled flight or a $30,000 medevac (emergency air ambulance). In January 2019, the Government of Nunavut informed ISC of its intention to eliminate the co-payment with the goal of having ISC pay the full cost of medical travel for Inuit. Intergovernmental discussions on this issue remain ongoing; in the interim, in 2020-21, ISC is allocating $64.7 million for medical transportation in Nunavut, which includes an increase of up to $20.2 million from 2019-20 to cover the increased co-payment from $125 to $715.
The Government of Nunavut is also receiving $9.2 million per year in funding to off-set costs of medical transportation under Health Canada’s the Territorial Health Investment Fund (scheduled to sunset in 2020/21).

If pressed on the availability of mental health services in Nunavut
• In Nunavut, counselling services continue to be available at health centres in every community.

• Since April 2020, $19.9 million in funding was provided directly to the Government of Nunavut and community organizations for the coordination of mental wellness teams and other mental wellness services.

• We have also committed $228.1 million over 10 years, beginning in 2017, through the Nunavut Wellness Agreement for community wellness initiatives, including those focused on mental wellness programs and initiatives.

• We will continue to work with partners to ensure Nunavummiut have access to the services they need.
If pressed on responsibility for medical travel costs in Nunavut
• The Government of Nunavut is responsible for the provision of health services to all of its residents.

• Medical transportation is a necessary, but costly, element of Nunavut’s health care system.

• We are working with the Government of Nunavut on ensuring continuity of services while a longer-term approach to accessing health services is developed.

• Through the Nunavut Partnership Table on Health, we will continue to collaborate with the Government of Nunavut and Nunavut Tunngavik Incorporated to improve access to health services.
If pressed on Nunavut Recovery Centre
• The Government is contributing up to $47.5 million over five years and up to $9.7 million ongoing towards the construction and operations of the Nunavut Recovery Centre.

• The construction and planning of the Centre is being led by the Government of Nunavut in partnership with Nunavut Tunngavik Incorporated.

• The Recovery Centre is part of a made-in-Nunavut approach to address substance use and trauma.

• We will continue to work with our partners to support treatment and wellness services that are Inuit-led and build on cultural strengths.