Health Care Services—Nunavut

Opening Statement to the Standing Committee on Public Accounts, Independent Officers and Other Entities

Health Care Services—Nunavut

(2017 March Report of the Auditor General of Canada to the Legislative Assembly of Nunavut)

8 May 2017

Michael Ferguson, CPA, CA
FCA (New Brunswick)
Auditor General of Canada

Unnusakkut. Good afternoon, everyone. Thank you, Madame Chair, for this opportunity to discuss our report on health services in Nunavut. I am joined today by James McKenzie, Principal, and Liliane Cotnoir, Director, who were responsible for this audit.

In conducting this audit, we wanted to know whether community health nurses and other front-line health care personnel in Nunavut’s health centres received the support they needed to do their jobs. We examined topics such as whether orientation and training were delivered consistently, whether health care personnel worked in a safe environment, and whether the Department of Health continuously improved the quality of care its health care personnel provided.

I would like to provide you with a brief overview of our findings.

Overall, we found that the Department of Health did not give its nurses and other health care personnel the support they needed.

We found that the Department of Health did not deliver consistent orientation and training to its nurses and certain other health centre personnel. For example, some staff members in local health centres who were responsible for taking X-ray images had not received sufficient training. This lack of training was highlighted in an analysis the Department conducted, which indicated that 45 percent of the X-ray images taken in certain health centres were of too poor quality for the purpose of diagnosing patients’ conditions.

Clerk interpreters, who must translate Inuit patients’ needs to health care staff, also had not received adequate training. It is important to have trained interpreters with knowledge of medical terminology to ensure that health care providers and their Inuit patients who do not speak English understand each other.

We found that the Department of Health did not provide a safe environment for its staff. Although staff members reported threats and incidents of verbal and physical abuse, and break-ins occurred at health centres, the Department did not track these incidents. As a result, it did not have the information it needed to know how to minimize the risks these incidents posed. Security measures in health centres, such as panic alarms, were not always operational, and Department officials did not consider guidelines for working alone to be realistic or effective.

Although the Department of Health had procedures to review and improve the quality of health services, these procedures were seldom followed. For example, reviews to ensure that community health nurses properly completed patient charts were not done as required. Patient charts are key to capturing the results of a patient’s visit and ensuring continuity of care. Annual visits to community health centres by regional directors, which were intended to ensure that these centres operated effectively, were also not conducted as required.

In 2016, almost half of all positions within the Department of Health were vacant, and many were filled by temporary staff. We found that the staffing process, which also involved the Department of Finance, was lengthy. It took, on average, a year and a half to fill vacant positions. Some nursing positions remained vacant for many years. Despite high vacancy rates, the Department of Health did not have an effective system to track and manage its staffing actions, and it lacked an up-to-date recruitment and retention strategy for nurses.

Finally, we found that although the population in most of Nunavut’s communities had increased, the Department of Health had not done any analyses to determine whether the allocation of nurse and physician resources was sufficient to meet community needs. The Department had started an initiative to improve how it delivered health care services. We noted, however, that the Department did not expect to consult with Nunavummiut until it identified options to improve how it delivered health care services. In our opinion, early engagement is important to the success of the review.

We made 17 recommendations in our report, some of which address long-standing issues. The Department of Health and the Department of Finance agreed with our recommendations. The successful implementation of these recommendations will be important to strengthen the delivery of health care services in Nunavut.

Madame Chair, this concludes my opening remarks. My colleagues and I would be pleased to answer any questions Committee members may have. Thank you. Qujannamiik.