Opening Statement to News Conference – Health Care Services

James McKenzie, Principal, Office of the Auditor General of Canada—7 March 2017

Good afternoon. I am pleased to be in Iqaluit today to discuss the Auditor General of Canada’s report on health care services in Nunavut. The report was tabled in the Nunavut Legislative Assembly this afternoon.

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

Overall, we found that the Department of Health was not giving its nurses and other health care personnel the support needed to properly care for the residents of Nunavut.

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 or had not received training in many years. 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 poor quality for diagnosing patients’ conditions.

Clerk interpreters, who have the critical role of translating Inuit patients’ needs to health care staff, also had not received adequate training. Having trained interpreters with knowledge of medical terminology is important to ensuring 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 was not tracking these incidents. As a result, it did not have the information necessary to know how to minimize the risks these incidents posed. Security measures in health centres, such as panic alarms, were not always operational, while Departmental officials did not consider guidelines for working alone realistic or effective.

While the Department of Health had procedures for reviewing and improving 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 for ensuring continuity of care. Regional directors’ annual visits to community health centres, which aim to ensure that these centres operate effectively, were also not conducted as required.

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

Finally, we found that although most of Nunavut’s communities have experienced population increases, 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 for improving how it delivered health care services. In our opinion, early engagement is important to the success of the review.

We made a number of recommendations in the 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 strengthening the delivery of health care services in Nunavut.

This concludes my opening statement. I am happy to answer any questions you may have.

NT5

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