Nunavut must hire more, train better to improve health care: auditor general

James McKenzie, the Auditor General of Canada’s principal investigator for its recent review of Nunavut’s health department, speaks to reporters at the public release of the report March 7 in Iqaluit. (PHOTO BY STEVE DUCHARME)

Nunavut nurses and other health care professionals are not getting the support they need from Nunavut’s health department, creating large gaps in capacity, training and safety, according to a comprehensive report released March 7 by the Auditor General of Canada.

It’s a debilitating, front-end deficit that could severely compromise the quality of health care for Nunavummiut, the report concluded.

“While the Department of Health had procedures for reviewing and improving the quality of health services, these procedures were seldom followed,” principal investigator James McKenzie told reporters in Iqaluit’s Arctic Hotel, around the same time the report was being tabled across the street at Nunavut’s legislature.

While provinces have their own auditors general, the territories do not and so the Office of the Auditor General of Canada is responsible for auditing the performance of territorial governments.

The OAG has examined numerous Nunavut departments and programs and released numerous reports, including reports on education, child and family services, schools and childcare facilities, and corrections.

This week’s health care report is based on interviews the Office of the Auditor General conducted with senior managers, health care providers, community representatives and Inuit organizations.

Investigators visited seven undisclosed community health centres across Nunavut’s three regions: the Kitikmeot, Kivalliq and Qikiqtaaluk.

The OAG laid down 17 recommendations, calling on the Government of Nunavut to provide up-to-date training for nurses, track the performance and needs of community health care providers, and also resolve capacity problems that cripple the department.

That’s because more than 500 indefinite positions—or 46.6 per cent of the department’s permanent workforce—were vacant as of Dec. 31 2016, the report said.

During the 2015-16 fiscal year, the Department of Health spent about $16.3 million on agency nurses—or nurses hired through a contractor—along with $15 million on casual employees, the report said.

Based on information provided, the auditor general says it takes on average about 562 calendar days for the department to hire a new employee after a position becomes vacant—about 18 months.

The report recommended the Department of Health develop and implement a human resources strategy because none exists right now. It also said Health should work with the Department of Finance—responsible for human resources within the entire GN—to streamline the hiring process.

Meanwhile, the capacity crisis is having a snowball effect on service across the territory, weakening full-time staff morale and hurting the quality of training for basic diagnostic or interpretation services.

“Several department officials told us that there was a lack of training for X-ray takers,” the report noted.

It then cited a 2014-15 investigation by the health department concluding that 45 per cent of X-ray images taken in certain communities “were of poor quality for diagnostic purposes, raising concerns about risks to patients, staff and the department.”

The auditor general noted that approximately $950,000 was earmarked for enhanced training for X-ray staff in the government’s budget last year.

But the health department isn’t dedicating base funding for orientation and training programs, instead relying on external grants or internal non-training funds to deliver them ad hoc, the report said.

“There was also no systematic monitoring of the licenses and certifications requiring renewal after a community health nurse was hired,” the report said. It recommended the department create systems to monitor the level of training among employees, while creating dedicated resources to bring them up to speed.

As for the impact those shortfalls are having on patients, the auditor general doesn’t know—partly because the Department of Health doesn’t know either.

“The Department of Health did not track the number or type of incidents involving patient care… [and] could not analyze such incidents to identify problems and trends,” the report said.

Investigators received 93 incident reports after requests to the department, but were told those reports represented “only a portion of the incident reports produced, and that incidents were under-reported.”

Nunavut Health Minister George Hickes released a statement, shortly after the report was tabled in the legislature, thanking the auditor general’s office for the insights and recommendations put forward in its investigation.

“The Government of Nunavut is committed to providing quality health care services. This report reinforces the actions and direction already in place to improve health care delivery and services for Nunavummiut,” Hickes said.

“The Department of Health and the Department of Finance agreed with our recommendations,” McKenzie said at a media briefing.

“The successful implementation of these recommendations will be important to strengthening the delivery of heath care services in Nunavut.”