Public Accounts Committee on April 29th, 2015

[Yvonne Jones, Liberal, Labrador, NL]

Thank you very much.

Thank you for joining us today to answer all of these questions that we have.

My questions are going to focus on Report 4 right now. It is a huge concern for me to see that essential services, while they are defined appropriately by Health Canada, are certainly not delivered appropriately in terms of ensuring that adequate facilities exist in these remote areas, and ensuring that the human resources on the ground—in this case, the nurses in particular—have the adequate training they require.

It is a huge concern, and I would like to note that the clinical process in northern Canada is not a new process to me. I have six remote clinical facilities in the riding I represent, and five semi-remote facilities, all staffed by nursing staff, so I understand the additional training that is required for those nurses to deliver on the responsibilities and essential services they are required to do.

My question has to do with the high turnover rate we see in the staffing in many of these clinics. What is the contributing factor to that high turnover rate? Why aren't the nurses who are placed in these positions given the appropriate training upon accepting the positions? I would like to know what rationale and explanation are given for that.

[Michael Ferguson]

In general terms, we didn't address the question of turnover directly in terms of the staffing of the nursing positions. We did identify that, first of all, all of the nurses in northern Ontario and Manitoba we looked at in the audit who are employees of Health Canada are registered nurses, but sometimes, because of the circumstances in the environment in which they have to work, they have to work outside their scope of practice. We have explained that in the audit. Because of those circumstances, Health Canada has said that those nurses need to have additional training in order to provide those extra services. In our sample we found that only 1 out of 45 nurses had received all of the five mandatory courses to be trained in delivering those extra services.

It was simply that Health Canada had set these requirements for their nurses to receive this training but they weren't making sure it was happening. They've said it is important. It is work that the nurses have to do that is outside what a nurse would normally have to do, so they should get the extra training, but they just weren't getting the training.

[Yvonne Jones, Liberal, Labrador, NL]

Is there any requirement within Health Canada that any of these nurses would have to have nurse practitioner training, or is registered nursing the acceptable hiring standard, accompanied by those courses?

[Michael Ferguson]

We talk in the audit about the fact that the nurses are required to work outside of their scope of practice, that is, do some things that a nurse is not normally required to do—this is in section 4.35—and we talk about the fact that Health Canada has explored some options to deal with this problem. The options that have been discussed include putting medical directives in place so that the nurses' activities beyond the scope of practice are delegated by an appropriate medical professional, working with the provinces to amend the relevant provincial nursing acts and regulations, or perhaps hiring more nurse practitioners. The concept of nurse practitioners in those remote areas is something that has been discussed, but at the time of the audit, in the communities that we looked at, the services were still being provided by nurses. These services were outside the scope of what a normal nurse would provide, and the nurses had not received all the training that was identified as necessary for them.

[Yvonne Jones, Liberal, Labrador, NL]

I don't know if this something you examined or not, but can you speak to the fact that some of these vacancies or the high turnover rate may be due to the fact that the package—the salaries—being offered to these nurses to work in those remote and isolated regions isn't attractive enough to maintain that level of stability in providing essential services?

[Michael Ferguson]

Again, the turnover rate wasn't something that we specifically addressed, so I can't talk to exactly what the turnover rate was in those communities or what those reasons were. It just was not an aspect of the audit that we got into.

[The Chair, NDP, David Christopherson]

Sorry, time has expired, Madam.

Moving along, over to Mr. Aspin.

You have the floor, sir.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Thank you, Chair.

Welcome, Mr. Ferguson and your team, to our committee.

I'm going to focus on chapter 7, which is on the office of the ombudsman for the Department of National Defence and the Canadian forces.

In chapter 7 you concluded that the:

Office of the Ombudsman for the Department of National Defence and the Canadian Forces...had inadequate controls for financial management, contracting, and human resource management in carrying out its mandate....

In your remarks, on line 27, you state:

After 2012, the workplace environment stabilized, and efforts to close long-standing files were successful.

Can you speak to how these issues are being addressed under the current ombudsman?

[Michael Ferguson]

There still is a lack of clarity in terms of the line on the roles and responsibilities between National Defence and the office of the ombudsman. This issue is important because the ombudsman's office needs to have the independence to conduct its investigations. The investigations that it's doing are about complaints that members of the military, or their families, or civilian employees of National Defence have about the operations of the military or National Defence. The ombudsman's office is the way that those employees have to get their concerns dealt with, so the ombudsman's office needs to have independence to conduct those investigations.

On the other hand, all of the staff and the budget for the ombudsman's office come from National Defence, so National Defence has a responsibility to make sure that the hiring rules are respected, that the financial management rules are respected, and that values and ethics are respected. They have to do monitoring of the ombudsman's office to make sure those administrative rules and roles function properly.

You can see that, almost by definition, there's a push-pull between those two things, where National Defence has to monitor the ombudsman's office, but the ombudsman's office has to do independent inquiries into National Defence's activities.

We certainly did find that the problems were at their worst between 2009 and 2012. There were some actions that were taken in the latter part of 2012 into 2013 to try to resolve the issues. The investigations started to be completed on a more timely basis again, but there still are some places where the roles and responsibilities are not totally defined. It's important to make sure that the inquiries can be done independently but that there can also be appropriate oversight of the management and administration of the ombudsman's office.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

I take it that's what you mean in point 28 of your remarks when you say that:

Since the Office's investigations are carried out independently from National Defence but the Office's staff and budget reside with the Department, the organizational relationship with National Defence is a complex one that needs to be better defined to ensure adequate monitoring in all areas.

You're talking about that independence.

[Michael Ferguson]

That's right, and I'm concerned that National Defence needs to find a way to monitor the administrative part of the office of the ombudsman, to make sure that the financial contracting and human resource rules are being followed and being respected, but not be doing it in a way that gives people the perception that National Defence is using that as a way, somehow, to perhaps impede the independence of the investigations.

It's a very complex relationship. Trying to protect, both respecting the rules but also respecting the independence of the investigations, needs to be sorted out.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

DND and the ombudsman's office have virtually accepted all your recommendations. Could you speak to the effectiveness of the actions already taken for better controls of financial management?

[Michael Ferguson]

I think, again, we identified in the audit that in the latter part of 2012 we saw that things had started to improve, both in terms of investigations and in terms of what was happening in the workplace. I think, though, there is still some education that needs to be done and some systems and controls that need to be put in place to make sure there are good financial controls in the office of the ombudsman. That's why we've made the recommendations again that National Defence and the ombudsman's office have to sort out those roles and responsibilities. There's still some work to do there.

[The Chair, NDP, David Christopherson]

Thank you.

Mr. Allen, you have the floor again, sir.

[Malcolm Allen, NDP, Welland, ON]

Thank you, Chair.

Mr. Ferguson, I'll get back to the antimicrobial piece because there has been a discussion back and forth about leadership, coordination, working to a consensus of some description in a pan-Canadian piece. Let me take the beginning of the chapter, which is on page 8 at paragraphs 1.38 and 1.39, where you talk about, it seems to me, what Public Health Canada is responsible for. Is that correct? When I look at those two paragraphs this is really the purview of Public Health Canada, these particular pieces that talked about looking at “obtaining, analyzing, and disseminating national-level surveillance information about antimicrobial resistance and antimicrobial use.”

Is that actually the purview of...? Basically, Public Health Canada should be doing that. Albeit it has to bring it in, but actually has it got to do that role?

[Michael Ferguson]

Well, we say in paragraph 1.39 that “the Public Health Agency of Canada is responsible for obtaining, analyzing, and disseminating national-level surveillance information about antimicrobial resistance and antimicrobial use.”

So it's clear that they need to collect this information to give them that pan-Canadian picture of what's happening in terms of antimicrobials and the development of resistance to the antibiotics that are used to treat these organisms.

We identified that the Public Health Agency of Canada is not right now collecting all of the information that it would need to give it that picture. I believe further on in the audit we describe some of the things they are doing about collecting information and where some of the weaknesses are.

[Malcolm Allen, NDP, Welland, ON]

It reminds me of a subcommittee on listeriosis in 2009. Public Health Canada actually said the same thing. One of their problems was they didn't have the information. They said they couldn't get it out fast enough to talk to folks. It seems they didn't learn their lesson. Maybe we'll hopefully learn a lesson come the next time.

I was interested in your comments, Mr. Ferguson, when you opened this meeting. It was actually near the end of your written piece. At paragraph 32 it says that you were concerned that the issues you are seeing today may be the “symptoms of bigger problems in the future if they are not resolved quickly”.

“It is important for departments to focus on addressing these issues promptly, to avoid bigger problems which will cost more to fix down the road, in terms of time, money and effort.”

A simple question. Did you mean all of the reports that you presented today, or are there some that you think have a higher priority in the sense of the timeliness of the actions needed to happen?

[Michael Ferguson]

I think if you go through the various reports, and again you can start with the report on antimicrobial resistance where we said it appears that the Public Health Agency of Canada is many years away from having that national strategy that they say they need to have.

We also identified that Health Canada had been working for a number of years on closing some of the gaps that exist in the importation of drugs for use in farm animals. Some of those controls needed to be tightened up. They had recognized that, but still hadn't done it.

I think that you can go on to the health services on remote first nations and those types of problems where the nurses weren't getting all the training, the facilities were not in sufficient condition that they could be properly used, and that sort of thing. Again, those problems need to be resolved quickly.

You can go into information technology investments at CBSA, I talked about that earlier, and the need to apply that framework to make sure those systems are delivered properly.

Preparing offenders for release, I think is another good example of that. As offenders spend more of their time within the facility, it means they have a shorter amount of time under supervision in the community. That could become a bigger problem in the future.

As for the office of the ombudsperson for National Defence, it's important to make sure those roles and responsibilities are clear so that there can be appropriate oversight of that office to prevent a recurrence of the types of issues that were happening between 2009 and 2013.

I think you can look at a number of these audits and see that thread of issues that needs to be resolved now, so that we're not talking about these same issues in four or five years' time.

[The Chair, NDP, David Christopherson]

And speaking of time....

[Malcolm Allen, NDP, Welland, ON]

Speaking of four or five years' time—

[The Chair, NDP, David Christopherson]

Sorry.

[Malcolm Allen, NDP, Welland, ON]

Since 2013, CBSA—

[The Chair, NDP, David Christopherson]

Mr. Allen. Mr. Allen. Please, that's not like you.

[Malcolm Allen, NDP, Welland, ON]

Yes, Chair.

[The Chair, NDP, David Christopherson]

You're done.

Mr. Falk, you have the floor, sir.