Public Accounts Committee on June 1st, 2015

[Sony Perron]

In all regions of the country we are trying to work as closely as possible to the provincial or the territorial health system to make sure that clients, whether they are first nations or Inuit, will benefit from the same access to emergency transportation wherever they live. In some provinces there is a model whereby everybody residing in the province will be covered by the province and will only pay the co-payments for them. Some of the other provinces exclude de facto first nations or Inuit, so we will assume 100% of the bill.

There is a protocol in place to avoid having to call us beforehand, so the evacuation goes first. It's only an administrative procedure to decide who is going to pay the invoice for emergency transportation. We have a really solid arrangement in some provinces where I would say it's seamless. In some others we are working to make it even more seamless.

Wherever it is possible that we can have a protocol with the regional health authority or the provincial health system we will let them make the call about the transportation and will only be there after the fact to deal with the administrative and financial sides so that people get the services.

[The Chair, NDP, David Christopherson]

You have 15 seconds.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

That's fine.

Thank you, Mr. Chair.

[The Chair, NDP, David Christopherson]

I appreciate your consideration. Thank you, Mr. Hayes.

I see we have Mr. Casey with us, not a regular member, but sitting in today. Welcome, sir, and you now have the floor.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Mr. Chair, anything but regular I can assure you.

Mr. Ferguson, you found in your report that we had nurses working outside their scope of practice. You found some pretty profound shortcomings in their compliance with the mandatory training program.

My background before coming here was in defending lawsuits, many of them involving medical malpractice. When I read your conclusions, it looked to me like a field day for the plaintiffs bar.

I don't know if my question is for you, Mr. Ferguson, or if it may be best for Mr. Perron. In view of the shortcomings identified with respect to the compliance with mandatory training and the instance of working outside the scope of practice, has the department or its employees been sued as a result of what's been identified by the Auditor General?

[Sony Perron]

No. When there is an incident, we review the incident in collaboration with the regulatory authorities or the coroner to make sure we learn from these situations, but no.

[Sean Casey, Liberal, Charlottetown, PE]

The nurses in your employ would be obligated to carry liability insurance, I presume. Correct me if I'm wrong. If this is the case that they are obliged to carry professional liability insurance, has their insurance rating been affected by the shortcomings identified in this report prior to the publication of the report?

[Sony Perron]

Again, the answer on this one as far as I can tell is no. I'm not aware of that.

Robin, do you have anything to add on this question?

[Robin Buckland]

The question I believe was do they carry mandatory insurance.

[Sean Casey, Liberal, Charlottetown, PE]

Yes, and has it been rated up because of the shortcomings identified?

[Robin Buckland]

Nurses are obliged to carry coverage, as you would know. The federal government does provide that coverage for all of the nurses who work for us in the first nations and Inuit health branch. That's the same for nurses working elsewhere within the federal government as well. I'm not aware of any increase because of any situation.

[Sean Casey, Liberal, Charlottetown, PE]

Okay, so their professional liability rates have not increased based on experience in recent years. Is that right?

[Robin Buckland]

That's correct.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you.

We saw recently where the RCMP ran afoul of the occupational health and safety regulations in New Brunswick because of how ill-equipped their members were. When we see in the report things like a septic system that prevented the availability of nurses for two years, or faulty seals on an X-ray room door, I ask you the same question. Has the department been investigated by provincial occupational health and safety officers as a result of these violations?

[Sony Perron]

No.

[Sean Casey, Liberal, Charlottetown, PE]

Certainly, in the last four years the government has been extremely preoccupied with balancing the books. They have gone through the deficit reduction action plan. There have been deep cuts in the civil service.

Has your department been immune, and if not, how have they impacted the types of things that have been identified in the report?

[Sony Perron]

There has not been any reduction to the clinical care programming or the non-insured benefit for medical transportation, which were the two elements in the scope for this audit. In fact, we have had reinvestment in 2012-13 into clinical care because the costs were getting higher mainly due to the fact that we had a high turnover, a high dependency on agency nurses. We are still using a lot of agency nurses to compensate for the fact that we have vacancies in the branch for these services. So, no, instead of a reduction, there has been additional investment to meet the increased costs.

If I could add to this, we are really hopeful that our investment in retention and recruitment will allow us to use some of these resources that currently go to agencies to improve services in the communities as well, because it's a very costly model to rely on agency nurses to complement our staffing in the nursing station.

This is something we are really hopeful we can do better with the money because I know the public accounts committee is pretty concerned about efficiencies as well. There is a potential there to change the model of business to reinvest the resources that currently we spend on agency nurses in the clinical care program, in enhancing our services.

[The Chair, NDP, David Christopherson]

Very good. Thank you. The time has expired.

Moving along, Mr. Aspin, you now have the floor, sir.

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

Welcome, Auditor General Ferguson and officials of the health department.

I have an overview question to begin with. What are the engagement processes at the national and provincial levels with first nations and provinces?

[Sony Perron]

This is an important question, because we believe that the best way to improve health services, not only clinical care but all health services, through integration of health services is by creating more first nations control over these services. I think one of the honourable members mentioned the model in British Columbia, which is probably the furthest advanced transformation that we have in the works. Since 2013 we have transferred all operations, and this model is now fully under the control of the First Nations Health Authority, with the important participation of the provincial government in that.

This is the best way to integrate the services to maximize the impact of the investment and to get rid of some of the challenges we have with jurisdictions on who is doing what and why. I think that when you get to the kind of model we have in B.C., these kinds of questions are not important anymore. What matters is the continuum of services and the continuum of care in the community.

In all provinces we have co-management tables with first nations, and in most provinces we have trilateral tables to deal with service integration. Unfortunately, I would say that in the last few years, the focus has not been much on clinical care. One of the most important priorities for our first nations partners, and often for the provinces as well, has been on the mental health side, but we have made great progress there.

I will ask my colleague Valerie Gideon to give you a sense of where we are with the main initiatives in various regional and trilateral tables.

[Valerie Gideon, Assistant Deputy Minister, Regional Operations, First Nations and Inuit Health Branch, Department of Health]

Very quickly, we have a trilateral table in Ontario with the Ontario Ministry of Health and Long-Term Care. We also have a specific northern table that the northern first nations have asked for, and in that table, which has just started this year, we do anticipate that we're going to be talking quite a bit about clinical and client care and medical transportation and engaging them in terms of our follow-up actions on that plan.

In Manitoba, we've had a committee for several years that was at a more junior officials level. We've now bumped it up to an assistant deputy minister level, with the Province of Manitoba, the Grand Chief of the Assembly of Manitoba Chiefs, and me. As well, we will be using that table to engage first nations in Manitoba with respect to our actions on this report to ensure that we're also monitoring progress and partnership of first nations.

Those are just two examples that are more relevant to this audit, but there are many more across the country. We also have national partnership agreements with the Assembly of First Nations and the Inuit Tapiriit Kanatami, which we signed this year.

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

Thank you.

What is the benefit of accreditation in improving health services in first nations communities? In your view, what progress have you made in that direction?

[Sony Perron]

The accreditation is something that is being used in provincial and territorial health systems to ensure quality of service in health institutions. We were talking about comparability earlier, and applying the same standards in the nursing stations in remote and isolated communities is the way to go to make sure that services are similar in terms of quality.

Robin, maybe you want to add to that in terms of where we are with our accreditation process.

[Robin Buckland]

Yes. We're working hard to increase the uptake of accreditation in health services delivered to first nation communities. As of 2014, we actually have 87 health centres—this is outside of the nursing stations—that have been accredited and 43 treatment centres that have been accredited as well.

Accreditation is really about a continuing improvement process and working with a set of standards that the health service or the nursing station can compare itself against and then constantly work with to improve the quality of the care they are delivering.

Again, a big focus for us since 2013 has been building capacity in first nations community members in delivering health services themselves. As for where we're going in the next component of our strategy, it's actually looking at what we can do to increase the uptake of nursing stations, both Health Canada-delivered and first nation-run, for the accreditation process. In Canada, we only have one nursing station that is accredited, and it's run by aboriginal community members in Quebec. So we have a lot of work to do, but there's a lot of promise, and there has been a commitment to increase that number to 18 between now and 2018.

[The Chair, NDP, David Christopherson]

Time has expired, Mr. Aspin. Thank you.

We'll move now to Mr. Allen.