I agree with some of his points, obviously, that work in the communities is challenging. It's not an easy task. The isolation factor, as I mentioned before, with its small teams and lack of connection, is a challenge.
The infrastructure is a challenge as well, because it is really far to go there and to have problems fixed. I think the Auditor General's audit pointed out the fact that some of the repairs were needed but not done on time.
As for the example of the Deer Lake residence that you mentioned, this was fortunately not the nurses' residence. It was one of the residences, but it's not the one used by the nurses. There were other residences for them. Having good residences for the nurses is an important factor for retention, and we have invested in the last few years in the maintenance and construction of residences.
Those factors are all in there, but the problems and the issues appeared to be a bit different in the different locations. I would say that what has made a huge difference over time is the ability to create a team that is well integrated in the community.
One of the recommendations is about the integration of clinical care into the health planning of the community. We have in many communities where Health Canada delivers the clinical care services a situation where we deliver services and the community runs everything else in terms of health programs. There is a need to have really good integration, because the nurses are essential to the delivery of some of the community health programs, and the community health worker can also be a great support to the nurses to deliver what they are doing and deal with what they see in their day-to-day consultations with clients.
This element of integration and making sure that the nurses' work fits well with the community health plan is an important element going forward that we have tried to invest in, and we have to do it again. There is a divide there in terms of what we are doing and what the community is doing, but there is attention being put on that.
I think improving the infrastructure is also on the electronic side, electronic medical records and telehealth. We have made a lot of progress in various provinces and regions to deploy telehealth in the communities so that a patient can consult with a nurse or a physician over telehealth, or they can access mental health workers through telehealth. This is an important element of our strategy to improve the quality of the service and the connection between the nursing team, the community, and health professionals elsewhere.
Implementing electronic medical records is essential. I was talking to a physician who practises in one of the nursing stations. What they want is, when they visit for a week or so in the nursing station working with nurses, the ability to continue their practice on electronic medical records that is part of the provincial system. They will be able to advance their work and make sure that the client's next step in terms of treatment will be in the system that they know when they practise in the south.
We have to invest more and we are into the enabling infrastructure, not only the physical infrastructure but also the IT infrastructure. This is one place where the nurses have complained about connectivity for years. In northern Ontario we have five communities where the high-speed large bandwidth is not yet available. We are getting there working with partners so that these communities will be well connected going forward.
It's building this infrastructure that allows a small team into an isolated community to be connected with the rest of the health system, to transfer files, do referrals, and receive results of exams and tests electronically. This has been more and more visible in the community in the last five to ten years. We still have some issues to deal with to build that in some of the remote northern communities in Ontario and Manitoba, but we are getting there. By building the enabling infrastructure I think we'll also have a better chance to retain nurses. That can't compare because sometimes they work part-time for us and part-time elsewhere, and they say they're missing some things there that, if they had them, would work way better.
They do not dream about having road access. There won't be road access there in the near future, but they dream about having access to information that allows them to practise with their full capacity there.
Adding nurse practitioners on the team is also a way to reinforce the nursing team so that they don't feel that they are isolated, because they can get guidance from nurse practitioners in terms of doing some of these actions that otherwise they wouldn't be able to do or they wouldn't be able to do without breaching their scope of practice.