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Auditor general criticizes Nunavut for not supporting remote health centres

Auditor general criticizes Nunavut Health

OTTAWA — A report from Canada's auditor general says Nunavut's health system doesn't adequately ensure the quality of its service or the safety of its workers.

"The department did not ensure that community health nurses, X-ray takers, and interpreters received the training they needed to work in isolated communities," said the report from Michael Ferguson, released Tuesday.

"It did not adequately manage the safety risks faced by health care personnel in community health centres."

The report looked at the delivery of health care in Nunavut's 25 communities, which are served by 22 community health centres, regional health centres in Rankin Inlet and Cambridge Bay, and the Qikiqtani General Hospital in Iqaluit.

The health centres are typically staffed by a nurse-in-charge and community health nurses. Doctors and specialists visit periodically and provide telephone advice.

Ferguson's report recommends addressing major concerns with proper training of those workers. One analysis found that 45 per cent of X-ray images taken in 2014-15 in some communities "were of poor quality for diagnostic purposes.

"Although some training sessions were offered since then, we found that most of the X-ray takers we met had not taken training, felt more was needed, or had not taken training in many years," the report says.

Funds should be made available to ensure workers are properly trained, it recommends.

Audits of patient care, used to ensure quality of services, were also rarely performed. Out of seven communities visited, Ferguson's office could find fewer than 20 per cent of the audits that were supposed to have been done.

Nunavut did not track safety problems in health centres between 2014 and 2016. However, the report found evidence of 49 separate incidents during that time.

"The safety-related incidents included staff receiving verbal and physical abuse, threats from patients, and break-ins at health centres," the report says.

A 2015 health department survey of community health nurses working outside of Iqaluit found many respondents were worried about their safety while on call, the report added.

It also criticized the length of time the department takes to fill vacant positions.

"It took an average of 562 calendar days (or about 18 months) to hire a new employee after a position became vacant," it said of the 25 vacancies filled during the audit period.

In December, it found nearly half the department's permanent positions were vacant, although many had been filled with temporary staff.

The report discusses the harsh realities of northern health care, including the difficulty finding staff to work in isolated communities with high cost of living and few job opportunities for spouses. It also underlines how much money the territory is forced to spend transporting patients — $70 million out of a $420 million budget.

Nunavut has long had some of the poorest health outcomes in Canada. 

Life expectancy is only 71.6 years, almost a decade less than in the rest of Canada. Infant mortality is 21.4 per 1,000 live births compared to 4.8 in the south.

Smoking rates are much higher in Nunavut, where 61 per cent of those over the age of 12 light up daily. That's more than three times the Canadian average.

The auditor general's report makes 17 recommendations, all of which the territorial government has accepted.

— By Bob Weber in Edmonton. Follow him on Twitter at @row1960

The Canadian Press

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