ISC adapted to shortcomings in pandemic response, but failed to meet nursing needs—Auditor General

The coronavirus pandemic has revealed a glaring inadequacy when it comes to direct health care delivered by Indigenous Services Canada (ISC) in 51 remote or isolated First Nation communities: a lack of nurses that despite extreme measures cannot be filled.

“This longstanding issue is one that does need to be addressed and we see it in so many other places when we audit Indigenous Services. We would have seen it in February in my audit on water quality. They lacked skilled water system operators,” said Canada’s Auditor General Karen Hogan.

“So it isn’t just isolated to healthcare workers and it is something that Indigenous Services Canada needs to address in collaboration with Indigenous communities so that we can fix the lack of skilled resources in those communities going forward.”

Lack of nurses and paramedics, along with lack of personal protective equipment (PPE), were deficiencies identified by Hogan in the report she tabled Wednesday, May 26 in the House of Commons on “Health Resources for Indigenous Communities—Indigenous Services Canada.” The report covered March to December 2020.

“When you already start with a shortage of healthcare workers, the pandemic makes that gap even worse,” said Hogan.

In an attempt to fill the need, ISC streamlined its processes for hiring nurses for remote and isolated communities, as well as made contract nurses and paramedics available to all First Nations communities. Private air service was also contracted to transport nurses to the remote communities. However, despite these actions, the gap was so large and the demand so great, ISC was unable to meet more than half of the 963 requests it received for nurses and paramedics.

Hogan recognized ISC for its quick pivot to the streamlined process, which enabled ISC to hire more nurses during the audit period than ISC had hired the previous year.

“So we recommended to them they should consider whether or not this streamlined approach is really something that should be used going forward,” said Hogan.

As for PPE, ISC fell short in hand sanitizer, gloves, masks, including the N95, because it did not follow the policy it put in place in 2014 for procurement. ISC also lacked complete and accurate documentation of its stockpile.

However, because ISC’s stockpile is the third line of access for Indigenous communities and steps were taken by those communities in the first wave of the pandemic to cut themselves off from COVID-19, ISC caught a break.

“In Indigenous communities, the demand didn’t really hit Indigenous Services Canada in a significant way until bulk procurement had started federally,” said Hogan.

ISC received two per cent of that bulk procurement from the National Emergency Strategic Stockpile so was able to not only fulfill the needs of healthcare workers, but provide PPE to individuals supporting the delivery of health services, those in the community caring for people sick with COVID-19, and police officers. The department responded to 1,622 requests for PPE and on average had it to the community within 10 days.

The timely delivery of PPE, said Hogan in her report, “is significant given the challenge of shipping items to communities that are often remote or isolated.”

The report also acknowledges ISC for meeting with Indigenous communities and organizations throughout the pandemic to discuss their needs.

“We do know that we can always do more and the real success story of this pandemic is that we are doing all of this hand-in-hand with First Nation, Métis, and Inuit leaders. We’ve asked them what they need and how we can continue to support them,” said ISC Minister Marc Miller following the release of Hogan’s report.

“Let’s remember (there was) a great period of uncertainty as to the impact of the virus, its nature, its spread, and its potential to devastate Indigenous communities. So the first thing my team did was a communications exercise to talk to health mangers in communities, health leadership and see what the needs were and we moved, as the report stated, quite quickly to fulfill those needs,” he said.

Miller also pointed out that in the first month of the pandemic, his department identified the need to have an efficient PPE management request system in place and had implemented that change by September.

Hogan’s report does not track the use of federal funds provided directly to Indigenous communities and organizations to purchase their own PPE. She said there was no mechanism in place at this point for her to do that.

Miller said that accounting will come in the summer.

“We are deploying financial instruments in record speed to keep people safe, to get the vaccine into arms and with good results. My focus right now is on that,” he said.

Direct funding was provided to both on-reserve and off-reserve organizations for programs to support the Indigenous populations.

“Some transparency” is necessary, said Miller, “particularly so we can get a sense of how we develop good public policy, health policy, going forward and which ones can be transported neatly into a context that is outside COVID.”

Hogan also tabled a performance audit on how the Public Health Agency of Canada (PHAC) secured PPE and medical devices for its National Emergency Strategic Stockpile. She found that PHAC had not addressed issues raised in numerous internal reports and because of that the stockpile was lacking and the inventory not tracked adequately. However, like ISC, Hogan pointed out that PHAC and government agencies adjusted quickly to meet the needs of provinces and territories.

Local Journalism Initiative Reporters are supported by a financial contribution made by the Government of Canada.