Nunavut's $500K 'model of care' review was over budget and overdue, documents show

Nunavut's "model of care" review project is supposed to have the answers for many of the shortcomings in the territory's delivery of health care. 

But the project came in over budget, didn't meet its deadlines, was sent back to the drawing board, and may not be as comprehensive as the government had hoped, according to documents obtained by CBC News through an access to information request.

While Department of Health officials said the project would be completed in March 2017 — in response to criticisms from Canada's Auditor General around how Nunavut staffs its community health centres — the final report from the $501,000 project still hasn't been made public. 

"It's good, but at the same time there's certain aspects of it that I thought could have been even a little bit more detailed," said Health Minister George Hickes.

At the end of the day, the information is valuable. It's hard to put a price tag on things like that.- George Hickes, Nunavut health minister

"Overall, there's a lot of good information in there. There's some stuff we knew, [and] some stuff maybe got flushed out in a little bit more detail."

He also said the project's final report is ready to be tabled in the fall, and he intends to have it up on the department's website before then.

'It wasn't fulsome enough'

The model of care review was launched in 2016 in response to several recommendations from lawyer Katherine Peterson's report into the 2012 death of a three-month-old baby in Cape Dorset, Nunavut. 

The project was tendered to Health Intelligence Inc. — a Halifax-based health-care consulting firm which has done work in seven provinces and territories, including Manitoba's 2017 health care overhaul, and Yukon's 2013 health-care review.

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Initially, the project was awarded for $472,500. Hickes said he doesn't know for certain why the project came in more than $28,000 over budget, but suspects the extra time it took to be finalized was a factor.

Ultimately, the government received the final report from Health Intelligence in April 2018, nearly two years after the due date set out in the original contract. But the government had also received an initial "final report" earlier in September 2017, only to send it back.

"I wouldn't say it was shelved. Basically, it wasn't fulsome enough," Hickes said, adding the second version of the final report went deeper with more interviews, and had a better grasp on the realities of health-care delivery in the North.

"It's one thing to take an industry professional from outside of the territory and bring his or her expertise to the table. But as soon as you cross that border into Nunavut and take a look at our health-care system, the demands that are put on it are different from anywhere else in the country."

'A road map'

While nearly everything in both reports is redacted — including all of the recommendations — the summary from the second report indicates nearly 200 interviews were conducted, including with supervisors from all 25 communities. The report also created 25 individual profiles highlighting the needs of each community.

A December 2018 Department of Health draft memo also states "Nunavut how has a road map to deliver a new 'Model of Care.'"

Hickes said one of the biggest takeaways from the report is the I.T. systems used in other parts of the country, as well as the need for administrative support in health centres.

"We've got our supervisors of of health spending too much of their time working on administrative work versus dealing with clientele," Hickes said.

"So that's one aspect of the report that I knew it was needed. But it's nice to have it in black and white that I can use that to justify some of the decisions that I'll have to make going forward."

Hickes said the data contained in the report will also be useful in determining staffing levels across different health centres — an issue raised in the 2017 review from Canada's Auditor General.

"One of the big questions that I've always had is how do we choose how many nurses Whale Cove has over Igloolik? There is population bases but there's also the type of care that's that's being demanded," he said.

'It might be a visitor's guide'

Still, Hickes said the report contained a lot of information the government already knew, and said it wasn't as encompassing as he would have liked.

"I don't know if I'd call it a road map. It might be a visitor's guide," Hickes said.

As for whether the information was worth $501,000, Hickes said it's too early to tell.

"I think that at the end of the day, the information is valuable. It's hard to put a price tag on things like that because as we assess and implement some of the strategies that are outlined in there, that's where we'll really see the results."

Hickes said business cases are still being developed for many of the initiatives the department wants to undertake from the review, but there are financial constraints in implementing some of the report's recommendations.

According to the documents obtained by CBC News, the department had planned on implementing some recommendations in a handful of pilot sites across Nunavut. Hickes those projects are still in the planning stage.