The Department of Health and Social Services doesn’t know whether it’s providing the right programs to improve the health of Yukoners, says Canada’s auditor general Sheila Fraser, in a withering report released Tuesday.
Fraser found that the department doesn’t track the prevalence of disease in the territory.
It lacks clear plans and priorities.
And, by consistently blowing its budget, the department has broken the law.
“Clearly, we should expect the department to have much better information than they do,” Fraser told reporters yesterday.
Her audit aimed to answer two questions, Fraser explained: “What are you trying to achieve? And how do you measure progress?”
Unfortunately, the answers to these questions proved hard to come by.
Some of the information that Fraser sought ought to be fairly simple to produce. For example, the department already has a database capable of tracking disease prevalence. It’s just not being consistently used.
The system in question is used to track physician payments. It also accepts internationally-recognized disease codes.
But, over the last three years, more than half of physician claims lacked such a code. The Yukon Hospital Corporation doesn’t use these codes consistently, either.
As a result, Fraser is skeptical about the Yukon’s reported disease rates. The territory reported that 5.5 per cent of its population was diabetic in 2009, compared to 5.2 per cent for the rest of Canada. But, without a complete picture, “the diabetes rate may be understated,” Fraser’s report states.
“Unless the department knows how many people have diabetes and how many are susceptible to it, it cannot determine if it is delivering the right programs and services to treat those with diabetes and those with a higher risk of getting the disease.”
The Yukon hasn’t submitted information on prescription drug use to a national database in recent years, either.
Similar tracking problems exist for alcohol-and-drug services. The department “does not regularly collect, compile or analyze data” associated with these programs, Fraser found.
It didn’t used to be this way.
Alcohol-and-drug-program staff once prepared a quarterly report for senior staff that provided statistics on case loads, counselling hours and program attendance.
But these reports were scrapped in December of 2009. Similarly, evaluations of the drug-and-alcohol programs stopped five years ago.
“We’re recommending that they should put that back in again,” said Fraser. “These are important programs for Yukoners. They should know whether they’re successful or not.”
Useful information on drug-and-alcohol abuse is stored at Whitehorse General Hospital, which deals with the messy consequences of these addictions each night. But it’s not shared with the department.
In 2009-10, the emergency room faced 1,744 alcohol-related admissions. That’s approximately five each day.
Just 22 clients accounted for one-third of these admissions. Three people were admitted 60 times or more. That’s more than once a week.
“This information was not provided to the department, and the department did not request this data from the corporation in order to determine what it might be able to do to assist these high-risk individuals,” the report states.
The Yukon’s much-vaunted Substance Abuse Action Plan, released in 2005, lacks “targets, goals, performance measures, or evaluation requirements.” Without measurable goals, Fraser was unable to say whether the plan achieved anything.
To fix this, Fraser recommended that the department come up with measurable goals for its drug-and-alcohol programs. The department agreed, but warned that “limited resources preclude the department from committing to a time frame for department-wide implementation.”
Health is Yukon’s biggest department, accounting for nearly 30 per cent of the territory’s total expenses. That’s a slightly smaller piece of the pie than health care gets in a few provinces - but in the Yukon, it’s growing fast. Health expenses expanded by nearly 50 per cent over the past five years.
As the territory’s population ages, these costs are only expected to grow. As a result, by 2018, the Yukon could face an annual revenue shortfall of as much as $250 million, according to the 2008 Yukon Health Care Review.
The department reliably overshoots its budget each year, even after being topped-up mid-year with supplementary spending bills. It overspent its budget by $1.4 million in 2008-9 and by $3.7 million in 2009-10.
For that reason, Fraser deemed the department ran afoul of the Financial Administration Act. The department blamed its cost overruns on unexpected health expenses from other jurisdictions.
That didn’t satisfy Fraser. The department ought to make an estimate of out-of-territory health costs and properly budget for these expenses, she wrote. The department is now working on getting timelier billing and making better spending forecasts.
While the report is overwhelmingly critical, it’s not entirely negative. Fraser praised the department’s decision to weigh the costs and benefits of a new magnetic resonance imaging system before splurging on such an expensive machine. It turned out the MRI would pay for itself over time, by removing the need to fly many Yukoners Outside for scans.
That kind of business sense should be applied more frequently, said Fraser.
Her report doesn’t delve into the Yukon Hospital Corporation’s ambitious plans to build new hospitals in Watson Lake and Dawson City. Doing so would require “a very different audit,” said Fraser.
For 2009-10, Health and Social Services employed 874 full-time workers at a cost of $74 million. In August of 2010, the department concluded that 20 per cent of this workforce could retire in the next five years. Yet the department still lacks any plan to replace its aging workers.
Health spending per person in the Yukon trails Canada’s other two territories yet remains above all provinces. The territory spends an average of $6,204 annually on every Yukoner’s health, compared to the national average of $3,957.
The department has agreed to work towards adopting all of Fraser’s recommendations. She’s especially pleased that the department will start producing an annual report by the spring of next year. The Yukon is one of two Canadian jurisdictions that doesn’t already do this.
Opposition leaders seized on the report as further proof that the territory’s badly managed under the Yukon Party.
Liz Hanson, leader of the NDP, compared the department to someone “paddling down a river full of rapids with a blindfold on.”
Arthur Mitchell, the Liberal leader, noted that Premier Dennis Fentie has ran afoul of the Financial Administration Act before, when the territory found itself caught with $36 million invested in asset-backed commercial paper after the market for that product had imploded.
“It’s very disappointing the premier learned nothing from his previous adventures outside the Financial Administration Act,” he said in a release. “Yukoners no longer trust this government and this is another reason why - they keep breaking the laws they were elected to uphold.”
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