STANDING COMMITTEE ON PUBLIC ACCOUNTS Hansard Verbatim Report No. 22 — February 26, 2019 Legislative Assembly of Saskatchewan Twenty-Eighth Legislature STANDING COMMITTEE ON PUBLIC ACCOUNTS Mr. Trent Wotherspoon, Chair Regina Rosemont Mr. Don McMorris, Deputy Chair Indian Head-Milestone Hon. Lori Carr Estevan Mr. Todd Goudy Melfort Ms. Lisa Lambert Saskatoon Churchill-Wildwood Mr. Warren Michelson Moose Jaw North Ms. Vicki Mowat Saskatoon Fairview Mr. Randy Weekes Biggar-Sask Valley Published under the authority of The Hon. Mark Docherty, Speaker STANDING COMMITTEE ON PUBLIC ACCOUNTS 455 February 26, 2019 [The committee met at 09:02.] the SHA; Terri Carlson, executive director from the SHA; Leanne Ashdown, chief audit officer from the SHA; Davin The Chair: — Okay. Good morning folks. We’ll convene the Church from eHealth; and Lisa Thomson from Saskatchewan Standing Committee on Public Accounts here today. I’ll Health Authority. We will ask officials to introduce themselves introduce members around the table: Deputy Chair Mr. should they come to the microphone to address the committee. McMorris, Mr. Goudy, Ms. Lambert, Mr. Weekes, Mr. Michelson, Ms. Mowat. And do we have a substitution for . Mr. Chairperson, the Provincial Auditor plays a vital role in No substitutions here. Okay. ensuring the government remains effective, open, and accountable. At the Ministry of Health we firmly believe in these We have the following items to table: PAC 64-28, Ministry of same principles. They guide not only our overall strategic Agriculture: Responses to questions raised at October 4th, 2018 direction, but the day-to-day operations of front-line care. The meeting; PAC 65-28, Ministry of Education: Report of public ministry, Saskatchewan Health Authority, and the other health losses, September 1st, 2018 to November 30th, 2018; PAC agencies are committed to the responsible, efficient, and effective 66-28, Ministry of Finance: Report of public losses, October 1st, management and delivery of health care. Knowing that the 2018 to December 31st, 2018; PAC 67-28, Ministry of Advanced Provincial Auditor also shares this goal, we welcome this report Education: Report of public losses, October 1st, 2018 to and appreciate the effort and detail that was put into the various December 31st, 2018; PAC 68-28, Ministry of Health: Report of reviews. public losses, October 1st, 2018 to December 31st, 2018. Progress has been made on a number of the auditor’s I’d like to introduce the officials that have joined us here today recommendations and work continues in many areas, both at the from the Provincial Comptroller’s office: Terry Paton, Provincial ministry and with our partners, on areas of specific concern. Our Comptroller; Chris Bayda, executive director of the financial ultimate goal is to strengthen and improve health services for all services branch. I’d like to introduce and welcome Judy Ferguson Saskatchewan residents, and we look forward to answering the and her officials that I know will be introduced by our Provincial committee’s questions. Thank you. Auditor with each of the respective chapters. And at this point I think we’ll turn our attention to the Saskatchewan Cancer The Chair: — Thank you so very much, Assistant Deputy Agency and the reports: 2016 report volume 1, chapter 14; and Minister Wyatt. And we have some serious health horsepower in the 2018 report volume 2, chapter 38. the room here today. Thanks to everybody for the work that they do across the province for people. I’d like to welcome officials from the Ministry of Health and the Cancer Agency for their attendance here today and for their I’ll turn it over now to the Provincial Auditor to address chapters work. Maybe I’ll turn it over real quick for an introduction of the 14 and 38, and we’ll go from there. officials that are with us here today. I’d ask us not to get into the chapters just now because I’ll pull it back to the Provincial Ms. Ferguson: — Thank you very much, Mr. Chair, Deputy Auditor and then turn it back for a subsequent response and then Chair, members, and officials. We’re pleased to be here this questioning of committee members. Thank you so much for morning and actually to discuss the bulk of the work that we’ve being here today. done in the last few years in the health sector. This morning we’re going to present the two items on the agenda for Cancer Agency Health together. And you’ll find that there’s various ones today that we’ll be grouping wherever we can. Mr. Wyatt: — Good morning and thank you on behalf of the Ministry of Health. I’d like to thank everyone for the opportunity Before we launch into that, I’m going to introduce Ms. Tara to discuss the 2015, 2016, 2017, and 2018 Provincial Auditor Clemett who’s the deputy provincial auditor responsible for the reports. My name is Mark Wyatt; I’m assistant deputy minister. health division and has led the bulk of the work that’s presented And several ministry and health partner staff are joining with us today. And behind her is Kim Lowe. Kim is actually here with today to assist in answering specific questions regarding the double duty today; she’s got two hats. She’s our PAC [Public report. From the ministry, we have Billie-Jo Morrissette, Accounts Committee] liaison, but she’s also an integral member assistant deputy minister; Kimberly Kratzig, assistant deputy of the health division team too and has led a good chunk of the minister; Deborah Jordan, executive director of connected care work that’s on the agenda today. Tara will be making the bulk of services; Linda Restau from continuing care; Bev Hungle from the presentations today too, so you won’t have to listen to my finance branch; and to my right, Kayla Edgerton, manager of raspy voice. contracts and CBO [community-based organization] review with financial services branch. Before we launch into the presentation, we do want to take a moment to thank the officials at the Cancer Agency for the We also have a number of officials from both the Cancer Agency, co-operation extended to us during the course of this work. Tara. the Saskatchewan Health Authority, and eHealth Saskatchewan, including Dr. Jon Tonita from the Cancer Agency along with Ms. Clemett: — Chapter 14 of our 2016 report volume 1, on Linda Weir from the Cancer Agency; Robbie Peters, vice pages 163 to 180, reports the results of our audit of Saskatchewan president with the Saskatchewan Health Authority; Corey Miller, Cancer Agency’s processes to deliver its systematic vice-president of provincial programs with the SHA population-based screening program for breast cancer. The [Saskatchewan Health Authority]; Andrew McLetchie, also program suggests women over 50 years of age have a vice-president with the SHA; Sharon Garratt, vice-president with mammogram every two years. In 2014-15, Cancer Agency spent 456 Public Accounts Committee February 26, 2019 about $3.8 million on its screening program. The agency accessible through using a mobile mammography bus and using recognized the participation rates in the screening program were ads to make individuals aware of the timing of visits to their low. community. We concluded that for the period of March 1st, 2015 to February However we found the agency did not use the information it had 29th, 2016, Cancer Agency had — other than reflected in our already collected, for example the geographic information, to recommendations — effective processes to deliver its screening determine or assess participation rates of those difficult-to-screen program for breast cancer. We made five recommendations. I’m populations, so those living in rural or remote areas. As a result, going to focus my presentation on those five recommendations. it didn’t know whether its targeted strategies were actually increasing participation of difficult-to-screen populations in its Our first recommendation on page 170: we recommend that the screening program. By August 2018 we found the Cancer Saskatchewan Cancer Agency evaluate the success of its Agency had implemented this recommendation. It was analyzing screening program for breast cancer promotional activities its information. In addition it undertook new strategies to educate against expectations. The Cancer Agency educates the public and reach difficult-to-screen populations. about its screening program through various promotional activities. Each year it spent about $43,000 on its promotional In our fourth recommendation on page 177, we recommend that activities. Two staff were responsible for organizing these the Saskatchewan Cancer Agency broaden the use of its key activities. We found the agency had not established how to quality indicators relevant to Saskatchewan to regularly analyze determine the success of its promotional activities. For example, the performance of its screening program for breast cancer. We it did not determine the expected percentage increase in found that while the Cancer Agency did some monitoring of its participation rates for a particular promotional activity for a programs, the information it used wasn’t current to enable the targeted region or group. Rather the agency informally evaluated agency to monitor whether its screening program is effective, so its promotional activities on an annual basis. It discussed what whether breast cancer is correctly identified through the worked well, what it needed to improve. It did not keep record of screening test, and to monitor the performance of its individual these discussions or decisions. radiologists. By August 2018, as reported in our chapter 38 of our 2018 report [09:15] volume 2, although the agency had developed tools to begin evaluating its promotional activities, it wasn’t using them The agency was trying to use national results published by a consistently.