Disability, Rental Housing, Registry Programs Inadequate

A November 17th media release from the Auditor General of Nova Scotia:

The Auditor General found problems with government services for persons with disabilities, provincial rental housing programs and government registries, according to his latest report to the legislature released today, Nov. 17.

Jacques Lapointe's report to the House of Assembly included three performance audits that were completed this summer in two departments as well as three chapters on government financial matters.

An audit of registries operated by Service Nova Scotia and Municipal Relations raised concerns about the security of computer systems protecting personal and business information, primarily in the land, business and joint stock registries. Weaknesses were found in the way passwords are controlled, computer accounts are set up and cancelled, and security changes are made. Disaster preparedness was also found to need strengthening.

On the other hand, the Auditor General said business processes to control the collection and recording of registry data were sound, and both business processes and IT systems in the Registry of Vital Statistics were well controlled. The report also noted that the recommended remedies require "relatively minimal resources to implement."

The audit of services for persons with disabilities at Community Services focused exclusively on the community-based options stream of the program, including family support, independent living and small options homes where three or fewer people with disabilities receive care.

The Auditor General said client-needs assessments were inconsistently completed and did not always provide adequate plans to meet identified needs. Reassessments were not always completed as required.

In addition, policies and procedures to investigate complaints about the homes or the services they offer are inadequate and there was no evidence that appropriate actions are taken to follow up and resolve complaints.

Mr. Lapointe said those weaknesses could result in persons with disabilities not receiving the level or type of services they require.

The report notes that the services for persons with disabilities program has been under review since 2002. While the department has made a number of improvements to the program as a result, many recommendations from these reviews have not yet been fully Implemented. A comprehensive plan for the future of the program has yet to be produced.

The audit of Community Services' rent supplement housing program found policies that have not been updated for 15 years, inadequate assessment and monitoring of rental units for safety and affordability, and inadequate evaluation of applications from housing developers applying for subsidies.

The department offers up to $75,000 per rental unit for new or renovated affordable housing. However, the auditors could find no evidence of a formal evaluation process for proposals received or, any evidence of how evaluations are conducted. In addition, once the units are constructed, the department does not follow up to ensure the units continue to meet program affordability requirements.

Other chapters in the report deal with government's financial reporting. One chapter provides the results of financial audits and reviews, and includes recommendations to improve financial controls.

The report also provides indicators of the province's overall financial condition, expanded this year to compare Nova Scotia with five other provinces. And a review of audit opinions of government agencies and Crown corporations highlights a need for them to pay more attention to implementing recommendations of their private sector auditors.

The full report and related documents are available online at www.oag-ns.ca.


FOR BROADCAST USE:

The Auditor General has found problems with government services for persons with disabilities, provincial rental housing programs and government registries, according to his latest report to the legislature released today (November 17th).

Jacques Lapointe's report to the House of Assembly raised concerns about the security of computer systems protecting personal and business information, primarily in the land, business and joint stock registries at Service Nova Scotia and Municipal Relations.

Mr. Lapointe says weaknesses with client-needs assessments and complaint investigation for persons with disabilities at Community Services' community-based options could result in persons with disabilities not receiving the level or type of services they require.

The audit of Community Services' rent supplement housing program found policies that have not been updated for 15 years, inadequate assessment and monitoring of rental units and inadequate evaluation of subsidy applications from housing developers.

The full report and related documents are available at www.oag-ns.ca.

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Media Contact:

Jacques Lapointe
Auditor General
902-424-5907
E-mail: lapoinjr@gov.ns.ca

Hospitals told to meet mental health standards

An article posted today by CBC.ca:

Health minister sends letters after AG's report

Nova Scotia's Minister of Health has sent hospitals across the province a reminder about their obligations when it comes to mental health services.

Maureen MacDonald [pictured] has ordered top hospital administrators to comply with seven orders, in a one-page letter sent to all nine of the province's district health authorities.

MacDonald said the directive is a response to criticism levelled against her department in a recent report by the province's auditor general.

"I was surprised when I saw the auditor's report," she said Thursday. "There is no point in having standards if you don't implement and monitor the standards."

Last week, Auditor General Jacques Lapointe released a report that looked at whether Nova Scotians were able to access timely mental health care, no matter where they live in the province.

He said Nova Scotia was failing to meet its standards when treating mental illness, and said there is no plan to fix the situation.

Lapointe also said there was inadequate oversight of the system and no effective monitoring of the standards.

The auditor general's office found that of 538 Nova Scotians who received mental health care in Colchester-Hants counties, the Annapolis Valley and the Capital District Health Authority in Halifax, only 14 per cent of the patients got care that met mental health standards.

MacDonald said the letter — sent by Deputy Minister Kevin McNamara on her behalf — was sent to the CEOs of the health authorities on the same day Lapointe's report was released.


DHAs


"District health authorities are not spending their own money and they're not spending my money, they're spending the public money and they need to be accountable for that," she said.

"I'm accountable for the health care system on the floor of the house of assembly but the district health authorities are accountable to me for how they deliver health care services."

MacDonald said as part of her seven directives, she reminded hospitals they cannot refuse to admit patients simply because they do not live in the district.

"There are no geographic barriers to getting health-care services within the province of Nova Scotia," she said.

The Health Minister said she has not yet heard from any of the health authorities in the week since she issued the directives.

Health authority responds

Peter Croxall, the director of the mental health program in the Capital District Health Authority, said one of the problems is that the standards are vague and hard to measure.

"Full of, really, of too much mental health jargon and not really written in a clear, explicit fashion," he said.

Croxall said statistics show one in five Nova Scotians will develop a mental illness.

That large number makes the issue difficult to address, he said.

"The fact that we only have … four per cent of the health budget, I think you can draw your own conclusions from that," said Croxall.

"I'm not saying that we're doing terribly badly but we certainly could use more resources or a redistribution of resources within health into the mental health area."

Croxall said in his experience, there was nothing to indicate Nova Scotians were getting substandard care, despite the auditor general's findings.

Official defends mental health service

An article published in today's edition of The Chronicle Herald:

Provincial official says officials know system needs more resources

By John McPhee, Health Reporter

Mental health providers are doing the best they can with limited resources for Nova Scotians, the acting head of mental health services for the province said Thursday.

Faizal Nanji was responding to the auditor general’s report released Wednesday. It highlighted failures to meet standards of mental health care.

Jacques Lapointe [pictured] also criticized the standards for being vague and the fact that a clear monitoring system doesn’t exist.

"We knew these standards were something we’d need to aspire to, and really, that a significant amount of resources — financial, human capital — would be required to help bridge the gap," Nanji said in an interview.

But those resources don’t yet exist, he said.

"That’s our constant battle, to continue to advocate from here for increased funding, to make the case," Nanji said. "We’re at a key juncture."

Nova Scotia is the only province to have mental health standards, which were established in 2003.

Lapointe’s office studied 358 cases in three different health authorities and the IWK Health Centre in Halifax in an attempt to gauge how well those standards are being met. Only 14 per cent of those cases met all of the standards the auditor general selected for testing.

For example, when a doctor refers a patient to mental health care, that referral should be reviewed within one working day. The auditor general’s office looked at 125 cases in the Capital, Annapolis Valley and Colchester East Hants health districts, and at the IWK. Of those referrals, 41 were reviewed in one day.

As well, a patient accepted into the system should be assessed within 10 working days. Out of 54 cases examined in the three districts and at the IWK, only six people were assessed within that time, the auditor general said.

The Capital district health authority, the IWK and the other health districts targeted in the report have accepted the auditor general’s recommendations.

Lapointe was working with information from a year ago, a Capital health district official said Thursday.

Progress has already been made in some areas that were singled out, said Barbara Hall, vice-president of person-centred services.

The district does keep tabs of wait times and how quickly cases are reviewed, Hall said.

"Some of those systems are not the best. There a lot of manual processes, and we have been working on improving that."

The province’s mental health services department will work with each of the province’s nine health authorities to improve care, Nanji said.

On top of the auditor general’s report, an IWK official told MLAs this week that up to 1,000 families are on a year-long waiting list for mental health services.

"We’re doing the best we can to provide a service that’s good, safe and accessible," Nanji said. "But again, we do need more resources in various forms."

Photo credit

Auditor General's Report - Mental Health Services in Nova Scotia

An excerpt for the Auditor General’s Statement to the Media today:

A second audit covered in this report was hampered to a lesser extent by the same restrictions on information. The Department of Health, under instruction from the Executive Council Office, refused to provide us information on budget requests related to mental health services.

Treatment of mental illness is a significant part of the health care system. Mental illness accounts for over 15 per cent of the disease burden in developed countries, and for 3.4 per cent of the Nova Scotia health budget.

In 2003, Nova Scotia became the first province to implement mental health service standards. The Department was aware at the time that funding levels were inadequate to achieve these standards.

When the standards were introduced, the Department acknowledged it would take five to ten years to fully achieve compliance with them. Seven years later, our audit found that the mental health service standards were met in only 14 per cent of the cases we tested; and there is no evidence of a plan or funding to close the gap.

The Department of Health has failed to meet its legislated requirement to monitor and evaluate the quality of mental health services. The lack of departmental oversight and monitoring significantly increases the risk that the mental health care system will fail the people who need it most.

The Department of Health has accepted our report and agrees with all 19 recommendations. However, the government has a poor record of implementing our recommendations. I would draw your attention to the next chapter of this report - a follow-up on the 82 recommendations we made in June 2007. To date, the government has implemented just 27 per cent of those recommendations. This is the worst performance since we began tracking government response to our recommendations in 2002.

The Department of Health was the subject of 48 of those recommendations, and accepted all but one. Two years later, 34 recommendations - 71 per cent - were still not implemented.

This is a concern given the nature of the 2007 recommendations, dealing with issues like financial and quality controls in nursing homes and equitable placement of seniors in need of care.

To access the entire Auditor General’s Report, please click here (PDF).


Also see:

Lax oversight of mental health standards, N.S. auditor says