Mr. Chair, thank you for this opportunity to discuss our Spring 2015 Report on Access to Health Services for Remote first nations Communities. Joining me at the table is Joe Martire, the principal responsible for the audit.

In this audit, we looked at what Health Canada has done to support first nations access to health services in remote communities. first nations individuals living in remote communities have significant health needs and face unique obstacles in obtaining health services. We found that Health Canada had not adequately managed its support of access to health services and medical transportation benefits for remote first nations.

According to the department, its support to these communities extends to 85 health facilities where health services are delivered through collaborative health care teams led by approximately 400 nurses. These health facilities serve approximately 95,000 first nations individuals. For these individuals, initial access to health services is usually provided by nurses at nursing stations.

We found deficiencies in the way nursing staff and stations are managed. For example, while all 45 nurses included in our sample were registered, only one of the 45 had completed all five of Health Canada's mandatory training courses we examined.

Health Canada acknowledges that its nurses sometimes work outside their legislated scope of practice to provide essential health services to remote first nations communities. Examples of such activities include prescribing and dispensing certain drugs and performing X-ray imaging of chests and limbs. Nevertheless, we found that Health Canada had not put in place supporting mechanisms that would authorize the nurses to perform activities outside their legislated scope of practice, for example, medical directives to allow nurses to perform specific tasks under particular circumstances.

We also found that Health Canada could not demonstrate whether nursing stations built since 2009 had been constructed according to applicable building codes. Moreover, the department had not addressed 26 of 30 health and safety or building code deficiencies that we examined in seven nursing stations built before 2009.

These deficiencies included malfunctioning cooling and ventilation systems and unsafe stairs, ramps, and doors. In one community, health specialists cancelled their visits to the residence intended for their use because issues with the septic system caused the residence to be closed. These issues dated back more than two years.

In addition, we found that Health Canada did not take into account the health needs of remote first nations communities when allocating support. For example, we noted that the number of nurses assigned to nursing stations was based on past practice, and not on each community's current health needs.

We also found that Health Canada had recently defined essential health services that should be provided in nursing stations. However, the department had not assessed whether nursing stations had the capacity to provide the services, nor had it informed first nations individuals of the essential services that each nursing station provided.

With respect to access to health services outside the community, we found that medical transportation benefits were available to first nations individuals who were registered in the Indian registration system, but those individuals who were not registered may have been denied access to benefits.

We also found that Health Canada's documentation concerning the administration of medical transportation benefits was insufficient. For example, there was a lack of documentation to demonstrate that the requested transportation was medically necessary and to confirm that individuals attended the appointments for which they had requested transportation.

Furthermore, Health Canada committed to providing first nations individuals living in remote communities with access to health services comparable to that provided to other residents of Manitoba and Ontario living in similar locations. Even so, we found that the department had not gathered the information it needed to know whether it was achieving its objective.

We also noted weaknesses in the coordination of health services among jurisdictions. For example, we found that committees comprising representatives of Health Canada and other stakeholders in Manitoba have not proven effective in developing workable solutions to interjurisdictional challenges that negatively affect first nations individuals' access to health services.

This finding is important because the lack of coordination among jurisdictions can lead to the inefficient delivery of health care services to first nations individuals and to poor health outcomes for these individuals.

Workable solutions are needed to improve accountability and ensure that individuals in first nations communities have access to health services comparable to those offered to other residents.

Our report contains 11 recommendations aimed at improving access to health services for remote first nations communities and the health outcomes of individuals, and Health Canada has agreed with all of them.

Mr. Chair, this concludes my opening remarks. We would be pleased to answer any questions the committee members may have.

Thank you.