CONTENTS
Standing
Committee on Public Accounts
Saskatchewan Impaired Driver Treatment Centre
Saskatchewan Housing Corporation
THIRTIETH
LEGISLATURE
of
the
Legislative Assembly of Saskatchewan
STANDING
COMMITTEE ON
Hansard Verbatim Report
No.
9 — Wednesday, October 15, 2025
Chair
Wotherspoon: — Well good morning, folks. We’ll
convene the Standing Committee on Public Accounts. My name is Chair Wotherspoon. I serve as the Chair of the
Public Accounts.
[08:30]
I’d like to
welcome and introduce the committee members that are here: Deputy Chair Wilson,
MLA [Member of the Legislative Assembly] Beaudry, MLA Chan, MLA Crassweller,
MLA Gordon, and MLA Pratchler.
We have the
following document to table: PAC 53‑30, Ministry of Education: Report of
public losses, June 1st, 2025 to August 31st, 2025.
I’d like to
welcome and introduce the officials from the Provincial Comptroller’s office:
Provincial Comptroller Brent Hebert and Assistant Provincial Comptroller Jane
Borland.
I’d like to
welcome and introduce our Provincial Auditor, Tara Clemett, and her officials
that are with us in attendance here today with the Provincial Auditor’s office
as well.
Health
Chair Wotherspoon: — Our first agenda items here today will
focus on the Ministry of Health. Quite a few different chapters that we’ll
focus on from various reports here this morning, and they’re all sort of
independent presentations from the auditor, or chapters by the auditor. Then
we’ll come back to the Ministry of Health for response on each of those, and
then open it up for questions.
At this time
I’d like to welcome all the officials with the Ministry of Health that have
joined us here this morning, all those that are involved in the important work
that you take on every day as well that’s connected to our considerations here
today.
I’d like to
thank you for the status update that’s been provided as well, and I’ll table it
at this time. I’ll table document PAC 54‑30, Ministry of Health: Status
update, dated October 15th, 2025.
And I’d ask
Assistant Deputy Minister O’Neill, who is seated at the centre of the table
there, to give a brief introduction of all the officials that are with him here
today. And then we’ll turn it over to the auditor to make a presentation on the
first chapter and then come back your way for comment.
Norman O’Neill:
— All right. Thank you and good morning to everybody. So we’ll start by just
thanking the Provincial Auditor of Saskatchewan, Tara Clemett, and her team for joining us today. We recognize the
crucial role that the Provincial Auditor plays in providing oversight for the
Ministry of Health and our partner health agencies. We appreciate the
opportunity to review these previous auditor reports and provide important
progress updates.
So we are joined today by staff from the
Ministry of Health, the Saskatchewan Health Authority, 3sHealth [Health Shared
Services Saskatchewan], and eHealth to address any follow-up questions or
discussions.
Ministry
of Health representatives include David Matear, assistant deputy minister;
James Turner, assistant deputy minister; Chad Ryan, assistant deputy minister;
and to my left, Dave Morhart, executive director of acute and emergency
services branch; to my right, John Ash, who’s a vice-president of Saskatoon
integrated health with the SHA [Saskatchewan Health Authority]. Other senior
leader team and ministry officials will be introduced at the microphone as we
progress. In addition to John, the SHA is represented by Felecia Watson who’s
the executive director of patient and client experience.
3sHealth
representatives joining us today will be as follows: Mark Anderson, chief
executive officer; Alana Shearer-Kleefeld, vice-president of employee benefit
plans; Luke Malach, executive director of internal audit and enterprise risk
management; and Boye Adetogun, director of claims services.
In
the afternoon we’ll be joined by eHealth representatives Davin Church, chief
executive officer; and Aaron Mula, vice-president of digital services and chief
information officer. Additionally Crystal Zorn, vice-president of security and
privacy, will join us.
So
again thank you to everyone for being here this morning, and we’re prepared to
discuss progress on any outstanding recommendations. The Ministry of Health and
our partner agencies are committed to full implementation of all remaining
recommendations. Our ministry and health partners share the same goal as the
Provincial Auditor and her team, which is to continually improve and provide
high-quality health care services for all Saskatchewan residents.
We
look forward to today’s review and believe they will help inform future work on
these important recommendations. Thank you.
Chair Wotherspoon:
— Okay, thank you very much, ADM [assistant deputy minister] O’Neill and all
the officials that have joined us again here today, and those that are
connecting to the work we’re considering here today as well.
I’ll
kick it over now to our Provincial Auditor and her team to make a presentation
on their chapter 14 from the 2023 report volume 2.
Tara Clemett: — Thank you and good morning. Thank you,
Mr. Chair, Deputy Chair, committee members, and officials. With me today is Mr.
Jason Wandy, and he is the deputy provincial auditor that is responsible for
the Ministry of Health. Behind me and to the far left is Ms. Kim Lowe. She is a
senior principal but works on a number of health audits that are going to be
under consideration today. And then beside her is Ms. Michelle Lindenbach, and
she is our liaison with this committee.
Jason’s going to present the chapters
for the ministry in the order that they do appear on the agenda, and this will
result in seven separate presentations. He will pause for the committee’s
discussion and deliberation after each presentation. The first presentation
about coordinating the provision of timely neurosurgery services includes eight
new audit recommendations for this committee’s consideration. And then the
remaining six presentations all include status updates on the outstanding
recommendations that this committee previously did agree to.
I do want to thank the assistant deputy
minister and all the staff at the Ministry of Health as well as the SHA for the
co-operation that was extended to us during the course of our work. With that,
I will turn it over to Jason.
Jason Wandy: — Thank you, Tara. Chapter 14 of our 2023
report volume 2 reports the results of our audit of the Ministry of Health’s
processes, for the 16‑month period ended May 31st of 2023, to coordinate
the provision of timely neurosurgery services in Saskatchewan. We concluded the
ministry had effective processes other than the areas reflected in our eight
new recommendations for the committee’s consideration.
Neurosurgery
services provided by the Saskatchewan Health Authority includes consultations
and surgery related to the brain, spine, and nervous system that may be needed
to treat conditions such as a pinched nerve in the back or neck, damage to the
brain or spine from an injury, or a brain tumour.
At April 30th,
2023 about 240 Saskatchewan patients were waiting more than a year for a
neurosurgeon to provide surgery. From April 1st, 2022 to April 30th, 2023 the
ministry and the Authority paid over $18 million to neurosurgery
physicians for services provided to patients.
Coordinating
the provision of neurosurgery services is one of many aspects of the ministry’s
role in maintaining a system to provide comprehensive health services. The
ministry’s acute and emergency services branch is its primary unit responsible
for coordinating neurosurgery services. This branch determines estimated
funding required each year for delivering these services.
While the
ministry’s medical services branch works with physicians to develop initiatives
toward improving access to specialists, such as neurosurgeons, the medical
services branch also works with the Saskatchewan Health
Authority on physician
resource planning activities as well as negotiates the physician
compensation agreement with the Saskatchewan Medical Association.
In our first recommendation, on page
117, we recommend the Ministry of Health and the Saskatchewan Health Authority
communicate clear expectations and monitor the number of neurosurgery services
provided by each physician to determine whether neurosurgery needs are met.
At June 2023 there were seven
neurosurgery physicians in Regina and 13 in Saskatoon. Neurosurgery physicians
can work either on a contracted or a fee-for-service basis. Under contractual
arrangements, the Authority pays regular monthly amounts to licensed
physicians. Under the fee-for-service arrangement, the ministry pays licensed
physicians for each specific insured service provided to a Saskatchewan
resident based on preset rates negotiated with the Saskatchewan Medical
Association.
The fee-for-service model rewards
productivity but also promotes a competitive environment where fee-for-service
neurosurgeons may want as many surgical patients as possible. This creates
challenges for the ministry to manage actual surgical volumes and patient
wait-lists.
We found fee-for-service physicians had
triple the number of patients waiting for surgery compared to contracted
physicians, and nearly twice as many operating room cancellations. This
suggests some neurosurgeons may have too many patients while other neurosurgeons
may have capacity to treat more patients.
Our review of the contract templates for
both contracted and fee-for-service neurosurgeons found they did not set out
clear performance expectations. Contracts provide an opportunity to reinforce
and clarify expectations for neurosurgeons to promote consistent understanding
and resulting practices, such as expectations for managing patient volume and
wait-lists.
Clear performance expectations could
support efforts to balance patient loads and treat neurosurgery patients more
timely.
In our second recommendation, on page
121, we recommend the Ministry of Health forecast the number of neurosurgery
physicians and other staff required to provide neurosurgery services annually
and over the long term.
Having an appropriate supply of
neurosurgery physicians and support staff is important to ensure wait times are
reduced and managed appropriately. The ministry uses IT [information
technology] systems to forecast up to 10 years of demand for neurosurgery
services by considering historical surgery volumes, medical trends such as an
increase in stroke risks, and population changes such as the size or aging of
the population.
For 2023‑2024 we found the
ministry provided its forecasts to the Authority to support the Authority’s
annual planning processes. However the ministry did not know whether the
Authority used the forecasts. Other than funding for new contracted physicians,
we found for 2023‑24 the Authority budgeted based on expected demand for
health services and did not consider how many physicians are required to meet
the province’s needs. As a result the ministry does not know whether the
Authority has enough or too many neurosurgery physicians and support staff to
meet the anticipated neurosurgery volumes.
Since the ministry does not forecast, or
request from the Authority, the number of physicians and support staff needed
to deliver neurosurgery services in the province, it cannot complete a
sufficient gap analysis to assess whether the Authority has an appropriate
number of physicians and support staff delivering neurosurgery services. This
also impacts the ability to sufficiently conduct workforce planning over the
long term.
In our third recommendation, on page
123, we recommend the Ministry of Health analyze patient referral systems used
for neurosurgery services and determine an efficient system to use for
referrals across the province.
Saskatchewan physicians use two
different systems to refer patients for neurosurgery services. The Saskatoon
neurosurgery division uses a pooled referral system while the Regina
neurosurgery division uses a direct referral system. Under the pooled referral
system, patients have the option of seeing the first available neurosurgeon in
the pool or waiting to see a specific neurosurgeon. If one neurosurgeon in the
pool is at full capacity, patients float to others who are not, which
eventually results in a more or less equally distributed workload.
At March 31st of 2023 Saskatoon had 268
patients waiting for spine surgery compared to 765 in Regina. Additionally our
analysis of data found patients in Saskatoon waited about 43 days on average
for their neurosurgery consultation, compared to almost 152 days in Regina. The
ministry noted some patients wait longer than others due to the surgeon to whom
they are referred. For example that surgeon may have a longer wait-list.
We found the ministry had not analyzed
the reasons for the delays to determine any related action it may take to help
patients access more timely consultations. Without analysis to determine the
effectiveness of using pooled versus direct referrals, patients may be waiting
longer than necessary to see a neurosurgery physician. Patients who wait longer
to see a physician may risk declining health that affects their quality of
life, or have difficulty working that causes financial hardship.
In our fourth recommendation, on page
124, we recommend the Ministry of Health collect and analyze complete wait time
data for patients directly referred to a neurosurgery physician.
Not collecting complete referral data
limits the ministry’s ability to analyze and assess wait times as well as the
effectiveness of the direct referral system. It also means the ministry does
not have a good understanding of total neurosurgery wait times, the total time
from when a family physician makes a referral to a neurosurgery physician to
the point when a patient receives surgery.
In our fifth recommendation, on page
125, we recommend the Ministry of Health work with the Saskatchewan Health
Authority to increase the use of spine pathway referrals to reduce potentially
unnecessary neurosurgery consultations and surgeries.
[08:45]
The Saskatchewan spine pathway is a
standardized assessment and treatment process for patients with low back pain.
Physicians and other health care providers can refer patients to a spine
pathway clinic managed by the Authority located in either Saskatoon or Regina.
At the clinic, health care providers
work with patients to help assess whether surgery is necessary or an alternate
treatment option, such as physiotherapy, may resolve their condition without
surgery. During the audit, neurosurgeons advised us that the spine pathway
allows patients to access other supports, like physiotherapy, and many spine
patients’ conditions will resolve in time with these supports without surgery.
In 2022‑23 Saskatoon referred
about 20 per cent of its 1,583 initial assessments completed through the spine
pathway for surgical consultation, and Regina referred only about 4 per cent of
733 initial assessments. These rates may suggest that more referrals to the
spine pathway could significantly reduce the wait-list for spine consultations
and surgeries as well as limit the number of patients getting surgery because
of alternate treatments.
Between 2017 and 2023 Saskatchewan’s
spine surgery rates averaged higher than the Canadian average, ranking in the
top three highest rates. Referring more patients to a spine pathway clinic can
help the ministry and Authority better manage timely access to neurosurgery
services for those who need spine surgery.
In our sixth recommendation, on page
126, we recommend the Ministry of Health work with the Saskatchewan Health
Authority to document surgery prioritization criteria to support timely and
fair access to neurosurgery services.
Neurosurgery physicians assign patients
to a prioritization category when completing booking forms to place patients on
the surgical wait-list. The Authority’s scheduling units generally schedule
surgeries on a first in, first out basis according to the assigned priority on
the booking forms. We found neither the ministry nor the Authority had
documented factors or criteria to guide the neurosurgery prioritization
decisions to support consistency in fairness of access to services by patients.
Our testing of 19 patient files found
the Authority completed surgery within the prioritization time frames 26 per
cent of the time. From February 2022 to April 2023 our analysis found similar
results in that the Authority completed 36 per cent of surgeries within the
prioritization time frames. This means up to three-quarters of neurosurgery
patients may be experiencing longer periods of pain, suffering, and reduced
quality of life as they wait longer than expected for surgery.
In 2022‑23 the ministry found
Regina neurosurgery physicians prioritized more spine procedures as emergent or
urgent at 83 per cent, compared to Saskatoon at 68 per cent. Inconsistent
prioritization processes can lead to variation in how different surgeons categorize
their patients, resulting in inappropriate surgery delays for some patients. It
also increases the risk surgeons can manipulate the system to get their
patients in sooner, while also increasing the volume of surgeries they can
complete and be paid for. Good prioritization drives scheduling expectations
and capacity planning to help prevent delays for patients awaiting surgery.
In our seventh recommendation, on page
129, we recommend the Ministry of Health work with the Saskatchewan Health
Authority to assess enhancements for improving efficiency of scheduling
patients for neurosurgery. The Authority’s operating room scheduling teams
schedule patients for surgery in the Authority’s IT surgical scheduling system
based on allocation of operating room time to surgeons, as well as patient
prioritization and equipment availability.
During 2022‑23 Regina and
Saskatoon operating room scheduling teams allocated operating room time to
surgeons in four- to six-week blocks of time to manage resource uncertainty and
reduce the risk of rescheduled surgeries. We found the ministry had not
assessed whether the time frames used to schedule neurosurgery are effective.
The ministry has a number of
opportunities to look at the Authority’s scheduling processes — including
operating room flex days, after-hours surgeries, cancellations, and late starts
— to determine whether changes can improve neurosurgery wait times. Without
assessments to determine the most efficient scheduling processes, patients may
wait longer for surgery than necessary. Better analysis and consideration of
scheduling alternatives and enhancements such as flex days may result in better
use of operating room blocks, save the health sector money, and provide
patients with necessary surgery.
In our eighth recommendation, on page
131, we recommend the Ministry of Health formally establish annual action plans
to address gaps in neurosurgery services. We found the ministry prepares a
number of standard statistical reports from its surgical registry and provides
these reports weekly or monthly to management at the ministry and the
Authority. The ministry prepared over 10 different weekly reports and about 40
different monthly reports for management’s review.
These reports include information such
as counts of surgeries performed, patients waiting, bookings, and cancellations
by month; as well as surgeries performed, outlining cases exceeding, meeting,
or not meeting target time frames. However we found the ministry completed very
little analysis related to the statistics reported to make review of the
reports efficient and effective.
Additionally, in May 2023, the ministry
provided the Authority with a report analyzing neurosurgery services, which it
compiled in response to patient concerns. While the report contained good
information, we found it lacked analysis, such as the causes of results, and
action plans or recommendations to address the identified gaps.
Senior management and partners need
robust analysis reported about progress toward targets so they can set and
revise action plans to achieve long-term goals and to reduce patient
wait-lists.
I will now pause for the committee’s
consideration.
Chair
Wotherspoon: — Okay, well thank you very much for
the presentation and the important focus of the chapter as well. I’ll turn it
over to ADM O’Neill for brief remarks. We have the status update. We appreciate
the actions being detailed there. Brief remarks, and then we’ll open it up for
questions.
Norman O’Neill:
— All right. Thank you. Just regarding the first recommendation for the
Ministry of Health and the SHA to communicate clear expectations and monitor
the number of neurosurgery services, comprehensive work to establish
expectations with service providers has been carried out. The framework for
ongoing monitoring is in development.
In response to the auditor’s
recommendations, the ministry and the SHA established a neurosurgery steering
committee. Moving forward, the neurosurgery steering committee will establish
ongoing processes for monitoring expectations and provision of neurosurgery
services, with ongoing communication and reporting to neurosurgeons.
Concerning the second recommendation,
for the Ministry of Health to forecast the number of neurosurgery physicians
and other staff, the department of surgery is developing a multi-year surgical
resource plan to determine the number of surgeons required to meet patient
demands, including neurosurgeons.
Regarding the third recommendation, for
the Ministry of Health to analyze patient referral systems used for
neurosurgery services, the ministry and the SHA have worked with the department
of surgery division of neurosurgery to implement pooled referrals. Most of the
neurosurgeons located in Regina have agreed to participate in a provincial
neurosurgery pool supported by eHealth’s referral management services program.
Referral management services has worked
with the SHA and neurosurgeons throughout 2024‑25 to develop
documentation and algorithms for a provincial service to collect data to
onboard new providers. Efforts are also under way to create a separate pooled
referral stream specifically for low back pain referrals. The timeline for a
launch of a provincial spine surgery pooling service is Q3 [third quarter] of
2025.
In relation to the recommendation
no. 4, for the Ministry of Health to collect and analyze complete wait
time data for the patients directly referred to a neurosurgery physician, the
ministry has taken measures to improve the quality of wait 1, which is the
referral-to-consult time, by using the data in the surgical registry and in
billing systems. The ministry has been making changes to the surgical registry
to require more robust information about referral and consult times. We
anticipate this information will be available to the ministry and surgical
leaders by the end of the fiscal year.
With regard to recommendation 4, for the
Ministry of Health to work with the SHA to increase the use of spine pathway
referrals, consultations were held with stakeholders, the ministry, and the SHA
to plan to make the spine pathway part of a pooled referral service
specifically for patients suffering from low back pain. The spine pooled
referral service will begin accepting referrals by March 2026. Once this pooled
referral service is implemented, referrals for low back pain are received by
RMS [referral management services] central intake, and they will be
automatically directed to the spine pathway clinic where the patient will be
assessed to determine whether a surgical consult is appropriate. Based on the
assessment, the referral will be forwarded to a surgeon or directed to
conservative management.
Regarding recommendation 6, for the
Ministry of Health to work with the SHA to document surgery prioritization
criteria, a diagnosis-based surgical prioritization was implemented on April
1st, 2024 and has replaced surgeon priority in the surgical booking system.
Starting April 1st, 2024 a surgeon indicates the patient’s diagnosis on a
surgical booking form, but the surgeon does not enter a clinical wait time
priority for the surgery. The surgical system provides the standard priority
associated with the diagnosis. Surgeons must provide a rationale if they wish
to override the standard clinical priority.
Surrounding recommendation no. 7,
for the Ministry of Health to work with the SHA to assess enhancements for
improving efficiency of scheduling patients for neurosurgery, improvements in
surgical efficiency are a priority of the system. As noted previously,
diagnosis-based surgical prioritization will help address and improve
efficiencies.
The ministry and SHA will track
efficiency measures, like the postponement reasons, and address them. For
example a large percentage of postponements are related to medical
complications or consent withdrawal. Preoperative patient optimization
initiatives make better-screened patients so that they are ready, willing, and
able to undergo surgery, and allow for more efficient elective slate scheduling
and reduce postponements.
Concerning the final recommendation, for
the Ministry of Health to formally establish annual action plans to address
gaps in neurosurgery services, the provincial
neurosurgery steering committee was formed in 2024 to provide
multi-stakeholder monitoring and planning of neurosurgery services related to
the Provincial Auditor’s report. The provincial neurosurgery steering committee
intends to create a standard dashboard to review and monitor results as well as
identify any gaps in neurosurgery services.
In 2025‑26 the committee will
start a process of establishing formal action plans with the reporting to the
provincial surgical executive committee.
And those are my remarks. Thank you.
Chair
Wotherspoon: — Okay. Thank you very much, and
thanks to all those that are involved in, have been involved in the work that’s
reflected in those comments in the status update.
I’ll look to committee members now that
may have questions. Don’t jump all at once. MLA Pratchler.
Joan Pratchler: — Thank you, Chair.
And thank you for being here today. By your most recent count, how many
patients have been waiting more than a year for a neurosurgeon to provide
surgery?
Norman O’Neill:
— In answer to the question, our most recent information is as of March 31st,
2025, and we have 99 people that have been waiting more than one year for
surgical treatment from a neurosurgeon.
Joan Pratchler: — Could you
differentiate that between Regina and Saskatoon as well?
Norman O’Neill:
— Probably.
[09:00]
In front of us we don’t have that data,
but we can get it before lunch. We’d just follow up with the officials that are
back in the office.
Joan Pratchler: — Thank you. I know
that quarterly reviews are planned, but what is the current frequency of those
counts? Is it yearly? It says March 31st that you just mentioned. Are you now
currently doing them quarterly to assess how many are on the waiting list, or what
would be the frequency?
Norman O’Neill:
— I’ll have Dave introduce himself and answer the question.
Dave Morhart:
— Hi. Dave Morhart, executive director, acute and emergency services branch
with the Ministry of Health. In terms of the frequency of reviewing the wait
time data, there would be kind of ongoing informal review that happens all the
time through, you know, the provincial head of surgery working with the
department leads. However, formally that is done through the quarterly meetings
as part of the neurosurgery executive committee.
Joan Pratchler: — So they’re
currently on quarterly?
Dave Morhart:
— Yes, they’re quarterly. Yeah.
Joan Pratchler: — Okay, thank you.
Chair
Wotherspoon: — MLA Gordon.
Hugh Gordon: — Good morning. Just
wanted to see if I can sort out a couple of these different items that were, I
guess, identified by the Auditor General in her report. One is with respect to
fee-for-service and contract, and one is with respect to pooled and direct referral
methods. So I understand correctly, you are now moving towards a pooled method
and moving away from the direct referral. Do I understand that correctly? So
was there analysis done on that to determine that that was the best way to go
forward as per her recommendations?
Dave Morhart:
— In terms of kind of the pooled referrals versus direct referrals, so there
was analysis done. So we looked at, you know, what other jurisdictions are
doing, and it’s certainly a best practice.
We kind of had the advantage, at the
time of the audit, that we had pooled referrals in Saskatoon but not in Regina,
so we could see the differences in those processes, in those wait times. So
even just looking at that data and seeing, you know, the time that it took to
see a physician for a consult, the difference between a pooled process and a
direct referral, the differences were quite vast. So we could see that.
And then the other thing too with a
pooled referral process, we do have that ability for all patients to be seen
through a pathway, where they can get that assessment before surgery is ever
booked, to see if they’re actually an ideal candidate for a surgery. So they
get to see like a physiotherapist and other health care providers that do that
assessment to see if they actually are appropriate for surgery. So that’s the
other advantage of being able to do that through a pooled referral system.
Hugh Gordon: — I guess there’s a
couple things happening at the same time. We have contracted neurosurgeons, we
have fee-for-service neurosurgeons, and we know according to the auditor’s
report that the fee-for-service surgeons were handling way more patients than
the contracted ones but also had higher wait times, right? And they all appear
— sorry, not all — but a good majority of those fee-for-service neurosurgeons
resided in Regina. We know Regina was getting backlogged.
So
I’m just curious, now that you’ve moved to a pooled referral system
province-wide, if you’re seeing those fee-for-service neurosurgeries being done
and completed at a higher rate in Regina. Is that allowed, that those
fee-for-service neurosurgeons do more surgeries, or are we still seeing the
same kind of backlog in Regina for the fee-for-service neurosurgery?
John Ash:
— Greetings. I’ll take this next question. My name is John Ash. I’m the
vice-president for integrated Saskatoon health with the Saskatchewan Health
Authority and have provincial accountability for the overall surgical program
within the SHA.
So to answer your question specifically,
of the neurosurgeons there are only three that are still fee-for-service. The
provincial department head is actively engaged in working with them to support
the transition to contract.
Running parallel to that, we started
some work regarding kind of the pooled referral process, and certainly we’ve
worked with our neurosurgeons to get them to sign a letter of understanding
around how they would participate in pooled referrals. So far all but four have
signed that memorandum of understanding to participate in pooled referral. And
once again the provincial department head is actively working to transition the
remaining over to sign the pooled referral, and good progress is being made.
Just to highlight, prior to the audit
there was roughly 100 patients waiting greater than 24 months for spine
surgery. Currently that number is zero.
Hugh Gordon: — Sorry, just to
quickly add onto that, the number of neurosurgeons in the province has not been
reduced. We have just now transitioned more of the fee-for-service to contract.
Do I understand that right? Thank you.
Chair
Wotherspoon: — MLA Pratchler.
Joan Pratchler: — So how has the wait time for neurosurgery
consultations been impacted since this implementation of pooled referrals?
[09:15]
Dave Morhart:
— So I just want to clarify before answering the question. So we’re just
actually in the process of onboarding Regina to the pooled referral process, so
we haven’t actually completed that work. So we don’t have the data yet to see
what the impact would be, because previously we just had the wait time data for
like the direct referral process that would have been cited in the auditor’s
report. So we don’t actually have the data yet to see what that pooled referral
process in Regina, how that will have an impact on the wait times.
Joan Pratchler: — So when did it
start in Regina, this new process? You’re waiting for the data. When did it
start?
Dave Morhart:
— Yeah, so I can provide some additional clarity. So we have been working with
the physicians, with the surgeons to move to the pooled referral, but it
actually isn’t in place yet. So we’re looking at Q4 of this fiscal to have that
in place, yes.
Joan Pratchler: — Okay, thank you.
I’m just looking at the recommendation no. 5 on page 2 of the document
that was submitted, and I see the last part of that recommendation:
“unnecessary neurosurgery consultations and surgeries.” And then I draw your
attention to page 131 of the report. It says, “Saskatchewan generally performs
more spine surgeries per 100,000 population than most other provinces.” And
Saskatchewan has a spine surgery rate of 130.1 per 100,000 and Manitoba has 54
and Alberta has 80.4.
Saskatoon refers
patients to the spine pathway more than twice as often as Regina, and only
10-25% of patients referred through the spine pathway required a subsequent
surgical consult.
This drew my attention that, is there a
possibility that unnecessary neurosurgeries are happening here in our province?
John Ash: — First off, thank
you for your question. So part of looking at the audit recommendations and
overall wait-lists, one of the identifying factors was that we had a variation
in the utilization of, or the implementation of the pathway between Regina and
Saskatoon. We certainly recognize there is variation and, to your point, noting
that the rates of spine surgery are higher in Saskatchewan than in other
jurisdictions.
The root cause analysis identified that
one of the contributing factors is we need to standardize the use of that
pathway. So that has been a primary focus for the SHA and working with our
surgeons. I know we’re focusing on that letter of understanding to get pooled
referrals and work through that process because we want to be able to bring
patients in, have them properly assessed by a multidisciplinary team to
determine whether there is a non-surgical path for them to receive the
appropriate care.
And we’re roughly around kind of 15 per
cent of people going through that pathway now are determined to need surgery.
So we want to continue to focus on that work.
Joan Pratchler: — I just want to
circle back to the pooled referral process and the outcomes with that. Have any
of these pooled referral patients been sent to other cities in the province for
their surgeries?
Dave Morhart:
— So thank you for the question. So again the pooling right now is only
happening in Saskatoon. So in the current process for those patients that are
pooled in Saskatoon, they are only referred to a Saskatoon surgeon. So they
aren’t referred out to another location. However with the future state, with
the provincial pooled referral system that we are working to implement by Q4,
patients will have the option to indicate if they are willing to travel to see
the surgeon that has the shortest wait-list essentially. And so in that case,
if they do choose to travel, they may be referred to a surgeon in another
location.
Joan Pratchler:
— Does the ministry have any plan to contract neurosurgery services from the
private sector?
Dave Morhart:
— Can I just ask for clarification? Did you say for “neurosurgery service”?
Joan Pratchler:
— It’s for neurosurgery . . .
Dave Morhart:
— Okay, specific to neurosurgery.
Joan Pratchler:
— Contract neurosurgery services to the private sector, such as out of
province, or other type of private sector care.
Dave Morhart:
— Thank you.
John Ash:
— Thank you for your question. So we have no plans to send patients out of
province for back surgery. We do have a third-party provider that provides
surgical services long-standing for about 13 years within the province. We’ve
just renewed that contract with them. And there is a very small subset of spine
surgeries that could be treated at that surgical centre. But just to be really
clear, most spine surgeries are quite complex, which would not be appropriate.
It would be just a very small subset.
Chair
Wotherspoon: — MLA Gordon.
Hugh Gordon: — Just want to try
to tackle a couple of different things here. One of the points that the Auditor
General highlighted in her report was there seems to be a lack of analysis to
determine whether or not the ministry had enough, or you had enough staff and resources
in order to hit your targets. So I just was wondering if the ministry is not
doing a sufficient forecast for the number of neurosurgeons, and maybe we could
expand that to support staff, all staff required to
perform the yearly target for surgeries.
I
was wondering if you could comment on that, if you’ve done a sufficient
forecast on resources in that regard now and you’ve got a good idea of what
that is, and if you could also share with me what that target is and if you
expect to hit it with current resources.
John
Ash:
— In follow-up to your question, the Ministry of Health identifies volumes. We
then work with the Ministry of Health and internally within the SHA, identify
what is the specific resourcing required — that’s staff and equipment — to be
able to meet those volume targets. So our department head of surgery and
department head of anesthesiology are all in the final stages of developing an
HHR [health human resources] plan specific. It’s being laid out in order to
meet those volume targets.
Sorry.
Since the audit, we actually have added an additional neurosurgeon.
Hugh Gordon: — So as a follow-up
to that, just curious as to . . . Okay, I don’t know if the targets,
your targets, were clearly reflected in the report.
[09:30]
So I’m just wondering what those are and
with your current staffing resources are you confident you’re going to be able
to reach that target? That was the, I guess, the gist of my question.
Dave Morhart: — Thanks for the
question. So in terms of the targets specifically for neurosurgeries, so with
our modelling what we forecasted as our annual neurosurgery volumes should
reach 1,060 procedures in Regina and 1,150 in Saskatoon. And in terms of if we
have the physician resources to meet the target, we feel that we would have the
sufficient amount of surgeons to meet that target.
Joan Pratchler: — I was wondering if
we could talk a little bit about operating room scheduling. As noted in the
report, if I understand correctly, Saskatoon has flextime; sort of urgent cases
come up, you just schedule down that. I noticed Regina has a higher proportion
of surgeries performed on the weekends and a considerable amount performed
after hours. That costs, higher costs for that.
So having this pooled referral, as that,
you know, moves forward, will the consideration of scheduling surgeries, where
it appears to be quite successful in Saskatoon with flextime, and Regina, the
disparities between the two, will those be addressed then as well?
John Ash: — In response to your question, so
specifically with regards to flextime in Regina, we have not implemented that
as of yet. Our intention is to focus on the pooled referrals and transitioning
the surgeons to contract, at which time then we would look at the flextime
process.
Joan Pratchler: — And just a
follow-up to that. So this recommendation came out in 2023 report, which meant
the situation obviously was occurring prior to that. And when I look at
recommendation no. 7, it said that preoperative patient screening
implementation, the after-hours review, will be happening April 1st of 2026. So
that’s like three years, four years till it comes to fruition. What are you
sensing are the key barriers impacting that length of time in addressing this?
John Ash:
— With relation to your question, there is quite a bit of work going on, or
there has been historically around, you know, preoperative assessments and
screening and so forth in each city.
Our primary work is looking at engaging
physicians to standardize that process. And everything’s interrelated, so it’s
really around pooled referrals to achieve that. It’s moving them to contract,
the LOU [letter of understanding], also working on standardizing preoperative
assessment and screening which then feeds into some of the pathway work. So all
of that is kind of coming together, which would allow us to address this
recommendation — hence the timeline.
Joan Pratchler: — And then would
that follow sort of a pilot kind of process as well to see if it’s working, and
then fully implement? Or how does that process eventually come to working
really well?
John Ash:
— We know in many . . . Like I had indicated earlier, some of this
work is going on already in each site, so it’s really around standardizing it.
With our surgical executive team — and specifically with the neurosurgery team
and the committee that they have — that will be part of their review process to
identify are all of our processes ensuring the best possible patient care and
what continuous improvement work would need to continue. And the primary focus
of that neurosurgery team is really around continuous improvement around many
of the processes that are in place.
Joan Pratchler: — So do you
anticipate it could be done before 2027?
John Ash:
— I wouldn’t be able to comment on that. But if we’re able to make things
happen quicker, it certainly will. We’re going to implement based on our
readiness. And if that happens sooner, then that certainly will occur.
Joan Pratchler: — Thank you.
Chair
Wotherspoon: — MLA Gordon.
Hugh Gordon: — I just want to
circle back to the spinal pathways recommendation there. You did mention you’re
hiring more physiotherapists. Can you give me a number about how many you have
hired? And then, you know, how many of them are out of province, new graduates,
or internal hires, if you have any of that information. And if you don’t,
perhaps you can provide it at a later date.
Dave Morhart:
— So in terms of hiring the physiotherapists, so we are just starting that work
to expand the spine pathway. And so for ’25‑26 it was identified we
needed four additional physiotherapists to work within those pathways. So
funding was provided in the ’25‑26 budget for those four additional
physiotherapists.
To date, two of those have been hired.
And I can’t comment on if they were internal hires, or if they were new or came
from out of province. I don’t have that data.
Hugh Gordon: — And you’ve
determined four additional is going to assist in meeting your goal?
Dave Morhart:
— Yeah, so in response to your question, we have determined that at this time
those four additional would be sufficient for this year. However we do know
that as we expand the pathway we’ll need to continually evaluate that, and we
may need to add additional resources in the future.
Chair
Wotherspoon: — Any further questions, committee
members? Not seeing any. These were eight brand new recommendations here today,
so substantive considerations. Thanks so much to Health for your focus on them,
and good questions from committee members.
I’d welcome a motion to concur and note
progress with respect to recommendations 1, 2, 3, 4, 5, 6, and 8. Do I have a
mover? MLA Beaudry moves.
All agreed? That’s carried.
And I’d
welcome a motion that we concur with recommendation no. 7. Moved by MLA
Beaudry. All agreed? That’s carried.
All right,
we’ll move right along to the 2023 report volume 2, chapter 21.
Jason Wandy: — Thank you, Mr. Chair. The Ministry of
Health, under an agreement with the Saskatchewan Abilities Council, a service
provider, loans special needs equipment such as wheelchairs, walkers, or lifts
to persons with disabilities at no cost. It refers to this arrangement as the
special needs equipment program. The total cost to operate the program in 2022‑23
was $7.6 million.
Chapter 21 of
our 2023 report volume 2 describes our third follow-up audit of management’s
actions on the two outstanding recommendations we made in 2016 about the
ministry’s processes to provide special needs equipment to persons with
disabilities. By June 2023 the ministry implemented one recommendation through
its service provider completing maintenance as required on loaned equipment or
appropriately following up with clients to schedule repairs. One recommendation
remained outstanding.
On page 194 we
continue to recommend the Ministry of Health work with its service provider to
identify special needs equipment on loan that is no longer utilized and to
recover this equipment within a reasonable time frame. We found the ministry
reviews information in the IT system that tracks loaned equipment and
periodically provides the service provider a list of deceased clients or
clients who had equipment on loan but who left the
province.
[09:45]
However the ministry has not set out its
expectations of the service provider in using this information, and we found
the service provider does not use the information to focus its efforts to
recover unused equipment. Our analysis of the ministry’s lists identified some
unused equipment on loan the service provider may want to focus on recovering.
For example we identified seven power wheelchairs, which can cost up to $20,000
to replace, loaned to clients within the last five years who are now deceased or
no longer living in Saskatchewan.
At March 31st, 2023, the service
provider had 63 clients waiting for power wheelchairs with 15 clients waiting
for more than four months. Efforts by the service provider to recover unused
equipment from deceased clients or clients who left the province may reduce the
amount of clients waiting and their wait time. Establishing criteria to
identify unused equipment worth recovering would help the ministry and its
service provider focus their efforts on recovering usable and much-needed
equipment for persons with disabilities.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Thanks so much for the follow-up on
this work. Of course this has already been considered by this committee.
There’s been questions and whatnot. Thanks for the status update showing the
implementation on this front and the work on that front. I’d open it up now
. . . or if there’s a brief remark from the ADM.
Norman O’Neill:
— I’ll just note maybe on the first recommendation, regarding the
recommendation to work with service providers to identify special needs
equipment on loan that is no longer utilized and to recover this equipment
within a reasonable time frame, the ministry and its service provider
implemented a process to recover special needs equipment of significant value
which is no longer being utilized. And I’ll stop there.
Chair
Wotherspoon: — Thank you for that. Any questions,
folks? MLA Gordon.
Hugh Gordon: — I’ll try to keep
it tight here. I’ll try to pack a couple things in here. Hopefully you can
knock them off in due course.
Could you just tell us how many pieces
of special needs equipment are on loan or currently in the possession of
individuals who are either deceased or out of province? And could you share
with us your plans to recover any outstanding items that are in possession of
people no longer in need of that equipment?
Chad Ryan:
— Just to clarify, that was special needs equipment?
Hugh Gordon: — Yes, I believe so.
Chad Ryan:
— Okay. ADM Chad Ryan. So currently right now we have total on-loan equipment
. . . Sorry, I just thought I had it in front of me. We have 3,526
pieces of equipment on loan. What we look at is that we also look at a variable
rate with returns over the course of a year. It’s hard to determine specific
returns. We can’t average returns just due to some years we may have 1,000
pieces of equipment returned; some other years we may have only 200. It really
depends on that utilization.
Part of the return policy that we do is
that we have an agreement with SaskAbilities that issues equipment. What
SaskAbilities does is that, any equipment over $1,000, what they do is (1) they
put a sticker on it; (2) is they actually send out a letter. And so as of
January 2025, we sent letters to all people who have equipment on loan to them
reminding them to return it. So those are typically people who are deceased and
equipment over 1,000 that we’re targeting.
We do see higher rates of returns, and
so in certain years we may see a return at again about 118 per cent of
equipment versus other years about 60 per cent.
Hugh Gordon: — And if you could
share your plans, like what are your exact plans to recover? Say you’ve sent
the letter and you’ve got no response for whatever reason. What other steps do
you take in order to recover that equipment?
Chad Ryan: — Yeah, we’ll take a
moment here. Okay. Yeah, so a bit of a process here. So what we do is that we
do communicate with the individual who had the equipment loaned to them. Now if
we’re not able to contact with them, we do contact the immediate family, and
that progresses onto the estate for that individual as well. Notification is
sent monthly to those individuals.
As well, what we also do is that
specifically we have a large amount of equipment loaned out to long-term care
facilities, for example. So we work with those facilities specifically to
contact them — as well as the same kind of procedure, on a monthly basis and
through letters — to have that equipment returned from the facility itself.
Joan Pratchler: — So I just want to understand the new
process that you have in place. I’m looking at page 195 of the report where it
says the ministry is working with eHealth to improve an IT system to enable
better tracking, you know, of equipment. It says here that management indicated
that the current system lacks functionality enabling the service provider to
remove obsolete or outdated equipment.
My question
is, did eHealth create their own program? Did that IT department create their
own tracking program of software? And I don’t know; I just wonder.
Chad Ryan:
— So the system itself is not a specialized system under eHealth. It’s actually
just a SaskAbilities program that they operate internally themselves. The
program itself is being prioritized for an upgrade under eHealth in the coming
years, and so that work is going to be prioritized to work on, coming later.
Joan Pratchler: — And do you think
that there will be some consideration to talking to the end-user to make sure
that the functionality is working for them?
Chad Ryan:
— Yeah, so there would be working with multiple stakeholders, specifically
SaskAbilities themselves, as well as the Ministry of Health to ensure we kind
of see those based on the auditor’s recommendations so they’re aligned, yes.
Joan Pratchler: — Okay, thank you.
Chair Wotherspoon:
— Not seeing any further questions — and just noting to all those folks that
are watching this at home, we have considered this chapter before and this is
simply follow-up — I’d welcome a motion to conclude consideration of chapter
21. Moved by MLA Crassweller. All agreed?
Some Hon. Members:
— Agreed.
Chair Wotherspoon:
— That’s carried. We’ll move right along to chapter 12 of the 2024 report
volume 1. I’ll turn it over to the auditor.
Jason
Wandy: — Thank you. The Ministry of Health
directly compensates fee-for-service physicians at agreed-upon rates for
specific services provided to residents with valid health coverage. The
ministry pays over $560 million to almost 1,900 physicians under a
fee-for-service arrangement each year. Physicians may submit bills for
incorrect amounts because of misunderstandings, mistakes, or on occasion,
deliberate actions. The ministry cannot practically confirm the validity of all
billings before paying physicians. As such, the ministry must have effective
processes to detect inappropriate payments to physicians.
Chapter
12 of our 2024 report volume 1 describes our third follow-up audit of
management’s actions on the two outstanding recommendations we originally made
in 2017 about the ministry’s processes to detect inappropriate fee-for-service
payments to physicians. By March 2024, the ministry implemented one of the
recommendations by implementing a new physician-claims IT system to improve
processing for physician billing.
The
system will help reduce the amount of labour-intensive manual assessments
previously done by ministry staff. It will notify physicians immediately if
their billing submissions are rejected or accepted, thereby reducing
overpayments. The ministry will continue to add edit checks to the new claims
IT system as it identifies new risks in relation to inappropriate physician
billings.
Having
a risk-based strategy supported by an adaptable IT system will allow the
ministry to detect inappropriate physician billings before payment, reducing
the amount of effort needed to assess and collect inappropriate payments back
from overpaid physicians.
The
ministry partially implemented the remaining recommendation on page 167, where
we recommended the Ministry of Health assess options to conduct more
investigations into physician billing practices that it suspects of having
inappropriately billed the government.
At March 2024 we found the ministry had
not yet revised its investigation capacity or design. As a result, with the new
claims IT system still in its infancy, the ministry had not yet performed
additional investigations because significant amounts of data were not yet
available for analysis. Therefore the ministry’s process to investigate
physician claims remained unchanged from our 2022 follow-up audit.
In 2023‑24 seven physicians were
ordered to pay roughly $1.3 million compared to 12 physicians ordered to
repay about $2.6 million in 2022‑23. Enhancing the ways the ministry
conducts investigations into physician billing practices may identify and
recover more inappropriate billings as well as reinforce with physicians the
importance of appropriate fee-for-service billing practices or identify areas
where the ministry needs to offer further education and support.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Well thanks so much for the
follow-up. Thank you to the ministry for detailing the actions that’ve been
taken to implement these important recommendations. I’d invite ADM O’Neill to
offer a brief remark, and then we’ll look if there’s any questions.
Norman O’Neill:
— As the first recommendation is implemented I’ll just touch on the second,
which is for the ministry to assess options to conduct more investigations into
physician billing practices. The ministry explored options to conduct more
investigations. The new physician-claims IT system implemented in 2024 improved
data collection, enabling better data analysis to identify inappropriate
billings. The ministry’s also staffed two permanent full-time audit positions
to increase audit and investigation capacity.
And those conclude my remarks.
Chair
Wotherspoon: — Thank you for that. Committee
members, any questions? MLA Gordon.
Hugh Gordon: — Thank you. I was
wondering if you could expand or tell us . . . utilizing a new IT
system for physician billings. I was wondering if you could just tell us how
many physician billings have been requested under this new system? And are you
actually seeing a reduction in inappropriate billings because of that new
system being engaged? Are you seeing that impact on inappropriate billings?
[10:00]
James Turner:
— Good morning. ADM James Turner. So just on the total volumes through the
system. So physicians do have six months to submit billings, so sometimes
there’s a lag in the timing of their submission of billings. So the ’23‑24
total paid amounts through the system were $566 million and that was an
increase of 0.7 per cent from ’22‑23. Now we would anticipate probably a
similar growth rate going forward, just as a standard utilization increase. So
that’s probably what we can expect in terms of the volumes.
In terms of the tools in the system, so
like just as an example, physicians can now input times and add documentation
into the submission with their billings. So actually it will self-serve, so
that we don’t have to spend time adjudicating things or looking at them at the
back end. It goes in. The system will actually check for it, make sure it’s
valid. So those are the kind of tools that will reduce some of the
inappropriate submissions. I don’t have a hard number to tell you about what
that total looks like. I think as the system stabilizes, we’ll know what that
difference looks like relative to what it was before.
Hugh Gordon: — Exactly, and that
kind of gets to the heart of my question which is like, you know, talking about
actual dollars in terms of inappropriate billings. You would know what that
looked like over the last few years, you know, leading up to these changes. So it
would be very interesting to note if you can report in the future what those
savings actually look like in dollar terms. And we could say yes, this IT
system is assisting in reducing that by this amount. Does that make sense? I
know you probably . . . Maybe not in like real-time terms, but just
sort of like historically, we’ve been able to save or reduce inappropriate
billings by a certain amount. Because if it’s done appropriately, like at the
source, every time it catches it you wouldn’t know what you’re saving, right?
Am I understanding it correctly?
If it’s up to the physician to put the
appropriate documentation in, fill out all the data, and then, you know, if
it’s catching it at source then you may not be able to quantify that. But I’m
just talking about maybe in historical terms you could say, with the
introduction of this new system you could give us a dollar figure in a year’s
time — I don’t know when — to say, we’ve reduced it by X amount.
James Turner: — I can probably
just answer that one. So I think there is a plan to do a pre- and
post-assessment on what that looks like. We’re just not stabilized through that
system. And then we might actually see that it’s actually like a lot lower now,
given those checks. So the evaluation might show the inappropriate billings are
actually far lower given those checks relative to what we were seeing before,
but that will have to be evaluated through a pre/post review.
Chair
Wotherspoon: — MLA Pratchler.
Joan
Pratchler: — Thank you. Are any investigations
automatically triggered by one rejected claim? By multiple rejected claims by
the same physician? And how many claims were found to have been rejected in
error?
James Turner:
— All right, so thanks for the question. The answer is yes, we do have the
capacity in the system to actually look at combinations of billing or actually
look at targeted practices. And so we are able to do that. One example would be
sort of time-based codes. So we can actually have the system look at where
time-based is overlapping to actually look where there is concurrent billings
for the same time. So the time-based codes have enabled us to actually see and
sort some of those out easier.
In terms of the rejection-in-error
number, I don’t have a total number of what would be rejected in error. And so
this is also a benefit of the new system, is it actually rejects before it even
gets through. So on the old system it would get through and then get rejected.
And so we actually now are able to prevent the submission of billings that
aren’t meeting the proper criteria. So there’s an upfront screen that just,
they don’t even get to submit it.
Joan Pratchler: — So would there be
any claims submitted in error then? I guess with time-based that would be
different.
James Turner:
— Yeah, there would still be codes submitted in error. So the payment schedule
is a really complex document — it’s over 400 pages — and so this is where the
education component would come in, in that sometimes it’s not that physicians
are intending to bill inappropriately. It’s that the rules are very complex.
And so there might be a combination
where they bill a couple things inappropriately that the system didn’t detect
because the initial screen is fairly simple. And so there might be some
complexity at the back end where we’re like, no, that doesn’t quite look right.
And so I think that can still happen in the new system. It’s just reduced the
frequency of the most common combinations of things that aren’t able to be
billed.
Joan Pratchler: — So just to refresh
my memory, when did that new system start taking effect?
James Turner:
— So it was February of 2024.
Joan Pratchler: — And then are there
continual reviews or checking in on that system to see if there’s any
modifications or updates? Has the pilot gone far enough that there has been
some review?
James Turner:
— I think the stabilization period for the first year, it was a bit rockier
than we anticipated in that first year. And so I think there will be sort of
constant reviews and improvements done as a PDCA [plan, do, check, act] to
check and adjust things. I just think that first period of stabilization was
far more intense than we actually anticipated, and so I think some of those
things that we had planned for the first year are now just starting to get
actioned.
Joan Pratchler: — Thank you very
much.
Chair
Wotherspoon: — Not seeing any further questions on
this follow-up chapter. Thanks again to those that have been involved in the
implementation of these recommendations. I’d welcome a motion to conclude
consideration of chapter 12. Moved by MLA Chan.
All agreed?
Some Hon. Members: — Agreed.
Chair Wotherspoon: — That’s carried.
We’ll move
right along. I’ll turn it back over to the Provincial Auditor to focus on chapter
13 of the 2024 report volume 1.
Jason Wandy:
— Thank you. The Ministry of Health is responsible for monitoring the
prescribing and dispensing of opioid medications. The ministry monitors
prescribed opioids by funding the prescription review program operated by the
College of Physicians and Surgeons of Saskatchewan. While opioid medications
can bring significant improvement to patients’ quality of life by relieving
pain, opioids pose a risk for misuse or diversion leading to addictions,
overdoses, and deaths. Saskatchewan had 343 deaths related to opioid toxicity
in 2023, an increase of about 91 per cent since 2019.
Chapter 13 of our 2024 report volume 1
describes our second follow-up audit of management’s actions on the four
outstanding recommendations we originally made in 2019 about the ministry’s
processes to monitor the prescribing and dispensing of opioids to reduce misuse
and addiction. We continue to find two recommendations not fully addressed.
By March 2024 the ministry assessed the
benefits and challenges of recording hospital-dispensed opioids in the
provincial drug IT system and determined the challenges outweigh the benefits.
Therefore it does not expect to record hospital-dispensed opioids in the
provincial drug IT system. Rather opioids prescribed at patient discharge from
a hospital will be recorded in the provincial drug IT system and monitored
through the program.
In addition the ministry provided the
program with provincial access to urine drug-screening results to help program
staff conduct effective analysis in identifying potential opioid misuse. Urine
drug-screening results can help program staff confirm whether patients used
opioid medications as prescribed or identify potential opioid misuse.
In 2023 the ministry engaged an external
consultant to evaluate the program’s effectiveness and impact on reducing the
misuse of prescribed opioids in Saskatchewan. The consultant assessed the
program in four areas — design and delivery, effectiveness, efficiency, and
sustainability — and reported that while the program demonstrated positive
results in changing prescribing practices for some opioids, the opioid crisis
persists in Saskatchewan.
The ministry planned to meet with its
partners, for example the College of Physicians and Surgeons of Saskatchewan
and the Saskatchewan College of Pharmacy Professionals, in late May 2024 to
establish an advisory committee and a working group to implement agreed-upon
recommendations from the consultant’s report, including developing clear
program objectives, determining opioid information to share with partners, and
establishing service agreements with each of its partners
It expected to complete this work in
2024‑25. Having clear program objectives with regular information sharing
and reporting between key program partners would strengthen the program and
give the ministry a sense of the number and nature of potential opioid misuse
cases in the province.
The ministry did not implement our
recommendation on page 173 where we recommended the Ministry of Health
establish a risk-based approach to identify concerns in opioid dispensing in
Saskatchewan pharmacies.
The external assessment of the
prescription review program in June 2023 identified a need for better
collaboration between the program’s partners, specifically having the program
share regular monitoring results with the Saskatchewan College of Pharmacy Professionals
to monitor opioid dispensing in pharmacies. The ministry expected to have a
more detailed approach to better monitor pharmacy dispensing after all program
partners met in May 2024.
At present program staff continue to
refer any potential cases of inappropriate pharmacist dispensing practices to
the Saskatchewan College of Pharmacy Professionals. In 2022‑23 program
staff referred 15 pharmacists with potentially inappropriate dispensing
practices to the college.
At December 2022 Saskatchewan had just
over 1,200 pharmacists and 140 pharmacy technicians in 418 community
pharmacies. Because the program does not specifically collect and analyze data
about dispensing practices in Saskatchewan’s pharmacies, the ministry does not
know whether any specific provincial pharmacies contribute to Saskatchewan’s
opioid crisis.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Okay, thanks so much for the
follow-up. Very important chapter originally presented to us a number of years
back and this committee considered, I believe, in 2022. I’ll turn it over to
the ADM for brief remarks. Then we’ll open it up for questions.
[10:15]
Norman O’Neill:
— As recommendations 1 and 4 are considered implemented, I’ll just touch on
numbers 2 and 3. So regarding the second recommendation — to determine whether
the prescription review program is helping reduce the misuse of prescribed
opioids — the Ministry of Health had an external program evaluation completed
on the prescription review program in June 2023. Key areas identified for
improvement include developing clear annual program objectives, determining
what opioid-related information should be shared with partners, and
establishing formal service agreements with each partner.
In May 2024 the ministry met with all
partners to establish an advisory committee and a working group to implement
the agreed-upon recommendations. The advisory group has been tasked with
advancing the development of program objectives, clarifying information-sharing
protocols, and formalizing service agreements. In continued collaboration with
partners, the ministry remains committed to moving this work forward, with full
implementation expected by summer 2026.
Regarding the third recommendation — to
establish a risk-based approach to identify concerns in opioid dispensing in
Saskatchewan pharmacies — the Ministry of Health has not yet developed a
risk-based approach. The external assessment of the prescription review program
completed in June 2023 highlighted the need for improved collaboration among
program partners by sharing regular monitoring results with the Saskatchewan
College of Pharmacy Professionals to support oversight of opioid-dispensing
practices in pharmacies. In continued collaboration with partners, the ministry
remains committed to moving this work forward, with full implementation by
summer 2026.
That concludes my comments.
Chair
Wotherspoon: — Thanks for the comments. Thanks for
the work that’s been undertaken and the work that’s committed to on this front.
Looking to committee members that may have questions. MLA Pratchler.
Joan Pratchler: — Thank you. What is
the rough estimate of the cost to change other IT systems such as eHR Viewer to
make them compatible with the proposed changes to hospital dispensing records?
And is there a cost estimate for the modification to track patients’ in-patient
versus out-patient medications?
Chad Ryan:
— All right, so I’ll just provide an update for the question. So specifically
when it was looked at, when the analysis was completed on the IT system, the
cost resource outweighed the patient safety component based on the analysis.
And so what they found is that having
the two operating data systems proved better for patient regarding
prescriptions being provided within the hospital, being controlled setting, as
well as looking at the community in a different setting whereby focusing on the
referring GP [general practitioner] or moving then to the community pharmacist
for oversight.
Joan Pratchler: — Do you track how
many people die of opioid overdose in this province who are prescribed opioids?
Chad Ryan:
— Okay, just to start out on this, and so when reporting these numbers, these
numbers are tracked and publicly reported through the coroner’s office. So in
2024 we have 346 deaths suspected related to drug toxicity. And the explanation
behind that is that we don’t have it confirmed between illicit and licit drugs,
so a better answer to come through possibly the coroner’s office on that.
Joan Pratchler: — And then just to
follow up, was there any cost-benefit analysis or did the cost-benefit analysis
estimate by what margin those deaths could have been reduced then?
Chad Ryan: — Okay, just going
back to the issue at hand, so again we are not able to differentiate between
illicit and non-illicit drugs and deaths. And so the issue then would be is
that we cannot apply an analysis to that to determine the cost estimates on
those.
Joan Pratchler: — So if I wrote down
properly, we’d have to go through the coroner to find those details?
Chad Ryan: — What I know is those numbers are posted
publicly. And whether or not, I don’t know specific how they post it on that.
But it would be a follow-up on that side.
Joan Pratchler: — Okay. And what would be the reason that the
Ministry of Health wouldn’t or this department wouldn’t do that, given the
connection that we have with the pharmacists dispensing, hospitals dispensing
doctors’ prescriptions for opioids? Wouldn’t that fit under the IT umbrella of
this?
Chad Ryan:
— Again, I think it just goes back to the simple component is that it’s
suspected deaths. So we are tracking confirmed and suspected drug toxicity
deaths. We do have those numbers. Those are then posted by the coroner’s office
which actually does that investigation into that. So we do receive those
numbers back, as well as the public, back on that. But beyond that we don’t
have the actual illicit versus non-illicit drug use for that individual who’s
affected.
Joan Pratchler: — Right. And so
someone has the precursor information that person X was prescribed opioids for
a certain amount of time, could have had a drug toxicity for a variety of
. . . How many different drugs are out there? But somebody does have
the precursor or the access to the precursors that opioids were prescribed to
person X on their exiting the hospital or as part of their treatment plan.
[10:30]
Chad Ryan:
— So again I’m going to have to go back. So the issue is that if an individual
does pass away as a result of an opioid, it is suspected, so we will know if
that individual on our side was prescribed that opioid. However what I do not
know is I do not know whether that opioid that was prescribed was actually the
cause. Therefore it’s still suspected.
What I do know though is that in the
event where we’re seeing irregularities within prescribing or dispensing, we do
have the prescription review program which then monitors both physicians as
well as pharmacies in prescribing as well as dispensing. As noted that any
information that would have been shared between, say, the coroner’s office and
prescription review program or any data that would have been monitored, that
would have been highlighted by the prescription review program and then sent
off to the College of Pharmacy essentially then, to professional College of
Pharmacy, to then look at that a little bit more to analyze it and then contact
that said pharmacy where that possible error or issues were arising for
prescribing those opioids.
Joan Pratchler: — Right. Well that
helps clarify. Because we know research shows that if someone has been on
opioids for, you know, a wisdom tooth pulled out, and that just carries on and
carries on and now we have a bigger problem. But I’m glad to hear that it’s
tracked in some manner. Thank you.
Chair
Wotherspoon: — MLA Gordon.
Hugh Gordon: — I was curious,
touching on your prescription review program, if your jurisdictional scans of
other PRPs [prescription review program] gauge how much those PRPs reduced the
misuse of prescribed opioids and their jurisdictions, and if so, did that help
formulate your goal for Saskatchewan?
Chad Ryan:
— So I can report that the prescription review program does have an advisory
committee, and this advisory committee is conducting a j-scan [jurisdictional
scan] right now. This j-scan will result in benchmarks which the committee then
will implement by the summer of 2026.
Hugh Gordon:
— Thank you.
Joan Pratchler: — I just want to
talk a little bit more about the recommendation regarding that risk-based
approach to identify concerns. And you’ve mentioned there’s been some progress
towards that, on establishing that and identifying, you know, some concerns. Is
the goal then to actually implement a risk-based approach then by June of 2026?
Chad Ryan:
— So I can report that on that recommendation, it’s in progress. And so what I
mean by that is, to date, that the prescription review program is tracking the
dispensing as well as prescriptions of pharmacies. A more targeted approach on
the risk assessment is in its works. Again, we’re going to look at full
implementation by summer 2026.
But specifically some of the moves that
we’ve made in the interim is that we’ve implemented requirements for all
pharmacists and physicians to look at prescriptions, look at the pharmaceutical
information program, so the PIP system, to ensure that they’re looking at that.
The other thing too is that we’ve required pharmacies to have delayed safes
installed within pharmacies which then protect those opiates from robbery and
such.
As well as that we also do quite a bit
of education through the prescription review program, so specifically looking
at forgery components in communication and small steps. The prescription review
program is an education component to it and allowing the regulatory body then
to follow up with any further investigations. So I could say that it’s in
progress and on way with implementation summer of 2026.
Joan Pratchler: — What have been
some of the successes in improving collaboration with the partners like the
College of Pharmacy Professionals?
Chad
Ryan: — Okay. Just
a couple to note is that again, going back, is that the implementation
. . . Some success is the implementation of the time-delayed safe.
We’ve also had field officers that go out and inspect within pharmacies
themselves. We also have greater collaboration with the federal government
who also does inspections on an annual basis.
As well as the main component is that
education to the prescribing and dispensing. To note, we are looking at, in
this next eight to nine months, is an implemented competency assurance program,
working on a broader audit framework which includes a review of pharmacy
prescribing and dispensing practices. So creating some guidelines and terms
around that, and specifically focusing on narcotic audits, including narcotic
destruction as part of their regular field office visits. So again, that
education as well as more practical.
Joan Pratchler:
— Thank you. Just ballpark, how many potential cases of
inappropriate pharmacists’ dispensing were referred to the College of Pharmacy
Professionals last year? Do you know offhand?
Chantelle Patrick:
— Hi. Chantelle Patrick, executive director of drug plan and extended benefits
branch. So the Saskatchewan College of Pharmacy Professionals, they track this
on a calendar year, and so not fiscal year. And so in 2024 there was 21
reported.
Chair
Wotherspoon: — MLA
Gordon.
Hugh Gordon: — I understand that
the ministry still hasn’t got a service agreement with the College of Pharmacy.
Do I understand that correctly? Yes. So I just was wondering when we can expect
to see that in place. I notice your update said there were informal discussions
going on. And I just was curious what you expect to gain from that service
agreement? What would that entail? How does this assist in reducing the misuse
of prescribed opioids?
[10:45]
Chad Ryan:
— So what we know to date, the partners are getting what they want to speak to,
so agreements are coming. Specifically what we’re looking at within the
agreements themselves is to get a bit of a cadence regarding the types of
reporting that we’d want to look at, the frequency of actually meeting to
discussions, update to any of the information that’s available to public or any
of the partners there, and offer clarity across the board to each where they
stand.
So we are looking forward to these
agreements. There’s a lot of conversations happening to date regarding that, to
that, for again that implementation for the summer of 2026.
Chair
Wotherspoon: — MLA Pratchler.
Joan Pratchler: — Thank you. And
just to follow up a little more, have you tracked how many incidents of
inappropriate prescribing were caught as a result of the prescription review
program staff accessing drug-screening results? Those may or may not have been
referred to the College of Pharmacy.
Norman O’Neill:
— So we don’t have the data in front of us but we can provide a written
response after. Last time we had 30 days as our window, so if 30 days works we
can follow up.
Chair
Wotherspoon: — Yeah, you bet. Thirty days is great
and you can supply that back through the Clerk to the committee. Thank you very
much.
Joan Pratchler: — Just one last
question: what safeguards are in place to ensure that the prescription review
program staff appropriately access results?
Chad Ryan:
— And so just a point of clarity . . . Just to clarify, access
results in what type?
Joan Pratchler: — I’m not even sure
what kinds and how they go about doing it. But surely there must be safeguards
in place that people can’t willy-nilly go and get things.
Just
like ER viewer. As a nurse, you have to have the credentials. You have to have
these things. And they do regular checks to see who’s accessed the information
and who hasn’t. It would be flagged. I don’t know if that’s how this works as
well. I’m not sure. I just want to know what might be in place for that to keep
everyone safe.
Chad Ryan:
— So with regards to your questions and the safeguards in place is that, yes,
there are appropriate safeguards in place. And so specifically what that would
mean is that staff would go through a similar process as it would be a nurse or
any other health care professional. So access is based on a privilege and
analysis of that individual and allowed that right. So that information then is
held and not obtained or accessed externally.
Joan Pratchler: — That’s all my
questions.
Chair
Wotherspoon: — Any further questions on this
chapter? Certainly it’s, you know, a very important chapter and substantive
questions and responses, so thanks for all the work on this front. I’m not
seeing any. I’d welcome a motion to conclude consideration of chapter 13. Moved
by MLA Beaudry. All agreed? That’s carried.
We’ll turn things over, back to the
Provincial Auditor to focus on chapter 19 of the 2024 report, volume 2.
Jason Wandy:
— Thank you, Mr. Chair. The Ministry of Health is responsible for ensuring
people with chronic diseases such as diabetes receive appropriate care. It
works in partnership with various agencies, for example the Saskatchewan Health
Authority or eHealth Saskatchewan, to deliver diabetes-related programs and
monitor the incidence and prevalence of the disease in the province. At March
2023 there were about 101,000 Saskatchewan residents with diabetes.
This chapter describes our fourth
follow-up audit of management’s actions on the three outstanding
recommendations we first made in 2012 about the ministry’s strategies for
preventing diabetes-related health complications. By September 2024 the
ministry implemented the three remaining recommendations.
The ministry collected and analyzed care
information related to diabetes and diabetes-related complications. For
example, it continues to increase physician use of its chronic disease
management quality improvement program IT system. This system collects data
from participating physicians about key health care services and programs
provided to people with diabetes.
There were 900 physicians and nurse
practitioners using the system in May 2024 compared to 791 using the system in
July 2020. Using this data the ministry began producing monthly chronic disease
reports as well as clinic reports for Saskatchewan Health Authority-operated
clinics. These reports help inform priorities for service improvement. The
ministry also collects and tracks data on diabetes-related complications and
uses this information to assist with program planning.
The ministry also provides the Authority
with chronic disease information organized by geographic area, prevalence, and
age-standardized prevalence. The Authority began using this information to
generate an online dashboard in 2024. According to the Authority’s dashboard,
the overall diabetes prevalence rate increased from 8.2 per cent in 2017‑18
to 8.5 per cent in 2020‑21, with the northeast, including communities
such as La Ronge, Creighton, and Big River having the highest prevalence rate
at 10.1 per cent and Saskatoon having the lowest at 7 per cent.
In 2024 the ministry and the Authority
started a mobile point-of-care testing pilot project in northeast Saskatchewan
for diabetic clients. Having data on the prevalence of diabetes across the
province can help the Authority and the ministry determine areas with greatest
need for resources. Preventative measures and better disease management can
reduce the prevalence of diabetes-related complications and the impact of the
disease on quality of life and lead to lower health care costs.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: —
Thanks for the follow-up on this front. I’ll turn it over to the ADM for a
brief remark, and then we’ll check in and see if we have questions.
Norman O’Neill:
— As all outstanding recommendations are considered implemented, I’ll just
forgo any remarks.
Chair
Wotherspoon: — Thank you
very much. Thanks for the work on this front as well to all the officials that
made it happen. I’ll open it up if there’s any questions. MLA Gordon.
Hugh Gordon: — Thank you.
I just was wondering if you’ve seen a reduction in hospitalization for
diabetes-related health complications since the usage of your IT system CDM-QIP
[chronic disease management quality improvement program] increased.
Norman O’Neill: — So we think we can
capture that data. We don’t have it with us. We’ll take a look into our systems
with what we do have and if we can we can return in 30 days.
Chair
Wotherspoon: — MLA Pratchler.
Joan Pratchler: —
How may individuals have participated in the mobile point-of-care testing pilot
project?
[11:00]
Norman O’Neill:
— So this is another one that I think we’ll have to follow up with. We just
don’t have the data in front of us at this time.
Chair
Wotherspoon: — Thanks. So on that front you’ve made
an undertaking to get that information back to us within 30 days. Is that
reasonable?
Norman O’Neill:
— Yeah.
Chair
Wotherspoon: — Yeah,
thanks so much. Pratchler.
Joan Pratchler: — In just circling back to the question that my
colleague asked about reduction or the data on the reduction of hospitalization
for diabetes and related health complications, it seems to me that that would
be a wonderful indicator to show the success of the program. Is that? And when
you provide that, if that is not an indicator, what would it take to make that
an indicator? That would be something to be celebrated, I would think.
Melissa Kimens:
— Thank you. Melissa Kimens, executive director of the primary care branch,
administrative health. Thank you for the question. We don’t have that data as
we had mentioned earlier. However it would be something to celebrate if it did
show the trend that we expect that it will. However we will have to look for
the rate as opposed to a whole number just given population change, growth that
we’ve experienced in the province. So overall the number is likely going up in
terms of whole people, and yet the rate we would like to see that there has
been an impact from the use of the CDM-QIP. Thank you.
Joan Pratchler: — Great. I have one
last question regarding that point-of-care testing pilot project. Does the
ministry have any way of gauging which individuals using these services would
have had to travel for care versus not seeking care?
Melissa Kimens:
— Thank you. We don’t track the travel saved for individuals. So I’m sorry
we’re not able to answer that question.
Joan Pratchler: — Is there any
consideration for tracking that? Because sometimes that’s a barrier to access.
Melissa Kimens:
— We could look to see if there’s a mechanism to gather that when patients are
receiving the point-of-care testing. So that is something that I can certainly
take back and look how it could be operationalized, but at this point in time
it’s not.
Joan Pratchler: — Thank you.
Chair
Wotherspoon: — Any further questions, committee
members? Not seeing any with respect to chapter 19, so I’d welcome a motion to
conclude consideration. Moved by MLA Crassweller. All agreed? That’s carried.
We’ll move along to chapter 20 of the
2024 report volume 2, and I’ll turn it back to the auditor.
Jason Wandy:
— Thank you. In health care a critical incident is a serious adverse health
event that did or could have resulted in serious harm or death of a patient.
Critical incident reporting is a recognized tool in improving patient safety in
the health care sector.
The Ministry of Health is responsible
for overseeing critical incident reporting, evaluating whether those steps
health care organizations identify are likely to prevent reoccurrence of
similar future incidents and preparing patient safety alerts that address
system-wide concerns. In 2023‑24 health care organizations such as the
Saskatchewan Health Authority and the Saskatchewan Cancer Agency reported 215
critical incidents to the ministry compared to 145 reported critical incidents
in 2022‑23.
This chapter describes our first
follow-up audit of management’s actions on the 10 recommendations we made in
2021 about the ministry’s process for using critical incident reporting to
improve patient safety. By June 2024 the ministry made some improvements to its
critical incident reporting processes, but further work remains.
It implemented three recommendations.
The ministry expanded the list of adverse health events it requires health care
organizations to report as critical incidents to fully align with good
practice, it confirmed critical incident reporting forms are complete, and
compared specific critical incidents to other health data sources such as from
the Canadian Institute for Health Information.
The ministry partially implemented the
two recommendations on page 198 where we recommended the Ministry of Health ask
health care organizations to include root causes of the incident when reporting
critical incidents, and where we recommended the Ministry of Health or
responsible health care organization apply consistent criteria to assess
whether planned corrective actions effectively address causes of critical
incidents.
When completing a critical incident
report, the ministry requires health care organizations to document recommended
actions for improvement to address contributing factors or causes identified.
In May 2023 we found the ministry appropriately added documentation guidance to
the Saskatchewan critical incident reporting guideline, which provides
additional information about each field required in a critical incident report,
including a description for contributing factor and recommended action.
The ministry’s critical incident review
committee reviews all reported incidents for compliance with the guideline,
including an assessment of contributing factors identified and whether
recommended actions sufficiently addressed those factors and prevent or
mitigate future harm. Good practice recommended by the Canadian Patient Safety
Institute includes using the hierarchy of effectiveness to aid in determining
whether corrective action will be strong enough to modify behaviour and improve
patient safety.
Our assessment of 20 critical incident
reports found 17 reports with weak planned corrective actions based on the
hierarchy of effectiveness, for example, expecting actions like updating
protocols or training staff instead of adding an IT system alert that forces
action.
We also found in 10 reports health care
organizations did not explain why the incident happened. Without this
information, the health care organization may not identify all contributing
factors and develop appropriate actions to address them.
The ministry did not implement our
recommendation on page 201 where we recommended the Ministry of Health follow
up when receipt of critical incident reports are beyond established reporting
deadlines. The Critical Incident Regulations, 2023 set out time frames
for our health care organization to notify and report the results of critical
incident investigations to the ministry.
Our analysis of reported critical
incidents between April 2022 and May 2024 found most incidents reported to the
ministry came from the Saskatchewan Health Authority. It reported 334 critical
incidents to the ministry, and the Saskatchewan Cancer Agency reported six
critical incidents.
Our analysis of critical incidents found
the ministry continues to frequently receive critical incident reports from
health care organizations later than the time frames required by law. In 2023‑24
we found the ministry received 62 per cent of initial notifications later than
the three-day requirement compared to 44 per cent in 2019‑20. We also
found the ministry received 90 per cent of the critical incident reports later
than the 60‑day requirement compared to 73 per cent in 2019‑20. The
ministry indicated it does not follow up with the Authority to determine why it
takes longer than the required deadline of three business days to notify it of
a critical incident.
In addition, we found the ministry does
not follow up on final critical incident reports not received within 60 days of
the notification of the incident. The ministry indicated it expects to focus on
the timeliness of reporting once it sees improvements in the quality of reports
and implementation of recommended actions.
The ministry partially implemented our
recommendation on page 204 where we recommended the Ministry of Health monitor
the status of implementation of corrective actions set out in critical incident
reports. In September 2022 the ministry began receiving quarterly critical
incident listings from the Authority that included the number of corrective
actions or recommendations, the due date, the status — such as incomplete or
complete — for each incident.
We also found the ministry does not
regularly confirm whether the information provided by the Authority is complete
and accurate. We identified six critical incidents that the Authority
previously reported to the ministry but were not included in the March 2024
listing.
On page 205 the ministry partially
implemented our recommendation where we recommended the Ministry of Health
and/or responsible health care organization utilize criteria to determine when
to issue patient safety alerts, and it did not implement our recommendation
where we recommended the Ministry of Health work with the Saskatchewan Health
Authority to monitor the effectiveness of patient safety alerts.
In October 2023 the ministry drafted
criteria for when to issue patient safety alerts, which the provincial patient
safety executive committee approved in December 2023. Following a critical
incident review, the ministry determines whether a patient safety alert may be
required based on specific criteria, for example, consideration of the
potential for the issue, including risk of death, to exist at other reporting
health care organizations.
When a critical incident meets the
criteria, the ministry then conducts further analysis and issues a patient
safety alert. We found the criteria and rationale for issuing patient safety
alerts aligned with good practice. The ministry had not issued any patient
safety alerts since September 2019, but it indicated it planned to potentially
issue two safety alerts by December 2024.
The ministry also had yet to develop
guidance for assessing the effectiveness of patient safety alerts; it planned
to do so in 2024‑25. Using standard criteria to determine when a patient
safety alert is warranted reduces the risk that an alert is made for a minor or
localized issue.
The
ministry partially implemented our recommendation on page 207, where we
recommended the Ministry of Health analyze critical incidents for systemic
issues. In 2022 the ministry began preparing annual reports on critical
incidents using information from its critical incident IT system and the
Authority’s quarterly critical incident listings to summarize and analyze
incident information by areas such as by health care organization, department,
or patient outcome.
In
each area the ministry provides trend information for a five-year period. While
the number of critical incidents decreased significantly in 2022‑23, the
ministry noted the decrease was not necessarily an indication the health care
system was safer; rather, organizations may not be reporting all critical
incidents.
The
ministry’s annual reports on critical incidents highlighted certain systemic
issues identified through its trend analysis. For example, in both its 2021‑22
and 2022‑23 reports, the ministry noted the two most common never events
were critical incidents related to an unintended foreign object left in a
patient following a procedure and stage 3 or 4 pressure ulcers acquired after
admission to a health care facility.
In January 2023 the ministry created the
framework for implementing critical incident system-wide improvements that
include steps such as identifying an area for improvement, collecting data,
developing strategies, implementing strategies, and monitoring their
effectiveness.
[11:15]
The ministry, along with the Authority,
planned to trial the framework on the unintended foreign objects left in a
patient following a procedure. Management expected to begin this work in 2024‑25.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Thank you very much for the
presentation and I think for the follow-up on this front as well. This chapter
was originally brought to us in 2021. This committee’s supported, concurred in
these recommendations. We’ve had some of the actions detailed as well by
Health.
I’d invite some brief remarks from the
ADM if there’s any, and then we’ll open it up for questions.
Norman O’Neill: — I’ll touch on the
items that are not considered implemented.
So starting with recommendation
no. 2, concerning the recommendation for the Ministry of Health to ask
health care organizations to include root causes of the incident when reporting
critical incidents, the ministry now requires reporting organizations to amend
their critical incident reports if the critical incident review committee
identifies that the contributing factors provided do not truly explain why a
critical event incident occurred. If the reporting organization is unable to
provide the requested information, then they are asked to state this in the
critical incident report. The ministry is continuing to work with the SHA to
implement further improvements over the fall of 2025.
Regarding the third recommendation,
which is to apply consistent criteria to assess whether planned corrective
actions effectively address causes of critical incidents, reporting
organizations will be required to amend their critical incident reports with
improved corrective actions, unless the critical incident review committee is
satisfied that better options were explored and found to be unattainable. These
reasons will be documented in an amended critical incident report.
Implementation of an updated critical incident report template is expected to
be completed in January of 2026.
The next item is recommendation
no. 5, which is for the Ministry of Health to follow up when receipt of
critical incident reports are beyond established reporting deadlines. The
ministry and SHA held a two-day improvement event for all reporting organizations
in September of 2025, and included other stakeholders such as patient and
family advisors.
The purpose of this event was to better
understand critical incident reporting processes and barriers or challenges
experienced by each organization, which will lead to the identification of
internal process improvements towards meeting reporting deadlines. A work plan
for improving on the timeliness of critical incident reporting was developed at
the event, and progress on deliverables throughout the fiscal year will be
monitored.
The ministry will also disseminate a
monthly report that is shared with the reporting organizations, listing all
critical incident reports that are overdue. A phased implementation began in
September of 2025 with a focus on closing the oldest critical incidents first.
The implementation of a follow-up process for overdue critical incident reports
will be completed by Q4 of ’25‑26.
Regarding recommendation no. 6,
which is to monitor the status of implementation of corrective actions set out
in critical incident reports, the ministry and SHA are planning a second
improvement event with a date yet to be determined for all reporting
organizations to attend in the late fall, where the focus will be on improving
processes to implement corrective actions.
Regarding recommendation no. 7,
which is for the ministry and all responsible health care organizations to
utilize criteria to determine when to issue patient safety alerts, it is deemed
implemented by us as of April 2025. The criteria include consideration of the
potential for the issue to exist in other reporting organizations. It can be
corrected by systemic actions taken to prevent or reduce errors by front-line
care providers.
For recommendation no. 8, which is
for the ministry to work with the SHA to monitor the effectiveness of patient
safety alerts, the ministry will collaborate with reporting organizations as
they work through the new process for monitoring the effectiveness of patient
safety alerts. The duration of this process will vary depending on the
reporting organization based on how the patient safety alerts apply to their
programs. The start of patient safety alerts monitoring by the ministry and
applicable reporting organizations will begin in Q3 of this year.
For recommendation no. 9, which is
for the ministry to analyze critical incidents for systemic issues, we do
consider this recommendation as being implemented as of April 2025.
In 2023 the ministry developed a
framework for implementing critical incident system-wide improvements. This
includes an analysis of past critical incidents in comparison with other health
data sources. Since 2024 the ministry has applied the framework and completed
an analysis of three subsets of critical incidents. Results from the analysis
were shared with the patient safety executive committee and the relevant
operational leaders from reporting organizations to support strategic planning
and improvement initiatives. Ongoing, the ministry will continue to utilize the
framework to analyze critical incidents for systemic issues on an annual basis.
And that concludes my comments.
Chair
Wotherspoon: — Thanks for the presentation. Thanks
for much of the work that’s been undertaken as well. I’d look to committee
members that may have questions. MLA Pratchler.
Joan Pratchler: — Thank you. My, a
lot of work has happened. When I look at the definition of what a critical
incident is — it’s on page 195 — it’s a serious adverse health event that did
or could have resulted in serious harm or death of a patient. And I’m just
curious, would poorly communicated ER [emergency room] closures be considered a
critical incident?
Dave Morhart:
— Hi. Dave Morhart, executive director of acute and emergency services branch
with the Ministry of Health. Thank you for the question.
So specific to your question, like a
disruption itself wouldn’t necessarily be considered a critical incident. But
if it did lead to a delay in diagnosis or treatment that did lead to serious
harm to the patient, then that would certainly qualify as a critical incident
based on the definition.
Joan Pratchler: — Yeah. And so I’m
referring to if there’s an ER closure in location X and the notice on the door
says, go to location Y. And location Y is also closed, that that may be
considered a critical incident that they were asked to go to a place where now
. . . there is no more.
Dave Morhart:
— Yeah. So I think that, like the clarification would be that it would, you
know, depend on the event. And like if that occurrence resulted in a delay or
diagnosis that led to harm to the patient, then that’s where it would be
considered a critical incident.
Joan Pratchler: — So that would be
tracked. That kind of event could be tracked and would be tracked and
addressed?
Dave Morhart:
— Yes, we would anticipate that if an event like that were to occur, that that
would be reported to the ministry. Yeah.
Joan Pratchler:
— Okay, thank you. How many deaths from nosocomial
infections were there last year?
Dave Morhart:
— So we were able to look at our data, and in ’24‑25, which would be the
most recent, there was one reported.
Joan Pratchler: — Good. Just want to
refer to page 195 in the report where it says as of June 30th, 2023, 94 per
cent of corrective actions noted were not yet implemented by the Authority. I’m
just wondering, how does that compare with how many aren’t implemented this year?
Dave Morhart:
— So specific to that data, so a couple of things . . . And I know
you didn’t note that in the auditor’s report it said 340 outstanding corrective
actions as of June 30th, 2023, and 94 per cent not yet implemented.
So the updated data based on ’24‑25,
so the number of outstanding corrective actions is 198 in total, and the number
that are outstanding would be 85 per cent.
[11:30]
Joan Pratchler: — Thank you.
Chair
Wotherspoon: — MLA Gordon.
Hugh Gordon: — When a critical
incident is caused by staff error, I was wondering if you could tell us what
the process is for mediation of that situation.
Dave Morhart:
— So I just want to provide a bit of clarification. So when we talk about
critical incident management, it’s really looking at kind of a system-level
view of errors. It actually doesn’t get down to, like, the individual staff
level. But I do know that reporting organizations, mainly the Saskatchewan
Health Authority, they do have a separate process that would deal with specific
errors made by staff, and it’s something that they would call an accountability
review. So they would have a process in place for dealing with those individual
errors.
Chair
Wotherspoon: — MLA Pratchler.
Joan Pratchler: — Have any systemic
issues been identified as a result of tracking critical incident notification
information or improvements, so that it goes from 94; now we’re down to 80 —
whatever I wrote down here — 80‑something? Are there systemic issues that
are behind any of this? Those numbers seem awfully high.
Dave Morhart:
— So just I hope I understood the question correctly. I think you were looking
if there was any systemic issues that is preventing faster progress or further
progress on implementing corrective actions, right? Okay, so yeah. I don’t know
if I would necessarily call these systemic issues, but I can provide you, like,
with some of the reasons.
So you know, when we first started doing
this work a few years ago after the initial auditor’s report, there was a lot
of focus on improving critical incident reporting and management. And so a lot
of that work, particularly with the SHA, was around addressing like a backlog
of critical incidents that they had — and I guess, which is a good thing
obviously. But what comes with addressing a backlog is now you have a
significant number of new corrective actions that are being added. So even
though we’re seeing that number come down from, you know, it was 300-and-some
down to 198 with still several overdue, I think we have seen that progress
considering that there are a number of new corrective actions that have been
identified with addressing that backlog.
Some other reasons that might be
contributing is when you are dealing with a backlog, sometimes you’re dealing
now with information that is several years old. And so you have new people
involved, new staff that were maybe a part of that initially that are no longer
with the system anymore, so it becomes challenging to close off some of those
corrective actions when there’s been that kind of lag in time. So we’re working
with the Health Authority on how we can address those.
And then some of them identify things
that require maybe IT system improvements and things like that. So they can’t
actually be implemented until those things happen, which can take some time as
well.
And just the last thing I would note is
there was reference to a two-day improvement event that happened in September.
That event really focused on kind of the initial reporting — so addressing some
of those delays in timelines in reporting, and the content of the report
itself, and ensuring there was quality in terms of corrective actions — and the
contributing factors were identified. We do have another event planned for
later this year, where we’re going to address kind of that next step, which
would be once we receive the report at the ministry, how can we improve that
process for implementing and monitoring corrective actions, so that we’ll
hopefully identify some of those additional issues that you had mentioned.
Joan
Pratchler: — So have you noticed maybe over the
past that the increases or decreases in critical incidents are either that
people are reporting more — they’re getting better at reporting so it looks,
you know, there’s more, because we want improvement and patient safety — or
there’s just simply a decrease in events? What might be driving some of those
numbers as people become more educated about this process?
Dave Morhart:
— So I think, you know, first I would note that in ’24‑25, which is our
most recent data, there were 139 critical incidents reported. So I think in ’22‑23
was what the auditor’s report had noted was 146. We did go up to 212 in ’23‑24
and then saw the drop to 139.
So I don’t know if I can, you know, with
great certainty know what the decline could be a result of. I mean it could be
that there are fewer occurring, but it could also be that there is
under-reporting. You know, when we look at some other sources of data, it could
indicate that there is under-reporting.
Tara Clemett:
— Can I just make a comment? I just want to say that when we did the audit, we
did make a recommendation around the need for the ministry to analyze the data
that was coming by the health care organizations that report the critical
incidents. In many instances that is the Saskatchewan Health Authority that is
encountering the critical incidents.
So when we did this follow-up, we were
satisfied the ministry’s doing a better job of correlating, okay, what are
these critical incidents that are coming to us from the SHA and comparing that
to other data. So the SHA is required to report to CIHI [Canadian Institute for
Health Information] as such. And so they started to correlate and to sort of
make sure the SHA, what they’re reporting to this Canadian organization is also
is what’s getting reported to them. So we were more satisfied they are making sure
there’s completeness there.
I will just add too, as an office we do
anticipate undertaking work at the Saskatchewan Health Authority around
critical incident reporting. And I think that’ll give us a line of sight
whether there is critical incidents occurring at the Saskatchewan Health
Authority that are not making their way to the ministry as such. So it’ll give
us just a different area of focus that’ll go, okay, this is their role as
almost more the regulator. There is then obviously the doer who has to report
as such and fix. So we’ll be undertaking that work soon.
Chair
Wotherspoon: — Thank you, Auditor. MLA Gordon.
Hugh Gordon: — Just to kind of
touch on what you mentioned about what constitutes a patient safety alert. I’m
just wondering if you could elaborate about what warrants such an alert — and I
wonder if it’s tied in to something that you just mentioned — and why no incident
has met that threshold apparently since September of 2019.
[11:45]
Dave Morhart:
— In response to your question in terms of the criteria of a patient safety
alert, I guess I would note too that individual organizations would have
processes for patient safety alerts. So like the Saskatchewan Health Authority
would have their own process for a patient safety alert, and they would have
issued several in that time. The ministry itself developed the criteria for
identifying patient safety alerts I think around the time of the follow-up
audit or just before that. So it’s been around for a few years I guess. But
prior to that, there were no like established criteria for doing that. So I
think that maybe the issue is you didn’t have the criteria, hence the auditor’s
recommendation so that these time frames wouldn’t go by where one isn’t
identified.
So in terms of the criteria itself, it
is quite detailed. So in ’24‑25 the ministry adapted the patient safety
alert criteria used by NHS [National Health Service] England to determine when
to issue a patient safety alert and then began formally applying it at that
time. So currently when the critical incident review committee reviews a
critical incident and closes that critical incident, they do apply the patient
safety alert criteria and its applicability to determine if it would meet the
criteria for a patient safety alert.
So the ministry has a new work standard
that they’ve developed for issuing and monitoring patient safety alerts through
the critical incident review committee. I do have, it’s kind of like a decision
tree box that NHS England uses that does have some of that criteria. So it asks
if it’s within our scope. Is there a risk of death or disability? Can the issue
be rapidly addressed at the source? Is the issue new or under-recognized? Are
there constructive organization level actions that would reduce the risk of
death of disability?
So I think the one thing to note is just
when the ministry issues a patient safety alert — versus, say, an organization
— that’s typically too when we’ve identified that the issuing of a patient
safety alert would benefit all organizations across the health system, so not
just one. Like if it’s an SHA issue then we would expect them to issue a
patient safety alert. If it’s just something very specific to the SHA, but if
it’s something that could potentially cross all health care organizations, then
that’s where the ministry would kind of step into that role of issuing a
patient safety alert.
Chair
Wotherspoon: — Any further questions, members? Not
seeing any I’d welcome a motion to conclude consideration of chapter 20. Moved
by Deputy Chair Wilson. All agreed?
Some
Hon. Members: — Agreed.
Chair
Wotherspoon: — That’s carried. We’ll move along to
chapter 4, and I’ll turn it back to the auditor.
Jason Wandy:
— Thank you. Chapter 4 of our 2024 report volume 2 reports the results of the
2023‑24 annual audits of 35 health care affiliates. For each of the
health care affiliates, all have effective rules and procedures to safeguard
public resources. The 2023‑24 financial statements for each of the health
care affiliates are reliable. All health care affiliates except for All
Nations’ Healing Hospital Inc. complied with legislative authorities governing
their activities. All Nations’ did not comply with legislative requirements and
obtain approval from the Ministry of Health for two 2022‑23 capital
projects exceeding $100,000 until 2023‑24.
As All Nations’ did not undertake any
further capital projects valued at greater than $100,000 during ’23‑24,
we were unable to confirm it would have obtained Minister of Health approval as
required by legislative requirements. Not seeking the minister’s approval for
capital projects increases the risk money may be spent on items not considered
a priority for the health care system.
I will also just note that the audit
results for the 2024‑25 found All Nations’ still did not undertake any
further capital projects valued at greater than $100,000 during ’24‑25.
As such, our upcoming 2025 volume 2 report in December 2025 will deem this
recommendation addressed.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Okay, thanks so much for the
follow-up here. Thanks to the ministry for the implementation; of course this
has been questioned and considered and concurred in by this committee. Any
quick remarks, ADM, before we see if there’s a question?
Norman O’Neill:
— As it’s considered implemented, I’ll just note that we’ll continue to send
out the reminders that we do every year and leave it at that.
Chair
Wotherspoon: — Great, thank you. Any questions,
members? Not seeing any, I’d welcome a motion from a committee member. Moved by
MLA Chan. Well I guess I should state the motion first: to conclude
consideration of chapter 4. MLA Chan moves. All agreed? Okay. That’s carried.
Saskatchewan Impaired Driver Treatment
Centre
Chair
Wotherspoon: — We’re going to move right along and
turn our attention to the Saskatchewan Impaired Driver Treatment Centre and
chapter 21.
Jason Wandy:
— The Saskatchewan Impaired Driver Treatment Centre located in Prince Albert
provides a residential treatment alternative to incarceration for adults
convicted of a second or subsequent impaired driving offence.
The centre received just over
$1 million from the Ministry of Health in 2021‑22 to provide care to
the 319 clients that were admitted. Chapter 21 of our 2022 report volume 2
describes our second follow-up of management’s actions on the one remaining
recommendation we first made in 2018 relating to the centre’s processes to
deliver the impaired driver treatment program to reduce recidivism.
By July 2022 the centre implemented the
last remaining recommendation. The centre developed the remaining program
success measures and targets for its three program objectives and reported
results to its board quarterly. If a target was not met, the centre described
action plans to improve the results. Overall the centre was meeting its targets
for each of the objectives at April 2022.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Okay. Thanks again for the focus of
this work. For folks following at home, this has been considered here before.
This is a follow-up and implementation has been reported. So thanks to all
those that have been involved in making that happen. Any remarks, ADM?
Norman O’Neill:
— As it’s considered implemented, I’ll just forgo any remarks.
Chair
Wotherspoon: — Any questions from committee
members? Not seeing any, I welcome a motion to conclude consideration of
chapter 21 before us. Moved by MLA Crassweller. All agreed? All right, that’s
carried.
3sHealth
Chair
Wotherspoon: — We’re going to move right along,
shift gears just a little bit for a follow-up chapter with respect to 3sHealth.
And I’ll turn it over to the Provincial Auditor.
Jason
Wandy: — Thank you.
Health Shared Services Saskatchewan, also known as 3sHealth, administers four
disability benefit plans for certain health care employees, for example health
care staff working in hospitals and long-term care facilities. In 2022‑23,
3sHealth served 46,000 active plan members. The disability plans protect plan
members against loss of income due to injury or illness. In 2022, 3sHealth
issued over $52 million in disability income payments to plan members.
Chapter 8 of
our 2024 report volume 1 describes our first follow-up audit of management’s
actions on the four recommendations we originally made in 2022 about 3sHealth’s
processes to manage disability claims for certain health care employees. By
January 2024, 3sHealth implemented two recommendations and partially
implemented the remaining two recommendations.
3sHealth
partially implemented the recommendation on page 147, where we recommended
3sHealth send completed disability benefit claim applications to adjudicators
on time. 3sHealth did not always process incoming disability benefit
applications on time, which delays adjudicators’ decisions.
3sHealth’s
goal is to have claim decisions completed within 8 days 90 per cent of the
time. In our testing of 30 applications we found 3sHealth met the 8‑day
target 73 per cent of the time. Management indicated that staff turnover,
leaves, and an increasing volume of applications were major factors
contributing to not meeting targets.
We found
3sHealth did take action to improve its processing of disability claims timely
after our follow-up audit period by filling four vacancies and adding two more
staff to the benefits service team. Delays in processing incoming applications
affect timeliness of claims, decision making, and payment of benefits to plan
members.
3sHealth
partially implemented the recommendation on page 146, where we recommended
3sHealth follow its established timelines to complete appeal reviews on
disability claims and document reasons for significant delays. We found
3sHealth began tracking the timeliness of appeals and documenting the rationale
for delays in a spreadsheet. It expected staff to complete all appeals within
30 business days.
3sHealth’s
records indicated that staff completed 85 per cent of appeals on time. The two
main reasons for any delays were high volume or waiting for additional
information. However we also found 3sHealth’s tracking spreadsheet contained
inaccurate calculations and incomplete information, resulting in inaccuracies
in its timeliness calculations. These inaccuracies reduced 3sHealth’s results
for completing all appeals within 30 days from 85 per cent to 55 per cent for
the February 2023 to January 2024 period. Missing
appeals and inaccurate calculation of timelines present a risk of inaccurate
reporting to management and the public. It also risks not identifying
additional resources to address delays in completing reviews.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Okay, thanks so much for the
presentation, the focus of the work. Of course this is a follow-up presentation
here today. And thanks as well to the team at 3S [Health Shared Services
Saskatchewan] for some of the actions and updates that have been sent our way.
I’ll invite ADM O’Neill to provide a brief remark if he has one.
Norman O’Neill:
— I’ll just touch on the first two recommendations. So in regards to the
sending disability benefit claim applications to adjudicators recommendation,
3sHealth strives to meet service standards, including sending completed
disability benefit claim applications to adjudicators on time. Year to date for
2025, 3sHealth has achieved or surpassed the 90 per cent target in six out of
seven months. One month reported 88 per cent. Benefit services has dedicated
resources to the processing of new disability applications.
And on the second recommendation,
regarding the recommendation to establish timelines to complete appeal reviews,
3sHealth strives to meet its service standard of completing disability claim
appeals within 30 business days and is now processing the majority of claims
within this standard. At the start of 2023, 3sHealth had a backlog of appeals.
They dedicated additional resources to clearing this backlog. With more
resources contributing to the appeal reviews and improved tracking and
visibility, 3sHealth is now better able to meet our demand.
3sHealth is leveraging service now to
better track and manage appeals due to triaging errors at the point of original
receipt, which impacted our metrics. We have worked with our administrative
staff to improve their knowledge to minimize these errors in the future. The
service now tracks all appeals in progress, and 3sHealth uses the service now
to run reporting on a daily, weekly, and monthly basis. And this allows the
manager and specialists to monitor how work is progressing to ensure that it’s
completed on time.
That’s my remarks.
Chair
Wotherspoon: — All right, thanks so much. Open it
up to committee members if there is any questions. MLA Pratchler.
Joan Pratchler: — Congratulations on
all the work that must have happened in that period of time. Just a quick
question or an observation that there appeared to be a lot of staff turnover
that might have been part of, you know, the challenges. Are all vacancies
currently filled now? And how many FTEs [full-time equivalent] are currently
working in adjudication?
[12:00]
Mark Anderson:
— Okay. All right. Thank you very much for the question. My name’s Mark
Anderson. I’m the CEO [chief executive officer] at 3sHealth. Pleased to provide
an answer there.
So there’s two parts to the process and
so there’s staff involved at both stages. The first is setting up the
application when it first comes in, and we have a team of what we call benefit
services officers that do that. We have 18 of those individuals. And we have
one administrative position that is currently vacant. But all the BSO [benefit
services officer] positions are filled. And then we have 13 adjudicators that
actually handle the adjudication of the claim and determine if it’s eligible,
and those are all full at the moment.
Joan Pratchler: — Thank you.
Chair
Wotherspoon: — MLA Gordon.
Hugh Gordon: — Just was wondering if you could list some
of the reasons for significant delays and then the measures used to address
them.
Mark Anderson:
— Okay. Thank you for the question. So one of the key drivers of delay is
volumes of applications that come in and fluctuations. It’s not always a steady
number; it can vary depending on different periods. And then of course the
workforce that’s available. And so if we do get a number of things come in, as
an example, during the summer, that can cause some issues as well. Or as was
reported previously we have some turnover, then it can cause some challenges in
terms of caseloads.
So in terms of things we do about that,
we have a daily meeting to load level and take a look at caseloads by
adjudicator and also to monitor and track those service metrics that I
mentioned. So we can move work between . . . The benefit services
officers at the front end do other work other than just setting up initial
applications, so we can pivot some of their other focus to ensure we’re caught
up on that front. That’s another tactic we use to try to maintain the service
standard.
Hugh Gordon: — Just to add onto
that, is a lack of information also contributing somewhat to delays? Is there
poor communication for example?
Mark Anderson:
— It can contribute, you know, if we don’t have a complete application, as an
example, or if there’s missing medical. Those types of things can contribute to
delays on that side of it. But often we try to follow up with an initial
expectation call so people understand what that’s going to look like and what
kind of information we need.
Hugh Gordon: — And just one last
question here: I was just wondering if you’ve seen a reduction in the number of
complaints from plan members regarding disability benefit claims, and if you
have seen an improvement in the timeliness of resolution for those claims.
Mark Anderson:
— So just I have an answer to one and then just a question on the second one
just to make sure I understood the question. But in terms of number of
complaints that we’ve received, so in 2022 we had 11; in 2023 we had 13; 2024,
10; and so far in 2025, seven.
And the second question, I’m sorry, was
around timeliness of the adjudication process?
Hugh Gordon: — Yeah, essentially.
Mark Anderson:
— Of the adjudication, okay. Thank you. Okay regarding the disability initial
application in quarter 1 of 2025 we met the service standard of 8 days 93 per
cent of the time; quarter 2, 94 per cent; and quarter 3, 94 per cent.
Hugh Gordon: — Thank you.
Chair Wotherspoon:
— No further questions, folks? Okay. Thanks, CEO Anderson, to you and your team
for the work on this front. I’d welcome a motion to conclude consideration of
chapter 8 here. Moved by MLA Beaudry. All agreed? Okay, that’s carried.
We’ll have a recess and reconvene at 1
p.m. with a focus on eHealth.
[The committee recessed from 12:07 until
13:00.]
Chair
Wotherspoon: — Okay, we’ll reconvene the Standing
Committee on Public Accounts. I’m going to turn it over just briefly here to
ADM O’Neill. He’s let us know he has an answer to a question that was asked
this morning with respect to chapter 14.
Norman O’Neill:
— So you had asked about our wait-list. And we had 99 individuals on the
neurosurgery wait-list, and it was the split between Regina and Saskatoon that
you’d asked about. So as of March 31st, 2025, the 99 is broken down between 22
in Saskatoon and 77 in Regina. We also checked more recent, so July 31st, 2025
we have 81 individuals on the wait-list and 35 of those are in Saskatoon, 46 in
Regina.
eHealth Saskatchewan
Chair
Wotherspoon: — Thank you. Thanks very much for
providing the information here today. We’ll turn our attention here now to
three chapters. We’re going to consider each of them one at a time here with
respect to eHealth. First chapter has six new recommendations. I’d welcome CEO
Church and his team here as well to the committee, and I’ll turn it over to the
Provincial Auditor to make presentation on chapter 13.
Tara
Clemett: —
Thank you, Mr. Chair, Deputy Chair, committee members, and officials. With me
today is Mr. Jason Wandy and he’s the deputy provincial auditor that is
responsible for the audit at eHealth Saskatchewan. Behind me as well we have
Mr. Jordan — on my far left — Mr. Jordan McNaughton, and he is a senior manager
in our audit that was involved in the audits at eHealth Saskatchewan. And
beside him is Ms. Michelle Lindenbach and she’s our liaison with this
committee.
Today Jason will present the chapters on
the agenda in the order that they appear and it will result in three separate
presentations. He will pause for deliberation and consideration by the
committee after each presentation. The first presentation about maintaining key
health care IT servers does include six new audit recommendations for the
committee’s consideration, and the other two chapters and presentations are
status updates on outstanding recommendations previously agreed to by this
committee.
I do want to thank the CEO of eHealth
Saskatchewan and his staff for the co-operation that was extended to us during
the course of our work. With that, I’ll turn it over to Jason.
Jason Wandy:
— Thanks, Tara. Chapter 13 of our 2023 report volume 2 reports the results of
our audit of eHealth Saskatchewan’s processes for the period ended July 31st,
2023, to maintain IT servers that host key health care systems and data to
protect against known vulnerabilities. We concluded that eHealth had effective
processes other than the areas reflected in our six new recommendations for the
committee’s consideration.
eHealth manages the health sector IT
network, including more than 5,000 servers and over 1,000 applications, hosting
a significant amount of confidential data. These IT systems are essential to
the delivery of health services by the Saskatchewan Health Authority,
Saskatchewan Cancer Agency, and 3sHealth. Outdated IT infrastructure and
software provide an opportunity for online attackers to breach IT networks and
compromise data. Cyberattacks can take an IT system or entire organization
offline, leading to patient care interruptions, privacy breaches, and expensive
recovery costs.
In our first recommendation on page 100
we recommend eHealth Saskatchewan regularly detect and quickly remove
unauthorized IT servers, if any, on the network. eHealth manually tracked
physical servers it manages using spreadsheets and asset tags, and it kept
information about virtual servers using an electronic server management system.
We found the information tracked in the server management system did not
include details about the applications or databases hosted by the server or how
critical these systems and their data are for delivering health services.
During our server testing we found
eHealth’s network diagrams were not up to date. For example, referred to
incorrect or replaced servers, making it difficult to determine specific
servers related to each key health care IT system and their related criticality.
Without this information, eHealth cannot efficiently consider IT system
criticality to help prioritize when it applies updates to each server.
We also found eHealth did not have a
way, such as an automatic discovery system, to alert its staff when new servers
connect to the network. These discovery systems help to quickly identify and
remove any unauthorized or rogue servers that can introduce vulnerabilities. A
rogue server can not only be a target for attackers but also can create
performance issues such as slowing down a network. Exploited vulnerabilities
through an unauthorized server can lead to unauthorized access or changes to
sensitive health systems and data.
In our second recommendation, on page
101, we recommend eHealth Saskatchewan track the IT systems and their
criticality hosted on key health care IT servers to support maintenance
decisions. By March 2024, eHealth planned to implement an asset management
system to track information about servers, including hosted IT systems, and to
automatically identify any unauthorized servers connected to the network.
Without sufficient tracking of IT systems hosted on key health care IT servers
and their related criticality, eHealth may not appropriately prioritize updates
to efficiently maintain all servers to protect them from known vulnerabilities.
eHealth can use this information to prioritize updates for critical IT systems.
And our third recommendation, on page
103, we recommend eHealth Saskatchewan implement security measures to address
the risks introduced by having unsupported servers hosting key health care
systems and data. Our testing of 341 key health care IT servers found 20
servers who were running unsupported operating systems where vendors no longer
supply updates for new vulnerabilities identified. Operating system vendors
identify new vulnerabilities daily, so the longer servers are unsupported, the
greater the risk an attacker may identify and exploit an unpatched
vulnerability.
Agencies should carefully evaluate risks
of delaying IT system and related server upgrades — for example, additional
costs to address a successful cyberattack, significant server downtime, risks
to the agency’s reputation, or compromised patient data. We found eHealth did
not have a plan to address risks of unsupported servers timely.
In one case, it planned a project in
2021 to upgrade unsupported servers and described related risks to its partners
in the project plan. However eHealth and its partner delayed the project with
no clear timeline set for completion, and did not add mitigating controls in
the interim, for example, additional intrusion monitoring or isolating
unsupported servers on the network. Without effective and timely plans to
protect unsupported servers from new vulnerabilities, there’s increased risk of
unauthorized access, or changes to, or downtime of key health care systems and
data.
In our fourth recommendation, on page
104, we recommend eHealth Saskatchewan periodically review whether appropriate
individuals have privileged access to key health care IT servers. Privileged
accounts pose a greater security risk, as these users can bypass security
controls built into an IT system by accessing the system directly through the
servers instead of logging in to a user account in the IT system.
Our testing of 87 users with access to
make changes to IT servers found one user who left eHealth in November 2022,
but whose access eHealth had yet to remove at July 2023. We found eHealth used
controls to prevent this user from logging in to the privileged account after
leaving eHealth. Additionally, we found nine users where eHealth was uncertain
of the continued appropriateness of their level of access granted.
Without a process to periodically — for
example, quarterly — review privileged server access, there’s increased risk of
unauthorized individuals inappropriately accessing and making changes to
sensitive health care systems and data.
In our fifth recommendation, on page
105, we recommend eHealth Saskatchewan regularly analyze security information
logged for key health care IT servers to support timely server updates for
identified security vulnerabilities. eHealth used server vulnerability scans to
identify missing security updates.
We found 16 of the 341 servers we tested
were not included in the vulnerability scans. This means eHealth did not have
all possible information to help protect the servers against potential security
vulnerabilities. Management advised us its vulnerability scans missed these 16
servers due to implementation issues when transitioning from a monthly scanning
process to a continuous scanning process during 2023.
eHealth also did not analyze security
information such as trends from scans over time, network incidents, or problems
reported through security tickets to identify potential risks for maintenance
processes.
At July 2023, eHealth was transitioning
operation of its vulnerability management processes to an external service
provider. It expected this service provider would help to verify whether it
scans all servers as well as help it analyze security information to identify
potential risks related to maintenance processes.
In our last recommendation, on page 106,
we recommend eHealth Saskatchewan regularly report to its senior management and
partners about significant risks and mitigation plans related to maintenance of
key health care IT servers. At July 2023, eHealth had not sufficiently defined
reporting requirements about IT server maintenance risks to share with its
senior management or partners.
eHealth signed a master service
agreement in 2022 with its key partner, the Saskatchewan Health Authority, but
the agreement did not set out reporting requirements or agreed-upon service
targets, for example, IT server update and availability levels.
We found that while eHealth prepared a
preliminary report for the Authority in June 2023 as part of its work to define
reporting requirements, the report did not include targets or results specific
to IT server maintenance. Establishment of key service targets can also help
eHealth to define reporting requirements to its senior management. Such
reporting may help eHealth identify potential risks early and avoid missing
certain service expectations.
Without sufficient formal reporting,
senior management and eHealth’s partners may not sufficiently understand
existing risks that could prevent timely provision of health care services or
that could compromise the security of patient data. Health care providers need
timely access to accurate and complete patient information to support quality
health care.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Okay, thanks so much for the chapter
and the presentation. It’s got some new recommendations before us here today.
I’ll turn it over to ADM O’Neill for some brief remarks and then we’ll get into
some questions.
Norman O’Neill:
— Okay, regarding the recommendation for the removal of unauthorized IT
services, eHealth centrally manages the provision of resources and access to
its core data centres to prevent unauthorized implementation on its IT
infrastructure. Strong physical controls exist for the core data centres.
Through ongoing inventory reviews, eHealth will identify and retire
non-compliant servers to strengthen infrastructure security and consistency
during 2026‑27. Automation will be leveraged in 2027‑28 to
continuously detect, validate, and manage server assets, preventing
unauthorized deployments and maintaining compliance.
Concerning the second recommendation to
track IT systems and their criticality, eHealth has developed a comprehensive
asset list for servers, which identifies the server attributes, the
applications housed, and related criticality. eHealth continues to work with
partners to understand the criticality of services provided. This information
will help support future maintenance planning.
Regarding the third recommendation, to
implement security measures to address risks introduced by having unsupported
servers, eHealth works with technology vendors and partners to identify changes
in support status, which will guide work plans for upgrades or requirements to
provide compensating controls.
eHealth implemented a
third-party-managed security operations centre to improve the management and
responsive server updates based on vulnerabilities. Development of a
vulnerability management policy is under way which will formalize steps such as
identifying risks, remediating issues, and reporting on security matters. The
timeline for implementation of the vulnerability management policy is March
2026. Network reference architecture is being developed to provide direction
for network segmentation and further security controls for unsupported servers.
[13:15]
An
identity road map has been established which includes further improvements such
as the implementation of a tool that will enhance privileged access management.
The first round of projects is expected to begin in ’26‑27. eHealth is
exploring the ability to limit privileged actions to certain machines.
Regarding
the fifth recommendation to analyze logged security information for key health
care IT servers, eHealth utilizes a variety of tools to log and analyze
security-related risks and events across its IT environment. eHealth has
engaged a third-party-managed security operation centre to improve the
management of and response to vulnerabilities.
And
finally with regards to recommendation no. 6 which was to regularly report
to senior management and partners about significant risks and mitigation plans,
eHealth continues to update and develop information technology service
agreements with its partners to govern and manage the provision of IT services.
Under these agreements eHealth is implementing partner-specific IT risk
reporting. Informal discussions are held with partners on an ad hoc basis. A
new joint security, privacy, and risk subcommittee supports the SHA’s
information technology service agreements.
Utilizing
eHealth’s developing asset inventory as mentioned, a core set of KPIs [key
performance indicator] is being identified to report on risk and mitigation
plans for IT systems. The initial focus for KPI and reporting development is
aligned with the criticality of systems identified through disaster recovery
program enhancements.
Those
are my comments.
Chair Wotherspoon: — Thanks so much for the comments.
Thanks to those that are involved in the work on this front. I’m going to open
it up now to committee members for questions. MLA Pratchler.
Joan Pratchler: — Thank you.
Hello. I was wondering, has eHealth had any known cyberattacks in the past
three years?
Davin
Church:
— Davin Church, CEO of eHealth Saskatchewan. So just due to the nature of our
organization, we manage various cyber events on a regular basis, on a daily
basis. We have not had any cyber events in the past three years that have
resulted in any type of compromise of health system or any information that we
house.
Joan Pratchler: — Do you have a dynamic workload
management system?
Davin
Church:
— Are you able to define what you’re referring to by dynamic workload
management system?
Joan Pratchler: — That you’ve got all these servers. If
one server needs help, it moves and discusses with other servers and moves the
workload around so that it’s not particular to specific servers, that they’re
all connected.
Davin
Church:
— So we do use virtualization technology to allow that load balancing to occur
across our environment.
Joan Pratchler: — So how
many unauthorized IT servers have been removed from the network in the last
year? And did eHealth identify any of these servers were on the network for the
purposes of cyberattack or theft of patient data?
Davin Church: — We have had zero identified and zero
removed.
Joan Pratchler: — Zero identified and sorry?
Davin Church: — Zero
removed.
Joan Pratchler: — Zero
removed. On page 101 of the report it says that eHealth expects staff to test
and apply all emergency updates, you know, within 48 hours. Could you help me
understand what your policy is of time expectations for normal updates?
Davin Church: — We have a
monthly patch management schedule that we also work in conjunction with the
vendors on when they will be releasing various updates and patches for their
systems. And then we also work with our partners to ensure that when those are
applied they have minimal disruption to operations. And so we also plan that
schedule out with our partners across all systems.
Joan Pratchler: — Is that monthly? Weekly? Yearly?
Davin Church:
— We
have a monthly patch cycle.
Joan Pratchler: — Okay. How far are you along in defining
criticalities?
Davin
Church:
— We have worked with our partners across the system to identify all
mission-critical applications. And we’re now working through which remaining
applications are considered vital is that next layer, and we’ll continue to
work down from a priority perspective through that process.
Joan Pratchler: — Okay. Was there any attempt to start
with the servers that are known to be the most critical?
Davin
Church:
— Yes, that was the approach, was to start with the most critical servers.
Joan Pratchler: — And can you tell me more? Like how many
of those there would be?
Davin
Church:
— So because of the virtualization, a physical server doesn’t have
. . . Critical apps can be across a number of those and so really
with that workload management, we focused around what are the critical
applications and then identifying which servers that they are on as opposed to
starting with the servers themselves and moving to the applications after.
Joan Pratchler: — Okay.
Chair Wotherspoon: — MLA
Gordon.
Hugh Gordon: — I was wondering if you could help
out a non-technophile here. Just wondering if you could just explain to me how
when a new server connects to the network, how does it go undetected? How does
that even happen?
[13:30]
Davin
Church:
— So to clarify, like the servers that were unauthorized, they were not servers
that were connected to the environment, you know, in recent times. They were
servers that were sitting in facilities from legacy business operations. And so
as those were identified, we were then bringing them into our approved
environment. So protective services as an example is one, where because of the
nature of their business, they had servers in facility within their own offices
as opposed to within the provincial environment. And so as we identify those
unauthorized servers, that’s when we bring them into the approved data centre
environment on our servers.
Hugh Gordon: — Does that mean they still had access
through those servers to the rest of the system?
Davin
Church:
— They were running their legacy applications for their business operations on
those legacy servers. Now, and as we identified them, we moved those into our
provincial environment for them to continue to operate.
Chair Wotherspoon: — Pratchler.
Joan Pratchler: — I’m looking at page 103. This is
talking about provincial access to IT service. It says here that one of the
users left in November 2022, and it wasn’t removed until July 2023. That’s
about nine months, nine users. They were of uncertain appropriateness.
When I look at the recommendation here,
it says that a policy will be developed in 2025‑26, will be implemented
’28‑29. The pattern I’m seeing is there’s a long delay of time between
the time an incident or a situation or a concern is, you know, brought forth to
a certainty when it will be ameliorated. And in that time, you know, a variety
of things could happen that may not be all that good. Can you help me
understand why such a delay of time in a computer world like that?
Davin
Church:
— So your question around delays of timeliness in removing the privileged
access, essentially, you know, that is a breakdown in process between
individuals completing the proper forms in a timely way when they’re
offboarding an employee. So since then we have implemented a new process around
guidance and follow-up of employee offboarding. And then our revised policy
will also address the timeliness of reviewing those privileged access accounts
on a more frequent basis.
Joan Pratchler: — And what would that more frequent basis
be?
Davin
Church:
— Quarterly would kind of be the general standard, on a quarterly basis.
Joan Pratchler: — Okay. Have there been any privacy
incidents due to users with wrongful privileged access to the servers in the
last year?
Davin
Church:
— There have not.
Joan Pratchler: — Thank you. On page 104 it reads that
during 2023, eHealth was transitioning from a monthly scanning to a continuous
scanning process. Management advised that its vulnerability scans missed these
servers, 16 servers, due to implementation issues. What is your exception
process for those situations?
Davin
Church:
— During that time we were in the process of deploying that scanning to servers
and we continue to do that. And so we will be completed and have that
vulnerability, real full-time scanning on by the end of the fiscal year.
Joan
Pratchler:
— And so those 16 servers, are they still an issue or is that a . . .
Davin
Church:
— No, we would have been in implementation at that point in time.
Joan Pratchler: — Oh, okay. I understand that you have
some service providers. Do you get regular reports from your service providers
on your security scan results?
Davin
Church:
— We do get regular reporting, both internally as well as from our partners,
that we leverage around our security scanning and security support. And we’re
currently developing KPIs within that as well and continuing to improve and
evaluate those on an ongoing basis.
Joan Pratchler: — So regular means weekly? Daily?
Monthly?
Davin
Church:
— Monthly. Now if there’s any critical vulnerabilities, those are in real time.
Joan Pratchler: — Okay. When did those server scans by
that external service provider begin?
Davin
Church:
— I don’t have the exact timing in front of me, but we can get it before we’re
done today for you.
Joan Pratchler: — Sure. Okay, thank you.
Chair Wotherspoon: — Go ahead, MLA Gordon.
Hugh Gordon: — Reference here to
the external service provider. Can you please share with the committee who that
external service provider or providers are?
Davin Church:
— We have a managed service provider. Security Resource Group, out of Saskatchewan, is our managed service
support for that. And then there’s varying numerous tools used that are
leveraged for that monitoring.
Hugh Gordon: — Sorry, what was the name of the provider
again?
Davin Church: — Security Resource Group, SRG.
Hugh Gordon: — And they’re based out of Saskatchewan?
Davin Church: — Yeah.
Hugh Gordon: — That’s good. Could you just share with us
briefly perhaps how that service provider has assisted in improving your
ability to analyze security information on its key health care IT servers?
Davin Church: — So some of the supports and services that
they provide are 24‑7 monitoring of our environment. They review all logs
from across the entire environment to identify any potential issues,
vulnerabilities, those kinds of things. They also provide us automated
detection response. So if there is anything detected they also respond and
support our teams in any response if anything is detected. And then they have
also been a partner in expanding the end-point protection work that we’ve been
doing in relation to previous other audit recommendations.
[13:45]
And also
kind of have been key in supporting us in deploying the vulnerability
management tools and supporting response strategies around those
vulnerabilities.
Hugh
Gordon: — Thank you.
Chair
Wotherspoon: — MLA Pratchler.
Joan Pratchler: — I’d like to look
at page 105. It says that management advised us at eHealth that they used an
informal, internally set target that at least 80 per cent of servers have all
current patches applied. Now this was as of, well 2023. So that would mean 20
per cent, or up to 20 per cent, don’t have current patches applied. It just
requires one to have a problem, and hackers have all kinds of automated tools
these days.
Can you give us some peace of mind that
100 per cent of the patches are applied 100 per cent of the time?
Davin Church:
— So any servers that aren’t maintained from a patching perspective are running
legacy applications used by our health care partners and their business
operations, meaning that the systems that they currently use cannot operate on
newer technologies.
So our first approach in those scenarios
is to segregate those servers from the rest of the network so that they can’t
actually have any impediment on the rest of the health system network. Where
that’s not possible, we deploy other mitigating controls from a technical
perspective and work with our partners to identify and create a risk-informed
plan around how to address that going forward so that we can have a plan going
forward but not negatively disrupt their business operations in those
scenarios.
Joan Pratchler: — Okay, thanks. I’m
looking at page 106, the discussion around reporting to senior management and
eHealth partners regarding, you know, security. And it looks to me that the
recommendation or the time frame for implementation for addressing security
risk be 2026‑2027. Can you tell me what your top five KPIs are for
security?
Davin Church:
— So I have the answer to your previous question as well as this one. So I’ll
start with the most recent question, and we can go back to the previous
question on vulnerability reporting and when that started.
So a couple things. So our top five KPIs
that’s reported internally are vulnerability management, so number of
vulnerabilities identified versus remediated; number of malicious incidents or
attempts on our environment; the success of our training and awareness
campaigns and our phishing campaign, where we do simulated phishing tests
across the organization; number of threat risk assessments completed in order
to identify potential risks of new systems and ones that are being asked for;
and then as well, progress scans to our ISO [International Organization for
Standardization] maturity index model there.
We also have a security officers
committee with the SHA — which includes their internal audit as well as our
enterprise risk management teams and security teams — who are currently
defining which KPIs we’ll be reporting to their board. And then we also report
the number of vulnerabilities to the 3sHealth board for the systems that
they’re running and technology that they’re operating on.
For your previous question, we began
reporting, giving those monthly reports on vulnerabilities in March 2024 from
our partner. And the vulnerability management project when we started to
. . . The project to actually begin deploying the vulnerability
detection software was in 2023.
Joan Pratchler: — Okay, thank you.
There was a challenge it appears in this report of transferring that
information from your server maintenance risk reports to senior management. So
what is being done to ensure that senior management is reading the IT server
maintenance risks? And are these being shared with ministry officials or they
are with just eHealth senior staff?
Davin Church:
— We provide that reporting in those KPIs on a monthly basis to our executive
team — so we read that monthly — as well as our senior leadership team. And
then we also provide that through the security officers committee to our
partner organization, which have senior level management on those groups, who
then take that back through their own organizations, and in some cases they
report that also through their boards.
Joan Pratchler:
— So do I hear you say that information is provided to ministry officials as
well then?
Davin Church:
— Yes.
Joan Pratchler:
— Okay. Good. Thank you. That’s all I have for this chapter.
Chair
Wotherspoon: — Any
further questions from committee members? Okay, so these are all six new
recommendations, and so I’ll welcome a motion that we concur and note progress
with recommendations 1, 2, 3, 4, 5, and 6. Do I have a mover? MLA Beaudry. All
agreed? Okay, that’s carried.
Moving right along, I’m going to turn it
over to the auditor to focus on chapter 17 from the 2024 report volume 2.
Jason Wandy:
— Thank you, Mr. Chair. eHealth Saskatchewan is responsible for managing
critical IT services used to administer and deliver health care services in
Saskatchewan, which includes configuration and security of portable computing
devices accessing the eHealth IT network. Portable computing devices — for
example, laptops and smartphones — create security risks because they may
become infected with viruses or malware and are easy to lose. At August 2024
almost 32,000 portable computing devices could access the eHealth IT network.
eHealth
partially implemented the recommendation on page 177 where we recommended
eHealth Saskatchewan implement a written, risk-informed plan to protect laptops
with access to the eHealth IT network from security threats and
vulnerabilities. eHealth implemented its standard laptop configuration
including encryption with almost all its laptops using a supported operating
system as of August 2024. However eHealth continued to permit unrestricted use
of USB [universal serial bus] ports in laptops. It planned to implement a pilot
program to mitigate these risks by March 2025.
eHealth
also needs to restrict the users’ ability to access a laptop’s BIOS [basic
input output system] settings, permitting users to control device settings at
the hardware level. eHealth decided in August 2024 to restrict access to BIOS
settings and was working on a plan to implement this as a standard
configuration setting.
Blocking
USB ports can prevent devices from downloading data or uploading malicious
software or tools. Access to BIOS settings allows users to change hardware
configurations increasing the risk of security vulnerabilities if they make
unauthorized changes.
eHealth
partially implemented the recommendation on page 177 where we recommended
eHealth Saskatchewan standardize the configuration settings for mobile devices
with access to the eHealth IT network to mitigate associated security threats
and vulnerabilities. And it implemented the recommendation on page 178 where we
recommended eHealth Saskatchewan analyze the cost-benefits of using a central
mobile device management system to secure and monitor mobile devices with
access to the eHealth IT network.
eHealth
selected a central mobile device management system to help secure and monitor
mobile devices. While we found eHealth appropriately configured the central
device management system in accordance with good practice, it had only
transitioned 14 per cent of its mobile devices to the central system, resulting
in the configuration settings for many mobile devices continuing to not align
with good practice in several areas, for example, password requirements,
blocking jailbroken or rooted devices, or containerization.
eHealth
indicated it planned to transition all mobile devices to its central mobile
device manager by March 2026. Inconsistent configuration settings on mobile
devices results in increased security risks.
eHealth
partially implemented the recommendation on page 179 where we recommended
eHealth Saskatchewan take appropriate action to minimize the risk of security
breaches when a portable computing device is reported lost or stolen. eHealth
uses information from its ticketing system to manually update a spreadsheet
about lost or stolen devices.
[14:00]
Between
January 2023 and August 2024, we found eHealth recorded 12 incidents that
resulted in 18 lost or stolen devices. Using information obtained from the
Saskatchewan Health Authority, we found six additional lost or stolen devices
managed by eHealth not included in its tracking spreadsheet. While we tested
two of these devices and found eHealth appropriately disabled the devices and
removed them from the network, eHealth may not know the full extent of lost or
stolen portable computing devices at health sector agencies to which it
provides services.
Additionally
we found eHealth does not have authorization to disable all of the Authority’s
mobile devices, that is, for almost 2,400 mobile devices in Saskatoon. eHealth
indicated it is working with the Authority to obtain authorization to disable
these devices when necessary to do so. It expected to obtain such authorization
by March 2026.
Not
having complete information about lost or stolen devices or a centralized
incident management process increases the risk of lost or stolen portable
computing devices not being appropriately removed from the network and those
devices being compromised, putting personal health information at risk.
eHealth
partially implemented the recommendation on page 180 where we recommended
eHealth Saskatchewan implement a risk-based plan for controlling network access
to mitigate the impact of security breaches. eHealth indicated it was
developing a plan for establishing network access controls for all health
sector agencies. Establishing IT network access controls to restrict user
access to only what they need at any given time makes it much harder for
attackers to escalate privileges and take aim at vital assets in the event a
portable device is compromised.
Without
network access controls, eHealth does not sufficiently control access to the
eHealth IT network, and it does not restrict where users and devices can go or
what they can do on the eHealth IT network. Without adequate security on
network access ports, the eHealth IT network may be vulnerable to attack
through these open ports. Controlling IT network access helps to mitigate the
risk of security breaches and the extent of breaches.
eHealth
partially implemented the recommendation on page 181 where we recommended
eHealth Saskatchewan utilize key network security logs and scans to effectively
monitor the eHealth IT network and detect malicious activity. eHealth continues
to monitor pieces of the eHealth IT network, including end-point protection and
real-time scanning from key points in the eHealth network, but it does not scan
all areas of the IT network and analyze results to detect malicious activity.
While
eHealth Saskatchewan began using a service provider in May 2023 to help monitor
and manage the security of its IT network, at August 2024 it had yet to
transfer responsibility for monitoring all aspects of the network to the
service providers as planned. Without effective IT monitoring, eHealth may not
detect malicious activity and mitigate risks of a successful attack on its
corporate network within sufficient time to prevent a security breach.
I
will now pause for the committee’s consideration.
Chair Wotherspoon: — Thanks so much for the follow-up
work on this front. And I’ll turn it over to see if there’s brief comments from
ADM O’Neill. Otherwise we’ll open it up.
Norman O’Neill: — I do have brief comments. Just
surrounding the written plan to protect laptops with access to eHealth IT
networks from security threats and vulnerabilities recommendation, eHealth has
implemented protection on the system’s settings which has been rolled out as
part of our standard laptop configuration.
eHealth
has completed a risk assessment on the use of USB ports as part of its overall
information security management system. The pilot to restrict the use of USB
storage devices is progressing within eHealth. Use will only be permitted on an
exception basis where there is a business need. Expanding the restriction of
USB storage devices to other agencies will be explored.
Regarding
the second recommendation to standardize configuration settings for mobile
devices, eHealth continues to transition devices to the standard mobile device
manager. As of mid-August 2025, 45 per cent of devices have been transitioned.
The remaining devices will be transitioned in 2025‑26 using a phased
approach to minimize potential impacts.
Regarding
the fourth recommendation, to take appropriate action to minimize the risk of
security breaches for lost or stolen devices, eHealth has obtained
authorization to disable all partner mobile devices when required. This is
expected to be completed in this fiscal year. A knowledge document has been
developed to formalize the provincial process. Monthly reporting out of the
ticketing system has been developed to support the tracking of lost or stolen
devices.
Regarding
the fifth recommendation, which is to implement a risk-based plan to control
network access, eHealth continues to mature the information security management
system, which determines security controls using a risk-assessment approach.
eHealth developed a multi-year network and connectivity road map that outlines
the target end state for establishing centralized, facility-based network
controls for all health sector agencies and network access ports. Planning for
resource commitment and capital funding has begun. The first round of projects
is expected for 2026‑27.
Chair Wotherspoon: — Thank you. I’ll open up now to
committee members for questions. MLA Pratchler.
Joan Pratchler: — Have there been any security incidents
due to USB storage devices being used in this past year?
Davin
Church:
— Davin Church, CEO, eHealth Saskatchewan. No, there has not.
Joan Pratchler: — I see on page 178 when we’re talking
about devices and processes to secure them, it says that eHealth enforces a
policy of password protection, that kind of thing, in one of its three mobile
device management systems. For 14 per cent of the mobile devices that they
manage now, or that they manage, I think I heard that that number is better
than 18 per cent. It’s 45 per cent. That still would leave 55 that aren’t, and
the deadline that I heard here is not for another year or so-ish. Did I understand
that?
Norman
O’Neill:
— It’s the end of this fiscal year.
Joan Pratchler: — Oh, this fiscal year, okay. And you
feel that that’s safe enough? Quick enough?
Davin
Church:
— That 45 per cent was as of August. We only have 1,600 users left, so we’re
over 90 per cent complete.
Joan Pratchler: — Oh, okay. Thank you. Do you use the
mobile device manager locks in managing any of these mobile devices at all?
Davin
Church:
— Are you referring to what the policies are technically to how long your
password has to be, and those . . . Is that what you’re referring to
around using mobile device management for locks?
Joan Pratchler: — Perhaps I should ask this first. Have
there been any security incidents due to a mobile device that did not have a
mobile device manager installed? And so one of those may be a mobile device
lock or manager?
Davin
Church:
— No, there have not been any incidents as a result of a mobile device.
Joan Pratchler: — Okay, thank you. How many devices were
lost or stolen last year? And has there been any effort to track whether the
devices were lost or stolen due to improper procedure on the device user’s
part?
Davin
Church:
— Between September 2024 and August 2025 there were 19 devices that we manage,
lost or stolen. Our role in the event of a lost or stolen device once we are
notified is we initiate a remote wipe of that device so that if it is turned on
it will . . . and all information will be wiped. And then we also go
through the process of disabling in the interim until we have the opportunity
for the user to reset their credentials and passwords and so forth.
Joan Pratchler: — Okay.
Chair Wotherspoon: — MLA Gordon.
Hugh Gordon: — Just to add on to that really quick.
How are you tracking lost or stolen devices?
Davin
Church:
— Since the audit occurred we’ve implemented a new ticketing system. And so all
of that lost and stolen device is tracked and reported on through there, as
well as all steps are provided that are necessary to any teams that have roles
and responsibilities involved in that process.
Hugh Gordon: — So just to clarify, that’s not a
spreadsheet you’re using anymore? That’s something else?
Davin
Church:
— Yeah.
Hugh Gordon: — Part of the IT system now?
Davin
Church:
— Yes, we’ve implemented a new tool across our service desks for that.
Hugh Gordon: — Thank you.
Joan Pratchler: — And I’m just looking at that last
recommendation on page 181. It appeared what precipitated that recommendation
was that second paragraph and I highlight it: “. . . but it does not
scan all areas of the IT network and analyze results to detect malicious
activity.” And I see that planned actions for implementation are continued
improvements to the managed service program. Could you give me an example of,
you know, two or three improvements?
[14:15]
Davin
Church:
— So some of those improvements that we’re working through are edge monitoring,
threat hunting, advanced threat analytics, increased sophistication of our
end-point monitoring, as well as additional monitoring of any of those legacy
technologies that we are unable to properly segregate from the rest of the
network.
Joan
Pratchler:
— And is that through your service provider that is mentioned here?
Davin
Church:
— It’s a combination of our internal teams as well as our service provider.
Joan
Pratchler:
— And it says here that on the recommendations that the timeline for
implementation for continued improvements is TBD [to be determined]? Can you
quantify that?
Davin
Church:
— We have a five-year security road map which we are continuing to follow.
Really the biggest thing is that as that threat environment changes, we then do
shift if there is any maybe later opportunities that we’d planned that we need
to pull ahead in the schedule. So really what we’d be basing it on now is
working through our year-to-year road map.
Joan
Pratchler:
— So it’s quite fluid then?
Davin
Church:
— It can be, depending. Yeah.
Joan
Pratchler:
— That’s all my questions.
Chair Wotherspoon: — Any further questions on the chapter,
committee members? Not seeing any, thanks for the work and for the commitment
to implement these recommendations, the work that will be required. I’d welcome
a motion to conclude consideration of chapter 17. Moved by MLA Crassweller. All
agreed? That’s carried.
I’ll
kick it back over to the Provincial Auditor to focus on chapter 1, our final
chapter with eHealth here today.
Jason
Wandy:
— Thank you. Chapter 1 of our 2024 report volume 2 reports the results of our
annual integrated audit of eHealth Saskatchewan for the year ended March 31st,
2024. We found eHealth’s financial statements were reliable and it complied
with the authorities governing its activities related to financial reporting
and safeguarding public resources. Additionally eHealth had effective rules and
procedures to safeguard public resources except for the areas highlighted in
our two recommendations.
eHealth
partially implemented the recommendation on page 15, where we recommended
eHealth Saskatchewan sign an adequate service-level agreement with the
Saskatchewan Health Authority. At March 2024 eHealth did not yet have an
adequate IT service-level agreement in place with the Authority as they had not
finalized key aspects — for example, security and disaster recovery
requirements — of the agreement signed in May 2022. eHealth management
indicated they expected to finalize the remaining key aspects of the master
services agreement with the Authority during 2024‑25.
Adequate
service-level agreements clearly outline key IT service expectations. Without a
clear understanding of expectations and whether they are fulfilled, the
Authority’s systems may be vulnerable to security breaches or be unavailable.
eHealth
partially implemented the recommendation on page 16, where we recommended
eHealth Saskatchewan have an approved and tested disaster recovery plan for
systems and data. At March 2024 eHealth was responsible for 52 critical IT
systems. These are critical for the delivery of health care in Saskatchewan. We
found eHealth completed 36 partial tests — for example, recover a component of
a system from a backup — and 10 tabletop tests of IT system disaster recovery
playbooks. However eHealth had not completed any full disaster recovery
testing.
Disaster
recovery testing verifies plans can be implemented successfully and critical IT
systems can be restored after a disruption. Without tested disaster recovery
plans, eHealth, the Saskatchewan Health Authority, Saskatchewan Cancer Agency,
and the Ministry of Health may not be able to restore their critical IT systems
and data — such as the personal health registration system or provincial lab
systems — in a timely manner in the event of a disaster.
I
will now pause for the committee’s consideration.
Chair Wotherspoon: — Thanks so much for the follow-up and
the presentation. I’ll turn it over to ADM O’Neill for brief remarks, and then
we’ll open it up to questions.
Norman
O’Neill:
— All right. I’ll just touch on recommendation 2, surrounding the approved and
tested disaster recovery plan recommendation. eHealth established a disaster
recovery program. The five-year disaster recovery road map continues to be
implemented. All critical eHealth-managed services have a disaster recovery
playbook and have been tested using various testing methods, for example,
walk-through exercises, tabletop exercises, and partial tests.
Chair Wotherspoon: — All right, thank you for the work on
this front. I’ll open it up to committee members for questions. MLA Gordon.
Hugh Gordon: — I’d like to ask you, if the system goes
down, what is your mean time for recovery?
Davin
Church:
— Currently we’re working through the business impact assessments with the
partners to identify, based on the level of criticality, what those
return-to-operation times are and acceptable downtimes are, in order for us to
then identify the gaps between our current capabilities and identify how we
would then resolve the need and the resumption times to the capabilities.
Hugh Gordon: — To follow up on that, you know,
understanding how long it would take for your system to recover if it went
down, I think, would be really important. I imagine a number of very, very
essential services that everyone is depending on at various levels, in the
ministry and SHA and elsewhere, for all kinds of health care providers.
Are
you able to provide me any insights as to how much data you can accept the loss
of if there was a system that went down? Do you have a grasp of how much data
you can acceptably lose, or is that dependent?
Davin
Church:
— The business impact assessment will determine what that recovery point
objective is, and that is unique to each business area within our partner
organization. So that’s really up to them to determine as opposed to eHealth.
eHealth proper, our business impact assessment will be done by the end of this
fiscal year, so we’ll have that for our internal systems completed.
Important
to note when we talk about loss of data as well, we do have geographical
redundancy in our backups. And so we do have that between two data centres of
backups of the data that we house as well in that. And then we’re also
continuing to work through and improve our disaster recovery testing of those
critical systems to determine how and ensuring that we can recover those and
how quickly we can recover those critical systems and the prerequisite systems
that also need to be recovered in the event of a disaster.
Hugh Gordon: — So to kind of tie into that a little
bit, have you been able to identify which systems are critical for continuing
operations on a day-to-day basis, that in the event they weren’t recoverable,
you’ve got an adequate plan in order to I guess mitigate that?
Davin
Church:
— We are confident that in the event that a specific system could not be
recovered — of those critical systems that were originally identified through
that audit of those mission-critical systems — that we could recover those with
data up to the most recent backup. It’s important to note though, business
continuity is obviously, you know, would be within those specific service areas
around maintaining the continuity of the actual services being provided in the
event of an outage.
Hugh Gordon: — But to be clear, you haven’t done a
full assessment on the mean time for recovery of those systems either yet.
That’s still in the works.
Davin
Church:
— That’s correct. What we’re currently identifying is a way to actually go to a
full rebuild because we don’t have the opportunity to take lab systems down and
attempt to rebuild them from a production perspective. So our process has been
working through some of those partial trials, and then as major upgrades are
required, working through that full plan as those major upgrades are occurring
in order to achieve that.
Hugh Gordon: — Thank you.
Chair Wotherspoon: — MLA Pratchler.
Joan Pratchler: — So IT people tell me that if you
haven’t tested a disaster recovery plan, you don’t have a disaster recovery
plan. Have you tested your disaster recovery plan?
[14:30]
Davin
Church:
— We believe we have tested that DR [disaster recovery] plan for those critical
systems. Our approach is not to take those systems down end to end, as a
traditional disaster recovery testing would indicate, because of the impact to
patients and citizens of removing those systems. So through our incremental
testing and tracking those incremental tests to get to a full test of those
plans, we do believe we have.
Joan Pratchler: — Okay. I see here on the last
recommendation, it was in the 2007 report and then 2008. And here we are in
2025. And in the recommendation it says here it’s a five-year road map with
milestones along the way. Twenty years — in computer time, that’s a pretty long
time.
How does one . . . And us in
the Public Accounts are to represent the voices of the citizen. How does one
justify almost 20 years length of time to secure citizens’ and health care
operations data? And what steps are being taken to speed that up and to ensure
that it’s going to be always current and not take that amount of time to ensure
such critical information in health care in this province will be at the level
it needs to have for the excellent . . . for our citizens.
Davin
Church:
— I can’t speak to historically how approaches or attempts were made to resolve
this recommendation over the last 18‑or-odd years. What I can say is we
have taken the approach of the five-year road map, as well as an independent
audit every 18 months against an ISO standard around our disaster recovery
model and our maturity against getting there, and which we also report that to
our board. And the independent auditor has an opportunity to speak to our board
and present that. And from our perspective, we’re confident that at the next
follow-up audit by the Provincial Auditor that we’ll have this implemented.
Joan Pratchler: — Good. Thank you.
Chair Wotherspoon: — Any further questions, committee
members? Not seeing any, I’d like to thank CEO Church and the entire team over
at eHealth for their work on these fronts and for their involvement in our
considerations here today. And I think that concludes our consideration with
respect to eHealth, but also Health here today. So I’d certainly invite ADM
O’Neill to provide any parting remarks and to thank him and his team all across
Health for their time here today and all their work on these fronts as well.
Got any parting remarks before we kick you out of here?
Norman
O’Neill:
— I’ll keep them brief because you’re going to kick me out. But I would just
thank the Provincial Auditor and her team for the good relationship that we
have. We’ll thank the committee for listening to our subject matter today. And
I’ll thank the officials that joined us and provided their knowledge.
Chair Wotherspoon: — Thank you. Thanks again. And thanks
to committee members. We’ll have a very brief recess while we . . .
Well I guess we should have a motion to conclude consideration on — thank you
very much MLA Crassweller — to conclude consideration on
chapter 1. He’s identified it, so he’s the mover. All agreed?
Some Hon.
Members: — Agreed.
Chair
Wotherspoon: — Okay, that’s carried. Thanks so much
everyone.
[The committee recessed for a period of
time.]
Social
Services
Chair Wotherspoon: — Okay, folks, we’ll reconvene the
Standing Committee on Public Accounts here. And we’re going to turn our
attention to the Ministry of Social Services, and then we’ll conclude with some
review with respect to the Sask Housing Corporation.
I
want to welcome all the officials that have joined us here today and all those
that are connected to the work that we’re considering here today. And I want to
welcome Deputy Minister Bourgoin to provide just a brief introduction of all
the officials that have joined her and us here today. You can refrain from
getting into the chapters at this point. We’ll get over to the auditor for her
presentation, then come back your way. So I’ll turn it your way, Deputy
Minister Bourgoin.
Richelle
Bourgoin:
— Thank you very much.
Chair Wotherspoon: — Oh, whoa. Uh-oh.
Richelle
Bourgoin:
— Oh, dear. Well the carpet’s a little cleaner than when we started, so thank
you.
I’m
very happy to be here today and I’m really pleased to introduce my colleagues
that are with me: Brittany Csada, our assistant deputy minister of housing and
president and CEO of the Saskatchewan Housing Corporation; Tobie Eberhardt, the
assistant deputy minister of child and family programs; Grant Hilsenteger, the
assistant deputy minister of finance and corporate services; to my left, Joel
Kilbride, the assistant deputy minister of disability programs; and Julene
Restall, the assistance deputy minister of income assistance.
As
you can see, we’re also joined by other ministry colleagues who will introduce
themselves if they are called upon to answer questions. And we’re really happy
to be here and look forward to the conversation. Thank you.
Chair Wotherspoon: — Thank you very much. I’m going to
turn it over to the Provincial Auditor. The two chapters before us here today,
we’ll deal with them independent of one another, and we’ll focus first, of
course, on chapter 31.
Tara
Clemett:
— So, thank you, Mr. Chair, Deputy Chair, committee members, and officials.
With me today is Mr. Jason Wandy, and he is the deputy provincial auditor that
is responsible for the portfolio of work that does include the Ministry of
Social Services as well as Sask Housing. And behind him is Ms. Michelle
Lindenbach, and she is our liaison with this committee.
Jason
will present the chapters for the ministry in the order that they do appear on
the agenda. This will result in two separate presentations. He will pause for
the committee’s deliberation and consideration after each presentation.
The
first presentation does include just a status update on previous
recommendations that the committee has agreed to. The second presentation
includes four new audit recommendations for the committee’s consideration.
I
do want to thank the deputy minister and her staff for the co-operation that
was extended to us during our work. With that, I’ll turn it over to Jason.
Jason
Wandy:
— Thanks, Tara. The Ministry of Social Services funds and licenses group homes
and approved private service homes to provide accommodation, meals, and care to
about 1,700 adults with intellectual disabilities, referred to as clients. In
April 2024 the ministry licensed about 280 group homes and 180 approved private
service homes in Saskatchewan.
Chapter
31 of our 2024 report volume 2 reports the results of our first follow-up audit
of management’s actions on the nine recommendations we first made in 2021 about
the ministry’s processes to monitor whether ministry-funded group homes and
approved private service homes provide quality care to adults with intellectual
disabilities. By April 2024 the ministry implemented one recommendation and
continued to work on six recommendations, and did not implement two
recommendations.
For
the two recommendations on page 269, we found the ministry partially
implemented our recommendation that the Ministry of Social Services use a
central system to track key information about group and approved private
service homes, and it implemented our recommendation that the Ministry of
Social Services monitor resolution of deficiencies stated in conditional
licences for group and approved private service homes within a reasonable time
frame.
We
found the ministry developed a centralized tracking system for monitoring group
homes’ licensing information — for example, licence expiry dates — but had yet
to update its system to also include licensing details for approved private
service homes. It planned to do so during 2024‑25.
We
found the ministry appropriately monitored home operators’ resolution of
deficiencies set out in conditional licences. At March 2024, 18 per cent of
group homes and 20 per cent of approved private service homes had conditional
licences, compared to 45 per cent and 70 per cent in 2021, respectively.
Our
testing of 15 homes with conditional licences found the ministry maintained
regular contact with home operators who had conditional licences. Having a
centralized system to track steps completed in the home licensing process can
help with monitoring licence expiration, completion of inspections, along with
receipt and review of required documentation.
[14:45]
For
the two recommendations on page 271, we found the ministry partially
implemented the recommendation that the Ministry of Social Services update home
inspection checklists to cover key risk areas at group and approved private
service homes, and did not implement the recommendation that the Ministry of
Social Services annually inspect each group home to assess if it meets the
minimum program standards requirements.
We
found the ministry updated its home inspection checklist for staff to examine
key risk areas at group homes — for example, handling of medications — but had
yet to update its home inspection checklist for approved private service homes.
It expected to do so by October of 2024.
We
found the ministry continued to not require its staff to visit each group home
at least annually to assess whether each home meets minimum program standards.
The ministry indicated it continues to look for opportunities to increase the
number of group homes it reviews annually through establishment of a quality
assurance unit. In 2023‑24 the ministry inspected 104 out of 282 group
homes.
Having
comprehensive checklists to assess key home safety areas potentially impacting
clients’ health and safety is necessary to determine deficiencies and correct
them before serious incidents occur. Without regularly inspecting each group
home to assess program standards, the ministry may not know whether clients
receive appropriate and quality care.
We
found the ministry did not implement the recommendation on page 272, where we
recommended the Ministry of Social Services verify completion of periodic
criminal record checks for people caring for adults with intellectual
disabilities. The Residential Services Regulations require group home
operators to establish policies requiring criminal record and vulnerable sector
checks for management, staff, and volunteers working with clients. The
regulations also require approved private service home operators to provide the
ministry with the results of criminal record and vulnerable sector checks for
operators and other adults in the homes.
However
the ministry indicated it is working to determine how often to require criminal
record checks and vulnerable sector checks for people providing services to
people with intellectual disabilities in group and approved private service
homes. It expected to establish a process to verify completion of periodic
criminal record checks during 2024‑25. Lack of verification of periodic
criminal record checks for people providing services to vulnerable populations,
such as adults with intellectual disabilities, increases the risk of financial,
physical, or sexual abuse.
We
found the ministry partially implemented both recommendations on page 273,
where we recommended the Ministry of Social Services periodically assess the
quality and fulfillment of person-centred plans for adults with intellectual
disabilities, and where we recommended the Ministry of Social Services have
regular contact about the person-centred plans with adults with intellectual
disabilities.
We
found the ministry drafted standards for providing person-centred case
management to adults with intellectual disabilities based on their assessed
needs, desires, and goals. It planned to pilot these draft standards during
2024‑25. Until implementation of the new standards, we found the ministry
continued to expect group and approved private service home staff to develop
person-centred plans with their clients and review them at least every two
years. Additionally we found the ministry continued to expect its case managers
to have at least once-a-year contact with clients living at group homes and
once every quarter with clients living in approved private service homes.
Our
testing of 30 client records found three client records did not include any
person-centred plans; four client records had existing plans over two years
old, with the oldest plan developed in 2015; 14 client records did not have
evidence of ministry staff reviewing clients’ person-centred plans or outcomes;
and 11 client records indicated ministry staff did not have regular contact
with the clients — that is, no contact within the last year.
Without
periodically reviewing the person-centred plans and meeting with clients, the
ministry does not know whether clients receive quality care to live fulfilling
lives. Furthermore the ministry may not know whether any issues or concerns
exist if ministry staff do not periodically visit or contact clients.
We
found the ministry partially implemented the recommendation on page 274, where
we recommended the Ministry of Social Services analyze serious incidents for
systemic issues. Since our 2021 audit, we found the ministry developed a
serious incident dashboard, providing some analysis of serious incidents
reported by group and approved private service homes.
In
addition, we found the ministry implemented a new form for reporting serious
incidents in April 2024. The new form requires ministry staff to document the
physical address of where the incident occurred. Such information can help the
ministry to better identify homes with more frequent or persistent concerns
when analyzing serious incidents.
While
the ministry currently has limited data to inform analysis by physical address,
staff indicated they will comparably analyze incident data in 2024‑25 of
the various homes providing services to clients. Limited or ad hoc analysis
risks the ministry not identifying homes with persistent issues, increasing the
risk of missing homes providing unsuitable services for adults with
intellectual disabilities that should not be licensed.
We
found the ministry partially implemented the recommendation on page 276, where
we recommended the Ministry of Social Services monitor for timely
implementation of recommendations set out in serious incident investigation
reports at group and approved private service homes. We found the ministry did
not consistently follow up with home operators on their implementation of
recommendations from serious incident reports.
We
tested eight serious incidents from 2023‑24 that warranted an
investigation and found six of the final reports included recommendations.
However not all recommendations included expected timelines for implementation.
Ministry staff did not properly follow up with three home operators regarding
timely implementation of recommendations.
The
ministry not following up on and monitoring the status of serious incident
recommendation implementation may lead to similar incidents reoccurring.
Identifying delays in implementing corrective actions will provide the ministry
with important information about whether it needs to further support the home
to prevent specific types of incidents from occurring.
I’ll
now pause for the committee’s consideration.
Chair Wotherspoon: — Thanks very much for the
presentation and the important follow-up here. I’ll turn it over to Deputy
Minister Bourgoin for brief remarks. Of course, this is a follow-up chapter and
we’ve concurred already at this table as a committee with these recommendations
and had an opportunity to have some questions. But, Deputy Minister, go ahead,
and we’ll see what we have for questions.
Richelle
Bourgoin:
— Thank you very much. And thank you for the presentation. Related to the
recommendation that the ministry use a central system to track key information
about group homes and approved private service homes, the ministry considers
this recommendation implemented. We have updated our centralized licensing
database to better track key information related to licensed group homes and
approved service homes.
There
are two recommendations under 3.2, and I will speak to them separately. Related
to the recommendation that the ministry update home inspection checklists to
cover key risk areas at group homes and approved private service homes, the
ministry also considers this recommendation implemented. We’ve updated our
inspection checklists to address best practices for water temperature,
medication handling, and waste disposal, for example. The program standards
checklist that is used for group home licensing was updated in January of 2024,
and the annual review checklist used for approved private service home
licensing was updated in October 2024.
Related
to the recommendation that the ministry annually inspect each group home to
assess if it meets the minimum program standard requirements, the ministry
considers this recommendation partially implemented. In January 2024 we fully
implemented the program standards report, and that report includes the
requirement to complete a minimum of one program standards review every year
for each service provider licensed under The Residential Services Act.
But
since the previous audit, the ministry’s new disability programs quality
assurance unit was established, and that team is beginning program standards
review in our north service area group homes this month, in October. We will
expand this to group homes in the rural centre service area by March of 2026.
The quality assurance team will conduct an analysis of the completed program
standards reports to determine the effectiveness of this approach.
Related
to the recommendation that the ministry verify completion of periodic criminal
record checks for people caring for adults with intellectual disabilities
living in group homes and approved private service homes, the ministry
considers this recommendation implemented and on track for full implementation
by the end of this fiscal year.
The
ministry began a phased approach to fully implement an annual criminal record
declaration for all service providers by the end of this fiscal year. Group
home operators were informed of this new requirement in May. We’re on track to
have that completely delivered by April, when new service agreements will
include the requirement for annual criminal record declarations. The
requirement’s also being added to agreements with approved private service home
operators over the course of this fiscal, and again at the time of annual
licensing renewals.
The
ministry considers the following two recommendations under chapter 3.4 to be
partially implemented: that Social Services periodically assess the quality and
fulfillment of person-centred plans for adults with intellectual disabilities
living in group homes and approved private service homes, and that the ministry
have regular contact about the person-centred plans with adults with
intellectual disabilities living in group homes and approved private service
homes.
I’ll
speak to each recommendation separately, but with respect to the quality of
person-centred plans, or what we call PCPs, the program standards report was
rolled out in January of 2024 and verifies that the PCPs are in place. The
ministry also has a case management project under way, and that has developed a
tool to measure the quality of those plans specifically.
With
respect to having regular contact about the PCPs, I noted earlier the program
standards report verifies that those person-centred plans are, in fact, in
place in group homes and tracks completions as well as renewal dates of those
plans. Approved private service home operators are also now required to
implement a new residential support plan for all residents this fiscal as part
of their annual licensing review.
To
fully implement both recommendations by the end of the 2026‑27 fiscal
year, the ministry is expanding our outcomes-based service delivery project.
This project focuses on ensuring that clients served by third-party service
providers receive quality support and have positive outcomes from the programs
and services that we deliver. For disability sector service providers already
participating in the project, we will work with them to integrate the
outcomes-based service delivery framework into individual, person-centred plans
and focus on service-level indicators in overall planning and program delivery.
Related
to the recommendation that Social Services analyze serious incidents related to
adults with intellectual disabilities for systemic issues at each group home
and approved private service home, we also consider this recommendation
implemented.
The
new disability program’s quality assurance unit oversees and tracks serious
incident reporting. To strengthen their work, new serious incident definitions
have been developed. A process is in place to flag outstanding abuse
investigations to ensure they are completed in alignment with policy and
expected timelines. And finally, a proactive strategic plan has been developed
to analyze reported serious incidents for common trends and provide
recommendations to address and prevent those trends.
Related
to the recommendation that the ministry monitor for timely implementation of
recommendations set out in serious incident investigation reports at group and
approved private service homes, the ministry considers this recommendation
partially implemented.
Standardized
reporting on serious incidences has been established and those reports are
being scrutinized and monitored by the quality assurance unit. The ministry has
conducted analysis that will be the basis for recommendations to improve
service quality and incident follow-up. And by the end of the 2026‑27
fiscal year, we will move forward on key actions based on those anticipated
recommendations that will come from that work.
Thank
you very much. I’ll turn it back over to the Chair.
Chair Wotherspoon: — Thanks so much, Deputy Minister
Bourgoin, and all those that have been involved in this work and the
commitments that have been made as well. I’ll open it up to committee members
now for questions. MLA Pratchler.
Joan Pratchler: — I really have to commend this group on
the amount of work that must have happened in these last . . . half
of a year practically. Thank you for that.
I’m
looking at recommendation 3.1, just a little more information maybe. What
specific data will be tracked in that database mentioned in that
recommendation?
[15:00]
Chair Wotherspoon: — Just before you provide a response
there, I just wanted to table the status update as well: PAC 55‑30,
Ministry of Social Services: Status update, dated October 15th, 2025. Thanks to
those that are involved in that work that’s reflected in that status update and
those that prepared it.
Joel
Kilbride:
— Thanks very much. Joel Kilbride, the ADM of disability programs. So in that
database we have information about the addresses of the homes: those that are
licensed, those that are up for renewal for licensing, those that have
deficiencies that need to be addressed. All that information is located in
there.
Joan Pratchler: — One-stop viewing.
Chair Wotherspoon: — MLA Gordon.
Hugh Gordon: — So what did the ministry find when it
was reviewing its inspection checklists? What, if anything, was added to the
checklist?
Joel
Kilbride:
— Some information and expectations were outlined in amendments that were made
to The Residential Services Act in regulation around safe water
temperature, waste disposal — what’s the other piece? — and medication
administration.
Joan Pratchler: — Has anything else been added to that
checklist for those few items or was anything else enhanced?
Joel
Kilbride:
— We’ll have to bring that back. I’m sorry, we don’t have any additional
information on that.
Joan
Pratchler:
— [Inaudible] . . . usually about a month. If you can just send it to
us, that would be great. Just wondered.
Joel
Kilbride:
— Well thank you.
Chair
Wotherspoon: — Thanks so much. So we’ll just keep it
formal through the Chair on the undertaking. You’re able to provide that
information within a month? Is that reasonable? And you can just do it through
the . . . The Clerk will provide you kind of the process to do that.
Any further questions, MLA Pratchler?
Joan
Pratchler:
— Can you provide an update on how the program standards reviews in the north
service area are going so far?
Joel
Kilbride:
— So we just started that process, and only one has been completed so far.
Joan Pratchler: — How many do you think will be needed
to be completed? Like what’s your “-ish”?
Joel
Kilbride:
— We should be able to get that answer back to you shortly. If you want to move
on, we can come back to it.
Hugh Gordon: — I just want to touch on the resolution
of deficiencies in a number of your care homes, both private and otherwise.
What were some of the barriers that you had to overcome or are overcoming in
order to monitor the resolution of those deficiencies in those homes?
Jeff
Redekop:
— Good afternoon. Jeff Redekop, executive director with service delivery and
disability programs. So the question was about what are some of the issues we
have to address in some of the inspections. So we have a short list of a few
things that are on our list here.
Sometimes
it’s the physical repairs, sometimes fairly extensive ones that can include,
just going from memory, bathroom and kitchen repairs in terms of some of the
homes. Sometimes we have a temporary space increase during, you know,
renovations that need to be addressed as part of that remediation. And
sometimes there are things related to, I can’t think of an example, but things
might be related to zoning if there’s something we have to remediate in terms
of the zoning of a home.
And
I think that’s generally the list. A lot of it is repairing. You know, I’m just
looking through at some of our capital, just going through my memory in terms
of some of the capital improvements we’ve had to do to adjust some of these
things. And in addition to renovations, we’ve addressed these, like sometimes
making the ground level. That can change over time in terms of the physical
structure of the group homes. Those are a few examples.
Hugh Gordon: — I guess just to clarify, I was just
wondering like if there was issues that were getting in the way of resolving
these deficiencies in these care homes. Like is it just a matter of working
with those different stakeholders, making sure that they have adequate either
funding to resolve issues that are detected, they have adequate training,
adequate personnel? What might be the delays in that process in ensuring that
when these deficiencies are detected that there’s, you know, a timely resolution
of that? And I’m just curious if it’s something that’s across the board or if
it’s something unique to each facility.
Richelle
Bourgoin:
— I speak to the very specific needs that we have with some of our group homes
and the clients specifically, because we do at times transition clients from an
existing group home into another group home or have a change in residency. The
needs of the individual might be very specific. And so for example, a certain
size of bed that simply needs to be procured. And so we can sometimes
experience some delay in making sure that we have the right fit for the client
that we’re serving in that time.
It
may not be something that’s profoundly structural, but to Jeff’s point where we
do have larger issues, such as shifting in some communities and houses that are
not brand new as an example, or if we see that there’s been some moisture and
there’s a problem with the basement, then we are sometimes at the mercy of the
contractors that provide the support that we need to be able to bring those
homes to the point that we want them to be, just like many of our neighbours on
the blocks that will be experiencing similar types of problems with the houses
that they are in.
Hugh Gordon: — Thank you. I want to move on to
completing annual inspections. I just also was wondering, you partially
implemented that recommendation. I’m just curious to know what further
challenges remain in order for you to, you know, fully implement that recommendation?
And if you could tell us what those barriers might be.
Joel
Kilbride:
— Thank you very much for the question. I just want to start by sort of being
clear that we do have people that go in the homes annually. There’s caseworkers
that go in the homes. Each home, a physical inspection is done. There’s fire
inspections, health inspections that are done. And we also have other positions
that visit homes. There’s managers of community and client service that have
relationships with CBOs [community-based organization] and clients. So we are
in the home.
This
is really just about the program review. And one of the reasons in the past I
think that we wanted to make sure a program review was done for every CBO and
not necessarily for every group home is that there are program coordinators
that oversee more than one group home, and so they would be responsible for the
programming. Now we do want to move in the direction of trying this out again
in the North and then move to a rural centre service area and see if there’s
any value in reviewing every home.
And
I have a follow-up answer on the number of homes in the North. It’s 55.
Hugh Gordon: — Thank you.
Chair Wotherspoon: — MLA Pratchler.
Joan Pratchler: — Just one last question, I think. Heaven
forbid there’s a serious incident. Could you just walk us through what is the
ministry’s process should that occur? And how does that look like until
resolution of some nature?
Jeff
Redekop:
— If I recall the question — oh, sorry, Jeff Redekop. The question was about
what’s kind of the process if there’s a serious incident. Yeah, first of all I
mean, I guess the fundamental requirement there is that we have policies and
processes in place to report serious incidents, which are in place.
And
with our own directly operated homes and the homes that are approved private
service homes operated by private individuals licensed under our residential
services Act and CBO or third-party providers that are providing group homes,
so that process is in play for our staff and our community contractors. And
making sure that people are aware of that critical thing. So this is the
foundation for ensuring that reporting does occur.
And
when there’s an incident, the requirement is . . . And it depends on
the type of incident. For example, if it’s an allegation of abuse, that would
be something that would be reported immediately to within our various systems.
We have processes in our service incident reporting documentation that shows
kind of who reports to who, when. So that’s all laid out.
And
once there’s a report in, you know, we — for example, our ministry folks —
would engage with the third party . . . I mean of course, before
that, taking steps to make sure whatever incident is stopped and people are
safe, if people need to go to the hospital — which is a rare thing, but it does
occur in some serious incidents. Making sure that clients are safe is the
number one priority.
[15:15]
Following
that, we would certainly engage with the organization, and the next step — I’m
not covering every step because we have other things to get to — but following
that there may be a need to do a further review of an incident and document
steps that we could take to prevent such instances from occurring again. And
then whatever those might be, implement those recommendations.
But
one of the critical things that Joel spoke about earlier, and Deputy Minister
Bourgoin, was the establishment of our new quality assurance unit which
provides basically the staff to do the work and focus on reviewing how we’re
performing, and having a look at not only the serious incidents that occur at a
one-off but on a systemic basis, whether that be per group home, per
community-based organization, or per individual. So we now have, with our
refined dashboard, the availability to analyze that information in a far more
detailed way.
Joan Pratchler: — Thank you.
Chair Wotherspoon: — Any further questions, committee
members? Not seeing any at this time, I’d welcome a motion to conclude
consideration of chapter 31 moved by Deputy Chair Wilson. All agreed?
Some Hon. Members: — Agreed.
Chair Wotherspoon: — That’s carried. We’ll turn our
attention to chapter 9 of the 2024 report volume 2. We have some new
recommendations in this chapter, and I’ll turn it over to the auditor.
Jason
Wandy:
— Thank you, Mr. Chair. Chapter 9 of our 2024 report volume 2 reports the
results of our annual audit of the Ministry of Social Services for the year
ended March 31, 2024. We found the ministry complied with authorities governing
its activities and had effective rules and procedures to safeguard public
resources, except for the matters described in our chapter.
The
ministry implemented two recommendations in 2023‑24. We found the
ministry implemented our recommendation about starting to verify the accuracy
of Saskatchewan income support, or SIS, program clients’ income information
with the federal government. The ministry implemented a process to start
verifying the accuracy of SIS program clients’ income information and confirmed
the accuracy of income for a sample of clients based on federal government
information. It intended to further expand this work in 2024‑25.
We found the ministry partially
implemented the recommendation on page 55, where we recommended the Ministry of
Social Services record and recover overpayments related to its Saskatchewan
income support program in a timely manner. An overpayment occurs when the
ministry pays a SIS client before receiving all information necessary to
confirm a client’s eligibility for benefits or it makes an error in determining
a benefit amount or when a client potentially provides inaccurate information
to the ministry. At March 2024 the ministry reported accounts receivable of
almost $10 million related to SIS overpayments, a 38 per cent increase
from 2022‑23.
The ministry’s IT system used to
administer SIS benefits allows staff to establish automatic payment recovery
beginning the following month and record the related amount due that is
accounts receivable for overpayments from future SIS benefits.
Our testing of eight SIS client files
with known overpayments found ministry staff did not record the overpayments
for seven files and did not set up the collection from future benefits through
the automatic payment recovery process. Ministry staff set up the overpayment
for one file but did not do so timely. Not recording amounts due and not
initiating automatic payment recovery delays timely overpayment recovery. In
addition the ministry will have limited ability to collect on overpayments if
clients leave the SIS program.
Our annual audit of the ministry also
included assessing the design and implementation of the ministry’s processes up
to July 31 of 2024 for procuring hotel rooms when income assistance or child
and family program clients require hotel stays. We decided to do this work in
response to concerns raised in the Legislative Assembly during 2023‑24.
This chapter includes four new recommendations for the committee’s
consideration in relation to this work.
In the recommendation on page 61, we
recommend the Ministry of Social Services maintain sufficient documentation to
support appropriate selection of hotels needed for its child and family program
clients. In March 2024 the ministry implemented a pilot project requiring staff
to obtain three quotes from hotel providers when procuring hotels rooms for
clients in Saskatoon, Regina, Prince Albert, and Moose Jaw.
The ministry’s program support branch
developed a list of confirmed hotel providers by contacting hotels located in
these cities to identify interested providers. Branch staff maintain a
price-quote list, calling three hotels for each location on the listing twice
each week, on Monday and Friday, to obtain nightly room rates. Branch staff
share the price-quote list each Monday and Friday with other staff — for
example, caseworkers or after-hours service providers — who may be booking
hotel rooms for clients.
When procuring hotels for clients, the
ministry expects staff to document details in the case management systems
surrounding a client’s need for a hotel — for example, they are homeless, the
shelters were full, or domestic abuse — along with necessary approvals by a
supervisor or a manager as well as the nightly rate obtained.
We assessed the ministry’s
implementation of its three-quote pilot between March and June 2024 for four
income assistance clients. We reviewed documentation within the case management
system, confirming staff appropriately used the price-quote list and obtained
necessary approvals to procure the hotel rooms.
For three child and family program
clients we reviewed documentation within the case management system, confirming
staff within the child and family programs branch obtained necessary approvals
to document the hotel rooms. However, we were unable to determine whether they
appropriately used the price-quote list when selecting the hotels — for
example, staff did not document their consideration for each hotel chosen — or
whether they obtained the lowest-priced hotel from the current price-quote
lists.
Having sufficient documentation about
hotel selection enables the ministry to demonstrate its consideration of best
value in its procurement of hotel rooms while treating hotel providers fairly
and equitably.
In the two recommendations on page 63 we
recommend the Ministry of Social Services centrally track and monitor hotels it
pays and at what rates for clients of its income assistance and child and
family programs. And we recommend the Ministry of Social Services complete a
robust evaluation of its pilot projects to procure hotel rooms for clients of
its income assistance and child and family programs.
At the end of 2023‑24 the ministry
initiated two pilot projects associated with procuring hotel rooms for clients,
as I have already discussed. One project requires staff to obtain three quotes
when procuring hotel rooms and choose the hotel appropriate for client needs with
the lowest rate. The other project involves contracting a hotel provider in
both Regina and Saskatoon to provide five hotel rooms, every night, at a single
fixed rate for a one-year period.
Beginning in August 2025 the ministry
planned to evaluate its two pilot projects for the one-year period ending July
31st, 2025. However, we found the ministry had yet to consider all data
requirements or to determine baselines or targets needed for its evaluation.
While we found the ministry did contemplate its data requirements for the two
contracted hotels within its agreements with the hotel providers — that is,
requiring hotels to provide monthly reporting about usage and any damages — the
ministry cannot easily obtain data for evaluating its three-quote process as it
maintains detailed client hotel data within multiple systems. For example, the
ministry indicated staff spent considerable time during 2023‑24 compiling
data about client hotel stays to help answer questions from legislators.
To effectively evaluate its pilot
projects, the ministry needs reliable data on which to base its assessment. The
ministry requires such information to determine whether the project’s improved
its ability to procure suitable hotel rooms for clients efficiently and
effectively. It needs to complete this evaluation timely and provide the
results to senior management to also support future decisions and/or changes
needed.
In the final recommendation, on page 64,
we recommend the Ministry of Social Services work with the Ministry of Finance
to consider how to publicly report payments made to vendors on behalf of income
assistance and child and family program’s clients. When the Ministry of Social
Services pays vendors on behalf of its clients, it records these payments as
operating transfers. These are transfers to or on behalf of individuals for
which the government does not receive any goods or services directly in return.
According to the financial
administration manual maintained by the Ministry of Finance, the government’s
Public Accounts volume 2 includes payee details for transfers where payees
received $50,000 or more except in the following circumstances: for high-volume
programs of a universal nature, or income security and other programs of a
confidential and personal nature.
Historically the Ministry of Social
Services has applied the exception when preparing its disclosures for volume 2
and has not disclosed payments made to vendors like hotels on behalf of its
clients. We compared the ministry’s payee details in volume 2 to similar
reporting in two other Canadian provinces, that being Alberta and Manitoba, and
found the ministry’s counterparts in both provinces report the payee details
for payments made to vendors like hotels and grocery stores on behalf of
clients exceeding a specific threshold, for example, $10,000 or $50,000.
Public reporting about payments made to
vendors on behalf of clients such as in volume 2 or within the ministry’s
annual report can help the ministry to increase transparency about its use of
vendors and demonstrate accountability for its programs.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Well thanks for the presentation,
the important chapter, and the focus of your work here today. I’ll turn it over
to Deputy Minister Bourgoin for comments and then we’ll open it up for
questions.
Richelle Bourgoin:
— Thank you very much, and thank you for presentation. Related to the
recommendation that the ministry record and recover overpayments in the
Saskatchewan income support program in a timely manner, the ministry considers
this recommendation implemented.
Since the audit the ministry developed
and implemented a strategy to ensure overpayments are recorded and recovered in
a timely manner. Specifically this includes a targeted review of Saskatchewan
income support program cases with an overpayment to ensure a plan to recover
the overpayment has been established. This work continues and cases that do not
have a recovery plan in place are being addressed.
Training for employees on the process of
entering and recovering overpayments in the system have been developed and
implemented. And finally, new system functionality enables overpayments to be
transferred and recovered across case files.
Related to the recommendation that the
ministry maintain sufficient documentation to support appropriate selection of
hotels needed for its child and family program clients, the ministry considers
this recommendation implemented.
We’ve updated our processes and
implemented training to ensure consistency of documentation for hotel selection
for children and families in need. By the end of January of this year, we
updated child and family program’s business process manual to include the
ministry’s three-quote hotel price process and held a series of information
sessions with child and family program employees on the three-quote process;
and ensuring that consistent documentation of hotel selection, the rates, and
the other relevant information is contained in our case management system.
Going forward, the ministry will continue to use the price-quote list for
hotels to identify the most affordable, as well as appropriate, accommodation
to meet the immediate needs of our clients.
There are two recommendations listed
under 5.4 that I will address separately. Related to the recommendation that
the ministry centrally track and monitor hotels it pays, and at what rates for
clients of income assistance as well as the child and family programs, the
ministry considers this recommendation implemented.
Since the auditor’s report, the ministry
has developed a centralized process in Saskatoon, Prince Albert, Regina, and
Moose Jaw where designated employees track and monitor hotel invoices. This
information helps us to really provide an overview of the number of hotels in
use, the rates charged. It of course supports transparency and gives us the
ability to analyze those trends over time. We continue to review the current
processes and the administrative requirements to track hotel usage. It remains
a priority, and this will inform any potential adjustments or alternative
approaches that balance operational demand with the importance of transparency
in reporting.
Related to the recommendation that the
ministry complete a robust evaluation of its pilot project to procure hotel
rooms for clients of income assistance and child and family programs, we also
consider this recommendation implemented.
In response to the recommendation, we
conducted an evaluation of two pilot processes that were put in place in 2024:
the contracted block-room model in Regina and Saskatoon, as well as the weekly three-quote
process used in Regina, Saskatoon, Moose Jaw, and Prince Albert. Our evaluation
included data collection, incorporating information from the centralized hotel
invoice-tracking process, hotel invoices, vendor master lists, weekly hotel
price quotes, contract information, utilization records. And we also conducted
interviews with the employees that were involved to understand their experience
in that process.
Our detailed evaluation report has been
provided to the auditor’s office. Findings confirm that hotel stays remain a
necessary part of service delivery at the Ministry of Social Services. But in
line with the report’s recommendations, the ministry will continue to use the
three-quote hotel price process, and it’s extended the procurement of blocked
hotel rooms. The renewed contracts include five hotel rooms in Saskatoon —
unchanged from our previous contract — but eight hotel rooms in Regina, which
is an increase in three rooms per night to meet demand in the city.
[15:30]
Related to the recommendation that
Social Services work with the Ministry of Finance to consider how to publicly
report payments made to vendors on behalf of the income assistance and child
and family program clients, the ministry considers this recommendation
partially implemented. We note that the Provincial Auditor found the ministry’s
reporting standards to be consistent with the government policy for reporting
payee details.
We will continue to adhere to the
government’s financial reporting policies. Presentation of vendor payments will
not change in the 2024 Public Accounts volume 2 being released this fall. We
will continue to work with our colleagues at the Ministry of Finance to ensure
that we’re fully compliant with their policies on public reporting.
And I will turn it back over to the
Chair.
Chair
Wotherspoon: — Thanks for the update on the work
that’s been undertaken. I would open it up now to committee members that may
have questions. MLA Gordon.
Hugh Gordon: — Do you have any
data on overpayment rates or track how much overpayment occurs?
Julene Restall:
— My name’s Julene Restall. I’m the assistant deputy minister of income
assistance programs. So a little bit more about overpayments. So overpayments
occur when a ministry pays benefits to a client that they’re not eligible for
or there’s a change in circumstances which individuals don’t inform us about,
and therefore it impacts their eligibility for benefits.
Within our SIS program we have a policy
that outlines the amount of recoverable overpayments that we assess on a
monthly basis. So that would be a recovery of $50 a month because we want to
ensure that people aren’t experiencing hardship because of those overpayment
amounts. We reflect that overpayments are a debt to the Crown. And we do have
to collect on those, but we obviously take that into consideration with working
with clients.
If there’s a ministry error that has
driven the overpayment, we do have the ability at the supervisor and manager
level to decrease the overpayment recovery rate to $25 a month. So we do have
that ability within our policies.
So that’s why you also would see an
increase in the overpayment amounts within our programs, which is a different
approach from what we’ve had in the past. Overall for the amounts, we do not
collect that regularly and actually report the overpayment amounts outstanding
on an annual basis.
Richelle
Bourgoin: — I can
maybe just add for some additional context, an overpayment does not necessarily
mean that a mistake has been made. And in many cases with our clients, that
payment occurs and then subsequently there’s a change in circumstance for that
client, so for some of our clients, for example, transitioning to the
Saskatchewan employment incentive. And so it allows us to work with that client
through case management to balance out.
And when
Julene was talking about the repayment that occurs, it gives us the flexibility
to ensure that those clients continue to have what they need to be successful
while we manage that over a period of time.
Chair Wotherspoon: — MLA Gordon.
Hugh Gordon: — Sorry, if I could just tag on to that then.
Like do I understand correctly that payments under SIS are still being given to
the client and not to the landlord, for example?
Richelle
Bourgoin: — Not
exclusively. And so the baseline for clients that are enrolled in the
Saskatchewan income supplement means that they have agency to make independent
decisions, but we want to support them to be successful with the resources that
are being provided. And so we have individuals that do manage their own
finances and successfully, either with supports that are available in the
community, through the ministry, or within their own family unit.
But alternatively if that isn’t a
solution that will be successful for the client, we have the ability to roll
them into trustee management services. I can say the acronym is TAMMS
[trusteeship and money management supports] and it’s very long. I can’t think
of it. But it allows us to work with partners in the communities that we have
that will help with money management services to ensure that things like rent
are paid directly to the landlord.
Hugh Gordon: — The point, I
guess, I’m trying to discern here is that, you know, for those clients that are
capable, that’s great. You know, you hopefully do not incur an overpayment, and
everything goes well and goes to where it’s supposed to be. But I’m just
wondering, for those clients where they had a payment going directly to the
landlord, that would have been another check and balance in ensuring an
overpayment doesn’t occur. Because the landlord would be receiving an amount;
they would be like, well why am I receiving this? This client’s no longer
renting from me.
So that’s why I just put that out there.
I don’t know if there’s a more clear answer to my question.
Julene Restall: — I think talking about direct pay, I do want
to preface that there is direct pay that’s available on the SIS program for
clients that do require it for direct pay for rent as well as utilities, so
that is an option. We also have expanded obviously our
trusteeship and money management supports, our TAMMS program. We now actually
have over 1,300 spaces available throughout the province that can really
support clients on managing not just their rent and utility bills, but their
overall income assistance benefits. And that’s a really great benefit for
individuals that could have very complex needs.
For example, they also have the ability
to support them by providing them supplementary money throughout the month
instead of having one big payment. They can look at the whole amount of money
that they’re receiving through our SIS program and provide them weekly benefits
on a weekly rate, which is a really big benefit for individuals that are
requiring that additional support.
So I think that’s the major one, but I
do want to preface that we do have direct pay that’s available on SIS. What we
also have seen in the past is obviously people do move and then we have to look
at how can we collect back that benefit. So there’s a little bit of a balance
there too.
Chair
Wotherspoon: — MLA Pratchler.
Joan Pratchler: — So just hearing
your explanations, over the past while it seems to me that it would be quite a
variety of amount of time to collect an overpayment. I mean that’s going to
really . . . Even if I asked an average, it wouldn’t give me very
much information.
Now how does that compare with concerns
with SAID [Saskatchewan assured income for disability]? Like do we have
overpayments in SAID? Would that follow the same kind of story as what’s here?
Julene Restall:
— Yes. So our SAID program has an overpayment assessment policy as well. It is
separate from SIS. It’s dependent on the full amount that an individual is
eligible for, and there are specific policies on that amount. But we have a
very similar approach for both of our programs.
Joan Pratchler: — Thank you.
Chair
Wotherspoon: — MLA Gordon.
Hugh Gordon: — Since implementing
recommendation 4.3, has the ministry seen a decrease in time that it takes to
recover an overpayment?
Julene Restall:
— At this current time we don’t track the period of time that it takes to
recover because it is on a case-by-case basis, dependent on what that amount of
overpayment is.
Hugh Gordon: — I’m wondering if
you could explain the increase in accounts receivable for overpayments from ’23
to ’24.
Julene Restall:
— So a little bit about that. As I mentioned earlier, since the closure of the
SAP and TEA programs, our caseload has actually expanded greatly. So with the
higher amount of cases that are on the caseload, we would anticipate a higher
probability of overpayments being made as we continue to grow and mature as the
program ages.
Hugh Gordon: — Thank you.
Chair
Wotherspoon: — MLA Pratchler.
Joan Pratchler: — What are the steps
that the ministry takes to ensure consistent documentation in the CFP [child
and family programs] Linkin case management system surrounding hotel selection?
Tobie Eberhardt:
— Good afternoon. Tobie Eberhardt, ADM for child and family programs. Since the
policy came into place about the three-quote process, we’ve taken a number of
steps in CFP to ensure that this recommendation was implemented.
We held four sessions with our employees
at the end of 2024 to go through the processes of how they should document it
in our Linkin case management system. And that presentation content is
available to all staff on a SharePoint now.
In addition, in January 2025 we updated
our business manual for Linkin to outline where they should be locating that
information in Linkin. And again we developed some Q & A [question and
answer] sessions that were offered to all our staff, including our management
staff providing the oversight around that.
Joan Pratchler: — And do you feel
that, you know, a comfort level, the staff has a comfort level in feeling
successful in doing those with all that support that you’ve given them?
Tobie Eberhardt:
— Yeah, I think that they feel that there’s consistency on where to document it
into Linkin. So very clear on where they should be placing it, and then that
allows our supervisors to go in there and make sure that they’re documenting it
in the right place as well.
Joan Pratchler: — And compliance
would be quite high with the documentation?
Tobie Eberhardt:
— I know we were going to do a follow-up. So yeah.
Joan Pratchler: — Okay. Good. Thank
you. Okay, I have another question. I know on page 58 of the report there’s a
list of the hotels all the way up to ’23‑24. Are there additional hotels
that need to be added to that list?
Grant Hilsenteger:
— My name’s Grant Hilsenteger. I’m the ADM responsible for finance and
corporate services. So on page 58, these are the hotel expenditures that we put
together. There was a request for this, and so we put this together
specifically to provide information back to a member of the legislature that
asked for this. And what we were providing here was just the top three hotels
that were being used that year in whatever city at that time. So what you’re
seeing here is all that we were reporting.
Joan Pratchler: — Are there
additional ones that are on that list that you can provide us? Not right now.
Grant Hilsenteger:
— I think we did for these years. I think we still have that, yes. I think we
could provide that.
Joan Pratchler: — Okay, great. If
that could . . . just add it. Add it to the list.
A
Member: — Yes, we can table that.
Chair
Wotherspoon: — Thanks. And just to make sure we
have the . . . Thanks for the undertaking to provide that
information. And is 30 days reasonable? And that can be supplied through the
Clerk back to this committee. Thank you very much. And that’ll provide updated
information for the previous years, this past fiscal year as well. Is that
correct?
Richelle Bourgoin:
— That’s correct.
Chair
Wotherspoon: — Right, thanks. MLA Gordon.
Hugh Gordon: — Thank you very
much. And just to tie on to that one, is there like some robust vetting policy
procedures you go through when selecting a hotel? Have you guys, you know, I
guess reinforced your vetting procedures as to which hotels and what kind of
criteria you use before selecting them? Like for example, are there any
conflict of interest guidelines that you adhere to?
Richelle Bourgoin:
— So maybe I can speak to that in two parts. I can speak to the conflict of
interest guidelines. Specifically as public servants, we would not be engaged
in the vetting of vendors related to conflict of interest with members of the
Legislative Assembly. That’s done outside of the work that we do within the
ministry.
But in terms of vetting hotels, we do
have expectations with all of our vendors around standard practices like
reporting transparency in the financial process. How we enter into the
contracts would be consistent with our process, as well as that of the SaskBuilds
and Procurement team. And so we would treat those hotels as we do any other
vendor that we work with at the ministry.
Hugh Gordon: — Thank you.
Chair
Wotherspoon: — MLA Pratchler.
Joan Pratchler: — I’m just going to
try to look at that last recommendation. So something’s not quite aligned in my
thinking, and maybe you can help me understand. It’s the one regarding the
reporting policies. So it suggests that our neighbours — Alberta and Manitoba —
report payees, but Saskatchewan doesn’t because there’s a reporting policy not
to or . . . I just don’t understand. Asking for the transparency on
that and I’m confused.
Richelle Bourgoin:
— So I will say that I’m not specifically familiar with Alberta and Manitoba,
with their specific reporting requirements. But Erin can speak to the work that
we do with our colleagues at the Ministry of Finance.
[15:45]
Erin Kiefer:
— Hi, I’m Erin Kiefer. I’m the executive director of finance. So when the
ministry makes a payment to a vendor on behalf of a client, it’s considered a
transfer payment. So the ministry makes many thousands of transfer payments on
behalf of clients each year. So the financial administration manual
communicates treasury board’s policies and the Provincial Comptroller’s
directives to ministries and public agencies, and these financial policies and
directives are made pursuant to The Financial Administration Act.
So
section 2010.01 states that “For transfers, details are not provided for
high-volume programs of a universal nature, or income security and other
programs of a confidential and personal nature; or where governing program
legislation requires payee information to be kept confidential.”
So to support the client-facing services
that we have at Social Services, we additionally have our own stand-alone
financial systems that do both case management — so we can keep track of people
and their needs — and to make payments to them. And so because transfer
payments to individuals are excluded from public reporting and have been for a
very long time, since at least the ’80s when the first of the systems were
completed, they were never designed to provide the rolled-up reports of the
amounts that are being to paid to vendors on behalf of our clients. And so
that’s what makes it very difficult for us to be combing through to find the
specific details to report.
So I could say that what we have done so
far is that . . . Most vendors paid on behalf of clients are chosen
by the client. They’re not chosen by us, right. So sometimes we make payments
that are invoice based. So, for example, the ministry might make a payment to a
local pharmacy on behalf of a child and family caregiver. Or other payments
that we make are requisition based. So that would be in a circumstance where
someone comes into the office, and someone on the front line would write them a
requisition for groceries, per se. And so then that person takes their
requisition to a store of their choice. And as long as that store accepts our
requisitions, they hand it in and then the business fills it in, sends it back
to us, and we make the payment to them.
So for example, we have a standing offer
that we use to purchase car seats. So we buy a lot of car seats because when
children come into care, you need to make sure you have a car seat, and they
expire and so on and so forth. So we do things like that to make sure that
we’re finding the best public value on those bulk purchases that we do.
Joan Pratchler: — Thank you. I
didn’t realize it was that complex.
Chair
Wotherspoon: — Just on this one here, so like the
recommendation 2, you’ve committed, you’ve implemented, which is then the
tracking of those costs to the hotels and monitoring the situation. And then
you’ve provided, I believe, a commitment here to provide the information on the
payees, if you will, the hotels, because no one’s looking for the information
of the clients, that that information is private.
So what’s in question here is the
summary annually of the costs paid to those vendors, to those hotels. From my
understanding, no. 2, you’ve committed to implementing or have implemented
it, which then compiles that information. And we’ve had an undertaking I
believe here today to provide us the updated information for the previous years
on the amount paid to those vendors.
So I guess just a question is, what’s
standing in the way? We can come to the committee and we can seek it here.
We’ve received that undertaking. But why wouldn’t that just be published? And
of course the recommendation is to work with the Ministry of Finance to look at
options on that front. So whether or not it’s in volume 2, that could be one
place that it fits by working with the Ministry of Finance. But nothing stops
the ministry from publishing this in its annual report, for example.
Richelle Bourgoin:
— And so what we have done is, taking the position that we are certainly
meeting the expectations of our colleagues at the Ministry of Finance, looked
at hotels as one service that we provide in a broader range of services related
to that program. That is the income assistance program that’s specifically
identified in the FAM [financial administration manual] guidelines. And so
hotels would be one service that we provide.
And again I think we’re still working
together with our colleagues at Finance to determine, but if that was to go
into volume 2, it would be a much broader piece of work because hotels are just
one component of the services that we procure on behalf of clients, or directly
through clients in the income assistance programs and in the child and family
programs.
Chair
Wotherspoon: — Sure, but the focus is on hotels in
this case here, and you’ve committed to, I believe, collecting that
information. You’re providing that back to us here. So it’s sort of secondary
whether or not it’s provided through volume 2 or whether it’s provided
publicly. I think the recommendation of the auditor calls for it to be publicly
reported. What prevents the ministry? You could have something in the annual
report for the Ministry of Social Services just stating those numbers without
it even being — and I’m not suggesting this is the best way to go about it —
without it being in the volume 2.
Richelle Bourgoin:
— I think that’s the work that we’ve committed to continue to do with the
Ministry of Finance.
Chair
Wotherspoon: — And so at this point is there a
commitment to have . . . I guess we’ve received a commitment this
year to receive the vendor information, the payments that were made to hotels
in the previous fiscal year here. Is there a commitment then to make that
available again next year? And at this point do you know . . . I
think, I guess you’re suggesting at this point you’re not sure how you’re going
to provide that information, but do you commit to make sure that that’s going
to be public next year?
Richelle Bourgoin:
— Not at this time.
Chair
Wotherspoon: — I guess to the auditor, maybe with
respect to 4 here, do I understand your recommendation properly? It’s to have a
public reporting of these amounts. You’re not prescribing necessarily that it
has to be in volume 2. It could be with some . . .
Tara
Clemett: —
I would say that we acknowledge there might be some challenges in perhaps the
way this data is compiled for the ministry, and you’ve got to think through
that. In terms of, I guess the FAM reporting requirements right now, I don’t
think they align with good practice. So I think the Ministry of Finance should
look at them and look at what other jurisdictions are doing, and it should be
updated accordingly.
I think that if this information was
made publicly, you know, I think it would have helped the circumstances that
arose around the hotel vendors and what should have been available to
legislators and the public overall. So I do think that these are . . .
While they’re payments on behalf, they are payments that are made by the
government to specific vendors with public money, and that information should
be out there so the public and their legislators are aware of how much was paid
to what vendors.
Chair
Wotherspoon: — And I think the auditor’s
recommendations are clear on this front, and it would seem to me on this front.
And this isn’t towards the good lead civil servant that’s before us here today
or any of the folks at the back of the room. But this one, you know, to the
minister: like we have the information. There’s a duty to the public. Like
let’s get on with it.
We’ve had, you know, these pretty
serious issues that we’ve gone through without having the level of transparency
that the public deserves, and we have the ability here to provide that
information. So you know, we can take that up, you know, with the minister if
that’s the barrier. But the recommendation’s real clear, and you know, I
certainly value all the progress we see on recommendations 1, 2, and 3 here.
But you know, no. 4 should also be something that’s able to have a clear
commitment from the ministry and have that information provided to the public.
Any further questions from committee
members at this time on these ones? Not seeing any. These are all new. Well we
have the outstanding recommendation then we have four new recommendations, so
I’d welcome a motion that we concur with and note compliance with
recommendations 1, 2, and 3. Moved by Deputy Chair Wilson. All agreed? That’s
carried. And with respect to recommendation no. 4, I would seek a motion
that we concur with the recommendation. Moved by MLA Chan. All agreed?
Some
Hon. Members: — Agreed.
Chair
Wotherspoon: — Okay, that’s carried.
Saskatchewan Housing Corporation
Chair
Wotherspoon: — Okay, whipping right along here,
we’re shifting gears just a little bit here. And we’ll turn our attention to
the Saskatchewan housing authority and the pertinent chapter and the new
recommendations. And I’ll turn it over to the auditor while I think some
officials adjust at the front. And if there’s some officials that are departing
that were involved in these last couple chapters, thanks very much for your
time with us here today and your service.
Tara Clemett:
— I’m going to turn it over to Jason to do a presentation. Just so you are
aware, there is eight new recommendations within the presentation today that
does require the committee’s consideration and deliberation. With that, I’ll
turn it over to Jason.
Jason Wandy:
— Thanks, Tara. Chapter 12 of our 2024 report volume 2 reports the results of
our audit of the Saskatchewan Housing Corporation’s processes for the 18‑month
period ended June 30th, 2024, to plan for social housing units to meet the
needs of people in Regina.
We concluded the corporation had
effective processes, other than the areas reflected in our eight
recommendations. Having stable housing is important for individuals and
families to succeed. Through its social housing program, the corporation
strives to make safe, adequate housing available by providing social housing
units and subsidizing rent based on financial need. The corporation owned about
3,000 social housing units in Regina as of June 2024, and the Regina Housing
Authority managed these units.
Between 2019 and 2024 Regina had the
highest level of vacancies in corporation-owned units, with a vacancy rate
ranging from about 16 per cent to 25 per cent. At May 2024 the corporation had
over 400 households waiting for social housing units in Regina. On page 102 we
recommend the Saskatchewan Housing Corporation further analyze social housing
applicant data to help determine social housing needs in Regina. We found the
location and design of the social housing and portfolio in Regina does not
align with current social housing need, demonstrated through persistent unit
vacancies, yet long applicant wait-lists.
The corporation can produce a current
approved applicant list from its provincial housing IT system. While the
corporation considered the approved applicant list in Regina in its capital
budget requests, it does not analyze its approved applicant list to
sufficiently determine and adapt to changes in social housing need, such as
analyzing changing trends and types of applicants waiting, for example,
families, singles, seniors, or people with disabilities.
At May 2024 the Regina Housing Authority
approved 308 families or single persons and 96 seniors — so a total of 404
applicants — for the social housing program, but had not placed them in a
social housing unit in Regina. Our analysis found the approved applicant list
may be inaccurate or not up to date. Management indicated the corporation was
reviewing the potential replacement of its provincial housing IT system,
providing an opportunity to improve available data for decision making.
Our analysis of the monthly social
housing vacancy reports for Regina found the demand for family or single social
housing units significantly exceeded available units. Between February 2023 and
May 2024 the number of approved family or single applicants increased to 308,
but the number of vacant units available decreased to 56 in total, while more
units were available for seniors than the number of approved applicants.
Additionally our analysis of the approved applicant wait-list at April 2024
found almost 50 per cent of applicants seeking units with three bedrooms or
more.
Without having accurate data and
sufficient analysis, the corporation is unable to appropriately determine
social housing needs. Periodically analyzing data on requested unit size and
household compositions can provide insight into the demand for different types
of housing units. This can also help the corporation plan future developments
or adjust its housing portfolio to better meet applicant needs in a timely
manner.
[16:00]
On page 105 we recommend the
Saskatchewan Housing Corporation complete its forecast of long-term social
housing needs in Regina. We found the corporation last forecasted core housing
need in Regina in 2019 when it engaged a consultant to prepare a forecast to
2026. Our review of the corporation’s forecast found it used data from the most
recent census from 2016. Their forecast estimated Regina having about 15,500
households in core housing need by 2026 compared to 12,000 households from the
2016 census. Management acknowledged that lack of data, for example, tenant
preferences, or requests for repairs from its provincial housing IT system
impacted the breadth of information used in its forecast.
While the corporation engaged its
consultant to update the core housing need forecast for Regina to 2038,
management had yet to validate the forecast using the latest federal census
released in 2021. They expected to complete this validation work in fall 2024.
Without a long-term forecast of social housing needs in Regina, there is an
increased risk of misalignment between social housing priorities and expected
future demand.
On page 110 we recommend Saskatchewan
Housing Corporation implement plans to help reduce vacant social housing units
in Regina. While a social housing need exists, the corporation is facing
challenges with accommodating clients’ needs with its available social housing
portfolio. At May 2024 Regina had 534 vacant social housing units, but only 170
were available for rent because 364 were out of service, that is, in need of
repairs. This is in comparison to 404 households waiting for social housing
units, 308 of which were families.
Beyond accumulating the vacancy data, we
found the corporation does not further analyze its vacant units, for example,
types of units under repair, which would allow it to focus repairs on units
with higher demand, such as larger family units.
We also found the corporation does not
track the time a unit available for rent stays empty. While it can determine
chronically vacant units, those vacant for greater than six months, its
reporting does not specify chronically vacant units available for rent versus
those under repair. Due to data limitations within the provincial housing IT
system, the corporation does not track how long vacant units are in disrepair.
Our comparison of vacancy reports from
May 2024 found 334 chronically vacant units that mostly appeared to be under
repair. Additionally we found these chronically vacant units reside in 32
social housing buildings in Regina, with 23 of these buildings noted as
preferable locations by approved applicants. This indicates applicants want to
live where these chronically vacant units are located in the city.
Our analysis of the corporation’s
ongoing cost to hold chronically vacant units found the estimated monthly
costs, including things like property taxes or utilities, to be relatively
consistent, about $300 per unit per month at December 2023. However when
applying this estimate across all 334 chronically vacant social housing
properties in Regina, the estimated annual cost is about $1.2 million for
the corporation.
On page 111 we recommend Saskatchewan
Housing Corporation periodically analyze data to identify and respond to
possibly over-housed social housing tenants in Regina. Household needs can
change, for example fewer people living in a home, resulting in tenants
possibly residing in units now too large for their household needs. This refers
to tenants as being over-housed.
The corporation uses the federal
government’s National Occupancy Standard as a guideline when considering the
maximum number of bedrooms a household needs. For example, for households with
children or dependents, parents are entitled to their own bedroom, and there
should be no more than two children to a bedroom. However while the corporation
has specific requirements, we found it does not analyze the prevalence of
over-housing within its social housing units in Regina.
At May 2024 our analysis identified 108
single individuals residing in two-bedroom seniors’ social housing units,
indicating these individuals may be over-housed when there are applicants
currently waiting for two-bedroom units. We also found the corporation had 105
vacant one-bedroom units available where single individuals could move.
Periodic analysis, such as annually, to
identify possibly over-housed tenants can provide valuable information about
whether the allocation of units address clients’ needs effectively. Such
information can provide the corporation an opportunity to consider changes to
existing unit allocations to help meet the needs of more clients and reduce the
applicant wait-list.
On page 115 we recommend the
Saskatchewan Housing Corporation set performance benchmarks for its social
housing operational reviews of the Regina Housing Authority. The corporation
completes operational reviews every three years for its largest housing authorities,
for example Regina and Saskatoon, and every five years for smaller ones. It
last reported on an operational review of the Regina Housing Authority in 2023
and plans to do another in 2025‑26.
Our review of the 2023 operational
review report for the Regina Housing Authority found the corporation did not
include benchmarks for measuring the housing authority’s performance. For
example, the corporation did not include benchmarks such as expected time
frames for the Regina Housing Authority to place applicants in a rental unit.
We found the corporation also did not
set benchmarks to measure tenant satisfaction with repairs in their units. The
2023 operational review report indicated 66 per cent tenant satisfaction with
the quality of completed repairs and 53 per cent regarding the time taken to
complete repairs. Both decreased from the 2017 operational review and were
slightly worse than the other five large housing authorities.
Without setting and monitoring results
against benchmarks in its operational review report, the corporation may be
unable to effectively assess whether the Regina Housing Authority meets
expectations and takes actions where necessary. This increases the risk of the
housing authority not delivering appropriate services to social housing
tenants.
On page 116 we recommend Saskatchewan
Housing Corporation require the Regina Housing Authority to develop action
plans addressing issues and recommendations identified in its social housing
operational reviews. In its 2023 operational review of the Regina Housing
Authority, the corporation noted three compliance issues and two
recommendations.
The corporation expected to implement
requirements in 2024‑25 for the housing authority to document its action
plans to address issues and recommendations from the operational review.
Without having a formal process to follow up on compliance issues and
recommendations, there’s an increased risk of the Regina Housing Authority not
taking timely action to improve its operations as expected by the corporation.
On page 116 we recommend Saskatchewan
Housing Corporation enhance its monitoring and analysis of social housing
tenant complaints in Regina. Both the Saskatchewan Housing Corporation and the
Regina Housing Authority receive complaints, for example face to face, over the
phone, or through email about social housing. However we found neither the
corporation nor the housing authority track the complaints to analyze
complaints received.
From January 2023 to April 2024,
management compiled tenant complaints for our audit and indicated the
corporation received 127 tenant complaints. It was unable to provide details on
the tenant complaints. Without monitoring and analyzing complaints, there’s an
increased risk of unresolved social housing complaints.
On page 118 we recommend Saskatchewan
Housing Corporation expand analysis and reporting on progress made against its
building conditions target related to social housing in Regina. We found the
corporation reports on progress made against some key goals and targets. For
example, we found it annually reports against several goals relating to social
housing as set out in its bilateral agreement with the federal government under
the national housing strategy.
We found the corporation also provided
periodic reporting about social housing vacancies to its responsible minister
and to its board and housing management committee. However the corporation
established a target to reduce the number of units with the facility condition
index, or FCI, of critical or poor, but had not identified by how much. It had
yet to start analyzing or reporting on this measure.
At the time of our audit, the housing
portfolio in Regina was in poor condition with an average FCI of about 22 per
cent. Having more information and analysis on its FCI improvement target can
help the corporation identify issues and focus its efforts on buildings of
highest need.
I’ll now pause for the committee’s
consideration.
Chair
Wotherspoon: — Thanks so much for the
. . . this is a new chapter, and for the focus of this work. We’ve
got new recommendations before us. So I invite Deputy Minister Bourgoin to
provide some brief remarks, then we’ll kick it open for questions.
Richelle Bourgoin:
— Thank you very much. I’ll be very brief. I’m going to turn it over to my
colleague Brittany, who is the assistant deputy minister of housing and the CEO
of the Saskatchewan Housing Corporation.
Brittany Csada:
— Thank you. Good afternoon, everyone. I’ll provide the updates for SHC
[Saskatchewan Housing Corporation] this afternoon.
Related to the recommendation that the
Saskatchewan Housing Corporation further analyze social housing applicant data
to help determine social housing needs in Regina, the ministry considers this
recommendation partially implemented. Saskatchewan Housing Corporation has
already strengthened reporting to provide greater insights into social housing
needs. We’ve added provincial approved applicant wait-list data into our
dashboard report and our ’25‑26 quarterly corporate reporting, and a
working group has been formed to lead vacancy response efforts and conduct a
detailed analysis of vacancy data and the approved applicant wait-list.
More work is under way to be implemented
by the end of December 2025. Monthly reports will be produced and shared with
housing authorities to ensure accurate and reliable applicant data is used to
assess social housing needs, and program and policy changes will follow from
the vacancy response working group’s analysis and recommendations.
Related to the recommendation that SHC
complete its forecast of long-term social housing needs in Regina, the ministry
considers this recommendation implemented. The core housing need forecast was
updated to the year 2031 using the University of British Columbia’s housing
assessment resource tools model. The housing need forecast will be updated
again following the 2026 census.
Related to the recommendation that SHC
implement plans to help reduce vacant social housing units in Regina, the
ministry considers this recommendation partially implemented. Capital
investments of 10.8 million are budgeted in ’25‑26 to repair and
renovate units in Regina to serve the growing demand for social housing in the
community. This includes 4.3 million to begin a multi-year renovation and
repair to 154 units at Prairie Place in Regina to bring vacant units back into service.
Along with this funding, the vacancy
response working group that I mentioned earlier will analyze housing demand in
communities — including Regina — review potential policy changes regarding
vacant units, and implement actions as identified to reduce vacancies. Our
timeline for full implementation is March 31st, 2026.
Related to the recommendation that SHC
periodically analyze data to identify and respond to possibly over-housed
social housing tenants in Regina, the ministry considers this recommendation
not implemented. We are currently developing policy criteria and processes
related to social housing tenants that may be living in units that provide more
space than they currently need. An implementation plan will be prepared by the
end of 2025.
To fully implement this recommendation
by December 31st, 2026, we will gather and analyze data, including establishing
a new periodic review schedule to identify instances in Regina where social
housing tenants may be living in space larger than they need, and we’ll prepare
plans to accommodate those with greater demand on the wait-list.
Related to the recommendation that SHC
set performance benchmarks for its social housing operational review of the
Regina Housing Authority, the ministry considers this recommendation
implemented. SHC has developed an action plan that includes benchmarks and
goals to enhance communication with tenants and approved applicants, ensure
more accurate and timely data entry, and improve the repair process. The plan
has been reviewed with the Regina Housing Authority, and benchmarks will be
reviewed as part of the ’25‑26 operational review.
Related to the recommendation that SHC
require the Regina Housing Authority to develop action plans addressing issues
and recommendations identified in its social housing operational review, the
ministry considers this recommendation implemented. SHC has drafted an action
plan and is working with the Regina Housing Authority on addressing compliance
issues and recommendations from the 2022 operational review report. Meetings
are occurring biweekly and additional follow-up will occur during the ’25‑26
operational review.
Related to the recommendation that SHC
enhance its monitoring and analysis of social housing tenant complaints in
Regina, the ministry considers this recommendation partially implemented. SHC
currently maintains an internal database that is used to track tenant
complaints received throughout the province. To address complaints in Regina,
the Regina Housing Authority is working to develop an app to track and assign
maintenance tasks in a clear and concise format.
As part of the ’25‑26 Regina
operational review, tenants will be surveyed to provide a representative
overview of tenant satisfaction with their unit, the service provided by the
Regina Housing Authority, and other key indicators. Responses will help confirm
whether the housing authority has compliance issues and will help in developing
recommendations from the operational review. We anticipate fully implementing
this recommendation by December 31st, 2026.
Related to the recommendation that SHC
expands analysis and reporting on progress made against its building conditions
target related to social housing in Regina, the ministry considers this
recommendation partially implemented. In July 2025 SHC completed its annual
facility condition index, or FCI, update. And SaskBuilds and Procurement is
also conducting inspections on select SHC-owned buildings. The annual FCI
update will be included in the Q3 dashboard report, and we are exploring
opportunities to include additional details in the ongoing reporting, such as
FCI breakdowns by community and building components. We anticipate fully
implementing this recommendation by March 31st, 2026.
I’ll turn it back to the Chair.
[16:15]
Chair
Wotherspoon: — Thanks so much for the update and
for all the actions that have been undertaken. I’ll open it up to committee
members that may have questions. MLA Gordon.
Hugh Gordon: — Hi there. You
mentioned there was some progress made in terms of, you know, the approved
applicant list for social housing. And you mentioned accuracy, also trying to
improve the accuracy, I guess to reflect the actual needs of the clients that
you’re serving. When did you expect that to be fully implemented, that
recommendation?
Brittany Csada:
— December 31st, 2025.
Hugh Gordon: — Because what it
seems to be is like we’ve got . . . According to the report, there’s
a bit of a disconnect between the demand, right, for seniors and for families,
and that the supply is out of whack. So I’m just curious what efforts the ministry
is taking in order to, you know, rebalance that need versus supply.
Brittany Csada:
— So we know from the data that there’s a growing demand for family housing,
and in particular family housing with, you know, three bedrooms or more. That’s
a trend we’re seeing. And so you know, we use that information. I’ll give you
an example of something that we’ve done to rebalance the portfolio. One example
is reflected in the investments made into the Regency Gardens property in
Regina, and that’s where we replaced units to accommodate larger families to
meet that growing need.
Hugh Gordon: — Sorry. Is that
going to be sufficient for the need? You think that once that’s done at one
facility that that’s going to help rebalance the portfolio?
Brittany Csada:
— No. That’s an individual example. And so when we have the opportunity to sit
down with the working group that is meeting on a biweekly basis and really
trying to look at ways to maximize the capacity of the inventory, in particular
in Regina, it’s going to take a series of interventions to make sure that we
can get there, including working with clients who are in larger units whose
family composition may have changed over time — maybe they’re empty nesters;
maybe their children have moved into another unit because they’re now living
independently — and to be able to support those clients to effectively find the
most appropriate housing.
So I think it’s an all-hands-on-deck
approach in addition to adding some larger family units — like the example that
Brittany provided which would be where we see also a growing trend in the
number of children that are in the family unit — to be able to have the
diversity in the portfolio.
And we look at a property in North
Battleford like Valleyview Towers. There’s two of those towers. Traditionally
they had been assigned for seniors’ housing but we know that the demand for
seniors’ housing has shifted, in particular with the demographic of the
province. And so we don’t see individuals coming off the farm looking for
support in a seniors’ housing unit the way that we maybe did 30, 40 years ago.
How can we use that to provide an
immediate response to a number of needs that are emerging — whether it be
family housing, affordable housing, social housing — and try and meet the need
of the community? By being flexible but very clear in how we support clients
that are existing in those properties to be successful, either there or in an
alternative location, but trying to be just I think really flexible in how we
work with our housing authorities to ensure that we’re maximizing all of the
space that we have available.
Hugh Gordon: — Correct. And I
would think, you know, also getting a handle of, a good understanding of who
may be in an over-housed situation is going to assist, particularly in Regina,
going forward. So that’s very important work that you need to continue to do, I
would imagine.
And on that point, if I heard correctly,
you did say that the funds that have been allocated for renovating or repairing
homes was going to be 154 units that were going to be renovated. Do I
understand that correctly?
Brittany Csada:
— That’s at Prairie Place here in Regina. Correct.
Hugh Gordon: — In Regina. Of that
amount — it sounds like a large amount though — how much do you think this is
going to reduce the demand or help rebalance the demand for family units in
Regina? Is that going to be a sufficient number? Does the ministry need to
continue, let’s say two, three . . . They have a five-year plan of
having more units made available. And maybe you can comment on that first.
Roger Parenteau:
— Good afternoon. Roger Parenteau, executive director of housing operations.
With regard to your question on Prairie Place, that’s just one example where
more units will become available for seniors’ housing in Regina. But there’s
also other initiatives and partnerships that are occurring throughout the
portfolio in Regina.
Another example of that is Lovering
Place, where through PATH [provincial approach to homelessness] we had
supportive housing initiatives. And we had an RFP for groups to respond to an
RFP to provide supportive housing services, and they required a building to
operate out of. And Lovering Place is a building that is SHC owned, where we
provided a group with a service provider to deliver supportive housing services
out of that building, so taking that building out of its current role as
seniors’ housing and changing it to supportive housing, so just pivoting with
using our portfolio for different purposes and trying to balance our portfolio
based on the needs that we have.
Hugh Gordon: — Fair enough. But I
guess my question really was, of 154 units that are going to be renovated,
right, the government has said for this year it’s going to be 283 units total
across the province, if I’m not mistaken, of publicly owned homes, right, that
are going to be refurbished or renovated and be made available — 283. Of that,
154 units appear to be allocated for renovation in Regina.
What I’m asking is, is that sufficient
to meet the demand in Regina? And if not, what steps is the ministry prepared
to take or going to ask to be taken in order to ensure more units come online
and are available in the future?
Richelle Bourgoin:
— So what I might do is just provide a bit of context. And I’m going to ask my
colleague Kim to speak specifically about some of the real estate decisions
that are being made more broadly in Regina. But you know, in the longer term,
thinking about the forecasted demand in this city in particular, we are in the
process of working with our colleagues at the Government of Canada. They have
committed to renegotiating the national housing strategy, which is significant
for us, which will allow us to make decisions on larger capital investments to
be able to respond to the trends that we see and to the forecast that we have
developed.
We also are starting to understand more
about the potential for Build Canada Homes and what that might mean in
Saskatchewan, although there’s still work to do to fully understand how we can
maximize the provincial investment to ensure that we are making those spaces
available.
But I will ask Kim to speak about what
we’re doing right now just more broadly in Regina.
Kim Hornung:
— Kim Hornung. I’m the executive director of housing infrastructure and
business information. So in Regina what we’re talking about, Prairie Place,
that is only 154 units. The other investments we are looking at within Regina,
we are looking at additional $4.6 million of operational capital
maintenance. So that investment would be across all the unit types. Whether
it’s to support individuals or families, that would go across that whole gamut
of units.
We’re also investing an additional
1.9 million for large component replacements. So that would also cover
family initiatives like Prairie Place. Recently we’ve issued an RFP for a large
family unit within Regina as well, Greer place, which is in the east end,
towards the east end.
So again we are looking at larger
investments, and we selected that location again based off of the demand.
There’s a school nearby. There’s supports for families around. There’s doctors.
There’s schools. There’s bus routes, transportation. So we’ve really worked on
using the information that we have to be able to select those locations to best
invest in going forward.
Hugh Gordon: — So to be clear
then, those 154 units are insufficient, is what you’re saying, and that you’ve
identified a need going forward for more units. Do I understand that correctly?
Richelle Bourgoin:
— So the 154 units are major capital repair. What is important is that we
maximize the capacity of each of the units that we have available, so ensuring
that we’re making capital investments, at the same time making sure that we’re
turning over units quickly when a family or an individual moves from one unit
to another, that we’re reducing the time frame between occupancy, trying to
make sure that we’re working with the housing authority to remove any barriers,
to make sure that we are using every single available unit while at the same
time understanding how we can shift the portfolio where necessary to meet the
needs of today. Because some of them were built for needs that were previously
existing, in particular seniors’ housing in some of our rural communities.
And so what we know is that in order to
make assessments on future capital investments, we need to make sure that we
are fully using to the best of our ability all of the available space that we
have. And then to continue to monitor, to the auditor’s recommendation, on
using the analysis as we successfully move quickly to be able to meet the
demand to understand precisely what would come next. And that would be part of
our larger capital plan.
Hugh Gordon: — So sorry. I’m
going to continue to beat a dead horse a bit perhaps, and I apologize if I’ve
been repetitive. I guess maybe to help clarify the problem, and perhaps the
solution is, what is your current demand for family or senior housing right now
for households who do not have a place? And how many vacant units are there
awaiting a renovation or some other capital upgrades that need to be done to
bring them online? Like that to me would help paint a better picture of what
the demand and the supply, the need is, right.
Richelle Bourgoin: — Just for a point of clarification,
speaking specifically to Regina in this instance, so we have a portfolio of
2,965 units in the city. 1,519 of those are for seniors. 1,446 of those units
are designated for families.
The vacancy rate in June, which is the
most recent data that we have, overall was 15 per cent, slightly higher rate
for seniors’ units and a lower rate for family units. But the availability rate
— so that’s the number of units that’s available for tenants to actively move
into — was 5.5 per cent, so about 165 units that are in turnaround, so to
speak. So perhaps it’s minor painting or cleaning a carpet. Somebody moves out
on the 31st and we’re not quite prepared with the housing authority to move
them in on the 1st. So that breaks down to 91 seniors’ units and 74 family
units that would be available. At this point in time we have 350 families or
single individuals on an approved wait-list with the Regina Housing Authority.
We have 68 seniors.
Just a point of clarification to your
question: because the clients are on a waiting list does not mean that they are
unhoused. It just may mean that they are seeking the opportunity to move into a
Regina Housing Authority building. So they may be in another community with an
opportunity, for example, to come closer to some of the services that Regina
has. They may be in independent housing. They may be renting from the market
and this may just be a preferable and more favourable option for their family.
Hugh Gordon: — Thank you.
Chair
Wotherspoon: —
MLA Pratchler.
Joan Pratchler:
— Will any of the findings on the social housing needs be made publicly
available? And if so, how often will they be made available to track any
changes or trends?
[16:30]
Richelle Bourgoin:
— So it’s excellent timing. I can speak to that because we’ve had those
conversations very recently. We’re in the process of evaluating how we best
develop the dashboard that will provide reporting to ensure that there is
transparency for housing authorities, but as well for individuals and families
that may be looking for options. And so we do expect that that will be publicly
available.
I don’t have a timeline at this point.
There’s a bit of technical work that needs to be done in the background, but
the intent is to have that publicly available.
Joan Pratchler: — And if we were to
ballpark, are we talking one year, five years?
Richelle Bourgoin:
— I think within the year.
Joan Pratchler: — Okay.
Richelle Bourgoin:
— I should say within the fiscal.
Joan Pratchler: — Recommendation 4.4
reports that core housing need forecast was updated to 2031. Can you share what
the core housing need is forecast to be in 2031?
Brittany Csada:
— So I’ll share the core housing need projections for Regina. So 10.3 per cent
of total households, or 9,290 in total, are considered to be in core housing
need. By 2031, the number is projected to increase to 10,500 total households
in core housing need.
So what we know is that based on census
data, 23.1 per cent of renters and 4.1 per cent of homeowners are considered to
be in core housing need. We also know that, you know, 23.9 per cent of families
are in core housing need that were lone parents, and 21.3 per cent were
Indigenous households.
Joan
Pratchler: — How many housing units will need to
be built or repaired to meet that 2031 core housing need forecast?
Brittany Csada:
— So the SHC portfolio is not the only mechanism to meet core housing need. It
supports, you know, other providers such as the market, other housing
providers. But I would like to highlight that SHC continues to offer a number
of housing programs that do address core housing need across the province, and
I’ll highlight a few of them.
The social housing program offers units
at a rent geared to 30 per cent of an eligible household’s income. The
Saskatchewan housing benefit provides a monthly benefit that helps eligible
Saskatchewan renters better afford their rent and utility costs. Home repair
programs, including the emergency home repair program and the Adaptations for
Independence program, offer financial assistance to help homeowners complete
repairs to ensure the adequacy of their homes. And the rental development
program provides one-time capital funding to help housing organizations develop
affordable rental units for households with low incomes.
Chair
Wotherspoon: — Pratchler has the floor maybe for
another one here, then we’ll come back your way, Gordon. MLA Pratchler and MLA
Gordon. I should be proper here.
Joan Pratchler: — So I don’t think I
heard the answer I was looking for, so maybe I didn’t ask the question
properly. How many housing units will need to be built or repaired to meet the
2031 core housing need forecast?
Richelle Bourgoin:
— And so perhaps I can provide a little bit of clarity, but we don’t have an
expectation that the Saskatchewan Housing Corporation inventory will meet the
need for every single individual who’s identified on the core housing list. So
our approach is to ensure that we are fully utilizing every available door that
we have in the inventory, and supplementing the inventory to ensure that we
have immediate needs where they can’t be filled by another solution.
And so the programs that Brittany was
talking about — for example, the Saskatchewan housing benefit — allow
individuals and families to afford market rent options where social housing may
not be the solution for them. We also look at things like the rental
development program to partner with other organizations, like municipalities as
an example, to bring on innovative solutions that maybe haven’t been
contemplated before.
And so we see a number of, I think,
really interesting community partnerships that are developing housing options
that would be considered non-traditional. And I think about in Regina some of
the work that RT/SIS [Regina Treaty/Status Indian Services Inc.] is doing, for
example, or an organization like the Oxford House that provides a housing
solution outside of the portfolio.
And so rather than thinking about the
number of doors that would be required, we’re trying to look at not only the
best practices across Canada but tools that we have available to directly
support the individual and unique need of the family or the applicant who is
seeking our support.
So we do that by providing navigational
services. We stack on programs like the Government of Canada’s Reaching Home
program to work with organizations like the Métis Nation of Saskatchewan. We
work with Indigenous governing bodies to try and support the community
regardless of what that looks like. And so we want to ensure that when we’re
working in communities, they understand that the Saskatchewan Housing
Corporation is an important tool, but it is not the only mechanism that’s
available.
And so I know we’re speaking generally
of Regina, but when we look at some of the successes we’ve had outside of
Regina, it’s also been in ensuring that the inventory that we have is being
used most appropriately for that community. If that means divesting some of the
assets or looking to partner with an organization . . . One that
comes to mind — just because I had the opportunity to speak with them earlier
today — in Saskatoon is the partnership we have between the Saskatoon Housing
Authority and Egadz, which is a children-serving organization that allows young
people to live in the property to develop skills to build and maintain the
property.
And so if you need a deck built, these
guys know how to do it because they’ve done that maintenance on the building
and they set the rules for their community. And they receive the support that
they need to be successful to keep them from becoming at risk of homelessness
as young people who are seeking independence.
And so I don’t have the number that you
might be looking for because we are looking at all of the solutions that we can
bring to bear to meet core housing demand, of which the Saskatchewan Housing
Corporation portfolio is one.
Joan Pratchler: — So if I’m to
understand correctly, that could be every couple of years to even figure out
what’s needed there.
Richelle Bourgoin:
— You know, I would suggest that that’s an ongoing task. And to the auditor’s
recommendations, that importance of being on top of the analysis and making
sure that we have the input data to be able to make good decisions and
recommendations to government to provide us with direction to respond will be
critical.
Joan Pratchler: — And do you feel
you have that data or you have access to at least generating it?
Richelle Bourgoin:
— Yes, yes. Absolutely. And what we’ve seen is, I think, across the country a
real shift in expectations of communities and how they support individuals who
are at risk of homelessness or individuals who are unsheltered.
And so we have the benefit of learning
from our neighbouring provinces and territories, and as well our partners with
the Government of Canada, who can work together with municipalities, with
Indigenous governing bodies, with provincial and territorial governments to try
and bring solutions to bear at a time where we can be innovative and take some
risk because the payoff is so important.
Joan Pratchler: — Thank you.
Chair
Wotherspoon: — MLA Gordon.
Hugh Gordon: — I just was
curious. I guess part of this data collection is an ongoing process, and
hopefully you’ll make, you know, some real progress in that regard. I’m just
wondering how is the ministry currently prioritizing which units do get
repaired or renovated?
Roger Parenteau:
— So the main component to make our decisions on what we are doing on the units
that we’re repairing is our applicant data and the demand for the family unit.
So paying a lot of attention, making investments in our family portfolio, and
trying to get those units turned over and back in operation as quickly as
possible, and also getting back to the Prairie Place and major capital
investments that are required. So identifying buildings that are in need of
major investments and asking government to make those investments, and getting
those units back in operating service and making it ready to meet the demands
of the wait-list.
Joan Pratchler: — Would you be able
to talk a little bit more about the goals and the benchmarks created in the
action plan from recommendation 4.9?
Brittany Csada:
— So benchmarks and goals have been set for the Regina Housing Authority within
the action plan developed following their last operational review that I
mentioned. And these are really around enhanced communication with tenants and
approved applicants. They consider the housing authority performance with
regard to customer perspective, financial management, asset management, and
business governance.
The benchmarks include targets related
to overall tenant satisfaction, including repair time and repair quality
satisfaction — and these are included — as well as targets related to support
provided by the housing authority. Respect shown and fairness are also included
as benchmarks.
Joan Pratchler: — Thank you.
Chair
Wotherspoon: — MLA Gordon.
Hugh Gordon: — Getting back to
the over-housing, I guess, data collection. Can you just tell me what policy
criteria processes are under development? What are the factors you’re going to
take into account when determining an individual is over-housed?
Brittany Csada:
— The Regina Housing Authority regularly reviews tenant income and household
composition to ensure that households are living in units that are most
appropriate to meet their needs. As we’ve talked about, there’s high demand for
rental units for families here in Regina, and by matching tenants with the
appropriate units for their household, more individuals and families in need
can have access to housing.
[16:45]
We are working to centrally analyze data
on tenants who have more bedrooms than they require. We’re in the process of
developing policy criteria and processes to respond to possibly over-housed
social housing tenants, and this will include a plan for implementation by the
end of 2025.
The scope of these policy changes and
processes will be to address circumstances where a client is over-housed for
reasons other than disability or medical need. So we know there are times when,
you know, people might need more than one bedroom, and so we’re going to make
sure that we go through the data to sort through that. And the focus would be
on those where, you know, medical or disability is not at play.
We’ll also work to provide policy
guidance to the housing authorities to address these situations where
individuals may be over-housed. Once implemented, we’ll review with the Regina
Housing Authority the implementation of the policy criteria as part of their
ongoing operational reviews — so we’ll build them into there — to assess
compliance, and that will be established on a regular schedule.
Richelle
Bourgoin: —
And if I could just add, we also understand that while it is necessary that we
maximize the capacity of the inventory we have, it will not be easy for
individuals who have been housed in an apartment or in an SHC unit for an
extended period of time, and where they may have raised their children who have
now moved independently. And so as part of the policy work that is being
developed within the ministry, we are also looking at how we support
individuals who will inevitably be required to move to be successful in their
new community.
Chair
Wotherspoon: — MLA Pratchler.
Joan Pratchler: — How many
inspections of select SHC-owned buildings have there been so far, and how many
remain? What are the trends you’re noticing?
Roger Parenteau:
— So to answer the part of your question on the amount of inspections, our
cycle is to have an inspection of the units, of all our units between three to
five years, so our technical people going through the units every three to five
years.
Joan Pratchler:
— And have you noticed any trends over . . . Oh, sorry.
Brittany Csada: — You know, much of the social housing
portfolio was created over 35 years ago, and so demographics and housing needs
have changed over that time, and we’ve talked about some of that. I think in
terms of our portfolio, that’s where we’re seeing some of the major component
investments that we’re having to do now, right — boilers, roofs, some of those
pieces. Like I say, that’s a trend, and that’s the focus of some of our capital
repairs this year.
Joan Pratchler: — So more larger
. . . Okay.
Brittany Csada: — Yeah.
Chair
Wotherspoon: —
Any further questions from committee members? Not seeing any, we have eight new
recommendations here. I’d welcome a motion to concur and note compliance with
respect to recommendations 2, 5, and 6. Moved by MLA Crassweller. All agreed?
Some
Hon. Members: — Agreed.
Chair
Wotherspoon: — That’s carried. I’d welcome a motion
that we concur and note progress with respect to 1, 3, 7, and 8. Moved by MLA
Beaudry. All agreed? That’s carried.
And I’d welcome a motion that we concur
with recommendation no. 4. Do we have a mover? MLA Chan. All agreed?
Some
Hon. Members: — Agreed.
Chair
Wotherspoon: — Okay, that’s carried as well. So
that concludes our considerations with the Ministry of Social Services and Sask
Housing authority and for the day, in fact. But thank you very much to Deputy
Minister Bourgoin for joining us here today, along with all the Social Services
officials, as well as the officials with Sask Housing authority. Thanks for the
work that you’re involved in, day in, day out.
Deputy Minister Bourgoin, do you have
any brief remark before we shut this meeting down?
Richelle Bourgoin:
— Yes, I’ll be very brief. Thank you very much, Mr. Chair. And to the members
of the committee, we really do appreciate your time and taking this opportunity
to update you on the progress we’ve made. And thank you, of course, to our
colleagues at the Provincial Auditor’s office for your work that supports the
ministry to improve the essential services we provide to the people of
Saskatchewan. Thank you.
Chair
Wotherspoon: — Okay, well
thank you for that. Committee members, unless folks have a bunch more business,
is there a motion to adjourn? MLA Crassweller
moves. All agreed?
Some
Hon. Members: — Agreed.
Chair
Wotherspoon: — That’s carried. This committee
stands adjourned until Thursday, October 16th, 2025 at 10 a.m.
[The committee adjourned at 16:51.]
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