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Paul Martin is the auditor general for New Brunswick. Image: Submitted/Auditor General of New Brunswick

No value for money in travel nurse contracts: auditor general

By Brad Perry Jun 4, 2024 | 12:20 PM

New Brunswick’s auditor general has released a damning report on the use of travel nurses in the province.

The province has spent more than $173 million — and counting — on travel nurse contracts, according to the report.

“The overall conclusion of our work was that travel nurse contracts were not reflective of best practices and did not demonstrate value for money,” Paul Martin told a committee of MLAs on Tuesday.

Martin’s report focused on the Department of Social Development, Horizon Health Network, and Vitalité Health Network.

It raised a number of concerns, including a lack of bidding, no proper contract development, and payments being made without review.

Martin also found no requirements for criminal record and vulnerable sector checks in some contracts.

Biggest concerns with Vitalité Health

However, his biggest criticisms were reserved for Vitalité Health, which he said did not provide information to his office as required.

The auditor general noted the health authority refused to release a series of internal audit reports it had conducted.

“Due to the lack of cooperation from Vitalité, risks that may have been identified in the audit reports and to what extent those risks were addressed is not known,” said Martin.

Vitalité had spent over $123 million on the use of contracted health-care workers as of the end of February, with over $93 million going to Canadian Health Labs.

Martin found that Canadian Health Labs (CHL) charged significantly more than the others to provide registered nurses, licensed practical nurses and personal support workers.

The CHL contracts gave the company the right to deploy a minimum number of staff teams regardless of the actual need, according to the report.

In addition, one of those contracts allows for annual automatic renewals for up to five years if the company meets its obligations for fulfilment and language.

“While Vitalité cited the requirement for the provision of French-language services as the reason for the large contracts with Canadian Health Labs, we found that the contract only required limited French-language services in some hospitals,” said Martin.

The auditor general also noted that travel nurses were not always being provided in the areas with the most need based on staff absences due to COVID-19 and unplanned absences for other reasons.

Vitalité plans to keep using travel nurses until 2026

While Vitalité plans to keep using travel nurses until 2026, the auditor general noted that social development and Horizon focused on short-term usage.

Social development used travel nurses during a six-month period in 2022. Horizon no longer allows their use without approval from its executive leadership team.

Horizon spent nearly $48 million on travel nurses while social development expensed nearly $3 million.

The auditor general credited Horizon for its processes to ensure services paid for had been received, but noted inadequate support for payment of travel expenses.

Martin noted the largest contract signed by social development was written by the contractor and lacked adequate legal review, resulting in undue risk to the province.

The auditor general made a total of 34 recommendations to the Department of Social Development, Horizon Health Network and Vitalité Health Network.

Response from Vitalité Health Network

The president and chairperson of Vitalité Health said they welcome the auditor general’s report on travel nurses.

In a joint statement, Dr. France Desrosiers and Thomas Soucy said most of the recommended measures are already in place, while others will be implemented “in the coming days.”

“Measures already put into practice include the Network’s reduction plan, based on a solid recruitment and retention strategy that is bearing fruit,” said the statement.

However, the health authority said the report omitted details about the emergency situation occurring at the time travel nurses were brought in.

It also said that information and testimonials provided by Vitalité do not appear to have been factored into account in the analysis.

“Furthermore, the Auditor General suggests a lack of co-operation from the Network, whereas we have been irreproachable in this regard and have fulfilled our obligations in the context of this audit,” said the statement.

“All requested documents were submitted, except for three documents protected by privilege that could have been shared with a non-disclosure agreement from the auditor general’s office, which was refused.”

Vitalité said it is in a dispute with one of the companies targeted in the investigation and sharing the documents could have been detrimental to certain negotiations underway “in the interests of public finances.”

The health authority said it will work with its board to optimize processes and controls, particularly in managing agency contracts.

Horizon Health Network responds

The president and CEO of Horizon Health also welcomed the review of travel nurse contracts.

Margaret Melanson said the use of travel nurses has been critical in supporting our health-care system over the past couple of years.

“The report found the need for travel nurses within Horizon was well identified,” Melanson said in a statement.

“Our focus on the short-term use of travel nurses and our due diligence in ensuring services were provided as outlined in our contracts with agencies was also noted.”

Melanson said Horizon Health has already implemented eight of the nine recommendations contained in the report.

The final one, an internal post-implementation review on the use of contracted travel nurses, will be completed by September, she noted.

While most of Horizon’s travel nurse contracts concluded at the end of last year, Melanson said they still require travel nurses to staff some critical areas such as emergency departments.

“Horizon has undertaken aggressive nursing recruitment strategies, and, so far this year has already hired 193 registered nurses, and we expect to no longer need to use travel nurse agencies by the end of this calendar year.”