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Status report on the AG's recommendations

Strengthening oversight, accountability and workforce stability

As Newfoundland and Labrador’s health-care system evolves to meet growing demands, NL Health Services is taking meaningful action to strengthen oversight, reduce reliance on private agency staffing, and build a more stable, sustainable workforce.

In response to the recommendations outlined in the Auditor General’s report on the use of private health-care agency staff, we have accepted all 15 recommendations and we are making measurable progress. This work reflects our ongoing commitment to transparency, continuous improvement, and delivering high-quality, patient-centred care across the province.

1. Engage supply chain management

Recommendation: Newfoundland and Labrador Health Services should fully engage its supply chain department, ensuring that legislation, public procurement policy, and best practice are followed.

Fully implemented

Since April 2023, Supply Chain has operated as a single provincial program, ensuring all work meets the Public Procurement Act (PPA) and best practice standards. Staff town halls and education sessions on the PPA began in 2023 and will continue through 2025 to help staff and partners understand their responsibilities.

2. Ensure emergency exemptions for procurement

Recommendation: Newfoundland and Labrador Health Services should ensure emergency exemptions for procurement are pursued in accordance with provincial legislation and policy, including appropriate disclosures and pre-contract approvals.

Fully implemented

The Supply Chain team follows the Public Procurement Act for all emergency exemptions. Regular education sessions and reporting ensure staff know the rules and contract awards and exemptions are disclosed on time and in line with provincial requirements, including at set thresholds and within 15 days of contract award.

3. Complete formal evaluations before awarding contracts

Recommendation: Newfoundland and Labrador Health Services should complete formal evaluations against predefined evaluation criteria before awarding contracts.

Fully implemented

NL Health Services uses standard procedures to ensure all contract awards are based on clear, predefined evaluation criteria. These criteria are shared in procurement documents and proposals are reviewed by a cross-functional team of subject matter experts. A fairness advisor may be included to support the process when needed.

4. Ensure future agency nurse contracts use standardized language

Recommendation: Newfoundland and Labrador Health Services should ensure that any future agency nurse contracts use standardized contract language, terms, and conditions that clearly state Newfoundland and Labrador Health Services’ expectations and standards.

Fully implemented

Fully Implemented

Ensure future agency nurse contracts use standardized language

In 2024, NL Health Services issued an open call to establish a standing offer for travel nurse agencies. All awarded agencies signed the same standardized contract, which includes clear language on expectations, performance standards and contract administration. Key schedules outline the statement of work, fee structure and travel/accommodation expenses, ensuring all parties understand their responsibilities for the duration of the contract.
NL Health Services made a temporary rate exception for one highly specialized RN to maintain care until the role could be filled internally. All positions are now filled, and orientation is expected to be complete in early 2026, after which agency nurses will be released.

5. Ensure invoice approval process

Recommendation: Newfoundland and Labrador Health Services should ensure that a comprehensive invoice approval process is documented, communicated and used consistently across the organization.

Fully implemented

NL Health Services has a standardized process to review and approve agency contracted resource invoices, supported by a common template that outlines the required verification steps. Periodic compliance reviews will be part of the Internal Auditor role, which is now filled.

6. Ensure invoice verification and approvals

Recommendation: Newfoundland and Labrador Health Services should ensure that the invoice verification and invoice approval duties are segregated and that verifiers and approvers sign and date all invoices when their tasks are completed.

Fully implemented

Since August 2023, NL Health Services has had a provincial agency office to oversee agency nurse invoice processing. This process ensures verification and approval duties are kept separate and follows the Delegation of Signing Authority policy, updated in February 2025 based on Treasury Board Secretariat advice. All invoices are signed and dated by designated verifiers and approvers as part of the documented process.

7. Complete audits of all amounts paid to Agency A

Recommendation: Newfoundland and Labrador Health Services should complete an immediate comprehensive audit of all amounts paid to Agency A from April 2022 to present, to recover public funds paid in error.

➔ Partially implemented

The audit work being completed by Deloitte is still ongoing. The anticipated timeline was adjusted as part of the audit process to ensure a complete and thorough final report. Once the final report is received, NL Health Services will review the findings and determine next steps.

8. Develop nurse staffing plans

Recommendation: Newfoundland and Labrador Health Services should develop comprehensive nurse staffing plans, with regular reporting that enables management to perform effective evaluation.

Fully implemented

NL Health Services uses projections to assess registered nurse supply, demand, and gaps based on recruitment needs, attrition, service demands, and practice considerations. These projections align with the Department of Health and Community Services’ 10-year Human Resources Plan, released in May 2025, which includes 18 recommendations for nursing recruitment, retention, innovation, and automation. A minimum data set with key workforce indicators is shared quarterly with executive leadership and the Department of Health and Community Services to support planning and evaluation.

9. Develop policies/processes for use of casual nurses

Recommendation: Newfoundland and Labrador Health Services should develop policies and processes to ensure that casual nurses are utilized as a possible alternative to contracted nursing services.

➔ Fully implemented

NL Health Services has a guiding document and request form that set provincial criteria for using agency nurses. These tools help managers and the provincial agency office ensure agency resources are requested and approved appropriately, with the COO as final signing authority. Enhancements to this process were shared with managers in July 2025. Agency nurse bookings are being entered into the provincial staffing and scheduling system (ANSOS) to improve visibility and compare usage against actual need.

A provincial form has been created as a documented process to confirm the shortage of work by the responsible manager. An organizational communication was distributed on February 26, 2026, advising of the form and new process.

10. Ensure employees awareness of conflict of interest legislation

Recommendation: Newfoundland and Labrador Health Services should ensure that all employees are aware of their roles and responsibilities under conflict of interest legislation, with processes to ensure compliance occurring on an annual basis.

Fully implemented

NL Health Services sent out a memo to all staff and physicians reminding them of their responsibilities under the Conflict of Interest Act of Newfoundland and Labrador. This will be repeated annually. Education on the Act has been available to all staff since December 2024 through the organization’s learning management system (LEARN) and will be part of mandatory onboarding for new hires. Senior leaders also completed training in Fall 2024 provided by the Public Service Commission. A provincial Conflict of Interest policy was approved and published in November 2025.

11. Ensure conflict of interest screening

Recommendation: Newfoundland and Labrador Health Services should ensure that conflict of interest screening occurs when assessing potential contractual relationships, such as with property lessors.

Fully implemented

NL Health Services’ Supply Chain team facilitates and reviews conflict of interest declarations during the assessment of potential contracts. Standard terms require bidders to declare any potential conflicts, and future open call documents will include the organization’s Conflict of Interest policy for reference. Advice from the Public Service Commission’s Conflict of Interest Committee will be sought to strengthen screening processes.

12. Rectify current accommodations in compliance with legislation

Recommendation: Newfoundland and Labrador Health Services should rectify any current accommodations that were not acquired through an open, public, and transparent procurement process, in compliance with the Public Procurement Act and the Conflict of Interest Act.

Fully implemented

NL Health Services reviewed and corrected leases that were not acquired through an open process, notifying employees of potential conflicts in April 2024 and issuing follow-up letters in August 2024. All new accommodations are now secured through publicly posted open calls, in compliance with provincial legislation.

13. Provide information for contracted nursing services usage/spending

Recommendation: Newfoundland and Labrador Health Services should ensure management and the Board of Trustees are provided with complete and adequate information to facilitate assessing and monitoring of all aspects of contracted nursing services usage and spending.

Fully implemented

NL Health Services provides the Board’s Finance and Audit Sub-Committee and the Board of Trustees with enhanced reports that include key performance metrics and data trends identified in the Auditor General’s report. These reports track contracted nursing usage and spending over time to support monitoring and decision-making.

At the zone level, standardized monthly reports give VP/COOs and senior leadership data on staffing needs, spending, and agency nurse locations. Monthly meetings with the CEO, senior executives and zonal leaders review this information and update annual projections as needed.

14. Develop/execute corrective action plan for expenditures

Recommendation: Newfoundland and Labrador Health Services should develop and execute a corrective action plan when agency nurse spending exceeds planned expenditure.

Fully implemented

NL Health Services uses monthly zone-level reports to track performance against spending targets for agency nurses. If spending exceeds predictions, a standardized corrective action form is completed and the issue is communicated to the CEO and Board of Trustees through the Finance and Audit Committee.

15. Assess contracted nursing service provider performance

Recommendation: Newfoundland and Labrador Health Services should formally assess contracted nursing service provider performance during contract execution and consider these assessments before renewing contracts

➔ Partially implemented

NL Health Services has established performance standards in travel nurse agency contracts and begun monitoring against them. A performance management scorecard will be used for each engaged agency to ensure accountability and support renewal decisions.

Documents

Public Accounts Committee – OAG Report, Tabled Documents (PDF, August 12, 2025)

Learn more

NL Health Services Outlines Plans following Release of Auditor General Report (June 25, 2025)
NL Health Services Outlines Approach to Leased Accommodations (November 18, 2024)
NL Health Services Takes Steps to Standardize the Use of Agencies for Nursing Staff (August 14, 2024)
NL Health Services Announces Plans to Reduce Use of Private Health-Care Staff (May 2, 2024)

Status report on the AG's recommendations

Strengthening oversight, accountability and workforce stability

1. Engage supply chain management

1. Engage supply chain management

Fully implemented

2. Ensure emergency exemptions for procurement

2. Ensure emergency exemptions for procurement

Fully implemented

3. Complete formal evaluations before awarding contracts

3. Complete formal evaluations before awarding contracts

Fully implemented

4. Ensure future agency nurse contracts use standardized language

4. Ensure future agency nurse contracts use standardized language

Fully implemented

5. Ensure invoice approval process

5. Ensure invoice approval process

Fully implemented

6. Ensure invoice verification and approvals

6. Ensure invoice verification and approvals

Fully implemented

7. Complete audits of all amounts paid to Agency A

7. Complete audits of all amounts paid to Agency A

➔ Partially implemented

8. Develop nurse staffing plans

8. Develop nurse staffing plans

Fully implemented

9. Develop policies/processes for use of casual nurses

9. Develop policies/processes for use of casual nurses

➔ Fully implemented

10. Ensure employees awareness of conflict of interest legislation

10. Ensure employees awareness of conflict of interest legislation

Fully implemented

11. Ensure conflict of interest screening

11. Ensure conflict of interest screening

Fully implemented

12. Rectify current accommodations in compliance with legislation

12. Rectify current accommodations in compliance with legislation

Fully implemented

13. Provide information for contracted nursing services usage/spending

13. Provide information for contracted nursing services usage/spending

Fully implemented

14. Develop/execute corrective action plan for expenditures

14. Develop/execute corrective action plan for expenditures

Fully implemented

15. Assess contracted nursing service provider performance

15. Assess contracted nursing service provider performance

➔ Partially implemented

Documents

Learn more

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