Finance Committee on Oct. 10th, 2024

[Yvan Baker, Liberal, Etobicoke Centre, ON]

Thank you for your advocacy on that. I'll go see the minister after this and reinforce what you said.

[Linda Silas]

Good. Say that Linda says hi.

[Yvan Baker, Liberal, Etobicoke Centre, ON]

Yes, I will say that.

I want to circle back on that a little more if I could.

One of the reasons the five MPs signed that letter was that the five of us had in our ridings long-term care homes during the initial stages of the COVID crisis where the Canadian Armed Forces were asked to come in to serve because the situation was so dire. Many will remember that the Canadian Armed Forces wrote a report that documented some of the horrific conditions in some of those homes. When we became aware of that, we felt like we had to do something. There was a letter to the Prime Minister, but there was also a letter to Premier Ford, asking for a number of things. One of them was national standards for long-term care.

I'm a big believer that you measure what you treasure. If we treasure our seniors and the quality of care they receive, then we need to set a standard, measure our performance against that standard and, like you said, enforce that standard. Thank you for your advocacy on that.

Can you just talk a bit about how, if those national standards were enforced, that could impact the quality of care for our seniors?

[Linda Silas]

If I just look at the 4.5 hours of care per day per resident.... We're talking about residents being properly assessed, getting their medication on time and being able to, like I said, live their last days the best way possible. The fact that we have a free-for-all system doesn't help. The pandemic and those areas where the military was brought in were a shame on our country. We were all embarrassed. However, those who work in the system were saying, “I told you so. I told you so. You're not coming in to investigate us. You're not coming in when we call occupational health and safety. Residents don't have any rights, and we knew it was going to happen.”

The government worked hard on building these standards. Now, the next step is enforcing them. It's very similar to when we talk about a national pharmacare program. We have to put standards, and we have to fund them. You can't get off the hook that easily; you have to fund them. You have to help the provinces and territories. However, the money cannot go towards the private sector. It was so embarrassing to know that stakeholders were getting their shares while seniors weren't even getting a meal during the pandemic. That should never happen in any country, especially ours.

[Yvan Baker, Liberal, Etobicoke Centre, ON]

I agree with you 100%.

Thank you very much.

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Baker.

Members and witnesses, we are moving into our third round. This will be our final round.

We are starting off with MP Hallan.

[Jasraj Singh Hallan, Conservative, Calgary Forest Lawn, AB]

Thanks, Mr. Chair.

Ms. Kothawala, I want to pick up from where some of my colleagues left off.

My previous colleague asked you a bit about the capital gains tax hike impact on some of your members. You mentioned that most of your members who are owners are immigrants or new Canadians, and that those who own their businesses would be impacted by the capital gains tax hike.

Is it fair to say that some of those people would be considering selling their businesses at the end as their retirement plan?

[Anne Kothawala]

I'm sure that a number of them will, because, again, a lot of them come to this country. Their extended family works in the store. That's kind of their nest egg, so, absolutely, a number of them would look to sell their business as their retirement.

[Jasraj Singh Hallan, Conservative, Calgary Forest Lawn, AB]

My family and I came here as immigrants, too. We all came here for the Canadian dream. For some, that Canadian dream is also owning a business and eventually selling it. As you said, at the end of the day it could be their retirement.

How do you think your members feel when they might have been banking on selling that as their retirement and then got hit with this tax increase from capital gains?

[Anne Kothawala]

They certainly wouldn't feel good, but I don't even know if some of them are going to get there. The reality is that we're seeing a lot of convenience stores close, and we're seeing those closures largely because of the issues I raised. That's why it's so important for the government to take urgent action on interchange fees, contraband tobacco and nicotine pouches.

[Jasraj Singh Hallan, Conservative, Calgary Forest Lawn, AB]

Would you also consider that some of the decisions those business owners are making are because of the rise in crime rates in their stores?

[Anne Kothawala]

Absolutely. We do surveys of our members, and that's an issue that, a few years ago, didn't used to be high on the list. It is much higher on the list in terms of their concerns. Again, to be clear, their primary concern is the safety of their employees because, unfortunately, some of the crime can get quite violent. First and foremost, they are concerned about protecting their employees.

[Jasraj Singh Hallan, Conservative, Calgary Forest Lawn, AB]

Agreed. I would imagine that most of the employees are also immigrants and newcomers to the country. Is that right?

[Anne Kothawala]

That's right. If most of you go into your local convenience stores, you will probably find that, by and large, they do tend to be staffed.... Whether it's the extended family of the store owner or whether it's a corporate store, oftentimes, they are new Canadians working in those stores.

[Jasraj Singh Hallan, Conservative, Calgary Forest Lawn, AB]

Would you say, for your members, that rural and remote communities are hit harder with crime?

[Anne Kothawala]

Well, yes, but what I think rural and remote communities are really hit with as well is a lot of these issues that we're talking about, particularly contraband. We see a much bigger impact in terms of contraband because a lot of those stores are located close to a smoke shack or another point of sale that is not necessarily a legitimate point of sale.

[Jasraj Singh Hallan, Conservative, Calgary Forest Lawn, AB]

I would imagine that a lot of the crime that's happening is done by repeat offenders, people who would most likely hang around and maybe lose the fear that they would be arrested because of broken bail policies after nine years of the Liberal government.

What would you want to say on behalf of your members about this revolving door of bail that has been granted to repeat offenders, which may have impacted the stores that your members own, as well as their employees?

[Anne Kothawala]

We think that, both for them and for some of the elements of organized crime that are involved in contraband trafficking or other..., basically, we do need to ensure that there's more of a disincentive, whether it's a fine.... There need to be stronger disincentives so that we don't have more repeat offenders, which is what we are seeing now, for sure.

[Jasraj Singh Hallan, Conservative, Calgary Forest Lawn, AB]

If there are repeat violent criminals robbing a store repeatedly because of the bail system that we currently have, do you think it would be fair to say that your members would want stricter penalties—jail and not bail—for those repeat violent offenders?

[Anne Kothawala]

Again, we haven't spoken to our members directly about their feelings on this, but again, I'm happy to canvass them.

We have focused on a whole myriad of issues that impact their ability to conduct business, and obviously the retail safety and the repeat offenders are issues. However, I don't know their exact opinions in terms of bail reform because we haven't asked them specifically about that.

[The Chair, Liberal, Peter Fonseca]

Thank you.

Now we'll go to MP Thompson, please.

[Joanne Thompson, Liberal, St. John's East, NL]

Thank you.

Welcome to all the witnesses. It's really nice to see familiar faces.

Ms. Silas, I have to start with you. In full disclosure of my bias, I started nursing many years ago, and, though I left for a number of years, I did come back and am proud to say I've kept that registration. This one is really personal for me, so thank you for the work you're doing.

I want to begin by highlighting a couple of the points you made, and then I'll turn it over to you for comments.

I want to begin with the nursing retention tool kit, which is a step, and I'll give a shout-out to Minister Holland and Dr. Chapman, the Canadian chief nursing officer. Having that role within Canada is incredibly important and is part of the government's work in ensuring that the nursing voice is not only acknowledged as being important but physically seen as important because we do have that chief officer role.

My second point moving into this is a note that in budget 2023, $200 billion was set aside over 10 years to improve primary health care. The challenge that I'm seeing, which you have alluded to, is the work of the provinces and territories. Certainly, I'll say at a very personal level that we have to understand where the cracks are in the systems, because funding alone is not going to see stronger outcomes.

Looking at outcomes, I want to reference the nurse practitioner as an example and the continued barrier to seeing nurse practitioners working in the full scope of practice.

To that end, I want to link to the role of the nursing colleges, which is provincial and territorial; [Inaudible—Editor] I believe it's territorial as well, but it's certainly provincial. It's a legislative body. It's tied in to provinces. It's really linked to nursing, which is highly regulated, and the ability to work in that highest scope of practice. When you speak about private nursing agencies, I agree with you that it's challenging. I think we need to fight for our universal health care and equity for all.

How do we take all of these partners—certainly there is your role at a national level but there is also the role of the colleges across the country—and use the accountability lens for provinces and territories to do what, indeed, they said they would do when they signed on that line when they received the funding? How do we pull all of these players together and then ensure that what is pledged to happen does indeed happen? I'm really interested in your thoughts on that.

[Linda Silas]

Do we have all day?

Thank you very much for your question. We're also connected as eastern nurses.

The first thing is a health human resource strategy. We have a population of 40 million in Canada. We have one million health care workers, but there's no strategy for any of them. They provide great care. We need to bring in all the stakeholders you mentioned and develop a strategy. Help the provinces and territories with the evidence. We have amazing researchers, amazing data analysts and amazing strategists in this country, and we commission them for report after report, but there's nothing pulling it together.

The extra funding announced two years ago was greatly appreciated. I'm sure every health care employer is saying the same thing, but because we're in a crisis, they have a hard time putting it where it should be going, which is in primary health care, home care, enhancing our long-term care and, of course, helping our acute care. Acute care is in crisis, and when you're in a crisis mode, you just fix the crisis mode. That's my critical care nurse way of thinking, but that's what happened.

With our nurse practitioners and the whole aspect of primary health care, the biggest barrier is access. We don't have enough in the country. In the U.S., they have 100 times more nurse practitioners than we have in Canada. Is it the cost? It's because of knowing that we need to have more access to primary health care.

The other aspect is the method of payment. We're still backwards in how we pay our physicians via fee-for-service and how we pay our nurse practitioners via salaries. I know nurse practitioners in P.E.I. who will replace a locum—a replacement physician—and they get their salaries with overtime and are expected to work 24 hours.

Really, we have to make our system better.

[The Chair, Liberal, Peter Fonseca]

Thank you.

[Joanne Thompson, Liberal, St. John's East, NL]

Just quickly, Ms. Yetman, I have to go to you. Welcome back.

What does pharmacare mean, even if it's just in terms of contraceptives, for you and your workers and also the students?