Health Committee on Nov. 28th, 2017

[Michael Ferguson]

We didn't get down to identify the impacts of those things. The department acknowledged, and we acknowledged as well in the context of the report, that there are other things that determine oral health outcomes.

Again, I think those are things that the department needs to take into consideration as it puts together its overall approach for this program to try to close that gap. When these populations have a rate of dental disease that's twice as bad as that of other populations, then all of those factors to try to figure out what could be causing it, how we prevent it, and how we manage it need to be taken into consideration.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Yes. They should all be tracked so that you can correlate.

[The Chair, Liberal, Bill Casey]

You're done.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Okay.

[The Chair, Liberal, Bill Casey]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Chair.

According to documents recently released under access to information, the federal government spent more than $110,000 fighting a first nations girl in court to block payments for orthodontic treatment that cost $6,000. Stacey Shiner, the child's mother, sought payment for the braces under the first nations and Inuit health benefit program, but was denied by Health Canada. She appealed three times to no avail. Ultimately, she had to take the case to Federal Court.

Cindy Blackstock, executive director of the First Nations Child and Family Caring Society of Canada and an intervenor in the Shiner case, said the following:

As a human being, I think it's immoral that Canada would not fund services where two concurring pediatric orthodontists agree that without treatment this girl will experience chronic pain and will have difficulty eating and talking. As a taxpayer, I'm absolutely floored that Canada would spend $110,000 defending [against] a $6,000 investment to help [an indigenous] child. They could have used that money to buy 18 children in medical need the orthodontic services they needed.

In your view, does this expenditure of $110,000 in legal fees represent good value for money?

[Michael Ferguson]

Again, it wasn't the objective of the audit to look at that particular instance or other particular instances. I think the department would have to explain their decision. I mean, certainly when you look at the decision on the basis of those numbers, it's fair, I think, to question the decision, but I think the department would have to explain that.

One thing we did identify was that in the course of their giving a decision on appeals, they had time frames for appeals. The ones where they didn't meet their 30-day service standard on giving a decision on appeals were primarily related to orthodontics. I think there are certainly improvements that the department needs to make on how it's managing appeals for orthodontics.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

During this committee's study of the cannabis act, Bill C-45, we learned that the federal government covers the cost of medicinal cannabis for Canadian veterans but not for first nations and Inuit populations. In your view, how does oral health coverage for registered first nations and recognized Inuit compare with other populations, such as veterans, for which the federal government provides oral health coverage?

[Michael Ferguson]

Again, I can't speak to that, because we didn't do that comparison in the audit. I would take the opportunity to remind the committee that we did do an audit on the prescription drug program for veterans that included the medical marijuana, but we didn't do that comparison of this program for oral health with other programs for oral health.

[Don Davies, NDP, Vancouver Kingsway, BC]

According to report 4 of the 2017 fall reports of the Auditor General:

The Department [of Health] had known for many years that Inuit and First Nations people's oral health was poor, and attempted to develop a strategic approach to improving it. We found that the Department drafted strategic approaches to oral health in 2010 and 2015, but did not finalize them.

In your view, why did the department previously fail to finalize its strategic approaches to oral health in 2010 and again in 2015?

[Michael Ferguson]

I'll start and then I'll ask Ms. Thomas to add to it.

This is an issue that we see in a number of different places, and it continues to concern us when departments identify the need for a strategy, start a strategy, get a draft strategy in place, but don't finish it.

In this case, they identified it in 2010. They identified it in 2015, but when we were in doing the audit, there still wasn't one developed. Explaining why is something the department would have to do. We don't give departments credit for draft strategies. If they say they need a strategy, then we expect to see a strategy developed and approved so that it can move on to implementation, but in this case, they identified the need in 2010 and 2015, and it still wasn't developed.

I'll ask Ms. Thomas if there are any more details to add.

[Casey Thomas]

The only detail I would add is that in 2010 and in 2015, the department's report on plans and priorities also made the commitment to developing a strategic approach, but they still hadn't finalized it in 2016 or 2017. They instead developed regional plans. These regional plans were exactly that. They covered the regions. They looked at the current state of the gaps and possible solutions for those gaps, and we were told that those were being used until the strategic approach could be developed.

[Don Davies, NDP, Vancouver Kingsway, BC]

Did you find any evidence that those regional plans had actually been implemented?

[Casey Thomas]

We did. The regional plans have been implemented.

[Don Davies, NDP, Vancouver Kingsway, BC]

What were those regions?

[Casey Thomas]

The seven regions that are covered are Atlantic, Quebec, Ontario, northern, Saskatchewan, Manitoba, and Alberta.

[Don Davies, NDP, Vancouver Kingsway, BC]

Did they give you any explanation for why the overall plan has not been implemented yet?

[Casey Thomas]

No. They simply told us that they had decided to change direction, to work on the regional plans until they could develop their strategic approach.

[Don Davies, NDP, Vancouver Kingsway, BC]

Did they give you a timeline for when the strategic approach might be done?

[Casey Thomas]

No, they did not.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you. Those are my questions.

[The Chair, Liberal, Bill Casey]

Thanks very much.

We're going now to Dr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you all for coming.

I'm reading through this, and I don't know if this was within the scope of your audit, but of course, in any large system, sometimes there are problems with the scope of programs that have to be administered under a given body. In particular, in Indigenous and Northern Affairs, there has recently been a recent change, now that there are basically two ministries and one ministry is dedicated to the provision of services.

Is there an opportunity or likelihood that this may improve the administrative efficiency and perhaps be a step to improving these issues?

[Michael Ferguson]

I'm not so much focused on the structure of the delivery. I think what's important is that whoever is responsible is putting the focus on the health outcomes.

We identified in the audit, for example, that Health Canada—the department that was responsible, of course, during the period of the audit—had done some work to determine what the health status of these populations was, but the department doesn't have anything that they use on a regular basis to try to determine whether their day-to-day activities are going to help move the bar in terms of those overall health outcomes.

If they're simply going to come along and measure the health outcomes periodically, say every five or every 10 years, they need some interim measures to actually know whether what they're doing will end up moving those longer-term measures in the direction they need to. Whatever department is responsible for this, what's important is that they have good ways of identifying whether what they are doing is going to contribute to better outcomes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right. Thank you.

I note that some dental services require pre-approval. Do you have not a comprehensive list but maybe just the categories of the kinds of procedures that require pre-approval and those that don't?