Health Committee on Sept. 22nd, 2022

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much for that.

Dr. Ungar, resilience is one of those things that are, I think, fascinating to all of us here. It's really about recovery and how we take on tasks in the future. From your perspective on resilience, do you have any suggestions on moving forward on that topic, on what we need to study in the future with respect to how it relates to the pandemic, in particular with respect to children?

[Dr. Michael Ungar]

Absolutely. I think what we need to do is delve a bit deeper into what the protective factors were or what actually helps a child get through a crisis like this. Lots of funding went out to research studies. Those results will come in over the next year or two, so we don't have a good picture yet, but we do know that children who, for instance, maintained routines in their families and families that had access to technologies for kids seemed to do much better. Children who maintained connections with their extended family members seemed to do much better. Some of those hints are there.

I might also say, because I study resilience, that there's a fascinating emerging conversation—and I say this very cautiously, because the pandemic was horrific for our economy and many people died—about the huge number of lessons learned, things that we should have known were coming. For instance, we saw, especially among adolescents, more accessible counselling services. Adolescents hate coming to counselling generally, but many more would engage and many of them would in fact feel much more comfortable coming to a therapist or seeing a mental health specialist online. This is anecdotal but it's what my colleagues are saying.

Also, in my own home province of Nova Scotia, for instance, we discovered—surprise—that only 93% of our kids had access to technology at home to access the Internet. That was remedied through school programs and government programs to make sure that kids had access to that technology and to Internet connections.

Some of this simply taught us that we had the capacity to create environments that would help children to be much more successful, and that, I think, is really encouraging.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ungar and Dr. Ellis.

Next is Mr. Jowhari.

Go ahead, please, for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses for being with us in person today.

I'm going to focus most of my questions on the Canadian Dental Association. First of all, thank you for being here today. Thank you for your submission to the committee and for a number of the recommendations you have made. For full disclosure, I want to disclose that my wife has been a restorative hygienist for 25 years and she is amazing at the work she does. I have access to more than 200 oral health practitioners, whom I proudly advocate for. As well, I fully support my colleague MP Don Davies in ensuring that the level of care provided to those who go to the dentist or who seek oral health care be maintained at the same level regardless of their income and that doctors be entitled to full compensation for providing it.

I want to go back to the recommendations you made, specifically your recommendation number one, regarding consultation and collaboration on dental care. I'm going to quote the summary of the recommendation that you made:

CDA recommends that the federal government proceed slowly and carefully, taking the time to develop a long-term solution that is well-informed, targeted, comprehensive, and effective. The federal government should consult broadly with dentists and other oral health care stakeholders, as well as collaborate with other levels of government.

I could say that the news around the program that we just rolled out is welcomed broadly by all stakeholders. However, we see that you are cautioning, or you recommend that the federal government take its time and proceed slowly and carefully.

Can you expand on why you are saying that? On what basis are you saying that we should proceed slowly and carefully?

[Dr. Lynn Tomkins]

Thank you.

Yes, certainly. We have the opportunity to get something going here that's going to have long-lasting effects and, hopefully, is going to be a long-lasting program. It's definitely worth taking the time to consider all the aspects and to consult with stakeholders, dentists, dental associations, the provincial and territorial dental associations, the provincial governments and the patients as well, the people who are receiving the care. It's really important in this first phase—and we appreciate that it's an interim phase—that the input or feedback from the providers is taken into account, because we're the ones with all the questions about the practicality of how this is going to work.

We've had questions here today that highlight that the federal government provides the funding but the provinces decide where the funding goes. I'm not a politician, but there has to be discussion between the levels of government, and if funding does end up being transferred to the provinces for dental programs, which is where they're currently delivered, there have to be significant strings attached.

We would certainly want some sort of national standards of care for a basic program. Also, as I mentioned earlier, we have 10 dental schools across the country with very substantial academic and intellectual depth that can provide information about programs that work and jurisdictions that work well, but right now we have different provinces—10 provinces and three territories—and we have just as many programs, more than one in each province.

All of that has to be taken into account, because we want to avoid unintended consequences. Two-thirds of Canadians have some sort of coverage through employer-sponsored health benefits—all of you would have that—and we don't feel that needs to be disrupted. Seventy-five per cent of Canadians report feeling that they have good access, so it's really about designing something that is going to address the gaps in those groups that are not currently accessing care. It's complex.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

I have a list of questions that my network is asking. I'll gladly share that with the government and the ministry. However, could you share with us the top issue that dentists have regarding the rollout of this program around fees? I would really appreciate that.

[Dr. Lynn Tomkins]

One thing that's important is that we would not like to see something that adds to the administrative burden. We don't want to be the gatekeepers on determining eligibility and having to chase patients and make them verify. That really comes between the doctor and the patient in the relationship. In terms of the remuneration for the services rendered—I mentioned this earlier—it's not unreasonable to expect that costs be covered and that the person delivering care be able to make a living doing that. We treat as many patients as possible, and we look forward to seeing more.

The other aspect we're hearing about from dentists is something that existed before COVID and certainly has been exacerbated by COVID. There is a shortage of dental staff, and dental staff are highly trained staff. The person who assists the dentist in the office is a highly trained individual with a lot of responsibility, and at any one time in Canada up to a third of dental offices are looking to add at least one person to their staff.

I know that across the health care sector there is a shortage of staff, but it is something that is affecting dentistry. We will do our best to handle the influx of patients, but that is an issue.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tomkins.

Thank you, Mr. Jowhari.

Mr. Perron, you have two and a half minutes.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Thank you, Mr. Chair.

I'm going to continue with you, Dr. Tomkins or Dr. Burry.

Do you feel that Bill C‑31 provides dental insurance?

[Dr. Lynn Tomkins]

I'm sorry. I was listening in two places.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Do you feel that what Bill C‑31 provides constitutes dental insurance?

[Dr. Lynn Tomkins]

No. If you look at it, actually, it's more like a health spending account.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Are you concerned that not all of the amount would necessarily be spent on dental treatments?

As I explained earlier, based on how it works in the bill, individuals would be required to submit only one receipt to automatically receive $650 per child. For example, they could submit a $100 receipt, then receive $650, and they wouldn't be required to account for the remaining $550.

What's your opinion on this? Are you concerned about it?

[Dr. Lynn Tomkins]

Well, certainly we would like to see the money being put toward dental care for children. As to whether or not the person actually does it, as I understand it, CRA has various mechanisms for audit and for checking on how the money is used. We wouldn't want to see dentists having to demand that patients justify how they're going to spend the money they've received.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

I hear what you're saying. In an earlier response, you stated that you were concerned about the administrative burden. I feel that it could be an issue too. Of course, you want the money to be spent on dental care, and I understand that. However, don't you feel that decentralizing the handling of the funds to the provinces would make it easier to administer this and prevent excessive red tape by keeping another level of government out of the health care systems?

That's one of my concerns.

[Dr. Lynn Tomkins]

That's a question I really cannot answer, because it's in the design of the program.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Does that sound reasonable to you?

You said you're concerned about the administrative burden. I usually sit on the Standing Committee on Agriculture and Agri‑Food, and we have the same problem every time we deal with the federal government. It's such a long and complicated process and we always end up with a lot of administrative paperwork.

We already have a level of government looking after health care. Wouldn't it be easier to transfer the funds for those services to that level of government to ensure that it's local services that are making consistent decisions tailored to community realities?

[The Chair, Liberal, Sean Casey]

Give a brief response if you can, please, Doctor.

[Dr. Lynn Tomkins]

I refer to what we have now as a health spending account. In a sense, the administration of that is very simple. Going forward, whether we have a federal program or whether we have transfers to provincial programs with the accompanying administrative burden, we would want to be able to see something that utilizes the current system. When you go in to see your dentist, you present, they take your claim and they send it directly to whoever the payer is going to be. That would be the preferred system of doing it. Whether that happens at the federal level or the provincial level is not for us to decide.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Perron.

Mr. Davies, go ahead for two and a half minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Could you clear some of this up? I have read Bill C-31. Of course, to get the money, a person has to attest that they will use the money for dental services and has to keep the receipts for the service. When we send Canadians the child benefit payment every month, we have no guarantee they're going to spend it on their children either, but we still send the money to families.

Mr. Perron just made a wonderful argument for why the Canadian health care transfer has to have conditions attached to it—so we can make sure that provinces spend it on the things that it's being transferred for, much like he wants to make sure that the money transferred to families ends up being paid for dental care, I would suppose.

I want to finish the question I asked before. The CDA's written submission to this committee noted that in 2017, only 39% of Canadians had access to community water fluoridation, whereas 73% of Americans had access to it in 2018.

How important is fluoridation to oral health, and what steps should the federal government take to try to encourage fluoridation of our water?

[Dr. Lynn Tomkins]

It's extremely important to oral health, because if you get community water fluoridation and you get fluoride added to the water in the right amount, it will enable those teeth to be stronger. I have benefited from that myself. You probably have as well.

However, it comes down to the municipalities deciding whether or not to update their infrastructure. Whatever the federal government can do to support the infrastructure that is going to.... First of all, we need to have good water systems. In the beginning, we need to have a good water supply and to make it possible for those municipalities to add the fluoride to the water through their support.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Douglas, I have a quick question for you. What is the impact to children of not having access to pediatric formulations in, say, oncology? To be brutally blunt about it, do children die as a result of not having access to formulations specifically for them?

[Sarah Douglas]

The challenge with the lack of pediatric formulations for children results from using adult formulations off-label. What this tends to mean for children is compounding of drugs. In some forms it's a pharmacist, either in a hospital setting or in a community pharmacy setting, crushing a tablet. It could sometimes be parents crushing tablets and mixing them with apple sauce or something like that for their children to take the medication.

However, the problem is that sometimes children find it difficult to.... They don't like the taste because sometimes, when the medicines are compounded, they have a taste to them that children don't like. Getting adherence from children to take their medication is difficult at the best of times, so this makes it much more challenging. The advantage of having specific pediatric formulations is that you can make medications for children in forms that are appropriate—like syrups for younger children, or microtablets but with syrup flavours that children like—and children are going to be more compliant with in their therapies.