Indigenous and Northern Affairs Committee on May 10th, 2016

[Sony Perron]

Actually, we are seeing constant growth in that budget, but I do not have the details with me today. With the transfer of health responsibilities to the British Columbia First Nations Health Authority, funding for the various components of the program was consolidated in a $140 million envelope that was transferred in its entirety to that agency. As a result, the program budgets you see in the estimates or the annual reports have changed because the funds for British Columbia have been segregated and put in a separate envelope. I can confirm that on an annual basis, the Non-Insured Health Benefits Program is growing on the basis of 5%, while spending continues to increase, probably at a faster pace. To answer your basic question, the budget has not been reduced.

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

Thank you.

What are the three major challenges you are facing in delivering services, and, more specifically, what solutions have you identified to improve the Non-Insured Health Benefits Program?

[Sony Perron]

One of the major issues is the availability of nursing resources. In remote and rural areas, recruitment and retention are challenges. The workload at the nursing stations is very heavy, and this makes it difficult to keep people in those positions for very long. Of course, there are people who make this their career, but it is difficult to attract new workers. Our workers also have to have solid experience, because they have to be able to offer a range of services, to meet the demand, which is very considerable. There is also the challenge of supporting these workers and connecting with the rest of the health care system. The fact that this is an enclave of health services funded by the federal government, surrounded by services for activities that are under provincial jurisdiction, is also a challenge. We have made a lot of progress in terms of integration, but this is still a major challenge.

For example, doctors come under the provincial program. Those are insured services. Our major challenge is to maintain the coherence and integration of these services. That is why the British Columbia model that I referred to is so important. That model puts all resources, responsibilities and authorities under an entity controlled by the first nations, and so the problems of jurisdiction, service integration and collaboration among the various services are eliminated. With this process, we have given the first nations full control of their services, while the province has committed to working with first nations and the federal government to act as a financial partner and a partner for resolving the issues that the system faces. Service integration is probably the second major issue.

The third major issue is mental health. Your colleague referred to this earlier. It is a challenge. The need is growing, and is largely a result of historical situations that have affected the communities. There are also new needs, such as those related to the abuse of prescription drugs. These kinds of challenges have an enormous impact on the communities, and, more specifically, on the most vulnerable communities. There are very urgent situations. This becomes a problem for health services, in that additional pressure is put on those services. It can have the effect of creating demands that did not exist before. In these circumstances, we have to provide additional services and we have programs that enable us to do that. The work with first nations and Inuit on defining strategies is extremely important. We do have to do that, and we have to do it from a culturally responsible perspective. We have to rebuild what was destroyed by the colonization model that was applied for over a century. We have to make culture central to our actions and respect the autonomy of the first nations, but that must be done one step at a time. Another challenge is building capacity in the organizations and communities.

Some communities have very sophisticated plans that enable them to take charge of programs and adapt them to meet their needs. We have to look after human resources and attract workers to these communities who want to stay and contribute to those plans. In some communities, we are seeing extremely important situations and major progress being made. What we often see in the media are the challenges, and we have to pay attention and work in the places where there are special challenges. There really are places where extraordinary progress has been made, where there is creativity and the first nations have taken control of their health services and are designing intervention plans and models that very much merit attention.

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

Thank you.

In his 2015 report, his audit, the Auditor General identified specific issues. You have talked about committees composed of representatives of Health Canada and various bodies. We have talked about jurisdictional issues. I would like to hear what you can tell us about what the Auditor General meant by jurisdictional issues. What are they? What solutions to this particular problem have been explored?

[Sony Perron]

The big challenge is to ensure that we can function with the national programs at a provincial level. Some provinces offer services to first nations on the reserves and in their communities, while others offer them no services or exclude them from their systems. Still other provinces provide primary health care to the communities. The model is therefore very different from province to province.

As a result, our programs have to be adapted to the situation in each province. That is why we have created trilateral tables, where services can be coordinated and integrated, and we can discuss problems, not only with the communities, but also with the provincial and territorial partners. I can tell you that we are making progress. We are taking small steps forward on each subject, in order to create models that work.

For example, we participate in a trilateral table with Ontario and the first nations. We are making progress on common subjects and issues. The same is true in the western and Atlantic provinces. These tables are needed, to solve service integration problems.

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

Thank you.

[The Chair, Liberal, Andy Fillmore]

We're moving now to the five-minute round, and the first question is from Todd Doherty, please.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Perron, I want to deal with the emergencies that we have in La Loche and Attawapiskat. Can you tell me why there is a delay in getting these communities the critical help they need? La Loche is still waiting for some critical support. Even to this point, our honourable colleague was taking it easy on the panel today. Clearly he had an opportunity to ask these questions. We have a crisis. We've all talked about it. There's been a considerable amount of media attention. This is not new. These are crises we're seeing in many first nations communities, not just these two that we've mentioned. Specifically, why is there a delay in getting that critical help to these communities?

[Sony Perron]

I'm going to share my time with my colleague, Keith, who can talk about the situation at Attawapiskat. He just visited the community, and is quite familiar with the file. I will talk about the La Loche situation.

There is a reserve nearby, the Clearwater River Dene First Nation. This is where Health Canada's first nations and Inuit health branch mandate is. We have worked with the community and with the Meadow Lake Tribal Council. They have a mental wellness team to provides additional support to the first nation Dene community. Two weeks ago, I had my regional executive reaching the chief to make sure that what we have done and the services that were provided by the Meadow Lake Tribal Council were satisfactory. We got the signal that things were working well, and they were working with the province.

If you're referring to the La Loche community, this is not a place where our mandate is operating. We were on reserve in the first nation Dene community. I would say that for that portion, the assessment is that we have been responsive. Now we are looking at the long-term needs of this community. Fortunately, the Meadow Lake Tribal Council, which is the authority that provides service to the first nations in this area, has one mental wellness team, which we referred to earlier today. It has been the instrument that has been used to leverage some capacity. There was also help from other first nation organizations in Saskatchewan that were directed toward the community to assist with that tragic situation.

Maybe I will ask Keith to talk a bit about the situation at Attawapiskat.

[Keith Conn, Assistant Deputy Minister, Regional Operations, Department of Health]

In terms of Attawapiskat, we did have a sense from our communications with the chief and council and the community members that there were issues percolating, so we were able to deploy some mental health resources through the Nishnawbe Aski Nation organization, which has a crisis response. Even before the declaration, some surge capacity was deployed to the community with our assistance.

Once the declaration of emergency was made, about two and a half days later a crisis response team was deployed to the community through our NAN partnership. That included mental health crisis counsellors and a youth coordinator.

This is a crisis kind of environment, so there's a bit of a rotation. I think we need to look, at as the Chief has said, the more medium- and long-term work in terms of a transition from crisis to stability to mental health supports for youth in the community writ large.

I think we were responsive. We now have our provincial partners. I won't speak for them, but I know I can say they are physically there at present. That's the emergency medical assistance team who were deployed I think a week after the call. Minister Hoskins was responsive in terms of making that happen.

They are there. They are continuing. They have nurse practitioners, mental health workers, and psychologists who were hired through NAN who are in and out on rotation. There are people who need some respite care, of course, given the volumes of work and the intensity of the work in that community.

We were looking at a more sustainable model in terms of medium-term planning. We'll be deploying some federal presence at an executive level this week to look at the more medium- and long-term planning processes.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

I really appreciate your comments, but I think if you asked our honourable colleagues from both La Loche and Timmins—James Bay, they might have a different opinion on what is really happening and the critical need in the medium to long term. There are challenges we face today. The suicide epidemic is still taking place. We have children who are still choosing to take that avenue or seeing that as the only way out.

I'm going to switch. Hopefully, my colleague from Timmins—James Bay will follow up on that.

Thank you for your time.

[The Chair, Liberal, Andy Fillmore]

The next question is from Don Rusnak.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

I've worked a little bit in health in northern Manitoba. I forget the year, but if you know the “64 agreement” through which there was a divvying up.... We often called it “doctors in the middle of the north with a bottle of rye deciding who was going to do what for which community”. Some communities, Norway House, for example, had a federal hospital. I don't know if it still has a federal hospital. The provincial nursing stations were providing care for communities like Easterville. That was many years ago, so my memory fails me. It was an agreement that probably worked at the time but perhaps doesn't work today. I don't know the status of the agreement. I was with Manitoba Health at the time and was in discussions with Health Canada and the provincial government and the first nations to come up with something better. I know that's what needs to happen across the country. There are successful models that work and that provide good care and continuous care for people in first nations communities and indigenous communities across the country.

I'm going to shift a little bit, because I want to clarify a remark my friend Mr. Angus made when he asked you a question about the fund set up by the previous government regarding Jordan's principle. You started to answer the question by saying that the fund was no longer there, and that it was removed as a result of deficit cutbacks. What year was that in?

[Sony Perron]

That was in 2012.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

Okay, so it was put in by the previous government and cut by the previous government. I just want to make that clear, because I like the facts, and I think the facts are important.

[Sony Perron]

I think the fund was created in 2008, but it was cut in 2012.

[Don Rusnak, Liberal, Thunder Bay—Rainy River, ON]

I'm going to switch gears again on you, and I know I have only five minutes. The Auditor General's 2015 audit found that only one in forty-five nurses examined had completed all five of Health Canada's mandatory training courses. The audit recommended that Canada should ensure that its nurses working in remote first nations communities successfully complete the mandatory training courses as specified by the department.

In its response to the recommendation, Health Canada notes that significant vacancies and turnover rates for nurses had made it a challenge to meet the training course requirements.

Why are the mandatory training courses not provided prior to the assignment of nurses to first nations communities?

[Sony Perron]

That's an excellent question. Since the OAG report we have made some progress. Leila can give you some progress for each of the courses. These are the five mandatory courses that were identified by Health Canada in order to make sure that we prepare the nurses properly for the work they will have to perform in a remote and isolated community. The plan is to train nurses when they come in, and this is what we do. Before we send nurses into the field, there is a week or two of intensive training—onboarding—to prepare them for the work to make sure that they meet the mandatory requirements. One of the challenges, and it's related to the vacancies, is the renewal of the training. After two years the nurse needs to go through the training for recertification. When we were facing a certain level of vacancy in some areas—and we still are—it was difficult to take a nurse out from where there's a need for nurses and send them for two weeks of training at a time. This is where we got behind in terms of training. Our vacancy rate in the last two years went from around 35% down to 16% now, so we have made some progress. All these nurses coming in need to be trained. Whether they work part-time or full-time, they are trained the same way.

Maybe, Leila, you can give us some results in terms of training compliance for each of the programs.

[Leila Gillis]

Sure. We have five mandatory courses that are identified, and they are provided as part of the on-boarding program. It is the recertification that affects statistics in that regard. We have improved the rates to 55% of all nurses who are working in the field. Our goal by the end of this fiscal year is still 100%. That is the goal that we have set for our employees. I don't know if you wanted specifics, but the courses are advanced cardiac life support, pediatric advanced life support, international trauma life support, handling controlled drugs and substances, and immunization. It's the combination of all of those being active certifications that we are monitoring with all employees.

[The Chair, Liberal, Andy Fillmore]

The next question is from Kevin Sorenson, please.

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

I'm not a regular on this committee, but I certainly appreciated your testimony today. I'm a member of Parliament from Alberta. Right now, obviously, we are watching our north very closely. In Alberta, we're watching the Fort McMurray area. We've talked about emergencies in Attawapiskat. That's obviously a massive issue and emergency that we need to deal with—and also at La Loche.

I'm just wondering how Health Canada is involved in the evacuation, if they are. In previous years, when there were fires at La Ronge in northern Saskatchewan, I was at an evacuation site in Saskatoon and I was impressed by the way it was set up. I think it was Health Canada that was there, diagnosing and looking at people, especially aboriginal and first nations people, making certain they were in good health and checking for other health issues as well.

Are you involved in this Alberta evacuation?

[Sony Perron]

We are working on this with partners, including first nations. This is a tragic situation, and we have a responsibility in that context. As soon as first nations living on reserves are impacted, we have a role. I mentioned initially that we have a role in terms of providing health benefit services, health protection services, and nursing services. Our team in the Alberta region have been working with Alberta Health and the emergency authorities to try to organize services. We have provided some surge capacity to our regional office with additional nurses. We have reached out to other regions to bring additional environmental health officers. We have also organized services for people who have to move from their place of living. For example, when you leave your community to go into a different place, you may have left your medications behind, so Scott's team have issued communications to pharmacists, to clients, to facilitate them in refilling their drugs. We have sent more staff there. So in various fashions we are working with first nations. We are working provincial and federal partners to respond and support first nations communities that are affected by this.

The environmental health issue is a challenge, so we will have our HO inspecting if there are concerns for first nations to make sure that their place of living is safe. We are doing these things.

There was one thing I wanted mention, and it's just slipped out of my mind. It was very important.

Sorry, it was about Fort McMurray. Several first nation communities get their services from Fort McMurray. Community members leave their communities to go to Fort McMurray to see a doctor, to go to the hospital, to get the needed services. One thing we did in the first few hours of this crisis was to start working with all these first nation communities to redirect clients toward other points of service. Therefore, they will still be able to see a physician, they will still get access to care, but not in Fort McMurray. Because we manage medical transportation, there were some logistics involved. But this was probably one of the first tasks that our Alberta regional office started to work on, to redirect clients toward other points of service.

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Mr. Rusnak asked part of my question, because the Auditor General's report in 2015 did speak of the need for nurses. My wife's a nurse, my daughter's a nurse, and we know the good work they do.

He also mentioned one fund that was cut in 2012 by the former government, but the estimates show there was a 5% increase in funding even through those years.

[Sony Perron]

The 5% increase is for the non-insured health benefits program, which is for drugs, dental care, medical supplies, vision care, etc. There's a 5% escalator in that budget of around $1 billion. However, some programs have no escalator. This one has a 5% escalator—

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Some programs, as they are deemed not needed, may be cut or they may be held at the same level. For other programs, there is an increase in funding. Is that correct?