Indigenous and Northern Affairs Committee on May 3rd, 2022

[Martin Shields, Conservative, Bow River, AB]

Thank you, Ministers.

[The Chair, Liberal, Marc Garneau]

We'll now go to Mr. Powlowski. You have six minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

It seems like escorts not getting approved is a major problem. Who makes that determination of whether or not someone is approved? What are the reasons that are most commonly given for not approving someone?

Ms. Green suggested that if you need somebody as an interpreter, they'll get it approved, or if you need somebody because of your lack of mobility, they'll be approved, but if it's because you're someone from Cambridge Bay who has never been outside of your community, and you speak a bit of English, you're out of luck. If you don't speak any English, you get someone to come with you.

Is that the biggest reason for not approving escorts? Is there an appeal process? This is a major question. It seems like it affects all of you. As a doctor having worked in Nunavut, I know that there aren't tertiary medical resources and there aren't a lot of specialists, if any, in those places, so they have to be referred out.

I'll ask all of you about the process, why people are being denied escorts and whether there is any effective appeal process.

Could we start with Minister Green, and then you can pass it on to other people?

[Julie Green]

We mirror NIHB with our own ministerial policy on medical travel. The policy has four or five criteria, but none of them involves cultural safety or dislocation compassion or whatever. They speak strictly to areas such as mobility; interpretation; about to give birth; and needing help to understand an aftercare plan and so on.

Our territorial policy has an appeal process. I'm not sure if the federal government has an appeal process for its administrative side of the program, but an appeal process is a good idea. If there isn't one in place, it would be useful to have it so that people who are denied an escort can have someone else take a look at their file and see if it would be useful.

That's my view on it. I'll ask John Main what he thinks.

[John Main]

Thank you.

When it comes to escorts, I think Minister Green explained it quite well. I share the concern around the lack of cultural sensitivity, I guess, included under the program. One of the issues we have around escorts is that from time to time a second escort is required if it's, say, for example.... At the end of the day, I like to talk about examples, because this program is about people. It's not dollars and cents. It's about health care for Canadians who live in the north or who are [Witness spoke in Inuktitut]—indigenous.

When you look at second escorts, in some cases we get requests from clients in the case of a child who is undergoing cancer chemotherapy. In some cases, the parent who is escorting that child needs support. It can be very heart-wrenching. That's an example where, for that second escort, as the Government of Nunavut we could approve that, and we will bear the cost on compassionate grounds.

In wrapping up my response, I'd like to mention that we have seen some improvements in this area through the Inuit child first initiative, which is a new and kind of exciting avenue for Inuit in terms of second escorts and additional family travel around medical needs.

[Tracy-Anne McPhee]

I'll be very brief.

The non-insured health benefits approve escorts that are considered medically necessary in our context. That tends to be quite a narrow criteria.

I agree with my colleagues and certainly with the examples given.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

What you said, Minister McPhee, was kind of interesting, because Minister Green said there were about five criteria and you're saying that it's whether it's medically necessary. Is there no common one requirement for escorts that applies all across Canada?

[Tracy-Anne McPhee]

Yes, understand that there is the basis of one. It's generally wrapped around this concept of “medically necessary”, and I think that's even what Minister Green is saying as well. There are a few criteria but they [Technical difficulty—Editor] are sort of in that basket, if I can say it that way.

Of course, as the NWT administers the federal program through their system, they may well have incorporated some of those. I'll leave that to her.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

This is probably less of a question and more of a comment.

Minister McPhee, I thought your comment about needing more than one escort when there's a child, especially in a life-threatening situation, was an excellent point.

Thanks.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Powlowski.

I will now give the floor to Mrs. Gill.

Mrs. Gill, it is my understanding that you will be sharing your time with Mr. Morrice. So you have six minutes to share.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

I would like to thank Ministers Main, McPhee and Green for their appearance before the committee today.

I have some questions for them regarding non-insured health benefits, specifically in the north. I think the issue of accompaniment, which we've already touched on, is one of them.

Would you like to make any other recommendations to the committee with respect to the fact that the territories are remote and therefore naturally receive fewer health services?

My question is for all of the ministers.

[The Chair, Liberal, Marc Garneau]

Why don't we start with Minister Green, if you care to comment? We'll then go to Minister Main and to Minister McPhee.

[Julie Green]

Thank you, Mr. Chair.

I want to clear up a bit of confusion that I see between my answer and Minister McPhee's answer. The escorts that I am talking about are non-medical escorts. They are not there to provide any kind of medical service. They are there to assist the person getting on and off the plane, to speak in the language of their origin, to accompany someone who's having a child, and so on and so forth. They are non-medical escorts.

We've had representation from people who would like the escort criteria to correspond with age. That is to say, if you're over a certain age, you would automatically receive an escort. It turns out now that the older you are, the more likely an escort will be approved, but that's not always the case.

Having a wider availability based on age is one possible way to address the question of how to bridge the gap for someone coming from a very small community to a city the size of Edmonton for medical services. It is truly bewildering in ways that those of us who have been in those big cities—

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Minister.

We are running out of time. Mr. Main, Ms. McPhee, I don't know if you would like to add anything else to the list of recommendations.

[John Main]

Thank you very much for your question.

In terms of the escort piece, adding some flexibility within the policy would be valuable. It would allow the territorial health departments to consider things such as cultural considerations and language considerations when looking at who gets a non-medical escort.

The other recommendation I would have is around the Inuit child first initiative. Right now it's very new, and I'm very appreciative of it. The Inuit child first initiative and the non-insured health benefits are in silos. They don't talk to each other very well or mesh very well. That's something that I believe could lead to improvements, if we could figure out ways—specifically for the Inuit—to make those two streams work better together.

Thank you.

[The Chair, Liberal, Marc Garneau]

Go ahead, Minister McPhee.

[Tracy-Anne McPhee]

Thank you so much.

I must say that I agree with the concept of flexibility. That's the umbrella, with respect to how the policies are written and interpreted. That would allow us to take into account, for instance, compassionate reasons and culturally appropriate considerations, as well as language and medical concerns. However, the flexibility is key.

[The Chair, Liberal, Marc Garneau]

Mrs. Gill, are you going to turn it over to Mr. Morrice?

[Marilène Gill, Bloc, Manicouagan, QC]

Yes, Mr. Chair. Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you, Mrs. Gill.

Mr. Morrice, you have about two minutes.

[Mike Morrice, Green, Kitchener Centre, ON]

Thank you, Mrs. Gill.

I hope to have time for two questions.

My first is to Minister Green.

I hope all parliamentarians in this place are committed to following through on the Truth and Reconciliation Commission's calls to action.

Minister Green, you spoke about call to action 20 specifically. Do you have any additional recommendations for this committee with respect to NIHB to ensure that we follow through on call to action 20?

[Julie Green]

In order to advance reconciliation, it's important to take cultural safety into consideration. There's a lot of mistrust in the health system, even to this day, because of the way it has been administered historically. If there are ways to take that mistrust into account and to allay it by providing more flexibility, as Minister Main said, I think that would go a long way toward meeting this recommendation.

Thank you.

[Mike Morrice, Green, Kitchener Centre, ON]

Thank you, Minister Green.

At the last meeting of this committee, Vice-Chief Pratt from AFN shared that.... His words were “For our first nations, NIHB can be seen as a bureaucratic and intimidating entity.” He went on to talk about concerns with respect to “cost containment” ahead of “adequate and timely medical benefits”.

Would any of the ministers be open to sharing their views on recommendations that would address the concerns raised by Vice-Chief Pratt?

[The Chair, Liberal, Marc Garneau]

You'll have to direct that to one minister, because we won't have the time.

[Mike Morrice, Green, Kitchener Centre, ON]

How about Minister McPhee?