Indigenous and Northern Affairs Committee on May 6th, 2022

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you very much, Ms. Atwin.

There were only about 10 seconds left there.

We now go to Mrs. Gill for six minutes.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

I would like to thank Ms. Hajdu, Ms. Gideon, Mr. Doidge and Mr. Adams for being here today.

Minister, as you know, administration of the non-insured health benefits program has been centralized since 2013, and that extends to the predetermination of benefits, billing, the provision of dental care and so forth. We have heard, however, that since the program was centralized, a good many issues have persisted. The system now has even more red tape, when people had been calling for less bureaucracy and more flexibility.

The Assembly of First Nations Quebec–Labrador told us that it was able to interact and communicate more effectively with program administrators when there was a Quebec office. Basically, the system worked better.

Again today, we are hearing that the problems have only gotten worse. Delays in payment and reimbursement for services are increasingly common. Nevertheless, these are essential services. Problems also exist on the health care provider side of things. They are simply choosing not to provide services to this population. Obviously, when service providers don't get paid, it creates problems for them, so they choose not to participate in the program.

Since the system isn't working, are you considering decentralizing administration of the program? If not, what can you do, or what will you do, to make sure that members of first nations have access to the services?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Maybe I can just highlight a couple of points and then turn to Val or Scott, but I will say that the NIHB program encourages dentists to enrol directly with NIHB so that clients don't have to be billed and face charges at the point of service. I guess that would be a form of decentralization, in that, no matter where a dentist lives, they can work directly with NIHB and clients can have that direct access.

Also, we provide coverage of travel costs to access dental services when not provided in the community or in a residence. Again, it's trying to make sure that, no matter where a person lives, they are fully able to access care regardless of their location.

Maybe you can talk a bit about the decentralization in general, Scott.

[Scott Doidge]

Sure.

With respect to service providers, we watch our provider enrolment numbers very carefully to make sure we're not losing providers. For example, with dentists, over the last five years we've actually had a 12% increase in the number of dentists who are actively providing services, so these aren't just dental offices that register just in case they see an indigenous patient. These are active service providers.

With respect to some of the concerns you—

[Marilène Gill, Bloc, Manicouagan, QC]

Sorry to cut you off, but I just want to clarify something here.

You said the number of participating dentists had gone up. While that may be true in urban areas, the number of dentists has not increased where I'm from, a remote region. Things always have to be adjusted to account for remote areas, and I wanted to point that out. The numbers may be positive in some places, but that really has no impact on places that only have one dentist. I'm not even talking about remote communities, because they don't have any dentists, and people there have to travel 200, 300 and sometimes 400 kilometres to see a dentist.

Sorry to have cut you off. You can continue.

[Scott Doidge]

When it comes to those types of situations—and thank you for clarifying—we do our best to provide contract dental services, whether through contract dentists or hygienists, in order to try to get their services into the community. That is the number one priority, and a lot of our expenditures in dental are really geared towards that.

We're always open to trying to devise ways to improve how we can deliver those types of services, because the fee-for-service business model, where people have to leave their community, is really not optimal. Certainly, we're open to any and all feedback to try to improve that service.

[Marilène Gill, Bloc, Manicouagan, QC]

I had asked about decentralization. What about that? I realize that it's not a short-term solution, but are you open to the idea since the Assembly of First Nations Quebec–Labrador is telling you that the model isn't working, that it strongly recommends a different model or even a return to the old one, with improvements of course? That is something first nations, themselves, are calling for.

[Valerie Gideon]

I was just going to say this.

We have been working for several years with the First Nations of Quebec and Labrador Health and Social Services Commission on a governance project so that first nations can take over all of our department's services in the area of health and social services.

At the national level, the centralization of dental care has allowed us to meet standards consistently across the country. Previously, there were regional offices where payments could sometimes be 12 weeks late. The only way to deal with the capacity issue in our regional offices was to centralize administrative services and better support the 15,000 dentists registered in the program.

[Marilène Gill, Bloc, Manicouagan, QC]

Was an assessment done to see if there were places where it was not going well? I've had people tell me that things were working well before the change, but things got worse after the change. You're helping someone, but at the same time you may be hurting someone else.

[Valerie Gideon]

Our last evaluation was in 2015. By the way, we have started a new evaluation process, which will run until 2017 or 2018. We will then have an overview of the situation and ask this specific question.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

I might add this, which I think Val touched on briefly. As you know, in my mandate letter I am mandated to create codeveloped health legislation with indigenous communities and/or regions, and that is a form of decentralization that's working extremely well, if you look at B.C. and the First Nations Health Authority.

Increasingly, self-government is proving to be a way of decentralization that is meeting indigenous people's needs, so that's an exciting piece of work coming.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Gill.

Ms. Idlout, you have the floor for six minutes.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

Thank you.

I welcome you to this. I've enjoyed the presentation. It's informative.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Mr. Chair, we're not getting the interpretation, so I can't hear the question. I'm sorry.

[The Chair, Liberal, Marc Garneau]

Okay.

As we said, it takes a little while to get the interpretation. Let's go ahead and wait. Be patient.

Go ahead, Ms. Idlout.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

I welcome you to this very informative presentation.

I have a question about traditional healers. They are life counsellors and, most often, a lifeline. How do you recognize and validate the important work they do in the community?

If you can let us know how you can further assist traditional healers in doing their work, would you let me know now?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Thank you very much.

I'm sorry for the confusion at the beginning.

Increasingly, people across the country are talking about the value of traditional healers. That's why we've moved to be able to compensate traditional healers for their work.

I will turn to Val to talk about how traditional healers are selected and how they're recognized.

[Valerie Gideon]

In 2017, through the non-insured health benefits program, we were able to access funding for the first time to support first nations and Inuit to include traditional healing services. They manage those services, so they identify their traditional healers, they compensate them and they support the services. The government does not do that directly. For example, IRC, the Inuvialuit Regional Corporation is funded to provide those services.

We also offer services through the Indian residential schools health support program. Again, there are many northern residents who access that program.

For traditional healing services, we do not recognize them or certify them or anything. We usually receive a letter or a note from the Inuit or the first nation community organization that advises that this traditional healer or this cultural practitioner is recognized or is part of their services.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

I would like to have in writing what is available and who those resources and counsellors are who are listed as your traditional counsellors. You say that the Inuvialuit Regional Corporation has a list of traditional counsellors. It would be very helpful to have the list. Thank you.

Secondly, I want to ask you about people who go on medical travel. What are the agreements when it comes to medical travel?

I have heard of an elder by the name of Raymond Ningeocheak. Many people know him in Nunavut. He was at the Embassy West in Ottawa, suffering from dementia. The doctors had said that they could not bring him back home because they had no specialized caregivers for his condition. The family petitioned to have him brought home for his last days. They identified caregivers within the family who would look after him, with a schedule. They provided all that, but the doctors kept refusing the family, so the family members fundraised over $20,000 to have a charter bring him back home for his final days. He went home.

Now we know he is happy. He has good caregivers in the family. It shows us and the medical people that an elder who was unhappy and removed from his homeland into a foreign land can survive in his own home environment.

How can we make it understood that we, too, are capable of looking after our own elderly and sick if they are homesick for their homeland in their final days?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

First of all, what a touching story. It's one I've heard all across the country from indigenous people. Many indigenous communities are trying to adjust to increasingly more local elder care, whether it's the creation of long-term care homes, which many communities are working on, or more supports for active at-home aging, which many people would prefer than long-term care homes. We have to do better for elders across the country, and I would agree with you. You're raising a really important point.

Maybe Scott can speak about the specific topic, but from my perspective, as minister, you're right. The evidence has shown over decades that the closer people are to family and home as they age, the happier and more content they are, and their quality of life is much better. That actually matters.

I think we can do more in this space, and I look forward to working with you on that. I would also like to turn to Val or Scott, if they have anything to say about this specific situation.

[The Chair, Liberal, Marc Garneau]

Ms. Gideon, go ahead very quickly, please.

[Valerie Gideon]

The Government of Nunavut makes the direct decisions around the coverage, but we pay the cost of that. We do have a partnership table with them, so we can talk about this situation in collaboration with them.

On long-term care, we do have a mandate, since 2019, to work with first nations and Inuit to develop options together for a better continuum of care services, including long-term care, not just at the level of specialized services but more for this community approach.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

We have time to start a second round at this point.

Mr. Schmale, you have five minutes.

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

Thank you very much, Chair.

Good afternoon, witnesses. I apologize for not being there in person, but I do appreciate your testimony and contribution here nonetheless.

Minister, during our last meeting, we heard from three witnesses when we were conducting our study. One was a Plains Cree family physician, one was the president-elect of the Canadian Medical Association, and the other was the vice-president of the Indigenous Physicians Association of Canada. Each one of those individuals talked about the crippling bureaucracy that is slowing the care of individuals in their community.

Were you aware of this situation? Have you heard this before?