Indigenous and Northern Affairs Committee on May 6th, 2022

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Thank you.

Go ahead.

[Colleen Erickson]

I was going to add that one of the things about the FNHA is that we have really comprehensive engagement with our communities. These plans are very much designed by the community and, as we roll them out, the community provides us with very quick and comprehensive feedback as to what's working and what's not working. That enables us to design a plan that serves everybody.

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Thank you both for that.

Ms. Erickson, maybe I could quickly follow up on your last point, speaking to some of the advantages of being able to deliver health care in culturally appropriate and contextually specific areas. Could you please speak a bit more to how you're able to deliver services at the local level in that manner?

[Colleen Erickson]

Again, it goes back to the engagement that's in the community. British Columbia is very diverse in that we have many nations, so there's not one program that will fit everybody. That's what's so unique about our program here in British Columbia. First nations people in B.C. worked very collectively and collaboratively to build the FNHA.

It was many nations getting together, so our engagement pathways were established and it was a very comprehensive process that took many years—I believe it was over 10 years—before the first nations assumed control of their health. Having those comprehensive engagement pathways into the community, people are very much connected to their program and advise us as to how to design programs.

[Richard Jock]

If I could add to that quickly, we have regional offices where we have VPs who are involved with local service delivery aspects. That's not only the input and engagement, but right down to service delivery. We are getting that closer to the ground.

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

To touch on that, as well, we've heard from other witnesses in the study that there have been issues with delays and administrative burdens. How has the FNHA been able to approach issues like that? Has your model been able to address that as well?

[Richard Jock]

I would say there are some key elements. One of them is that the electronic system actually minimizes any delays. The other part of that is that, by clearly following the fee schedule at 100%, the providers have confidence in what they can do. There's not a lot of checking back and forth. They can actually focus on providing service to the client. When the providers are enabled to provide that service, the access results in much more engagement by the providers, so that we don't have the issues of people not wanting to provide services to first nations people, or some of the complications and implications of having people pay up front. I would say there are a number of areas where we do that.

We also have apps for those who have phones and access to computers. People can check their eligibility and actually see what they've been provided. There are those kinds of more forward-looking ways of approaching wellness overall. I think we've put a lot of premium on that and the communication that goes with it.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Weiler.

I'll now give the floor to Mrs. Gill. You have six minutes.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

I'd like to thank all the witnesses who are with us today.

My questions will be mainly for Ms. Messier and Ms. Verret, from the First Nations of Quebec and Labrador Health and Social Services Commission. Of course, a few minutes isn't much time to say everything we'd like to.

Ms. Messier, can you give the committee more recommendations? You talked a lot about management and administration, but you certainly have other priorities that are just as important to you. Indeed, it's possible to do several things at once.

What do you recommend this committee do, on an urgent basis, to facilitate access to the program not only for the first nations of Quebec and Labrador, but ultimately for everyone?

[Jessie Messier]

Thank you for the question.

Several recommendations were made as part of the joint review of the program, which began in 2014.

It is a priority that work continue not only in consultation with first nations, but also in collaboration and partnership with them. First nations communities and various first nations advocacy groups have developed mechanisms to find creative ways to deliver services that are sometimes outside of the program's processes and administrative framework. When it comes to the basket of services available to first nations, the government needs to think about—

I'll slow down. I certainly understood the good advice I got.

[Marilène Gill, Bloc, Manicouagan, QC]

Ms. Messier, if you have anything else to add to your answer, please send it to us later. The committee can take note of it.

[Jessie Messier]

It's a topic of interest and passion.

It's about having some flexibility to allow communities to propose and implement innovative solutions. Whether it's transportation, dental care or other services, there are other ways of delivering services. Sometimes providing a service through the private sector, for example in the transportation sector, can lead to savings in overall costs. So, thinking about a more holistic vision for health and the basket of services could be a way to properly manage the public funds that are provided through the program. Ultimately, it's about recognizing the legitimacy of the communities, which must be at the heart of the thoughts and solutions proposed. That is a central element.

As of today, absolutely no decision, no direction, no change must be implemented within the framework of the NIHB program without first nations having had an opportunity to analyze the impacts on their populations. That is sort of what we deplore, meaning that first nations often find themselves behind decisions that are made unilaterally in the country, without being able to link services together, putting in place safety nets for people who are more vulnerable or thinking about different solutions. This is central to this reflection and to the continued work on improving the program.

There is also a need to ensure that work continues, that information is shared with professionals and that adequate support is provided to patients.

There is a one piece of data that we don't see anywhere: we don't know how many patients will ultimately not get the service. At the First Nations of Quebec and Labrador Health and Social Services Commission, we have exchanges with professionals. We have a liaison officer who provides support to communities in the Quebec region. Many professionals have told us that many patients will forego a service when they are told there are additional fees. However, that information is nowhere to be found.

Earlier, Valerie Gideon mentioned that there were 15,000 dentists enrolled in the program. However, how many of them actually follow the fee schedule for the services provided? They may be registered in the program, but are their services actually accessible to first nations populations?

This absolutely must be taken into account when considering improving the program.

[Marilène Gill, Bloc, Manicouagan, QC]

Ms. Messier, do you have any recommendations for modulation, which I think should be done on a community‑by‑community basis? As you said, each community has its own needs and realities. There is also a big difference between more urban and remote areas. What I hear on the ground is that it is difficult. Service delivery is envisioned in one way, whereas there are many realities.

You also talked about empowerment, but what would you recommend about remote communities? I'm thinking about mail, for example.

[Jessie Messier]

The issue of mail is a good example of how the administration of the program needs to be modernized.

One of the challenges we often see in small communities or in very remote areas is that there are very few professionals to deal with. There are monopolies. There are a number of components of the NIHB program that coexist, particularly when it comes to medical transportation. It allows residents or the local population to travel to obtain care. In return, the program limits this transportation to the nearest professional, who may be a professional charging exorbitant prices for services because they are in a region where, due to a lack of competition, they hold the monopoly. This makes it harder for people to access services.

So I think that communities should be allowed to choose their professionals, even if it means going further for care, and the basket of services that corresponds to their reality. That would certainly be one way of increasing the accessibility of services.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you, Mrs. Gill.

Ms. Idlout, you have six minutes.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

Thank you, Mr. Chairperson.

First, I want to welcome you all. It's very useful information we're hearing, because we also see, when you present before us, how capable we are as aboriginal people in the fields of work that we do.

I think I will ask all of you this, in the order of your presentation. With your experience in the health field and work to date, what recommendations do you have to improve NIHB as they exist today?

[The Chair, Liberal, Marc Garneau]

I suggest we start as Ms. Idlout suggested, with the First Nations Health Authority.

[Richard Jock]

I'll make a few comments, and then I'll ask Colleen to add to that.

One thing that has been really important is to adopt a different approach to designing the system. We've learned through our process that what has worked well for us is when we pick a provider that will then partner with us to design the program. Rather than putting out specifications and program design and having people bid on delivering it, we've had a much more partnered approach to our work with providers. This has yielded a much different product, one that's based on mutual respect and respect for our communities, as well as a desire to provide that service in a culturally safe way.

The other part is that we've worked with our partners to look at the administrative costs. We start with a certain amount, and we adjust it based on our experience. Rather than going hard and cold on the business side, up front, we've worked with businesses to achieve our objectives. We are doing that and using technology, and we look forward to doing a similar approach with medical transportation, which is one of the biggest challenges.

[The Chair, Liberal, Marc Garneau]

Thank you.

Do you want to add anything, Ms. Messier?

[Jessie Messier]

In answering a question from Mrs. Gill earlier, I touched on the whole issue of flexibility. I would add that in order to improve the program overall, there has to be client‑centred thinking.

It's important to ensure that every step is taken to facilitate the patient's experience within the system, whether it's an administrative step, a request for justification or any step that facilitates the relationship between the patient and the professional. It's important to understand that it's very difficult for a patient to have to ask their health care professionals for justifications, especially when you consider the history of first nations and all the discrimination their members have experienced in the various health systems.

So it's important to ensure that each step is taken in the sincere interest of patients and in a way that promotes their well‑being.

[The Chair, Liberal, Marc Garneau]

Thank you.

Ms. McKenzie or Mr. Dalton, would you care to reply to Ms. Idlout's question?

[Carl Dalton]

Can we please get another summary of the question, as we both missed it? Our earpieces weren't operational.

[The Chair, Liberal, Marc Garneau]

Ms. Idlout, perhaps you can repeat the question.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

With your experience and work to date, what recommendations do you have to improve NIHB as it exists today? What improvement does it need?