Indigenous and Northern Affairs Committee on May 6th, 2022

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

Not having heard their testimony, it's a bit general for me to comment on that. However, I will say that the department is working right now to eliminate the layers of bureaucracy and to move more quickly to self-determined models of care that will go a long way in reducing some of the bureaucratic hurdles.

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

In some of the testimony we heard, we heard of physicians trying to beg whoever was on the phone from the program to approve certain levels of treatment that would most likely have been easily passed through any other existing system, such as a provincial system or what have you. There was even one story that Dr. Makokis talked about, where he had to threaten the department itself with bad media coverage in order to get the treatment his patient needed and deserved.

Can you also tell us about some concrete steps you're taking to maybe improve training, or how the department is speeding this up?

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

I will turn to Val to talk about the training, but streamlining the process of payments for providers for Express Scripts and access to benefits like dental care and vision care is a top priority for the department.

Val, maybe you can talk about, from a practical perspective, what that means with individual employees.

[Valerie Gideon]

We did implement a mandatory culturally competent training policy in 2020 for all employees in the department. A couple of years ago, within the first nations and Inuit health branch, where NIHB is housed, we also implemented an aboriginal peoples employment program, as it was called at the time.

We asked all areas of the branch to identify positions that would be targeted specifically for indigenous employees on the basis of the need for cultural competency in those particular jobs, or if they were offering direct service, partnering or liaising with first nations and Métis communities or clients. We implemented a number of improvements.

On the NIHB side, we also have removed a number of prior approvals on pharmaceuticals or medical supplies and equipment that relate to the health conditions that were raised specifically by Dr. Makokis. For example, with respect to HIV treatments, these are considered open benefits, and we now have no need for a predetermination for a number of pharmaceuticals or products relating to gender-affirming supports.

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

Do you know how many indigenous individuals, either the total or the percentage, are working within this program or at least are taking the calls from indigenous physicians or health care providers?

[Scott Doidge]

I don't have the exact number. It's something that we could provide.

I would also note the composition of the expert committees the minister referenced in her speech. Many of those members are practising indigenous physicians, dentists and folks who would provide us with advice around medical supplies and equipment.

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

Thank you.

[Scott Doidge]

We can get you those figures.

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

Yes. I'm just curious, because I can't remember which witness it was, but one of them did speak about the fact that there were little to no indigenous employees working to take the calls who would understand and who wouldn't ask questions like, “Well, can't you walk?” instead of asking for transportation. Quite troubling situations like that were brought up.

Minister, recently the First Nations Financial Management Board, which I know you know about—it's a top-notch organization supporting economic development for indigenous communities—wrote a letter to the standing committee that we're addressing here today. In that letter, the executive chair summed up the situation, using the example of housing. Mr. Harold Calla said, “While the budget makes significant investments in new housing, it does nothing to change the failed systems for getting homes built nor change the pay-as-you-go systems that support [indigenous] housing.”

Minister, are you tackling the systemic inequalities that keep these indigenous people in poverty, poor health and without adequate housing? Clearly, although the money is nice, I think most people are looking for outcomes.

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

Thank you, Mr. Schmale.

I will say, yes, absolutely. First of all, I also respect the work of the board tremendously and the very practical recommendations. We'll be working with a number of partners to streamline how we get the significant investment in housing out the door as quickly as possible. It is my goal to spend every dollar as quickly as possible, obviously through first nations leadership, to build those homes. This is the top priority for many first nations leaders across the country.

You're absolutely right that it's a critical social determinant of health. In fact, it's so much so that it's deeply connected to outbreaks of COVID, outbreaks of tuberculosis and of course many other health outcomes. It's a priority for me. The department and I have had many conversations already on how we can streamline the process of getting money through the door. I'm working with my ministerial colleagues on that as we speak.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Schmale.

We'll go to Mr. McLeod for five minutes.

[Michael McLeod, Liberal, Northwest Territories, NT]

Thank you, Mr. Chair.

I want to say thank you to the minister and her team for taking the time to talk to us today about this very interesting and very important issue of NIHB.

One of the main concerns about NIHB that I hear from my constituents and from indigenous governments in Northwest Territories is around escorts for medical travel. It seems very inconsistent. Some people qualify and some don't. Some jurisdictions allow for more medical escorts than others. It's not very clear. This point was echoed by Minister Green from GNWT on her presentation to committee at the last meeting.

My first question is this. Is the Government of Canada able to make the changes needed to make the process for getting an escort for medical travel easier and also clearer?

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

Thank you very much.

As you know, we work in partnership with provinces and territories, including Northwest Territories, to augment the cost of medical transport. Absolutely, we have been working on ensuring that people do have escorts, as I think we've talked about—for example, adding the ability for a pregnant mother to have an escort of her choice so that her birthing experience is much improved. Children also are always covered for an escort. There's also coverage for a client to have more than one escort, if needed, for medical or legal reasons. Those are requests that are considered on a case-by-case basis.

Maybe I can turn to you, Scott, to speak about the process of applying for an escort and the areas you see that we could streamline.

[Scott Doidge]

Thanks very much.

Escort travel is certainly something that we know will continue to be a conversation that we need to have, probably through the AFN joint review, when we're able to get back to the business of the medical transportation review. At any point, we are certainly willing to work through our regional offices as well as through first nations partners who administer aspects of non-insured benefits to make sure that the policy framework is clear, well understood and being applied in a consistent manner.

Unfortunately, I don't have good figures to provide to the committee other than to say that we do have high utilization of escorts in NIHB. For example, we had nearly 1,600 mothers who travelled for childbirth, which is—

[Michael McLeod, Liberal, Northwest Territories, NT]

I'm going to interrupt you. I was looking for an answer on how you're going to make it better. You pointed to some of the areas. I appreciate that.

I recently had a friend who had cancer and was very sick. He was sent to Edmonton by air ambulance from Yellowknife. The diagnosis was terminal cancer, and he was then told to travel back on commercial aircraft. He didn't have his shoes or a jacket, because he was medevaced there. We need to be more sensitive when it comes to dealing with people who are so sick that they are brought in on an air ambulance and can barely walk. It was really embarrassing to have to try to find a way to explain that or talk about that.

One of the key ways to improve the medical escorts element is to make the non-insured health benefit more culturally appropriate. In my riding, we have residents and elders in small communities who don't speak English, and a lot of them can't eat or refuse to eat hospital food or western food. They feel very uncomfortable just leaving their community to go to Yellowknife, for example, never mind going south to larger centres like Edmonton.

In what ways is the government able to make NIHB more culturally appropriate?

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

I will say, MP McLeod, that I'm happy to take the specifics of that particular case back to the department, because I share your outrage. That shouldn't have happened to that individual and we would like to look into the case.

You mentioned, for example, translation or personal care. There is coverage for an escort in those situations. A non-medical escort, such as a family member or a person chosen by the client, is covered to accompany them.

It's important when we hear cases like that, and really, for all members of Parliament who hear of cases like that in their constituencies, to bring them to me as the minister or to the department, so that we can follow up to find out what went wrong. I obviously have no specifics about this case, but it shouldn't have happened. Someone shouldn't have been discharged with no shoes and no winter coat and stuck on a plane to travel back without any care. That's unacceptable and we'll get to the bottom of that particular case.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. McLeod.

We'll go to Madame Gill.

You have the floor for two and a half minutes.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

I want to go back to the red tape issue. Obviously, the first nations and Inuit of Quebec have questions about what they see as an archaic way of doing things. I have to say that this has more impact on some communities than others, when we talk about the fax machine, for example, or letters.

Let's take my constituency as an example. There is an area of 400 kilometres without roads, where the post arrives in a very uncertain way. Depending on the time of year, the mail sometimes arrives after three, four, five or six weeks. These are huge waiting times. It is also a region where there is not necessarily a network giving access to the Internet. So you see the difficulty.

The same goes for the language issue. Often, there are professionals who do not want to take these steps because of the administrative burden.

What can you do to address this? On the one hand, there is the language issue, of course. On the other hand, some practices should be adapted to the 21st century, so that people in the communities are not discouraged when it comes to making claims.

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

Those are all very good points, Madame Gill.

I will say that the department makes every effort to be able to communicate in both official languages with providers. I would imagine that there are things like direct deposit that are available to providers, so that we can avoid delays with mail, for example. There are a number of other ways to make sure that people are getting their payments on time.

Mr. Chair, with your permission, I want to amend something I said earlier. I'll leave it to you as to when it is the best time to make that amendment.

On your issue, Madame Gill, it is a commitment of the department that services are available both to client and practitioner in the official languages, as well as multiple choices for how payment is remitted.

[Marilène Gill, Bloc, Manicouagan, QC]

I understand. It's nice in theory, but in practice it doesn't necessarily work for some people. I know some who don't speak either language, so it's very difficult for them. There is also the issue of literacy. Sometimes it is very complex for people, who are not always supported in this process. So I would like us to think about this. Indeed, the situation is very different depending on the communities, territories and age groups.

We want everyone to have access to the program, so it would be a matter of ensuring that this is the case and modulating the program according to people's different needs. There are currently people who can't make it and it's difficult for them. That's what we see in our offices.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Gill.

I noticed that your statement ended with a comment.

Minister Hajdu, can you quickly make that amendment and then we'll carry on?

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

Yes.

In response to MP McLeod's comment about the person discharged without shoes or shirt, I neglected to mention that the hospital in the territory would also have a high degree of responsibility in making sure that the person was cared for.

I will say that it's disappointing to see, at all levels—provincial and municipal governments—people abdicating their responsibility to provide equitable care. That is a perfect example of a situation where a provincial service needs to be reflecting on their treatment of the patients in their care.

[The Chair, Liberal, Marc Garneau]

Thank you.

We'll go to Ms. Idlout now.

Ms. Idlout, you have two and a half minutes.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

Thank you.

My question is about medical escorts.

We hear over and over that Nunavummiut have to go on medical leave, and most of them require medical escorts to travel. They go on a volunteer basis as medical escorts, with no pay. We want to make sure that those essential, much-needed service providers are paid or remunerated for their services. Some of those medical escorts can be gone for a long time, up to a month. They are away from their families and children. They have to take leave from their jobs, and sometimes they lose their jobs when they become medical escorts and they are escorting patients.

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

Thank you very much, MP Idlout.

I think this is a challenge with anyone who has a sick member of their family or a member of their family requiring medical care. It's a challenge for the non-clinical medical support person to have time away from their own daily activities. It's something that I'm sure will come up in the review with the AFN, and we'll make sure that it's flagged.

To my knowledge, medical escorts are not compensated right now. This isn't a unique problem in terms of indigenous communities. We've certainly heard this in non-indigenous communities as well. However, there's a significant pressure when there is an aspect of travel and remoteness that's additional.

We'll flag that for our conversation with the AFN review and certainly follow up with you in the discussion that happens.