Evidence of meeting #18 for Indigenous and Northern Affairs in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was care.
A video is available from Parliament.
1:50 p.m.
NDP
Lori Idlout NDP Nunavut, NU
[Member spoke in Inuktitut, interpreted as follows:]
Very quickly, I have another question.
Is AFN also looking at Inuit issues, or do you look after Inuit people in your region?
1:50 p.m.
Liberal
Patty Hajdu Liberal Thunder Bay—Superior North, ON
I would imagine not specifically.... We will make sure, though, through the new policy that's been approved by ITK, that ITK is, of course, fully consulted.
On the compensation for medical escorts, I know, and probably some MPs know more than I do, that there is a new benefit through employment insurance for caregiving of a very sick family member. That was something that our Liberal government introduced and passed a number of years ago. It's something to flag for escorts, that there is some provision of care through EI. Unfortunately, it wouldn't apply if the person was not employed, but there is a benefit for employed individuals losing access to income as a result of the severe illness of a family member.
1:55 p.m.
Liberal
The Chair Liberal Marc Garneau
Thank you, Ms. Idlout.
Colleagues, we have only a few minutes left, and I would like to finish the round.
I would ask the Conservatives and then the Liberals to limit their questions to a two-minute period, please.
If that's possible, then I have Mr. Vidal...or maybe it's Mr. Shields.
You have two minutes.
1:55 p.m.
Conservative
Martin Shields Conservative Bow River, AB
Thank you, Mr. Chair. It's Mr. Shields.
I have a quick question, in the sense of establishing the dental fee for services for social determinants.
Are those established by province? I know the fee scale for dental in Alberta. Is it the same fee schedule for indigenous services as it is for others? Do you adopt the dental fee-for-service scales?
1:55 p.m.
Director General, Non-Insured Health Benefits Directorate, First Nations and Inuit Health Branch, Department of Indigenous Services
We have a fee schedule that we've developed ourselves. It is based on every provincial dental association's fee guide. We work within that fee guide in terms of reimbursing restorative and preventative services. We pay a range of between 85% and 100% of the fee guide. It's something that's set by the provincial dental associations.
1:55 p.m.
Conservative
Martin Shields Conservative Bow River, AB
It's between 85% to 100%. Why don't you just adopt it directly?
1:55 p.m.
Director General, Non-Insured Health Benefits Directorate, First Nations and Inuit Health Branch, Department of Indigenous Services
It depends on the nature of the service that's being offered. We try to reflect the fees that are paid through private insurance as well as provincial programs.
1:55 p.m.
Conservative
Martin Shields Conservative Bow River, AB
I understand that, but there is a severe mistrust in the indigenous population because of that variation. Do you understand that mistrust is there as to why they are treated differently?
1:55 p.m.
Director General, Non-Insured Health Benefits Directorate, First Nations and Inuit Health Branch, Department of Indigenous Services
It's certainly something that we hear about, and we've made a lot of investments over the last few years to make sure that our fees are competitive. We work with every association to deal with those issues.
1:55 p.m.
Conservative
Martin Shields Conservative Bow River, AB
So you are aware.
When we're talking about reconciliation, trust is critical. I don't know why they would trust us to begin with, from what we've attempted to do to them. When you have a differentiation, do you understand how hard that is to overcome when you continue to have a differentiated scale?
1:55 p.m.
Liberal
Patty Hajdu Liberal Thunder Bay—Superior North, ON
Maybe I can respond, Mr. Shields.
I take it, from the nature of your question, that you will be supporting budget 2022, unlike the many other budgets that the Conservatives have voted against. That's how we get to a place where we can provide equity, by continuing to make ambitious investments in the equal treatment of indigenous people in this country. I'll look forward to watching you vote.
1:55 p.m.
Conservative
1:55 p.m.
Liberal
Vance Badawey Liberal Niagara Centre, ON
Thank you, Mr. Chairman.
Mr. Doidge, I'm going to ask you a specific question. It's something I've been working on over the past few weeks with respect to access to advanced diabetes technologies for indigenous adults who currently have only case-by-case access to advanced glucose monitoring technology through the NIHB program.
In that regard, for example, an indigenous adult who may be eligible to access the Ontario drug benefit program could access advanced glucose monitoring technologies such as flash glucose monitoring. However, if they are not eligible for the public plan nor have any access to a private insurance plan, they would have to be reviewed by the NIHB program before even being considered to have access to this life-changing diabetes technology.
Is this an issue of NIHB not having the funding it needs to improve access to innovative technologies, which many non-indigenous people are already benefiting from?
1:55 p.m.
Liberal
1:55 p.m.
Liberal
Patty Hajdu Liberal Thunder Bay—Superior North, ON
Thanks for the hard question.
The honest answer is, yes, we need additional funds to be able to universally cover that particular medical equipment. I am working on that as we speak. It has undoubtedly been lobbied for by many pharmacists in my riding and across the country.
It is technology that can reduce the burden of illness for people living with diabetes and improve health outcomes. I would argue that it would decrease the burden on our health care systems as well, although that's never the primary reason we would do something.
Let me take that away to continue to work on that. I'll look forward to your support in those efforts.
2 p.m.
Liberal
The Chair Liberal Marc Garneau
Thank you, Mr. Badawey.
With that, I'd like to thank Minister Hajdu and her officials for coming today for this first hour of our afternoon committee. We very much appreciate your opening statement and answering our questions.
With that, colleagues, we're going to suspend momentarily as we prepare for the next panel.
Thank you very much.
2 p.m.
Liberal
The Chair Liberal Marc Garneau
I'll call the meeting to order.
Welcome, everyone, to the second hour of our committee today.
Our panellists this time are Colleen Erickson, board chair of the First Nations Health Authority; with Richard Jock, CEO of the First Nations Health Authority. Second, we have Jessie Messier, interim manager, health services, First Nations of Quebec and Labrador Health and Social Services Commission; as well as Isabelle Verret, adviser, health access services, First Nations of Quebec and Labrador Health and Social Services Commission. In the third group, we have Mr. Carl Dalton, CEO, Nishnawbe Aski mental health and addictions support access program, as well as Orpah McKenzie, director, e-health telemedicine services, Nishnawbe Aski mental health and addictions support access program.
Welcome to our witnesses today. Some are in person, and some are with us virtually.
The way we proceed, as you probably know, is that each group will have five minutes to speak in the order in which I named them, and that will be followed by a question period.
If you're ready, either Ms. Erickson or Mr. Jock, you have the floor for five minutes.
2:05 p.m.
Colleen Erickson Board Chair, First Nations Health Authority
Greetings.
My name is Colleen Erickson, and I am Dakelh from the Nak'azdli, which is in the north region. I am also honoured to serve as the chair of the board of the First Nations Health Authority.
I would like to start by acknowledging the territory from which I call in this morning, the land of the Squamish, the Musqueam and the Tsleil-Waututh. I would like to thank the people who have endeared themselves to this land since time began for allowing us to conduct this business in their territory.
I'd also like to acknowledge the chair and the members of the standing committee. Thank you for the opportunity to be a witness in the study of the administration and accessibility of indigenous peoples to the non-insured health benefits program.
The First Nations Health Authority—the FNHA—is a health and wellness partner to over 150,000 first nations people and 203 first nations communities across B.C. Alongside our governance partners, the First Nations Health Council and the First Nations Health Directors Association, we work together towards our shared vision of healthy, self-determining and vibrant B.C. first nations children, families and communities.
In 2013, the FNHA entered into a historic agreement with Health Canada to assume responsibility for delivering health benefits. During the following five years, the FNHA established new partnerships and engaged extensively with communities to redesign the benefits plan. The new wellness-centred plan focuses on removing barriers to accessing care while supporting our most vulnerable clients. The plan reflects the needs and the priorities of first nations in B.C. and supports self-determination.
Historic mistreatment of first nations people in Canada has resulted in generations of trauma, racism and unequal access to health care services. While status first nations people across Canada have access to basic health benefits, we believe that the policies and funding levels perpetuate health inequities. These challenges are further exacerbated by anti-indigenous racism that exists in the health system.
Part of our goal was to eliminate health disparities, and I will now invite our chief executive officer, Richard Jock, to speak about the changes we have implemented to our benefits plan as a result of our extensive community consultations and where we are going next in our transformation journey.
Thank you.
2:05 p.m.
Richard Jock Chief Executive Officer, First Nations Health Authority
Thank you, Colleen.
Part of our submission is a brief that we have submitted to the committee. It gives a fair amount of detail about our delivery of the health services that we call first nations health benefits, which are known nationally as non-insured health benefits.
One of the things I want to comment on in the short amount of time we have left is that partnership has been a key operative term and an approach we've used throughout our work over the past eight years. For example, we partnered with communities as an important way to drive the work going forward. Similarly, we partnered with B.C. PharmaCare to create a new drug plan and a mechanism for delivering services very effectively. We used our experience there to engage further with communities on the development of an involved dental plan, which has yielded a lot of benefits and success within the first nations community and population.
We've also transformed our service delivery system from manual systems to electric systems and have included ways not only to access services in a more seamless way, to be clear and transparent about it, but also to provide quicker access and repayment where needed.
We still have work to do in the area of medical transportation which, I would say, is our next challenge. As I say, we will do that in partnership with a client-centred approach that measures satisfaction and provides continuous quality improvement as a key principle.
Thank you.
2:10 p.m.
Liberal
The Chair Liberal Marc Garneau
Thank you very much, Mr. Jock.
We'll now turn to our second group of witnesses.
Jessie Messier and Isabelle Verret, I'm not sure which one of you will speak or if both of you will, but you have five minutes.
2:10 p.m.
Jessie Messier Interim Manager, Health Services, First Nations of Quebec and Labrador Health and Social Services Commission
Good afternoon.
First of all, I would like to acknowledge the unceded territories we are on.
We thank the members of the committee for allowing us to outline the issues related to the administration of the non‑insured health benefits program and access by first nations to this program.
My name is Jessie Messier. I am non‑native, and I am the interim manager of health services with the First Nations of Quebec and Labrador Health and Social Services Commission. With me today is Isabelle Verret, who is Wendat, and who is the advisor for health access services for the same organization.
We'll begin by highlighting the complexity of the processes for accessing program services. Indeed, these processes don't take into account the realities or the real needs of first nations.
The administrative burden required to provide access to non‑insured health benefits, or NIHB, has frustrated professionals, who view it as a significant overload of work. In recent years, many professionals have decided to stop working with the program, leaving patients to pay for services and seek reimbursement on their own. Sometimes it can take several weeks between the request for pre‑approval for a service and the response from the program indicating whether the request is accepted or refused. This reality is of great concern, especially for remote and isolated areas where the number of professionals located close to the community is limited.
The lack of awareness by professionals and first nations of the program's services is an additional barrier to access. All eligibility criteria for services and treatments are not transmitted, which is a major barrier for professionals who must determine the best treatment plan for their patients. This issue creates unacceptable delays for patients and professionals, who must take specific steps to have some of these services covered by the program.
This reality can have a significant impact on the health of our populations. As a result, the program forces first nations to justify certain medical treatments that are available to the vast majority of Canadians. This contributes to the continued systemic discrimination against first nations in the health care system.
In order to improve the knowledge of program professionals and the accessibility of services for patients, several strategies should be put forward. For example, information on the realities of first nations and the specifics of the services offered to them should be included in university training programs as well as in training offered in the provincial health system. Eligibility criteria should also be communicated openly to professionals working with this clientele.
Better support, adapted to the local reality of first nations, would increase access to services for a population with urgent health needs, given, among other things, the prevalence of chronic diseases.
Further complicating access to the program is the fact that the management of the various program services is shared between the NIHB national office and the NIHB regional office.
In recent years, the administration of some services that were previously managed regionally has been centralized in Ottawa. We note that this centralization has distorted the collaboration and communication that existed between the regional administration, the communities, the beneficiaries and the service providers. The adapted approach, the proximity and the relationship of trust that were established facilitated better access to services and minimized the effects of several administrative difficulties. Regional management also provided a better understanding of the specific needs of first nations at the local level.
The support and accompaniment provided to suppliers is now diluted in a uniform national approach that is rigid in relation to our reality in Quebec. While we understand that the goal of centralization was to better manage federal government resources, in reality, this has created significant challenges, including delays in authorization and reimbursement for services. It is essential that quality control mechanisms be established and closely monitored, all in cooperation with first nations.
As is the case with many programs and services for first nations, the NIHB program operates at the margins of programs established by provincial governments and is implemented without any real alignment.
First nations' eligibility for some provincial programs is often ambiguous and inconsistent across provinces and territories in Canada. Flexibility in access to the NIHB Program would allow for services that are tailored and complementary to what is offered by provincial and territorial governments.
The issue of responsibility for payment of services is also an issue we would like to draw your attention to. The NIHB program requires first nations to approach private or government insurance programs in advance of any application to the federal government. In addition to causing significant and unreasonable delays, this can be very complex for individuals who are not familiar with this type of approach or for whom English or French is not the first language.
The elements we are bringing to your attention today are just concrete examples of the many challenges first nations face when accessing services under the NIHB program.
It is essential that the work begun in 2014 as part of the joint review of the program continue in partnership with first nations to find concrete and sustainable solutions. Until then, the federal government must ensure that first nations are kept at the heart of any decision affecting the management of and access to the program.