Indigenous and Northern Affairs Committee on May 6th, 2022

[The Chair, Liberal, Marc Garneau]

Good afternoon.

I call the meeting to order.

Welcome to meeting number 18 of the Standing Committee on Indigenous and Northern Affairs.

We are gathered here today on the unceded territory of the Algonquin Anishinabe nation.

Today, we are continuing our third study, which focuses on the administration of the non-insured health benefits program and its accessibility to indigenous peoples.

On our first panel, we'll be hearing from the Honourable Patty Hajdu, Minister of Indigenous Services, and officials from the Department of Indigenous Services and the Department of Crown-Indigenous Relations and Northern Affairs.

Keep in mind the Board of Internal Economy's guidelines for physical distancing and mask use.

To ensure an orderly meeting, I would also like to outline a few rules to follow.

Members or witnesses may speak in the official language of their choice. Interpretation services in English, French and Inuktitut are available for the first part of today's meeting. Please be patient with the interpretation. There may be a delay, especially since the Inuktitut has to be translated into English first before it can be translated into French, and vice versa.

The interpretation button is found at the bottom of your screen, in either English or French or Inuktitut. If interpretation is lost, please inform me immediately, and we'll ensure interpretation is properly restored. The “raise hand” feature at the bottom of the screen can be used at any time if you wish to speak or to alert the chair.

Before speaking, please wait until I recognize you by name. If you are on the video conference, please click on the microphone icon to unmute yourself. For those in the room, your microphone will be controlled as normal by the proceedings and verification officer. When speaking, please speak slowly and clearly. When you're not speaking, please put your mike on mute. As a reminder, all comments should be addressed through the chair.

Colleagues, all of you know the standard procedures for these meetings.

We are about to hear from Minister Hajdu. Minister Hajdu has requested to speak for eight minutes. As you know, our routine motions normally limit this to five minutes. I understand that Ms. Gill and Ms. Idlout are fine with eight minutes.

I'd like to ask the Conservatives whether they're okay with eight minutes.

[The Clerk of the Committee, Ms. Vanessa Davies]

Mr. Vidal indicated that the Conservatives are fine with that, sir.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

With that, I'll turn the microphone over to Minister Hajdu.

You have the floor for eight minutes, Minister.

[Patty Hajdu, Liberal, Minister of Indigenous Services]

Thank you very much, Mr. Chair, and thank you to my colleagues for giving me a bit of time.

Kwe Kwe. Tansi.Unnusakkut. Good morning.

I, too, am on the traditional and unceded territory of the Algonquin Anishinabe people today, but from the traditional Robinson-Superior Treaty area, and I'm very happy to be here.

I think that, first of all, in this conversation it's our duty for all of us to acknowledge that colonization, through displacement, discrimination and systemic racism, has caused immense intergenerational trauma for indigenous peoples and has perpetuated inequities in the determinants of health and well-being.

In line with Canada’s commitments under the UN Declaration on the Rights of Indigenous Peoples and the Truth and Reconciliation calls to action, addressing health inequities is a key priority for Indigenous Services Canada.

To “reconcile” means that we must move forward on, importantly, equality, truth and self-determination, and on services that are designed by and for indigenous peoples, with sufficient funding and supports in place for people to access them. We need to do better, because health care is a right for all Canadians.

We recognize the strength of indigenous peoples, families, youth and communities who have been pushing governments to find a holistic, distinctions-based approach that will improve access and culturally relevant, trauma-informed and community-based services. We know that there is still much work to do together. The federal government cannot act alone in implementing all the changes necessary. Through conversations with indigenous partners and the provinces and territories, however, we can chart a path forward to better serve indigenous, Inuit and Métis communities across the country.

The non-insured health benefits program administered by Indigenous Services Canada is one area where considerable work has been done to address these inequities. The program provides first nations and Inuit with health benefits that are not covered by provinces and territories, including things like prescriptions and over-the-counter drugs, dental and vision care, medical supports and equipment, mental health counselling and transportation to access health care services that are not available locally, regardless of where clients live in Canada. These benefits are different from other private or public health insurance programs because they're not income-tested and there are no copayments or deductibles.

The NIHB pharmacy benefit is one of the largest publicly funded drug plans in the country, and it's guided by three expert advisory committees of highly qualified health professionals who provide impartial and practical expert medical advice.

In partnership with the Assembly of First Nations, we're working to review the NIHB program. It provided partners an opportunity to identify and address gaps in benefits and streamline service delivery to be more responsive to client needs, and this collaborative work has resulted in tangible changes, such as additional supports for expectant mothers so that they don't have to travel alone if they need to travel outside of their communities to deliver their babies.

The NIHB program also engages regularly with the Inuit Tapiriit Kanatami to discuss Inuit-specific issues.

With the signing of the 2017 Canada-Métis Nation Accord, we have begun to transfer funding for distinctions-based, Métis-specific programming to Métis governments.

As someone who has worked on the issue of mental health and substance use for over two decades, and as someone who regularly hears stories from communities each time I'm on tour, I'm also acutely aware that there is no one single approach or program that will address the varied, complex and interconnected drivers of mental wellness.

The department works closely with first nations, Inuit and Métis partners to improve service delivery, which means supporting increased access to quality, culturally grounded wraparound care, such as Nishnawbe Aski Nation’s choose life program. It means making sure that federally funded programs provide flexible supports to organizations that support people to stay connected to their culture, traditional healing and traditional ways of being. For example, under our government, for the first time, coverage is provided for traditional healer services in support of mental wellness.

We've made significant recent investments to improve mental wellness in indigenous communities, to a total of about $645 million in 2020-21. Budget 2022 proposes to commit an additional $227.6 million over two years for trauma-informed, culturally appropriate and indigenous-led services to improve mental wellness.

These investments included a renewal of essential services, such as crisis lines and mental health and cultural and emotional support to former Indian residential schools and federal day school students and their families, as well as those affected by the issue of missing and murdered indigenous women and girls.

Medical transportation is also essential for rural and isolated communities. While provinces and territories manage the delivery of physician and hospital care, we know that this is not always possible. In 2020 and 2021, NIHB invested $525.7 million in medical transportation. This is about 35.3% of the total NIHB expenditures. This, along with other prenatal supports, ensures that families get the support where they need it.

The NIHB dental program is also universal. That means it covers all eligible first nations and Inuit individuals regardless of age, income or other measures of socio-economic need. Again, recipients don't need to pay deductibles or copayments and have no annual maximum.

In 2016, NIHB established an external advisory committee to support the improvement of oral health outcomes, and we are committed to working with other partners to take best practices as we look to explore dental coverage for all Canadians.

Mental wellness, medical transportation and dental are just three examples of the comprehensive supports provided through NIHB. There is much more work to do, and I'm committed to working together with indigenous leaders and communities to improve services.

I am very pleased that I have Valerie Gideon, the associate deputy minister, and Scott Doidge, director general, non-insured health benefits, in the room with me. As well, Dr. Evan Adams, deputy chief medical officer of public health, whom you heard from earlier this week, and Keith Conn, assistant deputy minister, first nations and Inuit health branch, are on video. They will help me in responding to your questions.

Meegwetch. Nakurmiik. Marci. Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you very much, Minister.

We'll now proceed with the first round of questions, beginning with Mr. Vidal.

Mr. Vidal, you have six minutes.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you, Mr. Chair.

Thank you, Minister, for being with us again today and for talking about some of these very important issues.

Minister, as you talked about in your comments, and as I think you're fully aware—you were out in Saskatchewan a few weeks ago—in my riding people travel great distances to access medical services to attend appointments. You talked about medical travel in your comments. There are a lot of people who rely on that in my riding in very significant ways. Because of the great distances, they are often hours and hours away from these appointments. In the last few weeks, on multiple occasions, I've heard from people who operate the medical taxi companies about how they're struggling with the increased costs of things like fuel. Those are exaggerated, obviously, in a remote location and with the distances. I see my colleague from the Bloc nodding, as we shared some common questions today in question period about remoteness. These are a lifeline for many of these people. If the medical taxi companies can't survive the increasing costs, that creates a whole new issue for us.

We heard from the vice-chief of the FSIN the other day about the ongoing reviews. We referenced them today as well. I'm curious as to whether there is anything going on in that process in the context of this medical taxi service. Is there some review that creates a fee that adjusts with fuel prices or anything that would help these businesses survive?

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

Thank you very much, MP Vidal.

I'll generally say that inflation is top of mind right now for Indigenous Services Canada, not just with respect to this aspect of medical care but certainly with respect also to infrastructure development and many other aspects the department supports.

Maybe I can turn to Val or Scott to answer these questions specifically.

[Valerie Gideon, Associate Deputy Minister, Department of Indigenous Services]

I'll start, and then I'll invite Scott to add briefly.

To reimburse mileage rates we use the National Joint Council commuting assistance, which actually does take into account cost drivers such as inflation. We are in the process now of doing a review of the medical transportation benefit with the Assembly of First Nations. We made a change last year, for example, by increasing by 25% meal and accommodation rates in response to calls that we hadn't sufficiently increased our rates for a number of years.

I'll invite Scott to speak to anything that's more specific to the medical taxi issue.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

If you could be brief that would be great. I have such limited time and I have lots of questions.

[Scott Doidge, Director General, Non-Insured Health Benefits Directorate, First Nations and Inuit Health Branch, Department of Indigenous Services]

I would have nothing to add then.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Okay, that was brief. Thank you.

Minister, another thing you talked about—and I think you are well aware of the problems with this in my riding—is the challenge of mental health. When I was first elected in 2019, one of the first things I dealt with was a crisis at one of the first nations very close to my community.

One of the things that I hear on the ground when I talk to the leaders in my communities is that they're looking for something as kind of a whole-family approach, rather than an individual approach.

Is that going on through the non-insured health benefits? Is there some openness to some new ideas? Where are we at with that?

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

Thank you for using that example, because there are communities in my riding doing exactly that kind of innovation: recognizing that substance use and mental health issues are actually systemic, community problems, and not so much individual problems. That certainly fits well with an indigenous lens—that holistic lens of community wellness. Yes, there is flexibility for programs designed and delivered by indigenous people.

I referenced the choose life program in my remarks. This is a youth suicide prevention program that was designed and delivered by the community. With the flexibility of that design, individual communities can adapt it to their needs. Yes, there is flexibility in the funding so communities can provide family and social group...all kinds of alternative approaches.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you.

Mr. Chair, I'm sorry. I didn't start my clock today, so you're going to cut me off at some point. I don't know where I'm at in my questions today.

[The Chair, Liberal, Marc Garneau]

You have a minute and a half.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you. I'll be very quick with my next question.

Minister, you referred to this already, but I want to ask you more directly about it.

If there was an organization with innovative, culturally sensitive ideas, and it wanted to do a pilot project and get some support for those ideas—not just a community-based or family-based thing, but also.... In a lot of our areas, we have to do this regionally as well, because we can't be everywhere. If there are ideas like that, which they want to bring forward, what would the process be?

How hard is it to get the department to do some out-of-the-box thinking on things it's never done before? That's the way I would say this.

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

I'll answer generally and then turn to Val.

It depends on where that community group is. For example, if it's in an urban setting, it can be a bit more challenging. If it's in a first nation or regional community—a tribal council, for example—I think there's quite a bit of flexibility at the department to work quickly on a conceptual idea and then actually implement it on the ground.

Val, do you want to add to that?

[Valerie Gideon]

I would say it's exactly that. Wherever possible, we're finding horizontal ways to work across sectors, so that we can be more flexible in our policy authorities and funding envelopes.

[The Chair, Liberal, Marc Garneau]

Thank you very much, Mr. Vidal.

We'll now go to Mrs. Atwin for six minutes.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you, Mr. Chair.

Thank you, Minister, for being with us today.

I'm speaking from unceded Wolastoqiyik territory here in Oromocto, New Brunswick.

Minister, I want to thank you again for your remarks and your willingness to acknowledge that things have not been perfect up to this point. You're really committed to righting some of the wrongs. It's very refreshing to hear that humility.

You and I both share a passion for mental health and mental wellness. It is Mental Health Week here in Canada, so I'll pick up on a couple of great questions that Mr. Vidal asked. You mentioned traditional counsellors, and it makes me think about the community of Attawapiskat, in particular, when they lost many youth simultaneously. They asked for things like culturally appropriate mental health supports and indigenous-led programming.

Could you talk a bit more about how our government is investing in cultural healers for mental health, and how that has been expanded in the last little while? Thanks so much.

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

I'll try not to eat up most of your time, because you're right. This is an area I'm passionate about.

I think flexibility in the way indigenous people, and even non-indigenous people, can access mental health and substance use supports is critical to moving forward on this very difficult issue. For far too long, governments, including ours, tried to overlay a very western approach on wellness or healing, in particular around substances. It is a very individualistic approach. One-on-one counselling or even 12-step programs—which I know are undoubtedly very helpful for some people—don't have a cultural lens or perspective that can necessarily easily translate in some communities.

As Val said.... We know her as Val; that's how accessible she is. As Val said, working with communities on an innovative approach that will work in their communities is what I think will really be a game-changer, because the many communities I work with in my own riding tell me that substance use and mental health are systemic problems. Think about the people in your life who you've loved and who have suffered. You can send someone away for treatment, but if they come back to exactly the same system, it's very hard for them to stay recovered.

Some communities, like Long Lake 58 in my riding, are doing entire friend group treatment and other group approaches that help the person and others lean on each other in their journey of recovery.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you so much.

In the spirit of talking about some of the other improvements—because that's clearly an improvement that's been made to the NIHB system—what are some of the other areas that have been looked at by the department to make sure it's more user friendly perhaps, or that accessibility piece?

We've had some pretty powerful testimony in our committee so far around this, and some of the areas may still need a focus on improvement. What's been done so far to increase the accessibility of this program?

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

Val, maybe I can turn to you in a moment.

I think the top line I would say is that the department is really leaning into self-determination, autonomy, equity and, of course, honesty. I think using those principles to guide the redesign of programs has helped to shift the trajectory of the department overall.

Scott or Val, maybe you can talk about what that looks like in practice.

[Valerie Gideon]

I can start. I can give you lots of examples.

It's the fact that now every pregnant woman who needs to birth outside of her community has access to an escort. The criteria is no longer limited to a medical need. In dental, we've significantly increased coverage for preventative services, for example, adults having coverage for fluoride treatments. Before it used to be limited more to children. We've removed a number of pre-approval requirements for a number of our pharmaceutical and medical supplies and equipment categories.

We have information that's publicly available around all of the improvements we've made through the joint review process we had with the Assembly of First Nations. I believe you're going to hear from one of our core committee members who's been part of that process through the First Nations of Quebec and Labrador Health and Social Services Commission. There are gender affirmation treatments and products, and support for that, removing pre-approval requirements for a number of those.... These are just examples.

I would say that having first nations and Inuit representatives who provide us with feedback very directly has helped us tremendously to improve access, and we're continuing down that path.

[Jenica Atwin, Liberal, Fredericton, NB]

If I could follow up on that, what does that process look like, where you're getting feedback from users of the program? What are the mechanisms for communicating, perhaps a complaint or a suggestion?

[Valerie Gideon]

We started out with a chiefs assembly resolution, which is pretty powerful, and then a Minister of Health commitment to actually undertake the review process. We went benefit by benefit.

We funded the Assembly of First Nations to coordinate the process. They identified regional representatives and NIHB navigators. We have over 30 NIHB navigators who are first nations- or Inuit-employed, who are working directly with clients and then coming back and giving us that feedback.

These are examples of how we have a very active network of first nations and Inuit—client representatives, really—coming to us for those service improvements.