National Defence Committee on Nov. 27th, 2020

As I was saying, I support the comments that Ms. Estabrooks has just made. I completely agree with her analysis.

Since we have less time to address you, I'm going to focus instead on a number of facts that should outrage all Canadians.

In this first crisis, Quebec experienced true “age-icide”. I use that word deliberately, because that is really what it is all about, in my opinion. In Quebec, 10% of people living in a CHSLD died during the first wave. In Ontario it was 2.3% and in British Columbia it was 0.6%. Of all the European countries, only Spain has figures somewhat similar to ours. In that country, 5.3% of people living in long-term care facilities died from COVID-19. The death toll was twice that in Quebec.

Why did Quebec experience such a massacre? Several reasons can be cited. I will list some of them, so that what Quebec went through never happens again, in this province or elsewhere.

It became clear that in Quebec, living conditions in facilities like CHSLDs had been neglected over the past three decades. First, CHSLD management and governance have been completely “swallowed up” by much larger health care facilities. As early as 2003, the boards of directors and executive management of CHSLDs were eliminated, and CHSLDs were merged with hospitals and local community service centres in all Quebec communities. This first major reform in 2003 caused the CHSLDs to lose their own administrative entity.

New structural reforms came in 2015. This is when the integrated health and social services centres, or CISSS, were created. Rehabilitation centres and youth centres were integrated and establishments across an entire region were merged. In Quebec, we therefore ended up with very large groups with several missions: the hospital mission, of course which is still predominant; the frontline services mission; the CHSLD mission; the rehabilitation mission, and that of youth centres.

New Brunswick and Alberta also experienced a major merger of this kind that places the hospital at the centre of institutions and marginalizes the other missions of these huge complexes. We are therefore left with CHSLDs that no longer have their own management. Investigator Yves Benoit, who produced a report on the situation at CHSLD Sainte-Dorothée, says the following: More than five reporting lines stand between the CEO of the Laval CISSS and the managing first responder (coordinator) of CHSLD Ste-Dorothée.

If you count the ministry, that makes six reporting lines. For example, it could take several days or even weeks to submit a problem to hospital management and get a response. A significant loss of agility was having an impact on how these facilities were managed.

Staffing shortages, especially of personal support workers, are the second major problem. Over the past few years, the work of PSWs has been devalued, not only due to inadequate pay, but also, I would argue, because the human element has been removed from what they do. Putting a time limit on each of their tasks has obscured the PSW's role, which is to provide residents with emotional support. The PSW's value lies therein. The quality of the work environment has deteriorated over the last five years, in the wake of the major reforms in 2015. Over half a billion dollars in excess wage insurance, overtime hours and the use of freelance labour show that things have deteriorated.

The third major issue is the deterioration of medical and nursing care. Physicians have been steered towards clinical practice. They have therefore abandoned CHSLD practice. Similarly, nurses have been steered towards hospitals, where greater needs arose. As a result, medical and nursing care in CHSLDs no longer made it possible to monitor patients properly and, above all, to treat them in the event of acute deterioration.

The fourth major reason is facilities are obsolete. Some facilities have multi-bed rooms, shared bathrooms, or ventilation and air conditioning problems, and some do not have a spare room to provide end-of-life care or isolation rooms for treating infections.

The pandemic has been mismanaged due to the focus on preparing hospitals to receive patients with the virus and massive transfers to CHSLDs of patients at the end of acute care. Priority was also given to hospitals in terms of infection prevention and control, resulting in a lack of both these in CHSLDs. Staff have been moving freely, and they still are, unfortunately. This has contributed to outbreaks and spreading the virus. Problems arose with availability of equipment, and priority was again given to hospitals. Visits by family caregivers, who provide residents not only with emotional support, but also with necessary, even essential, day-to-day care, were not permitted.

Designation of hot spots came late once outbreaks were under way, and staff could not get tested in those facilities. These oversights led to a major crisis. Imagine if it were 10% of children in schools, 10% of children in daycare centres, 10% of an indigenous community. People would be horrified, everyone would stage un rebellion. However, we had no “Old Age...” or “Old Lives Matter” movement for seniors in the first wave. I fully agree with Ms. Estabrooks that this pandemic brought thinly veiled ageism to the fore.

I'd like to thank the Canadian Armed Forces for coming to help limit the damage of this pandemic in our residential facilities.

Thank you, Madam Chair.

1:15 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much, Professor Hébert.

Now we go to Mr. Richard Shimooka, please.

1:15 p.m.

Richard Shimooka Senior Fellow, Macdonald-Laurier Institute, As an Individual

Thank you for having me at this committee meeting. I really appreciate the opportunity.

My testimony and remarks today are heavily based on my recent report on the post-COVID defence and security environment. I'm a senior fellow at the Macdonald-Laurier Institute—

1:15 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

On a point of order, Madam Chair, we have French coming in over the English channel.

1:15 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Plus, we have no French interpretation.

It's all right now. It's been fixed.

1:15 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

Thank you.

I'm a senior fellow at the Macdonald-Laurier Institute where my focus is international security and strategic and military studies.

In the past year, the COVID-19 pandemic has caused significant dislocations in the Canadian economy, politics and society. If you look into the international sphere, the pandemic has accelerated a number of long-standing trends and introduced several new challenges. Over the past decade, we have witnessed the fragmentation of political, economic and military arrangements that underpin a rules-based international order. The post-Cold War consensus has broken down and, driven in part by the growing conservativeness of national actors in international relations, Russia, China and Iran have rejected or worked to usurp this western-led order.

The fraying of the post-Cold War consensus has occurred among our close allies where populism and nationalism have emerged as powerful and disruptive forces. Their growth is variously blamed on historical lows in public trust of governing institutions, declining economic prospects and rapidly changing societies.

Manifestations include populist leaders such as Viktor Orbán in Hungary or Jair Bolsonaro in Brazil. One of the clearest indications of this emerging era of global power competition is evident in the military sphere. Over the past decade, a dramatic modernization effort has been undertaken by major military powers encompassing increases in funding, reorientations of force structures and the fielding of new capabilities. The breadth of these technological advances arguably sets the period apart from earlier eras, which will affect the fundamental nature of warfare, like with artificial intelligence.

1:20 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Madam Chair, I have a point of order. I am sorry.

The interpreter is doing what she can, but sadly it is too hard to interpret what the witness is saying. Perhaps if he spoke more slowly, it might help our interpreter. She just told me that the sound is choppy and she is doing what she can, but if you want to help her do her job, maybe we could find a way.

1:20 p.m.

The Clerk

Yes, Mr. Brunelle. We're looking into it.

Mr. Shimooka, if you could put your microphone a little bit closer to you, speak more directly into it and little bit more slowly, it might help.

1:20 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

Okay. Thank you.

Collectively, these new technologies have increased the lethality and potential of ways to apply force. Many are vast improvements over existing systems or have no preceding analogue. The technological developments are not strictly limited to military kinetic issues. They also affect our political, economic and social systems such as with cyber-capability. Perhaps one of the most problematic aspects of this emerging military reality is the lack of norms around these new technologies, which may result in greater instability.

The COVID-19 pandemic has further undermined public trust in the governance structures of western states, a fact that is exacerbated by the disinformation campaigns conducted by foreign powers. This is evident in major protests and civil unrest surrounding public health measures and participation in the violent far-right and militias rising in several countries.

Moreover, states' emergency and economic responses to the pandemic have saddled many of them with large debt loads that will require decades of austerity measures to eliminate, thereby limiting their ability to address domestic and foreign challenges. These challenges are particularly key for developing states, which are less well equipped to handle economic and political consequences of the pandemic. They face a weakened global trade system and a growing risk of political fragmentation due to the same forces that are affecting developed states.

In the pandemic's aftermath, many states will adopt a strong domestic focus to rehabilitate their economies and societies. This is evident in Canada's southern neighbour. The incoming Biden administration has already highlighted the immediate need to focus on domestic issues upon entering office. In foreign affairs, the president-elect was clear. He believes that diplomacy is a primary foreign policy tool of the United States, and tends to work through alliances and international institutions. While his administration will likely provide greater leadership than his predecessor's, this means that Canada and other allies will need to shoulder an increasing burden for international security, despite facing the same economic and political challenges as the United States. At the same time, we will be less able to rely on multilateral institutions that have suffered significant legitimacy and credibility issues as a result of the pandemic.

The Canadian Armed Forces are likely to experience greater foreign demands in the coming years, as weak states succumb to centrifugal pressures created by the difficult economic and political environment, and fewer developed states wish to assist in stabilization efforts. The nature of these conflicts poses significant risks for the Canadian Armed Forces. The proliferation of new technologies and capabilities will greatly complicate Canada's ability to intervene as well. The conflict in Nagorno-Karabakh shows how relatively modest unmanned aerial vehicles can have decisive consequences on the battlefield. Particularly concerning is their low cost. Armenia and Azerbaijan are relatively modest economies that could easily afford these novel capabilities.

It is not just low-end conflicts that the Canadian Armed Forces must prepare for. We can observe that China has thus far weathered the pandemic in better condition than most other developed economies, posting a positive growth rate for the rest of this year. Meanwhile, the Russian Federation has continued to play a spoiler role internationally, despite suffering the pandemic's effects. Thus, the challenges of a great power conflict will likely become increasingly acute as the decade wears on.

To respond to these challenges, the Canadian Armed Forces must become increasingly nimble, and nowhere more so than in how it acquires and incorporates these new technologies. The 2017 defence policy white paper, “Strong, Secure, Engaged”, is far too rigid in this age of rapid technological development. Many of these systems require quick, iterative upgrades to maintain their fighting edge, which our government is not well organized to deliver.

The procurement system itself is severely hampered by an overly regulated oversight system that ensures project delays and cost overruns. These issues are exacerbated by the reality that successive governments have seen defence procurement as a vehicle to direct government money into domestic constituencies. This only causes further delays to procurements and eats into the defence budget. The temptation to further exploit defence procurement to these ends will be particularly acute given the clear economic challenges facing the country.

None of this suggests that Canada should act like a global policeman at the outbreak of violence; however, the trajectory of recent international relations, particularly after the pandemic, suggests that the world is becoming increasingly unstable, and that military force may be required to ensure this country's security and prosperity. Canadians must be clear-eyed to the challenges they face, and the country must possess the appropriate tools to address them.

Thank you.

1:25 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much, Mr. Shimooka.

Now we'll have Madam van Beusekom speak.

1:25 p.m.

Michelle van Beusekom Co-Founder, Protect People in Long-Term Care, As an Individual

Thank you, Madam Chair and committee members, for the invitation to speak here today.

I'm a co-founder of Protect People in Long-Term Care, an ad hoc citizens' group that launched a petition on April 7 asking for emergency funding for LTCs, a national coordinated strategy and the implementation of shared standards. To date, our petition has garnered over 98,000 signatures from every province and territory in Canada.

I'm also speaking to you today as someone with a unique lived experience and perspective. Both of my parents live in Grace Manor, one of the five LTCs in Ontario that received military assistance in May.

I'd like to underscore that many of us with loved ones in LTCs saw this tragedy coming. We are intimately familiar with the systemic gaps and failures in this sector. When we saw what was unfolding in Spain and Italy in February, we quickly realized what was coming our way. Chronic understaffing is endemic in this sector. When families and volunteers were locked out on March 13 in many parts of the country, we knew that staff who were already overstretched would quickly become overwhelmed. Our anxiety rose as we learned that LTC staff were having to fight to get access to PPE. We watched in horror as outbreak after outbreak was announced, yet LTCs in many jurisdictions were not being prioritized by their public health authorities for access to testing to ensure the rapid assessment and cohorting of residents.

My parents' LTC in Brampton, Ontario, reported its first case of COVID on April 7. Each day the numbers rose, but they had to wait an agonizing eight days after that first positive case until their public health authority, which was following Ontario Ministry of Health directives, would finally give them access to testing for all residents.

By then it was far too late. In their LTC, with a population of 120 residents and 36 staff, there were 65 resident cases, including both of my parents, and 21 staff cases, which ultimately resulted in 12 deaths, including two staff.

With staff levels so depleted, those remaining were working up to 16 hours a day. The senior administration at Holland Christian Homes, the not-for-profit that runs Grace Manor, reached out to the Province of Ontario and the local health authority for help. They hoped to partner with the two local hospitals in Brampton and to receive redeployed medical staff from those hospitals. When that didn't happen, they asked—as a last resort in an increasingly desperate situation—to be considered for military assistance. On April 24, the Ontario government formally made the request for military assistance on behalf of five homes.

For Grace Manor, that assistance was vital. Half of its staff was gone. The military presence gave remaining core staff the breathing room to recruit, bring in and train new staff and ensure that proper infection control protocols were firmly in place. Military personnel also provided much needed human contact for residents—many of them frail, vulnerable and confused—who, by this point, had been completely cut off from any in-person visits with their families for over a month. My father so appreciated his conversations with the military personnel from places like Nova Scotia and Petawawa. He told me yesterday that it was a good thing they came.

Why did this happen in the first place? Why was military assistance needed? How did it get so bad?

As we've heard today, it got this way after decades of political leaders ignoring dozens of reports that flagged a host of critical systemic issues, such as underfunding, chronic understaffing, poor labour practices, the lack of shared standards of care and training standards, deregulation, privatization and absence of accountability. We had plenty of warning. This catastrophic failure to protect our most vulnerable should not have happened.

Here we are today in the second wave. Over 12,000 people in Canada have lost their lives to COVID. Eighty per cent of all deaths in the first wave were of people living in long-term care—the worst record in all OECD countries. Dozens of long-term care facilities across Canada are once again in outbreak, yet the same struggles with access to testing and rapid cohorting that we saw in the spring continue.

Kat Cizek is one of my co-founders. Her dad lives in Toronto's Lakeside, an LTC currently in outbreak where COVID-positive residents have been left on the same floor as those who have not contracted the virus. Another co-founder—we're only four—is Kitra Cahana. She is seeing staff and resident infections skyrocket at the Maimonides facility in Montreal, where her father lives. Despite this alarming outbreak, the public health authority has not made testing mandatory for staff and visitors.

I don't have words to describe how excruciating it is to watch this again. Despite all we know, all we learned in the first wave and all the studies and policy recommendations, so little has been done to address the root problems that have caused this crisis. We should not be relying on the military for last-resort crisis management in a sector where the problems and the solutions are this well known. This is not a good use of military resources and training. I am sure it has compromised military operations and budgets in many ways to come to the aid of a sector where private operators have continued to reap handsome profits for their shareholders throughout this crisis.

We've begun to see reports of how Operation Laser has impacted the mental health of military personnel who were thrown into an acute-crisis situation in a unique environment that they didn't necessarily understand. Military medical staff are not long-term care specialists. Caring for high-needs elderly, over 80% of whom suffer some form of dementia, is a skilled activity, even if our society does not recognize it as such.

In the throne speech on September 23, the federal government made a commitment to national standards, yet almost 10 weeks later the details and a timeline have not been shared. It is so disheartening to see the jurisdictional bickering that is blocking the groundswell of grassroots support right across this country for national standards. It is imperative that all levels of government come together to fix this broken system.

I am so thankful that the military was there for my parents and for Grace Manor. I never want to see this happen again. This sector needs to be properly supported. The long-standing problems need to be addressed. We need concrete action on those national standards. The military has other work they should be doing. Speaking on behalf of the 98,000 who signed our petition, I hope we can count on you to help make that happen.

Thank you.

1:30 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much, Madam van Beusekom.

Colonel Malcolm, I believe you are presenting the opening statement.

1:30 p.m.

Colonel Scott Malcolm Deputy Surgeon General, Canadian Forces Health Services Group Headquarters, Department of National Defence

Yes, Madam Chair. Thank you.

Madam Chair and members of the Standing Committee on National Defence, it is a great honour and privilege to be here today, along with Major Karoline Martin. I thank you for the invitation to discuss elements of the Canadian Forces health services deployment into Ontario's long-term care facilities, supporting Canada's most vulnerable in the midst of the COVID-19 crisis.

As you heard in previous testimony, Operation Laser saw the deployment of hundreds of health services personnel. Nurses, medical technicians, medical assistants, physician assistants and dental personnel all came together to form composite teams known as augmented civilian care teams. As the director of health services operations, I was the architect behind the medical aspects of the plan that saw the augmented civilian care teams deploy into long-term care facilities in Ontario. Major Martin had the distinct pleasure to deploy as the officer commanding the augmented civilian care teams within Ontario.

From April to August, we deployed into seven long-term care facilities with the primary mission and goal of saving Canadian lives. Upon our arrival, we witnessed a sector in crisis. Our clinicians and Canadian Armed Forces personnel immediately mobilized and began to work tirelessly alongside our civilian health partners to stabilize the situation and support not only residents but also the organizations and clinicians we were deployed to support.

Although CAF personnel are not experts within the long-term care sector, we responded to the call during a critical moment in Canadian history. Clinical excellence, compassion and patient advocacy are the cornerstone ethical principles that all Canadian Armed Forces clinicians live by. As such, when concerns regarding the conditions and the standards of practice arose, we as Canadians, as clinicians and as soldiers had a clear duty to report our observations. I'd like to stress that our observations were only a snapshot in time that reflected the realities within the long-term care facilities in which we worked during the early stages of the COVID-19 crisis.

The CAF health services personnel who deployed on Operation Laser are a passionate and dedicated group of clinicians who will always advocate for patient and resident well-being and the provision of high-quality health care to Canadians. It is with this lens of systemic improvement that we graciously accept your questions and queries.

We thank you once again for this opportunity and look forward to your questions.

Thank you, Madam Chair.

1:35 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you, Colonel Malcolm.

Thank you to all the witnesses for keeping your remarks brief. That leaves more time for questions.

We'll start the questioning round.

Mr. Benzen, you have the floor.

1:35 p.m.

Conservative

Bob Benzen Conservative Calgary Heritage, AB

Thank you, Chair.

Thank you to all the witnesses for appearing today. It's really appreciated.

Mr. Shimooka, you mentioned in your opening remarks that we have a new global era of competition, marked by increased modernization of the military and lots of new technical advances.

Can you give us some sense of what other militaries are doing in terms of this modernization and advancement and tell us if the Canadian military is keeping pace with that, and also how COVID-19 may be affecting our ability to do that?

1:35 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

As I stated in my remarks, the nature of the technological development is quite broad. It's not just one or two areas like in previous eras. It's not just, let's say, ICBMs, intercontinental ballistic missiles, or it's not just greater communications. Basically in almost every area of military capability we are seeing some advancement.

That is, in part, driven by something that is generally called the broader technologies, such as AI, which are affecting how all capabilities are starting to operate together with greater connectivity between different military capabilities. You see a much greater focus on network capabilities as well as some very specific and unique capabilities that are narrow in focus, such as hypersonics, which is a significant area of growth in the last decade or so among the United States, China and Russia as well. Russia has recently just deployed several new types of hypersonic weapons on large missiles or carried by airplanes.

In that sense, there are quite a few areas that the Canadian Armed Forces must be aware of. As I said in my remarks, if we look at the Azerbaijan and Armenia conflict just recently, we see that UCAVs were a significant part of that conflict and that really did change what occurred and the outcome. Those capabilities range from very low-cost items that cost several hundred dollars, to extremely expensive, unique capabilities that have very wide effects.

The Canadian Forces are trying to adapt to this capability. I would argue that in many cases the priorities that were laid out, let's say in 2017, may not be as relevant as they are today. One of the best examples, referring back to Nagorno-Karabakh, is the development of new types of air defence systems. I'll give an example in the United States. I believe there are now six or seven ongoing air defence system projects that the U.S. Army is undertaking and implementing into service.

Canada has one program in the defence capability guide. It is the GBAD program, and it is identified for delivery, I believe, in 2026 or 2027. That means, for the next six or seven years, the Canadian Armed Forces will not have a dedicated air defence system to defend against threats that, as we just witnessed, have decisive effects in a conflict and are easily and cheaply available to many different countries.

Does that answer your question? Does that give you a perspective of where this squares up?

1:40 p.m.

Conservative

Bob Benzen Conservative Calgary Heritage, AB

You gave me some sense of what we need to do to modernize. I think you're saying we can't do everything, but we need to pick some niches, some areas.

You mentioned something about waiting until 2026 to get this air defence, and you talked a lot about technological advances and technological products that we're buying now but that aren't being delivered for six, seven, eight or 10 years. By the time we get them, they will already be out of date.

With COVID-19 we've learned that we have to be quick and nimble, and we have to change on the fly. Is there something from COVID-19 that we can take as a lesson to shorten the procurement time to get our products to us quicker?

1:40 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

Absolutely. If we look at the development and the rollout of vaccines internationally, as somebody who watches innovation and development of very high-end military capabilities, I'm utterly astounded. We are literally watching, in front of our eyes, a modern scientific miracle, where we have developed a vaccine from almost scratch in the space of a year and will have it basically rolled out and hopefully put into Canadians' hands or arms, or whatever, in just over a year. That's impressive.

One of the things in observing how government operates, especially during times of crisis, is that a lot of the rules, a lot of the straitjackets that are placed on policy implementation, are quickly removed in order to identify ways that we can be more efficient and quicker to do what's required. In terms of the military capability, I believe there has been quite a bit of process put into the system that has actually prevented the Canadian Armed Forces from getting the equipment they need.

If we're talking about GBAS specifically, I look at other countries that identified the problem of UAVs that provide great threat to their countries. They immediately purchased a system, put an interim system into operation and then looked at the long-term solution. However, in Canada, in a lot of cases, and we can look back to Afghanistan or other operations, I feel that we tend not to actually acquire the capabilities that we need until there's a crisis. At that time, it's the worst time. I'd probably ask some of the military members of this panel right now, if they did not have the capabilities needed, how quickly did they have to scramble to get some of them?

I think that's the case.

1:40 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

Mr. Baker, please.

1:40 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

Thank you very much, Chair.

I'll start by thanking all the witnesses for being here. We have so many wonderful witnesses and I hope we have the time to really have a conversation with each of you and hear from all of you. Rest assured that we'll do our best to ask questions to all of you throughout today's meeting.

First off, in my community of Etobicoke Centre, we lost 42 residents to COVID-19 at the Eatonville Care Centre. This is one of the homes in which the Canadian Armed Forces initially served in Ontario. Therefore, Colonel Malcolm and Major Martin, on behalf of my community, I thank you for your work, for your service and for the service of the men and women who served under your command, for all the work you did and for caring for, and frankly, saving the lives of constituents in my community.

Also, thank you for preparing the report about what you discovered, the horrific conditions in long-term care homes in Ontario and in Quebec. As a result of your report, certainly in Ontario, the five MPs who represented the homes in which you served ended up, in late May, writing to Prime Minister Trudeau and to Premier Ford asking for a number of things, including national standards to be put in place for long-term care. Of course, as was mentioned by Ms. van Beusekom, in the throne speech the government announced that it would be working with the provinces to establish national standards for long-term care.

Your report enabled awareness and transparency, which has led to advocacy, which has led to the government committing to national standards. When we get to those national standards and they are implemented, that will make a difference for seniors for generations to come, so for that, I'm deeply thankful to you and all the men and women who served under your command. Thank you.

My first few questions are for Ms. van Beusekom. Thank you for being here and for your testimony.

What do you believe needs to be done to address the horrific conditions, frankly, and the practices that were identified by the Canadian Armed Forces in long-term care?

I'm really focusing on the long term. I know there's a response that's needed immediately in the context of COVID-19, and I'm not trying to deprioritize that, but I'm curious about what you think needs to be done over the long term.

1:45 p.m.

Co-Founder, Protect People in Long-Term Care, As an Individual

I think Carole Estabrooks has done a ton of work on this. I'm so thankful to all the people who have been working on these issues for decades.

The first one is staffing. As I said in my testimony, this sector has been chronically understaffed for decades. Family and volunteers were the glue that held it together. When they were forced to leave it fell apart. As I also said, it was not a surprise to us. In Ontario, the Registered Nurses' Association of Ontario and others have been advocating for a four-hour minimum of direct patient care per day. That's a really good beginning. We need the staffing levels to be increased. We need proper funding for this sector. We need proper training for PSWs. I was talking to the doctor at Grace Manor yesterday and he asked why Sheridan College and others don't have programs for PSWs in long-term care? It's specialized.

As we've heard in today's testimony, it is a specialized skill to care for older adults with complex needs. We need standards of care, and they need to be the same across the country. B.C. did great. Early in April they increased salaries for people who are chronically underpaid, which made it possible for them to work in just one home. They did really well in testing, but it's so uneven across the country. We really need those national standards. Start with adequate funding and with the staffing ratios. Other things can come in the medium and the longer term, but for now we need to support those core staff. The military came in and that was fantastic, but they don't have the relationships. The most important thing is the relationships with the residents. That's what the core staff have. We need to support those core staff who know the residents, who know what they need so they're not run off their feet.

This has been known for decades. We knew this before COVID. There's no excuse for why this isn't happening now.

1:45 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

I appreciate that very much.

I think I have a little less than a minute and a half remaining in this segment.

Ms. van Beusekom, I'll ask you this question but ask you to answer within about a minute or so, if you can. First of all I should say that MP Sonia Sidhu was the one who recommended that we reach out to you. Thank you for coming today. I wanted to let you know that.

Ms. Sidhu advocated, and you have advocated tremendously, as have others in our caucus and elsewhere outside government, for national standards for long-term care. You alluded to that a moment ago. Can you speak to why those standards need to be established?

1:45 p.m.

Co-Founder, Protect People in Long-Term Care, As an Individual

Yes.

I'm so grateful to Ms. Sidhu. When we launched our petition, we wrote to all kinds of federal and provincial ministers. We got a lot of responses. Member Sidhu was the one person who really engaged with me as a human, and I really appreciate that.

The national standards are so important. Long-term care should come under the Canada Health Act. The needs are complex. People are living to be a lot older. It's not just taking care of people; it's delivering complex medical needs. Canadians should have that same guarantee, that whether you live in Iqaluit, Igloolik, Dawson City, Vancouver, Winnipeg or Whitehorse, you get access to the same standards of care. That should be a principle of our country. Right now as we've heard, it's broken, it's uneven and it's untenable, but we do know how to fix it, thanks to the work of so many people.

1:50 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

Thank you very much.

1:50 p.m.

Liberal

The Chair Liberal Karen McCrimmon

All right. Thank you very much for that.

Mr. Brunelle-Duceppe, you have the floor.

1:50 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Thank you, Madam Chair.

I'd also thank the witnesses who are with us. We're addressing issues that are quite significant. I'd like to extend special thanks to the two members of the Canadian Armed Forces.

I thank you for the help you provided in Quebec.

My first question is for Mr. Hébert.

Good afternoon, Mr. Hébert. Thank you for attending the meeting today.

I'm going to cut to the chase. For decades, federal health transfers to Quebec have been shrinking. It goes without saying that you're aware of this, given that you are a former health minister for that province.

Can you describe the impact of the federal government's backlog in administering health care in Quebec and the provinces as the result of declining health transfers? We must remember that when the legislation first came into force, transfers were at about 50%. Today, they are at about 22% or 23%.

1:50 p.m.

As an Individual

Thank you very much, Mr. Brunelle-Duceppe.

Federal transfers have indeed gone down. What I found most worrisome is that, under the Conservative government, federal transfers were not always evenly distributed. Not only were transfers capped at a certain percentage of gross domestic product, but they were distributed on a per capita basis, regardless of age. Provinces with aging populations, such as Quebec and the Atlantic provinces, found themselves at a disadvantage. It was an equity issue that caused a lot of trouble in those provinces, which had to cope with a more significantly aging population.

What I find more disturbing is how negligently the provinces, particularly Quebec, use the funds. More of this money has gone to hospital services and physicians' salaries than institutional care, and the COVID crisis has made that abundantly clear. Home care has been particularly neglected.

Our Canadian system is really based on hospital care. The system was developed in the 1960s and 1970s when we had a young population, based on medically required hospital care. Now, with an aging population, we really need to look at long-term care, and it's much better to provide long-term care at home. In Quebec and Canada, home care has been neglected over the past 50 years. Compared to other OECD countries, we invest only 14% of public funding in long-term home care, unlike other countries like Denmark, which invests 73% of its budget in long-term home care. We have the lowest marks in the OECD class.

If we had further developed the home care component, we could have avoided some of the massacre we experienced in facilities. If they had had the choice, many people would have stayed at home rather than opting for the institutional solution. I believe things really need to change in Quebec and Canada in this regard.

1:50 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

I want to clarify a few things with you. You agree with me that, with inflation, costs in the health sector have increased enormously and that, on the other side, federal transfers have declined dramatically.

I understand that choices had to be made in managing these funds, but the funding rate is around 22%. The premiers of every province and territory and the premier of Quebec are asking to raise this figure to 35%.

Once the provinces have access to these funds, if the federal government decides to transfer them as it should, do you think it will then be easier for the provinces to do their job?

1:50 p.m.

As an Individual

To me, this issue is that, even with more funding, there would not be more money for institutional and home-based care.

If the past is any guide, the provinces will need to reach an agreement with the federal government in order to set priorities other than hospitals and physician pay and to address the real issues that have been exposed by the COVID crisis, namely, providing high-quality care in institutions, with quality standards, and especially home care. Funding for home care cannot be given to institutions as is currently the case with hospitals. Users must be the focus of public funding decisions.

I believe we need to move toward what several other countries have done, which is long-term care insurance. When I was in the Quebec government, I proposed a form of this insurance. Unfortunately, I ran out of time to implement it. But I think it's essential if we want to provide high-quality care to people.

1:55 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Yes, you did run out of time.

If you were Quebec's minister of health, which is clearly a provincial jurisdiction, and Ottawa was giving you funding on the condition that you use it in a specific way, I imagine you would say to keep the conditions and provide funding instead, which is what is needed to implement this kind of policy.

I assume we agree on this point?

1:55 p.m.

As an Individual

If, within the past few years, Ottawa had announced billions of dollars in funding for home care, the problem I see is that this money wouldn't necessarily go toward home care, but—

1:55 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Yes, I understand that.

1:55 p.m.

As an Individual

—instead to the provinces' priorities, and it would perpetuate a hospital-centric model that results in failing to take care of seniors who are losing their independence, and their numbers are increasing. Quebec will be one of the oldest provinces in barely a decade and one of the oldest societies in the world and that the health care system we have now is not at all suited to that reality, because it addresses people's health care needs using a hospital-based approach that is totally inappropriate.

1:55 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

I understand. So, you disagree with the provinces about asking for larger health transfers—

1:55 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

1:55 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

Thank you, Madam Chair.

I want to thank all of our witnesses for being here today and for the importance of their testimony.

I just want to start off by saying that I agree that this is an issue of ageism. It is absolutely appalling to me that we don't have a meaningful national seniors strategy in Canada. I think of all of the work that has happened in terms of workforce development and a plan to replace our aging population in the workforce, but there has not been a plan put together about how we're going to support seniors as they age in our country. I want to thank everybody for this important testimony.

I will go to you first, Ms. Estabrooks. You talked about the fact that we're not seeing the very important skilled workers in this sector being respected, especially with the appropriate pay. One of the things that I saw in my province of British Columbia as well as across Canada was that a lot of those care workers were working two or three jobs at two, three or four different long-term care facilities, and as soon as the pandemic happened, some of them lost their employment at other places and were trying to manage their everyday life just doing one part-time job. I'm wondering if you could talk about how that has an impact on the services to our seniors.

1:55 p.m.

Professor, University of Alberta, As an Individual

Thank you.

As many as 30% of PSWs and care aides were working more than one job pre-pandemic. About 70% of that group were working for financial reasons, and many of them couldn't make a decent wage. Wages in Canada pre-pandemic ranged from $12 an hour to about $22 or $24. You can't raise a family on $12 an hour. That condition was there although we didn't know it. Some of us knew it because we had samples from certain provinces that told us that, but we as a country really had no idea that this was going on.

The impact was that they were working multiple jobs and, specifically with regard to the pandemic, the more places you work and the more you travel, the more likely you are to spread the disease. It's not through any fault of your own; it's just the more traffic and the more exposure you have, the more it happens. We have put these “one work site” policies in place in many jurisdictions and they have helped, but they are fraught with unintended consequences.

For chains with perhaps 14 homes that are used to moving their staff around to cover shortages, which all of a sudden can't do that, we have seen some really catastrophic shortages and some loosening of the conditions around that policy to accommodate for that. However, the core issue is that if you don't pay a workforce that delivers 90% of the direct care a living wage and you don't make it possible for them to have full-time employment with sick benefits and vacation benefits, then you're going to have both a dispersion through different homes and issues with respect to workers' commitment to the organization they work for. There is a whole trickle-down effect.

I'm not suggesting that on a permanent basis we might want to put a one work site policy in place. The reason people are working more than one job shouldn't be that they can't make a living wage or get sick benefits.

2 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

Thank you. I really appreciate that.

Colonel Malcolm, first of all, I'd like to thank you and of course Major Martin for your service. I'm the lucky MP who represents the 19 Wing Comox. It's amazing. I know how hard you work and how dedicated you are, not only to our work internationally but here in Canada obviously.

I'm just curious as to whether you could answer two questions for me. One of them has to do with the process once the military is called in. How does that roll out? How do you make an assessment of what's happening and respond to it? Of course, you know the military did provide a report. I'm just wondering if you could give us a few recommendations with respect to how we could prevent this from happening again in the future.

2 p.m.

Col Scott Malcolm

Madam Chair, thanks for the opportunity to answer these questions. I'll cover the first one, and then we'll turn the floor to Major Martin, who will be able to speak to the lessons learned, bearing in mind that what we saw there was a snapshot in time, so she will share some of her observations from that moment.

With respect to how the provinces make a request, I will clarify that, as a health services member, it's outside my lane on how that specifically occurs. The process, very generally, occurs through the regional joint task forces, and I know that you've had some of the regional joint task force commanders speak in the past.

In very broad terms, the requests are coordinated from a request from the province itself based on the assessments done by the provincial emergency operations centres in discussions with the regional joint task force commanders. Then a request is sent up through the Minister of Public Safety that comes across to the Minister of National Defence. Based on the requests of the chief of the defence staff, we'll have a look at the availability of forces. Speaking specifically to health services, they would come to the surgeon general to reply as to whether we have forces available to meet those requirements. We would provide the response back to the chief of the defence staff, and then the planning staff would look at our overall ability to respond to that need.

Turning to your second question, I'll turn the floor to Major Martin to speak to the lessons observed in her time working in the long-term care facilities in Ontario.

2 p.m.

Major Karoline Martin Officer Commanding Standards Coy, Chief Standards Officer, Canadian Forces Health Services Training Centre, Department of National Defence

Thank you for the question.

A few themes arose out of the report on our observations, certainly echoing what has been said by other witnesses. Staffing was a huge concern. When we arrived, many of the facilities had as little as 20% staffing, irrespective of what their nursing ratios were pre-pandemic. That made a huge impact on the outcomes of patients.

Second was infection prevention and control and really having that situational awareness of who was positive and who was negative. There were delays with having the results. Sometimes there was a lag of a week or up to 10 days, so by the time you got your results, you no longer had a good situational awareness of where the outbreak was. Also, the IPAC stream has centralized and/or standardized IPAC protocols. We within the CAF had a central IPAC member who provided us that advice, but IPAC was very different among each of the facilities in terms of donning, doffing, what the standard was for PPE, etc.

Finally, there's training. I think when you are looking at a degradation within the health status of a large population, having individuals who are trained in that acute care is paramount.

2 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much for that.

Go ahead, Madam Gallant, please.

November 27th, 2020 / 2 p.m.

Conservative

Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON

Thank you, Madam Chair.

My questions are for Colonel Malcolm.

First of all, what vaccine safeguard protocols are in place for soldiers who receive an experimental vaccine?

2 p.m.

Col Scott Malcolm

Madam Chair, to date there have been no experimental vaccines, to my knowledge, that have been used on Canadian Armed Forces personnel, nor is there any intent to use any experimental vaccines on our Canadian Armed Forces personnel.

2:05 p.m.

Conservative

Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON

Who is responsible for providing financial compensation for soldiers who suffer adverse reactions to a vaccine or this vaccine?

2:05 p.m.

Col Scott Malcolm

Madam Chair, I'm unaware of any claims by serving or former serving CAF members against the use of an experimental vaccine. As I mentioned, to my knowledge there has never been an experimental vaccine used on our force. Therefore, I couldn't comment as to what the compensatory mechanism would be for that.

2:05 p.m.

Conservative

Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON

We did see, with an anti-malarial drug, that our soldiers were among the first in Canada to be dispensed that. It has been quite an uphill battle ensuring that this required inoculation has been adequately compensated for in the instances where they had bad reactions.

Will the government confirm that no military insurance policy will be voided for soldiers who take this COVID vaccine administered by the military?

2:05 p.m.

Col Scott Malcolm

Madam Chair, it would be outside my authorities to make a determination on that, regrettably. It's not a decision that would rest within health services.

2:05 p.m.

Conservative

Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON

Through you, again, Madam Chair, on whose shoulders would that responsibility lie?

2:05 p.m.

Col Scott Malcolm

Madam Chair, regrettably, within my current position as deputy surgeon general, I wouldn't have the answer to that question. I'm not responsible for the insurance plans of our members. I honestly couldn't suggest right now who within the department would be in a position to answer that question.

2:05 p.m.

Conservative

Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON

Thank you.

Once the vaccine is available, it doesn't make a whole lot of sense to vaccinate soldiers but not their families. When can military families expect to receive a safe vaccine?

2:05 p.m.

Col Scott Malcolm

Madam Chair, with respect to the prioritization of the impending COVID-19 vaccines, those prioritizations will first be made at the cabinet level based on expert advice, including from the national advisory committee on immunization. It will be based on those priorities, at which time it will be determined when our Canadian Armed Forces members will be vaccinated. Also prioritized among those, along with all other Canadians, will be the families of our military members.

Thank you.

2:05 p.m.

Conservative

Cheryl Gallant Conservative Renfrew—Nipissing—Pembroke, ON

For the next roto to Latvia, what are the current COVID precautions being taken for soldiers who are headed there?

2:05 p.m.

Col Scott Malcolm

For our troops deploying to Latvia, and for all of our troops deploying, measures are being taken to ensure that our members are not bringing disease into the country nor impacting those being deployed. Those folks are being quarantined in advance of their departure.

We have also been conducting operational testing on our members being deployed overseas to ensure that they are not, as we've termed it, “asymptomatic”, which means being infected with COVID-19 but not demonstrating any symptoms.

Then, of course, the Canadian Armed Forces has led the way in implementing very robust public health measures, including physical distancing, the use of masks, diligent handwashing and also strong recommendations for folks to have the influenza vaccine prior to their deployment, just to eliminate one other type of infection that could impact operations.

2:05 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

Mr. Robillard, you have the floor.

2:05 p.m.

Liberal

Yves Robillard Liberal Marc-Aurèle-Fortin, QC

Thank you, Madam Chair.

Good afternoon to the witnesses.

My first question is for Carole Estabrooks.

Dr. Estabrooks, I'd first of all like to congratulate you on your recent appointment to the Royal Society of Canada.

Because of your expertise in this area, I'd like to hear your views on the role of women and visible minorities in long-term care facilities, particularly as personal support workers or nurses.

2:10 p.m.

Conservative

Terry Dowdall Conservative Simcoe—Grey, ON

I have a point of order, Madam Chair.

I'm hearing both languages at the same time.

2:10 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you. Let's look into that.

Can we try it again, Monsieur Robillard?

2:10 p.m.

Liberal

Yves Robillard Liberal Marc-Aurèle-Fortin, QC

Do I start all over?

2:10 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Madam Estabrooks, I think the question was directed to you.

Were you able to hear the question?

2:10 p.m.

Professor, University of Alberta, As an Individual

No. I only heard about half of it.

2:10 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Then yes, please start all over again.

Thank you.

2:10 p.m.

Liberal

Yves Robillard Liberal Marc-Aurèle-Fortin, QC

Okay.

Good afternoon to the witnesses.

My first question is for Carole Estabrooks.

Is it working properly this time?

2:10 p.m.

Professor, University of Alberta, As an Individual

No.

2:10 p.m.

Conservative

Terry Dowdall Conservative Simcoe—Grey, ON

It's still twice. He has to press his button.

2:10 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

If I may, Madam Chair, in the interpretation options, there's the “mute original audio” function below “French” and “English”.

2:10 p.m.

Professor, University of Alberta, As an Individual

I have the correct one.

2:10 p.m.

Liberal

Yves Robillard Liberal Marc-Aurèle-Fortin, QC

Should I do what Mr. Brunelle-Duceppe is suggesting?

2:10 p.m.

The Clerk

Yes. At the bottom centre of the screen, there's the “interpretation” option.

2:10 p.m.

The Clerk

Choose the “French” option. Under this option, you'll have one that lets you mute.

2:10 p.m.

Liberal

Yves Robillard Liberal Marc-Aurèle-Fortin, QC

Is it working now?

2:10 p.m.

The Clerk

It's working for us. Let's do a test. Say something brief in French.

2:10 p.m.

Liberal

Yves Robillard Liberal Marc-Aurèle-Fortin, QC

I'd like to welcome the witnesses.

I think it's working.

My first question is for Dr. Estabrooks.

First of all, I'd like to congratulate you, Dr. Estabrooks, for your recent appointment to the Royal Society of Canada. Given your expertise in the area, I'd like to hear your opinion about the role of women and visible minorities in long-term care facilities, particularly as personal support workers and nurses.

2:10 p.m.

Professor, University of Alberta, As an Individual

Thank you very much for the question.

Over half of the PSW workforce are immigrants. Over half of the people who are immigrants don't speak English as a first language and sometimes don't speak English well enough to understand it readily in a conversational way. It's a highly racialized workforce. We pay almost no attention to that. We don't collect that data. I have that data because we've been working for over 15 years with a longitudinal group in the west. We asked them what language they speak and where they come from, so we have that data.

When I talk to colleagues in Ontario and Quebec, it's even higher. It's not the same in some regions of B.C., and in the Maritimes it's a little bit different. It depends on the ecosystem that you're in. That is part of the reason they are so poorly compensated. They're women. They're poorly educated. They're not given any continuing education. They're not regulated, which means there aren't even criminal background checks, and we don't count them accurately in the country. What we have done is create this workforce that's largely unregulated, and we've deprofessionalized it.

In Germany, they legislated that 50% of the front-line workforce has to be regulated nursing staff, RNs. In Belgium, it's even higher, almost 65%. That's similar in other jurisdictions. Here, the regulated workforce is less than 15%, and that has been a financial decision, coupled with the belief that you don't need complex, competent skilled care for these individuals.

We can provide that care with a high proportion of unregulated staff, but we have to give them proper education. We have to give them continuing education, and we have to support them. We have to address what kinds of issues it creates if we have a highly racialized workforce in terms of the discrimination they feel. We know that COVID had a disproportionate impact on racialized groups, and we know that in some jurisdictions that was manifest in what happened in the workforce, in the nursing homes that had a particularly high proportion of people from other ethnic groups.

Poverty plays a role. The fact that they're women plays a role. All of these things come together and stack up, until you get a workforce that's quite vulnerable. On top of that, they're pretty much voiceless. They're not unlike the residents who don't have a voice; we don't give them much voice. They're at the bottom of a hierarchy, and they're not included often in a lot of decision-making, but they care. This is the thing that astonishes me through all of that. The average care aide or PSW in this country builds relationships with residents and cares and wants to do good work. We aren't even acknowledging....

That's the first step. Then we have look at what it means if a workforce is predominantly female and you have COVID and they close the schools and there's no child care. That's a problem. If you're a woman and you have children and the schools are closed and you're caring for aging parents, that's a challenge, so we have issues and we don't value caregiving. We don't value it for children, and we don't value it for the elderly. There's a very big convergence of these compounding issues of disparity and inequality in this workforce.

2:15 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

Mr. Brunelle-Duceppe, the floor is yours.

2:15 p.m.

Liberal

Yves Robillard Liberal Marc-Aurèle-Fortin, QC

Given the vital role they play in these centres—

2:15 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Excuse me, Mr. Robillard, but it's Mr. Brunelle-Duceppe's turn.

2:15 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

I'm sorry, Mr. Robillard.

I'd like to thank the interpreters for their exceptional work. I'll do it quickly, but I want to tell them that they're exceptional.

Thank you very much.

It's not every day that we hear from a former minister of health at the Standing Committee on National Defence. You said it yourself, Dr. Hébert. I'm very happy to have you with us.

Just to be clear, do you agree with the demands of Quebec and the provinces that the federal government increase health transfers from 22% to 35%?

2:15 p.m.

As an Individual

Can you hear me okay?

I switched headsets.

2:15 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Yes. I can hear you just fine.

2:15 p.m.

As an Individual

Okay.

I believe that we need more health care funding federally and provincially. However, as I said earlier, continuing to invest in boosting physician pay and concentrating health care in hospitals is the wrong approach.

2:15 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Excuse me, Dr. Hébert, I don't have a lot of time. I understood that.

I was asking if, as a former Quebec minister of health, you agreed with the demands of Quebec and the provinces that the federal government pay its share.

2:15 p.m.

As an Individual

When I hear in the Speech from the Throne that there is a real focus on home-based care and residential care services, it's music to my ears. There is an important negotiation to be made with the provinces to ensure that this money is really directed to home-based care and institutional care, in Canada, in every province in Canada.

2:15 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

So, as a former minister of health, you disagree with this demand.

I have one last question for you.

In 2013, when you were minister of health, you said that the federal government does not provide any services to the public and that this duplication of staff is expensive.

Do you still agree with that statement?

2:15 p.m.

As an Individual

Yes, there is duplication in certain areas. At the time, it was in mental health and in areas such as health care for indigenous people.

I believe we can succeed in reaching an agreement on eliminating this duplication. We have so little funding for health care that we have to be very careful to avoid needless duplication.

2:15 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Okay.

Thank you very much, Dr. Hébert.

We'll make sure your position is known.

My next question is for Maj Martin.

Good afternoon, Maj Martin.

Several important courses, such as career development courses, have been cancelled or offered with a limited number of candidates. This means that there are fewer trained soldiers, NCOs and officers who, in turn, could have trained other candidates. The COVID-19 pandemic really hurt everyone, especially in this area.

Would you be able to tell us what impact these delays are having on the preparedness of our forces?

2:20 p.m.

Maj Karoline Martin

The preparedness and questions about training are not within my field of expertise, but I will turn the floor over to Colonel Malcolm, who is better positioned to answer.

2:20 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Perfect. Thank you.

2:20 p.m.

Col Scott Malcolm

I'll have to speak to that in my current role as deputy surgeon general.

Back in March during the first wave, in an effort to respect the public health measures put in place by each of the provinces, the Canadian Armed Forces took a very disciplined role to cease operations in moving and training candidates from across the country so as to avoid becoming a vector. It certainly did slow down our training operations at that time.

We continue now respecting.... With the new information we have about the virus and adhering to public health measures, we will be restarting the training machine as of this fall. While we do have some catch-up to do, we have a plan in place to move that along.

In terms of our current preparedness for wave two, we stand ready to assist as requested by the Government of Canada.

2:20 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

Mr. Garrison, go ahead, please.

2:20 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

It's already over?

Thank you.

2:20 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Thank you very much, Madam Chair, and thank you to the witnesses for being with us today. I apologize, as I had responsibilities in the House of Commons that prevented me from joining earlier, but I know that MP Rachel Blaney did a good job.

I want to start with a question for Colonel Malcolm and/or Major Martin, and I apologize if it overlaps in any way. I did hear part of your responses earlier.

Given the lessons we've learned and the current spikes in COVID-19 that we're seeing, do you feel there's a danger, especially in Ontario and Quebec, that the Canadian Forces might have to be called upon again to provide assistance in long-term care homes?

2:20 p.m.

Col Scott Malcolm

I will take that.

We are seeing right now that we have members deployed to support the long-term care facility in northern Manitoba, so it certainly remains top of mind for the Canadian Armed Forces. We have our teams prepared and ready to go, much as they were in wave one, should additional asks of that nature come from the provinces.

2:20 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Are there differences, given the lessons you've learned, in how you'll approach intervening, say, in Manitoba now, or if you had to go back into homes in Ontario and Quebec?

2:20 p.m.

Col Scott Malcolm

Perhaps I'll ask Major Martin, who has that coal face experience, to speak to what we've learned from our experiences there.

Major Martin.

2:20 p.m.

Maj Karoline Martin

Thank you, sir, and Madam Chair.

From our first experience, one of the big pieces we learned was team composition and really looking at what those critical clinical capabilities were. Certainly, nursing was at the forefront of it, so as part of our lessons learned, we submitted observations to Ottawa to bolster that team. Again, that is going to be predicated on staff availability and clinical availability, but certainly on more personnel when you're looking at severe staffing shortages.

2:20 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Given that we've seen COVID now appearing in large numbers in rural, remote and indigenous communities, which often have very limited health facilities, is there a contingency plan in place for the Canadian military to provide assistance to those rural and remote indigenous communities in coping with the spike in COVID?

2:20 p.m.

Col Scott Malcolm

Thank you for the opportunity to respond.

Dating back to wave one and our work with the whole-of-government response plan for COVID-19, part of our planning was related to the potential to respond to the requirements to support rural and remote northern communities.

2:20 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

Now we'll go to Mr. Dowdall, please.

2:25 p.m.

Conservative

Terry Dowdall Conservative Simcoe—Grey, ON

Thank you, Madam Chair, and thank you, James Bezan.

I want to take an opportunity to thank all the witnesses who are here with us today and certainly to thank all the military men and women for what they've done during this crisis.

I want to make one quick point. I know that we're short of time, we're worried and it's Friday. One concern is that I think the study and what I'm on this committee for was originally the pandemic and the Canadian Armed Forces. I know we're getting into other discussions that I know are fantastic, but because we're short of time, maybe we could narrow it down to how it's really truly affecting our forces.

My question is for Mr. Shimooka. I'll begin by saying that we had the opportunity on Monday of having his distinguished colleague here, Dr. Leuprecht. He testified before this committee that in his opinion 25% of our active armed forces were dedicated to “domestic operations”, like we saw here in Operation Laser, and that the Canadian Armed Forces response to the COVID pandemic is an ineffective use of military resources and will definitely begin to harm our readiness for international responsibilities.

I wonder if you agree or don't agree with this assessment that Canada perhaps should look at standing up and funding a dedicated section of the Canadian Armed Forces for exclusive domestic operations.

2:25 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

I would couch my answer by saying that I think that's not precisely a question for me. I think that's a question for, I guess, the body politic in determining what the roles are that the government wants to do for Canadians. If I look at different militaries internationally.... Let's take the Coast Guard or the protection of sovereignty. Canada uses its navy in a fashion that is probably more extensive than countries that have more robust coast guard capabilities—like Japan or something like that.

Relating that back to pandemics and aid to the civil power missions, like in this case, I think it is a reasonable ask, so long as there is planning and resources allocated that are commensurate to the task. Too often, I think, governments will saddle the Canadian military with a task and, as the fine representatives of the Canadian military here will show, they will do it to their utmost capability and ability, but the resources aren't applied and given to that mission. That's not just with the aid to the civil power. That's with a lot of different areas.

I would say my view is that I think that could be a legitimate use of the Canadian military. It just needs to be resourced properly and it must be clear that it is one of the tasks they must fulfill at the time.

2:25 p.m.

Conservative

Terry Dowdall Conservative Simcoe—Grey, ON

Thank you for that.

Also, COVID-19 and the rise of social isolation and physical distancing have affected how we plan and execute our military operations here at home and definitely abroad. Do you see more future use of cyberwarfare and artificial intelligence? What are some of the issues there in terms of our international norms?

2:25 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

I would argue that those areas of capability are increasing anyway. They are becoming some of the leading edge of military capability and power that we're seeing internationally. I can point to... just a couple of days ago, the U.K. announced, I believe, a 13-billion pound increase in its defence budget over a couple of years and a significant portion is going to go to cyberwarfare capabilities.

I don't necessarily believe that it might be a result of COVID or the pandemic itself, but certainly those are major areas of capability that are increasing in relevance in the international sphere.

2:25 p.m.

Conservative

Terry Dowdall Conservative Simcoe—Grey, ON

Thank you very much. I don't know if I have a lot of time left, so I have a quick question for Colonel Malcolm.

How many Canadian Armed Forces members are currently deployed on Operation Laser?

2:25 p.m.

Col Scott Malcolm

Unfortunately, I don't have the exact number right now. I'd have to take that one on notice and get back to you.

2:25 p.m.

Conservative

Terry Dowdall Conservative Simcoe—Grey, ON

This is just a quick follow-up. I know you don't have the number, but that would be interesting, for sure.

Do you know if those members will be deployed on the operation to coordinate vaccine distribution as well?

2:25 p.m.

Col Scott Malcolm

At this time, the role of the Canadian Armed Forces in the rollout of the vaccine is still being explored. Right now we have members—logistics experts and planners—working with the Public Health Agency to assist with planning, but it's yet to be determined what other roles the Canadian Armed Forces may play in the rollout of the COVID-19 vaccine.

2:30 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

We go next to Mr. Bagnell, please.

2:30 p.m.

Liberal

Larry Bagnell Liberal Yukon, YT

Thank you very much.

Thank you to all the witnesses.

I don't have a lot of questions because your testimony and your written input is so comprehensive. Thank you for the passion with which you are protecting people who cannot really protect themselves. Some of you in the military, and others, have put yourselves at risk. I really appreciate the efforts of all the witnesses and those who have done that.

I'd also like to congratulate Major-General Fortin, who is going to head up vaccine logistics and operations for the military, which the Prime Minister announced today.

Just as a reminder, in all the recent previous years, each year there has been an increase in transfers to the provinces and territories for health care. I particularly thank Professor Hébert for mentioning that we made a record contribution for the first time on home care recently. I think everyone here would agree that is very important, especially considering recent events.

My questions are for Major Martin. As you know, a high priority for everyone on the committee is increasing the importance of women in the military. My two questions for Major Martin are along that line.

First of all, I'm delighted you've been given such a senior and important role. That's fantastic. From all reports, you've done a wonderful job.

Have you noticed any special needs—I know Mr. Robillard asked this question as well—for the women in the long-term care homes, either as patients or as workers? Are there special needs they have, recommendations specific to women, or is there any discrimination similar to the ageism that was discussed earlier, but specific to women?

Are there any comments on that from your experience in your management role in this situation, Major Martin?

2:30 p.m.

Maj Karoline Martin

Thank you for the question.

I would say that when we're looking at staffing within long-term care, as described within some of the other testimony, certainly being able to provide child care and being able to provide care to other family members did impact those PSWs and those nurses when things started to shut down. Certainly there was a level of staffing degradation that was related to the role of women.

In terms of discrimination, there was none that I witnessed or that was reported to me. I think the majority of the managers who worked in all seven homes were women, so there was certainly a very prominent leadership role that women played within that sector.

2:30 p.m.

Liberal

Larry Bagnell Liberal Yukon, YT

Thank you.

Yesterday I was on a conference call with an organization, not military at all but a similar type of organization. They asked what they could do to increase the recruitment of women. You're obviously very successful. You were recruited. You've risen to the top. Do you have any suggestions about how we could increase women entering the military or how we could improve our recruitment efforts related to the special needs of women?

Is there anything from your personal experience that might help us or guide us to make improvements?

2:30 p.m.

Maj Karoline Martin

I can speak from personal experience. My husband and I are both military and have had an almost 20-year career together. Certainly, having communication about the support to families and the support to women's careers is very important. So is better communication about what the military does. I think from an outside perspective, most civilians look at the military as having that very infanteer, very hard, army-type mentality. Really, there could be communication on how there are wonderful opportunities within this organization.

2:30 p.m.

Liberal

Larry Bagnell Liberal Yukon, YT

Thank you, Madam Chair. That's all I have.

2:30 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

Mr. Bezan, please.

2:35 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

Thank you, Madam Chair.

I want to thank our witnesses for appearing. I want to thank Colonel Malcolm and Major Martin, our military members who are with us.

Major Martin, I particularly thank you for your testimony at the Ontario long-term care commission. I think it was brutally honest. It really gave everyone a clear picture of the unfortunate events that unfolded and that you and your team were sent in to clean up.

To start, I have a couple of quick questions for you, Colonel Malcolm. If we were in an operation like Afghanistan and had so many of our medical personnel deployed in managing role 3 hospitals in forward-operating bases, would we have been able to handle the domestic response that was required during the first wave of COVID-19?

2:35 p.m.

Col Scott Malcolm

Obviously, I can respond from only the health system perspective.

2:35 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

But that's exactly what I mean. It's about the number of medical personnel deployed at our role 3s in forward-operating bases throughout Afghanistan. If we had all those people deployed, how would we manage a pandemic like we're experiencing right now?

2:35 p.m.

Col Scott Malcolm

In order to tackle this very complex problem in the spring, we took a very different approach to it. We looked at it through a very needs-based health workforce planning lens. We looked at managing individuals and individual professions in this regard. We had to make some very deliberate decisions.

Certainly, in the face of a large-scale deployed operation like Afghanistan, more challenging decisions would have been made to manage the needs of a larger deployed force and balance those with domestic requirements.

2:35 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

Thank you.

Will medical health services be required to participate in the rollout of the COVID-19 vaccine, especially now that General Fortin has been appointed as the leader on the distribution of COVID-19 vaccines?

2:35 p.m.

Col Scott Malcolm

As of right now, the additional roles of the Canadian Armed Forces and specifically Canadian Forces health services remain to be determined, though I will note that in the omnibus RFA that was developed as part of Operation Laser, one of the planning contingencies included in it is a role for the Canadian Armed Forces in mass vaccinations. That's factored into the planning, but it remains yet to be determined whether or not we will be required in that regard.

2:35 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

In preparation, as part of your training and readiness with the Canadian Armed Forces and through your health services group, are you right now training members of the Canadian Armed Forces to actually administrate vaccines across the country?

2:35 p.m.

Col Scott Malcolm

For a number of our clinicians, the administration of a vaccine is a standard part of their training. The vast majority of those folks, be they medical technicians or nurses or physicians, are currently administering influenza vaccinations to our troops across the country.

2:35 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

I understand that the Canadian Armed Forces have been discussing their participation in the distribution of COVID-19 vaccines for some time as part of Operation Laser.

Colonel Malcolm, have you any idea how many members of the medical health services group will be required to help in this section of Operation Laser in the distribution of COVID-19 vaccines?

2:35 p.m.

Col Scott Malcolm

As the military continues to gain a greater understanding of the needs the Public Health Agency and perhaps the provinces and territories may have with respect to the rollout, the role that Canadian Forces health services may play remains yet undetermined, noting that we have provided a pharmacist and a health care planner as part of that initial planning team.

2:35 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

In this planning process, when would the Canadian Armed Forces, under the leadership of General Fortin, have a solid plan in place that could be explained to Canadians from coast to coast to coast, so that they understand how the vaccines are going to be distributed, what role the Canadian Armed Forces would be playing, how we get to vulnerable populations and how we innoculate those who are living in rural, remote and northern communities?

2:35 p.m.

Col Scott Malcolm

Madam Chair, that would be a question better placed to Major-General Fortin and the Public Health Agency of Canada. I'm not privy to the details and where things stand on that plan at this time.

2:40 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

We go over to Mr. Baker, please.

2:40 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

Thank you, Madam Chair. I would like to ask my first question to Professor Estabrooks.

Professor, it's good to see you again. I have about five minutes, so I'm going to try to split my time between you and Mr. Hébert, if possible. If we could keep it within two minutes, I'd be grateful, just so that I have a chance to ask him a question as well.

Professor, do you believe that it is important, in light of what the Canadian Armed Forces discovered and revealed as far as some of the practices and conditions in our long-term care homes are concerned, that national standards for long-term care be established? If so, why?

2:40 p.m.

Professor, University of Alberta, As an Individual

Yes, I do, for some of the reasons articulated earlier. There is a patchwork of what can be expected across the country. It would raise educational standards. It would probably raise care hours and our understanding of the kinds of mixes provided. At the minimum it would reassure and would help the public understand that there's a national interest and a common understanding of what you could expect when you get old and need long-term care.

Not everybody is going to need long-term care when they get old. Dementia is the main driver of admission to long-term care. Those people whose needs overwhelm the family and the community in home care do need long-term care. For them, it's the right place to be if it's done properly.

Right now I think Canadians are afraid—I know they are—to go into a nursing home. The pandemic has exacerbated it. There's no sense, I believe, in the country that this is a national effort in the same way, even though it's still a bit of a patchwork, that health care is. Long-term care is not health care. It's a combination of social and health care. There's no real sense of cohesiveness that I can see in terms of what you get to expect when you get old and need that kind of care.

2:40 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

Thank you very much. I'll switch to Mr. Hébert now.

Dr. Hébert, it's a pleasure to meet you virtually. Thank you for being with us today.

My question is the same one I just asked Dr. Estabrooks regarding national standards for long-term care facilities.

In the Speech from the Throne, the government announced that it will work with the provinces to establish these national standards. Do you agree that this is important and a good way of improving conditions in long-term care facilities?

2:40 p.m.

As an Individual

Thank you very much for the question.

I agree because, in every other field of medicine, we have standards, either Canadian or international, for treating diabetes, Alzheimer's disease, obesity and heart disease. These standards must be based on the best scientific evidence available and, because Canada's provinces have relatively similar health care systems, it makes sense to bring the provinces together to benefit from their respective experiences and expertise.

It's also worth noting that Quebec's health services are accredited by Accreditation Canada, which also have national standards and has applied these standards in Quebec for decades. So, it's normal to rely on not only Canadian standards, but also international standards, to ensure Quebec and Canada have the highest possible standards in the world when caring for elderly people in institutions.

2:40 p.m.

Liberal

Yvan Baker Liberal Etobicoke Centre, ON

We have about 45 seconds. Briefly, what were some of the most horrific or difficult conditions you or your personnel observed in your service in long-term care, and what could be done about them?

2:40 p.m.

Maj Karoline Martin

Certainly the report answers much of that, but I think for the clinicians it was actually seeing patients dying alone or not having their family with them. That was very challenging for all of the clinicians involved.

2:45 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

We will go on to Monsieur Brunelle-Duceppe.

2:45 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Thank you, Madam Chair.

Dr. Hébert, you spoke about national standards. Does Quebec's department of health and social services currently implement strategies for mental health and elder care? Has the department always done so?

2:45 p.m.

As an Individual

Yes. The Quebec government has mental health care and elder care strategies. What I have bemoaned for a very long time is that these elder care strategies have been a low priority and the result has been much more carnage in Quebec than in the other provinces and other industrialized countries. This is due to many years of neglecting this part of the system.

2:45 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

So, Quebec has elder care strategies. You said that was music to your ears. In other words, the federal government, which has no hospitals, or maybe one or two, is in a better position to overrule the people on the ground.

Is that correct?

2:45 p.m.

As an Individual

No, I absolutely did not say that, Mr. Brunelle-Duceppe. What I said—

2:45 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

Regarding national standards, that's what that means.

2:45 p.m.

As an Individual

No, that is not what that means. It means that all of Canada's scientists will be able to work together to set best clinical practices, as they do in other fields.

You know, science doesn't stop at the border between Quebec and Ontario. Science is happening across Canada and around the world. So I think that jingoism isn't really helpful in this area.

2:45 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

No, this isn't about jingoism.

So as Quebec's minister of health, you would have accepted national standards coming from Ottawa.

2:45 p.m.

As an Individual

I always accepted that Quebec needs to conform to the highest standards of practice. Whether it's service quality, treatments or diagnostic methods, Quebec must be at the cutting edge of national, Canadian and international standards.

2:45 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

So you believe that Mr. Legault is out to lunch when he says he is against national standards and that, as the Parti Québécois minister, you would have been for such standards.

2:45 p.m.

As an Individual

You are putting words in my mouth, Mr. Brunelle-Duceppe. I didn't say that.

2:45 p.m.

Bloc

Alexis Brunelle-Duceppe Bloc Lac-Saint-Jean, QC

The question is whether you would have accepted that.

2:45 p.m.

Liberal

The Chair Liberal Karen McCrimmon

All right. The time is up.

We will go on to Mr. Garrison, please.

2:45 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Thank you very much, Madam Chair.

One thing I'm very pleased to see today is the discussion of long-term measures for long-term care that might help prevent the future need for the Canadian Forces to use their resources to provide this assistance.

I was particularly pleased to hear Mr. Hébert talking about the need to move from a hospital focus to a home care focus, and Professor Estabrooks and Ms. van Beusekom talking about the need to recognize and appreciate care as an important service in terms of accreditation of staff, training of staff, living wages and all those kinds of things.

I know we're nearing the end of our time. My last question is about short-term measures. I think I'll ask Ms. van Beusekom first.

Do you believe the measures taken before the Canadian Forces departed from the long-term care homes were adequate to guarantee the health and safety of patients in those homes in Ontario?

2:45 p.m.

Co-Founder, Protect People in Long-Term Care, As an Individual

Thank you for the question.

No, I don't think the measures were adequate. In my view, the biggest issue was testing, which I spoke about. Long-term care should be given priority for testing. As soon as there is a confirmed case, everyone should be tested so that this population can be appropriately cohorted, negative with negative and positive with positive. If that can't be done, you take the positive people out of the location. That was a problem in the spring, and it's still a problem now.

It's testing and it's the cohorting. Those basic things that allow the teams on site to manage the outbreak are not systematically in place, and they're still not in place in Ontario.

2:45 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Thank you very much. I'm sorry that's the answer we have to hear, but I think it's important for all of us to hear that.

Professor Estabrooks, I would ask you the same question about short-term measures. Are there important short-term measures that you see could be put in place now to help mitigate the negative circumstances that we're certain to face in the coming months in long-term care homes?

2:45 p.m.

Professor, University of Alberta, As an Individual

Obviously, we have to address the testing issue. We have to address the infection and the adequacy of PPE. That's just fundamental, and it's not addressed everywhere. We have to continue to hammer away at the staffing issues because we're going to be.... We have outbreaks right across this country right now. The death tolls and the toll of suffering are not restricted to Ontario and Quebec right now. They're right across from border to border.

The one thing I think we have failed quite significantly at is that we haven't understood that public health measures affect long-term care. Long-term care doesn't sit in a bubble hidden away in some mountain range. If people aren't complying with public health measures, it will ultimately affect the positivity rate in long-term care, and it will ultimately result in deaths and untold suffering. We have to try to understand and help the public understand that we must enforce public health measures because the people in the long-term care setting have no ability to protect themselves beyond what we do for them. That would be, I think, a key issue that we have to address.

We also have to address loneliness. We talk about people dying alone as if it's just a sad thing that happens. It's a catastrophic event. Loneliness and isolation kill people before they ever get to the very end of life. We have to manage visiting in as a safe a way as we can and not shut it down entirely like we did before.

2:50 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much.

Mr. Bezan, please.

2:50 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

Thank you, Madam Chair.

My questions this round are going to be directed towards Mr. Shimooka.

You have done quite a bit of analysis of military spending in the past, and we know there's been a lot of spending during this pandemic to stimulate...to fill in the gaps in incomes for individuals and businesses.

Once we get this under control, have you put any thought into how future budgets by the government could impact defence spending?

2:50 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

Yes, absolutely. It's interesting to take an international view right now. I'd like to point out that many countries—I'll point out France and the U.K.—have actually boosted defence spending, specifically in the acquisitions sector, and have accelerated purchases of equipment partly as a way to stimulate the economy. I think in the last year you've actually watched, or during a certain time in the pandemic we've actually watched, three major tactical fighter air programs that are somewhere in the region of 20 billion to 30 billion dollars' worth of spending be announced. We've seen the seed money in those programs in order to.... It's sort of as a stimulus measure, partly because the aerospace industry in particular has been extremely hard hit, as we all know, and not just with regard to travel but also with regard to the actual manufacturing and MRO side.

With that being the case, Canada hasn't really done that. Canada just doesn't have a national defence procurement strategy in the sense that it is well-developed and providing money for the investment of capabilities and the like. I think what's going to happen—

2:50 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

Should we have that strategy?

2:50 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

Absolutely. I think that's part of it. We have what are called the key industrial capabilities or KICs, and what we do is we take the ITB—the industrial and technological benefits—funding and use that to support Canadian industry. It's not really an effective strategy. A lot of countries have moved away from such strategies. I think the government is going to look at the KICs and try to use them to fund domestic priorities in a kind of roundabout way. That's just going to cut into the budget of the Canadian Armed Forces for procurement and also increase time and delays for equipment.

I would probably caution the government about looking at that way as a stimulus measure for the economy, and I'm quite worried that this is actually what it is looking to do.

2:50 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

How then would you balance off the interests of economic drivers with the capabilities required for the armed forces, and trying to procure that in the best interests of the taxpayer?

2:55 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

I think that there's a balance. I'd probably point to some of the stuff that the United Kingdom and Australia have done in the last decade or so. They've moved away from very rigid formulas requiring 100% domestic offsets for foreign-purchased equipment to more flexible arrangements that actually look at the value of what they're getting and at the development of domestic industries.

They also provide significantly large, direct investments from the government rather than trying to do it completely through the ITB format. I think it's a real danger that we have in Canada and you start to see real problems associated with it, especially now that you can alter the selection of military capabilities based on the value proposition, the number of ITBs, where they're located or the value according to the assessment criteria. So—

2:55 p.m.

Conservative

James Bezan Conservative Selkirk—Interlake—Eastman, MB

Let's just look from the standpoint of one thing we've learned through COVID-19, through this pandemic. We didn't have sovereignty over the production of PPE. We don't have sovereignty over the production of a COVID-19 vaccine. We're depending upon other nations to provide that.

Is there critical infrastructure within the Canadian Armed Forces that we should have sovereignty or control over? Some of these supply chains are critical and paramount to the protection, safety and defence of Canada.

2:55 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Give a quick answer, please.

2:55 p.m.

Senior Fellow, Macdonald-Laurier Institute, As an Individual

I'd say it's stuff like cyberwarfare, stuff that requires really rapid and quick development and having the IT control over that, especially within Canada. Those are the areas that Canada should look at, towards maintaining a domestic industrial base.

2:55 p.m.

Liberal

The Chair Liberal Karen McCrimmon

Thank you very much for that.

Mr. Hardie.

2:55 p.m.

Liberal

Ken Hardie Liberal Fleetwood—Port Kells, BC

Thank you, Madam Chair. You run a very tight meeting. That's very good. Of course, it's what we would expect.

Major Martin and Colonel Malcolm, the Canadian Armed Forces must have gained some experience 102 or 103 years ago with the Spanish flu. Was there a playbook? Were there learnings from that that you've been able to carry forward into the situation you're facing now?

2:55 p.m.

Col Scott Malcolm

Thanks for the opportunity to respond to that question.

I would suggest that documentation and maintenance of that documentation over that century, while somewhat challenging.... Certainly we were able to look back to more recent lessons, specifically through the H1N1 experience and to roles there. There were some lessons learned but it was suggested that, again, we were looking at more of a known entity in an influenza, with H1N1. There's much more uncertainty with this pandemic, being the first-ever coronavirus.

2:55 p.m.

Liberal

Ken Hardie Liberal Fleetwood—Port Kells, BC

Thank you.

Early on in our experience with the pandemic, we watched in shock and horror what was going on in Europe, particularly in Italy. That was certainly where I saw the first involvement of the military, in helping civil authorities deal with the situation.

Have there been discussions, exchanges of intelligence or ongoing liaison with military in Europe as to how they've been dealing with this, and are there learnings for us?

2:55 p.m.

Col Scott Malcolm

Thanks for the question.

Both through our NATO allies and through other partners across the globe, we've been receiving valuable lessons, whether it's from Japan, Korea.... Everyone in the military sphere is quite willing to share lessons and we've been keeping abreast of those throughout this time. Given the fact that the first wave came a couple of months after it struck the other side of the world, we were able to be somewhat better prepared, given the limited knowledge that was available at that time.

2:55 p.m.

Liberal

Ken Hardie Liberal Fleetwood—Port Kells, BC

It seems that you will be called on with respect to the issue of getting the vaccines out. How good are you guys at logistics? This is your commercial.

2:55 p.m.

Col Scott Malcolm

Unfortunately, you're asking a doctor about how good we are with logistics. That's not my area of expertise but I can tell you that, when it comes to medical logistics, we relied very heavily on our medical logisticians to get PPE around the world—when we supported Operation Globe—and also into the long-term care facilities. They did marvellously. No member went into those long-term care facilities without having the top-quality PPE they required to protect themselves and the vulnerable populations they were serving.

2:55 p.m.

Liberal

Ken Hardie Liberal Fleetwood—Port Kells, BC

I have time for another quick question to Ms. Estabrooks and Ms. van Beusekom.

Isolation has been mentioned. What do we do about it? What are your suggestions?

2:55 p.m.

Professor, University of Alberta, As an Individual

We can't eliminate risk. We have to accept some risk when we allow visitors and family in, but we can mitigate that risk. We can limit the number of people in. We can ask that families comply, and if families don't comply with the infection control practices, they shouldn't be able to visit. However, we must let them in, because individuals who are older with dementia deteriorate not just physically from being alone in bed but very rapidly cognitively when they have no contact, in particular with familiar people.

Remember, people are walking into the room with masks, gowns and hats. They don't have good sensory comprehension as their dementia progresses. They can't hear well and they can't see well, so it's frightening and confusing. We can mitigate the risk. We must accept there'll be some. We can do this quite safely if we're thoughtful about it, and we have to. We can't let people die alone.

3 p.m.

Co-Founder, Protect People in Long-Term Care, As an Individual