Evidence of meeting #7 for National Defence in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was quebec.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Carole Estabrooks  Professor, University of Alberta, As an Individual
Réjean Hébert  As an Individual
Richard Shimooka  Senior Fellow, Macdonald-Laurier Institute, As an Individual
Michelle van Beusekom  Co-Founder, Protect People in Long-Term Care, As an Individual
Scott Malcolm  Deputy Surgeon General, Canadian Forces Health Services Group Headquarters, Department of National Defence
Karoline Martin  Officer Commanding Standards Coy, Chief Standards Officer, Canadian Forces Health Services Training Centre, Department of National Defence

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.

November 27th, 2020 / 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

Richard Shimooka

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

Richard Shimooka

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

Michelle van Beusekom

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

Michelle van Beusekom

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

Dr. Réjean Hébert

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

Dr. Réjean Hébert

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

Dr. Réjean Hébert

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

Dr. Réjean Hébert

—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.