Public Accounts Committee on June 1st, 2015

[Alain Giguère, NDP, Marc-Aurèle-Fortin, QC]

Thank you, Mr. Chair.

Mr. Perron, on page 3 of your presentation, you indicate an 88% compliance rate for controlled substances. I did a bit of medical law during my internship and if the non-compliance rate was close to 1%, the Order of Pharmacists of Quebec would intervene. You say that the non-compliance rate is 24 times higher than what is accepted in a hospital. I wouldn't be pleased with that.

Can you explain to me how your service came to distribute such a high rate, 12%, of non-compliant medications? That is really huge. That is between 24 and 36 times higher than what is acceptable in a hospital in Montreal or Toronto.

[Sony Perron]

It's not a question of non-compliant medication being distributed, but of the number of Health Canada nurses who were working in remote nursing stations who have the training concerning controlled medications. It is possible to renew that training. I will ask Robin to confirm if that happens every year or every two years.

We hope that 100% of our nurses will update their training with us so that they will know how to distribute the available medication in nursing stations, which are not pharmacies. In these stations, medications and the use of medications are extremely controlled. There is a form for every medication used. We provide training to the nurses so that they know how to use the pharmacy counter appropriately in these nursing stations.

[Alain Giguère, NDP, Marc-Aurèle-Fortin, QC]

The overall compliance rate for your service is 46%. That kind of percentage won't get you a degree. Even 65% won't get you the kind of degree that you would want to boast about.

[Sony Perron]

That is not really a satisfactory result, and I think that we admitted that in our response. The Auditor General's report, which was based on a sample from Manitoba and Ontario, gave us an overall compliance grade of 1%, but that was a very small sample. After having reviewed our files and attempted to provide a certain level of training, we now have 46% of nurses in nursing stations who have completed the five points of training which are listed in the policy.

We want to reach 100%. We will always be in training mode in the sense that this training expires after a certain time and new nurses always join our service. The goal is to maximize the level of compliance for all training and to ensure that every year, nurses follow a training plan to maintain their level on the subject.

[Alain Giguère, NDP, Marc-Aurèle-Fortin, QC]

We've been talking about administering care, but in health care, there's also the aspect of prevention. I don't know if you if you read the documents from the Cree Board of Health and Social Services of James Bay concerning nutrition problems in Canada. Unfortunately, there are people who are dying because they don't have decent drinking water, because they don't have healthy food to eat, and because there is no follow-up for major psychological care. People are really dying. These people can't wait five years.

There needs to be a change in attitudes, because we can't function this way. You can't ask us to look elsewhere when people are dying.

[Sony Perron]

Nurses are an important part of the health services provided in remote communities. But they are not the only part of the services provided. We provide funding for a certain number of programs. You mentioned nutrition. We fund a prenatal nutrition program. We also fund nutrition education programs and the diabetes prevention program and the diabetes support program.

Nurses are not necessarily at the hub of the service points. Often, it is the community workers who are properly trained to provide these programs.

In addition to the services mentioned in the Auditor General's report, there are a whole series of programs that aim to prevent problems, to change behaviour and to educate people. This is done in communities and we ensure that there is always an important cultural component.

[Alain Giguère, NDP, Marc-Aurèle-Fortin, QC]

Excuse me, but there is a problem here. Everything you're saying is all well and good. But as concerns the problem and the solution, if you look at this situation from a statistical point of view, you can see that the situation is getting worse. It is not improving. This is a major problem. We are able to prove statistically that communities are in danger. What will it take for the situation to improve even a little bit? I'm not talking about stabilizing things, but improving things. We can't go backwards.

[Sony Perron]

I agree with you, we need to have a comprehensive approach based on determinants of health. We are working on providing health care services and we are working on prevention and promotion. We need to change people's lifestyles, encourage physical activity and support good nutrition. There are also a certain number of other factors that are not necessarily included in Health Canada's programs and on which I cannot comment. Obviously, these are social determinants of health.

[The Chair, NDP, David Christopherson]

Mr. Perron, you may conclude.

[Sony Perron]

I may conclude?

I was going to add that we work to ensure that these aspects are linked to our work. We work on community planning with the communities so that we can develop new strategies. We talked about accommodation and water quality. We have to solve these problems because if we want better health results, we obviously can't only focus on health services. We need to tackle the determinants of health that fall outside the scope of the programs we are discussing today.

[The Chair, NDP, David Christopherson]

Thank you.

Mr. Albas, you have the floor, sir.

[Dan Albas, Conservative, Okanagan—Coquihalla, BC]

Thank you, Mr. Chair. I look forward to the testimony here.

I want to go back to something my colleague referred to earlier. It is interesting that he is talking about the importance of safe drinking water. I think we all understand that. We passed the Safe Drinking Water for First Nations Act, which actually allows a first nation to choose whether it wants to have a system that is equivalent to a provincial one, to follow provincial laws, or to follow federal ones. It can do that, but that member's party voted against all of those changes. Sometimes it's a little shocking to me.

Mr. Perron, Mr. Allen also raised some concerns around the specific example that was given of a septic field that basically made a facility unusable. You said earlier, sir, that many of these facilities are owned, operated, and maintained by individual first nations, and I think you said we have to work within the longer scope to make sure your priorities match their priorities. Is that correct, sir?

[Sony Perron]

And we have to support the process when there is a joint priority, to make it happen.

[Dan Albas, Conservative, Okanagan—Coquihalla, BC]

It's interesting. The members opposite in the House say that we are being paternalistic all the time by putting forward acts on safe drinking water etc., yet when we actually say we need to work with individual first nations to plan these things out, they get all upset that we aren't suddenly marching in and fixing septic fields and stuff that are not even federal assets but are owned by the first nations community. I don't want to isolate one particular example, because these things do happen on reserve, and septic fields go bad in many other areas, at least in my province where they're used in rural areas.

I also know that in many rural areas in my province, when I speak to mayors, including the mayors of such places as Keremeos, Merritt, and Logan Lake, they are always working with their provincial members of the legislative assembly to try to deal with doctor shortages, and I'm sure the same goes for nursing shortages. I can appreciate, specifically when I hear that some provinces have offered large raises and are attracting professionals from right across the country, that it makes operating in isolated areas very difficult for the provincial system, as some of the examples Mr. Perron gave show.

Could I just ask a quick question? Are we also trying to recruit from first nations to take these positions? Obviously they would have cultural understanding. They would be serving their communities. They would be making very good money. Is that something that continues to happen with recruitment?

[Robin Buckland]

Absolutely. It's an important part of our strategy.

[Dan Albas, Conservative, Okanagan—Coquihalla, BC]

Okay. I'm very happy to hear that.

Going back to codes and whatnot, the national building code is voluntary. Provinces then can adopt.... For example, British Columbia has its own building code, but a lot of people don't know that the City of Penticton in my riding has its own building code on top of that, which makes further revisions to the provincial building code.

Can we just explain how building codes work or don't work in the context of the Auditor General's report, Mr. Perron?

[Sony Perron]

I will ask Valerie to get on this one.

[Valerie Gideon]

Sure. There's an easy one.

We've always required that the buildings be signed off by the professional engineers and architects who actually worked on the project. What we're doing now, though, in light of the report, is making sure that it's explicitly written in our capital protocol agreement with the community, so that we'll get a report at the end that demonstrates that, yes, it absolutely meets the building codes. But it was always part of our requirement.

Now, we have buildings that pre-date the national building code requirement, so those need to be upgraded over time. When we're building new nursing or nursing station facilities, we will now, of course, follow the code of the moment, so that these are updated over time. We have facilities that are 25 to 35 years old. Part of this is making sure that we're upgrading and renovating them in partnership with the community so that they can meet the standards.

[Dan Albas, Conservative, Okanagan—Coquihalla, BC]

Auditor General, I've criticized some of your recommendations for sometimes being a little wishy-washy or a little too general. But in cases in which we have specific recommendations over a wide arch of issues—there is a spectrum of issues raised in this report—I think it's important that your office give very specific feedback. I don't see why having a quantity of recommendations somehow qualifies this report as different. I think your office is trying to be as helpful and instructive as possible in unique areas in which you think Health Canada could make a difference.

Earlier, Auditor General, you stated that this is a very complex environment to work in, and so I would see you as making these 11 recommendations with that in mind. Is that true?

[Michael Ferguson]

As I said earlier, the types of things we found here lent themselves to specific recommendations on specific issues. We would identify an issue, whether it be training, dealing with the scope of practice issue, or the building code issue. Those issues lent themselves to very specific and very concrete recommendations for which it should be easy to determine whether the department is able to put in place some measures to deal with those recommendations.

That was certainly an aspect explaining why there ended up being 11 recommendations in this audit.

[The Chair, NDP, David Christopherson]

Very good. Thank you.

That concludes our usual rotation and therefore concludes our hearing.

Let me pose one quick non-partisan question, in light of the fact that this is our last public hearing before the election of a new Parliament.

Tomorrow we will have the Truth and Reconciliation Commission report. Mr. Auditor General, I've been on this committee 11 years now consecutively, and this one file, involving services for remote communities, first nations people and Inuit has been a colossal failure across the board.

This is not partisan. I've been here under different governments, minority and majority. Your predecessor, the wonderful Sheila Fraser, as one of her last comments as she left office, raised this issue and talked about it as a remaining challenge for Canada, in her view.

I'm rather putting you on the spot, but I wonder whether you have any thoughts at all to give to the incoming Parliament, the 42nd Parliament. From that Parliament will be chosen the next government, and they're going to have to deal with these files.

Given the fact that we as a country—because I believe most of the people on these files are people of good will—have tried to overcome these challenges and give our sisters and brothers in the remote north the quality of life they deserve and that being a Canadian is supposed to guarantee, can you give any advice or thoughts to the next Parliament, as we adjourn here in this, the main accountability committee of Parliament, for both candidates and the next MPs to consider as they form government and move on this agenda?

What we don't want is another decade of failure. Do you have any thoughts or words of wisdom to give to that incoming Parliament on how we can have different outcomes from those we've been having?

[Michael Ferguson]

I think there are perhaps a couple of things that I would like to mention.

First of all, I was very happy with the fact that the committee decided to have a hearing on this report. Since I've been in this position, we've also issued the audit on policing services and the one on disaster assistance, and in neither case was there a hearing on those subjects. The fact that we've had the chance to talk about this, and that the department has had a chance to explain the issues they face, I think has been important.

I think, though, that the other thing is very much to get an understanding of what the departments that are involved have said—and there are many departments involved in providing services to first nations—and what they've committed to do in terms of providing services to first nations, so that we can get an understanding of whether they're living up to that.

Also, I think the other thing we've talked about today is that many of the types of issues we've talked about are issues that have been known for a while. They have come up in various other reports. For a future Parliament, I think perhaps it's important to go back and reflect on some of those studies and reviews that have been done on this file to determine where the departments are on them.

I think there's a lot that can be done to improve the situation. It's a very complex problem, obviously, with many departments involved and facing a lot of challenges, but I think one thing that has been a common thread for me in these audits is that it is possible, and it is within the power of the departments, to improve a lot of the services they're providing to these types of first nations.

[The Chair, NDP, David Christopherson]

Very good. Thank you very much, sir. We appreciate that.

Colleagues, I have a reminder that we will meet again on Wednesday to begin report writing.

With that, and with thanks to our Auditor General, his staff, and the departmental staff, we now stand adjourned.

Thank you.