Public Accounts Committee on March 22nd, 2018

[Chandra Arya, Liberal, Nepean, ON]

So, you don't know the reason that fewer children are accessing it, but you're happy with having a larger budget for it.

[Jean-François Tremblay]

Our understanding of this is that you keep the budget as it was 10 years ago, it's difficult to get the same result that you had a few years ago. We're quite confident that with this new amount of money, we'll be able to reach out more—

[Chandra Arya, Liberal, Nepean, ON]

Because of the budget—you say it's low, that funding was kept at the same level since 2005—have you ever turned away a child who came for the services?

[Jean-François Tremblay]

If we have been looking for...? Sorry?

[Chandra Arya, Liberal, Nepean, ON]

With the same budget, have you ever had a child who can't access the services you provide because there's no budget?

[Jean-François Tremblay]

No. What we've been doing is transferring the dollars to the communities, the same ones that had these programs. With the same amount of money, they were trying to continue the same services and to do what they could, but the costs, for example, of hiring people, the therapist and so on, increased over time, so we—

[Chandra Arya, Liberal, Nepean, ON]

Okay.

I have a question for the Auditor General. I know you looked at these two programs. But in looking at this program in isolation, I don't know if it is of benefit to us. This is just one program related to health. There are other health factors, for example, the increase in diabetes among indigenous people. There are things related to safe foster care. There are other issues like mental health services. Is it possible to look at the whole big picture that affects the children?

[Michael Ferguson]

Certainly, as you say, there are many different factors that we can look at. When we do a particular audit, we have to scope it down to what we can do within a particular time frame. That's why we picked this and focused on it, so we could get a report on one subject. Certainly, all of those other subjects could be the subject of audits in the future.

[Chandra Arya, Liberal, Nepean, ON]

The same question goes to the deputy minister. Do you look at this program in isolation? How are you fitting that with the mental health services that you provide, or the increase in diabetes, or the issues with foster care?

[Jean-François Tremblay]

Our objective over the long term is not to go program by program with first nations, Inuit, and Métis communities, but to go with the fiscal relationship and their community plans so we can address holistically the different elements, sectors, and issues they face, rather than going case by case. To answer your question, it's something that we're working on. We end up with a lot of programs. Programs are not necessarily as flexible as they should be. As you said, sometimes they are just one part of the story and don't necessarily give you a full picture—

[Chandra Arya, Liberal, Nepean, ON]

I have limited time, I'm sorry. I apologize.

On the contract dentists, I know there's an issue there. How do you think you're going to address it?

[Jean-François Tremblay]

What do you mean?

[Chandra Arya, Liberal, Nepean, ON]

I believe you have difficulty having enough dentists on contract.

[Jean-François Tremblay]

We have almost 16,000 or 17,000 dentists across the country. The real difficulty is more with the therapists.

[Chandra Arya, Liberal, Nepean, ON]

Okay.

[Jean-François Tremblay]

There are some provinces where therapists will not continue to work, and we were using, in some regions, for example, the Atlantic and Manitoba, the COHI programs that used a lot—

[Chandra Arya, Liberal, Nepean, ON]

The reason I asked that was our Auditor General found in one of the two regions that there were not enough contract dentists available to provide services in the communities they served.

[The Chair, Conservative, Kevin Sorenson]

Thank you. Your time is up, Mr. Arya.

We'll now go back to Monsieur Deltell.

Mr. Deltell.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Thank you again, Mr. Chair.

Let's continue our conversation about general care for First Nations, but starting with the example provided to us by the precise analysis and the commitments made by officials from the Department of Health.

I have a general question. When we talk about First Nations health, we know that there are a lot of issues, whether related to social services, substance abuse or dental care.

In your opinion, is dental care the health priority for First Nations?

[Jean-François Tremblay]

I would let the First Nations speak on that.

First Nations priorities are different across the country. We think oral health is a priority, for sure. When you look at the number of people who have access to those services and who want to have access to dentists, it shows that there is a need, that people want better oral health. Clearly, health is a priority, but it includes various aspects, as you mentioned, including mental health and various health issues, such as diabetes.

I could not speak for indigenous people and say what their priority is in that respect.

[Sony Perron]

I would invite you to look at the plan presented by the Assembly of First Nations in 2017, which lists health priorities.

In our partnership approach, the points of view raised by our partners are taken into account in order to drive action. You will see that, in that plan, the approach is multi-sectoral, and the priorities that have been identified include mental health, primary care, preventive care and oral care. The approach proposed is holistic.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Clearly, it's always difficult to make judgments. Let's be honest, those communities were there before us. I never thought that we had to tell people what to do. It should be up to them to tell us what they want. This is true for First Nations, as it is true for any area of public activity. It should be up to the people experiencing the problems to submit their comments so that we can assess that in a general way. At the end of the day, it is not up to us in the south to tell people in the north what is good for them. That's our vision.

Mr. Tremblay, my question was not about how First Nations see this. To your knowledge, as a senior official and administrator in the department, as well as deputy minister of Indian Affairs and Northern Development, must budgets for dental care be a priority?

[Jean-François Tremblay]

In terms of basic health services, I think it's important not to make choices as such. Basic health services should be provided to indigenous people as they are to all Canadian citizens. Access to health services is important, whether it is access to mental health services, primary care or hospitals. We do not consider the priorities related to these services in comparison to each other. We see them as basic services to which a citizen is entitled and to which they will have effective and easy access.

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

I will end my remarks with a general comment.

I think the sooner we deal with the problems, the more we avoid creating problems later. It's very easy to say, of course, but it's not easy to do. However, the more prevention is done and the more information is circulated, the more children are allowed to access quality care—whether dental, psychological, or basic care. This can help prevent unfortunate and regrettable incidents that can strike anyone in society. This is even more true for people who live in the regions and are at greater risk of experiencing such tragedies.

I think that, if we want to take a cognitive approach to health care, we must first focus on the care for young people.

[The Chair, Conservative, Kevin Sorenson]

Thank you very much, Mr. Deltell.

We'll now move to Ms. Yip, please.