Public Accounts Committee on March 22nd, 2018

[Jean-François Tremblay]

We are preparing to work with the public health sector, with Statistics Canada, as well as with First Nations and Inuit. As you have already heard, a national health survey is planned for 2021 or 2022. In collaboration with the First Nations and Inuit, our objective is certainly to develop a component for them, so that we can study the results of the programs. For us, that is an essential factor.

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

Okay. That was your first factor. What would be the second?

[Jean-François Tremblay]

It would be to continue to work in partnership with the indigenous peoples. Changes in health cannot be imposed on anyone; they must come from people. So the changes must be planned in partnership with indigenous people. In the long run, these changes should ideally be developed by indigenous authorities.

The third factor—

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

Forgive my curiosity, Mr. Tremblay, but what feedback or recommendations are you receiving from First Nations and Inuit regarding oral health? What are the basic aspects?

[Jean-François Tremblay]

I'm going to let Dr. Plante or Mr. Perron answer you, since they were the ones who led the consultations.

[Sony Perron]

The first aspect would be cultural safety, that is, serving the clients in an appropriate way with people who understand the culture.

The second aspect would be the control of the services. The approach cannot be the same in the Quebec City region as it is in northern Quebec, nor in northern Ontario compared to the Toronto area. Therefore, we have to work with indigenous partners to give them control of these programs so that they can organize and manage them according to their particular context. We already do this to a certain extent with our regional teams, but the best approach is for services to be managed by the communities themselves.

We mentioned earlier that the data did not include British Columbia because the responsibility for services was transferred to the First Nations Health Authority in 2013. So an indigenous organization, not the federal government, manages all health services for First Nations in British Columbia. Since the transfer, the indigenous people have slightly modified the services to improve and tailor them to their provincial context and to the needs of the regions of British Columbia.

We need to really move forward on this whole issue of the federal government transferring the management of services to people who are closer to the front lines and who can organize programs more effectively.

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

That is interesting, Mr. Perron. Could you explain how those transfers are done and how it works today? If I understand correctly, we are talking about an agreement that has been negotiated between your department and the Government of British Columbia.

[Jean-François Tremblay]

It is a tripartite agreement with the indigenous peoples and it was negotiated over a number of years.

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

Do you consider it as a model?

[Jean-François Tremblay]

We do. The recent budget allocated funds to support our negotiations on reworking health services. So we have to see how we can make sure that the services will not only be provided by the indigenous peoples, but also ultimately developed by them to meet their own needs.

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

Does that model influence your strategic planning nationally? We are hoping that it will all be worked out quite quickly so that we can all become familiar with your action plan. Would you like to extend the model to other provinces in the coming years?

[Jean-François Tremblay]

Yes, but it is more than that. Actually, the third point that I wanted to bring up is about the holistic approach. We cannot proceed program by program alone. What we have to do, clearly, is give indigenous organizations the means to provide a body of services. In our view, that approach goes beyond oral health care and services, which make up one part of the overall health care and social services.

We are also making efforts in education, as you were able to see with the negotiations that took place in northern Ontario. We mentioned the British Columbia situation, but we could also have mentioned the governmental autonomy in education in the Atlantic provinces., where the gap between indigenous and non-indigenous populations has been practically eliminated over the last 21 years.

That is the kind of approach we are looking at. We do not have one single approach because we do not want to impose one. The department's objective is certainly to move to that model across the country as quickly as possible.

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

Thank you, Mr. Tremblay.

Mr. Chair, if I may, I would like to ask Mr. Ferguson a question.

Mr. Ferguson, we have talked about strategic planning, about collecting and analyzing data, about administrative process, and about projects that seem to have produced results.

Have we missed anything as we studied your report, anything to which we should pay particular attention? Are there matters that you would like to see us address by the end of our study?

We have a few minutes left.

[Michael Ferguson]

In general, I believe that we have touched on the main points.

We first have to understand the impact of the services and the gap that exists between the two populations. We must also ask ourselves whether it is possible to narrow that gap. That is what I see as the most important.

In my opinion, there is one topic that we have not really dealt with, which is to fully understand all the obstacles that exist. We have discussed diet and geographic distribution, for example, but not the problems caused for the people doing the work.

There might be issues with facilities, with buildings, with housing, and with the way to get into those communities. Obstacles, in fact, that come from the very remoteness of the communities. Can the people who go to work in those communities have the equipment, the machinery and the housing they need in the communities? That is another aspect that we have not discussed today.

[Rémi Massé, Liberal, Avignon—La Mitis—Matane—Matapédia, QC]

Thank you, Mr. Auditor General. I am very grateful for your comments.

Your reports are clearly important. I was a public servant for a number of years. Sometimes, we focus on programs and service delivery, but we also tend to look at them in isolation. You allow officials and departments to sort of take a step back to determine whether the service delivery should be looked at again. We do it from time to time, but I must highlight once again the remarkable work you and your team do to help parliamentarians and public servants to provide decent services all across Canada to Canadians, to the First Nations and to the Inuit.

[The Chair, Conservative, Kevin Sorenson]

Thank you, Mr. Massé, and thank you to all of our guests here today.

Typically at the end of a meeting I remind those who have attended that the Auditor General issued his report on this. I think he had five or six recommendations. We also will be issuing a report on today's study. As you leave here, you may contemplate some of the questions that were asked of you. If you're like me and are on your way home and think that you could have added something to your answers or should have said something more, we encourage you to please submit to our analysts and our committee any further information you have that might be of benefit to us as we try to build a report around this.

We wish you all the best in the strategy you're building and as you deliver for our Inuit and first nations people.

I thank the committee for its good questions today and, as always, the Auditor General for a job well done on the audit.

We are now adjourned.