Public Accounts Committee on March 22nd, 2018

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

Thank you very much, Mr. Chair.

Thank you for testifying before us today.

When I was travelling to Ottawa one time, I was speaking to a nurse who was working in an indigenous community up north, and she continues to work in indigenous communities. She was telling me about a lot of the services that they provide. When individuals would come in, she would do regular checkups, but she would notice that their oral health, to say the least, wasn't very good.

I'm new to the committee, so I'm sorry if I ask repetitive questions, but how will the significant funds given in 2017 help you take a national approach?

[Jean-François Tremblay]

It will help on the prevention side, which is the dimension you were talking about, in how we will be able to reach out to more communities to work with them in developing prevention, and making sure that good habits are there from the oral health perspective. That's, in part, what it will do.

We will also build on this to develop the national strategy that, as we said, will be presented in the next few months.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

This question is for anyone: how do we do that in the most remote communities? How do we ensure that their oral health is—

[Jean-François Tremblay]

We have to work with the communities. We have to have professionals going there, working with the communities, reaching the families and the children, and actually working with them in training and showing them the benefits of good oral health. Doing this with the partners is the key element for us, the key point.

It's the same thing even for the national strategy. We have to sit down with our partners, first nations and Inuit. If we want to have targets over the long term, they are targets that they need to embrace, of course, as we will embrace them in the end. It's about the different working groups that we have and the different ways we have to actually reach out and work with our partners.

[Sony Perron]

You were talking about the patient journey and their going to see a nurse. I think this is a prime example.

In the north, where there is a nurse, a patient will see the nurse, and if there is a problem with oral health, the nurse will do a couple of things. First, the nurse will say that there is a dentist visiting the community in two or three weeks and they will put them on the list, but this is more for prevention and convincing the patient to take care of this. If it's urgent, the nurse will arrange with our services to get the patient out. Sometimes there is pain and there is a need. If there is no dentist coming soon, the patient's care is a priority, and she will help to arrange it so that the patient can get out and get services from a dentist somewhere if it's an emergency.

If there is no visiting dentist, we sometimes organize flights out to see a dental provider, but that's why earlier today I was talking about these regional plans, because each community deserves a different action. Sometimes there are already dentists who are visiting communities and there are already dental therapists residing in communities. In each case, we are trying to organize the service.

What really matters is that in all of the stages of health care provided, whether it's the nurse doing prevention work, the dental therapist seeing the patient, or the dentist outside of the community, we try to integrate all of that work to make sure it is patient-centric. We sometimes have a problem with the data and being able to see the patient's journey, but the staff and our partners have all the same information about what program can be leveraged to get the client to the service provider as soon as possible when there is a need.

[Marwan Tabbara, Liberal, Kitchener South—Hespeler, ON]

Just as a follow-up question, to give you an example, let's say a dentist were visiting the community and performed surgery or conducted something with the patient. Is there any follow-up? Maybe the dentist leaves again, but as you know, if you're extracting teeth you have to check if the patient is healing properly. Is there any follow-up? Or do nurses do that?

[Sony Perron]

Yes, this is part of the treatment and the process of serving the patient. There is a responsibility for the local nurse, for the treating dentist, and for the dental therapist.

What we have to work on is the stabilization of the service provider community in order to make sure that the same dentist or the same dental therapist visits the community. When there is a disruption, there might be difficulty in following up with the client. It's about investing in local workers as well and doing it with the community, so that there is someone locally who is in charge of doing the follow-up and calling back the clients to make sure they show up when the dentist comes. If it's only two days a month, there is that window, so we need local workers to organize that and to be very efficient. Again, that's why we need plans in each region to organize the service in the most efficient way. Ultimately, however, if there is an urgent need, we get the patient out to see a dentist outside the community, for sure.

[The Chair, Conservative, Kevin Sorenson]

Thank you, Mr. Tabbara.

Now we will go to Mr. Nuttall, please, for five minutes.

[Alex Nuttall, Conservative, Barrie—Springwater—Oro-Medonte, ON]

Thank you, Mr. Chair, and thanks to all of you for the presentation as well as the answering of questions today.

The Auditor General highlighted both the successes of and the need for improvement surrounding data. I want to pick up on where Mr. Christopherson was. It sounds like the data is being used effectively when looking at the focus on dollars spent.

Where it sounds like the data is not being used effectively is that it's supposed to focus on people and the actual person who's being helped, or taken from the person who has been helped and used within national statistics. At this point within your department, would you have data you could pull that would say “we're seeing this many issues in relation to oral health at this age with our young people” in first nation communities or even in the city?

[Jean-François Tremblay]

We have a lot of data on access to this service and what kind of surgery and services people receive. It's there. The issue is going to level 2, if you want. As you said, it's to use that data to try to prevent...to look at what the trends are and what other kinds of services we should offer in the future. Where do we see progress? Where do we see gaps? We actually have a lot of that data.

[Alex Nuttall, Conservative, Barrie—Springwater—Oro-Medonte, ON]

So, the funding that's put into this program, is it funding the analysis of this data as well, or would there be separate individuals who do that work?

[Jean-François Tremblay]

It is something that we're doing in the department.

[Alex Nuttall, Conservative, Barrie—Springwater—Oro-Medonte, ON]

It's within the department, so you have direct control over that.

[Jean-François Tremblay]

For the non-insured health benefits program, we have the information, yes.

[Alex Nuttall, Conservative, Barrie—Springwater—Oro-Medonte, ON]

So, you would be able to, then, turn this information around pretty quickly.

[Sony Perron]

Actually, we are using this. We are using the data we have to look at trends, the type of utilization, and prevention versus treatment. We do all of this. What we cannot do, and where I think our partners from the OAG are driving us, is to be able to say how much these services—because they are evidence-based—are improving overall oral health. The data doesn't tell us this, so we need more. We need to bring other data together with this data to be able to say whether, overall, as a result of scaling, the exams that are done, and fluoridation that oral health is improving.

We know that the services we are funding and supporting are increasing the demand, the utilization. These are all good indicators, but in the end, is all this leading to a better oral health outcome? We need a population-level survey, for example, to help us on that front, and we are working on this as well.

[Jean-François Tremblay]

We have a lot of information on—

[Alex Nuttall, Conservative, Barrie—Springwater—Oro-Medonte, ON]

But at the same time, the access is not increasing, right?

The data is there and the funding is there. You may ask for more funding, but the funding is there. However, the access is actually going down. To me, that's a management issue.

The reason I call it a management issue is this. We have the data to use to determine the path that we need to go to attain the results we're looking for. We have the funding in place as well, even if the funding remains the same and does not increase. Also, you're right, the CPI and all of these things are contributing factors. The idea is that we're finding efficiencies, at the same time, in every department in this government, not just yours. If we're finding efficiencies, if the CPI and funding remain the same, but access is going down, plus we have data that we're not using, then that's straight up a management issue. That's something I would like to see addressed in the future once we go through this report at committee. This is something I want to see reported back on because if that data is truly there, it should not take very long to be able to provide examples to this committee as to what changes are going to be taking place.

In fact, I can tell you—because we happen to be in politics and data is incredibly important to us—that if I go to a group with zero information and say, “I need a poll on these 10 subjects in these cities, and I need you to bring the information to me”, we can analyze it and turn it around from front to back in two to three weeks. If you have the data already, I assume you should be able to do a similar thing.

[Jean-François Tremblay]

I will just give you specific points on this.

We have a significant level of data on the access to the non-insured health benefits, which means going to the dentist and getting surgery, for example. On that usual access to the system, we have a lot of information. The area where we have seen a decline, and that we have to better explain in the future, is prevention. This program, as it was mentioned, is the $5 million per year. It's not our major program. It's actually a small program in comparison with the rest. That's where we need to have more information.

As the Auditor General mentioned, we don't necessarily have the same relationship with each of the individuals who participate in those events. That's the part that we need to actually work on.

[The Chair, Conservative, Kevin Sorenson]

I think Mr. Nuttall's frustration about this, without putting words in our Auditor General's mouth but paraphrasing him when he tabled these reports in the House of Commons, is that too many federal government programs do not seem to measure success in terms of how they affect Canadians. He said this not just about this department, but about other departments in government as well.

What Mr. Nuttall has said is that we do the data analysis, we pinpoint the money and where it's going, the issues, and all of that, but really, what it boils right down to is the effect on Canadians. That's where we have to take data. We have to improve it on the people side.

All right, Monsieur Massé, I think you may have the final say today. Go ahead. You have five minutes.

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

Mr. Tremblay and Mr. Perron, you have a number of years of experience in this organization. You have obviously consulted with First Nations communities for a number of years.

The oral health of indigenous people does not seem to be improving at the desired rate. Moreover, significant challenges remain in terms of data collection, service delivery and administrative mechanisms. Of course, we would not be here today if there were no problems. Clearly, there are some. Given your expertise and experience, here is my question for you.

If all means were at your disposal, which three priorities would you like to see addressed? Which three things do you think should be put in place to solve this significant challenge for our First Nations in the coming years?

[Jean-François Tremblay]

Is your question focused on oral health?

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

Exactly.

[Jean-François Tremblay]

Our main concern is still the need for information and, above all, results. So we really need surveys in order to find out the direct impact of the programs.

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

What is preventing you from having that type of information?