Public Accounts Committee on March 22nd, 2018

[Jean Yip, Liberal, Scarborough—Agincourt, ON]

It was found that indigenous services did not promptly inform clients and service providers about the changes it made to certain services. I would like to know how they are going to inform clients more promptly when they make service changes. Especially when you're dealing with kids, it's tough juggling schedules when you're relying on something as important as these appointments.

[Jean-François Tremblay]

Yes, and the difficulty with clients is this. Let's say you're a client, for example, for a filling. It's not something that on a day-to-day basis you wake up and ask, “What exactly is the new policy and what should I or do I have access to?” We need to find a way to make sure they know this and have access to it, especially when they need to know it. It's hard, because access to dental care is not something that people think about on a daily basis.

We're working with first nations and Inuit communities and organizations in trying to find ways to ensure that we actually reach out to and communicate to our partners and the clients. We're talking about a potential 853,000 clients at the moment, dispersed across the country, on and off reserve, so it's a vast population. For us, it means that we've been working with communities, the primary health care centres that exist in the communities, and the health professionals, and also, of course, potentially working with social media to make sure that clients have access to the most information perspectives possible. We also have newsletters that inform people about what we're doing, and that's something that we are looking at improving.

I don't know, Dr. Plante, if you want to add something on this.

[Dr. Marc C. Plante]

Yes. We're looking at a strategy and also working with our partners. They know better than we do how to get to the people who need the information.

We are looking into a plan in the next few months to do a better job about communicating. We've already made improvements. Clients now can subscribe on our website to have all the client newsletters. For the information on the program itself, they have the same information as the dentists. The issue with that information is that sometimes it's very technical, so that's why we're trying to find new ways of explaining the services that they have the right to have, basically. This is all work that's being done.

We're also working with the Canadian Dental Association. Whenever we make changes now, they also publish them, sometimes on their website, and there are the other associations also, such as the Denturist Association of Canada and the Canadian Dental Hygienists. They're helping us by trying to spread the word throughout the providers, but also on the client side, because they also see the clients in their offices. There's a lot of work to be done, for sure.

[Jean Yip, Liberal, Scarborough—Agincourt, ON]

Thank you.

[The Chair, Conservative, Kevin Sorenson]

Thank you, Ms. Yip. Before we go to the next round, because we do have another minute or two on your round, I would like to ask a question.

I'm looking at the Auditor General's paragraph 4.44, where he says, “Health Canada's data for the school years ending in 2014, 2015, and 2016 showed that the Children's Oral Health Initiative had not met its enrolment targets, but that it had met most of its targets for the delivery of preventive services...”.

I guess where I'm going with this is that when you have general health care among first nations or Inuit on or off reserve, typically off reserve, we know that it's not simply a doctor who can deliver that type of health care; it can be a nurse, a nurse practitioner, or a whole large group of people who can deliver some health care. On dental care, it's a little different. You have a dentist and a dental hygienist. I'm not sure if there are any groups other than those two who can do typical dental work.

However, the Auditor General said in his report that when it came to prevention.... I understand that there are things you can educate people about, such as the importance of brushing and hygiene, but there were “about 20 percent fewer fluoride applications in 2016” than in 2014. That struck me. We know that fluoride applications can help prevent cavities and help with dental health and health, certainly in remote areas where fluoride is not in the water supply. Why, then, would there be such a drastic drop in fluoride applications over two years, from 2014 to 2016?

[Jean-François Tremblay]

Dr. Plante, do you want to try that one?

[Dr. Marc C. Plante]

The fluoride program is a voluntary program. Parents can enrol or not enrol their kids. Also, fluoride is only part of the big team, basically, because fluoride can be provided by provincial programs and by NIHB, through private means—

[The Chair, Conservative, Kevin Sorenson]

Is that the case? Did it drop here because the province had increased...?

[Dr. Marc C. Plante]

We cannot say that. We can only—

[The Chair, Conservative, Kevin Sorenson]

Then how do you take this data of a 20% drop in fluoride treatment and respond to it if you don't know? It might be covered by the province, and it might be covered by other groups.

[Dr. Marc C. Plante]

That's why we need to look a bit more closely, as we said before, at why we are seeing this happen. We're just putting a hypothesis out there. We have to look really closely at what is happening there. In terms of putting the data together, that's one of the reasons: we'll also have a better sense of where the clients are going. The only data that we will not have for sure is the data from the provincial governments, but at least throughout our programs, if we are able to put the data together, we'll have a better story for each client individually.

[The Chair, Conservative, Kevin Sorenson]

Thank you.

Mr. Christopherson.

[David Christopherson, NDP, Hamilton Centre, ON]

I had indicated, Deputy, I would be looking to you for a further answer, but you're in luck. The answers the AG gave did give me what I wanted, but I do hope you'll reflect on that answer. It wasn't very good.

I do want to say that hope springs eternal, and a lot of emphasis in the response from the government is placed in the new restructuring, in that it should allow the synergies of the various components to work together to give us more service delivery. Whatever, I'll take anything, but somebody just show up and fix what's going on in terms of services for our first nations people.

We shall see, but just remember, every time you make a promise that gets you out of today, that promise has to be accounted for someday down the road.

I have two very brief questions. My last one will be on the macro data and how we're doing, Mr. Ferguson.

Deputy, I want to read one paragraph, and I'd like your response, because this just blows me away. On page 6 at paragraph 4.28, it states:

The Department had known for many years that Inuit and First Nations people’s oral health was poor, and attempted to develop a strategic approach to improving it. We found that the Department drafted strategic approaches to oral health in 2010 and 2015, but did not finalize them. The Department committed to the implementation of an oral health strategy and action plan in 2015 in its Report on Plans and Priorities. Department officials developed regional plans for oral health service delivery. They also continued to discuss a strategic approach to oral health, and in 2016, the department hired a contractor to develop one. At the time of our audit, the Department had not finalized a strategic approach.

What the heck is going on with this? Why is it so difficult to come up with a strategic plan? Why are there promises and then a failure to honour those promises? All we have today is another promise. Give me some reason to believe, Deputy, that this time you folks are actually serious about keeping the promise, as opposed to your track record.

[The Chair, Conservative, Kevin Sorenson]

Mr. Tremblay.

[Jean-François Tremblay]

First of all, I would say that there were regional plans. We were working on this. We knew that the oral health situation of first nations and Inuit was poor. We have programs that were developed for this. We made our decisions on an evidence base. We worked with experts in developing those programs, and we put them in place.

Now we're going to a more mature level in our programs where, yes, we will try to finally have a national approach where we can compare the data between and among our programs, as well as among regions, and try to make sure that we have the resources we need for the kinds of demands that we meet for the population we serve.

[David Christopherson, NDP, Hamilton Centre, ON]

I hear you going forward, and again, it's more promises, but talk to me about the failure along the way. How can this be? It's something that's so important, but there are all these fits and starts and we're still not there. This is about accountability. It's not just about what's going forward. We want to know what the heck happened in the past. This is a disaster, and I haven't heard you give me one good reason why it happened—it's not even acknowledged—so, Deputy, please.

[Jean-François Tremblay]

We acknowledge there is progress to be made. The national strategy is not necessarily everything that will fix everything here. As was mentioned, those issues are broader than just a strategy at the national level on how we will collect the data among those programs. It's an important step, and we will take that step. That's the way we see it.

[David Christopherson, NDP, Hamilton Centre, ON]

I have to tell you, I don't like that answer at all, and that's consistent with the other answers you're giving. I'm sorry, but I don't get the feeling you're listening and addressing what we're dealing with. You want to talk about what you want to talk about, and we're insisting you talk about what we want to talk about.

I'll leave that. I don't have a lot of time. This round is very brief. However, I'm sorry, but that answer was not sufficient, Deputy. It didn't address how the heck so many mistakes were made in the past and deal with why we should listen to this promise when you've made promises before and you didn't keep them.

I have a last question—a macro question.

Auditor General, I had raised the issue of data. I raised the fact that you'd come to us with a report asking us to make it as much of a priority as we can. We've tried to do that. We could always do a better job, like everybody and everything, but are we making a difference? Are we starting to turn the corner at all, or do we need to ramp up our efforts because we're still not getting the message through?

Can you give me your thoughts, sir?

[Michael Ferguson]

In general when we're doing audits, we still see many problems with how departments are collecting and managing data. I think, though, that the committee has been successful in starting to shed some light on this, and departments are starting to take it more seriously. However, I don't think it is yet showing up in our audits.

In this particular audit, I would like to point out that there were some places where we saw that the department was doing some good things with data, and then some places where they needed to improve in data.

The department has a lot of data about individual payments for individual services. When dentists are providing individual services and those services are being paid for through the department's program, they have a lot of data on that. They have done a lot of analysis on that data to make sure dentists are only claiming what they should and people are only getting paid what they should. They've been collecting a lot of data. That data is accurate, and they've been using that data to make sure that payments are appropriate. They haven't been using the data sufficiently to manage the outcomes, to manage what this data can tell us about dental health outcomes and how we can use that data to improve that.

Similarly, on something like the children's oral health initiative, they don't have the information about individual services because the department doesn't pay for each individual service. It pays for a hygienist, perhaps to go into an area in some of these programs. The hygienist gets paid, but not necessarily on an individual service, so they don't have as much information. That's why when we talk about the children's oral health program and there appears to be some data quality issues, it's because they don't collect the same level of data.

They're doing a good job on some of it, where they have the individual transactions. They need to use that information to get more insight out of that information. Then, in some of these other places, they just need to do a better job on collecting information in general.

[David Christopherson, NDP, Hamilton Centre, ON]

Excellent, that's very helpful. Thank you so much.

Thank you, Chair.

[The Chair, Conservative, Kevin Sorenson]

Thank you, Mr. Christopherson.

I will now move to Mr. Tabbara.

Mr. Tabbara, welcome to our committee.

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

Thank you.

[The Chair, Conservative, Kevin Sorenson]

The times is yours.

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

Do I have five minutes?

[The Chair, Conservative, Kevin Sorenson]

You have five minutes.

Because you're new, we can give you up to five and a half, maybe six minutes.