Public Accounts Committee on March 3rd, 2022

[The Chair, Conservative, John Williamson]

I call this meeting to order.

I must say, coming in here today, there was activity and there was discussion. It is starting to feel like a regular Parliament again. It's a very nice sign.

Welcome to meeting number eight of the House of Commons Standing Committee on Public Accounts.

Pursuant to Standing Order 108(3)(g), the committee is meeting today to undertake a study on “Report 11—Health Resources for Indigenous Communities—Indigenous Services Canada”.

Today's meeting is taking place in a hybrid format, in compliance with the House order of Thursday, November 25, 2021. Members can attend in person or remotely using the Zoom application.

The proceedings will be made available through the House of Commons website. So you are aware, the web broadcast will always show the person speaking rather than the entirety of the committee.

I would like to take this opportunity to remind all participants to this meeting that screenshots or taking photos of your screen is not permitted.

Given the current pandemic situation and in light of recommendations from public health authorities, as well as the Board of Internal Economy's directive of October 29, 2021, to remain healthy and safe, everyone attending the meeting in person must follow the health rules.

As the chair, I will enforce these health measures for the duration of the meeting, and I thank members in advance for their co-operation.

To ensure an orderly meeting, I would like to outline a few rules to follow.

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With regard to a speaking list, the committee clerk and I will do the best we can to maintain a consolidated order of speaking for all members, whether they are participating virtually or in person.

I would now like to welcome our witnesses.

From the Office of the Auditor General, we have Andrew Hayes, deputy auditor general. It's good to see you again, sir. We also have Glenn Wheeler, principal, and Doreen Deveen, director.

From Indigenous Services Canada, we have Christiane Fox, deputy minister; Dr. Tom Wong, chief medical officer, chief science officer and director general; and Robin Buckland, director general and chief nursing officer.

You have five minutes to make your opening statements. I will go to the deputy auditor general.

Mr. Hayes, you have the floor for five minutes.

[Andrew Hayes, Deputy Auditor General, Office of the Auditor General]

Thank you, Mr. Chair.

We are happy to appear before your committee today to present the results of our audit of health resources for indigenous communities.

I would like to acknowledge that this hearing is taking place on the traditional unceded territory of the Algonquin Anishinabe people.

Joining me today are Glenn Wheeler, who was the principal responsible for the audit, and Doreen Deveen, the director who led the audit team.

This audit focused on whether Indigenous Services Canada provided personal protective equipment, nurses and paramedics to meet the needs of indigenous communities and organizations during the COVID-19 pandemic. Overall, we found that Indigenous Services Canada adapted quickly to respond to the COVID-19 pandemic. During the pandemic, the department relied on the national emergency strategic stockpile to supplement its own supply of protective equipment.

Before the pandemic, the department was providing equipment and health care workers to 51 remote or isolated first nations communities. We found that during the pandemic, the department expanded access to protective equipment to all indigenous communities when provinces and territories were unable to meet the demand. It also expanded access to protective equipment to other individuals, such as police officers and people sick with COVID-19 or caring for a sick family member.

During the first 10 months of the pandemic, the department responded to more than 1,600 requests for multiple pieces of protective equipment. We found that communities, many of which are remote, received their shipments on average within 10 days of requesting equipment.

However, we found a number of weaknesses in the way the department managed its own stockpile of personal protective equipment before and during the pandemic. The department did not have complete and accurate data on the stockpile's contents. We also found that the department had not followed its own approach in procuring sufficient equipment before the pandemic. As a result, it did not have enough of some types of protective equipment in its stockpile when the pandemic broke out.

We also found that, in relation to providing nurses and paramedics to communities, the department streamlined its processes for hiring nurses in remote or isolated first nations communities. In addition, the department made its contract nurses and paramedics available to all indigenous communities to respond to additional COVID‑19 health care needs.

While the department took steps to increase capacity, the number of requests for extra nurses and paramedics also increased. As a result, the department was unable to meet more than half of the 963 requests that it received between March 2020 and March 2021 for extra nurses and paramedics.

The pandemic aggravated pre–existing challenges in meeting nursing needs in remote or isolated first nations communities. Several factors contributed to nursing shortages in many of these communities, including the national shortage of nurses, the challenging nature of the work, the diverse skill set required to work in remote or isolated communities, and poor housing.

Mr. Chair, this concludes my opening remarks. We would be pleased to answer any questions the committee may have.

[The Chair, Conservative, John Williamson]

Thank you very much.

Now I'll call Deputy Minister Fox. You have five minutes, please.

[Christiane Fox, Deputy Minister, Department of Indigenous Services]

Thank you.

Kwe kwe. Ullukkut. Tansi. Hello.

I want to acknowledge that I'm on the traditional and unceded territory of the Algonquin people.

Thank you for inviting me to speak to our department's response to the Auditor General's report concerning health resources for indigenous communities during the COVID-19 pandemic.

In the report, the Auditor General made two overall recommendations. The first was concerning personal protective equipment. The OAG noted that the department should review how we manage our stockpile of PPE, making sure that we have accurate records to ensure we have the right amount of stock for this current pandemic and any future emergencies.

To respond, we reviewed our inventory from before the pandemic. We then looked at how quickly the personal protection equipment—

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

I have a point of order, Mr. Chair.

[The Chair, Conservative, John Williamson]

Yes.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

There was an issue with translation, but I believe it's been fixed. Thanks. I'm sorry.

[The Chair, Conservative, John Williamson]

Please proceed, Ms. Fox.

[Christiane Fox]

Thank you, Mr. Chair.

We then looked at how quickly the personal protection equipment was being used during the first year of the pandemic, and overall, we were satisfied that we had enough equipment from the Public Health Agency of Canada to meet the needs of communities.

We must also recognize the challenge of acquiring this equipment on an international scale. In response to the recommendation, we also started working with the Public Health Agency of Canada on a joint automated inventory management tool. This will give us accessible, up-to-date information on the stockpile.

This past summer, we worked with a contractor to finish a full recount of all the equipment. That enabled us to update our inventory tracker accordingly.

I am very pleased to say that the department's inventory target has increased from six to 12 months' worth of equipment in its stockpile at all times.

We have now moved from a six-month to a 12-month supply at all times. We're also committed to conducting monthly inventory analysis so that we can be proactively managing the PPE stockpile, staying on top of trends and anticipating any needs. Finally, we're reviewing our chain of PPE custody and disposal practices to ensure a stable inventory.

The Auditor General's second recommendation concerned the shortage of nurses and paramedics.

The report said that the department should work with remote or isolated first nations communities to look at other ways to address the shortage of nurses and to review the nursing and paramedic support that communities received.

The department agreed with that recommendation. In response, we are now collaborating with the 50 first nations communities that we serve directly and the 29 communities that are managing their own nursing stations.

Supported by budget 2021, we are focusing on three areas: hiring new nurses, keeping them in the job and lessons learned during the pandemic.

All of this work is being done in partnership with nursing leadership within the department and our indigenous partners, and under the umbrella of the nursing health human resources framework. We're examining how we can better recruit and retain nurses by enhancing nursing supports and increasing access to practical nurses and nurse practitioners to augment the existing registered nurse workforce. The department has established and managed surge nursing and paramedic contracts to complement our workforce. Since April 2021, there have been over 11,000 service days of surge supports provided to help maintain essential clinical services in remote communities.

We're also working to create an internal primary care nurse service team. In time, this team will provide us with added flexibility to respond to the need for additional nursing resources. We're making improvements in areas such as customized nurse supports to resolve frontline issues related to IT, compensation and security.

We're also working to enhance our clinical practice supports and, of course, our continued 24-7 access to a customized nurse employee assistance program. As we all know, our frontline workforce has been working very hard under challenging circumstances throughout the pandemic.

We thank the Auditor General for the valuable recommendations, and we feel that the changes we have made have strengthened our response to this pandemic. They will also put us in a stronger place to respond to future health care needs.

Meegwetch. Qujannamiik. Marsi. Merci. Thank you.

[The Chair, Conservative, John Williamson]

Thank you, Ms. Fox. I think I might know your father. He used to be in politics, didn't he?

[Christiane Fox]

That's correct, yes.

[The Chair, Conservative, John Williamson]

Yes, very good.

Mr. Duncan, you have six minutes.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

Thank you, Mr. Chair, and to our witnesses for being here today.

I want to focus my questions on the shortage of additional health care staff, as alluded to in the opening statements.

For context, I'm proud to represent and work with the community of Akwesasne in my riding of Stormont—Dundas—South Glengarry, and while not being remote, it is an example that certainly speaks to the challenges of attracting and retaining health care staff. Dr. Ojistoh Horn is the only full-time general practitioner at one of the clinics in Akwesasne, for example, a community of 25,000. She works with two nurse practitioners who cover about 14,000 patients.

There was a good CBC article that came out at the beginning of the pandemic, and it notes—to get into my question—that even before the pandemic, as Mr. Hayes alluded to in his opening comments, there were some challenges already arising. This was before the pandemic exacerbated the challenges.

Mr. Hayes, for statistics purposes, there's one thing I was wondering. You provide data on the services being met or not met during the pandemic. To give us a context, do you have—and if not, the deputy minister might be able to provide our committee with this—an idea of the request for services prepandemic and what was met and not met so that we can understand perhaps the volume and percentage of success in meeting those requests? Did you look at that data, and if not, can we get that?

[Andrew Hayes]

I do not have that data on hand. The deputy minister might have a perspective on that, though.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

I'll go to the deputy minister then.

[Christiane Fox]

In terms of the question itself, I would say that the [Technical difficulty—Editor] that were requested in terms of surge during the pandemic were very much to complement the additional requirements beyond the staff we currently have in communities. It would be a different type of tracking in the sense that we have a permanent workforce in various indigenous communities across the country. At the time of the audit, it was actually 51 communities where we managed direct services and 28 where the service had been transferred to the indigenous communities. At this time we're at 50 and 29, because we transferred a community in Quebec.

In terms of the needs on the ground, it would have been assessed and met by the primary health team in the community, supported by the 18 physicians we have across the country, the regional medical health officers and the staff.

In the pandemic we saw an increased demand for surge support that would not necessarily have been common prior to the pandemic. We could probably provide the committee with statistics on the number of clients we saw per community, our workforce in the communities prepandemic and our workforce in communities postpandemic. I think that could give you an indication of the need surge during the COVID-19 pandemic, if that's helpful.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

That would be. Thank you for that and for the backgrounder.

On the contracts being distributed, how were they advertised and what did they look like? I'm assuming you worked with provincial partners, and obviously indigenous communities directly, but what more advertising or promotion was done in that sense?

I'll have a supplemental afterwards about what more could be done, but I'll leave it at that for the first part.

[Christiane Fox]

Thank you for the question.

Just to give you a sense of context, we employ 862 nurses within Indigenous Services Canada. In addition to that, at this moment in time we have approximately 600 nurses and paramedics on our roster of contracted nurses. We use that roster in order to fill surge and even in order to fill the requirements within communities. It's very much a mix of Indigenous Services Canada personnel plus surge contractors.

How do we get those? We definitely do work with the province. In fact, as you can imagine, during the COVID-19 pandemic health human resources was a challenge across the country. Therefore, we sometimes had to compete for that health human resource capacity. We had to think about what some of the creative ways were we could attract and retain. We worked with colleges and universities and with first nations-led institutions like SITT to try to get that health human resource capacity in indigenous communities.

I can speak to efforts going into the future, but definitely at this point we relied on ISC nursing staff and contract staff, and then used different ways to advertise and look for skills. Even within our own group, we have nursing staff who are in communities. We also have nursing staff within the department who are doing policy work. We look at our own workforce. We look at the retired workforce. Could we bring people back to be on contract with us, even if part time?

The last thing I would say is that we also instituted ISC CARE, which was turned around in about two weeks. It was a safe air transport that actually moved people from communities and that facilitated, safely, the arrival of our HHR personnel. We were able to fly over 5,400 health human resources in and out of those 51 communities.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

Thank you.

[The Chair, Conservative, John Williamson]

Thank you very much.

Mr. Dong, you have six minutes, please.

[Han Dong, Liberal, Don Valley North, ON]

Thank you very much.

First of all, I want to take this opportunity to thank the Office of the Auditor General for a very timely report and recommendations.

I also want to thank the public servants, especially the medical officers and scientists, who have guided the government with their expertise and facts. It was one of the biggest reasons that Canada was praised around the world as a nation with a better response to a pandemic that we haven't seen in 100 years. Sincerely, please convey my gratitude to all the public servants under your supervision.

I want to talk about the first recommendation. The Auditor General's report specifically talked about the stockpiling of PPE. I heard about the management of surge support for the indigenous community.

Deputy Auditor General Hayes, in your findings, was there any particular focus on the fact that PPE has an expiry date? Was that factor applied to the readiness of the department when it came to support for indigenous communities?

Then I'll move to the deputy minister on this point as well.

[Andrew Hayes]

Thank you very much for the question.

Our findings on the department's stockpile focused in on the fact that there was inaccurate and incomplete information of the amounts that were in stock. Before the pandemic there was an approach that was expected to have been followed to have the appropriate amounts in the stockpile, and we found that it wasn't indeed followed.

During the pandemic we identified errors in the stockpile, whether from manual errors in inputting information on materials or equipment received, or from the actual contents of the stockpile. Our recommendation was focused on accuracy and completeness. We didn't comment on the expiry dates. However, as we mentioned in the PPE and medical device report, that is an important factor to be aware of as you manage a stockpile.

[Han Dong, Liberal, Don Valley North, ON]

To the deputy minister, I just want to add another layer to the domestic production and manufacturing capacity, because we know there was a lack of that in the very beginning of the pandemic. Adding in the expiry nature of most of the PPE, going forward, how would the ministry better manage the stockpile of the PPE?

[Christiane Fox]

Thank you very much for the question.

I think we definitely took the recommendation on, and I think there would be two components that I would point to in terms of the department's response.

The first would be around the automated tool, which is very much centred on both outbound PPE and inbound PPE, having a very good sense of the type of PPE, the supply, the quantity, and where it's going. To give you a sense, since the beginning of the pandemic we received 2,241 requests coming into the department. Over 20 million units of PPE have been shipped. At this stage, 2,201 have been delivered.

Through this automated system and through the changes that we've done in the department, we can really track the flow of PPE that we have and we are able to determine both the expiry and the gaps in supply, whether it be gloves, sanitizers or whatever it may be. We have a very good sense of that. I think, as I noted in my remarks, that new tool, the sophistication that we brought to our current systems and how we manage the flow have allowed us now to build our supply to a 12-month turnaround period.

The way we worked with communities was that we would approve requests within two days of coming in and ship them right away. The average arrival of the PPE would be within 10 days.

I should also note that we provided PPE to the 51 communities and their health care workers, but we did not limit our PPE stock to just those health workers. If a school called, if a police officer called, if there were needs in the community, we did everything we could to respond to that need, and that was not limited to on reserve. We actually sent PPE supply to urban indigenous centres to be able to provide those essential supports for urban indigenous individuals who found themselves out of the community or even in very dire situations, in terms of the indigenous homeless population. It was very much not just limited to that.

How does it help us going into the future? I think we have a much better system to plan and track and to enable us to have confidence in our ability to meet the demands as they come in.

[Han Dong, Liberal, Don Valley North, ON]

Thank you very much.

I'll stay on the supply issue. You mentioned it taking about 10 days, Does that take into account a pandemic setting? Every country around the world is competing for those PPE. Going forward in the future, will we still, in the end, revisit the crisis situation, beginning with the lack of PPE?