Public Accounts Committee on March 3rd, 2022

[Christiane Fox]

Thank you very much for the question.

I wasn't here in 2014, but my understanding is that there was a reliance on the national emergency stockpile, and probably, in terms of when you talk about the “gap”, the gap was probably not a thorough assessment and a regular monitoring of the PPE supply and the state of the PPE that was in our possession. I think that's what, frankly, we're moving away from, to go towards this new system.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Thank you, Deputy Minister. We'll get back there.

Here's my concern, though. This sort of pandemic, as one of my colleagues rightfully said, was a one-in-100-year event, but we will have other significant events that will happen in the coming years. Are you assessing your other areas? Are there other gaps there? Is there a need for additional government resources? If you had a wish list, are there things where you'd like additional funding so we don't get caught again?

[Christiane Fox]

There are enormous needs within indigenous communities. In terms of future planning, I think we are taking the lessons of the pandemic for PPE specifically. I think I mentioned moving from a six-month supply to a 12-month supply, which allows for that buffer zone if ever we were to face a similar event.

What I think we need to really think about is emergency management in this country, and that is not just exclusive to a health pandemic. We faced significant challenges over the last two years, because not only were we facing a COVID pandemic, but in addition to that, we had fires and flooding. The requirement for PPE and safety protocols was not limited to a community. It was also important when there were evacuations. Data, I think, is a huge area of concern in terms of well-managed health human resources and health services that are culturally relevant.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Thank you, Deputy Minister.

You just said something I wholeheartedly agree with. I believe that in many sectors of the government—and this goes back multiple governments—we haven't invested appropriately in data management. I'm glad there's going to be data management involved in PPE, but is there a particular area in which the government could invest more money with respect to data management and maybe climate change resilience or something else specifically that maybe you'd take the opportunity to get on the record?

[Christiane Fox]

We absolutely think that data, capacity and governance are key to supporting indigenous leadership in this country for all areas of EM, health or economic development.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

With respect to the PPE, my understanding is that you were using nothing more sophisticated than spreadsheets up to this point.

Are there other significant areas in which your department is relying simply on spreadsheets to support data management? To be clear, I don't blame you. I think this is, as I said, a failure by multiple governments to invest in data management.

[Christiane Fox]

In full transparency, I would have to do a full review of the department. One thing that does come to mind is that, for data from our nursing stations that support communities, we should have access to better systems. These go beyond just the nursing station in terms of how they interact with the provincial data systems, but I do think modernizing our data from nursing stations would be a key priority as well.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Thank you. Those were excellent answers.

I'll just finish with one short question here to keep the chair happy. How much of the PPE that you are procuring or asking for is made in Canada and how much is made by indigenous-owned businesses?

[Christiane Fox]

I would have to check on that.

Of what we've received, 2% would actually be procured by PSPC and by the Public Health Agency of Canada. Then we also sent funding directly to indigenous communities to purchase their own PPE, some of which may have been from indigenous businesses. I would also note that we have a 5% target for indigenous procurement, and this department will be—

[The Chair, Conservative, John Williamson]

Thank you. Your point was made.

Ms. Yip, you have five minutes. Go ahead, please.

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

I'd like to thank Mr. Lawrence for realizing the importance of investing in data management. That's always great.

I'd like to thank all the witnesses for appearing today.

Welcome, Dr. Wong. My first question is for you. How were children, seniors and those who were immunocompromised treated during the PPE and nursing shortages, such as those requiring medical care for diabetes or cancer?

[Dr. Tom Wong, Chief Medical Officer, Chief Science Officer and Director General, Department of Indigenous Services]

Thank you very much for the question.

All of us in the department, even before the pandemic, have been very concerned about the most vulnerable population within each community, whether it's first nations, Inuit or Métis, especially individuals who are elders or who have diabetes or cardiovascular diseases. All of the individuals are at much higher risk of complications from COVID.

Because of that, one of the top priorities of the department was to convince the provinces and territories of the importance of prioritizing indigenous peoples for vaccination and to get public support for all other public health measures. Also, every day within each community and our regions we need to support the regional leadership and the health directors to try to make sure that, to the best of their ability, they can support the protection of the elders, pregnant women, children and other individuals. If we don't take care of the most vulnerable, we will not be able to eventually come out of the pandemic and minimize both hospitalizations and fatalities in the communities.

However, that being said, all of the long-standing social determinants of health, including housing, water, etc., are contributing to the vulnerabilities of the members of the communities, and those must be addressed.

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

Ms. Fox, just to stand up on Dr. Wong's answer, is there anything that can be done in the future to help these vulnerable groups should there be another crisis?

[Christiane Fox]

Absolutely. With some of the planning that's being done now, given the pandemic and the lessons we've learned to date, and hopefully postpandemic when we can really focus, there are going to be strategies in place in terms of how we manage the most vulnerable. That could be everything from housing to the anti-racism in the health care system strategy and our post-secondary strategy. There are a number of issues—I think housing is a key determinant of health—so we have to focus on these things.

I would also speak to the potential for health transformation and service transformation and empowering communities by having funds to allow them to take over those services.

We are seeing some examples of what health transformation can look like. We have NAN in northern Ontario. We have MKO in Manitoba. We have a group in Nova Scotia that has a proposal to take over health services and governance for 13 first nations. I think that the empowerment of those communities will help the most vulnerable, but it's not limited to just health. If you think about early learning and—

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

Thank you.

Dr. Wong, despite the lifting of restrictions across the country, there continues to be a concern about outbreaks. Are there any more outbreaks in the indigenous communities? I heard there was one in a Saskatchewan first nation. What is being done to support them in terms of PPE and health care?

[Dr. Tom Wong]

Thank you so much for raising this.

One of my concerns is that the public tends to look at the fact that the omicron wave is coming down in all of Canada, and in some parts of the north as well. However, that does not mean there are no outbreaks. Every day, there's a new outbreak. There's another outbreak in this community and that community, so one size doesn't fit all. Public health measures need to be commensurate with what's happening in the community. If there's a big outbreak in the community or surrounding the community, and the ICUs around the community are full, that's not the time to relax public health measures. As a matter of fact, it's the time to actually redouble vaccinations and other public health measures.

[The Chair, Conservative, John Williamson]

Thank you very much. I appreciate it.

We're now entering our third round. This is likely going to be our last round, because we have some committee business to take care of in the last 15 minutes.

Without further ado, Mr. Duncan, you have five minutes, please.

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

Thank you, Mr. Chair.

To the deputy minister, I want to follow up again on the aspect of staffing and some of the challenges there. I always hate asking for more statistics. If you don't have them, this isn't a make-work project, but you alluded to the recruitment aspect of working from a wide variety of demographic angles, I'd call it, trying to encourage people who have just come out of college or university as well as people who have retired and are possibly looking to work up north for short periods of time.

Do you have a breakdown of what you've found most successful so far? I don't think it's a lack of effort by the department or indigenous communities to attract staff. The reason I'm asking is this: What more can we do that the federal government is not doing already to bridge that gap? Again, this was a challenge not only during the pandemic with the surge demands. This was a challenge before then, and it will remain a challenge after COVID as well.

[Christiane Fox]

Thank you for the question.

I should say we have 862 nurses. I'd say about 50% are in remote and isolated communities and about 600 of them are on contract.

What worked in terms of strategies? Ideally we tried to ensure first that people had the right training and culturally relevant experience in order to work in an indigenous first nations remote community. That's really important. It's not just the kind of recruitment that a provincial government would do, for instance, for something in a hospital setting in downtown Toronto. That training is a really important requirement.

In terms of the contract nurses, is it a perfect system? It's not always. However, a lot of people don't necessarily want to commit to full-time employment, so this can be a really rich way to enhance the supports and have a workforce that we can call upon. We did have some successes in recruiting more people through the contract.

By changing our hiring practices and actually making more effort—not just putting up posters but also seeking candidates through various channels, indigenous networks, hospital networks, colleges and universities—we were able to hire 177 new staff who are part of this 862 now, and those include nurses and paramedics. I think it's more about being more proactive and not just using older approaches like putting a job poster on a website but really going after that talent.

The last thing I would say is that this idea of having surge teams that can be mobile and move to a crisis or be needs-based could be a really interesting way to not require someone to make a commitment to live in a particular area for weeks on end, year after year. Maybe someone would like that flexibility of coming in and out of community and not necessarily staying long term. That is something that I think could have some promise as well and could help meet some needs.

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

Thank you for that.

This may be the last aspect. When we talk about recruitment of medical professionals who are coming out of college or university, I know there has been a high level of student debt and young people having difficulty finding employment. I think in today's labour market it's a completely different situation, but one of the things I'm wondering about is whether there have been any discussions in the department about incentives for young people looking to pay off student debt and gain experience. Could there be some sort of extra incentive so that they would not only be paid but also pay off their student debt at a perhaps accelerated rate if they worked in communities that are underserviced or more rural or remote?

Do you have the ability or flexibility in your department to offer that, and has there been any conversation about that when you have talked about new strategies to address the recruitment shortage both prepandemic and during the pandemic?

[Christiane Fox]

Thank you for that question. I would say that during the pandemic and even postpandemic in conversations we're having within teams, we are looking at innovative approaches. We are looking at ways, and I think the one that you've raised is similar to how sometimes teachers college or a nursing program has students go and do a service in a community for a period of time. There's nothing concrete at this stage, but I think those are some of the ideas we're trying to focus on in terms of innovative ways.

I would say that, with respect to funding through the anti-racism strategy, ensuring that we have enough indigenous youth who have a path towards post-secondary and funding that post-secondary is probably the most promising route, because the talent that is within communities is what we have to develop and maximize. That's what health transformation is about.

From my perspective, as the deputy of the department, if we can increase the number of indigenous students in some of these areas—not just those in HHR but also water operators, engineers and construction professionals—these are the—

[The Chair, Conservative, John Williamson]

Thank you, Ms. Fox. I appreciate it.

We turn now to Ms. Shanahan for five minutes.

Go ahead, please.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Thank you very much, Chair.

I was very interested, actually, in the comments of one of my Conservative colleagues. I think it was Eric talking about Akwesasne. Yes, it's in your region, and it got me thinking about Kahnawake, which is technically not in my riding of Châteauguay—Lacolle but we are very close neighbours. They basically took over the management of their COVID-19 response and actually had no cases for many months until there were outbreaks almost everywhere. It was very interesting to see just how independent they were in putting forward their directives.

I don't really want to know if they obtained PPE from Indigenous Services—that's really their business—but if they had needed to obtain it, because of course they're an urban reserve, could they have obtained it? I'm asking the deputy minister.

[Christiane Fox]

Thank you very much for that question.

Yes, as I've said, we provided PPE to communities, not just limited to the health professionals or the ISC employees or the contract nurses. We really try to take an all-of-community approach to the PPE. If a community would have made a request, they could definitely have gotten PPE through our distribution channels.

The second thing they could have done was use ICSF money—indigenous community support funding—to purchase their own PPE if they preferred to do it that way. That was a second option that a community would have. Then, of course, we would also provide PPE to urban indigenous centres, just because of the need and the accessibility challenges they were facing with provincial and territorial governments.

The answer to the question is, yes, they could have and would have that channel to make that request.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Very good.

I would like to offer the balance of my time to my colleague MP Desjarlais, please.