Public Accounts Committee on March 3rd, 2022

[Andrew Hayes]

I will see what I can do with our people. We don't have an audit going on in Public Services and Procurement Canada right now, but I'll reach out to see what we can find.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Thank you.

In regard to that, we saw at the beginning of the pandemic that we sent a lot of PPE overseas. When we look at this 2% threshold and ISC in general, were they exempt from having their PPE sent to other parts of the world, or were we able to leave that strategic stockpile in the hands of ISC?

[Andrew Hayes]

My understanding is—and I'm drawing on the other report that was studied as well—that the scarce resourcing strategy was developed at the beginning of the pandemic to make sure there was enough capacity in the national emergency strategic stockpile, the Indigenous Services Canada stockpile and the provincial-territorial requirements. I think that the question of what went overseas versus what was in the stockpile is different.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

On page 18 of the report you said, “Because of the COVID‑19 pandemic, we did not visit Indigenous communities or organizations during our audit.”

To clarify, for consideration of this report, do I understand correctly that this means you would normally visit these communities? Do you believe that some information may have been missed because there was no physical presence on the ground in these communities?

[Andrew Hayes]

Our normal approach would be to visit communities and engage directly with the leaders and elders. In this case, because of the circumstances, of course, we weren't able to do that, so there is a possibility that we didn't have the information we would have received if we were able to visit these communities. However, we did see evidence in the files of consultation by the department, phone calls and Zoom calls, etc., which isn't as useful in the grand scheme of things when you can visit, but under the circumstances, that's what we were left with.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Thank you.

In exhibit 11.2, I find it interesting to look at the breakdown per province. We see that Manitoba received almost 800,000 masks. Across the board, they had a much higher amount of PPE sent to them, as compared to, say, Saskatchewan or Ontario. When you look at the population that is served by Indigenous Services Canada and compare the population numbers to the amount of PPE sent, why did Manitoba receive a vastly larger amount of PPE than any other province?

[Andrew Hayes]

The deputy minister might be able to answer part of this question.

For the purposes of our audit, we were focused on what the department did when faced with responses from the communities. What was happening in a particular province, whether it was the prevalence of the disease or the circumstances of distributing PPE—the access in the province—is ultimately all different.

In our report, we did identify which were the three top provinces for the department to respond to.

[The Chair, Conservative, John Williamson]

That is your time. Thank you very much.

Mr. Fragiskatos, you have five minutes, please.

[Peter Fragiskatos, Liberal, London North Centre, ON]

Thank you very much, Chair.

Thank you to our witnesses for their work and for appearing.

In the report, recommendation 11.61 states:

Indigenous Services Canada should work with the 51 remote or isolated First Nations communities to consider other approaches to address the ongoing shortage of nurses in these communities and to review the nursing and paramedic support provided to all Indigenous communities to identify best practices.

The department has agreed to that recommendation.

My question is on the 51 first nations and engagement. It's a question to the deputy minister. How exactly will engagement proceed? Are communities prioritized according to a particular set of criteria? If so, what are those criteria? How does engagement unfold in these cases?

[Christiane Fox]

Thank you very much.

I should specify that, at the time of the audit, it was in fact 51 communities, but we have transferred the service in one case. If I use the figure of 50, it's to show that we're at a different place now than we were, and it's great news in terms of the agenda for health transformation that the Quebec community has taken on.

In terms of how we will engage, I think the first thing is that we engage regularly. We have nursing staff in community at all times. For the 51 communities, there are constant communications between the chief, the band council and the health directors. That engagement happens consistently on the needs.

Specific to the recruitment and retention, what we want to talk to leadership about is not just how we recruit and retain, but how we modernize the practice environment. What is the well-being of the workforce? How do we encourage members of the community to pursue a career in HHR, and what are some of the supports that are required? How do we maintain a nimble and agile search?

These are sometimes very challenging postings. They're remote. They're rural. Over the summer, I spent some time with our nursing staff in Sandy Lake, Pikangikum and Norway House.

I think the strategy and the engagement has to be not just about what they need in terms of primary health care needs, but it also needs to be future looking. What does the health infrastructure in the community look like? What is the path towards the talent development? The department has emphasized health transformation, and that is about empowering communities to take on the health services for their communities.

We also talk a lot about health teams. The reality is that our health professionals, at times, are doing work that is perhaps administrative, in addition to their day-to-day work. How can we create these teams that are paramedics, nurses, physicians and lab technicians to conduct X-rays? How can we engage the community?

When I was in Sandy Lake, the X-ray technician and the person doing the rapid test kits or the GeneXpert testing for the community was a member of the community who was hired and then embedded into that nursing team. I think these are the types of engagements that we need to have.

[Peter Fragiskatos, Liberal, London North Centre, ON]

Thank you very much for that.

Deputy Minister, throughout the report, the phrase “best practices” is used a number of times. In talking about the need for the department to approach things with further engagement of indigenous communities and health practitioners as a view to coming around to establishing best practices, “best practices” is never defined.

I only have a minute or so left, so I won't put it to the Auditor General. I think the more important question would go to the department. How are best practices defined here? Is it reflective of indigenous principles around health care? Are there other ideals infused within that conception of best practices? How will the department approach best practices? What does that mean?

[Christiane Fox]

I have three thoughts on that.

The first one, in terms of best practices, is probably the most important: ensuring that we have culturally relevant health services for indigenous communities. That means training. It means hiring indigenous professionals to manage health services. That is a best practice that needs to be across the country.

The second piece is around innovation. We talk about tools that can help us, like IT systems that can help track PPE, but beyond that, what are some of the innovations in terms of best practices that we can adopt? We have teams that now have connectivity. If you're in northern Saskatchewan, you can connect with a physician in Regina or Saskatoon. What types of virtual care technologies can we do? These are some of the best practices—

[The Chair, Conservative, John Williamson]

Ms. Fox, I'm going to have to leave it there. Thank you.

[Christiane Fox]

Thank you. I'm sorry.

[The Chair, Conservative, John Williamson]

It's okay. No problem.

I'm just trying to keep things on track.

Ms. Sinclair‑Desgagné, go ahead for two and a half minutes.

[Nathalie Sinclair-Desgagné, Bloc, Terrebonne, QC]

Thank you, Mr. Chair.

My next question will mostly focus on the labour shortage issue, which has not spared first nations communities. I am especially interested in knowing more about this, which comes from the Auditor General's report:

Several factors contributed to nursing shortages … the challenging nature of the work, the diverse skill set required to work in remote or isolated communities, and inadequate housing.

When work is offered to staff coming from far away, can you explain to me how it is possible not to be able to make adequate housing available to them?

[Christiane Fox]

Thank you for your question.

The pandemic has exacerbated the housing shortage in some of our indigenous communities. We know this will affect not only community members, but also staff, such as nurses, professors and police officers who come from elsewhere and work in those communities. That is one of the challenges we are facing in recruitment.

Let's take for example a community where, in normal times, we have enough housing for three to five nurses. However, owing to COVID‑19, more staff had to be sent there for augmented teams. Given that context, there was occasionally no housing available for everyone.

That is a reality. The department is really trying to resolve the housing shortage issue. I think we have invested just under $1 billion in that initiative since 2015. Further investment is needed and will continue to be provided. That is the reality of our human resources services. They must think of not only housing, but also the safety—

[Nathalie Sinclair-Desgagné, Bloc, Terrebonne, QC]

Okay. Thank you, Ms. Fox.

You mentioned an envelope to help address that housing shortage. Do you have any other numbers for us? Do you have objectives, deadlines, an action plan specifically for the housing shortage, which, as we know, is serious?

[Christiane Fox]

Absolutely. We will be able to submit to you the investments planned over the coming years. As I mentioned, $991.5 million has already been invested in communities. At this time, 1,000 projects are underway. There are 3,500 new homes, 7,000 renovation projects have been carried out—

[The Chair, Conservative, John Williamson]

Thank you very much, Ms. Fox.

I understand that you have many things to tell us, but I must follow the rules when it comes to speaking time.

Mr. Desjarlais, you have two and a half minutes, please.

[Blake Desjarlais, NDP, Edmonton Griesbach, AB]

Thank you very much, Mr. Chair.

My questions will be directed to the deputy minister of Indigenous Services.

On the same line of questioning as my colleague from Quebec, related to housing, this is a systemic problem that the government has been aware of for generations. Before I was even born, my father had to build his own cabin in the northern part of Alberta, and we lived there. We lived there without clean water, and we lived there without power. We lived there without the basic things that many Canadians expect in a country as wealthy as the one we have. Throughout his time there, he eventually moved out of that house when he started to have children, and he attempted to get a government-sponsored house. Once he did, he already had four children, who ended up growing up in poverty. My oldest four siblings—I'm one of eight—during that time had many of the sicknesses that affected the community.

Housing is critical to health. Imagine if you had someone come into your house, which is overcrowded, with one bedroom and one bathroom, and there are eight people or 12 people living in your house, and then one comes home sick—you're all going to get COVID. That's what happened in indigenous communities across this country, because the housing crisis is real, and it's a massive indicator. The Auditor General even mentioned it in his statement. The Auditor General even mentioned in paragraph 9 of his statement that it was one of the criteria:

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.

That's a massive issue. If we've had these year-long plans year after year after year for the last 50 to 100 years, I'm not confident that this ministry has the ability to actually fix this plan. We need to know and we need to get down to the bottom of where it needs to be fixed. I'm interested in results and making sure that this doesn't happen again. I don't want to see more kids die. I mentioned in the last committee meeting that I've seen that.

I also want to mention in regard to the PPE supply that, when I was working in Alberta on behalf of indigenous groups, we actually met with the former minister of Crown-Indigenous Relations and she committed at that time to supplying isolation units for northern Alberta communities. Zero were delivered. That wasn't in this report, though. Zero isolation units were delivered to any of the Métis settlements in Canada. Not one Métis settlement got an isolation unit, and the minister committed to that—I was on the phone with her—and people passed away.

I would like the deputy minister to comment.

[The Chair, Conservative, John Williamson]

I'm afraid the comment is going to have to wait for your next round, sir.

[Blake Desjarlais, NDP, Edmonton Griesbach, AB]

The next round...yes.

[The Chair, Conservative, John Williamson]

Thank you.

Next up, please, is Mr. Lawrence.

You have five minutes.

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

Thank you, Mr. Chair.

I'm looking back, but I want to be helpful to the department, hopefully, going forward.

According to the Auditor General's report, in 2014 the department developed a procurement plan. However, it wasn't followed.

Deputy Minister Fox, I know that you are a great communicator, but briefly, if possible, could you tell me where the failing was? Was it a failure of resources from the government? Was it a failure of the department? Where did that failure happen?