Finance Committee on April 18th, 2024

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Morantz.

Now we'll hear from MP Weiler, please.

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Thank you, Mr. Chair.

I want to thank our witnesses for being here today.

I want to pick up on the last line of questioning from Mr. Morantz with Mr. Singh.

You mentioned some of the barriers and gaps you're seeing with dental providers across the country. You particularly mentioned the recommendation to invest resources to address these access-to-care barriers.

I was hoping you might elaborate on what the relative shortages are in rural and remote areas.

[Dr. Amrinderbir Singh]

I am aware of some communities, especially in northern and rural Saskatchewan, that do not have a dentist and have not seen a dentist in many years. Patients have to travel at least seven to nine hours one way to see oral health care providers. There have been therapists in some communities, but there is a shortage of oral health care providers at all levels.

In terms of the access-to-care barriers now, even if dentists enrol in the plan and the CDCP is implemented, if we are not doing something specific for the northern and rural communities and we don't specifically invest resources in that area, I think that may create a further divide. Some of our populations that have suffered disproportionately are the ones who have not seen dentists in years.

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

That's a point very well taken. As someone who represents some rural areas, although I wouldn't necessarily categorize them as remote, I know there is a big need.

As you may have seen in the budget we just tabled a few days ago, we are announcing our intention to expand the eligibility for student loans forgiveness for dentists and dental hygienists who go to work in rural and remote communities. Do you see this type of measure as an incentive that will help get more dentists and dental hygienists into the rural and remote areas that you just highlighted as having a big gap?

[Dr. Amrinderbir Singh]

I definitely see that, especially if there is a return of service agreement of some sort to specifically target the communities that have been historically underserved.

On top of that, I don't want to forget to highlight that the cultural safety piece is important. Ensuring that training happens in the right way for these future providers is essential. Any investment specifically in training would also be beneficial.

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Definitely.

Since this plan launched, we have seen over 1.7 million eligible seniors sign up. They're looking forward to getting the oral health care supports they need. I've done a few town halls in my riding, and people are very excited about this.

I was hoping you could share with the committee how we can keep up this momentum on the importance of maintaining dental hygiene as other cohorts begin to be eligible to apply. How does that align with the mandate of your association—ensuring oral health equity for Canadians?

[Dr. Amrinderbir Singh]

I think for preventative services and hygiene, anything we can do more upstream in education for the patient, including on scaling and hygiene appointments, is important. Ultimately, this is going to prevent the disease burden. It cannot happen overnight or in a few years. We have seen a huge disparity over the past number of years, so it's going to take time.

My view and suggestion would be to keep the communication plan very strong in cases where targeted communication is needed for seniors groups or adults. This could apply to certain communities and in certain languages so that nobody feels left out or did not know what to do.

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

That's very sound advice.

In the Canadian Association of Public Health Dentistry's 2020 submission to the committee, your organization stated, “people of lower socioeconomic status, immigrants, Indigenous populations, the working poor, and the elderly make fewer visits to the dentist than those of higher social and economic status.” I think it is fairly obvious that Canadians shouldn't have to choose between groceries and a visit to the dentist.

I was hoping you would explain to those in the room who don't support providing Canadians with equitable access to dental care why they should support the Canadian dental care plan.

[Dr. Amrinderbir Singh]

We have known that cost has been one of the barriers to accessing dental care. This is especially relevant to low socio-economic status. In other cases, there was no availability of service, so the physical availability of services is also important.

From my work and from discussions in our association, there is yet another barrier that is not generally talked about. It is the mistrust of certain population groups and patients of the health care system and the stories of discrimination and racism that exist. How do we build systems that support providers in building trusting relationships with patients and vice versa so there's no hesitancy when cost is not the barrier? How do we move forward in a way that is respectful of the patient? That becomes especially important when we are reversing cost-related barriers.

[The Chair, Liberal, Peter Fonseca]

Thank you.

Thank you, MP Weiler.

We'll now go to MP Ste-Marie.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Thank you, Mr. Chair.

I would like to acknowledge Dr. Singh and Mr. Laberge.

My questions are for Mr. Laberge.

Thank you for being here. I found your remarks inspiring. You reminded us that your facilities, located around the Saguenay, St. Lawrence and Great Lakes, are among the 17 largest and most strategic in the country. You spoke about 3,000 acres of industrial area capacity, among the largest in the country. This holds enormous potential for new industries, such as critical minerals and the transition to renewable and sustainable energy.

In Parliament, we're concerned about productivity in the struggling economy, along with supply chains.

How do your facilities play a strategic role in meeting these needs?

[Carl Laberge]

Thank you for your question.

The Port of Saguenay is strategic in a number of ways. It's one of the only deep‑water ports in Quebec. It can accommodate large transoceanic vessels from the St. Lawrence, which provides a unique advantage. It's also directly connected to the railway system, and has fairly large storage capacity. However, it has certain infrastructure limitations.

As I said in my remarks, we're in the process of significantly improving part of our infrastructure with a mechanized bulk materials transportation project. We're quite pleased with this project. Another project will improve our shoreside infrastructure so that we can keep pace. For this project, we're currently applying for funding from the national trade corridors fund.

The Port of Saguenay is located in the middle of one of Canada's major industrial hubs. It serves the aluminum industry in particular and the forestry industry. As you said, we have great and unique potential for industrial development in Canada around our facilities with the new industries. However, to serve these clients, we need to develop the infrastructure at the same time. We're heading in that direction. We have infrastructure under construction and commitments, especially from the Quebec government, another key partner in the development of industrial infrastructure.

We're currently implementing the right conditions to make the Port of Saguenay a significant part of the logistics chain. We're doing this by strengthening our transportation and transshipment capacities to ensure that they remain substantial and consistent. Investments in our port facilities also give the area a capacity for large‑scale industrial development. The area already has the necessary energy and land available, provided that the right infrastructure is in place.

Investing in the port means investing in our future. Around here, it's often said that you can't go wrong when you invest in unique projects of this nature. We have enormous potential here. It's important not to give up. We already have the support of all levels of government. However, this support must continue, especially the support from the federal government. In the recent federal budget, we would have liked to see additional funding for current infrastructure programs to help us make decisions.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Thank you.

The Port of Saguenay is truly strategic. It helps us achieve all our goals. Basically, your applications will help further develop the economy.

You said that things were going well with Mr. Rodriguez and the Department of Transport. However, your application for funding for the new berth, which you explained is vital, remains unanswered. Quebec confirmed its $20 million commitment last November. That was five months ago if I counted correctly. You still haven't heard back from Ottawa.

Did you send your application to Ottawa five months after sending your application to Quebec City, or did you send both applications at the same time? Is Ottawa a bit slow?

[Carl Laberge]

We submitted these funding applications at about the same time. In terms of the program, I would say that the funding applications were submitted in July 2022.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

The application was submitted in July 2022. Quebec responded in November 2023. As of April 2024, Ottawa still hasn't responded. We'll follow up with Mr. Rodriguez and the Minister of Finance on this matter.

With regard to your other application for the supplementary letters patents, you said that the unreasonable and lengthy processing time could lead to a funding holdup.

In concrete terms, what are the daily implications of not having these supplementary letters patents? What choices does this lead to?

[Carl Laberge]

In concrete terms, as I said, a major project to electrify our infrastructure is currently under construction. It's a $110 million project. It should be noted that the Saguenay port authority, while significant and strategic, is smaller than, for example, the Montreal or Vancouver port authorities. We don't have the same financial capabilities. For a $110 million project, we must borrow quite a substantial amount, by the way. We received support from the Quebec government to obtain loans. However, to accept these loans and use this money, we need the federal government's authorization. We must amend our letters patent to have the right to borrow this money. We already have financial commitments with the lender. We also need Transport Canada's authorization.

We started this process last year to get ready and to gain access to the money needed to continue the project. However, right now, the processing times are long and the process seems quite complicated. I would say that sometimes we get confused. Transport Canada has carried out analyses. These analyses have been completed. We gather that the recommendations are positive. I understand that this must go through the Department of Finance. We currently haven't heard anything. Our file is with the Department of Finance. We would like our file processed and returned to Transport Canada so that we can amend the letters patent to access the money. We can't stop work at this time. We must stick to the schedule. The contractor is on site and we must make payments. At this point, we're scraping together the money and things have become a bit complicated. If this drags on, we could run into problems in the near future. This could jeopardize the progress of the project. We could no longer meet our financial commitments. It wouldn't be because we lack the money, but because we don't have the right to borrow without the supplementary letters patent.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Thank you.

[The Chair, Liberal, Peter Fonseca]

Thank you, Mr. Ste‑Marie.

Now we'll go to MP Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'll go to the Canadian Association of Public Health Dentistry.

Is it Mr. Singh or Dr. Singh?

[Dr. Amrinderbir Singh]

Dr. Singh is fine.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Dr. Singh.

Dr. Singh, the research I have looked at says that Canada has a ratio of about 65 dentists for every 100,000 Canadians. That ratio has doubled since the 1960s. I am also aware of data that shows there's an oversaturation of dentists in major urban centres like Vancouver, Toronto and Montreal.

My question is twofold. Is the problem that we don't have enough dentists in Canada, or is it that we have enough dentists but that they're just not evenly distributed where we need them in the country?

[Dr. Amrinderbir Singh]

I'm not aware of all of the cities that are saturated; some centres may be. I think it's about the equitable distribution of providers and what opportunities we are creating for providers to be in areas that are high-need.

I'm not aware of why these providers may be choosing to be in the urban centres, but lifestyle resources, from my understanding, would be one of the reasons. As we are launching a plan like the CDCP, I think we also have to be mindful of how we bring services closer to home for community members who haven't had services in years.

[Don Davies, NDP, Vancouver Kingsway, BC]

Yes, I very much agree. That's why, in budget 2023, the NDP secured $250 million over three years, starting in 2025, and $75 million ongoing to establish an oral health access fund.

Are you aware of that fund?

[Dr. Amrinderbir Singh]

I am aware just to the level that you have described. I am not sure about the details of the fund yet.

[Don Davies, NDP, Vancouver Kingsway, BC]

That fund is precisely for the issues you've identified. We are aware that rural areas, underserved areas, remote areas and, frankly, even urban centres that may have enough dentists but have issues of access for people living with disabilities.... This fund is meant to address that. I think it will be open fairly soon for people to apply to.

There are innovative and creative ways.... I've heard of things like mobile units to go into care homes. I've heard about a proposal to outfit a train car. I think we're going to talk to a witness coming after this about establishing special access for people with disabilities—maybe someone in a chair or someone who is non-verbal. There is hope on the horizon.

Dr. Singh, you published a statement on the CDCP: “To encourage more oral health providers to support the plan and increase access to care...the CAPHD proposes alignment of the CDCP fees with existing provincial fee guides in the future.” I agree with you, by the way.

What is your understanding of what percentage of fees the CDCP's 2024 fee guide covers generally of the provincial fee guides?