Finance Committee on Sept. 30th, 2014

[The Chair, Conservative, James Rajotte]

Could we have just a brief response, please?

[Chief Roberta Jamieson]

There is a huge demand for indigenous students in the private sector as well. I can tell you that some of the people in our campaign cabinet—the CEO of Suncor, Shell, Air Canada, and all of these folks—are participating to grow employees. The natural resource development companies in this country are looking for our kids who are within 100 to 200 kilometres of their resource developments to work in their mines, to be on their boards of directors, and to be their CEOs, lawyers, and so on.

[The Chair, Conservative, James Rajotte]

Thank you.

Thank you, Mr. Van Kesteren.

We'll go to Mr. Adler, please.

[Mark Adler, Conservative, York Centre, ON]

Thank you very much, Chair.

Thank you to all the witnesses for being here today.

In particular, Mr. Mann and Mr. Ireland, thank you so much. I admire your courage. Thank you very much for being here today.

There is a lot of talk that next year in the budget we're going to have a fiscal dividend. We're here to hold pre-budget consultations on how to make the best use of that fiscal dividend.

Mr. Ireland, how can we help?

[Bruce Ireland]

I think the recommendations that have come out to the government are basically around the partnership and to investigate our key knowledge gaps including the impact of neurological conditions that begin early in life, which we are all seeing more of. There is also the relationship between mental health and our neurological conditions and risk factors associated with our brain conditions. As well, we need to do ongoing and expanded surveillance of neurological conditions, because you will recognize from the report that there is going to be significant growth over the next 15 years.

I think also the enhancement of the Canadian longitudinal study on aging will give us a very good perspective of what we need to really look at from the perspective of aging. We all know that we have an aging population, and those are definitely the kinds of things we are looking for from neurological health charities. We brought 24 charities together under one umbrella to collaborate and work together to really define the issue, define what we need, and define what we need the Government of Canada to do to support us.

[Mark Adler, Conservative, York Centre, ON]

Thank you.

Mr. Mann, could you please respond to the same question? How can the Government of Canada help you?

[Jim Mann]

I think the creation of the Canadian Alzheimer's disease and dementia partnership is the primary vehicle to move forward and improve research, but also to improve workplace education and improve the support offered through the First Link program.

I think all of those together collectively are the biggest step forward, because this is a national issue. Three out of four Canadians are impacted whether directly or as family-member caregivers. So it is significant enough that we need the focus. The partnership is modelled after the partnership for cancer, and the proof that it works there is before us. They have made huge strides, and we would hope to do the same.

[Mark Adler, Conservative, York Centre, ON]

Thank you.

Professor Carr, I'm a big fan of Mitacs. I think it's been a huge success. Could you please elaborate on really just how successful the program has been and why it's so important to continue down that road?

[Dr. Graham Carr]

Thanks for the question, Mr. Adler.

You asked Mr. Mann and Mr. Ireland about the benefits that would come to Canada of investing in their organizations. I think the benefits coming from an investment in Mitacs are that simultaneously we help train the next generation of researchers, many of whom will go out to be entrepreneurs themselves. We strengthen the research and diversify the research capacity of our universities.

One of the huge benefits I see at Concordia with the success of the Mitacs program, and I know my colleagues at other universities see this too, is that it provides an advantage for us in terms of recruiting top-quality students who not only want the basic skills training that they will get in our advanced degree programs but who see the opportunities for internship placements as diversifying their options entering into the workforce.

Finally, of course, it helps Canadian industry to be competitive and develop its own R and D capacity.

[The Chair, Conservative, James Rajotte]

Thank you, Mr. Adler.

On behalf of the committee, I want to thank all of our guests who appeared on this first panel today, contributing toward our pre-budget consultation. Thank you so much for being with us.

Colleagues, we'll break for about two minutes. Then we'll bring the second panel forward.

Thank you.

[The Chair, Conservative, James Rajotte]

I would ask colleagues to resume their seats as quickly as possible, please.

First of all, I want to welcome our guests to our second panel as we continue our pre-budget consultations for 2014. I do want to apologize in advance. We will have bells, I understand, at about 5:30 and a vote at about 6:00. I will seek unanimous consent of the committee to keep studying while the bells are going on, perhaps to about 5:50. We will hopefully go as long as we can here.

We have another five individuals or organizations before us. In this panel we have first of all from the Association of Universities and Colleges of Canada, the president and vice-chancellor of the University of Manitoba, Mr. David Barnard. Welcome.

We have, from the Canadian Alliance of Student Associations, Mr. Travis Gordon, who is the chair. From the Canadian Medical Association, we have the president, Chris Simpson. We have, from the Canadian National Institute for the Blind, Ms. Victoria Nolan.

Welcome to the committee.

From the Childcare Resource and Research Unit, we have Ms. Martha Friendly, the executive director.

Thank you, all, for being here.

You each have five minutes maximum for your opening statement. We will begin with Mr. Barnard.

[Dr. David Barnard, President and Vice-Chancellor, University of Manitoba, Association of Universities and Colleges of Canada]

Thank you, and I want to thank the committee for the opportunity to appear here. We certainly appreciate the important role that you have in shaping the federal budget, and we welcome the theme of supporting families and vulnerable Canadians.

As was mentioned, I'm the president of the University of Manitoba and also chair of the board of the Association of Universities and Colleges of Canada. I was the first person in my family to go to university. Universities today are quite a bit different from what they were when I attended. Universities are evolving through innovation and as a result remain the surest path to prosperity for Canadian families. They open us up to larger worlds, and they have never been more flexible, offered more options, or been more visionary than they are today. I think higher education in Canada is not standing still. Canada's universities are extending their reach and stretching the boundaries of traditional education to make sure we continue to lead in the world.

With respect to employment, as this committee examines the federal government's role in supporting families and vulnerable Canadians—the theme for today's panel—we believe good job opportunities are essential to success in this. Canada needs the skills of all kinds of graduates to keep us competitive in the global economy. The data are clear with respect to our sector. University education means high-quality jobs. Over the last six years more than twice as many new jobs have been created for university graduates as for colleges and trades graduates combined. Even in Alberta 56% of net new jobs have been for university graduates, and over their careers university graduates typically earn 50% more than other full-time workers without a university degree.

We welcomed the committee's study on youth employment and its recommendations last spring. We were pleased to see your support for our main recommendation to support increased experiential learning opportunities. That recommendation is here again in our submission to you for these pre-budget consultations. To be explicit, we recommend that the federal government invest in an integrated package of programs building on those that already exist and developing new options to offer more career-boosting opportunities for Canadian youth including supports for employers, especially small and medium-sized enterprises, to hire co-op students and paid interns, and additional funding for research internships through Mitacs' programs.

With respect to research, this committee has been steadfast in its support of the importance of research, contributing in a significant way last year to the funding of the Canada First research excellence fund in budget 2014. We believe that the world-class research done at our universities and in communities across Canada is also crucial to the goal of supporting families and helping vulnerable Canadians. Our researchers are helping to advance progress in everything from new ways to predict autism very early in a child's life to research on understanding the aging process—which is of more interest to some of us than to others—to shedding light on causes of disease and disability.

In the research component of our submission, AUCC recommends long-term sustained funding through the granting councils, with the rate of growth leading the economy, and predictable multi-year funding for research infrastructure through the Canada Foundation for Innovation.

As a final topic, with respect to aboriginal education, since we are talking today about supporting families and vulnerable Canadians, we know that some of the most vulnerable are from aboriginal communities. I had the honour to be with the Prime Minister in Alberta when the agreement on K-to-12 education was announced last February, and we urge government to continue to work with first nations leaders to address issues in the K-to-12 system. While doing that, though, we can look to the post-secondary level at the same time. Universities have made gains in increasing access and success. We offer 350 programs across the country with more than one-third of these offered off-campus in communities.

At the University of Manitoba, for example, we strive to ensure that first nations, Métis, and Inuit values are acknowledged, embraced, and infused into life on our campuses. Creating space to allow indigenous students to see themselves in the fabric of our university is crucial. For example, our own Migizii Agamik Bald Eagle Lodge is a place of pride for the over 2,000 indigenous students and many indigenous faculty and staff at the University of Manitoba. Supporting students is key to all of our academic institutions. We want to make our university a welcoming place for all of them. So with respect to this, we recommend direct financial support to students, and support for university initiatives working with local communities.

Again, thank you.

[The Chair, Conservative, James Rajotte]

Thank you very much for your presentation.

Now we'll hear from Mr. Gordon, please.

[Travis Gordon, Chair, Canadian Alliance of Student Associations]

Good evening, Mr. Chair, committee members, and fellow presenters.

I am the elected board chair of the Canadian Alliance of Student Associations and a student at the University of Prince Edward Island. I am pleased to have the opportunity to present the budget priorities of the Canadian Alliance of Student Associations on behalf of our 22 member associations representing over 280,000 students across Canada.

The Government of Canada has taken important steps to stabilize Canada's economy through measures including continued investment in education, skills, and training. While there is no magic fix for long-term economic health, CASA believes that a highly trained and educated population is at the core of creating a stable and prosperous economic future. In that light, CASA is calling on government to invest in education and skills training in this upcoming budget.

CASA believes no Canadian student should be punished for working to support themselves in school. Currently, students who receive financial aid through the Canada student loans program lose out, dollar for dollar, if they work over a maximum threshold. They are punished despite the fact that work experience contributes to the economy now and to employment success in the future.

In budget 2011 the federal government made a positive improvement to the Canada student loans program by increasing the weekly in-study income exemption from $50 to $100 per week. This opened financial assistance to more students and helped foster an environment where youth seeking employment can use their income to make ends meet and not have it clawed back by government. While this investment was positive, more must be done to enable students to work while studying.

With the rising cost of education, working while studying has become the norm for Canadian students like me. In 2011, 60% of students reported working an average of 18 hours per week. Under the current policy, the average student working 18 hours a week at $10 an hour will miss out on $2,720 worth of financial aid over an academic year. For a student like me, that's four months' worth of food and rent.

Moreover, as paid co-op and internship programs become increasingly common components of education, students are now finding themselves forced to choose between the student aid they need to attend school and the work experience they will need to succeed out of school. This hurts not only students but employers and Canada's economic future. By exempting from the student loans assessment all income earned while studying, we will ensure that students are not unfairly targeted by the unintended consequences created by this policy, while creating a simpler, more streamlined, and efficient student loans system.

The cost of tuition has risen at triple the rate of inflation over the last 10 years, increasing by over 45% since 2003. In the same time, the weekly loan limit of the Canada student loans program has risen by 0%. It is time that action be taken to move the cap from $210 per week up to $245 per week in order for students to meet the financial realities of education costs today.

Thirty-one per cent of Canadian students have financial need that exceeds the funding available to them. Faced with this funding shortfall, students have only a few troubling alternatives. One option is to turn to private loans and credit cards, which have extremely high interest rates and lack repayment flexibility. A more frequent option is for these individuals to turn towards their families, who are now often sacrificing their own financial stability.

In a poll conducted by Abacus Data, CASA found that one third of Canadian post-secondary education families reported taking funds out of their retirement savings in order to support their child's education, while another 14% went so far as to remortgage their home. The high cost of education is no longer just a student issue but an issue for Canada's middle-class families as well. Student debt is becoming family debt, and this should be a concern for all Canadians.

Finally, CASA wants to ensure that students from low-income backgrounds and with high levels of need are appropriately supported. We are asking government to build on its past successes by increasing the value of the Canada student grants program by 9.4% to account for inflation since the grant program was created in 2009. Moreover, CASA calls on government to extend the grants program in order to create access for graduate students, who are currently not able to apply for grants.

The most recent report from the Canada student loans program reveals that more students are borrowing to pay for school and the proportion of students with high debt levels is rising. Students who graduate with high debt levels are less likely to buy a home, start a family, or start a business, and are more likely to default. Targeted grants reduce student debt loads and support higher rates of successful repayment. In that context, CASA urges government to act in addressing and updating the grants program in this upcoming budget.

These recommendations are not isolated from each other but rather are part of CASA's comprehensive strategy to enable students to access post-secondary education and graduate with a reasonable and affordable amount of debt. A strong knowledge economy will in turn create a strong and prosperous economy for all of Canada.

Thank you very much. I look forward to your questions.

[The Chair, Conservative, James Rajotte]

Thank you very much, Mr. Gordon.

We'll now hear from Mr. Simpson, please.

[Dr. Chris Simpson, President, Canadian Medical Association]

Thank you very much, Chair, for the opportunity to present as you prepare for next year's federal budget.

It's no secret that Canada's population is aging more rapidly than ever before and that this trend will have widespread implications for different aspects of our society. Finance Canada recognized this demographic shift in its 2012 report, entitled “Economic and Fiscal Implications of Canada's Aging Population”, and the effects it will have on labour force growth and public finances with the ratio of seniors to working-age Canadians expected to nearly double by 2032. Already patients who are aged 65 and over account for nearly half of Canada's health care spending. Seniors also face challenges accessing health services across the continuum of care, despite most provinces already having seniors care strategies in place. These challenges are only intensifying.

Canadians echo these concerns. The CMA released a public opinion poll in August that found that 95% of baby boom Canadians aged 45 and over believe we need a national strategy for seniors care, and 90% believe a seniors strategy would improve the overall health care system.

As a physician, I wholeheartedly echo those concerns. Take the situation you will find in hospitals across the country on any given day—the high number of alternate level of care, or ALC, patients. I'm referring to patients, many of them seniors, suffering from dementia and other chronic conditions who remain in hospital beds when they should be elsewhere because we don't have sufficient long-term care infrastructure or home care assistance for them. In my hospital today there are 55 ALC patients. The patient I was going to operate on tomorrow was cancelled a couple of hours ago. The entire hospital is shut down with no elective activity happening and no transfers coming in from the region.

One day of care for a patient in a hospital clocks in at $1,000. By contrast, one day in a long-term care facility costs $130 and one day of home care is about $55. If we were to move all the ALC patients from their hospital beds to more appropriate care, we estimate that the system would save $2.3 billion per year. That's just one example of how a national seniors strategy can lead to smarter spending and a more effective health care system overall.

We need to realize the critical role of informal caregivers—the backbone of any health care or social care system. Statistics Canada released a study just last week reporting that 1.9 million young Canadians are providing care to the sick and elderly: that's 27% of the population between the ages of 15 and 29. We must ensure that these caregivers receive sufficient public support to override the significant risks they face in relation to economic costs, lower productivity, and impacts on the labour market.

Finance Canada's 2012 report recognized the need to act early to prepare for the shift ahead, to put in place policies to help strengthen the Canadian economy and not reduce services or cut benefits for seniors down the line. It's not hard to do the math on what this demographic trend could do to the health care system in the not-too-distant future, so it's not hard to understand why the CMA is recommending that the federal government provide targeted funding to support the development of a national strategy for seniors, one that integrates home care, hospitals, hospices, and long-term care facilities into the continuum.

Canadian doctors believe there's a strategic opportunity, in this era of fiscal surplus, to invest in our seniors. This investment will benefit not only Canadians in need today but also generations to come. If we can improve the way we care for our seniors, we'll go a long way to creating a high-performing health care system for all Canadians.

I'd be pleased to take questions at your discretion.

[The Chair, Conservative, James Rajotte]

Thank you very much, Dr. Simpson.

We'll hear now from Ms. Friendly, please.

[Martha Friendly, Executive Director, Childcare Resource and Research Unit (CRRU)]

Thank you.

I'm the executive director of the Childcare Resource and Research Unit. I'm talking about the other end of the age spectrum compared to what Dr. Simpson was talking about, but there are actually a lot of policy similarities.

I'm really pleased that you asked me here today to talk about the relationship of child care to the priority of supporting families and helping vulnerable Canadians by focusing on health, education, and training.

I want to make a few points about Canadian child care. Canada is one of the world's wealthiest countries, but international analyses by the OECD, UNICEF, and other groups looking at child care policy and provision have repeatedly given us the very lowest ratings among OECD countries. I understand that this point came up in the previous session.

The most recent Canadian data from 2012 showed that progress on many aspects of child care is essentially stagnant. At the same time, high-quality child care remains out of reach for most families, as there are only enough spaces to cover about 20% of children aged zero to five, and fees in most of Canada are out of ordinary families' reach.

Families of all types lose out, but some lose out more than others. If parents are lucky, they may be able to find quality child care that not only allows them to go to work or to school or to train, but benefits the children's health and social and educational development. If parents are vulnerable—if they're low income, if they're newcomers to Canada, if they're single parents or indigenous—they're doubly disadvantaged. Not only will they have a hard time finding a quality child care space, but they will undoubtedly be unable to pay for it if they do find one.

As the research shows, young children who are in poor-quality child care while their parents are working, training, or going to school—as most children are in this country—are vulnerable to the potentially negative effects of poor-quality child care. This is true whether or not they're already vulnerable for other reasons.

Today's families are united by their drive to access early childhood education and child care that meets two criteria: one, it allows them to work, study, train, or learn English or French and, two, it allows their children to thrive, learning through play, making friends, and building language and social skills. Changing child care to make this happen for most families would be a great opportunity for Canada.

Overall, changing Canadian child care needs a national child care program that involves all three levels of government. The federal government's role in such a program would be to develop, in collaboration with provinces and territories, an overarching national policy framework, including a long-term sustained funding plan that is needed to ensure that the system's principles and goals can be achieved over time. This would mean a commitment by the federal government to be a major funder of the system and a policy leader and convenor.

This is the finance committee, so I want to talk about the financial aspects. I'll make a couple of recommendations about those.

One key to changing child care for the better in this country is that federal funding needs to be supply-side funding, or funding services, rather than demand-side funding, which is giving money to parents. I really want to cite solid evidence showing that demand-side funding such as income splitting and cash allowances like the universal child care benefit and the child care expense deduction are nothing but costly experiments that are ineffective and demonstrably poor social and fiscal policy.

Based on our analysis—and I would speak for other people who are working on early childhood education and care across Canada—in the next year we intend to argue that the next Government of Canada should begin the process of developing a national child care program based on the ideas here.

In the short term, in the 2015 federal budget, we propose first that this committee recommend that the Department of Finance evaluate the effectiveness of the universal child care benefit, the effectiveness of proposed plans for income splitting, and the effectiveness of the child care expense deduction, and publish the results publicly. These programs cost a lot of money. With the addition of income splitting, they would be costing Canadians about $7 billion a year.

The second thing I want to recommend is that there needs to be an immediate infusion of emergency money to the provinces and territories to shore up the child care that we have. Based on my calculations, that would be transfer payments of about $700 million in the next federal budget. Child care is crumbling. While a national child care program is being developed, the next federal budget could be a signal that this situation can change.

Thank you very much. I would be happy to take your questions.

[The Chair, Conservative, James Rajotte]

Thank you, Ms. Friendly.

We'll now go to Ms. Nolan, please, for a presentation.

[Victoria Nolan, Volunteer, Canadian National Institute for the Blind]

Good afternoon. I am delighted to be here today on behalf of the CNIB and CELA, the Centre for Equitable Library Access.

I am reading this presentation using adaptive technology, so I might be slightly over five minutes.

I am a Paralympian, a special education teacher, and a mom. I was diagnosed with retinitis pigmentosa at the age of 18. Following the birth of my second child, I had lost 97% of my sight. I know first-hand how important it is to have access to reading materials in alternative formats.

I would like to take a moment to introduce three people who are very interested in today's proceedings.

Sam Fulton is a retired teacher, and chair of the CNIB board committee responsible for the governance of library services. Sam has told me how frustrated he is that not enough materials are available in formats that he can access.

Craig Oliver, CNIB's honorary chair and a CNIB client, is also here today. Craig has repeatedly said that he strongly believes that CELA's library services are critical to the continued employment of blind or partially sighted Canadians.

Finally, Katja Newman is a college student who has grown up with the CNIB. Katja credits CNIB with sparking her interest in literacy from an early age. She has seen many technical innovations, and she now uses the CNIB library to help her with her academic work.

These three individuals reinforce how important it is to have access to alternative format print materials.

My remarks today will focus on two important priorities: the production of alternative format content and the shift from physical to digital delivery of that content.

First I would like to talk to the production of content, which is the CELA submission. CELA was launched on April 1 of this year to support public libraries in offering library services for Canadians with print disabilities. This service provides the widest range possible of reading materials in such alternative formats as braille and audio. It provides content in both official languages and programs for first nations. It places a special emphasis on young readers and on Canadian content. Its overall focus is to increase the number of new accessible titles and the speed at which they are made available. Our goal is to secure 50% of CELA's overall funding from the federal government, with the remainder being provided by the provinces and territories, Canada's large urban libraries, and private donations through CNIB's fundraising efforts.

We are asking for $3.25 million per year in federal funding for each of three years starting in April 2015. This funding will be used to support the production of published works in alternative formats, something that is fundamentally important to our community.

The second area I want to focus on is how alternative format materials are delivered to Canadians. Right now the federal government provides funding to cover mailing costs for the literature for the blind program. Over one million audiobook CDs—over two million pieces of mail—are sent out and returned to the CNIB through this program every year. However, thanks in part to federal government funding from 2011, the CNIB now has the infrastructure and collection in place to distribute its books digitally.

We are asking that you take the next logical step and provide funding to allow for digital delivery. This would mean reallocating the $9.9 million annual funding provided under the literature for the blind program. This is not a request for new funding but rather a transfer of existing funding. Digital delivery would allow Canadians with print disabilities to download accessible reading materials anywhere in Canada with Internet access. With the transition to digital delivery, the cost to the Government of Canada would be significantly reduced, savings would begin almost immediately, and by year five we anticipate an annual reduction of $7 million.

Why are these two initiatives so important? Canadians living with a print disability currently have access to a mere 7% of print materials. Greater access to a wider range of materials will make a big difference in our lives. It will improve literacy and enhance education, open up more opportunities for jobs and community engagement, improve access to information and knowledge, reduce barriers for persons with disabilities, and accelerate the adoption of digital technology.

I would like to conclude on a personal note. I turned to the CNIB library when I realized my vision loss wasn't affecting just me; it was also affecting my children, because I couldn't read to them. I now download books and we listen to them together. It's made a huge difference for my family. I've also seen the program's success at school, where I'm able to download books and play them for my students. However, when friends recommend books to me, I can't access them because alternative format content is still so limited.

Imagine the possibilities that will be unlocked by producing more content in alternative formats and by moving to digital distribution of that content. It will make a world of difference to me, to Sam, to Craig, to Katja, and to the three million Canadians with print disabilities they are here to represent today.

Thank you for your consideration.

[The Chair, Conservative, James Rajotte]

Thank you very much for your presentation, Ms. Nolan.

Colleagues, we'll do five-minute rounds, please.

Mr. Caron, go ahead.

[Guy Caron, NDP, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Thank you very much.

Once again, I want to thank all the witnesses for their very enlightening presentations.

Dr. Simpson, thank you for your presentation.

You probably know that the federal government made a unilateral decision—without negotiating with the provinces—to reduce the growth of health transfer payments to the provinces. The growth rate will drop from about 6% to 3% a year over the next 10 years. You are asking the government for additional investments, so that you can develop a long-term strategy for population aging, which will put pressure on provincial budgets.

How can you reconcile that request—which I think is perfectly legitimate—with the government's decision to reduce the growth of funding? An increase of 3% is below the 5% to 5.5% increase in health care costs forecast by the Conference Board of Canada.

[Dr. Chris Simpson]

Thank you for the question.

I think the message we're hoping to convey is that unlike the way money has been transferred in the past—and I'm thinking about the 2004 accord—there was money earmarked for wait-time reduction. I think in hindsight one could argue that the accountability attached to that was quite loose. The product that was delivered was okay, but we sort of managed to tread water but not really transform the system.

This time we're saying—setting aside the question on the amount of money, because I understand that's a very political issue—that if we accept there are going to be some federal transfers, let's attach some very smart accountability to those. What we're offering, I suppose, is the end result of a two- or three-year period in our organization's history in which we've really given this a great deal of thought. We thought, it's a big problem and it touches virtually every Canadian, but if you had to start somewhere, where would you start? Senior care is where everything seems to land, because if we can fix senior care, I think we'll fix a lot of what's wrong with the system. The targeted investments we're talking about now need to be tied to much more accountability for what that's going to deliver. Very importantly, it can't just be about the federal government. I think it has to be about what provincial and territorial governments bring. Frankly, it has to be what we bring to it, too. Physicians and other health care providers have to be part of the solution. We all have to step up our game.

[The Chair, Conservative, James Rajotte]

Colleagues, I do have unanimous consent to continue for another 20 minutes.

Thank you.

Mr. Caron.

[Guy Caron, NDP, Rimouski-Neigette—Témiscouata—Les Basques, QC]

You are leading me in an interesting direction because the second question I wanted to ask you is actually related to this.

As you know, health comes under provincial jurisdiction. So the provinces are not necessarily receptive to the fact that conditions are attached to those transfers. However, the issue of an integrated health care strategy for seniors is an important one. You talked about long-term care and home care. You could also include palliative care, a large part of which is used by seniors.

How can the federal government play a leadership role in order to handle these issues consistently in collaboration with the provinces, so that they could feel that their jurisdiction is respected?