Health Committee on April 17th, 2008

[The Chair, Conservative, Joy Smith]

Good afternoon, ladies and gentlemen. I want to welcome you to the health committee today.

I have to especially welcome our guests this morning. I am very pleased that you could join us today and that we'll have an opportunity to listen to your very insightful comments.

We have, from the Department of Health, Dr. Karen Dodds. She is the assistant deputy minister of the health policy branch. We have Ian Potter, assistant deputy minister of the first nations and Inuit health branch. Welcome.

From the Public Health Agency of Canada, we have Jane Billings, senior assistant deputy minister of the planning and public health integration branch. We have Dr. Arlene King, director general of the centre for immunization and respiratory infectious diseases.

From the Department of Finance, we have Krista Campbell, who is the senior chief. She is from the director's office of the federal-provincial relations and social policy branch. That's a very large title. We have Yves Giroux, director of social policy with the federal-provincial relations and social policy branch as well. That's another long title, but a very important one. And we have Jonathan Roy, senior policy analyst, health, justice, and culture, social policy, with the federal-provincial relations and social policy branch.

Ladies and gentlemen, pursuant to Standing Order 108(2), the motion adopted by the committee on March 13, 2008, and section 25.9 of the Federal-Provincial Fiscal Arrangements Act, the committee today begins the first of four meetings on the statutory review of the progress in implementing the 10-year plan to strengthen health care.

We have with us the senior officials today, the Public Health Agency and the Department of Finance--those members I've just gone through.

Dr. Dodds, we will have your presentation now, for approximately 10 minutes, but seeing that you're speaking for everybody, we might push that forward a bit.

Dr. Dodds.

[Dr. Karen Dodds, Assistant Deputy Minister, Health Policy Branch, Department of Health]

Good morning, Madam Chair and members of the committee. Thank you for the opportunity to provide an overview of the progress on a wide spectrum of health care reform initiatives as set out in the 2004 health accord.

In my opening address today I would like to take about the nature and purpose of the accord and the progress made by Health Canada and the Public Health Agency of Canada on fulfilling the commitments made in the accord.

The 2004 health accord was a historic agreement by all federal, provincial, and territorial governments to renew their health care systems and to enhance accountability to their residents.

In the accord, the first ministers established a five-year plan to ensure that Canadians have access to the health care they need when they need it.

To achieve that goal, all governments committed to move forward on a comprehensive set of health care renewal initiatives. The accord initiatives were broad in scope, including, but not limited to, such things as reducing wait times, reforming primary care, developing electronic health records, expanding healthy living and public health initiatives, supporting health innovation and research, and improving aboriginal health.

To allow Canadians to see how governments were doing on meeting their commitments, the accord tasked the Health Council of Canada to report on the performance of the health care system and the progress of accord implementation.

Today I would like to talk about what Health Canada and the Public Health Agency of Canada have done to advance initiatives to reform health care.

I'd like to describe the funding commitments that have enabled provincial-territorial governments to move forward on health care renewal.

As a result of that funding, the public health care system in Canada is on the road to sustainability. Its level of funding is foreseeable and is growing.

To support the accord, the Government of Canada is flowing an additional $41.3 billion over 10 years to provinces and territories. This funding includes $35.3 billion in increases to the Canada health transfer, $5.5 billion in wait times reduction funding, and $500 million for medical equipment.

Funding to provinces and territories through the Canada health transfer alone will amount to over $22.6 billion cash in 2008-09, and with the annual 6% escalator, it will reach over $30 billion by 2013-14.

In addition to fiscal transfers to provinces and territories, the Government of Canada has demonstrated leadership through investments in patient wait time guarantees, electronic health records, public health and disease prevention, and support for the Health Council of Canada and the Canadian Institute for Health Information to ensure accountability to Canadians on health care.

I would like to begin the overview of specific initiatives with one of the key accord commitments: reducing wait times.

Recognizing that provinces and territories have primary responsibility for the delivery of health care services, the Government of Canada is providing them with $5.5 billion through the wait time reduction fund. This fund has allowed provinces and territories to augment their investments and diverse initiatives to reduce wait times.

In addition, the government has invested in developing strategies to manage and reduce wait times, as part of the National Wait Times Initiative.

This program has supported work by health care professionals and provincial governments to improve the management of wait times for hip and knee surgery. It has supported work to ensure diagnostic imaging is used appropriately, so that patients can have timely access to the care they need.

In a variety of ways, the program has assisted knowledge sharing and the adoption of best practices in addressing wait times.

Coming after these achievements, the government introduced the idea of patient wait times guarantees when it came to power two years ago. The goal was to give Canadians better assurance that they would receive the health care they need when they need it.

Today, all provinces and territories have committed to establish guarantees by 2010 and to conduct pilot projects to help pave the way.

In Budget 2007, the Government of Canada invested more than $1 billion in patient wait time guarantees, including $612 million for a patient wait times guarantee trust, which provinces and territories can use as they see fit in working towards their guarantees. The trust includes base funding of $112 million, from which each province received $10 million and each territory received $4 million. The remaining $500 million was allocated on an equal, per capita basis.

The budget also invested $400 million in funding to Canada Health Infoway to support the implementation of guarantees through the development of health information systems and electronic health records.

And the budget included a $30 million patient wait times guarantee pilot project fund. This fund is assisting provinces and territories in testing innovative approaches, including offering patients options for alternative care or recourse when guaranteed timeframes are exceeded.

The Government of Canada is also directly supporting four pilot projects to test guarantees. Two will test timeframes for diabetes and prenatal care in selected first nations communities. A third, managed by St. Elizabeth Health Care, will evaluate a patient wait times guarantee model for diabetic foot ulcer care in selected Manitoba first nations communities. And the fourth addresses surgical wait times for children, in collaboration with Canada's 16 pediatric health sciences centres.

The accord also committed governments to reform primary care and continue the development of electronic health records.

Investments by the Government of Canada in the Primary Health Care Transition Fund supported the far-reaching reform of the health care system, which in fact changed the organizational culture and deliver of primary health care. From 2000 to 2006, the government invested $800 million in that fund to help the provinces and territories and other stakeholders improve the way primary health care services are delivered throughout Canada.

These investments have increased the emphasis on health promotion, disease and injury prevention, and chronic disease management. They have expanded 24/7 access to health care services, created the tools needed for team-based care, and facilitated better coordination and integration of health care services through improved use of information technology.

There has also been accelerated development of electronic health records as a result of new Government of Canada investments in Canada Health Infoway. These investments now total $1.6 billion, including $400 million provided in Budget 2007. All provinces and territories are working with Canada Health Infoway to implement electronic health records and telehealth, which allow health care to be provided to Canadians more effectively and efficiently.

In the 2004 accord, all governments acknowledged that public health efforts on health promotion and disease and injury prevention are critical to achieving better health outcomes for Canadians and ensuring the long-term sustainability of the health care system.

The Government of Canada is placing greater stress on public health and disease prevention. It will invest $1 billion over five years in federal preparedness to deal with bird flu and flu pandemics. It will support the FPT National Immunization Strategy.

This strategy works to strengthen immunization infrastructure--such as support for FPT and expert committees, and data collection--and align publicly funded childhood immunization programs across jurisdictions, including pneumococcal, meningococcal, chicken pox, and whooping cough vaccines. Through a Budget 2007 investment of $300 million over three years, the Government of Canada has further advanced the strategy by promoting the launch of human papilloma virus vaccine programs to prevent cervical cancer.

The government also launched Canada's first national cancer control strategy, providing $260 million over five years to support the Canadian strategy for cancer control, in collaboration with the Canadian Partnership Against Cancer. In addition, the government has contributed $4.2 million in 2007-08 and $5.2 million per year thereafter to support the development of the Canadian heart health strategy and action plan.

In November 2008, an advisory committee will report back to the minister with recommendations and options for a comprehensive national strategy. In order to improve the quality of life for Canadians and their families dealing with mental illness, the government established the Mental Health Commission of Canada. Budget 2007 provided $55 million over five years for the commission, while Budget 2008 allocated $110 million for the commission's innovative demonstration projects.

The accord also committed the Government of Canada to continuing to invest in science, technology and research relating to health-specific innovation.

Over the last four years, the government has provided $440 million in new funding for health-specific innovation and $1.6 million in new funding for innovation with a health component. The importance of the Government of Canada's support for health innovation was confirmed by the science and technology strategy announced by Prime Minister Harper on May 17, 2007, which recognizes health and life sciences as a priority sector.

Aboriginal peoples continue to face health disparities compared to the rest of Canada. However, the Government of Canada is making progress on achieving better health outcomes for aboriginal people.

We are starting to see the results of the $700 million that the Government of Canada invested in Aboriginal health over five years as part of a commitment made at the special meeting of first ministers and Aboriginal leaders in 2004. This led to improvements in health promotion and disease prevention programs, Aboriginal health human resources and the adaptation and integration of federal and provincial health services for Aboriginal people.

In addition, the government continues to invest new resources in health services. Budget 2008 provides $147 million over two years to stabilize current health programs, make concrete improvements aimed at better health outcomes for first nations and Inuit, and support improvements in health care delivery through greater integration with provincial and territorial health systems.

The government is also building strong partnerships with first nations and provincial governments. The tripartite first nations health plan between the Government of Canada, the Province of British Columbia, and the British Columbia First Nations Leadership Council will help us improve service delivery and health service integration.

We will continue to work with our provincial and Aboriginal partners to improve the health of Aboriginal people and bridge the health outcomes gap.

In the accord, governments committed to keeping their residents informed of the progress made to improve their health care system.

The Government of Canada has always demonstrated leadership when it comes to public accountability in these issues.

As part of this commitment to enhanced accountability, the government issued reports based on comparable indicators and national data in 2002, 2004, and 2006. Another report is planned for later this year.

The government also fully funds the Health Council of Canada so it can report to Canadians on the progress of health care reforms. Since 2004, the Health Council has issued a number of public reports on the various elements of the accord.

Canadians are also benefiting from highly regarded data analysis from the Canadian Institute for Health Information, such as reporting on wait times and health expenditures. This further advances health care system transparency and accountability.

The government provided an additional $22 million per year in Budget 2007 for the Canadian Institute for Health Information. This brings Government of Canada funding to this organization to a total of $81 million annually.

Less than four years after signing the accord, much progress has been made on implementing accord initiatives.

The Government of Canada has provided the provinces and territories with sustainable funding to support their efforts to reform their health care systems.

The government has also demonstrated leadership in health care system renewal in other ways: by supporting provincial and territorial governments to introduce patient wait time guarantees, increasing investments in Canada Health Infoway to accelerate the development of electronic health records, and placing more emphasis on public health initiatives.

Strengthening health care requires leadership and partnership between patients, health care providers, and all levels of government. The government will continue to work diligently and closely with all its partners to maintain, improve, and protect the health of Canadians.

Health Canada and the Public Health Agency of Canada will be glad to provide support for the committee in reviewing the accord. We will give you all the assistance needed so that the review is a success.

This concludes my opening remarks. My colleagues and I from Health Canada, the Public Health Agency, and Finance Canada look forward to answering your questions.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Dodds.

We'll now go into our round of questioning, and it will be seven minutes per committee member.

We will start with Dr. Bennett.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thanks very much.

Thank you all very much.

I got back from Washington yesterday, and I am very concerned that internationally Canada is falling way behind. Whether it's wait times or electronic health records or patient satisfaction, there is a concern that we have fallen dramatically behind in the last little while in the good intentions of 2004. Particularly on things like reducing wait times and improving access, where in the accord it says “reductions in wait times in priority areas such as”, and yet we seem to have stuck to the five original ones. We are being judged not only internationally, but by patients on how we're doing on all the other ones; whether it's for a shoulder injury, or for mental health visits, or finding a family doctor, this is a concern. So in terms of how we are reporting to patients on how we're doing on all these things, I think I'm quite concerned.

I'm also concerned in terms of the health human resources action plan including doctors, nurses, pharmacists, and technologists. I am not sure we're getting where we need to go. Particularly, I'd like to know what happened to the $100 million we gave to increase the number of aboriginal health resource professionals. We don't seem to be doing that, or for official languages, which I think is helpful to all. I guess you won't be surprised that I will ask, what ever happened to the goals and targets in public health? Have we set the targets we wanted from the health goals process that all the provinces and territories participated in? Do we have targets on any of the diseases or any of the social determinants of health?

I guess I'll leave it there, and my colleague will ask some of the other questions.

The strength of our health care system will only be the confidence Canadians have in it. I think we need to be able to show Canadians that they're doing as well here as they would anywhere. I guess that's why wait times become the talisman for this, the other point being that without an appropriate health human resources team in our country, poaching from province to province isn't going to work. That's why there was this accord, to make sure we had the right mix of health professionals for all of Canada.

[Dr. Karen Dodds]

I'll start, and I'll start by talking a little bit about patient wait times.

Yes, five areas were noted as key areas in the accord. I think people can tell that progress has been made in those five areas. The patient Wait Time Alliance came out with a report card today with some marks. Earlier this week the Taming of the Queue conference, which Health Canada supported, was hosted by the Canadian Medical Association.

Although there's been a focus on the five areas, I think that has helped raise the focus on wait times in general, and there has been work in other areas. Indeed, in my opening remarks I commented that what we've been doing federally includes some projects in areas other than the five specific areas for first nations health: prenatal care, diabetes care, and foot ulcers due to diabetes as well. I think the interest in wait times is spreading, and it's because of the attention the accord focused on them.

[Carolyn Bennett, Liberal, St. Paul's, ON]

With due respect, in the allocation of OR time, if you get down to how this is working, the five are skewing for the patients who need other things. I think this is the way I certainly have it reported back. That was just a comment.

Please, I really want to know about the health human resources piece and how that is going, and also about choosing targets for the health goals for Canada.

[Ian Potter, Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health]

Madam Chair, I can respond to Dr. Bennett's question with respect to the aboriginal health human resources initiative and the $100 million that was agreed to by Parliament for this initiative.

This initiative was intended to achieve four specific targets: doubling the number of first nations, Inuit, and Métis students receiving bursaries; doubling the number of health professionals over 10 years; increasing the number of certified health directors by one-third; and increasing by 50% the number of post-secondary institutions with aboriginal health student report programs.

The program has two more years to run. Up to the end of the last fiscal year, we'd spent approximately $36 million. We're in the middle of a review, Dr. Bennett, that will show us where we are. I can tell you that with respect to the bursaries and scholarships, we can actually show that there's been a sixfold increase in bursaries and scholarships since 2003-04. Anecdotally, there has been a significant increase in the number of medical schools and nursing schools that have particular programs to support aboriginal students.

With respect to health directors, we've had a successful meeting of the health directors who manage first nations clinics and medical services. They're organizing themselves. They're establishing professional practice standards, and I think we will see significant progress on that.

We should have a report at the end of this fiscal year, which will give you more specific details of what we've accomplished.

Thank you.

[Dr. Karen Dodds]

On the general issue of health human resources, it should be noted that according to data that's been released by the Canadian Institute for Health Information, progress has been made in increasing the supply of physicians and nurses since the 2004 accord. The number of practising physicians in Canada reached 62,307 in 2006, an increase of 4.9% since 2002, which is a rate of increase over the population growth, which is at just 4%.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Dodds.

I'm sorry, I'm going to have to stop now. The time is way over.

Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Madam Chair.

Thank you for being here.

Clearly the 10-year plan is an interference in matters that are under the jurisdiction of the provinces and Quebec. That is why Quebec is not a party to the agreement, under the Quebec clause, which was added to the action plan.

However, it is still worthwhile to take another general look at two objectives that are central to that plan. First, there are wait times to see doctors. I read in La Presse in 2007 that Canada ranked last among the seven countries surveyed in terms of how much time people had to wait to get an appointment with a doctor.

Since that study was published, on November 1, 2007, have things improved? If not, can you comment on the results of that study?

Second, better access to health care was one of the objectives. In a newspaper article published on January 9, 2008, I read that according to the 2007 National Physician Survey, 5 million Canadians had no family doctor.

Is that figure large or small? Is it better or worse than before? Can you comment generally on those figures, which were also published in the media?

[Dr. Karen Dodds]

First, I would like to point out that the 2004 accord specifically recognizes Quebec's desire to take responsibility for planning, organizing and managing health care services within Quebec.

With respect to wait times since November 2007, is there an improvement? No, I don't think we'd have any information on an improvement over the last five months. What we have is information on an improvement over the four years of the accord time.

In terms of access to health care services and health human resources, dollars were provided to provinces to do what they thought was best, in terms of the health human resources and to put them where they thought was best.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

In the introduction to your opening statement, you referred to certain actions taken by the federal government in relation to health care. I am thinking specifically of the Strategy for Cancer Control, the Mental Health Commission, the Heart Health Strategy and combating obesity.

In terms of those federal activities, is Quebec entitled to rely on what is called the Quebec clause, to withdraw with full compensation, and without any constraints or obligations dictated by the federal government?

[Jane Billings, Senior Assistant Deputy Minister, Planning and Public Health Integration Branch, Public Health Agency of Canada]

Those initiatives, such as the Strategy for Cancer Control, are intended for Canada as a whole. There is no specific amount allocated to each province. We are trying to change the living conditions of all Canadians.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

In your opinion, what was good about the 10-year plan to consolidate health care, Quebec having the power to withdraw unconditionally and with full compensation, could that also be applied to those strategies? Because, and this is quite plain, they relate directly to actions targeted to the particular audience, which everyone acknowledges as being under the jurisdiction of Quebec and the provinces.

[Jane Billings]

The question you have asked suggests that there were amounts allocated to each province. That is not true in the case of these strategies. We do not allocate a precise amount to each province or to the provinces that choose not to participate in the initiatives.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

My question was more about the principle rather than the application or the mechanics. When a principle is agreed to, then the practice can be adjusted.

Can you comment on the principle, and not how these various strategies are applied?

[Jane Billings]

These strategies are developed based on information that is exchanged in order to improve practices everywhere in Canada. If we have to divide the strategy up, the results will not be as good. These strategies are not developed based on the principle you referred to.

[Yves Giroux, Director, Social Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance]

Mr. Malo, if I could ...

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Yes, go ahead.

[Yves Giroux]

In the case of the Mental Health Commission, these are research projects to determine the best approaches for dealing with mental health issues. This is something that Senator Kirby looked into. He identified major deficiencies in that regard. Under the new budget, the Mental Health Commission has received or will receive $110 million, subject to Bill C-50 receiving Royal Assent, to conduct research projects in five centres. Those funds are not intended for direct service delivery. Rather, they are meant for developing innovative mental health practices for clienteles defined as being at risk.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Giroux.

Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you, Madam Chairperson.

Thanks to all of you for your appearance today regarding what we as a committee consider to be perhaps the overriding issue of concern.

Let me start with wait times. As you've mentioned, Karen, the alliance came out with its report today. It is pretty scathing. It calls attention to the lack of significant change in the last year. We all know that the reduction or elimination of wait times was one of the five key promises of the present government in the 2006 election. We know that in Budget 2007 a serious commitment was enunciated to deal with wait times—in fact, you talked about a patient wait time guarantee. Today the alliance, which is made up of every professional medical organization in the country, has said that nothing has happened in a year.

In our access indicators, we see a change from an “incomplete” to a “C-plus”. This is a positive change, but it is still only slightly above average in benchmark targets, in wait time information. Overall, this is a pretty dismal record for a government that promised to eliminate wait times.

I'd like to know the nature of the problem What is being done to address this and to keep the promise?

[Dr. Karen Dodds]

Reducing wait times remains a priority for all governments. The new report card shows that in some areas Canadians are seeing improvements each year. The report also shows that the provinces and territories are meeting their commitment to provide Canadians with meaningful information on wait times. We want public reporting to continue to improve, and we are continuing to see improvements.

Focusing on wait times has some unanticipated positive impacts. Health care professionals who never talked to each other before are now doing so. You don't necessarily see these areas highlighted in the newspapers or in public reporting, but progress is certainly being made.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I appreciate that there have been slight--very slight--improvements in the grades given to wait times, but at this rate, Canadians aren't going to see much change while they're alive. My question is, is there a plan to make a real difference in this regard, something more than just another empty election promise? Is there anything in the works in your department to deal with this in a real way?

[Dr. Karen Dodds]

It's clear that we're all anxious to see further progress. The government is supporting further progress through dollars to the Canadian Institutes of Health Research, which is doing work on providing benchmarks and information.