Health Committee on Nov. 25th, 2010

[Glenda Yeates]

Thank you for the question.

It is the case that we have noticed an increase, and we are not entirely sure why that is the case. Perhaps there is a growing awareness of the program. Perhaps there is a growing comfort with physicians in terms of recommending that their patients with various conditions access medical marijuana. I don't think we precisely know the reasons for the increase in demand, but we are certainly seeing the increases that have been ongoing and in fact are accelerating at this point.

That has meant, as is noted in the item on the website, that we are in fact not meeting the benchmarks that we set ourselves internally, because we realize this is an important benchmark to meet for individuals.

The member is absolutely correct. We are not requesting additional funding, but to our own reallocation we need to put and train more individuals, so they can respond to the increase in the demand. That is what we have done.

Our strategy has been to allocate and train additional individuals. We've also introduced a very tight tracking system to understand. We track now weekly. I see these numbers, and the branch sees them even more frequently to actually see how many we are getting in each week, how many we are processing, and if we are on track to clear the backlog.

One of the challenges for us is that we try to project what will come in the following week, so we train staff. There are certain challenges in terms of you can't just add anyone on a given day. There's a certain process of training to make sure that people can provide the steps.

That's the strategy we have put in place, and we're working through that.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Yeates.

We'll now go to Ms. Chow.

[Olivia Chow, NDP, Trinity—Spadina, ON]

Thank you.

I have several areas.

Correct me if I'm wrong, but a few years ago there was a plan to build a non-profit HIV vaccine manufacturing facility. I think earlier this year you decided not to go ahead with it, thereby saving $88 million, something of that nature. Are you transferring that money to the community-based HIV projects? Are you transferring it there?

As I recall, $26 million of that $88 million was taken from the community-based HIV projects. I remember that quite a large number of organizations in the Toronto area that I represent had difficulty because there was a cutback.

I assume some of that funding will be going back to restore or make sure that some of these non-profit organizations would be able to get their AIDS community-based funding. How much is being allocated in that area? How much is committed and how much has been spent so far this year?

[Dr. David Butler-Jones]

The CHVI initiative was undertaken with Bill and Melinda Gates, together with a number of departments across government, in order to further the development of an HIV vaccine. It's recognized internationally that ultimately that's the way we have to deal with it. The funds were not taken from programs; they were part of our overall budget allocation. In the last five years the money for that program has gone from about $54 million to over $72 million. So actually funding is higher than it's ever been, and we're continuing on that path.

In respect of the decision on the facility itself, there was a call for proposals. There were a number—

[Olivia Chow, NDP, Trinity—Spadina, ON]

I wasn't interested in that one. Of the $72 million, how much is committed?

[Dr. David Butler-Jones]

None of them met the standard, so now the money is being used for other HIV vaccine initiatives.

[Olivia Chow, NDP, Trinity—Spadina, ON]

What about the $72 million, the allocation?

[Dr. David Butler-Jones]

That's outside the CHVI.

[Olivia Chow, NDP, Trinity—Spadina, ON]

I understand that.

For the community grants, how much has been allocated?

[Dr. David Butler-Jones]

For this year, it's over $72 million.

[Olivia Chow, NDP, Trinity—Spadina, ON]

How much is actually spent, out the door?

[Dr. David Butler-Jones]

I don't know, but we can get that for you.

[Olivia Chow, NDP, Trinity—Spadina, ON]

Thank you.

So you're internally reallocating $200,000 to support the vaccine initiative, right?

With respect to isotopes, for some of the people dealing with cancer, there's still a shortage. Have you had input from the medical stakeholder groups regarding what you plan to do? Is it a short-term or a long-term solution? I see that you are making optimal use of the existing isotope supply. Part of the isotope supply initiative is $4.9 million, and the other part is the $1 million to deal with non-reactor-based production of medical isotopes. Is it a short-term or long-term strategy? Is it affecting the wait times of cancer patients who need the isotopes to get the scan? Where are things at on that front?

[Glenda Yeates]

I'll speak to the Health Canada portion, but it is part of a broader strategy. NRCan has some funding to deal with some of the technical issues. CIHR is looking at some clinical trials, to decide long-term questions about the research. For Health Canada's part, there were several things we wanted to know after the isotope crisis. We realized that during the shortages there were groups of people who used different isotopes or different alternatives to isotopes. We wanted to make sure that we had a mechanism to develop policies and protocols to establish when the various alternatives are preferable, and how the various outcomes compare.

So I would say it's in the medium term. It's not the longest-term research that CIHR is funding. It's more applied research—investigating, working with experts, to understand what we can learn from other countries about the effective and appropriate use of isotopes.

[Olivia Chow, NDP, Trinity—Spadina, ON]

Are you satisfied that what is happening is sustainable? Even if you have the alternative, you have to research alternative use, maximum usage of the existing stock. Are you concerned that there's still a shortage?

[Glenda Yeates]

What we all learned through the isotope shortage was that there are not many suppliers worldwide. Canada took a leadership role in bringing the international suppliers together for the first time to plan for shutdowns and understand how to manage worldwide supply. We also learned about some of the challenges, about our reliance on these isotopes.

Right now the supply is back up in Canada. We are not hearing any reports of delays. But we need to make sure that in the future there is a diversification of technologies. We need to explore that in the light of the best outcome for patients.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Yeates.

We'll now go to Mr. Uppal.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Thank you, Madam Chair.

Thank you all for coming this morning.

The first question will be for Madam Yeates, and after that whoever wants to pick up on them can answer.

Madam Yeates, as the deputy minister, what are you doing to ensure the financial integrity of your department? Do you feel that Health Canada has adequate accountability measures in place to protect taxpayer dollars?

[Glenda Yeates]

Thank you very much for the question.

There is a real sense among all deputy ministers that a crucial part of our role is to ensure financial integrity for the department.

I'm pleased to tell the committee that Health Canada has a strong financial management control framework in place. We have a strong internal control division that monitors the effectiveness of our internal controls. As other departments do, we have a departmental audit committee with outside members who are very helpful in advising the deputy on the strength and the completeness of our internal controls.

The Treasury Board Secretariat has a management accountability framework, and they assess every department on the strength of their financial accountability. They've given Health Canada good marks for our financial stewardship and financial management. Very much, there are other Treasury Board policy recommendations, and when we compare ours against those policy requirements, we do well.

We have a strong internal audit function. It's obviously very helpful when external auditors come and look at our programs, but we want to have a strong internal audit function as well, and that is functioning well, as I said, with a number of regular, scheduled audits looking at the highest-risk areas coming through our audit committee. When we do find areas where we think we can improve and where improvement is called for, we take strong action there.

I would note that the Office of the Auditor General, in their audit procedures on our transactions in the latest fiscal year, 2009-10, found no significant new issues for the department; therefore, there was nothing that warranted the issuance of a management letter. That is an important milestone, certainly, for me as the chief accounting officer, but committee members would also find this to be a real vote of confidence in the control mechanisms.

I wouldn't want to leave the committee with the sense that we are resting on our laurels. This is such a critical area for public trust that we want to always continue to push forward and make sure we are continuing to improve our practices, but I feel we have good practices at the moment and we will work to make them even better.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Good. Thank you. That's good to know.

One of the shortcomings identified--

[The Chair, Conservative, Joy Smith]

Mr. Uppal, may I interrupt you for one moment?

[Dr. David Butler-Jones]

I'm just not sure... You addressed it to all of us. I would be quite happy to--

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Yes, sure. Go ahead, absolutely.

[Dr. David Butler-Jones]

I would add that in departments across government, clearly deputies have a responsibility for the best use of resources and matching our responsibilities to the capacities that we have.

In public health, the focus on prevention has always been a good investment, but it has not always been the most invested area. In a sense we have duct-taped and binder-twined, and that actually occasionally works, but the point is that whatever resources we have must be focused on the areas that can make the most difference.

Glenda mentioned the calibre of both the internal audit processes and the external audit committees. For example, on our audit committee for the agency we have a former provincial auditor general, a former federal comptroller general, a former CEO, a head of health regions, and a deputy minister. From past lives they bring tremendous expertise not only in the fiscal and financial aspects but also in the links to whether we are spending money in the ways that will deliver to Canadians the best things we can do.

I'll leave it at that. Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

Is there anybody else, Mr. Uppal, you want to hear from?

Okay, go ahead.