Health Committee on Nov. 20th, 2012

[Hedy Fry, Liberal, Vancouver Centre, BC]

Is there such a plan?

[Glenda Yeates]

A great deal of work was done. Some of that has been implemented in various ways by individual jurisdictions, but it was not pursued as a collectivity.

[Hedy Fry, Liberal, Vancouver Centre, BC]

It was meant to be nationally done.

[Glenda Yeates]

There was policy work, as I understand it, Madam Chair, that was done collectively. Some jurisdictions chose to pick that up individually, but there was no will among the group, as I understand it, to go forward together. I would say that there was an interest in 2004 in strengthening the evaluation and the real world safety and effectiveness. We have in fact created the Drug Safety and Effectiveness Network. Again, a number of the individual mechanisms have been followed up and many of them have been implemented.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I just wanted to say, Ms. Yeates, that the accord categorically said, and I am reading, “The strategy will include the following actions”, and that piece on assessing, developing, and costing options for catastrophic pharmaceutical coverage was number one on the list. I still haven't had an answer as to why it wasn't done. It was signed in the accord and a report was to be made in March 2006. Why have we not seen that?

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Fry.

Do you want to make a quick comment on that, Ms. Yeates?

[Glenda Yeates]

I would say two things. One, the policy work was done jointly and it was decided jointly not to take it up. Two, the accord did offer a wider range of things that could be done together, but there was no specific tying of the resources to individual pieces of that. Again, as provinces and territories have moved on, the policy work was done but there's been no priority put on collectively moving forward although various pieces, as I mentioned, have in fact moved forward and been implemented.

[The Chair, Conservative, Joy Smith]

Thank you.

Mr. Lizon.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Madam Chair.

There's the small amount of $20,000 to Industry Canada for development of the global portal of the consumer product recall database.

Can you explain what that global portal is and how it will protect the health of Canadians?

[Glenda Yeates]

I think increasingly we're understanding the great protections we have in a post-market world. As we discussed earlier, there are many things we can do to ensure that products are safe before we introduce them to the market. Often we only get information on various products once they've been used in the real world and then we have the feedback and the understanding.

As we move towards working together, increasingly what we're doing across our regulatory responsibilities is pooling our information here in Canada with others. In fact, as we recall products, for example, we work within Canada to establish recall databases and other things. Again, Canadians can become aware of what's happening.

We work with the OECD as well, and if I'm not mistaken, it's a small charge for an ICT infrastructure so that Canada can participate in an international way to protect the health and safety of Canadians by having a web-based platform to inform Canadians of product recalls.

Again, we all know that the world is smaller and smaller in some ways, and as we get information somewhere else in the world, we want to see if we as Canada can be part of an international community sharing that information.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

If I understand you correctly, that portal would have information on the recalls in Canada and all other countries participating in it? Is that correct?

[Glenda Yeates]

That's my understanding. I don't have a detailed knowledge of that portal here, but that is my understanding. We have a portal for Canada, and Canada participates in the OECD international work as well.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much.

The second question I have is on the funding that is being allocated for the support of the development of new community-based integrated palliative care. Could you explain what these new care models are? How important are they for Canadians, and how do they work?

[Glenda Yeates]

What we see in the supplementary estimates is a re-profiling of some money.

There was an announcement in budget 2012 of money over three years to help support the development of some new community-based integrated palliative care models. I'm not able to describe the models because in a sense this is the money that is starting to do that work, and it's being given to the Canadian Hospice Palliative Care Association. They are doing some work so that we can develop some models that may be useful across the country on palliative care. We are re-profiling the money. They began their work last year. In fact, we've seen an increased amount this year as their work continues.

We're very mindful of the aging of the population and of the fact that palliative care and innovative ways of having palliative care done effectively in the community will be an important set of factors going forward. I think this organization is very well placed to do some of that development work, again, to be shared whether it's with a regional health authority, or a province, or anyone else who is interested in understanding the best practices in palliative care. The models are not yet finished, but this is the work that this money is supporting.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

I will ask just one more question on this, because I know I will be asked about details in my riding.

When can we expect some of the results of the work that's being done? How would it be shared with the provinces or territories on the implementation side? How can they benefit from that? In Ontario we have a shortage of beds in long-term care facilities. This would be a very important program to address that shortage.

[Glenda Yeates]

Yes, and thank you very much for the question.

It is something that Ontario, and all provinces—I'm a former Saskatchewan deputy minister of health—are looking for to be able to support their work. It is a three-year commitment. It began last year and this is the second year. Once the research funding is finished, then we will presumably have the outcomes and they will be shared. There will be consultation with jurisdictions in advance of that, so there's consultation to make sure that the palliative care association engages with stakeholders as the work is ongoing. I don't think it will be to the end of three years before people are able to connect to the work.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much.

Do I have any time left?

[The Chair, Conservative, Joy Smith]

You only have about half a minute left. There's really not enough time.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Maybe if Dr. Carrie—

[The Chair, Conservative, Joy Smith]

We've come to the end of this seven-minute slot. I want to ask the committee, we do have 15 minutes left, but there are two things. We have to vote on adopting and reporting the supplementary estimates, and then there are a couple of business issues that have come up that have to do with our trip to Montreal and a few other things.

I'm going to ask the will of the committee. Would you mind if we now went into a unanimous consent vote on the estimates, and I'll call them out, and then we'll go into committee business? Is that okay with the committee?

Let's have discussion on it first. We can continue the questioning if you absolutely want to, but that means we have to do business another day. I will have to stop to do the votes in 10 minutes anyway, so what is the will of the committee?

[Libby Davies, NDP, Vancouver East, BC]

Madam Chair, I think we should continue with questions because we do have the officials here. Two hours isn't a lot of time. I know we have to have a few minutes at the end for the estimates, but I think committee business wasn't on the agenda, so I would prefer that we wait and continue the questions.

[The Chair, Conservative, Joy Smith]

That's fine with me. We will stop at 12:55 p.m. to go through the votes.

We will continue on. Dr. Morin, go ahead.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

First, I would like to thank all our witnesses for being here today.

It is always a special time of the year when we can put questions to you or to the minister. I missed my opportunity to ask the minister questions today, but perhaps I will be able to do so next time.

I want to go back to the case of Ms. Lajoie. My colleague Mr. Lapointe brought the matter up; he is passionately involved in the case. Ms. Sellah spoke about it too. I am pleased that the minister was able to answer the question by stating categorically that she has no plans to create an ombudsman position, at least in the short term.

Could I get an answer from you, Ms. Yeates? When Mr. Lapointe and the minister were discussing the matter, they did not seem to be on the same wavelength in terms of the way the story unfolded. According to the information that my colleague has passed to me, Ms. Lajoie's oncologist did everything required under the rules, and nothing worked.

You can take a little time before you answer. I can even ask another question in the meantime, so that you can have a little more time to answer this one.

As my colleague and I understand it, everything was done according to the rules and yet the lady ended up not getting access to the health care she needed. I think that is the reason my colleague was suggesting the ombudsman position, to make sure that the situation will not happen again.

Perhaps it is too early for you to provide a report, but are there things that could be improved in the future, maybe by creating an ombudsman position or by anything else? Did everything go well in this case? Tell us what you think of Ms. Lajoie's story.

[Glenda Yeates]

Thank you for the question.

Because it is a little technical, I will answer in English.

I am not going to speak to the specifics of the case, but I would be very happy to take the committee through the process. There was a question asked, Madam Chair, about the process that would perhaps be helpful to understand.

Again, the vast majority of the drugs that we deal with are, in fact, drugs in this country that have gone through the clinical trial process and that have actually been reviewed and then approved by Health Canada for sale and use in this country.

We also understand there are instances where there are either emergencies or very unusual circumstances where practitioners feel that a product that is not approved, has not gone through the clinical trial process, and has not received a notice of compliance from Health Canada is appropriate. We therefore have the special access framework to deal with these situations.

Perhaps I could just mention the roles that individuals play here, as was mentioned. Practitioners are responsible for initiating the request of this program. We dealt with—the minister mentioned the numbers, but I'll mention them again—25,000 requests last year for over 500 different drug products for about 70,000 patients. We are talking about a substantial program. The practitioners make the request. They identify the particular drug from the particular source. They give a brief history of the patient's condition and the therapies that have been tried or considered. Basically, they then provide some data respecting what they are proposing to use. The program then takes that information, considers it, and evaluates the nature of the emergency and the drug. In many cases, these may be drugs that we are aware of from other requests and we may be able to look at that. We operate this program 24/7. We understand that in emergency situations there will be an urgent need.

Manufacturers also need to have some responsibility for deciding that they will provide the drug. Obviously, they are providing it in circumstances where there is not a notice of compliance and no Health Canada review. The manufacturers also have to be willing to provide the drug. We don't have any authority to compel the manufacturers to provide a drug. There can, in some cases, be circumstances where a manufacturer is willing to release a drug but Health Canada is not, and vice versa.

There are a very large number of these requests. Most of them are, as the minister mentioned, processed within 24 hours. Some do take longer to evaluate if they are new to the program. As I say, we work very hard to make sure that service is available on an ongoing and 24/7 basis.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

In that particular case, can you tell us if the request was not treated in a timely manner or was it denied?