Debates of Nov. 28th, 2006

Opposition Motion—Health Care

[Dave Batters, Conservative, Palliser, SK]

Mr. Speaker, I am very reluctant to rise on a point of order, and I rarely do, but the member is far afield from the topic and the motion that has been advanced by the opposition today. Today we are discussing the importance of health care wait times. I am questioning the relevance of much of this speech taking up the time of the House.

[The Acting Speaker, Conservative, Andrew Scheer]

I think the hon. member is talking about a comprehensive aspect about health care. However, I do hope she comes back to the main motion and addresses the motion that is actually before the House.

[Judy Sgro, Liberal, York West, ON]

Mr. Speaker, if the member had been sitting in his seat for most of my speech he would know that I have covered many of the areas that we are talking about today.

However, as if all of that was not bad enough, the Prime Minister broke his promise not to touch income trusts.

Canadians have learned quickly that they cannot trust the minority Conservative government.

Canadians have said repeatedly that health care is their priority and they believe it is the government's job to make it work. The Liberal government heard that message and was acting on it. I will continue to work to ensure that the commitments set out in the 10 year plan are honoured. I will accept nothing less nor will anyone on this side of the House.

On behalf of all Canadians and in the interest of protecting our public system of health care, we must all work together. A vote against this motion is a vote against strengthening public health care and providing timely care for Canadians.

I hope all members in this House will vote for the motion this evening so that we move in a non-partisan way to ensure that Canadians have access to the best health care system possible.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Speaker, the motion has to do with not only benchmarks for wait times but also a wait times guarantee. It appears that there was no money in the last budget to support this initiative. The concept of a wait times guarantee means that if people cannot get the service in their own hospitals, that they would be able to go to another hospital. It may be out of province or it may even be out of country. It would also involve transporting family or support persons to be with them, so that there would clearly be money required. The Prime Minister made an undertaking that this would be implemented immediately.

I wonder if the member would care to comment on whether one of the five throne speech commitments, which was to deliver on this health care guarantee, is not possible without additional funding to support the ancillary expenses that would necessarily be part of a wait times guarantee.

[Judy Sgro, Liberal, York West, ON]

Mr. Speaker, we have heard for several years about the trials and the difficulties in our health care system. Our wait times guarantee was an effort to help eliminate the kinds of difficulty and suffering that people have while waiting for several months for an MRI or months longer for cancer treatment and so on. Our effort was to ensure we worked with the provinces and other stakeholders to provide the access that was very important.

It was very disappointing to see no mention of that in the budget. It seems to have been one of the commitments that we all get criticized for, which is that in the heat of an election campaign we make all kinds of commitments and then we come back to reality.

Here we are, 11 months later, and no work is being done on guaranteeing Canadians that they will get access to the health care they need. It is a serious problem here in Canada and we need to be working, as often as possible, together as members of Parliament to meet one of our first obligations, which is to provide adequate health care to all Canadians.

[Dave Batters, Conservative, Palliser, SK]

Mr. Speaker, it seems passing strange that the member and a number of members opposite today have talked about a lack of progress on the health care wait times guarantee even though Canada's new government has been in power for 10 months. That is simply not the case. The minister is moving with due diligence. We are moving toward those goals.

I want to ask the member about the impact in 1995 of the $25 billion cut in transfer payments to the provinces, much of that affecting health care. The previous government often bragged about its financial record but it did so on the backs of students and patients.

I wonder if she would agree with me that much of the wait time problem that we currently have in this country from coast to coast to coast is actually the result of the $25 billion in cuts by the previous Liberal government.

[Judy Sgro, Liberal, York West, ON]

Mr. Speaker, I will take the member back to 1993 when the Liberals were elected. Rather than inheriting a $13 billion surplus, as the current government did, we inherited a $42 billion debt that we had to deal with. All Canadians had to make major sacrifices, whether it was about issues of health care or students. All Canadians had to join together with us to deal with that huge debt, otherwise Canada was at a point of bankruptcy. Some real difficult decisions were made and all Canadians made sacrifices.

Our country is now in an excellent time as a result of the steady work that was done in the years when the Liberals were in power. With the $13 billion surplus that the present government inherited, why has it not followed through on its commitment of a wait times guarantee? We all recognize how important that is. The work was done and we had agreements with the provinces and other stakeholders to move forward on it. The Conservative government has done absolutely nothing on this issue since it came into power. It did not have to redesign anything because it was already there and done. It just had to move on with it.

I know it is important to those members as well but we are getting impatient. It has been 11 months. I know this has a Liberal stamp on it and people on that side of the House do not like that, but let us get on with meeting the needs of Canadians and helping them with the whole issue of a wait times guarantee.

[Dennis Bevington, NDP, Western Arctic, NT]

Mr. Speaker, I have a little trouble with the member's chronology of the events of the last 13 years. Those years work out to about 150 or 155 months that the Liberals were in power and had opportunities to do quite a bit. They are certainly coming down very hard on the NDP for shortening that 155 months by 2 months by saying that we were responsible for the health care problems in this country because of it. My hon. colleague should really look at this in a rational fashion when she talks about responsibility for the health of Canadians.

Yes, we did go through tough times and the very tough decisions that were taken by her government did affect a lot of Canadians. However, what we did not see from that government was a plan that would have really reduced wait times, which was a strong, preventive health program within the government that could have examined every facet of what we do in Canada, whether it is housing, air pollution or nutrition, all the things that make up a healthy lifestyle. We did not see that from the Liberals in the days when they cut programs and preferred to sit on large surpluses.

Where was my hon. colleague in health prevention through those 13 years that led up to the two months that she is blaming the New Democratic Party for?

[Judy Sgro, Liberal, York West, ON]

Mr. Speaker, it was only in the last five years that the Liberal government was able to pay down the debt and to start reinvesting in all of the programs that needed to be supported.

The member has to remember that everything the government does has to be done in cooperation with the provinces. The provinces are the delivery agents. Trying to make significant changes and move in a positive way takes time, as with the child care agreements that the Liberals had worked on to finally be able to roll out one of the most important social programs for Canada. It takes time to get agreements with the provinces when trying to move forward, for example, the wait times guarantee. Those things do not happen overnight. There have to be prolonged negotiations.

One of the things we have to recognize is the pressure because of the demographics. Canada has an aging population that is putting additional pressure on the health care system. We need to find new ways of dealing with many issues.

Frankly, had the Liberals had the opportunity to stay in government, the wait time guarantees would have helped an enormous amount of people, as would have the child care system in trying to get more people into the workplace and providing choices for men, women and families of today.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, one area the government had complete responsibility over and did nothing was first nations health. I saw it in my own communities. I saw people year after year being fed nothing but promises that meant nothing. Health Canada has failed people on the James Bay coast abysmally.

The Liberal government failed. It sat on massive surpluses and did nothing to help the people of Kashechewan, Attawapiskat or any other community where we see horrific levels of health services, child mortality and other problems because when the Liberal Party was in power it did nothing.

Why did it have to wait for agreements to be signed with first nations that were--

[The Acting Speaker, Conservative, Andrew Scheer]

The hon. member for York West.

[Judy Sgro, Liberal, York West, ON]

Mr. Speaker, the Kelowna accord would have been in place today and there would have been millions of dollars going into the very communities that we care an awful lot about. Unfortunately, as a result of the NDP getting in bed with the Conservatives, the Liberal government was defeated. Those poor people are going to have to wait a long time before they get access to good quality care.

[Patrick Brown, Conservative, Barrie, ON]

Mr. Speaker, I am sharing my time with the member for Louis-Hébert.

I am pleased to have the opportunity to speak about wait times in Canada, which continue to be of concern to Canadian citizens and providers and are a key priority for the government.

I take health care very seriously. I am actively involved in my local hospital, the Royal Victoria Hospital. I sit on the physician recruitment committee. Our entire community is actively working toward our hospital expansion in 2008.

To give a bit of context about why health care is so important for my community, Barrie, Ontario is currently short 27 doctors. We have 30,000 individuals without a family physician. Our city council put forward $52.5 million toward our expansion in 2005. My community is doing everything it can to make health care the best it can be.

That is why I am so pleased that we are finally getting leadership in Ottawa on this very important file. We have a Minister of Health who actually understands the pressures of the health care system.

Just two weeks ago our Minister of Health visited the emergency department at RVH and talked directly to nurses, doctors and patients. The head of our nurses union, Tracey Taylor, remarked that it was great to see a health minister actually talk to the real providers of health care, the regular patients, the regular nurses who work hard every day.

Let us examine at the forefront how we got to this point. Why have wait times become such an issue for Canadians? It did not happen overnight and it is important to assess the root causes. During the Liberals' tenure in power, wait times to see a specialist rose from 9.3 weeks to 17.7 weeks. Between 1994 and 1999, the Liberal Party of Canada cut health care by $25 billion. The Canadian health care system could not sustain the assault imposed by the Liberal Party. Faith in Ottawa to support health care dwindled to an all time low.

Canadians need to have confidence that the public health care system will be there for them when they need it. Canadians expect a health care system that is responsive, fair, transparent and accountable. That is why over the past several months our Minister of Health has had discussions with the health ministers from every province and territory to obtain their views on the opportunities and challenges they see in reducing patient wait times.

Already some provinces have tackled complex issues and are achieving improved results. They are making progress on reducing wait times and moving toward being ready for patient wait times guarantees, which we see as the natural next step.

At the forefront of this progress is Quebec, which has proposed its own guarantees with recourse mechanisms for selected services, the first province to do so. Quebec is proposing a guarantee of access for three procedures: hip and knee replacements and cataract surgery. The province will offer recourse to patients in a stepped fashion with different access to service mechanisms kicking in at different times.

Manitoba and Quebec have also indicated they are providing a form of guarantee for some cardiac services and cancer treatment, which are improving access. For example, Quebec's service corridor model allows cancer patients waiting for more than eight weeks the option to be transferred between radiation oncology centres. Meanwhile, Manitoba's wait times for cancer radiation therapy are down to under one week from over six weeks in 1999.

Improvements in wait time reductions and management are evident elsewhere in the country too. In Atlantic Canada, provinces are collaborating on health infrastructure Atlantic. This involves capturing medical imagery through broadband networks, giving doctors quick access to test results which lowers costs and improves services.

In my province of Ontario we are also experiencing significant progress. Since launching the Ontario wait times strategy in November 2004, wait times for procedures have been reduced by 19.6% for cataract surgeries, 17.9% for hip replacements, 11.8% for knee replacements, 25% for angioplasty, 23% for MRI exams, and 13.6% for CT scans.

What does this mean for my local hospital? I am there regularly and I asked what this means for the Royal Victoria Hospital in Barrie. What does the new government's commitment mean on a local level? In 2006-07 it means $3.14 million has been directed, and this funding has had a dramatic impact for patients at my local hospital. It would allow the RVH to perform 606 additional cancer, cataract and joint replacement surgeries this year compared to 472 last year.

It means an additional 1,880 MRI hours. The hospital has been able to increase MRI operation to 24 hour coverage on weekdays and extended hours on weekends. As a result, RVH went from having the dubious distinction of the longest wait times in the province for MRI scans a year ago at an astounding 54 weeks, to 7 weeks today, a very impressive improvement.

Look at Alberta's success too. Alberta's hip and knee replacement pilot project has demonstrated a success in reducing wait times from 47 weeks to 4.7 weeks by streamlining the patient journey, increasing capacity and reorganizing resources.

In British Columbia the median wait time for cataract surgery fell from 9.7 weeks in 2005 to 7.4 weeks. B.C. has also reported significant wait time reductions between 2005 and 2006 for joint replacements. It attributes this decline as evidence that its innovative wait time strategy announced in February 2006 is helping reduce backlogs while building long term capacity in the health care system.

These examples, and there are many more, clearly show that when we work with focus and determination, when we have a common goal, and most important, when governments work together, we can deliver for Canadians the kind of health care system they deserve.

Last summer our Minister of Health met with health ministers from Denmark, Sweden, Mexico and France to see how other nations have been able to reduce wait times.

For example Sweden introduced its national maximum waiting time guarantee in 2005. Its plan includes patients to be treated elsewhere if the waits become excessive.

Denmark's extended choice of hospitals initiative was launched in 2002. If its health system is unable to provide treatment within two months, patients have the option of being treated in a private facility or another country.

The U.K. has a choice at six months policy. This means that patients who wait more than six months for elective surgery will be offered the choice of moving to another provider for fast treatment. The U.K. program is a good example of a system triggered recourse. The patient is not required to complain at six months; the choice is offered automatically.

These international examples show the kinds of guarantees that are possible for governments to offer their citizens. Sweden, Denmark and the United Kingdom did not deliver patient wait time guarantees overnight. It was a process founded on improving the management of their health systems and the use of taxpayers' dollars more efficiently and more effectively to provide their citizens with better health care outcomes.

The message from international experience is quite simple. The effectiveness of a nation's health care system depends on two things: its medicine and its management. To provide the very best, countries must do equally well.

Canada is a world leader in many scientific medically based endeavours. Our scientists and our scientific community are among the most valued in the world, often in terms of scientific citations being at the forefront of their disciplines. This is something we need to be very proud of as a country. Recent successes in the provincial management of wait times indicate that we are making progress on the management of our system. This includes the financial management of our system.

Let us address the money issue head on. There is a lot of new money going into the health care system: $41 billion in new dollars to the provinces and territories over 10 years with a 6% increase a year for inflation, $5.5 billion specifically for wait times reduction. Canadians want and demand to know that this money is being managed effectively. They want, as our government has promised, greater transparency in terms of what their tax dollars are delivering and they want greater accountability results.

Establishing a patient wait times guarantee is a process, not an event, building upon existing provincial and territorial reforms, comprehensive wait times initiatives while representing different provincial priorities as it relates to their respective health care systems.

Today I have provided just a few examples of the success stories achieved by the provinces and territories and health care system administrators who clearly are making progress on reducing wait times through better management and innovation. These are examples that also demonstrate the solid building blocks in place to move forward on a patient wait times guarantee.

We look forward to continuing to work with the provinces and territories to deliver outcomes Canadians want, and certainly ones they deserve in their health care system.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Speaker, the Conservative platform promise for a health care wait times guarantee during the last election was made to provide some assurance to Canadians that should the benchmark guarantees, which were set out back in 2004, not be met, patients would be transferred to other hospitals outside their own province or outside Canada to deal with that.

Clearly, it involves some additional cash to support this work outside of the established program funding for the health care system in the provinces. The budget presented by the government did not provide any additional funding for the wait times guarantee.

Could the member explain to the House and Canadians how a promise, which requires money, can be delivered when no additional money has been forthcoming?

[Patrick Brown, Conservative, Barrie, ON]

Mr. Speaker, it is always amusing to hear a Liberal member talk about funding for health care when it was the Liberal Party that cut health care by $25 billion between 1994 and 1999.

The new Government of Canada has made it very clear that the $41 billion for health care is a fundamental investment that it is willing to stand behind and support. It is making a tangible difference. I raised examples that patient wait time reductions were working across the country, from coast to coast. I know the Minister of Health is doing everything he can to work with his provincial and territorial counterparts to ensure that the government's goals for patient wait times guarantee can be realized.

I will read the statistics of the hospital in Barrie in the last year, which I find most impressive, and the government has only been in power for about a year. If we break down what funding in the budget means for local hospitals, for my local hospital it is $3.14 million for 2006-07. That funding has allowed the hospital to perform 606 additional cancer, cataract and joint replacement surgeries and an additional 1,880 MRI hours.

The investment that the Minister of Finance and the Minister of Health have put into health care is making a tangible difference in communities. It is in stark contrast to the days in the 1990s when hospitals and provincial health ministers were continually scared and in trepidation of the cuts the Liberals may inflict on health care systems.

We can ignore the $25 billion, but the growth in wait times was a direct cause of the cuts inflicted by the former finance minister at the time. It is unfortunate that it happened, but this government is doing everything we can to ensure that the health care system has the funding it deserves, and we are seeing that happen today.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Mr. Speaker, my question for my hon. colleague concerns wait times. If one were to talk to Canadians about what they value about Canada, it is the universality of our health care system. People identify that as one of the fundamental values of what it means to be Canadian.

One of the issues with wait times right now is the fact that we have seen more and more privatization. It began under the Paul Martin government and it is continuing now. A private emergency room is actually being opened. It is undermining everything that has been done in developing a universal access system.

How does my hon. colleague feel about moving toward private operations, health care services and health care delivery on the front lines? Would his government be willing to stand with New Democrats to stop that and ensure that the health care wait times we have gone after will be delivered under a universally guaranteed system?

[The Acting Speaker, Conservative, Andrew Scheer]

I remind the hon. member for Timmins—James Bay to refer to other members by their ridings or titles.

The hon. member for Barrie.

[Patrick Brown, Conservative, Barrie, ON]

Mr. Speaker, there is a lot of support in the House, myself included, for our universal health care system. Many Canadians take tremendous pride in that.

If we have seen a slippage toward private health, and that has been under the Premier of Ontario, Dalton McGuinty. He decided to remove eye and chiropractic care from the services available to many Ontarians. I was very concerned about that. It was an unfortunate process that the Liberal Premier of Ontario undertook.

I know this government is very committed to health care in Canada to ensure that all Canadians get the best possible health care.

[Luc Harvey, Conservative, Louis-Hébert, QC]

Mr. Speaker, today I find it ironic to talk about wait times in health care because what we are doing, in fact, is taking stock of the 13 years the Liberals were in power. Once again, it is somewhat like the environment file where they said they were working on it, but in the end there was no result and nothing happened. We are in a situation where the result is 35% worse than they had hoped it would be when they signed the Kyoto protocol.

Today we have before us a motion from the Liberals to force us into action on a promise we made during the election campaign. We made promises that we have kept. Nonetheless, I would also like to point out that it is not enough to spend money and to make promises; we also have to respect the jurisdictions.

We all know full well that health is a provincial jurisdiction. We are working together with all the provinces in order to achieve a positive result and to improve wait times.

The Liberals did not manage to do anything in 13 years. Today, when we have been in power for less than a year, we have receive a motion asking us, somewhat maliciously, to play bad politics with an issue on which ourMinister of Health is already working very hard in order to resolve the problem and meet with provincial representatives.

We also have research. This research suggests that we currently have more effective treatments, but we also have an aging population. It is not enough to inject funding in order to try to reduce wait times. We also need to have healthy management, something the Liberals still have not managed to prove.

I would like to talk about a document that is before me. The Canadian Institutes of Health Research and the provinces and territories want to use federal research funding to accelerate data collection in order to establish benchmarks, as far as wait times are concerned, to provide Canadians with acceptable waiting periods for major operations.

What does that mean? Before we say that we have to reduce wait times, we need to know what is acceptable and feasible. We know that there is a time lag between the moment we receive a diagnosis and the treatment of a disease such as cancer. Sometimes, it is a physiological disease such as a joint problem. Before a joint is replaced, other treatments may be provided to delay the operation or simply alleviate the joint problem.

Recently, the federal government announced $348,000 in funding for health research projects, including research into wait times.

I am pleased to say that last week the Prime Minister also announced $260 million in funding to expand the Canadian strategy for cancer control. Among other initiatives, the strategy will support and facilitate cancer research in Canada.

The hard truth is that the automation of health care administration lags nearly 20 years behind other sectors. To correct that, we are using Canada Health Infoway funds to reduce wait times by implementing electronic patient records, centralized databases and telehealth services.

There is also improved cooperation among the federal, provincial and territorial governments.

The federal government recognizes that federal-provincial-territorial cooperation is essential in order to reduce wait times and establish wait time guarantees for patients. Over the summer, the Minister of Health held talks with his provincial and territorial counterparts in order to hear their views on the existing possibilities and challenges for patient wait time reductions.

Our government hopes to continue working with the provinces and the territories in order to achieve the results desired, and most definitely deserved, by Canadians.

Improved training of human resources in the health field and their retention are essential to wait time reductions and improved access to health care. Canada's new government is investing in human resources in the health field in order to improve collaboration among various health care professionals, contribute to the recruitment of highly qualified health care providers, and retain health care professionals who have a great deal of knowledge and experience.

One example is our program to increase recruitment among health care professionals with foreign credentials who are prepared to work in Canada. This program will enable an additional 1,000 physicians, 800 nurses and 500 health professionals to join our health system within five years.

This is an important component. We cannot pull health care specialists out of thin air. We are talking about five years from now because we cannot entrust the lives of Canadians to unqualified individuals for the sole purpose of shortening wait times. We must assess the risks and consequences and the capabilities of the individuals who will help shorten these wait times.

This will all be carried out responsibly. This entails implementing measures for assessment and supervision, to ensure that the programs work effectively and efficiently, something the Liberals were not used to doing.

Benchmarks are the first component of wait time guarantees for patients. They represent the appropriate wait times for medical procedures based on clinical data.

In 2005, Canada announced its first set of 10 benchmarks based on solid evidence for acceptable wait times for the following procedures: bypass surgery, cancer screening and radiation treatment, hip and knee replacements and cataract surgery.

These benchmarks enable us to measure wait times to determine which parts of our health care system we need to focus on and which ones need improvement.

Recently, the author of an Ontario Medical Association study conducted last June stated that some wait times were getting shorter but others were not. In response to that, we can say that for the first time, we have benchmarks that enable us to measure certain elements. We are measuring progress in the system, so now we know what we have to focus on. This is a first.

When the first ministers met in October 2005, all governments confirmed that, as more data become available for the five priority sectors, additional benchmarks would be set in the health care continuum. We are committed to working with the Canadian Institutes of Health Research across the country.

In conclusion, reducing wait times is a process, not a one-time event. We may not have attained perfection in one day, but that does not mean we are not making progress. We have to start somewhere, and that means breaking new ground.

[Raynald Blais, Bloc, Gaspésie—Îles-de-la-Madeleine, QC]

Since we must start somewhere, I would like the hon. member to start by respecting our areas of jurisdiction. Starting somewhere would give Quebec the means to deal with the various challenges facing the health care sector.

To start somewhere would mean to start by recognizing that health care is a matter of provincial jurisdiction, as the hon. member did at the beginning of his speech. But the member then went on to discuss a number of possible encroachments on this jurisdiction.

When a member begins his speech with a certain logic, he must follow through, otherwise, the rest of the argument does not hold water.

[Luc Harvey, Conservative, Louis-Hébert, QC]

Mr. Speaker, I am pleased that my hon. colleague from the Bloc Québécois was listening because, on several occasions, we mentioned and I talked about consultations and meetings with the various health ministers in Canada, including the Quebec health minister.

I also talked about a benchmark, specifically, is the situation getting worse or is it getting better? This work has never been done. To ensure that the promise, which was to reduce wait times, is measurable and quantifiable, Canada needs a benchmark. This is somewhat similar to the Kyoto protocol referring to the year 1990. We therefore have a figure to refer to for wait times.

[Raynald Blais, Bloc, Gaspésie—Îles-de-la-Madeleine, QC]

Should my colleague from the Conservative Party not be saying, rather, that the real field of reference for the health care file is Quebec and its health and social services department?

[Luc Harvey, Conservative, Louis-Hébert, QC]

I never said anything to the contrary. There is no problem. I agree with my colleague.

[Daniel Petit, Conservative, Charlesbourg—Haute-Saint-Charles, QC]

Today's motion mentions that the Conservative government has broken its promise to reduce medical wait times. Since my colleague from the Bloc Québécois said this is a provincial jurisdiction, I imagine the Bloc members will vote with the Conservative Party today.

We might also wonder whether a strike by medical specialists in Quebec would not show that, no matter what the federal government does, it will not be able to do anything about wait times, since everything depends on the medical professionals in Quebec who are on strike.

I would like my colleague to say a few words about the possibility of reducing wait times. I realize that the Bloc Québécois has just informed us that it will vote with us.

[Luc Harvey, Conservative, Louis-Hébert, QC]

First of all, to determine whether or not wait times have improved, a benchmark is needed. That is the first thing we had to work on. You must also be able to quantify results. Are wait times decreasing or increasing? Are we making any progress?

When I worked in Africa, I liked the expression that said that change did not mean there was progress. I do not know if the Bloc Québécois is after progress or just change. Nevertheless, our objective is to determine if we are making progress. If we are, we need a benchmark to assess if we have made a change or if we are truly making progress.

The objective is to quantify the progress made. I do not think that quantifying the amount of progress infringes on a provincial jurisdiction. I would like to point out, and I will repeat for the benefit of my Bloc Québécois colleague, that the federal government—my government—has just announced $348 million in funding for health research, including that on wait times. In addition, another $260 million has been invested in the fight against cancer. This funding is not strictly for Quebec, or Ontario, or Canada, but is for all the provinces in Canada, in order to make progress in this matter.