Finance Committee on Oct. 21st, 2009

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

So you think we should focus on a few areas of research.

[Tyler Charlebois]

I think we need to focus, but we also need a strategy. That strategy can't be just that focus area; we need to have that strategy in place.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Am I out of time?

[The Chair, Conservative, James Rajotte]

You have five seconds left.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Is there time for one more comment?

[The Chair, Conservative, James Rajotte]

Yes, very briefly.

[Paul Charette]

Very briefly, I think a strategy is absolutely what's needed, and a strategy that differentiates from the universities. It's what you don't do for the colleges now. For example, no college research chairs are supported by the federal government. That's a travesty. If you don't have leadership, how do you have research? I think you need to look at that.

[The Chair, Conservative, James Rajotte]

Thank you.

We're going to go to Mr. McKay.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Thank you, Chair.

My first question is to Ms. Fralick, and it has to do with—how should I say?—the insanity of the health care system. The doctors, for better or for worse, are the gatekeepers, but the gatekeepers don't seem to be overly enthusiastic about ceding jurisdiction anywhere. So you have a doctor writing a prescription for a patient. The doctor has taken maybe one or two courses in pharmacology and he's telling the person who has taken four years of it the appropriate prescription for this patient. You have doctors telling a patient whether they need physio or OT, and the physio or OT can't go outside the doctor's prescription, even though the physio or OT has studied the subject matter for four years and probably knows 10 times what the doctor knows.

The difficulty for us as policy-makers is that in some respects the health care business hasn't got its act together. We just keep bandaiding and bandaiding with more and more money, and it becomes less and less effective. I'd be interested in your thoughts on how the health care professions are going to fix themselves.

[Pamela Fralick]

Those are difficult waters to tread, because there are professional bodies to speak on behalf of those professions.

[John McKay, Liberal, Scarborough—Guildwood, ON]

I know, but the professional bodies are a bit of a mess.

[Pamela Fralick]

First, I believe that the leadership of the professions is on the right track. We've spent five, six, seven years and $780 million of taxpayers' money developing a new approach to primary health care. It actually does remove the physician from being the gatekeeper and allows Canadians to access health care from the providers that they need to see. The leadership has signed on to that, literally signed on in a charter, and is doing what they can to get it down to the troops. It's a culture change.

[John McKay, Liberal, Scarborough—Guildwood, ON]

So why am I being lobbied by physios?

[Pamela Fralick]

I was going to speak to the physiotherapy example but broaden it a bit. One of the true barriers to that direct access is the insurers. The services you're talking about are privately funded. They're not part of the publicly funded system, and many of them still require you to see a physician before you see them. Why do they do that? There is no evidence to support the practice. They do it because they believe it's cost containment. They may believe it's a deterrent. I suspect they put that in place with the best of intentions. I feel it's a barrier and it costs our health system.

If there's one thing that I could have tackled when I was in that role, one thing I would take on from the Canadian Healthcare Association perspective, it is that piece. It needs to be addressed.

[John McKay, Liberal, Scarborough—Guildwood, ON]

I appreciate that I've opened up a huge can of worms here.

[Pamela Fralick]

Yes, but I wanted to give you a sense of optimism. We do have a pan-Canadian health human resource strategy in this country. Actually, we have five, and I have them in a file, but one comes from the federal government.

A question I would put to you is: where is it right now and who is coordinating it? Even Africa has a health human resource observatory that will coordinate activities in a non-partisan way. We don't have that. There has been a lot of resistance to the concept, despite the papers that have been written describing what it might look like. Many officials have been surveyed on it. So I think there's a lack of coordination. That's the third piece. If we could get the players together, we could have a more powerful impact on changing the very issue you raise

[John McKay, Liberal, Scarborough—Guildwood, ON]

Thank you.

Mr. Manahan, at one point in another life I was the P3 coordinator—

[Andy Manahan]

I recall.

[John McKay, Liberal, Scarborough—Guildwood, ON]

—for the federal government. It has gone through various mutations. To give credit to the government, which I don't often do, they've actually moved it towards an actual free-standing office. That free-standing office, as I recollect, about a year ago was opened to great fanfare. I haven't heard from it since. Can you give me an update on what's going on in the P3 office?

[Andy Manahan]

I was in Ottawa in mid-August for the Association of Municipalities of Ontario's meeting and I used that opportunity to meet with the P3 president, John McBride. They are still staffing, so it was a little slower than we had hoped for. One of the concepts we talked to him about was the $50 million threshold that Minister Flaherty put in place. We think that's appropriate for AFP/P3-type projects, but it's difficult when you're talking about, say, bridges. We talked about bundling certain infrastructure projects, like bridges, so that the federal government could get more involved with the P3 model.

[John McKay, Liberal, Scarborough—Guildwood, ON]

Thank you.

[The Chair, Conservative, James Rajotte]

We'll go to Mr. Wallace, please.

[Mike Wallace, Conservative, Burlington, ON]

Thank you, Mr. Chair, and I want to thank our guests who are here this morning.

I'll try to be fairly quick, because I want to ask a few questions and I only have five minutes.

I'll ask the theatre folks. On the piece that I hadn't seen before...I've seen the $125 million before from other arts organizations in regard to the Canada Council piece. I think it's a little excessive for this coming year, to be perfectly honest with you, asking for a 50% increase of $40 million a year.

But on the other piece that you asked for, who would manage the new marketing piece that you had in there, the market access development fund? Who would you expect to manage that?

[Lucy White]

We haven't decided among ourselves where the ideal place for such a fund would be. There are certainly a lot of advantages to placing that kind of activity within the Canada Council, which already has a great deal of expertise and knows the client base.

Another alternative would be to place it in the Department of Canadian Heritage. They also know the client base. They have a different approach. I think there are pros and cons with both, and we'd be very happy to work on the program development and make sure it fits the needs of both the community and the program.

[Mike Wallace, Conservative, Burlington, ON]

This is a new program that doesn't exist at present, is that correct?