Finance Committee on Sept. 20th, 2018

[Pierre Poilievre, Conservative, Carleton, ON]

So they left and they paid exit taxes.

[The Chair, Liberal, Wayne Easter]

We're going to have to cut it there.

Is your answer complete, Kim?

[Jennifer Kim Drever]

Yes.

[The Chair, Liberal, Wayne Easter]

Okay.

Mr. McLeod, you have the last question.

[Michael McLeod, Liberal, Northwest Territories, NT]

Mr. Chair, I just wanted to quickly ask a couple of questions for clarity, the first to the Canadian Centre for Policy Alternatives.

In your presentation you refer to first nations, Métis and Inuit, but then in your recommendation you only refer to “on reserve”. The Métis don't have reserves. The Inuit don't have reserves. In the Northwest Territories we don't have reserves. We have public communities, but we do have the highest core need for housing in the country.

Can you clarify whether that was intentional or unintentional? If it was intentional, does it include the north? If it does, how?

[Peter Bleyer]

Thank you for that. When you have a project that's gone on for 24 years, not only do you sometimes not get it exactly right, but you clearly learn and improve year after year. I'll look into that in terms of the detail but also, absolutely, in terms of the content, and I'm going to hand over to the clerk the copies as well as the online copy.

The focus in our section on first nations and indigenous peoples includes a broad gamut of needs. The specific program, the cap on funding increases for first nations programs and services, I believe goes beyond reserves. These are all the programs that had a cap—

[Michael McLeod, Liberal, Northwest Territories, NT]

Okay, thank you for that. If we could get clarity on it, that would be greatly appreciated.

The second question is to the museums association. I'm very happy to see that you made some recommendations that include the community cultural centres and museums.

In the north, we have a lot of artifacts that are not protected. I was just in coastal communities in my riding on the Beaufort Sea, and because of climate change, we're seeing ice receding. Two years ago, we got a report that there were at least 70 ships that came through. Now, when they say ships, we're talking about all sizes. The Inuit people, the Inuvialuit people in my riding, are saying that what was theirs historically forever, what they never had to protect, is now starting to disappear. People are coming with sailboats, and they see the artifacts on the ground in hunting areas, and they're taking them. We really need to step it up and start looking at protection.

We also have a few museums, some smaller community ones in the north. We have the Prince of Wales museum, as you know. It's full of artifacts from the aboriginal people of the area. We don't have a whole lot of people working there who are engaged in this.

Maybe you could talk a little about how we're going to step it up so that we can take full advantage of having people from the indigenous communities working in the museum, plus how we can do more to set up community centres and start protecting what's out there.

[John McAvity]

Those are excellent questions. Thank you very much.

We received some funding from the Royal Bank, and we have established an indigenous mentorship program. It's a very small program, but it's something that could be built upon.

I take your point. We have very few indigenous trained professionals. There's a great opportunity and need for that. The Canadian Museum of History operates a small program and trains about four or five per year, but the needs are much greater. The needs also are that they are employed back home in their communities, in their cultural centres, which are owned and operated by indigenous communities.

There's a huge opportunity, a huge need. It's one of the areas that our council on reconciliation will be looking at as part of the process.

[The Chair, Liberal, Wayne Easter]

We're going to end it at that and turn to our second panel.

I want to thank all the witnesses for their submissions and their discussion today. We will suspend for a couple minutes for the next panel.

[The Chair, Liberal, Wayne Easter]

We will call the meeting back to order. Everyone knows we're dealing with pre-budget consultations in advance of the 2019 budget. I want to thank the witnesses for coming and for the submissions sent in prior to mid-August. Those are on members' iPads and they'll be likely referring to those every once in a while.

We'll start with the Canadian Association of Social Workers.

Sally Guy, director of policy and strategy, welcome and go ahead, please.

[Sally Guy, Director, Policy and Strategy, Canadian Association of Social Workers]

Thank you very much.

Good morning, everybody.

On behalf of the Canadian Association of Social Workers' board of directors and our federation partners in the provinces and territories, I thank you for inviting our profession's perspectives to these important consultations.

We've been asked to provide recommendations on economic growth. Our simple message is that Canada will only thrive when children and families are supported to reach their potential. Over this past summer we released a major research report on child welfare that surveyed over 3,000 social workers, and also did 20 stakeholder interviews with leaders and experts from across the country. We found that right across Canada excessive caseloads are preventing child and family-centred care.

The intended role of social workers in child welfare roles is to protect children, yes, but also to develop relationships with communities, to reduce risks for children, and to support families to remain together safely. Families that could benefit from preventative interventions are only seen once they're already in full crisis. It puts children at risk and often leads to their placement into care. Beyond the critical argument for compassion, removing children from their homes and placing them into alternative care is incredibly fiscally costly, and it has compounding intergenerational consequences as well. Most social workers serve a mix of rural and urban communities, and for three-quarters of the social workers we surveyed, indigenous families made up more than a half of their caseloads.

We also know that child welfare practice is the most successful at keeping families together when the community has a long-term relationship with the worker. Currently, though, because of these high caseloads, we're seeing frequent burnout creating a turnstile effect in the communities that's rupturing families' relationships with these professionals and discouraging families from seeking supports up stream.

As it stands, there's no national standard governing caseload size in child welfare. There's been no large-scale study to help child welfare organizations, both on and off reserve, to determine what a healthy and appropriate caseload for social workers might look like. Tools for how to measure appropriate caseload size and complexity vary from region to region, and of course practices and successes then vary as well.

In light of this situation, we have three recommendations.

The first is that the federal government fund a nationwide child welfare caseload study to gather data and begin developing those standards. Right now we have no mechanism in place to gather information or to see what's working. We need caseload standards to make sure social workers can put children first and serve families effectively.

Our next recommendation is to implement student loan forgiveness for social workers who are in rural and remote communities. A 2012 CIHI report on rural and remote care found that out of 11 countries Canadians waited the longest for care. Things have only gotten worse since then, and the Mental Health Commission of Canada has identified harms directly correlated to these waits. Additionally, when you consider our particular context in Canada where many indigenous communities are located in rural and remote areas, these underserved populations are made even more vulnerable.

Social workers are highly trained professionals able to offer many of the same services as other mental health providers, and often at a lower cost. In a small community that can maybe only support one mental health provider, a social worker provides excellent value. We have broad skill sets and can provide myriad types of care: assessments, therapeutic counselling, case work, referrals. At the same time, many communities are having a tough time attracting mental health practitioners. We propose that eligibility for student loan forgiveness would greatly support social workers to be recruited to practice in, to stay in, and often to return home to rural and remote communities.

Finally, we recommend that to ensure Canada's competitiveness moving forward, we must determine where money is being spent, and of course whether it's being spent effectively, before we spend more. That's why we continue to advocate for the introduction of a social care act for Canada. This federal government has rightfully placed a high importance on data, evidence and innovation, but we argue that without accountability to the Canada social transfer, which we would hope would include a requirement to report on its use and outcomes, we are woefully without the right data or the conditions to support innovation and best practices in our country.

We are proposing that we adopt a social care act with principles similar to those of the Canada Health Act to guide the Canada social transfer and other social investments. The act could help the provinces and territories design policies that best fit their unique needs, while also helping the federal government to understand where the dollars are being spent and, in turn, where more targeted investments might actually be needed. It would help share evidence and best practices across different regions and to foster innovation.

Finally, and maybe most importantly, it would also support Canada's first poverty reduction strategy by helping to produce comparable outcomes across our country.

Thank you. We look forward to any questions.

[The Chair, Liberal, Wayne Easter]

Thank you, Sally.

We turn now to the Canadian Cardiovascular Society.

Dr. Kells, president, the floor is yours. Welcome on your 32nd anniversary.

[Dr. Catherine Kells, President, Canadian Cardiovascular Society]

Thank you. Happy anniversary day.

My name is Dr. Cathy Kells. I'm a practising cardiologist in Halifax and serve as president of the Canadian Cardiovascular Society. As such, I represent over 2,500 doctors across Canada, including cardiologists, heart surgeons and scientists who care for Canadians with heart disease. I appeared before this committee last year to recommend that the federal government invest a modest $2.5 million annually for five years to sustain a national cardiac benchmarking program. This program highlights pockets of excellence of care in Canada and demonstrates areas where there are gaps in care so efforts can then be made to focus on improvement.

There's currently no pan-Canadian system that does this despite the $25 billion that we spend annually on cardiac care. In 2017 this committee understood the importance of accountability and made it a top recommendation for funding. Unfortunately it was not included in the final federal budget, so, at your invitation, I am back.

Our inability to measure and compare access to care and results is like running a multi-billion dollar business without knowing our inventory and whether customers got the right product, whether it had a positive or negative impact, or whether the competition is doing it better. Cardiac data collection systems do exist in some provinces, but the systems don't communicate with each other. Many centres especially in small provinces have no ability to compare their outcomes with those of any other centre. This results in each centre operating in a vacuum while believing that they're providing excellent care but having no way to know if this is actually true.

Just this past weekend, a family doctor from Kensington, P.E.I., asked me if heart attack patients from P.E.I. do worse than those from Nova Scotia because of the long transport times to reach the centre. The truth is I don't know. We have no data.

Countries that systematically report on quality indicators have achieved the best results for quality and cost-effectiveness, and Canada is being left behind. Cardiovascular care costs will top $30 billion by 2020. With an aging population and disparities in access to care, this issue needs urgent attention. The solution is a pan-Canadian, transparent benchmarking program.

Recognizing this, the Public Health Agency of Canada funded us, the CCS, to develop this system. We engaged clinicians and partnered with the existing organizations, agreed upon what to measure, how to measure it, and how to communicate it back to providers to inform improvements. We now have a tested model with public reports like this one right here that we give back to the heart specialists and care teams across the country.

When the federal funding ended in 2016, we tapped our own resources to continue the project because we believe the data is essential to improving care. Now our discretionary funds are depleted and we are at a crossroads: either secure funds or end the work.

You might ask why CIHI or another Canadian health organization has not taken this on. The answer is that we collaborate extensively with them, but no current C-organization has this vital service within its current mandate. CIHI reports on administrative data but not on clinical outcomes like quality of life, access to specialist care, or adherence to medications. Individual provinces have similarly declined to take this on.

We're aware of the federal review of pan-Canadian health organizations, and this may lead to a reorganization and shifting of resources. However, this will take considerable time to build. Our hope for the long term is that our program will reside within a pan-Canadian entity and can serve as a model and expand to additional disease areas like diabetes or COPD. Until then, we strongly believe we cannot lose the gains we have made. We must sustain the project and we want to work with Health Canada to determine the long-term model.

In summary, imagine a country in which the government and the taxpayers know that our health care dollars are being utilized to deliver the best care in the most cost-effective way, and in which questions about why women and indigenous people with heart attacks don't have as good outcomes as do white men can be answered just by looking at the data.

Imagine if we have a system to determine whether new programs, such as a national pharmacare program, change outcomes after implementation. We actually have this program. We just need to not throw it out while we wait for reorganization. The CCS recommendation for budget 2019 is for federal investment of $2.5 million per annum for five years to sustain this program and provide bridge funding as we work with our partners in Health Canada for the future.

Thank you very much.

[The Chair, Liberal, Wayne Easter]

Thank you.

Turning to the other side of the table and the Canadian Medical Association, we have Ms. Osler, president, and Mr. Adams, chief policy officer.

The floor is yours.

[Dr. Gigi Osler, President, Canadian Medical Association]

Thank you very much for having me here today. I'm Dr. Gigi Osler, and I'm the current president of the Canadian Medical Association.

Thank you for this opportunity to speak to you today about our health and health care.

It's a pivotal time for medicine in Canada, with medical innovations, new patient expectations and emerging technologies set to revolutionize the way physicians practise and potentially transform our system. For physicians, these have important implications and raise many questions.

At our health summit last month in Winnipeg, we talked about how we can leverage innovation to deliver care in new ways. How do we scale up virtual care? How do we address the digital divide and ensure vulnerable populations aren't left behind?

Being able to deliver care in new, more effective and more accessible ways is even more important when we consider our current demographics. Canada has a rapidly aging population, and they have very specific health needs. However, our current hospital-focused system wasn't designed to respond to these types of needs—such as multiple chronic diseases, frailty, and Alzheimer's—or this level of demand, and the system is now straining under the pressure.

Much of this pressure comes down to the lack of long-term care beds and home care support. More support for caregivers is also very much needed. In many communities across the country, seniors are spending up to three years on wait-lists for long-term care, and it's often about geographic availability, especially in our northern and rural communities.

Not only are seniors in these communities waiting far too long, but they're often forced to accept a placement hundreds of kilometres away from family and friends. As we know, while seniors wait for long-term placement and/or home care, they often have no choice other than to stay in hospital.

Not only are they not getting the kind of specialized care they need, our health care dollars are not being put to the best use. That's because hospital care is about seven times more expensive than long-term care, and about 20 times more expensive than home care. It's hard to get an accurate figure for home care because many expenses are borne by family and caregivers out of their own pockets. Also, there are implications for the system as a whole. Our resources are overstretched, wait times in the emergency room are increasing and surgeries and tests are being cancelled.

Canadians across the board are being affected, so it's not surprising that their confidence in the system is divided. A recent Ipsos survey found that only half of Canadians are confident that the health care system will be able to meet the needs of Canada's seniors.

In recent weeks and months, we have seen provincial governments show a clear commitment to the issue, but the reality is that their vision of better seniors care will not come to fruition unless it's backed up by the appropriate investments.

In short, changes to current funding are needed in order to better support the real costs of health care.

While this is a national issue affecting all provinces and territories, those with the oldest populations, such as the Atlantic provinces, are feeling the hardest effects. We need to take population aging into account while determining funding levels so that certain jurisdictions and their seniors aren't disadvantaged.

That's why the CMA is recommending that the federal government address the health care costs of population aging by introducing a demographic top-up to the Canada health transfer. This new funding would account for age and would provide much-needed support for provinces and territories to create more long-term care beds, expand palliative and home care programs, and support the development of new, more effective and accessible care for seniors.

Not only would this funding help improve care for our seniors. It could improve care for Canadians of all ages. It could alleviate the pressures on our hospitals, emergency rooms and operating theatres, and create a system of better-coordinated care.

Our population is getting older and the challenges we see today are only going to get worse.

It is not too late, though. We can act now.

As we prepare for a future of better health, we look forward to working with the new Minister of Seniors, the Minister of Innovation, the Minister of Health and many others on these and other priorities that affect seniors and all Canadians.

Thank you.

[The Chair, Liberal, Wayne Easter]

Thank you very much, Ms. Osler.

Turning to the Canadian Nurses Association, we'll have Mr. Villeneuve.

[Michael Villeneuve, Chief Executive Officer, Canadian Nurses Association]

Thank you, Mr. Chair and members.

My name is Mike Villeneuve, CEO of the Canadian Nurses Association. I've been an RN for the past 35 years, and I worked for 40 years in the health care system in a couple of other roles.

I would like to thank the Standing Committee on Finance for the opportunity to present recommendations from CNA, which is the national and global professional voice of registered nursing, representing over 139,000 registered nurses and nurse practitioners across Canada.

Our submission highlights four recommendations, but I'd like to focus on two of them today.

Our first recommendation calls for the creation of a health care innovation agency for Canada. CNA believes that the federal government has an opportunity to build on what provincial and territorial counterparts have already achieved by facilitating new opportunities for health care innovations across Canada. We see the spark. There are some successful innovations right across the country, but there is no mechanism to help spread them and scale them up. A new federal agency would target funding on innovative health projects to ensure that they are adopted more widely for everyone in Canada, including indigenous peoples, wherever they live.

The new agency, for example, could lead efforts to evolve medicare to help overcome the sometimes fragmented nature of our health care system. To drive the notion of the right care provided by the right provider at the right time in the right place and delivered at costs we all can bear, we need innovations that will accelerate the de-hospitalization of health systems, not unlike what you just heard from the Canadian Medical Association president. Nurses work at all points in health systems, and we recommend that nurses have a strong leadership role in any such new agency. There are nearly 428,000 regulated nurses across Canada, and we're well poised to dig in and help.

The second recommendation I'd like to highlight today and encourage the committee to support is the third one in our submission, which is about improving access to palliative care and support for people in Canada who are acting as caregivers.

I am pleased to inform the committee that CNA is a member of the Quality End-of-life Care Coalition of Canada, and I serve as co-chair of a committee of the national network along with 38 other national organizations whose vision is that all Canadians have the right to quality end-of-life care that allows them to die with dignity, free of pain, surrounded by loved ones and in the setting of their choice. Most Canadians tell us that they want that care, and we know they could benefit from it. Better palliation drives down costs. Most Canadians never receive that care.

The challenges we face in palliative care are compounded by our country's aging demographics. As I always remind people, we are set to become one of 13 super-aging nations by 2020, just 18 months from now. Nearly one in four Canadians will be over 65 by 2031.

We recommend that the Framework on Palliative Care in Canada Act, which was passed into law in December 2017, must include targeted federal investments for both new and existing federal programs to improve standardization of delivery of palliative care for people across Canada. We were happy to support Bill C-277, tabled by the shadow minister of health. We acted strongly to help that move along.

New federal funding that is predictable and sustained would help to address the gaps that currently exist in palliative care across Canada. We are pleased that the framework recognizes the palliative care training and education needs of health care providers as well as other caregivers, and we urge the committee to support our recommendation to provide funding for early career access to palliative care training and education to nurses and all other health care providers.

Research tells us that our country does not have adequate palliative care training for health care providers. One way to address the gap is to include education and training in core curricula for students, but we also need to create structures to provide that education soon after licensure. We are also calling on the federal government to provide increased financial support for the country's 8.1 million caregivers by making refundable the former family caregiver amount tax credit, which is now under the new Canada caregiver credit, and extending the compassionate care benefits to include a two-week period of bereavement.

In its current form, the tax credit is not paid to recipients as a direct cash benefit. We support the drive to move care out of hospitals, but we have also pushed significant costs on ordinary people. Many caregivers face high out-of-pocket expenses for specialized medical aids, medications, transportation, hiring staff, lost wages and so on. A refundable tax credit could help ensure that all eligible households receive something in return for those expenditures of time and money.

Regarding the CCB, CNA believes that adding a two-week period for time for bereavement would allow flexibility for caregivers, many of whom are employed, after a patient's death. Such a measure also allows for a more reflective and humane palliative care process.

Currently, support that's provided for successful applicants only covers the caregiving period for up to 26 weeks and not bereavement. Adding that two-week bereavement period would surely provide caregivers with some important financial support after such a profound loss.

Thank you for hearing our ideas, and I look forward to our conversation.

[The Chair, Liberal, Wayne Easter]

Thank you very much, Mr. Villeneuve.

Turning to the Canadian Pharmacists Association, we welcome Ms. Walker.

[Joelle Walker, Director, Public Affairs, Canadian Pharmacists Association]

Thank you, Mr. Chair and members of the committee.

I will give my presentation in English, but will be pleased to answer your questions in French and English.

I'm here today on behalf of Canada's 42,000 pharmacists who work primarily in community pharmacies, but also in hospitals and primary health care settings. I think probably our biggest contribution to the economy is helping Canadians stay healthy in their day-to-day lives. But I would be remiss not to mention that pharmacies and the pharmacists that work in them are also important contributors to our economy.

With over 10,000 pharmacies in Canada, either owned directly by pharmacists or pharmacies that employ our members, pharmacists create almost 250,000 jobs and contribute over $16 billion to our GDP. It might interest some of the committee members to know there are probably about 340 pharmacies in your ridings alone that create over 8,000 jobs and contribute $500 million annually to our GDP. We have that many pharmacies so we can provide care in rural, northern and remote areas, offer specialized treatments, and offer and ensure patient choice.

Many of you will think of pharmacists as people who dispense drugs, but we do a lot more than that, particularly as the needs of our patients are changing. I will leave one parting message to the members here, which is that as flu season approaches I would encourage all of you to get your flu shots from your local pharmacists.

Today I would like to speak to our three budget recommendations.

Our first recommendation relates to pharmacare. Because pharmacists are on the front line of drug access and act as drug plan managers, we see the issue from a unique perspective and believe it's time for us to complete the coverage for Canadians. Recognizing that the consultation process is ongoing, we also felt it was important for us to highlight some of the areas where the federal government could invest some funding more immediately to address some of the gaps in coverage.

Specifically, we recommend that budget 2019 support a more harmonized catastrophic drug approach across Canada to limit out-of-pocket costs. To achieve this, we have envisioned a federal catastrophic drug transfer to the provinces requiring all provinces to limit out-of-pocket costs to 3% of household income. We estimate that such a transfer would likely cost the government approximately $1.4 billion a year, but would improve access and alleviate the financial burden for over 5% of Canadians who spend over 3% of their annual income on drugs.

We would also like to use this opportunity to stress the importance of improving drug utilization as part of any pharmacare program that's implemented and to recognize the importance of medication services. These services help improve drug safety, adherence, issues associated with medication over-prescribing, misuse and wastage, which are all key to a sustainable pharmacare system moving forward.

The second issue we would like to speak to is whether or not the cannabis excise tax should apply to patients, which we believe it should not. Patients who use cannabis for medical reasons have very different needs from recreational users. Unlike recreational cannabis users who seek the more euphoric effects of THC, medical cannabis patients tend to require strains that will alleviate symptoms while minimizing intoxication like those available through CBD. By applying the same recreational excise tax to the medical cannabis stream, a real concern is that cannabis patients won't be able to afford their medication, and they will have little incentive to remain in the medical stream, which will lead to them to self-medicate without any clinical oversight.

Our last recommendation is probably one that everybody is thinking about on the current opioid crisis in Canada. Pharmacists are on the front lines of the opioid crisis, and we want to play an even bigger role in addressing the underlying causes of opioid use and supporting people who are living with addiction. While there's a lot to be done in this area, our last recommendation is focused on medication return programs, and their important role in reducing drug diversion.

Like many Canadians I am sure we all have unused medications sitting in our medicine cabinet. About 90% of pharmacies currently accept medication returns. However, many Canadians are not aware of this, and more could be done to promote the programs to Canadians. Unused opioids in the home could accidentally be ingested by children, stolen by family members for their own use, or diverted to the black market.

I will leave you with the statistics. In 2017, on the Ontario student drug use and health survey, 11% of Canadian teenagers had admitted to using opioids to get high, and 55% of these teenagers say they obtained it from their homes. Therefore, we recommend that the federal government invest $1 million a year for five years in a nationwide awareness campaign for pharmacy-led medication return programs.

Thank you.

[The Chair, Liberal, Wayne Easter]

Thank you very much, Joelle.

From the International Association of Fire Fighters, Mr. Marks, the floor is yours.

[Scott Marks, Assistant to the General President, Canadian Operations, International Association of Fire Fighters]

Thank you for the opportunity to share my views with the committee on behalf of the International Association of Fire Fighters.

We represent over 25,000 men and women in 185 cities and towns across nine provinces and two territories. We are the first line of defence in the event of virtually any emergency, large or small. Canada's full-time firefighters are an all-hazard response on duty 24 hours a day, seven days a week, 365 days a year. Firefighters are highly skilled, cross-trained professionals who are on the scene of any emergency within minutes, whether it's a fire, medical emergency, vehicular accident requiring extrication, water rescue or an emergency involving hazardous materials.

The important work that firefighters do, like the work of all first responders, constitutes part of the nation's critical infrastructure and an important support in virtually all aspects of society and our economy, including the nation's ability to ensure economic competitiveness. In that vein, we recommend that the government renew its partnership with the International Association of Fire Fighters by providing a renewed funding contribution in the amount of $500,000 annually for the next five years for the IAFF's Canadian haz-mat and CBRNE training Initiative.

In our view, the growth in key sectors like mining, forestry, agriculture, transportation and energy requires a balanced investment in public and first responder safety. To this I would add the upcoming legalization of recreational cannabis that will potentially result in new and emerging public and first responder safety considerations.

Our haz-mat and CBRNE training program, thanks to federal government funding, has been a major success since our first courses were held in 2009. Since that time, we've trained thousands of first responders across Canada to a recognized level of haz-mat response that meets National Fire Protection Association standards. That means that millions of Canadians are better protected against haz-mat incidents, by firefighters and others who are now prepared to respond safely and effectively to some of the most dangerous emergencies imaginable.

All first responders are welcome to take our course. We've trained career and part-time municipal firefighters as well as airport, industrial, forest and first nations firefighters. Our program has trained hundreds of paramedics and municipal police officers, and we delivered it at firefighting schools in Ontario and Prince Edward Island. We've also trained search and rescue personnel and federal workers, including the RCMP, Canadian Forces personnel and Parks Canada staff.

Our program is available in English and French and promotes interoperability between various responder agencies within a jurisdiction and also amongst jurisdictions. The IAFF training model is cost-effective because we are a non-profit and because our training is delivered right in the first responders' own communities by two regionally based IAFF master instructors. In other words, our instructors travel, not the students. The training is provided free to municipalities, thanks to Government of Canada funding.

Since 2009, our training has been delivered to first responder agencies in hundreds of communities across nine provinces, the Northwest Territories and Yukon, from major cities like Toronto, Ottawa, Quebec City and Calgary to smaller cities like Vaughan and Pickering, Ontario, and New Westminster, B.C., to rural and remote communities like Oyster River, B.C., and Millstream, New Brunswick.

In total, we've had 278 courses that have trained more than 5,600 first responders for a total of 133,608 contact hours at a cost to the federal government of less than $30 per hour, per student.

Our training is customizable for specific hazards that exist in a community, for example, an area's unique industrial, agricultural or natural risks. We're now offering a train-the-trainer program that enables larger fire departments to develop their own ongoing training capabilities for the course. As we see cannabis and other economic sectors take form, there is the potential to adapt and use the IAFF delivery model as a template for new and emerging areas that require specific emergency response operations.

While a growing number of communities are safer due to our training, the need for the training is ongoing as cities grow, as first responder agencies experience natural turnover in personnel, and as training evolves in response to emerging hazards. Our program has been a success, but the current funding agreement expires at the end of March 2019, and it would be a shame to see this successful program come to an end when there are so many more communities that can benefit from haz-mat training.

We're asking the committee to support a recommendation for another five-year funding contribution arrangement of up to $500,000 annually. We appreciate the opportunity to bring this issue before you today.

With that, I welcome any questions you may have.

[The Chair, Liberal, Wayne Easter]

Thank you very much, Mr. Marks.

I've watched one of those training sessions, and I failed terribly at getting into a haz-mat suit in time.

We'll turn to Mr. Fragiskatos.

You have five minutes.

[Peter Fragiskatos, London North Centre, Lib.]

Thank you, Chair.

I want to begin with the pharmacists.

Southwestern Ontario has been plagued by an opioid crisis. Certainly, British Columbia is very correctly mentioned at the top of the list when it comes to this issue, but southwestern Ontario has not been immune to the problems.

I thank you very much for putting the whole issue of medication return programs on the table here today. I don't know much about them, except what I've read. You're an expert in this area. They seem to have had some success. I was reading about the case in Manitoba. A program there was recently renewed for five years. In 2017, according to a report in the Winnipeg Free Press, 16,000 kilograms of unused or expired medications were returned by citizens. That's medications in general, but it sounds very good.

I have two questions for you. Manitoba is participating. Is this program in place in all provinces? You said that 90% of pharmacies are offering this. I'm going to guess that provinces across the country offer this.

[Joelle Walker]

The programs will vary province by province. There's an association called the Health Products Stewardship Association, and it operates in about half of the provinces. It helps fund some of these programs.

Unfortunately, because health care is so disparate across the country, the reality is that some provinces don't have those programs. New Brunswick is one example where pharmacists pay out of pocket themselves for the destruction of the returns.

Health Canada continues to put in place certain parameters by which this can be done, to limit diversion, so pharmacists have to have bins and special bags in their pharmacies. They have to be able to dispose of drugs in a safe way, especially when you think about needles, sharps, as well as other potentially dangerous substances. Just about all pharmacies accept them, but the amount which they do....

I think the statistics you were referring to have more of a national perspective. I think the total approximate number of medication returns is about 400 million tonnes annually.

When you consider this in the context of the other issue we talked about with pharmacare, there's a lot of wastage in our system. Those are areas that we think should be tackled with both the opioid crisis that's happening, as well as—

[Peter Fragiskatos]

I'm sorry. You're saying 400 million tonnes are being...?