Evidence of meeting #86 for Finance in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was health.
A video is available from Parliament.
4:55 p.m.
Liberal
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Liberal
The Chair Liberal Wayne Easter
Thank you both for your presentation.
Thank you, again, Mr. DeWolfe and Ms. Brady.
Turning, then, to part 4, division 9, “Funding for Homecare Services and Mental Health Services”, from Health Canada, we have Ms. Voisin; and from Finance Canada we have Mr. Rajabali.
Whoever wants to begin, the floor is yours.
4:55 p.m.
Jocelyne Voisin Executive Director, Health Accord Secretariat, Strategic Policy Branch, Department of Health
Thank you, Mr. Chair.
Part 4, division 9, relates to the government's commitment in budget 2017 to work with provinces and territories to strengthen the health care system to adapt and innovate and address new challenges. It confirms the offer that was tabled by the federal government on December 19, 2016 to provide $11.5 billion over 10 years to the provinces to support key priorities under a new health accord including $11 billion to be provided directly to the provinces and territories to support improvements for mental health and home care services.
Clause 195 outlines the authorities and the conditions to flow funds for the first year of this $11-billion commitment, in 2017-18 to provinces and territories, as an immediate down payment on investments in home care and mental health. That is $200 million for home care services and $100 million for mental health services. Those would be allocated on an equal per capita basis.
As set out in the proposed amendment, a province or territory will receive its share of this funding in 2017-18 if the federal Minister of Health notifies the Minister of Finance before December 15, 2017 that, in her opinion, that province or territory has accepted the federal proposal to strengthen health care that was tabled at the finance and health ministers' meeting on December 19, 2016.
This December proposal envisaged a pan-Canadian approach and that provinces and territories would work with the federal government to determine how to measure and report on results and performance to improve these services to Canadians. The Minister of Health is now engaging with her provincial and territorial colleagues on the details of how this future funding would flow. She is also working with them to develop a multilateral framework for the 10 years of funding, which would include commitments to develop metrics and report to citizens, as well as outline their key priorities for action.
This multilateral framework would then be used as the basis for individual bilateral agreements with each of the provinces and territories for funding for the next nine years.
I'd be happy to take your questions.
4:55 p.m.
Liberal
Francesco Sorbara Liberal Vaughan—Woodbridge, ON
Thank you, Mr. Chair.
Good afternoon. Earlier today, I had the the privilege of speaking on Bill C-44 in the House. I spoke about the agreement that was reached by the Minister of Health to deliver health care dollars and also funds for mental health to the Province of Ontario over a 10-year commitment. I'm quite proud to say that was signed and I was quite pleased to see that occur.
In terms of accountability mechanisms, such as reporting requirements that have been built into bilateral health care agreements, can you comment on any such agreements with the provinces?
4:55 p.m.
Executive Director, Health Accord Secretariat, Strategic Policy Branch, Department of Health
The minister has just started discussions now, so we're engaging with the provinces and territories on what the multilateral framework would look like. First, we're looking at a pan-Canadian approach that would have common priorities and a commitment from all the provinces and territories that they would work with us to develop indicators. From there then would flow bilateral funding agreements that would include the specific indicators on which they would report.
The provinces are at different stages, in terms of progress in delivering mental health and home care services, and in some cases, we don't have pan-Canadian data yet, so those indicators need to be developed in collaboration.
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Liberal
Francesco Sorbara Liberal Vaughan—Woodbridge, ON
Thank you, Mr. Chair. I'll leave my questioning there.
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Liberal
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NDP
Pierre-Luc Dusseault NDP Sherbrooke, QC
Thank you for your testimony.
There is a provision in section 9 to determine the amount allocated to each province, I assume. It includes three criteria, A, B and C, with respect to home care and mental health services. Can you determine now the total amount that will be allocated in the coming year because of this provision?
5 p.m.
Omar Rajabali Chief, CHT/CST and Northern Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance
The amounts are actually the formula that's provided and the legislation indicates how it would be calculated for each province and territory. I don't have the numbers in front of me, but the legislation illustrates how that is to be calculated.
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NDP
Pierre-Luc Dusseault NDP Sherbrooke, QC
Okay. Are these amounts somewhere in the bill? I don't see them in section 9.
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Chief, CHT/CST and Northern Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance
It's not in the act per se. The formula is in the act for each province and territory, so it's just a pro-rated share of the population per province, as published by Statistics Canada on its website relative to the amount for home care and mental health funding.
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NDP
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Chief, CHT/CST and Northern Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance
That is correct, yes. That is because the legislation is only for the 2017-18 fiscal year and not the balance within the remaining nine.
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NDP
Pierre-Luc Dusseault NDP Sherbrooke, QC
So, for the next nine years, are negotiations under way to reach a long-term agreement, not just for one year at a time?
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Chief, CHT/CST and Northern Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance
I think that's fair, yes.
That's what Jo was talking about. She was indicating that a bilateral agreement will be established.
That being said, the press releases that have been issued for each of the 12 jurisdictions that have accepted the federal offer and the global amount that is provided to each province or territory—or is expected to be provided to each province of territory—are, I think, actually spelled out on the Health Canada website.
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NDP
Pierre-Luc Dusseault NDP Sherbrooke, QC
If Parliament approved these expenditures, which are supposed to be spent on home care and mental health services, could we, parliamentarians, ensure that this really is the case for the money allocated to each province? For example, if you do the calculation using your formula “A × (B / C)”, is there a way for parliamentarians to know the exact amount for 2017-18 for Quebec? Can we also know whether the money spent actually went to home care and mental health services?
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Executive Director, Health Accord Secretariat, Strategic Policy Branch, Department of Health
Are you talking about provisions in the bilateral agreements?
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NDP
Pierre-Luc Dusseault NDP Sherbrooke, QC
Actually, are there accountability mechanisms?
If, for example, $500 million is sent to the Province of Quebec, will there be mechanisms to ensure that all this money has been spent to cover the costs of home and mental health care services?
5 p.m.
Executive Director, Health Accord Secretariat, Strategic Policy Branch, Department of Health
While bilateral agreements still need to be negotiated with the provinces and territories, our goal is to have mechanisms in place to account for expenditures to citizens. We can, for example, ask the provinces to publish the bilateral agreements on their website. The bilateral agreements will also contain the amounts that the provinces will receive each year. Canadians will be able to see the exact amounts.
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Liberal
The Chair Liberal Wayne Easter
This would eventually show up in the public account documents, would it not? The figures would be available in the public accounts documents after the fact.
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Chief, CHT/CST and Northern Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance
In the context of transfers, because this is a legislative transfer, I would to have to verify, but yes, that would be my expectation.
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NDP
Pierre-Luc Dusseault NDP Sherbrooke, QC
Have you done a constitutional analysis of this aspect of federal health spending when it is directly allocated to specific targets? We will be called upon to pass this legislation, and we want to ensure that it is constitutional.
If we say that the federal government is going to spend a certain amount—of course, I don't have the figure—on home health care, it has to be constitutional, meaning that the federal government has the right to do that. As parliamentarians, we have the right to say that it will spend that amount on that part of your health care system.
Can we be reassured in this regard? The provinces raise this issue, of course. As you know, there was some reluctance in the health negotiations. In fact, the federal government wanted to decide where the money would be spent, which could be seen as an encroachment on the powers of the provinces to decide where they were going to spend their money on health care. Can you reassure the committee in that regard?
