Health Committee on Nov. 23rd, 2006

[The Chair, Conservative, Rob Merrifield]

I'll call the meeting to order.

We want to thank everyone for coming out to the meeting. We want to thank the minister particularly for his openness in coming to committee whenever requested.

We have before us the supplementary estimates. I want to note for the committee that the minister is going to be with us until 5:15, which is a significant time, or until the questions run out. They may run out before that time; I'm sure that's a possibility. Nonetheless, he has committed that much time to us if we so desire it.

We have Dr. David Butler-Jones, who has been before the committee many times. We want to thank you for being here as well.

I'll let the minister introduce the staff he has with him.

With that, as a bit of housekeeping, we want to let the committee know that when the minister is here we have a little different arrangement with regard to our questioning. We will take note of that and proceed from there.

We will now give the floor to the minister for his presentation, and then we'll proceed to questioning after that time.

Mr. Minister, the floor is yours.

[Tony Clement, Conservative, Minister of Health]

Thank you very much. Merci, monsieur le président.

Mr. Chair and colleagues, it is my pleasure to join you once again in the standing committee.

I will introduce a few of our officials who are here today. First is Dr. David Butler-Jones, who is of course the Chief Public Health Officer of Canada and head of the Public Health Agency of Canada. Next is Susan Cartwright, who is the associate deputy minister of Health Canada, and next is Frank Fedyk, the acting assistant deputy minister of the health policy branch in Health Canada. Then comes Chantale Cousineau-Mahoney, who is the chief financial officer of Health Canada; and Luc Ladouceur is the chief financial officer of the Public Health Agency of Canada.

With your consent, of course, Chair, I will ask them to address any of the more technical detailed questions that come up today when I am unable to answer.

But before we take those questions, I want to make a few points, including this one. These supplementary estimates are substantially about one fact: when it comes to our government, the new government of Canada, we are keeping our health promises to Canadians. Since Canadians elected the government, we have followed through on our campaign commitments.

Our main priority is one I will of course elaborate on further, but we have been working with the provinces and territories to introduce patient wait time guarantees. l'm proud to remind members that on Monday, I announced this country's first ever pilot project on wait time guarantees.

We've also shown our commitment through our announcement in July of nearly $1 billion that has been set aside in a special settlement fund for Canadians who contracted hepatitis C through the blood system before 1986 and after 1990. This is a promise our party made during the election campaign and of course has kept.

In fact, we've demonstrated our commitment to the health of Canadians through several recent announcements as well.

For example, two days ago we announced a series of measures to help the thousands of individual Canadians with autism spectrum disorder, or ASD, and of course their families. These measures include beginning to explore the creation of a research chair to focus on effective treatments and interventions; a consultation process to develop an autism surveillance program; a stakeholder symposium; a new web page on Health Canada's website; and the designation of my department's health policy branch as the policy lead on ASD.

Only a few weeks ago I announced that work will begin on the development of a new heart health strategy to fight heart disease in Canada. It is backed by an initial investment of $3.2 million this fiscal year and it increases to $5.2 million annually for future years.

We're taking concrete action on protecting human health and the environment. Canada has completed its systematic review of 23,000 chemical substances used in general commerce prior to 1994, and we are the first country in the world to do so.

In fact, the World Health Organization, among many others, has called our scientific and innovative approach “precedent setting internationally”. The completion of the process will form the basis for our chemicals management plan moving forward.

Mr. Chair, we're following up on our commitments through the budget as well. We are doing it through policy choices. We are doing it through program decisions. That's the real story of these estimates. We are backing up our commitments, with real money, right now.

Let me take a few minutes to comment on some specifics that prove that point, right across the health portfolio.

I will insert a few paragraphs in French in my presentation.

Let me start with my first priority, which is moving ahead on patient wait time guarantees.

In a nation as wealthy and as modern as Canada, I believe it's simply unacceptable to have a health system that permits unconscionably long delays, in some cases, and offers patients no recourse to alternative treatment options.

We see the development of patient wait time guarantees as a necessary evolution of our health care system. In fact, as I announced on Monday, Canada's new government is the first in the country's history to introduce a guarantee pilot project, based on patients receiving the care they need when they need it.

I announced that I am working in partnership with first nations to develop patient wait time guarantees for prenatal care on reserves. We'll begin by working with first nations communities to develop and test a set of guarantees, through pilot projects in up to ten first nations communities, that will ensure women on reserve will have access to early prenatal care in the first trimester and throughout the pregnancy.

We are also seeing progress on wait time guarantees across the country, as provincial governments take action within their own jurisdictions, most notably, of course, in the province of Quebec. Through discussions with my provincial and territorial colleagues, we're looking to expand that progress.

All Canadians will know what they can expect from the health system and will have recourse if their expectations are not met.

And our actions are helping governments deliver on those guarantees. A good example of this is our work on human resource issues in health.

We know that in order to better serve Canadians and get them the health care they need, when they need it, our system definitely needs more health professionals. Already we're investing $20 million annually to facilitate interprofessional education, to contribute to recruiting and retaining professionals, and to help forecast supply and demand for our health workers.

On Tuesday, I announced that through the internationally educated health professional initiative, Canada's new government is launching four new programs, totalling $18 million, to help increase the number of health professionals working in Canada. This initiative helps reduce barriers and build bridges, and it helps internationally educated health professionals secure their proper place in Canada's workforce. We believe this will lead to significant increases of up to an additional 1,000 physicians, 800 nurses, and 500 other health professionals.

There are certain other health needs that those professionals can help address. One is the potential of pandemic influenza.

When I appeared before you in June, I made my determination clear. Canada will be ready to deal with the potential of a pandemic influenza outbreak. I pointed out that Budget 2006 provides $1 billion over five years to further Canada's pandemic influenza preparedness. The supplementary estimates start putting that money in place, beginning with a total of $52.9 million across the government, including more than $24.1 million in the health portfolio. That money funds an improved capacity to detect a potential pandemic influenza outbreak. It funds our capacity to respond in case of an actual outbreak.

So for Health Canada, the Public Health Agency of Canada, and the Canadian Institutes of Health Research, the supplementary estimates are about expanding our emergency preparedness, research, antiviral stockpiling, and rapid vaccine development technology. They are about supporting the Canadian pandemic influenza plan for the health sector.

In fact, as part of that plan, my provincial and territorial colleagues and I have already agreed to work together to increase the joint national antiviral stockpile, from 16 million to 55 million doses.

This supplementary budget contains another element that proves our commitment to facing the eventuality of a flu pandemic: it is our investment in people.

As the provincial minister who oversaw the Ontario response to SARS in 2003, I saw firsthand how important a strong, skilled, and professional public health workforce is for the health and security of our citizens.

Our government is determined to continue working with all jurisdictions in this country to help ensure they have access to the public health professionals they need.

These supplementary estimates show that we mean what we say on the issue. They provide $4.2 million in new funding for the Public Health Agency of Canada and the Canadian Institutes of Health Research to increase the number of students in master's, doctoral, and post-doctoral programs relevant to public health; to increase the capacity of academic programs to provide training in public health; and to provide new tools for workforce development.

The money will boost the number of community medicine residents moving into practice and will support improved curricula and training resources for our public health professionals.

In short, Chair, we promised action, and the supplementary estimates demonstrate that we are putting real money behind our commitments to public health.

We met last in June. I also pointed out our Budget 2006 commitment to the Canadian strategy for cancer control. Together with the provinces and territories, we are moving forward on strategic priorities to address cancer in Canada.

Let me talk a bit about first nations and Inuit health. I mentioned some of the major new health initiatives of our government.

This supplementary budget also demonstrates our firm desire to shoulder our responsibilities with regard to the health of Aboriginals, notably by providing them with significant funds.

The estimates show that we're increasing funding for the non-insured health benefits program by $30 million to ensure it continues to meet the needs of eligible first nations and Inuit peoples. We're carrying forward another $8.1 million for that program so it can keep up with the need for eyeglasses, dental services, prescription drugs, and other items, as well as many services such as medical transportation.

As I mentioned earlier, this week I announced this country's first ever wait times guarantee pilot project for prenatal care on reserves.

Let me, finally, just make a few additional comments to end my opening remarks. I've only touched on some of the many actions covered by these supplementary estimates, and there are many more. For example, through supplementary estimates (A), the government increased the budget of the Canadian Institutes of Health Research by $31 million, bringing its annual budget to $737 million. That new money is now here in these supplementary estimates.

Over 10,000 CIHR-funded researchers and over 250 institutions across Canada are addressing priority areas such as wait times, cardiovascular disease, diabetes, fetal alcohol spectrum disorder, obesity, mental health, and cancer.

I hope to have the opportunity to describe our other initiatives during the rest of this hearing, but let me end with this point, Mr. Chair.

Promises made, results due. That is the objective of this supplementary expense budget.

Promises made, promises kept. That's the story of these supplementary estimates.

Thank you.

[The Chair, Conservative, Rob Merrifield]

We want to thank you for your presentation to the committee. We'll open it up now to questioning.

As I said before, we have a little different structure. We have fifteen minutes for the Liberal Party, then ten for the Bloc, ten for the NDP, and then we go over to the Conservatives for ten.

So we'll start with that rotation. The floor is yours, Ms. Dhalla.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Thank you very much to the minister and his officials for taking the time to come before the health committee today.

I know in the past, from sitting on the health committee, that all members of this committee have worked very closely together to address the issue of health. I think it's of tremendous importance to Canadians all across the country. Being the critic for health for the Liberal Party, I know that both myself and my colleagues here today have received numerous e-mails and numerous letters and phone calls from concerned Canadians across the country.

I want to speak about an issue that perhaps resonates with people from all across the country in all provinces and territories, and that is the issue of the wait times guarantee. We saw during the last election that the Conservatives promised the implementation of a wait times guarantee, perhaps continuing on the work that the former Liberal government had done, both with the signing of the health care accord and the investment of $42 billion, in particular the $5.5 billion for the reduction of wait times.

There were five areas that were decided upon, both by the former federal minister and the ministers of health from all the provinces and territories. Those were in the areas, as you know, Minister Clement, of cancer, cardiac care, cataracts, CT and MRIs diagnostic testing, and hip and joint replacement. I think it was quite disturbing to many people around this committee, and also to Canadians and parliamentarians, when they took a look at the stories that have appeared in The Globe and Mail over this past week. Just today, we have a story that I think says it all, where perhaps some individuals feel that Ottawa has dropped the ball on waiting times.

I would like to know, despite the promise that was made during your election platform, what you have in your supplementary estimates that says that as a new government you are investing in the wait times initiative.

I know that last week you announced the initiative or pilot project for prenatal care. Putting that specific project aside, which you have also mentioned in your speech here today, what other types of initiatives have you undertaken since coming into government, of working with the provinces, of working with the territories, to ensure that wait times are reduced? Despite the fact that a pilot project dealing with aboriginal women is of extreme importance, it did not address any of the five priorities.

When we take a look at the article, it talks about the fact that people affected with prostate cancer have to wait longer than the four weeks and that women in the country who have been affected by breast cancer have to wait longer than the targets that were set by the health care accord from the Liberal government.

So what types of initiatives have you taken, Minister, to ensure that this issue is addressed?

Secondly, what types of financial and monetary resources are you providing to the provinces and territories to address this important issue?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Thank you for the question. It's a very comprehensive one. Let me answer it in a couple of different ways.

First, of course, when it comes to patient wait time guarantees, there are a number of cornerstones that have to be part of any promise.

We made a promise that said we would work with the provinces and territories toward the establishment of patient wait time guarantees in this country. That's a promise that we are keeping and that we intend to keep. Of course, some provinces are moving more quickly than others.

The Province of Quebec comes to mind, with its five guarantee areas, including cancer, cardiac, hip and knee replacement, and cataracts.

The previous minister in Manitoba indicated, at the legislative committee in Manitoba, that the wait time guarantees operate, in essence, in his words, in cardiac and cancer.

Ontario's government has announced that in eight out of nine targeted areas, the wait times have been reduced.

So things are happening out there.

What I wanted to demonstrate on Monday was that although we are of course willing to work with provinces, we're not waiting for the provinces. In areas of federal responsibility, where the federal government can be active, we are willing to show leadership. That's what Monday was all about. But there are other cornerstones, which include research.

In order to have guarantees rolled out in this country, we have to continue the research. You mentioned the benchmarks. The benchmarks are not picked out of thin air. They are based on clinicians and their decisions and approaches to these medical procedures. I did of course mention in my remarks how the CIHR continues to have increases in its funding. The Canadian Institute for Health Information continues to be supported by virtue of Budget 2006, and there are funds specified within their envelopes directed to research when it comes to wait time guarantees. That's one.

The second one is that you need IT, and through our government's continued support for Canada Health Infoway, I believe we are helping the provinces have the IT infrastructure that is going to be necessary in order to roll out the guarantees.

The third one I believe I did allude to in my remarks, which is health human resources. You can't establish a guarantee and then not have the medical professionals who are required in order to get that done.

Those are three areas. The fourth area, of course, is federal-provincial cooperation, which obviously is something we continue to work with, with our colleagues at the provincial and territorial levels.

So I would say, on balance, in answer to your question, we are moving ahead and we're showing leadership where it is required to be shown, but this is a multi-year, complex process. That is something that I and the Prime Minister indicated very early on, that this is not something where you walk into the chamber just down the hall and put a bill down. You have to work to achieve some consensus, and I believe we're doing that.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Minister, with all due respect, you talk about showing leadership, but the bottom line is that Canadians across the country have not seen results. They are still waiting to see their doctors. They are still waiting hours in the emergency room.

You've spoken about the great work done in Ontario, the great work done in Manitoba--not one of them being provincial Conservative governments. But moving the partisanship aside, can you please tell me, in simple terms, either yes or no, for all people here, do you plan on downloading, and do you believe this is a responsibility of the provincial and territorial governments? That's number one.

Secondly, since getting elected, I know you have supported the Liberal health care accord, the investment of the $42 billion, the reduction of the $5.5 billion. Have you, as a new government, in your previous budget, put any additional moneys...? Are you fighting at the cabinet table to ensure that there is additional funding in place to assist these provinces and territories to ensure that there is a wait time guarantee across the country?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Health care is a shared responsibility. As a health critic, I'm sure you're aware of that. It is a shared responsibility with provincial and territorial governments, and our view, which is the view consistent with many other federal governments and many other stripes, is that the responsibility is not only with the federal government, particularly because as a former provincial health minister I know this, that a lot of the levers to actually effect the change are held by provincial and territorial governments rather than directly by the federal government. The provincial and territorial governments, as I'm sure you're aware, are the ones that have the relationship with the hospitals and the relationship with physicians, for example.

I'm aware of that. That does not mean that at the federal level you cannot have an influence over the future direction of health care in this country. I believe we are showing the leadership by announcing in areas that we can that we are willing to move ahead. Certainly when it comes to the budget of my department, when you look at Infoway, when you look at CIHR, when you look at our investments in health human resources, they are all directed to helping us achieve wait time guarantees and reductions in wait times for patients.

That really is job number one in terms of how I see our department and its resources. I can certainly assure this committee of that.

[The Chair, Conservative, Rob Merrifield]

Ms. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much.

Minister, I'm very interested in health human resources, because we know that wait times will never go down unless we have people to provide the care, and that's a huge part of the waiting list problem. It's mostly a management problem, but a big chunk of it has to do with health human resources.

I noticed that in your presentation you talked about “four new programs totaling $18 million dollars to help increase the number of health professionals working in Canada”, and that this will help “to reduce barriers and build bridges and to help internationally-educated health professionals secure their proper place in Canada's workforce”.

As a Liberal government, we had in fact put $67 million into increasing the number of health professionals working in Canada, so this $18 million is a drop in the bucket when you stop to think that reducing barriers and building bridges means providing training spots, internship spots, and residency spots for physicians. We know that the cost of one of those spots is $60,000 a year. It's not just the dollar cost, but it's where they are going to get the space to train in, because our tertiary care centres are filled.

These were some of the very real problems, and as the person responsible for that file in the last government, I have to tell you that we put in $68 million in a year, and we thought that was an absolute drop in the bucket.

Now I notice that you're saying $18 million would provide 1,000 new physicians, 800 nurses, and 500 other health professions. I don't understand how that math adds up at all. It is totally impossible to achieve those results with $18 million. I'd like to know how you propose to do this, other than to just talk about vaguely reducing barriers and building bridges, because you need absolute spaces and you need absolute funding to fund those spaces.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Sure, and I thank you for the question. I will make an initial remark and maybe turn it over to the chief financial officer or the associate minister to talk about globally what the funding is for all of these initiatives.

My understanding is the $18 million is in addition to funding that has already been in place. I believe there is already a fund of $75 million over five years that was already in place, and when you look globally, there's an investment of $20 million annually in the health human resources specific to specific projects that we are working on with either the professions or the provinces themselves.

But perhaps Susan would continue.

[Susan Cartwright, Associate Deputy Minister, Department of Health]

Yes, with pleasure.

The investment that is being made is an annual investment of $24.5 million in health human resources for first nations. It is $10.5 million to support internationally related health human resources issues and $20 million a year for us to address in-Canada issues relating to health human resources. So it's a total of $55 million annually.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Yes, I know, but I am asking how that could possibly produce 1,000 physicians, 800 nurses, and 500 other health professionals. In the work I've been doing on this file, that is an actual impossibility with that amount of money.

However, I also want to ask what happened to the internationally trained worker initiative that had been set up and the international medical graduate task force recommendations that had been made and on which our government had been committed to doing the work, looking at issues of credentialling and looking at issues of our pan-Canadian assessments, etc. Have any of those things been followed up? That issue is not a simple, one-shot deal; there are many components to it. It's very complex.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

I will turn it over to Frank Fedyk in one second, but part of the answer to your question is that there is work being done by my colleague, the Honourable Monte Solberg, who has carriage of some of the credentialing issues with respect to Immigration Canada. I did want to make the point that the work is being done, but you'd have to go to another committee to ask Monte about it.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I would like someone to tell me what the Minister of Immigration has to do with credentialing. Credentialing--under provincial jurisdiction--is a job that only the professional associations can do. The minster has no control over credentialing at all. When I last heard about it, it was a human resource development file and not an immigration file. I would like to understand how that is going to work.

[Frank Fedyk, Acting Assistant Deputy Minister, Health Policy Branch, Department of Health]

With respect to the internationally educated health profession initiatives, there's $75 million for that initiative over five years. There is a federal-provincial advisory committee that works with the provincial and the national associations to ensure that the health professionals who are trained internationally are being brought in and put through appropriate national screening criteria so that they can be integrated into the health care system of Canada. It's worked through a federal-provincial committee with the provincial licensing bodies in terms of—

[Hedy Fry, Liberal, Vancouver Centre, BC]

I know that, but with due respect, Mr. Fedyk, what's happened to the international medical graduate task force recommendations?

[The Chair, Conservative, Rob Merrifield]

I'm afraid your time is gone. We'll allow for a quick answer, if you have it.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

We're working on it.

[The Chair, Conservative, Rob Merrifield]

Madame Gagnon, you have ten minutes.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you. Good afternoon Minister.

I have a question regarding one of your Department’s programs because there is concern in the community. It is about the CAPC program (Community Action Program for Children). I’ve received many letters on this subject and my colleagues have received many phone calls. You of course know what the CAPC is about; it is a development program for children under 6 years of age. It also supports some at-risk communities and community groups who provide help to parents and the community so children can develop better.

CAPC is a $59 million program. This money is given to the whole Canadian population. Quebec received $11 million of that sum. Amounts vary according to the number of children under 7 years of age in each province. A number of people have written to me and colleagues have questioned me on the subject. They say that they fear for the continuation of the program. Will it continue? The program is of significant help to communities. Why, you will ask, are these people worried? I am sure that your public servants know what I am talking about and can provide a response.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

If I understand your question correctly, it is a program that helps parents and children improve children’s health and development. Is that right?

[Christiane Gagnon, Bloc, Québec, QC]

Yes, that’s right.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Alright. Perhaps Dr. Butler-Jones can answer you.

[Dr. David Butler-Jones, Chief Public Health Officer, Public Health Agency of Canada]

It is a program that was established in the last century. We are currently conducting a review of the country’s programs. The CAPC program and related budget have been extended until 2008-2009. It is currently a flat-lined budget.

[Christiane Gagnon, Bloc, Québec, QC]

I would like to clearly understand. You say you have extended the program budget to 2008. That is only two years. The program stems from a conference on children organized by the UN, where all countries in attendance made a real commitment to the process of helping children living in difficult conditions. It was at the UN’s 1990 World Summit for Children, I believe, that Canada made its commitment. How has it come about that this program is now in jeopardy and that its existence can only be assured in the short term even though Canada has pledged before the world to help low-income families living in difficult conditions? Right now, community groups don’t know what to do because, when it was launched, the program was to be long term. Is it because expected results were not achieved? Do you believe that organizations are not suitably efficient and that the program does not produce results?