Health Committee on June 6th, 2006

[The Chair, Conservative, Rob Merrifield]

We'll call the meeting to order.

I see that your hand is up, Madam Gagnon. Is it a procedural issue?

[Christiane Gagnon, Bloc, Québec, QC]

It is a procedural issue.

[The Chair, Conservative, Rob Merrifield]

Okay. We'll entertain a question if it's very quick. The minister is here, and we don't want to steal his time.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Chairman, as you know, we wanted to meet the minister to discuss the tainted blood and hepatitis C issue. I'd like to know how much time you will allot us to address that question alone, because I introduced a motion, which was accepted by the committee, provided the minister could also speak on other topics. So priority is given to the tainted blood issue, but we'll also be talking about the Health Department's estimates and budget. How are you going to proceed so that there's a question period devoted to tainted blood without the other subjects being addressed at that time?

[The Chair, Conservative, Rob Merrifield]

The minister is here to speak on the estimates of 2006-07. In the estimates, as you are aware, there's a broad range of issues, so I won't call very much out of order when it comes to speaking on the estimates.

I think we talked about the fact that the minister was going to come and speak on the estimates as well as any concerns that you would bring up in your questioning. Feel free to question the minister on anything you would have specific to that. I'm sure the minister will be very open and frank with that kind of a dialogue.

I hope that deals with the issue. The minister will be here for the full two hours. We're already ten minutes into it. He'll be here until 1 o'clock. I believe that will give us enough time for a fulsome debate and for him to deal with the issues you had wanted to place to him.

[Christiane Gagnon, Bloc, Québec, QC]

As you remember, Mr. Chairman, I wanted the minister to appear before the committee to talk about the tainted blood issue. I tabled a motion and we said that the minister could come on June 7. The Liberal Party moved an amendment stating that it also wanted to address other matters, but we nevertheless stated that there would be a question period on tainted blood and that we wouldn't mix up the issues. You know there's a follow-up and that we have to address the tainted blood issue in the first part of his remarks. That's what I understood when we passed the motion.

[The Chair, Conservative, Rob Merrifield]

Yes, I understand what your motion was, and I understand what the Liberals had suggested, that there are other issues as well. I had suggested that the minister was going to be here to speak on the estimates, which would include all of those things. I think we're going to carry on at this point, but if, by the end of the meeting, you feel that you have questions that are not answered, we can deal with it at that time.

I want to thank the minister for coming. I appreciate him being here, and his department. I would ask him to go ahead with his presentation. I appreciate the time he has given the committee to be able to deal with the issues of the estimates and anything flowing out of that.

I would ask you to introduce your group, Minister, and then the floor is yours.

[Tony Clement, Conservative, Minister of Health]

Thank you very much, Mr. Chair. Through you to the committee, thank you for your kind invitation to be here.

I'm here today to support your examination, which is so critical to our parliamentary democracy, of the estimates for the departments and agencies in the health portfolio.

I'd like to commence by introducing the officials with me today. I may call upon these people from time to time to add additional information as needed: from Health Canada, my Deputy Minister Morris Rosenberg, my Associate Deputy Minister Hélène Gosselin, and my Chief Financial Officer Chantale Cousineau-Mahoney. From the Public Health Agency of Canada side, I would introduce the Chief Public Health Officer, Dr. David Butler-Jones, and the Director General of Finance and Administration, Luc Ladouceur.

Mr. Chair, as you know, the health portfolio comprises one department, Health Canada, and a number of other bodies, including the Public Health Agency of Canada, the Canadian Institutes of Health Research, the Pest Management Regulatory Agency, the Hazardous Materials Information Review Commission, and the Patented Medicine Prices Review Board.

You, sir, are considering estimates that capture more than $4.3 billion during this fiscal year, and that does not take into account the new commitments we made in our budget last month. Those commitments will appear in our supplementary estimates later on this year.

The money in these estimates goes to responsibilities such as drug and medical device safety, the safety of consumer products, and information and guidance on many other health matters. It supports research, through the Canadian Institutes of Health Research, to improve the health of Canadians and to build a stronger, sustainable health system. It supports innovation in our health system and activities that enable us to implement legislated requirements in such fields as regulating pest control products and handling potentially hazardous materials.

These activities have an everyday impact on the lives of all Canadians.

Although the health portfolio is very broad, I'll briefly address three areas that are particularly important commitments for the Prime Minister and myself.

The first is our government's commitment to seek the cooperation of the provinces and territories in establishing a guarantee on waiting times for medically necessary services.

I expect that every one of us has heard specific concerns about wait times from people waiting for treatment or from people who have family members waiting for treatment. I've heard concerns from physicians in my own riding. Their patients will often encounter delays when referred to specialists located only in larger cities outside of Parry Sound—Muskoka, such as Sudbury, Toronto, or Barry. This is mimicked in many other areas in rural Canada, where they have to look to Edmonton, Toronto, Quebec City, Regina, Winnipeg, Vancouver, or Montreal for services.

I can tell you that I've already been in contact with most of my provincial and territorial colleagues on ways to get real results on wait times reductions. At a financial level, our government is making a substantial contribution through the $5.5 billion over 10 years that has been set aside for this issue specifically, as part of the $41 billion amount in the 10-year plan to strengthen health care.

That money will help the provinces and territories introduce and expand the innovations that will generate the results that Canadians want. They will enable more provinces to follow the lead of Ontario, for instance, with its Cardiac Care Network, or Alberta with its hip and knee pilot project, or Saskatchewan with its Surgical Care Network, and many other initiatives besides, and to do so in a manner that reflects their opportunities and specific situations.

Mr. Chair, the 2006 budget outlined that there will be a 6% increase in the Canada health transfer through to 2013-14. These estimates include specific funding for the national wait times initiative to cover specific activities within the health portfolio to get us to our goal. That money will be used to support wait times research and education related to wait times. It will fund demonstration projects on innovative wait times management approaches. It will enable the communication of best practices from Canada and other countries in wait times management and measurement.

Permit me to give you an example. These estimates include $10.4 million this year and $75 million over five years for the internationally educated health care professionals initiative. This initiative is supporting the provinces and individual professionals as we all work to get more of these wonderful women and men accredited to practise their professions in this country and help us to reduce the wait times and indeed improve timely access.

Mr. Chairman, the second point that I want to address is the work we're doing to prepare for an influenza pandemic that could occur at any time. I want you to know that Canada's preparations are progressing well, but that much remains to be done.

The estimates for Health Canada and the Public Health Agency of Canada that you have before you include $18.6 million for pandemic preparation. The supplementary estimates will include $100 million to be allocated to departments and agencies, and the potential for an additional $70 million, which will be set aside as a contingency to be accessed on an as-needed basis. As announced through the 2006 budget, these funds are the first-year allocation of our five-year $1 billion commitment to further improve our readiness to deal with a potential pandemic.

Mr. Chair, our commitments are clear. We are funding additional antiviral medicines for the national stockpile. This is not an issue exclusive to the health portfolio, either. Indeed, it goes far beyond the health portfolio. I have spoken with my cabinet colleagues on this very point, to emphasize that the whole of government must be engaged in preparation.

Of course, the need to be ready to deal with a pandemic is not only a federal government issue. As you may know, I met with my provincial and territorial colleagues on May 13 in Toronto to discuss our preparations and to identify our common actions. We're working to formalize our roles and responsibilities. We're putting the agreements in place so that we will all share health human resources and supplies across jurisdictions. We're supporting these efforts with an effective pan-Canadian public health information system.

Our job does not stop there, but allow me simply to say that we are on the right track: we have the capacity to produce vaccines and anti-viral drugs. We have one of the best action plans for dealing with the influenza pandemic in the world.

In late April, I went to Geneva to attend the annual general meeting of the World Health Organization, and met with other G8 Health ministers. I observed that there is now broad cooperation among countries and that Canada is making a significant contribution.

For example, we are a leader in tracking disease outbreaks around the world. We have moved effectively on planning and communicating with our citizens so that they can be prepared. We're working with other countries so that they can draw on our best practices.

The new money in budget 2006 means that there are still things coming down the pipeline. More improvements will be made in our readiness as a country and in our capacity to respond to outbreaks both at home and indeed abroad.

The final point I wish to make, Mr. Chair, is about our actions on cancer control. We all know that cancer is a major health issue for Canadians. An estimated 153,100 new cases of cancer and 70,400 deaths from cancer will occur in Canada in 2006. Each of those cases will have impacts, not just on the person who has been diagnosed with cancer but on their loved ones, their friends, their workplaces, their communities.

Beginning about 1999, the cancer community in Canada—led by the National Cancer Institute of Canada, the Canadian Association of Provincial Cancer Agencies, and Health Canada—came together to develop a pan-Canadian and strategic response to rising cancer numbers and the unnecessary suffering and death from this disease. The final product of seven years of work is called the Canadian strategy for cancer control.

In simple terms, this strategy consists of a series of expert-led round tables that will support the creation of new cancer knowledge already available to us. The Canadian Cancer Society estimates that the application of current knowledge more evenly across Canada will, over the next 30 years, save 1.2 million Canadians from getting cancer and save 423,000 of them from dying of this disease.

In the supplementary estimates, we will include the budget 2006 decision to invest $260 million over the next five years for the Canadian strategy for cancer control. This funding will support the pan-Canadian round tables developed by the CSCC, including but not limited to prevention, screening, clinical practice guidelines, surveillance, and research.

Our government recognizes that this type of investment in Canada—that includes the patient voice, and enhanced coordination among the federal government, cancer organizations, and the provinces and territories—is critical to developing a modern, flexible, and fast-learning health care system. It is essential in reducing patient wait times.

Mr. Chair, these are just three examples of the work taking place in the health portfolio. I have focused on these today, but there are many services that we deliver directly to Canadians all across the country. For instance, as you know, the single biggest component of Health Canada spending is on the federal responsibility for first nations and Inuit health, with approximately $2 billion for program activity.

Like you, Mr. Chair, my riding of Parry Sound—Muskoka has many first nations communities, seven in total in my case. Five Health Canada-funded nurses, employed by six local bands, travel between those communities to provide front line health services. The same is true in the seventh community that has taken on direct responsibility for these services through an agreement with my department. As in many other communities across this country, those nurses do more than just provide immediate health services; they help to link the communities to the broader health care system, such as physicians and hospitals.

In closing, Mr. Chairman, allow me to emphasize the importance I attach to this process. These estimates cover a broad range of interventions that have a direct impact on the health and lives of Canadians. The fact that ministers, departments and parliamentary communities can work together on these kinds of issues in the context of an accountability exercise constitutes the cornerstone of our democracy.

I also want to make it clear that as the new federal Minister of Health, inheriting this portfolio, I do value your counsel as to what the federal government can do to make Canada's health system more effective and responsive to the needs of Canadians.

Mr. Chair, I thank you for the opportunity to provide my comments. I'd be pleased to take any questions from the members of this committee.

Merci beaucoup.

[The Chair, Conservative, Rob Merrifield]

Thank you very much, Mr. Minister, and thanks to your resource people who are here as well.

I'll now turn the meeting over to members for questions.

As you heard earlier, Minister, committee members have been looking forward to your visit. Thank you for coming so early in your mandate.

With that, we'll give the first seven minutes to Ms. Dhalla, followed by seven minutes to Ms. Brown.

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

Thank you very much for taking the time to come to the committee today to inform us of some of the issues taking place under Health Canada.

When we take a look at the area of health care, we realize that it's one of the top priorities for Canadians across this country, especially in the first nations community. You mentioned that you have seven first nation communities within your constituency, so I'm sure this question is going to be of great concern to those individuals along with those from other first nations communities across the country.

The Assembly of First Nations has identified a gap of $2.85 billion in health spending over a period of five years. They have noticed that the $700 million commitment that was achieved at the first ministers meeting in September 2004, along with an $870 million commitment from the Kelowna accord, would help to reduce that gap.

Could you please provide this committee with information on the status of that $700 million? And in light of the fact that the new government has not honoured the Kelowna accord, how will the funding be received by the first nations people?

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

Thank you. I'll defer to my experts to go over the sometimes complex issues of the funding.

Let me just say for the record to the honourable member that this is a key interest of mine as health minister. It's an area where Health Canada does directly interact with citizens in Canada, with patients. Certainly, based on my consultations to date with many native chiefs and leaders in the first nations and Inuit communities, there is more work to be done. Indeed, I think there is a general consensus that the health outcomes in native communities, and amongst natives wherever they live in our country, are of concern. When you have, generally speaking, five to six times the suicide rates and two to three times the type 2 diabetes in those communities as compared with Canada as a whole, that signifies that what has existed in the past has not been successful on the health outcomes front.

I have engaged with first nations communities to ask them for their assistance, their advice, their guidance on how best to obtain better health outcomes for first nations, for aboriginal communities throughout the country. I really see that as one of the first orders of responsibility of my department. Of course, I will be working with Jim Prentice, the Indian Affairs minister, and many other players.

Before I get to the cold hard numbers, I can tell you that are some successes. I don't want this to be completely a story of failure. A number of individual programs are working quite well in various first nations communities. I'm reminded of a telehealth service in Ontario that connects about a dozen first nation communities with doctors, nurses, and hospitals. That has reduced wait times and given front line advice to sick aboriginal Canadians who need that advice quicker. A project in Nova Scotia that has focused on primary care and the access to primary care has reduced the wait time for primary care by, I think, 40%.

So there are some successes out there. What we have to do, obviously, is build on those successes and apply them sensitively to local traditions and surroundings, but I think there is something there that we can build on.

With that, just on the numbers, maybe I can turn it over to Madam Gosselin.

[Hélène Gosselin, Associate Deputy Minister, Department of Health]

Mr. Chairman, on the issue of the $700 million that was announced in budget 2005, it was to be in the supplementary estimates of 2005-06, but those were not tabled because of the election. Some funding was made available to Health Canada through Governor General's warrants so that we could start moving on some of these important initiatives. About $23 million was made available in 2005-06 through that process. It was spent on priority initiatives—for example, the diabetes initiative, the aboriginal health human resource initiative, and maternal and child health programs.

The remainder of the $700 million is part of these main estimates, tabled on April 25. We will be able to proceed with the full rollout of the initiatives once we receive approval by Parliament.

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

I am going to go on to my next question, because of the shortage of time we have, but perhaps the minister then would agree that not honouring the Kelowna accord is going to have a detrimental impact on the number of stakeholders and aboriginal communities that worked so diligently across the country to ensure that they would receive the health care services they required.

My next question is in regard to a concern that many Canadians have about our country becoming America's drugstore. In June of last year, it was this standing committee actually that passed a motion and unanimously agreed that the government ban the exports of prescription drugs that were intended really for the use of Canadians. This was endorsed by Parliament and all members in October of last year. However, since our new minister has come into effect, I don't think there has been any action on this file.

Could the minister please comment on that, and tell this committee and Canadians what he is doing to protect Canadians, to ensure that our country has a proper supply of drugs and does not become the drugstore for the States?

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

Thank you very much for the question. Indeed, I wish to assure the committee that we do have some levers available to us without any new legislation, for instance, to protect the supply of medications and the safety of Canadians. Upon recognizing a potential threat, certainly I would be coming to you and to Parliament with a plan to protect supply. But that doesn't exist at present. Indeed, since that resolution was adopted by this committee, there has been a noticeable downturn of this transborder activity. Whether it's because of the Canadian dollar or whether it's because of the new pharmaceutical plan the Americans are rolling out across their country, there has been at the very least a 20% decline in this kind of activity.

So we're monitoring it very closely. From time to time I do get questions from the American authorities, and my answer is the same to them, that we're monitoring the situation. Certainly when it comes to the access to drugs and the health and safety of Canadians, that will be my rule of thumb when dealing with this issue.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Ms. Brown.

[Bonnie Brown, Liberal, Oakville, ON]

Thanks very much.

I notice you were quite proud of the telehealth system in Ontario. I can understand that, because I think it was one of your babies when you were a minister there. This committee had a few babies too that we were very interested in. One of them was the Assisted Human Reproduction Act, and the agency that we anticipate with bated breath—although we may expire before that agency actually gets up and running.

You might be interested to know that we held two sets of consultations with Canadians on this very thorny matter. The stakeholders were vehemently opposed to one another's perspectives. There were two groups. Much to our dismay, after the act passed, officials from your department decided that before developing the regulations, they needed to go out and have consultations, even though they had sat through, in this very room, many of the consultations we had held. That was most annoying to us—as if we did not hear the truth and they had to go out and find out again, and actually reignite the opposition, one to another, of these two groups.

The agency was supposed to be established in January. Of course we didn't really expect it because of the intervening election, but it really is getting ridiculous how long we're waiting for this agency while, in the view of some of the committee members, appalling things are going on out there in the marketplace—commercialization of the very roots of human life, etc.

I'm wondering, is there any way that you can put a firecracker under the department? Or maybe Mr. Rosenberg would like to explain to us why it is the officials assigned to this file cannot seem to deliver this baby.

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

I'm sure Mr. Rosenberg can speak for himself.

What I have directed in the meantime is that...and certainly I think this committee is going to have a specific opportunity to discuss these issues in more fulsome detail later on in June. I will welcome your feedback and your input at that time.

We apparently are at the stage of actually focusing in on the regulations that will animate this process, and we are trying to get to the point at which the agency can actually be kick-started. I think you'll start to see some activity later on in the fall, or that's my understanding.

Mr. Rosenberg, if you want to take the baton....

[Morris Rosenberg, Deputy Minister, Department of Health]

Thank you.

Mr. Chair, we are looking at accelerating work on the regulations, and we have prioritized some of the key regulations to move forward on. We understand that it's taken a while. We hope to have progress and initial publication in the Canada Gazette by 2007, with coming into force, in part II of the Canada Gazette, as early as possible after the consultations take place.

I should also say that with respect to establishing the agency, we do need to put in place, of course, a board of directors, that's provided for in the legislation. We expect to be in a position to enable the minister and the government to make decisions on appointing a board of directors by the fall.

[Bonnie Brown, Liberal, Oakville, ON]

Good. We look forward to reviewing those regulations, because you'll recall that the act includes us in the process. Thank you for that.

I'm also looking at the dollars, at the increases and decreases. I have one particular concern about the Patented Medicine Prices Review Board and the 48.9% increase. I really didn't think there was that much activity over there that they'd have to have half again as much as they've had all along. I just can't imagine why they need almost a 50% increase in their budget.

Perhaps somebody can explain that.

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

It looks bigger when you put it in percentage terms as opposed to absolute terms. I may be corrected on this, but I believe part of the issue is the increased litigiousness of the brand name drug companies on the pricing mechanism. I think that's part of it.

Morris, do you have anything to add on that?

[Morris Rosenberg]

Maybe I can elaborate just a little bit more.

To deal with just two specific increases, the increase is mainly due to a transfer from Health Canada to provide for analysis of price utilization and cost trends under the national prescription drug utilization information system. That's $1.35 million. There was another transfer from Health Canada to monitor and report on the prices of non-patented prescription drugs in Canada, for $0.6 million.

On the latter item, you will know that the national pharmaceuticals strategy, with the concern about the cost of pharmaceuticals, has started to focus in on the cost of generic pharmaceuticals, where we seem to have comparatively higher generic pricing than some other countries. The idea was to have the board do some initial monitoring in advance of looking at policy options on how best to deal with that issue.

[Bonnie Brown, Liberal, Oakville, ON]

I can't remember if this committee actually recommended it, but we did suggest leaving the same letters in the acronym, with “Patented” Medicine Prices Review Board becoming “Prescription” Medicine Prices Review Board. I think that's what kick-started this idea about generics.

I have one more question. There is a 35.6% decrease in the planned spending of the policy, planning, and information branch. I would like to know what that's about. What were the criteria, and what will be the impact, etc., on that particular branch?

[Hélène Gosselin]

I can answer that, Mr. Chair.

The major decrease in that comes from the sunsetting of one program. I'm just looking through my list to make sure I get the right name of the program. I believe it's the Primary Health Care Transition Fund that has sunsetted. That accounts for the major decrease in that branch. There are other small changes, but that's the main one.

[Bonnie Brown, Liberal, Oakville, ON]

Thank you very much.

Thank you, Mr. Chair.

[The Chair, Conservative, Rob Merrifield]

Thank you. Your time is up.

Madam Gagnon.