Health Committee on June 6th, 2006

[The Chair, Conservative, Rob Merrifield]

Thank you, Mr. Batters.

Madam Demers.

[Nicole Demers, Bloc, Laval, QC]

Thank you, Mr. Chairman.

Thank you for being with us today, Minister. My question will be much more political than financial in nature.

However, it is a question that has a very significant effect on the finances of the provinces in the area of health. The provinces have to deal with problems arising from policies that have been adopted. In only the past five years, Health Canada's Special Access Program, which is intended to provide access to special instruments and drugs, has provided surgeons who so request on behalf of their patients with silicone gel breast implants.

However, as many as 67% of the requests submitted to that program concern silicone gel implants. But those implants were prohibited in 1992, and Health Canada has not approved them to return to the market. The problem is that the same program also has a mandate to provide certain drugs to people who need them.

As a result, six persons with HIV/AIDS who had requested drugs in April were denied access to those drugs, which could have saved their lives. And yet this program is supposed to enable Canadians to obtain drugs where they are not on the market, where they have not yet been approved or where other therapies have not worked.

Minister, I don't understand how priority can be given to the fitting of breast implants for women who have small breasts or a few ripples caused by implants filled with saline solution. When I think of people whose lives could end because they're denied access to drugs that could save their lives, I don't see how we can give priority to the replacement or fitting of silicone gel implants. Can you explain that to me?

I'd also like you to tell us whether you intend to repeal this program, at least as regards silicone gel breast implants. The person responsible for the program told us that he was unable to intervene when the physician decided that a given solution was best for a patient. That's what he recently said on television on a CBC program. He said that his role was not to intervene and that he relied on the physician's competence in determining the best solution for his patient. If he relied on the physician's competence in the case of silicone gel implants, why didn't he do the same thing for people suffering from AIDS who need drugs in order to live?

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

There's a lot to say on the subject, but I'm going to address two specific points to begin with. Then the deputy minister may perhaps add his own comments.

On the subject of breast implants, it's of course important that the system be able to protect women's health. It must include a physician authorization process. It's also important to emphasize that, for the moment, the special access system is probably a short-term solution. In future, it will be possible to opt for something else. Regardless of the decision that is made in that regard, the protection of women's health will be an essential condition.

As regards special access to drugs, I would say that this is done on a case-by-case basis. It's important that the system make it possible for a decision to be made with respect to each drug and each situation. For each problem, you have to find a solution and create a system that works for patients. That's my opinion.

[The Chair, Conservative, Rob Merrifield]

We'll allow a very short answer; time has actually elapsed.

[Morris Rosenberg]

I simply want to say that each situation is different. In fact, there are two programs, one of which concerns drugs, and the other medical instruments. The criteria vary somewhat depending on the program.

With regard to breast implants, this file isn't a new one; that's why you're more familiar with the situation than I am. Decisions have been changed depending on what was known about the health risks. Once new studies were published, the department determined that we knew enough about the risks incurred for it to be legitimate to support breast implants under the Special Access Program.

As for drugs intended to treat HIV/AIDS, the situation is somewhat different. In the case you referred to, we were in negotiations with the physicians. We offered access to the clinical trials program so that these drugs were accessible. That is ultimately what was done. The clinical trials made it possible to obtain more information on the subject. Consequently, it may be that it will now be appropriate to use the Special Access Program in the case of those drugs.

In short, we can't draw a direct comparison between these two entities. The point in both cases is to protect public health.

[The Chair, Conservative, Rob Merrifield]

Thank you, Madam Demers.

Mr. Dykstra.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thank you. I would like to share a little bit of my time with Mr. Lunney.

My question focuses around the educated health professionals from an international perspective. One of the challenges that certainly we face and that the country faces is our ability to get health professionals, doctors specifically, licensed to working in the profession so that we can actually fulfill a requirement or a demand that spreads across the country.

I just wondered, Minister, if you could give us your thoughts on what the government is presently doing to support these professionals, and obviously to maximize their underutilized potential.

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

Thank you for the question.

Let me concentrate specifically on doctors and nurses, although the question is broader than that; I recognize that, and will state that for the record.

When you look at the money that is flowing from the 2004 health accord, there are specific amounts designed to increase the number of health professionals who become licensed and integrated into our Canadian health workforce. So certainly in terms of the financing of the 10-year plan, that's one of the modules.

We do have to work with our provincial and territorial counterparts. In their relationships with their colleges, for instance, they have to be part of the solution. In our government, with my colleague Minister Solberg in particular, we're all working on a plan to smooth out some of the bottlenecks that exist internationally right now in terms of people who have already chosen to come to Canada or who in fact are already landed in Canada but have had difficulty getting their credentials sorted out.

This has been an endemic problem, and the reason it's been endemic is that if there were a simple solution to it, it would have been done by now. The fact of the matter is that you need the professional organizations, the colleges, you need Immigration Canada, you need Health Canada, and you need every single health ministry all rowing in the same direction if you're going to make some headway on this. But we all know that we have to do it, and it should be done.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thank you.

I'll turn the rest of my time over to Mr. Lunney.

[The Chair, Conservative, Rob Merrifield]

Mr. Lunney.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you, Mr. Chair.

Mr. Minister, I appreciate you being here to answer questions today, with all of your officials.

I have just a quick question. I didn't see this mentioned specifically here in terms of funding, but there is an issue related to the natural health products directorate. I don't see how much money is applied to that directorate. I know they've been working diligently, trying to approve products prior to a deadline of June 30, when all natural products were supposed to be compliant with regulations, meaning they should have been through an approval process, but the last time we inquired, they had approved some 1,200 products of the roughly 50,000 to 60,000.

We've heard rumours that perhaps there is a plan to extend that compliance period by a year at least, to allow the department to catch up or make some significant progress in that list. Is that something you could advise us on?

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

I never like to comment on rumours, but I guess what I can say for the record is that we're aware of the fact that we have a rather large gap between the number of products out there and ones that have gone through the licensing procedure. We have been involved in consultations with the stakeholders over the regulations, to see how we can improve in maintaining health and safety issues and targets and being a little bit more realistic in terms of how we manage things.

I don't know whether anyone else wishes to comment on that.

[Morris Rosenberg]

I would just say that this has been a challenge. We have introduced some improvements to try to move this more quickly. We're streamlining some of our practices. We're fast-tracking review of some of the natural health products. We creating priorities and we're creating an electronic review, all with a view to bringing this in as quickly as possible.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Great. Well, I'm sure that would encourage some people.

[The Chair, Conservative, Rob Merrifield]

Thank you very much. Your time has gone.

Ms. Dhalla.

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

Thank you very much.

I wanted to come back to the question that one of the members opposite had raised in regard to the recognition of foreign credentials. It's been an issue that I personally have had a great interest in, and it's been a great interest of many of my constituents in Brampton--Springdale.

Last year at about this time I had put forward a private member's motion for the government to create a secretariat that would allow the opportunity to work in collaboration with the various federal government departments, the provinces, and the regulatory bodies to ensure that when we did have new Canadians coming into Canada, they would have their qualifications, their licences, and they would be able to get recognized and accredited so that we wouldn't have various surgeons and professionals driving cabs or working as security guards.

This was passed by the House. It was subsequently implemented by the former minister of HRSDC, the Honourable Belinda Stronach, and then also given its stamp of approval by our former Prime Minister.

Mr. Minister, you mentioned that you're working very closely with Monte Solberg. This secretariat was put within the jurisdiction of HRSDC. Have you worked with Minister Finley in regard to this?

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

I can say that there have been some discussions about this. I mentioned Minister Solberg because he is the lead on it, and I do want to signify that. But we do know it is going to have to be cross-jurisdictional within the government, so Health Canada and Minister Finley's department are going to have to be actively involved as well.

Please let me know what your thoughts are as we roll this out. We are looking for responses and ways to make it better, and I hope you will continue to be engaged in this matter.

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

I want to go back to a question that was brought up by my colleague Madam Chamberlain in regard to the mental health commission.

In November of last year, the former minister had promised the establishment and the funding of a Canadian mental health commission. During the campaign, your parliamentary secretary, Mr. Fletcher, had written to the Mental Health Association basically reinforcing the fact that the Conservative Party had long called for a commission. It was also stated in that particular letter that the Conservative government would definitely ensure that such a commission would be established.

When Madam Chamberlain was asking you whether or not you would be committed to ensuring the establishment of the commission and ensuring the creation specifically of an action plan that would provide for beds, you said that you couldn't comment on this commission; meanwhile, your parliamentary secretary has said that you would be creating it.

Where do you stand on that?

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

I guess what I'm trying to do is.... There's a Senate report that they've spent a lot of time on. They've heard from many different individuals, advocates and mental health professionals. I take that report very seriously. I want to give the report the respect it deserves and have a comprehensive review of it as well as give a comprehensive response by our government.

I mean no disrespect to the question--it's a serious question--but I think my responsibility is not to respond piecemeal. I'm charged with the responsibility of having a comprehensive response or coherent response on the issues. That's what I'm working on. The issue of the commission is part of that response, and I guess I could signal that to you; we will be responding.

As you know, this report is somewhat voluminous, but that makes it a serious report. And we are taking it seriously, I want to assure you of that.

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

But even the senator has commented...you know, who's in charge, for the deputy chair for their particular committee, has also stated to the particular mental health associations, especially the Schizophrenia Society of Ontario, that he had received reassurances from both Prime Minister Harper and you that as the new government you would keep the Liberal commitment to the establishment of this commission.

So I find it a little bit surprising today that there has been no commitment from you in regard to the creation--

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

I guess the cat's out of the bag. What else can I say? Everybody knows we're going to appoint a commission, apparently.

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

So you are committing to....

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

I'm committing to responding to the report. Everybody is talking about what we're saying, so I guess it's part of the record.

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

You'll have to ask your parliamentary secretary on that one.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Your time has gone. You got as fulsome an answer as I believe you're going to get on that.

Madam Davidson.