Health Committee on Feb. 24th, 2009

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you. I'm glad we got that cleared up.

[The Chair, Conservative, Joy Smith]

I am too. It caused quite a bit of trouble last time. Thank you.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

We are in the midst of an economic crisis, and it has become even more critical than ever that we fully grasp our government spending in order to make important choices to support Canadians through these tough economic times. Health is a major spending item and obviously an area to examine. The Health Council of Canada has just launched an initiative to promote a critical value-for-money assessment of health financing in Canada. It's released a document to stimulate debate and launch a new website as well.

So one of my questions is this. Does the Auditor General have any comment on how this important value-for-money discussion might be inhibited by the state of health transfers, as described in your report?

[Neil Maxwell]

Thank you, Madam Chair.

We've had a chance to skim that report. I believe it was just released yesterday. I have a sense of the Health Council, and of course, we follow its work quite closely in terms of our audit work.

The reason we did this audit goes back to those three health accords. As I said in my opening statement, it's really about the importance of accountability. As we looked at the Healthy Canadians report, what we'd often ask ourselves was, is this a good report card? Does this give you a good sense of what's being accomplished by those many tens of billions of dollars that we've invested in health care in 2000, 2003 and 2004?

As we said in the audit, we found the report—and certainly the 2006 one, which we audited—quite deficient. We really questioned the value of putting it forward, but I would then certainly say that accomplishing this or getting a good report card on health outcomes is clearly something that's important for accountability.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Just as a follow-up question for the Department of Health, has Health Canada not conducted such assessments to make sound decisions on federal health spending?

I have another one as well. How can it make decisions if it doesn't ensure it has the information?

[Dr. Karen Dodds]

We collect information, as I said, from a wide variety of sources. We fund the Canadian Institute for Health Information, at $81 million per year. CIHI, as it's otherwise known, works with the provinces as well and has developed a very credible, solid reputation as a collector and publisher of health information. We fund Statistics Canada as well, and other surveys, which I mentioned when Mr. Malo asked his question about first nations. So we certainly put an investment into the information that we believe we need to make good decisions.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Health Canada has come before this committee for years acknowledging the vacuum of knowledge about where federal health transfers are used but pleading that it can't hold other jurisdictions responsible. What is disturbing about the lack of monitoring and surveillance is not whether or not the recipients are accountable per se, but that Health Canada doesn't appear to think it's worth its while to find out as much as possible about how federal transfer money is being spent. So when you consider that about $24-plus billion dollars are in play, ignorance is not bliss.

Now, why doesn't Health Canada follow its transfers to see if they're being used effectively, whatever the accountability is?

[Dr. Karen Dodds]

We take measures that we have the authority to take. As your colleague Mr. Malo noted, and as the Auditor General noted in chapter 1, all jurisdictions have their own responsibility, their own accountability. That's one of the issues with the Healthy Canadians report. In 2002 and 2004. All provinces did report on comparable indicators in their own jurisdictions, but they have ceased to do that.

We're not responsible for the transfers. I don't know whether my colleague from Finance has any further comment on those, but we do follow up all of the information that we can with respect to health and health care.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Did you want to add anything?

[Monika Bertrand, Chief, Federal-Provincial Relations Division, Federal-Provincial Relations and Social Policy Branch, Department of Finance]

What I would add is that under the Canada health transfer in 2009, we are providing about $24 billion in cash support to provinces and territories. The transfer stands from the 2004 accord, as you're probably aware, and it provides growing, predictable support to the provinces and territories in support of their health care needs. The health transfer is legislated until 2013-14, so it will grow to about $30 billion. As I said, it is very much based on a political agreement that was struck in 2004.

Some of the measures of the CHT are for specific purposes. In the 2004 health accord, you will see there was funding for medical equipment. But it is all part of the CHT now, and we do not follow the specific purposes that were set out in the 2004 accord. Instead, it's up to the provinces and territories to use the funding according to their priorities and to be accountable to their residents for how they spend this $24 billion-plus each year.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

I'm wondering if the Auditor General has any comments with respect to that, because obviously there seem to be some inefficiencies; it's not working the way it should. There are still some concerns with regard to how these transfer payments are not being monitored properly.

[Neil Maxwell]

Madam Chair, the study about how the transfers work is largely in the first chapter. What we said is that when there are conditions it's the responsibility of the federal government to ensure those conditions are being met and, if they're not being met, that they're taking action. This is a principle the government officials talked to us a lot about. You apply that principle to this particular case of the CHT, and I think that then becomes the basis upon which Health Canada, in its responsibilities, does the monitoring of the CHT. To the extent to which there are conditions--and they are conditions under the Canada Health Act, obviously--that then become the responsibility of Health Canada.

[The Chair, Conservative, Joy Smith]

Thank you very much, Mr. Maxwell.

We'll now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to thank the witnesses for being here today. When I knew that both of you were coming I was kind of excited, because one of the criticisms I always get as a politician is that people say the right hand doesn't know what the left hand is doing, and it seems that today we have a great opportunity because we have both hands right here in front of us at committee.

I wanted to ask a particular question, and it's directed to Mr. Maxwell.

You mentioned that the 2006 report was quite deficient, and here we have Health Canada in front of us and they've responded with the 2008 report. I thought Madam Dodds did a great presentation here. She's indicated that in Healthy Canadians 2008 they're going to be adding 19 new indicators.

What do you think of that? We have you here in the room now and I think it's a unique situation. Health Canada is saying what they have in this report coming up, but they also outline in 2010 what they would like to do: provide more data for first nations and Inuit health from Aboriginal Peoples Surveys, work with other federal departments, etc. In the spirit of efficiency and accountability, do you have some suggestions or comments for Health Canada proactively? What do you think?

[Neil Maxwell]

Yes, thank you, Chair.

There are several things. One is that, like any good auditor, we would reserve judgment until we can see it--we're from Missouri. Nonetheless, I think that in listening to what Health Canada has said it has done as part of 2008, there's certainly much more change there than we saw in any of the previous editions, and their conclusion was that each of the previous three editions was largely just a repetition of the one that preceded it, with relatively little creativity, relatively little sense of trying to continuously improve. On the face of it, what they have set out to do in 2008 is a step in the right direction.

In response to our recommendations, Health Canada made very clear, as does your question, that this is just an interim step, that there are a number of recommendations we made that they have not attempted to deal with in 2008 and that remain for future years.

Certainly, to your question and to some of the previous questions, I think one of the big unknowns in here is the extent to which the federal government, through its leadership, can bring the provinces back to the table. As Ms. Dodds said, when this all began after the 2000 and 2003 accords, the provinces were on board. Slowly over time the provinces chose to no longer publish comparable indicator reports in the form that was called for under the three accords, leaving just the federal government in that game. Certainly part of the original and continuing logic, the raison d'être of all this, is that Canadians would have the basis to look not just at what the federal government has to say but also at what the provinces have to say. That's the notion of comparable. In the title, “comparable” has a very important meaning, the ability to compare.

[Colin Carrie, Conservative, Oshawa, ON]

That's what I like to see. I see the two of you here in the room. I was wondering, do you have dialogue in between the reports, or would that defeat the purpose? Is that not exactly mandated? I would like to see, from an efficiency standpoint, if they're on the right track, which they appear to be. They've listened to you, they've made some changes, they've put some projections there. I think it would be a really good idea if there were that dialogue. Is that something you can do or is that something you do regularly?

[Neil Maxwell]

Madam Chair, absolutely. We have had discussions through the years. We've been involved in this production for some years, in each of the editions, in different ways. We have those ongoing dialogues. As auditors, when we do that we're very careful to maintain our independence, for the simple and very important reason that if we were so involved with working with Health Canada or any other departments that we were no longer objective, then we really couldn't do our audit job later on. However, within the confines of that, there's quite a bit we can and do do, absolutely.

[Colin Carrie, Conservative, Oshawa, ON]

Very good. Thank you.

To Health Canada, I was wondering if we could get a comment on the evaluation and the approach you're taking. Have you held public consultations on the issues of improving recording on health indicators? What were the outcomes of those consultations? Would you be able to elaborate on those today?

[Dr. Karen Dodds]

Thank you very much.

We have, in the past, had some consultations and we have responded to them. They go back a way. As we've indicated in our response to the Auditor General's recommendations, we plan on doing that again in this calendar year. It is not a large population in Canada that has had a real interest in health indicators. The value for money report by the Health Council may raise that, because indeed the chief purpose of that report is to prompt Canadians to ask questions about health care. There's no new information in the report. It's a report designed to have people ask questions. However, we've used people in the interim always—colleagues across Health Canada and the Public Health Agency—to provide input to us in terms of what indicators make sense and what data we do have.

[Colin Carrie, Conservative, Oshawa, ON]

Are there web-based consultations where average Canadians can put their comments in? Mr. Maxwell brought up a comment with the provinces. Is there that ongoing dialogue with the provinces to see how we can better work together?

[Dr. Karen Dodds]

There are many ways in which we work with the provinces. If you'd like to pursue that, I would. However, in terms of reporting and accountability, as Mr. Malo has said for Quebec, most of the provinces are in the same mindset that they will report to their residents on their progress. They do it in a variety of ways too.

We continue to work together on a number of elements, absolutely, under the health accord. We do have plans to have Healthy Canadians 2008 on our website. You can comment on anything on our website from the website.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Dodds.

Now we're going to be going to our second round. It is five minutes, and we'll start with Ms. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair, and thank you to all of you for coming.

I think we admire the goal of Healthy Canadians—anything to increase transparency and accountability. We're all interested in improving the health of Canadians. But I do have some concerns.

First of all, I guess it is national data. I wonder why the data are not disaggregated, because health conditions vary so much from one part of the country to another. I'm wondering what the data are comparable to. If we really wanted to do this, I think we would have a table of the health indicators and then by region and perhaps by vulnerable population.

These are some of the questions. I'm wondering when the 2008 report is due. I understand that a committee has been struck but that they're going to report after the 2008 report. I could be wrong on that. Is there a template for doing this? Is there a province or someone we can point to and say they're doing this well, and can we emulate that?

[Dr. Karen Dodds]

Those are good questions. Why aren't the data disaggregated? As I just said, it's clear in the accord that it's an agreement between first ministers. Each province will report to its residents, so it's not up to the federal government to report to Quebeckers or Ontarians on the situation in their specific provinces.

The other question you asked, by population, again, the only—

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Could I interrupt? I'm sorry.

It's impossible with national data to then set goals to make real change. Is there a way we can look at this differently?