Health Committee on March 18th, 2010

[The Chair, Conservative, Joy Smith]

Your time is just about up, Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

—as chief public health officer to do that?

[Dr. David Butler-Jones]

My obligation is to provide the best advice possible, both scientific and in matters of public health, and as the deputy responsible for the Public Health Agency to manage its affairs both in policy and finance. Those are my responsibilities.

I have seen this. I have seen this evidence and been part of the discussions with the Gates Foundation and with the scientists. It is my assessment, along with the Gates Foundation, that in fact this resource could be better spent elsewhere at this time, given the capacity that's developed in the world.

I have to take evidence as it arises. For example, throughout the H1N1 that we've been having, we saw things that arose on a certain date. It wasn't three weeks earlier, it wasn't three weeks later. You deal with it when it comes. This was part of additional due diligence beyond the original. Given the space of time, it was appropriate to assess what the capacity was in the world and how it had changed. The assessment was that the capacity had changed. Therefore, re-examination, given that none of the applicants passed the bar—they all had deficiencies and would require some major work in order to change that, whether in a new process or a revised process—and that capacity is now out there, it was my clear assessment and that of those who advised me, as well as the Gates Foundation, that in this case it is time to move on and use those resources for something else to move the agenda around an HIV vaccine.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

Ms. McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair.

I would like to start by building on my colleague's comment around tuberculosis. Not only is tuberculosis an issue, but we know there are significant health disparities within our native and Inuit communities. We obviously know that improving housing conditions, poverty, water, and safe drinking supplies are part of the solution, but certainly first nations and Inuit health have a critical role to play.

I notice there are some changes in terms of where you're going. You're talking about $237.3 million to stabilize primary health care services and non-insured health benefits, and I'd like to hear a bit more about what that will involve. How much of it is primary health care, and how much is related to drugs, eyeglasses, dental care? That's my first focus.

[The Chair, Conservative, Joy Smith]

Who would like to take that question?

Ms. Yeates.

[Glenda Yeates, Associate Deputy Minister, Department of Health]

Thank you very much, and thank you for the question.

It is the case that we have significant challenges in terms of supporting and improving health services and health status on first nations reserves. I think reducing the inequalities that we see is a very significant priority for the first nations and Inuit health branch. To that end, we have a number of programs. You mentioned the non-insured health benefits program, by which we provide a range of drugs, dental services, and other services to people living on and off reserve. You mentioned the estimates; the incremental amount there is $305 million that was put in budget 2009, over the two years, to help stabilize that program.

In addition, of those stabilization funds for the $440 million over the two years that was announced as part of the economic action plan, there is $135 million for infrastructure. We have a significant number of communities, around 200 communities, that are very isolated, where we have nursing stations and often we have nursing residences to support the staff who stay there. We have some significant ability with those funds to move forward on our capital program to construct and renovate and modernize some of those capital facilities as well.

In budget 2010 there is also $285 million, over two years, for aboriginal health programs in some of the prevention and treatment areas, such as diabetes, suicide prevention, maternal and child health.

These are investments that we think will be very important as we move forward to try to reduce the inequalities in health status that we see.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

The additional money is providing additional capital infrastructure, but is it changing what's available in each community, for example, in terms of non-insured health benefits or primary care services? Or is it more focused on ensuring some reasonable accommodation?

[Glenda Yeates]

In terms of the non-insured health benefits, it is a program that has rising costs every year. Typically that's because we're always adding new drugs, for example, so there would be an expanded range of drugs. But it's not a major policy expansion. It's simply that as new drugs come on the market and they are assessed, they are added to the formulary, for example.

In addition, we have increased population. We are covering more people because this is a growing population, so that leads to increased costs as well.

Where we have been able to have some new programming in recent years--and we are able to continue that with the $285 million in this coming budget--is in the area of youth suicide prevention and maternal and child health. These are programs that have been started in more recent years, and this money will allow us to continue those, to refine them, and to make sure that in addition to the very important treatment services we have some services on the prevention side as well.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

I'd like to shift directions. I think I like to explore Canada Health Infoway frequently because many people believe it is absolutely critical to creating success across Canada in terms of our electronic health records. Technology is supporting our communities, our physicians, our hospitals, and most importantly, of course, our patients and how we provide care.

I know that the audit federally was very positive. People's perception of what is happening is due to some unfortunate circumstances within some of the provinces, where perhaps people are not as aware of the good work. I would like to hear more about Infoway, where we're going, and how it's moving forward.

[Morris Rosenberg]

Thank you.

As was mentioned, the federal Auditor General did an audit of Infoway. While no audit is ever perfect, I think the Auditor General found that Infoway was largely on the right track. A few recommendations were made with respect to some of its management practices. Infoway did issue a management response and action plan to move forward on those recommendations. On that basis, in budget 2010 the government freed up the $500 million that was part of the economic action plan for Infoway.

A lot has been accomplished. I can give you a sense of some of the initiatives with respect to moving toward the benefits of electronic health records. Three-quarters of X-ray films--this applies to anybody who's ever had to go to a hospital and wait for X-rays, even though X-rays may have been taken before--have been replaced by digitized images in the public health system. So the accessibility of those X-rays, the reduction of needless duplication, I think is a very important part of this.

The development of drug information systems, which are a key building block of electronic health records, are in place in B.C., Alberta, P.E.I., and Saskatchewan, and that's really important. I think one of the main benefits of the electronic health record is getting information that will avoid error. If you can get a sense of what has been prescribed and what contraindications are, and avoid some of the written script where there are errors in terms of interpreting it by pharmacists, I think that's an important benefit of an electronic health record.

All communities north of 60 degrees are telehealth-enabled, or are in the process of implementing telehealth capabilities. Again, given the nature of Canada and the remoteness of a lot of our communities, the importance of having access to telehealth is huge.

In Alberta, 20,000 authorized health care providers are actively using the electronic health record, and this has helped Alberta start to implement a chronic disease management system.

Those are just some of the examples. Infoway continues to work with the provinces and territories. The Auditor General found a very prudential funding arrangement. It needs to see real proof of sound implementation plans before money will flow to the provinces and territories.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Rosenberg.

Now we'll go into our second round. It's five minutes for the question and answer.

We'll start with Dr. Bennett.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thanks very much.

I want to focus a little bit on maternal and child health, and the Prime Minister's commitment. Is that a priority for the G8?

I want you to explain how, with that commitment, in the main estimates on page 13-7, $900,000 has been cut from non-profit international organizations in support of their projects or programs on health. Can you tell us which projects those were, or table them, or let us know that none of those are to do with maternal child health?

[Morris Rosenberg]

I can't give you the list today. I think you're referring to some of the reallocations made as a result of the strategic review last year. Is that...?

[Carolyn Bennett, Liberal, St. Paul's, ON]

On page 13-7 in the main estimates.

[Morris Rosenberg]

If you'll just give us a second, we'll have a look at that.

[Carolyn Bennett, Liberal, St. Paul's, ON]

It's in the grants and it's for next year.

[Morris Rosenberg]

Thank you.

I'm informed--and we will provide you with more details--that none of those cuts deal with maternal health issues.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Okay.

In our domestic record on this, in terms of setting it as a priority, obviously there is some concern that the Centres of Excellence for Children's Well-Being have been cut and that the Centres of Excellence for Women's Health have received informal cuts and a much narrower mandate.

It's mainly in our domestic record on infant and maternal mortality in our first nations and Inuit that I'm concerned. We are seeing $70 million transferred from the community care programs for first nations and $50 million transferred from Inuit primary care. I would like to know how that is justified.

We are still having trouble having the data on infant mortality in terms of first nations and Inuit. We know it's higher. We know that when you average it in, it puts Canada worse than Cuba in infant mortality rates. I would like to know when you're anticipating having the data. What would be the strategy in terms of what, by when, and how we will reduce the infant mortality rate in our first nations and Inuit as well as among all Canadians in remote rural areas?

[Glenda Yeates]

Thank you for the question. There are two parts. I'll address the data part first and then speak to the programming section.

I think we all share the concern and the challenge about getting better data, because it does enable us as a country, whether be it at the local, regional, provincial, or national level, to actually understand where the fine points are, where the interventions are, where the challenges are, and where the interventions should be targeted.

As you mentioned, unlike some countries, we have not gone with first nations identifiers or ethnicity identifiers. The U.S. has taken a much different approach in their data collection than we have in Canada. At this point, the strategy is to work nationally with first nations national aboriginal organizations, and to work locally with bands and regions to understand their willingness to have data collected and to work with them, so that there is some understanding of the importance of having data that will give us better information on a first nations basis.

Having said that, working with organizations such as Statistics Canada or the Canadian Institute for Health Information, there are some ways of, writ large, trying to estimate some of the gaps in, for example, infant mortality. We do know that there are some higher rates. We are working with those organizations and with national aboriginal organizations to continue to improve the data.

Having said that, we do know this is an area of priority and of urgency, and we do have a maternal and child health program. The estimates reveal the reductions that you mention, because they don't reflect the $285 million over the next two years that was announced in budget 2010 for five programs, one of which is the maternal and child health program. In fact, there will be no reduction in funding to that program. Although, as you say, that's announced in the budget, it's not reflected in the estimates before you.

With that money, we have... You asked about the strategy. There is a multi-faceted strategy. I think we always understand the complexity of working with communities and individuals on maternal and child health. Some of the program elements that have been in place are things like home visitation, having community workers doing screening, for example, in terms of high-risk moms, and trying to both prenatally and postnatally support those particular families and individuals. There has been an effort to integrate culture into care, so it's working, again, to adapt, through elders and through translation into local languages, for example, some of those documents, supports, and guides that we have.

There is case management to help families who might be high-risk, who have specific needs, to try to help those targeted families access the services they need.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Yeates. Time is up.

We'll now go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

I'd like to follow up on some of the questions that Ms. McLeod asked. I too am interested in the Canada Health Infoway.

I appreciate the benefits. I'm just a little curious about how we monitor where it's going in the partnerships with the provinces, because every year we see these budget allocations, and in past budgets we had more money going towards the Canada Health Infoway.

I was curious, so I asked the CEO of our hospital in Barrie, Janice Skot, what investment she has seen in e-health come down from the province. She told me they haven't seen any e-health funding at our local hospital.

When we go back to our communities, what evidence should we be seeing of the federal investments in Canada Health Infoway? You mentioned to Ms. McLeod the digital copies of X-rays. Are there other examples like that, and would I be seeing that at my regional hospital? Would that be the result of federal investments into Canada Health Infoway?

[Morris Rosenberg]

Thank you for the question.

I think one of the realities of Infoway, and it really does go to the funding model, is that funding isn't flowing across the country on an equal basis. That is because Infoway, as part of its prudence in how it manages its money, will only flow money where it feels that provinces have met a threshold of readiness to implement projects. So you have some provinces—I think Alberta and P.E.I. are examples—that are further ahead than others. You have others—Ontario would be an example right now—that for a variety of reasons are less far ahead. So not everybody will see all of the benefits I talked about in an equal way.

The idea, though, in Infoway is that the country will be very close by the end of this year to having 50% implementation of electronic health records. Again, that will not be 50% across the board, but it will be 50% looking at various jurisdictions.

Obviously the idea is to get the entire country on a basis of electronic health records to establish standards in a way that, when people move across the country, there will be portability of those records even though the systems are going to be built on a provincial basis. That, by the way, is very similar to the way other electronic systems in other industries have evolved.

[Patrick Brown, Conservative, Barrie, ON]

I love the goal, but I'm curious to know where we are. You mentioned P.E.I. and Alberta being ahead. Where are we in Ontario? As an MP who resides in Ontario, what progress could I point to in Ontario where we've seen federal investments have success?

[Morris Rosenberg]

Ontario has been a little bit more problematic, as you're aware, because of some of the difficulties that occurred initially with Smart Systems for Health, and then more recently with eHealth Ontario.

One thing I will say is that there is one very good example, and that is the Ontario Telemedicine Network, which has over 2,000 health care professionals now delivering care to over 660 rural and remote sites throughout the province. In terms of the progress that I mentioned generally with respect to telehealth, I would say that Ontario is, in respect of that aspect, among the leaders.

I would also say that, in Ontario, following the much-publicized concerns and the provincial Auditor General's report around eHealth Ontario, I know that new management has been brought in. I know that a former federal deputy and former head of the board of The Ottawa Hospital, Ray Hession, who has an excellent reputation as someone who can come in and essentially put big informatics systems on the right track, has been working with eHealth Ontario, and I'm hopeful that within a reasonably short time you'll see real progress in Ontario.