Health Committee on March 18th, 2010

[Patrick Brown, Conservative, Barrie, ON]

You had mentioned the 50% implementation rate. Is that unrealistic to hope for by the end of the year in Ontario?

[Morris Rosenberg]

I think it may be. That's a national rate. I'd have to get back to you on where we would be with Ontario. I don't think Ontario will be at 50%. I think we're actually quite close to 50%, even though in the Auditor General's report the actual metric was somewhere just below 20%. The reason for that is in the way the 50% is calculated. Every element of an electronic health record has to be in place. Even if you have 10 elements, and nine are in place and the tenth isn't, it's not there yet. But in fact, in our discussions with Infoway, they were quite confident that we will actually see very significant progress in getting to that 50%.

[Patrick Brown, Conservative, Barrie, ON]

And--

[The Chair, Conservative, Joy Smith]

I'm sorry, Mr. Brown, your time is up.

Thank you, Mr. Rosenberg.

We'll go to Mr. Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Madam Chair.

The commitment made by the minister, Ms. Aglukkaq, concerning the backlog regulations on February 10, 2009, is as follows, and I am going to read it in English because it was made in that language:

“Our government is committed to eliminating the backlog by March 2010.”

So the minister told us that her objective, her political commitment, is to eliminate the backlog by March 2010. From what Ms. Boudreau said, her directorate's objective at the Department of Health was more specifically to start to address all files in the backlog by March 2010, to give them a file number, that is. Mr. Rosenberg, how is it that the minister's political commitment was not the message conveyed or understood by the directorate? Is it common practice for there to be dissonance between a directorate's objective and a minister's political commitment?

[Morris Rosenberg]

I began by saying, as Ms. Boudreau explained yesterday, that in part, it is the meaning of the words that is in issue. There is no intention to give you incorrect information. It is a complex question. I have to say that the department and the Natural Health Products Directorate are clear and transparent. On our website, there is information that had been there for some time and that advises natural product suppliers and consumers about the deadlines. If the committee wants, we can submit that information, which is public anyway. We are trying to deal with a challenging situation with as much transparency as possible. I can't give any reply other than that.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

You say the deadline is on the website. In her reply a little earlier, Ms. Boudreau told us about the deadline for the backlog. In her mind, it will all be eliminated by December 2010, but for the rest, 6,666, if my calculation is correct, what is the deadline and what financial resources have you given yourselves to deal with the normal workload?

[Michelle Boudreau]

To come back to the question Mr. Rosenberg answered, yes, we certainly have details on our website. There are information sheets created for consumers, pharmacists and the industry that have been posted for several months showing the three dates, 2009, March 2010 and December 2010.

In terms of the deadlines, for the rest, about 6,000 applications, we have no deadline as such, but we are in the process of addressing applications made by monograph. The other day I mentioned that we have monographs. Those applications, we complete them, with a final decision that is, within 60 days. That is a fairly respectable performance standard. For the others, somewhat complex applications, products that have several ingredients, for example, or more sophisticated health claims, we are working with our advisory committee, the one I referred to the other day, to develop performance standards. We are in the process of developing something that would still be respectable and reasonable, a performance standard between 90 and 180 days, which is still very respectable, as I said. In fact, the 180 day standard is a figure suggested to us by the industry for this type of more complex application. I admit that we are not there yet at this point. As Mr. Rosenberg said, this is a very complex field. We had a number of applications to deal with, as you undoubtedly know. There had been nearly 47,000 applications received since the regulations came into force and we have completed almost 37,000. So we have really progressed a lot, by completing 78 to 80% of the applications. As I told you, regarding performance standards, we are getting there and we think we can put those standards in place in a few months, with the help of the advisory committee.

[The Chair, Conservative, Joy Smith]

Thank you, Madame Boudreau.

We'll now go to Mrs. Davidson.

[Patrick Brown, Conservative, Barrie, ON]

Thanks very much, Madam Chair.

Thanks very much to our presenters for being here with us again this morning.

I want to change pace a little and ask some questions about seniors. We know that we are certainly coming up to having a large percentage of seniors in this country, and I think we have evidence that shows us that falls are the most frequent injury among seniors. We also know that many of these falls result in institutional placement and loss of independence, and all these things give rise to a far lower quality of life for our seniors.

The number of older persons in Canada is projected to increase greatly between 2005 and 2036, from 4.2 million to 9.8 million, and it is also estimated that the number of older persons who will fall at least once in 2036 will increase to 3.3 million. These figures are staggering.

We have also seen evidence that falls can be prevented through a combination of interventions, including education on their risks, how to prevent them, exercise, and those types of things.

Can you tell me what the Public Health Agency of Canada is doing to address the issue of falls in seniors?

[Dr. David Butler-Jones]

Thanks very much for the question.

All of us are aging. That is a good thing. The alternative is not preferred.

As we age, in many ways the challenges do increase. In terms of falls or aging, a number of things can be done. In some ways it's actually quite simple. A lot of the falls are based on declining vision, throw rugs, tripping in the home, etc. It can be from not clearing sidewalks, or from not having smooth transitions on stairs; suddenly you can't see the edges of stairs. Simply having strips on stairs can tell you where the edge is.

There are a lot of things that are fairly simple, so education is part of the answer. Partly it's also the municipalities and others, in terms of creating age-friendly communities--not just for the aged, but for all ages--that provide access and movement and exercise and all of these things that make for a healthy outcome.

In Vancouver on March 22 and March 23 there will be the first-ever conference on seniors' falls prevention. It is being sponsored by us. As well, we have been involved in the development of the award-winning Canadian falls prevention curriculum initiative. There are also e-learning issues. In 2005 we had our report on seniors' falls, and we plan to update it next year.

There is also my report this year on the state of public health. Each year has a theme, and this year's theme will be seniors. Clearly falls prevention is one very important aspect, and it is something that we've demonstrated we can do something about. It takes a little thought and effort. It's not expensive, though, and it can make a huge difference to quality of life.

[Patrick Brown, Conservative, Barrie, ON]

Thank you. I think it's commendable that we are definitely looking into these areas. It is definitely much needed as we look after the health and well-being of our seniors.

I have one more question. It's regarding the Patented Medicine Prices Review Board. When I looked at the main estimates, on page 13-13 I believe, I saw that you were requiring about $7.75 million for compliance and enforcement of non-excessive prices for patented drug products. This is an increase of about $704,000 for this particular program activity over the last year's estimates.

How many public hearings does the PMPRB expect to conduct in 2010-11 in support of its mandate, and how does this number compare with the number of hearings held in the previous year? Are we increasing the number greatly? Is this keeping up with the backlogs, and so on?

[Morris Rosenberg]

Thank you for the question.

Just to be clear, the regulatory mandate of the Patented Medicine Prices Review Board is to ensure that prices charged by patentees for their patented medicines sold in Canada are not excessive. The role of the board and its staff is to investigate prices of patented medicines that appear to be excessive. This may result in a report to the chairman for a possible hearing, once board staff and the patentee have determined that the matter can't be resolved by a voluntary compliance undertaking from the patentee.

Currently there are several patented drug products that appear to be priced excessively. Board staff will submit a report to the chairman for the issuance of a notice of hearing on one or all matters, if it's not possible to resolve these voluntarily.

As I mentioned the other day in response to a question from Mr. Malo, there has been a change over the last while with respect to the way the practice of that board is carried out. Traditionally, going back to the mid-1980s, when it was set up, most matters were resolved voluntarily. There has been a tendency lately for more matters to go to a contested hearing.

In 2009-10, the board completed four hearings and has issued to date two notices of hearing. At this time there are currently nine ongoing hearings, three of which are at the decision stage.

[Patrick Brown, Conservative, Barrie, ON]

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Davidson.

We're now going to go to Mr. Bagnell.

[Larry Bagnell, Liberal, Yukon, YT]

Thank you, Chair.

Thank you, everyone, for being here.

I want to ask a bit about the services you provide to residential school survivors. Budget 2010 commits $199 million to higher expected funding needs to support the settlement agreement. I know that some of that goes just to the fact that we owe individuals money, but the minister said some of it is going to services that you provide for mental health.

I'm wondering what the breakdown of that money might be. Of the $199 million, how much is going to survivors and how much is going to your department to provide counselling services, etc.?

[Glenda Yeates]

Thank you very much for the question.

The $199 million that is referenced in budget 2010 includes $65.9 million that is the Health Canada portion of it. That's for the Health Canada resolution health support program, to be able to respond to the growing demands that we anticipate as a result of the Indian residential school process.

[Larry Bagnell, Liberal, Yukon, YT]

Is that just for one year?

[Glenda Yeates]

No, it's for two years. The $199 million is a two-year figure, and $65.9 million of that is for Health Canada.

[Larry Bagnell, Liberal, Yukon, YT]

That's over two years? Okay.

How much did those services cost this year, the year before this $65 million came in?

[Glenda Yeates]

I don't have the precise figures. Some of the demands for services depend upon the uptake, and the truth and reconciliation process has been a bit slower than originally anticipated. It really is demand-driven, in terms of when people come forward to seek the services.

I have a note here that it was approximately $39 million last year.

[Larry Bagnell, Liberal, Yukon, YT]

Over the next two years it's almost the same, slightly less per year.

[Glenda Yeates]

Yes, and because it's a court-ordered amount, if it turns out that there are more people who come forward, this is something we would have to respond to in a supplementary estimates way. But this is our estimate, which would reflect the demand we expect in the next two years.

[Larry Bagnell, Liberal, Yukon, YT]

This is just for counselling, and health services, and things for these individuals, is it?

[Glenda Yeates]

Yes. There are a number of services here for mental health and emotional health support, including counselling. There's some traditional...using elders and others. There's a combination of services offered.