Health Committee on April 18th, 2013

[Hedy Fry, Liberal, Vancouver Centre, BC]

Minister, I would like an answer to my question and not a sense of what went on in the past. I'm talking about the future and how you will meet the needs Canadians have.

For instance, the drug and substance abuse funding has been cut by almost 50%, and all of the community funding that will go to drugs and substance abuse is down by 16%.

Given that substance abuse and addiction is at an all-time high, given its cost to the health care system, given its damage to the ability of human beings to live meaningful lives, and given that this is high in Inuit and aboriginal communities, how is the minister going to meet the needs of these communities? It's obvious that a 50% cut is huge.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you.

One of the areas we are looking at focusing on relates to the abuse of prescription drugs. Prescription drugs pose a serious and very complex problem. We have seen some of the media information out there related to a single pill. This is why we have provided funding and support to the Canadian Centre on Substance Abuse so that it could develop a national strategy on prescription drug abuse. That report and its recommendations will no doubt help to advance work in this area.

As a service provider for first nations and Inuit, this government has shown leadership by cracking down on prescription drug abuse in areas within our own jurisdiction. These measures have resulted in a 50% reduction in the amount of long-acting oxycodone provided to Health Canada's non-insured health benefit program, without a significant shift in other long-term areas.

The provinces and the territories, as well as health care professionals, pharmacists, and doctors, also have key roles to play in addressing prescription drug abuse. I have committed to working with all the partners, the Canadian Centre on Substance Abuse as well as the provinces and territories, to address this very issue.

Thank you.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Minister, the Public Health Agency of Canada has seen a cut since 2011 that is about 14%, and specifically disconcerting is that the surveillance part of the Public Health Agency of Canada has been cut by 26%.

Now, the minister assured us that the health and safety of Canadians are going to be a priority for her. How are you able to ensure the health and security of Canadians when you are not going to be able to do surveillance, when you're not going to be able to keep an eye on population health, and at a time when pandemics around this world can happen at any moment?

You are diminishing your ability to respond to anything—most specifically to the health and safety of Canadians.

I'd like to have an answer to that, please.

[Leona Aglukkaq, Conservative, Nunavut, NU]

I'll pass it on to Krista, but the surveillance systems that we have with public health agencies through the microbiology labs are not impacted. In fact, we are also evaluating the rollout of the pandemic plans so that we can continue to make improvements to the way provinces, territories, and the federal government responded during the H1N1 outbreak. We continue to do that.

I also said in my opening remarks that we are opening another site to detect food-borne illnesses. In terms of surveillance, those systems remain in place.

As for the amounts, I'll ask Krista to identify the budgets within that area.

Thank you.

[Krista Outhwaite, Associate Deputy Minister, Public Health Agency of Canada]

Thank you, Minister.

Thank you for the question.

The agency takes great care to protect its primary mandate, to which you were referring, in terms of emergency preparedness and response, leadership in health promotion, disease prevention and health protection, public health capacity, and science leadership. This includes things such as surveillance.

As we went about the exercise of looking at what efficiencies we could engender, we made sure that we protected our ability to do surveillance. We made sure that we protected our ability to do science in our three laboratories in the country, so that we could be ready and we will be ready when we next face a pandemic or other significant public health event.

This year the agency is facing a reduction of about $35.7 to $36 million, and 80% of those savings are coming from administrative efficiencies in the back office. So when we talk about surveillance, we are talking about our 55 surveillance programs not in terms of the data we collect or what we do, but in terms of how we do it in the back end.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you so much, Dr. Fry.

We'll go to Mr. Wilks, please.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you, Madam Chair.

Thank you, Minister, for being here today.

Aboriginals face many unique challenges when it comes to health care. The 2013 budget proposed investments to address these challenges. Can you please tell us how these investments will assist in improving health care services and outcomes for Canada's first nation and Inuit population?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that question.

As you know, improving the health of aboriginal people is a shared undertaking among all levels of government and aboriginal partners. The federal government is working with its partners to provide effective, sustainable, and culturally appropriate health programs and services.

As highlighted in budget 2013, we invest more than $2.4 billion annually for first nation and Inuit health, including primary health care on reserves as well as the non-insured health benefit program. We're also proposing an investment of $48 million to support the uptake of innovative technologies, such as electronic health services, within the remote and isolated first nation communities. Finally—and I spoke to this earlier on Dr. Carrie's question—budget 2013 also includes a proposed $4 million in investment over two years to increase the number of mental health wellness teams and specialized services available in first nation communities.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you for that.

You mentioned electronic health services. Could you expand upon that and explain to this committee how they will bring positive health outcomes, specifically for rural communities?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that question.

One of the biggest challenges we have is making sure that we respond to situations quickly in communities. Many of the first nation reserves or Inuit communities have nursing stations; they don't have hospitals. One of the biggest cost factors we deal with, before we even provide services, is flying patients to hospitals from remote communities—northern Ontario to southern Ontario, Iqaluit to Ottawa, Rankin to Winnipeg, or what have you. We face a number of challenges in getting patients there.

One of the things we're doing is investing in telehealth in the north, so that physicians or nurse practitioners have access to specialists in southern hospital settings to provide advice or make decisions on whether a person requires hospital service or not. Another is investing in X-rays that we can be sending to hospitals immediately, rather than flying people down to the hospitals to be seen. That can sometimes take some time because of weather, flight schedules, and whatnot. These investments in some areas are reducing costs and dependency on transportation, which we can invest in other areas. We're looking at those types of initiatives.

But in everything we do, technology will become a more integral part of how we ensure, in primary health care settings, that patients have access to the services we see in city-centred areas, such as here in Ottawa. We're looking at these options to make sure that we have great services in our communities.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you.

This proves that, just to take you back a bit, consultation and partnerships can be very helpful in improving the health of first nations.

Could you update us on the initiative taking place in British Columbia among the different levels of government?

[Leona Aglukkaq, Conservative, Nunavut, NU]

The work we're doing in British Columbia is historic and very innovative. The first nation communities and first nation leaders in that region, in partnership with Health Canada and the provincial government, have established a first nations health tripartite agreement. The first rollout of it will happen this summer, when the first nations authority will take responsibility for delivering health care, by first nations people for first nations people, in partnership with the provincial government.

The opportunity there is to break down the silos of delivering health care, with better partnerships and with collaboration with similar existing provincial programs. The provinces have partnered in this. This is the first of its kind in Canada—in a provincial setting, anyway—in which Health Canada direct delivery will be out. It will be a first nations health authority delivering programs.

Another exciting piece about this is that they'll have a great opportunity to better incorporate aboriginal knowledge into the delivery of their programs and to have a better design of community-based health care services incorporating traditional knowledge of aboriginal people in the medical practice, as an example.

It's the first of its kind, and we're quite excited about it. The first nation leadership in British Columbia has been fantastic, and it has been a great joy working with them. They're thinking outside the box, planning and prioritizing their areas based on their needs in their communities.

This summer and in the fall, the first nations health authority will be delivering that. This is really exciting.

I think we'll be able to share some of these types of models in other jurisdictions that may be interested in looking at how to break down some of the silos in a provincial, federal, and first nation health delivery system. This is one that has been in the works for over five years, and I commend the leadership of the first nations people in British Columbia.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Wilks.

We'll now go to our five-minute rounds.

Welcome to our committee, Ms. Crowder.

You have five minutes. We watch the clock carefully.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Great. Thank you, Madam Chair.

Welcome to the minister and her staff.

It's always a challenge when we're dealing with estimates, because we have to deal with the facts and figures that are before us and not what could be coming in the supplementary estimates. When you look at the department's report on plans and priorities for Health Canada, it shows that there will be cuts of $140 million from first nations and Inuit primary health care in the next three years. It goes from $980 million to $850 million. When you just look at the year 2012-13 in comparison with 2013-14, Health Canada will be reducing its spending by $40.5 million.

In your opening remarks, Minister, I understood you to indicate that there will be additional funds coming through the supplementary estimates. Could you tell me exactly how much? Is it $52 million that will be in the supplementary estimates for additional spending?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Do you want to take that?

[Glenda Yeates]

There are many documents before the committee. You mentioned the report on plans and priorities.

I can speak to the fact the allocations in budget 2013 include $48 million over two years, so $24 million a year. That will be apportioned according to these business lines. Of that $24 million, some of that will be in health infrastructure and some of it will be in primary care.

We have additional moneys coming through supplementary processes that will exceed these figures that we've given you today. They will appear in supplementary estimates (A) and (B).

In some of the programs, I'd say in both non-insured health benefits and in primary care, we tend to look year to year at the estimate of the need. It varies depending on the population and the usage. Then, if you look at the committee's historic records, we will have added money in primary care and in non-insured health benefits in some substantial figures during the year through supplementary estimates.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

It's interesting that you talked about depending on the needs of the population. We know that first nations and Inuit are the fastest-growing youth populations in Canada and have some of the poorest outcomes in Canada. It would be surprising to see less money required.

You talked about the fact that there will be additional money in the supplementary estimates and that some of that money will be targeted towards primary care. Can you tell us specifically how much money will go into primary care, including chronic illness management and mental health? I know the minister did indicate that $4 million would be going to mental health over two years, but will there be additional money?

[Leona Aglukkaq, Conservative, Nunavut, NU]

First, just to clarify in terms of the services to Inuit, those are through the Canada health transfers. Nunavut delivers their health care, as an example; Northwest Territories delivers their care; Quebec, northern Quebec, Labrador, and whatnot. The services here are for first nation reserves for primary care.

Thank you.

[Glenda Yeates]

There is new money in the budget, as the minister mentioned, for the mental health teams, and that will be added to the primary care portions. But in addition to those figures that are specifically outlined in budget 2013, there will be additional funding, essentially program integrity funding, that we will be applying for and expect to see coming in the supplementary estimates.

What I can say to the committee, just as we've said in past years, is that there are no program changes here. There are no reductions in the programming. We will get the money that will live up to the needs of the same level of programming for non-insured health benefits and for primary care services for 2013-14.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Just in terms of the electronic health services, has the department done an assessment on Internet accessibility in rural and remote communities? When I was on the human resources committee, we were hearing that there were some challenges in some communities. Have you actually done that assessment?

[Glenda Yeates]

Thank you for the question.

We are continuing to expand the supports that we have in first nation communities. We have a number of communities that are connected now with the additional funds that are available to us with this $24 million. We expect that $20 million of it, for example, will be focused on, in some cases, adding communities to the number that are connected. But in other cases, as the technology changes, we're actually broadening the broadband. We are actually adding additional connectivity to communities that are already connected but perhaps don't have the bandwidth to deal with the latest technology.

So it's some of each.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Yeates.

Welcome to our committee, Mr. Gill. It's good to see you.

You have five minutes.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Thank you, Madam Chair.

Thank you to the honourable minister and her officials for being here.

I'm no longer a regular on this committee. I'm just filling in for my colleague. It's wonderful to be here and to be able to join in this meeting.

Minister, my question is related to neurological disease. Neurological disease disorders and injuries represent one of the leading causes of disability in the Canadian population. They produce a range of symptoms and functional limitations that pose daily challenges to individuals and their families.

Can you please tell us what our government is doing to assist those suffering from this serious disease and the families who care for them?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that question.

The Government of Canada has invested $15 million, in partnership with neurological health charities across Canada, to carry out Canada's first national population health study of neurological conditions. The study results will provide reliable information on the extent of neurological conditions and their effects on Canadians. The study will be completed this year, and a full report will be available in 2015. This information will help to inform the future program and policy decisions we make.

The government launched the development of the Canadian MS monitoring system in March 2011 to support efforts to improve the care and quality of life of Canadians who are suffering from MS. That system will increase our understanding of MS in Canada and its treatment.

There is much to learn about the prevention, diagnosis, and treatment of neurological conditions. A total of $255 million has been invested by the Canadian Institutes of Health Research into neuroscience research since 2010. In addition, the 2011 budget committed $100 million to establish the Canada brain research fund in partnership with Brain Canada. This fund will support the very best Canadian neuroscientists and help accelerate discoveries to improve the health and quality of the lives of Canadians with neurological conditions.

Thank you.