Health Committee on March 11th, 2020

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Thank you very much, MP Davies.

Listen, as I've said repeatedly and as our government has said repeatedly, no Canadian should have to choose between drugs and food on the table.

I have met with both. Obviously I have met with Minister Morneau many times but I have also met with Dr. Hoskins and I want to thank him, first of all, for the volume of work that he led, with the committee, to ensure that we have such a comprehensive report.

In budget 2019 we announced those critical next steps for the implementation of national pharmacare. We have been working with provinces and territories and stakeholders to get a better sense of how we create this Canada drug agency together. We have taken steps forward in terms of creating a national formulary and creating a national strategy for high-cost drugs for rare diseases.

I have had conversations with all of my provincial and territorial partners. I will continue to push them to work with the federal government to ensure that they agree that we need national pharmacare for all.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks, Minister.

I'd like to turn now to the Canada Health Act.

Minister, your mandate letter instructs you “to ensure compliance with the Canada Health Act on matters of private delivery and extra billing”, yet the Liberal government has allowed the Province of Saskatchewan to violate the Canada Health Act for four years by permitting access to private MRIs. Now we know that wait-lists for public MRIs in that province have doubled over the last four years while wealthier Canadians are allowed to pay their way to get to the front of the line.

Why haven't you shut this down in Saskatchewan or penalized the Government of Saskatchewan as you are obligated to under the Canada Health Act and as your mandate letter requires?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

In fact, my deputy is just writing to me about the date, because I knew we had just recently done something.

The diagnostics policy takes effect on April 1, 2020. We will enforce the Canada Health Act, we have enforced the Canada Health Act and we've been the first government in a long time to enforce the Canada Health Act. It's a priority for the Prime Minister that we uphold the principles of the act so that we protect this public health system that, as we all can see, is so valuable to all Canadians.

[Don Davies, NDP, Vancouver Kingsway, BC]

On April 1, then, will you be withholding money from Saskatchewan on a dollar-per-dollar basis?

[Dr. Stephen Lucas]

It will follow the process we have in terms of the Canada Health Act, where provinces provide reports that we assess and, on that basis, make deductions and, if they change their policies, reimburse them. That approach is codified.

[Don Davies, NDP, Vancouver Kingsway, BC]

Are you going to ask for a report, or are you going to start deducting on April 1?

[Dr. Stephen Lucas]

No. We'll follow the process that has been followed for decades in terms of assessing on provincial user fees, making deductions and then working with them to bring them into compliance and, under the reimbursement policy, if they do achieve that, reimburse their deductions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

We now start a new round with Ms. Jansen for five minutes.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Ms. Hajdu, since the coronavirus first began, I've been day and night trying to help constituents who have been affected, whether they have been quarantined in Wuhan or on the Diamond Princess or on the Grand Princess. As you say, I've been taking emails and texts in the middle of the night, doing my very best to give them as many good answers as I can, helping to ensure they can get on a plane or find out whether or not there's a plane coming.

I was surprised yesterday when you mentioned that you were talking weekly with your provincial and territorial counterparts. I come from a farming background, and when there's something going wrong with the living crop, weekly checks on the crop are never enough. You have to really get in there and do it more often.

I'm just wondering. I saw you after question period yesterday and went to ask you how I could get a bit more information in a more timely fashion. You mentioned to me that I should phone Global Affairs. It's very difficult. I really feel for these people who are in great distress trying to figure out how to get onto planes, and all these sorts of things.

You talked about openness and transparency, and I've really struggled getting any openness and transparency. I even sent a message to the Minister of Foreign Affairs, and it took me days to get a response. I'm just wondering how I can better give information to my constituents as this continues to go on.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

I'll address the meetings first. I will say that I obviously have a daily meeting with my officials every morning. By the way, I don't even want to guess but I bet you that my officials have been working 14- to 18-hour days since early January.

Dr. Tam has daily meetings with her counterparts. The technical group meets daily. There are a number of other working groups that are meeting daily. This is an “all hands on deck” issue and crisis.

I will say that I find it slightly offensive that you would think that this is the only work we're doing. I meet with my ministerial counterparts once a week because, of course, just like me, they have committees and all kinds of other obligations, but a once-a-week meeting with provincial health ministers is actually very rare.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

What I'm actually wondering is—

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Normally we meet together about once a year. We may have one other call a year.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Is it possible, though, that we could somehow get some of the information that is being worked on by the other members of your team in a more timely fashion? It's very difficult for the constituents when I can't give them a more timely answer.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

I will also remind the committee that we have made offers every day for a situational update, and you are always welcome to come to the situational update briefing, and I would encourage you to do so. You will definitely get the information you need at those situational updates that are provided by my department every day. You have been invited.

I will also say, in terms of Global Affairs, that consular services are in the best position to help people who are in another country and that have a difficulty in terms of their own particular situation. Health Canada cannot assist those people. That is not our ability.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Yesterday you didn't mention the meetings. You told me to phone Global Affairs, which of course I have done a lot of. They have been helpful, but I was hoping to have a little bit more timely information.

I will move on to another question. We're looking at the estimates. We're being asked to sign off on over $30 billion, I think, and I'm struggling to figure out.... You mentioned numerous times the idea of $11 billion for palliative and home care. I was looking to see how much is being utilized in each of the different provinces, which is, as it turns out, very difficult to figure out. I managed to find out, through the Library of Parliament, that $60 million is being used by B.C. for palliative care. Then I looked at a CIHI study, which said we had about 16,000 palliative care patients. If I take that number and divide it by what's being given, it's about $3,700 per palliative care patient. We know that it's about $1,200 for one palliative care patient in hospital per day, which gives them about three days in hospital, or, if you go to somewhere like the Delta Hospice, you could get 10 days, because they are about $350 a night.

Do we feel that's enough? In general, we know that we need palliative care to ensure that people are not having to request MAID in order to get out of suffering, but if we don't have enough palliative care, how can we do that?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

I want to correct myself. We have offered the critics every day an opportunity to have the update, but we do send sitreps every single day. I would encourage you to read those every day, because it will give you an update on the situation in Canada.

In terms of the palliative care funding, obviously—

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

On a point of order, Mr. Chair, I'd just like to correct the record.

I'm sorry to do this to you, Minister, but we have not received invites to the situational briefings. If the situational reports, which just began on Sunday, after requesting them for seven weeks, is what you're referring to, then, yes, we have been receiving those, but just as of Sunday. Again, we have yet to be invited to the situational briefing that you're having daily.

I just wanted to correct the record.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I may too, Mr. Chair, since I was referred to as a critic, I would absolutely endorse what was just said by my Conservative colleague. It's a misrepresentation to say that every single day we have received an offer to have a briefing. That is just simply not the case. We have gotten situational briefings by email starting on Sunday after a month. I think the record should reflect that.

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

If I may, Mr. Chair, there is obviously some confusion, because my officials feel quite strongly that the critics have been offered technical briefings every day.

We will sort that out. If that is not happening and you are not getting the information, let's make sure you are getting the information correctly so that you are able to attend those technical briefings. We will continue to send the situational updates.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Jansen.

We go now to Mr. Van Bynen.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you very much, Madam Minister. I appreciate your taking the time to be here.

After hearing the dialogue and the conversations and the discussions throughout the last few weeks, I'm convinced that we're in good hands. I appreciate the dedication and the commitment this team has towards the delivery of a clinical response to a very critical issue or an important issue. I for one would much rather have you focus on the delivery of the clinical response to the issues we're facing as opposed to dispersing information, but for the benefit of people who are watching, could you tell us about the websites and the information that's available on the websites so that people can go to those sites for an appropriate response to their questions?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Thank you very much, MP Van Bynen. Obviously, as a former mayor of Newmarket, you would know that the local level of public health is so critically important in the response to crises like this.

There is information on the website at canada.ca\coronavirus. It's added to every day and has information about the current status in Canada. It has a number of different pieces of information for a variety of different kinds of purposes. We continue to augment that website as we discover more and as we have more to offer.

In addition, we have advertising going out through social media that is teaching people how to wash their hands and what to do about covering their cough. That will ramp up now with the additional $1 billion that was announced today. A component of that is actually to boost our ability to do public advertising to Canadians about all of the ways they can help contribute to reducing the peak and flattening the curve. I think that will be very important information for Canadians so that they can participate and feel they have a role to play, which they critically do.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

All of the solutions are local. All of the MPs at York Region now are receiving a weekly update from York Region that talks about what's going on, on the ground, and I think that's critically important. Any MPs who want to inform their constituents should reach out to the local medical officer of health. I'm sure that most of them are providing updates on a very regular basis. I think that's critically important.

Madam Minister, I recently met with Infection Prevention and Control, or IPAC, regarding their concerns about antimicrobial resistance, or AMR. Further to our earlier discussions, it's my understanding that AMR is becoming more a global threat in the face of climate change. Can you inform the committee what the government is doing to address the issue of antimicrobial resistance?

[Patty Hajdu, Liberal, Thunder Bay—Superior North, ON]

Thank you very much. It's such an important conversation, and one that few Canadians are aware of, that the growing threat of antimicrobial resistance is truly a threat to Canadians' health. That's why we've been committing to using antimicrobials responsibly.

As you know, though, right now there is a surge on hand sanitizer, which is not helpful in terms of the work that we're doing to reduce the use of things that contribute to the growth of antimicrobials. Of course, during certain situations we see an increase in the use of these products, but it's more than that. It's also working to improve data. It's strengthening the stewardship of antibiotics. It's using research and innovation to address the gaps and challenges. We look forward to launching a pan-Canadian action plan, which will give more detail about how we can work together with provinces and territories at local levels and with Canadians on what we can do to combat this growing threat in the coming months.

We continue to have those conversations because it is a complex issue, but it will require significant practice changes on behalf of all of us.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

My community, Newmarket, is 14 square miles. It has 80,000 residents. I think it's the third most densely populated community in Ontario. Just outside of Newmarket there are lots of rural areas. One area that this committee has agreed to study is an analysis to compare and contrast urban health care and rural health care. The urban-rural divide that we see in parts of the mandate letter commits to promoting and standardizing access to health care for all Canadians.

What work is your department doing to improve health outcomes for Canadians in rural areas?