Health Committee on Nov. 29th, 2022

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 46 of the House of Commons Standing Committee on Health.

Today we will meet for two hours to consider the supplementary estimates (B).

Today's meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022.

I will remind you that screenshots or taking photos of your screen of those participating virtually is not permitted.

In accordance with our routine motion, I'm informing the committee that all witnesses have completed the required connection tests in advance of the meeting.

Colleagues, could I have your attention? Once we get to 12 o'clock you're going to regret this extra couple of minutes of chatter, because you're going to want to question the ministers, I'm sure.

Okay. I've just gone through the preliminary remarks and I have indicated that witnesses have completed the required connection tests.

I would now like to welcome the ministers who are joining us for the first hour: the Honourable Jean-Yves Duclos, Minister of Health; and the Honourable Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health.

They are joined by the following officials, who will stay with us for the entire meeting: from the Canadian Food Inspection Agency, Philippe Morel, vice-president of operations, by video conference; from the Canadian Institutes of Health Research, Dr. Michael Strong, also by video conference; from the Department of Health, Dr. Stephen Lucas, deputy minister, Heather Jeffrey, associate deputy minister, and Dr. Supriya Sharma, chief medical adviser; and from the Public Health Agency of Canada, Dr. Harpreet Kochhar, president, and Dr. Howard Njoo, deputy chief public health officer and interim vice-president, infectious disease prevention and control branch.

Thanks to all of you for taking the time to be with us today.

We're going to begin with opening remarks from each minister.

Minister Duclos, if you would like to begin, you have the floor for five minutes or less. Welcome to the committee.

[Jean-Yves Duclos, Liberal, Minister of Health]

Thank you very much, Mr. Chair.

I would like to thank you for inviting us to appear before the committee today.

We are grateful for this opportunity to talk about our work in the health portfolio and our financial overview for supplementary estimates (B) for 2022-23.

I am accompanied today by Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health, as well as: Dr. Stephen Lucas, Deputy Minister, Health Canada; Heather Jeffery, Associate Deputy Minister, Health Canada; Dr. Supriya Sharma, Chief Medical Advisor and Senior Medical Advisor, Health Canada; Dr. Harpreet Kochhar, President of the Public Health Agency of Canada; Dr. Howard Njoo, Deputy Chief Public Health Officer, Public Health Agency of Canada; Dr. Michael Strong, President, Canadian Institutes of Health Research; and Philippe Morel; Vice-President of Operations, Canadian Food Inspection Agency.

Before we address the issue at hand, our appearance here today also provides us the opportunity to share with you the latest information related to the shortages of children's and infants' analgesics.

Thanks to close collaboration with our industry partners, a record number of children's analgesics are currently being manufactured across the country, with some companies producing twice as many units as they did at the same time in 2021.

As an example of this increased production, during the month of November only, a total of 1.1 million units of children's Advil products from Haleon will have been made available for the Canadian market, which is a significant amount versus the typical November.

This is obviously good news for Canadians: Children's pain medication is being produced in large numbers in Canada. This increased domestic supply is in addition to the importation of more than one million units announced last week, distribution of which is currently under way across Canada.

An additional importation of around half a million units is scheduled for the next three weeks. As we continue to approve increased supply to community pharmacies and retailers, work continues to ensure pediatric hospitals are well stocked and in a position to manage the shortage.

We are also looking to find longer-term solutions with provinces and territories, industry and stakeholders such as pharmacies and children's hospitals, and we will continue to keep the committee apprised of the progress.

To the matter at hand today—supplementary estimates—the Government of Canada continues to address the long-term effects of the pandemic, and our budgetary needs reflect this, as I mentioned earlier.

At this time, we are seeking $3.41 billion for the health portfolio. Beginning with Health Canada, I am seeking an additional $1.9 billion. This funding will be used to address Canada’s ongoing COVID‑19 response, as well as ongoing health care issues.

It also includes funding to improve mental health supports and services, as well as funding to address the opioid overdose crisis and problematic substance use.

My colleague, Minister Bennett, will have more to say about those two issues in a few moments.

As part of supplementary estimates (B), PHAC is seeking an increase of $1.4 billion to its reference levels. This includes $118 million in new funding and $1.2 billion in reprofiles from 2021-22.

Through supplementary estimates (B), the Canadian Institutes of Health Research are also seeking an increase of $106.1 million. This investment will help implement the important clinical trials fund and provide funding to support the study of the long-term health impacts of COVID-19, as well as other important initiatives.

And finally, the Canadian Food Inspection Agency, CFIA, will see a budget increase of $19.5 million.

Overall, this increase will help the agency respond to the impacts of COVID‑19 on Canada’s food production and supply chain, as well as to the economic implications stemming from disruptions in employment.

In conclusion, our commitments as set out in our supplementary estimates (B) are a reflection of our most pressing health priorities. They demonstrate how we are taking action to protect and improve our health system for all Canadians.

Merci. Meegwetch.

[The Chair, Liberal, Sean Casey]

Thank you very much, Minister Duclos.

Next is Minister Bennett. Welcome to the committee. You have the floor.

[Carolyn Bennett, Liberal, Minister of Mental Health and Addictions and Associate Minister of Health]

Thank you, Mr. Chair.

I am pleased to be here today to talk about a number of investments requested in the 2022-2023 supplementary estimates (B).

I would like to begin by acknowledging that we are meeting on the unceded traditional territory of the Algonquin people, who have been the stewards of this land and water since time immemorial.

I am pleased to be here, of course, with my colleague, Minister Duclos, and our colleagues from Health Canada, from the Public Health Agency and from CIHR.

While COVID‑19 has increased the number of people experiencing mental health problems, it has also made many of us more willing to talk about our own mental health.

We hope that this begins to reduce the stigma that remains a significant barrier to seeking care.

Since 2015, we have made historic investments to support mental health and to deal with problematic substance use, including the $5 billion to the provinces and territories to increase the availability of mental health care; $598 million for a distinctions-based mental health and wellness strategy for indigenous peoples; $270 million for the Wellness Together portal; $45 million to develop some national standards on the priorities I articulated by the provinces and territories; $350 million in the substance use and addictions program since 2020; and many other targeted investments on substance use and mental health promotion innovation.

The $5-billion investment through provincial and territorial bilateral agreements is currently providing $600 million of additional annual funding until 2027.

I am also pleased to say that the online portal, Wellness Together Canada, and its companion pocket app, PocketWell, which have specific funding included in the supplementary estimates (B), have assisted Canadians in getting the help they need both directly and as a stepping stone to receiving advice or finding more specialized care.

We know, sadly, that when so many Canadians need support, that support is still all too often out of reach. There is much more that needs to be done. Among other further actions, we will continue to engage with provinces, territories and stakeholders to invest additional funding through a mental health transfer.

The Standards Council of Canada, together with our provincial and territorial partners, is also developing national standards for evidence-based mental health and addiction services on the six priority areas identified with our provincial and territorial colleagues.

We are particularly encouraged by the incredible early progress of national standards for integrated youth services.

We welcome the CRTC's decision to approve the new 988 three-digit suicide prevention line, and we are working to ensure it has the capacity for a very successful launch next fall.

We want people to know that if they are struggling with thoughts of suicide, or know someone who is, help is available right now at 1-833-456-4566.

The toxic drug and overdose crisis continues to take a tragic toll on families, loved ones and communities. Our government will use every tool at its disposal to work with its partners to end this national public health crisis. Since 2017, we have committed more than $800 million to address the overdose crisis. We are taking concrete steps to divert people who use drugs away from the criminal justice system. This is a public health issue.

Approving B.C.'s decriminalization proposal for personal possession of small amounts of certain substances was an important step. So far, we have also supported 27 projects supporting a safer supply of drugs.

We must demonstrate to Canadians that we share their concerns and have been listening to those with lived and living experiences, the experts, and those on the front lines, to put in place evidence-based actions to address the parallel pandemics of mental health and the tragic ongoing toxic drug and overdose crisis.

I look forward to exploring this topic further by answering your thoughtful questions.

[The Chair, Liberal, Sean Casey]

Thank you very much, Minister.

We're now going to proceed with rounds of questions beginning with Dr. Ellis for six minutes, please.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair.

Thank you to both ministers for being here, and to your officials as well.

It is certainly an important time for Canada, with the health care crisis we have, not only in the delivery of health care but in mental health as well. Again, thank you for being here.

Minister Duclos, through you, Chair, if I may, the Prime Minister spoke very openly in the House of Commons about the 7,500 doctors, nurses and nurse practitioners that $3.2 billion was going to bring to this country.

The question is, where have we spent that money? How many of those doctors, nurses and nurse practitioners in each of those specific areas are actually here working on the ground now?

[Jean-Yves Duclos, Liberal, Québec, QC]

Thank you, Dr. Ellis.

Thank you, everyone.

First, on the statement of what we've done until now.... As we know, COVID-19—although it's not over—is better than it could have been. That's, in part, because the federal government invested $72 billion to a large extent to support the safety and the health of Canadians. That is continuing through vaccination, rapid tests and access to treatments like Paxlovid.

Second is the additional $2 billion that was announced in the last budget to reduce the backlog in surgeries. That, obviously, comes through supporting health workers, nurses and doctors, hiring more of them, recruiting more of them and retaining more of them.

Finally, there are other measures that are supportive of the health workforce, including the $3 billion in long-term care, the $3 million in mental health care and the $3 billion in support to home care and community care services.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you for that, Minister.

I guess the question was perhaps not clear. I didn't ask about COVID. I asked specifically about how many of the 7,500 doctors, nurses and nurse practitioners for $3.2 billion are actually working on the ground.

The Prime Minister spoke very clearly about these numbers in the House of Commons. I know you were there. I was there. I heard him say it in person. That's the question for which I'm looking for an answer on behalf of all Canadians and, perhaps, most specifically, on behalf of the 100,000 Nova Scotians without access to primary care.

Sir—through you, Mr. Chair, if I may—please provide the answer to how many of those actual health practitioners are on the ground.

[Jean-Yves Duclos, Liberal, Québec, QC]

On that specific piece, we would certainly want to commend the efforts of the provinces and territories, which in the past months, thanks in part to the support of the federal government, have been able to repair the damage created by COVID-19 by recruiting more health workers, by training more of them and by retaining more of the nurses who otherwise would have left the profession.

The $2 billion I mentioned earlier—the increase in the CHT from $43 billion to $45 billion—and the forthcoming additional increase to the CHT from $45 billion to $49 billion, which is a 10% increase, are all supportive of the efforts of the provinces and territories to hire, recruit and retain more of our health care workers.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Minister.

Mr. Chair, I guess that answer is not forthcoming, unfortunately. That being said, maybe I'll try something different.

Wait times are an entirely different topic and an incredibly important topic here in Canada. I've had an opportunity to meet with some of our orthopaedic colleagues. There is no health care shortage of orthopaedic surgeons, I'm told, so they're able to perform these surgeries.

Only $2 billion of the $6 billion available for wait time changes has now been deployed. We do know very clearly that folks who are awaiting total joint arthroplasties are often not able to work, which is creating difficulties for their families, and those on the wait lists need medications, etc. It would appear that would be an easy deployment of more of those funds. Can you please tell me what the government's opportunity is going to be there for deploying the funds specifically for total joint arthroplasties?

[Jean-Yves Duclos, Liberal, Québec, QC]

That's a great question. It points again to the $2-billion additional investment that we provided to the provinces and territories just a few weeks ago. That $2 billion is currently invested by the provinces and territories to reduce these very significant backlogs, as you said, in surgeries and diagnostics.

That's in addition to the efforts, as you also pointed out, that the provinces and territories are making to provide better access to family health teams, access to primary care and access to family doctors. That's key to making sure that people don't have to go to the emergency department and undertake difficult and expensive surgeries for things that could have been cared for and cured if they'd had access to, as you said, appropriate and accessible primary care and family health services.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Minister.

Mr. Chair, we heard about a Canada mental health transfer in the 2021 platform of the Liberal party. None of that money was deployed in budget 2022, and none of it was deployed in the fall fiscal update.

Can you give us an update, sir? The country wants to know when this mental health crisis is going to be addressed and when the money is going to be deployed. We still see that the finances are not being deployed out there. Canadians are hurting. They need to be served by this government. There's money out there that your government, sir, has committed. That money is not being deployed.

The questions that need to be answered, of course, are “when?” and “why?”

[Jean-Yves Duclos, Liberal, Québec, QC]

On the Canada health transfer, as I mentioned briefly earlier, it moved from $43 billion to $45 billion about nine months ago, plus an additional $2 billion for backlogs, surgeries and treatments. It's going to increase to $49 billion in March 2023, which is an increase of 10%. It will then move up to $51 billion, then to $53 billion and to $55 billion. Over four years, an increase of about 25% is already guaranteed.

The Prime Minister also pointed to the fact that we will be doing more. We need to. We acknowledge that we will be doing more. As you said, it's to acknowledge the fact that our health workers and patients are hurting across Canada.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

Next we have Ms. Sidhu, who's participating virtually.

Go ahead, Ms. Sidhu, for the next six minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you, Minister Duclos and Minister Bennett, and all the officials who are appearing at the health committee today.

My first question is for Minister Duclos.

Minister, I see the funding to support new national women's health research, which is an initiative to advance research in high priority areas.

COVID-19 highlighted the importance of health research and innovation.

Can you tell us the importance of investing in women's health research and what our government is doing?

[Jean-Yves Duclos, Liberal, Québec, QC]

Thank you very much, MP Sidhu.

Not only do I appreciate that question, but I think my colleague Carolyn will also appreciate it very much. CIHR is a key federal institution that supports not only research on diseases but also research in support of patients, families and caregivers. We often speak of diseases. More importantly, we want to speak of the importance of supporting those living with different diseases. That includes mental disorders and all of the impacts that these disorders and diseases have, like I have said, on families and communities.

There has been a total investment of $414 million in 965 research projects since March 2020. Many of them focus on COVID-19, but many others focus on mental health and substance use support needs of Canadians across our country, in particular through the difficult time that we've seen in the last two and a half years.

Again, there's a great level of support on the part of the federal government, but, more importantly, there have been immense efforts by researchers and scientists across the research community in Canada, which we not only want but need to celebrate on every possible occasion, including today.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Minister.

Minister, we know that there's significant pressure on our health system. Right now chronic diseases like diabetes play a role, and investing in healthy eating and research can help ease those burdens.

Can you tell us what you're doing to invest in research prevention and treatment?

[Jean-Yves Duclos, Liberal, Québec, QC]

Thank you, MP Sidhu.

Sonia, first of all, I think most people around this room would know of your significant work and considerable success in moving forward with a framework for diabetes in Canada. We're grateful to you and to all the other partners, leaders and experts who have supported that framework that we tabled on October 5, just a few weeks ago.

That framework is important and is also complementary to other investments and efforts we're making, including the release and implementation of Canada's new food guide, which we know is key to helping Canadians eat healthier and live healthier.

Just a few weeks ago, we also announced important front-of-package nutrition labelling, which is going to be of great help by informing Canadians of the type of healthy food they might be able to purchase in a grocery store and to encourage the food industry to reduce the levels of sodium, sugar and fat in the food that people rely on to live their lives.

Again, MP Sidhu, Sonia, thank you for your leadership on that. We're quite fortunate to be able to support that leadership.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Minister.

Minister, parents were concerned about the children's pain medication shortage. What type of steps are being taken to increase our domestic manufacturing capacity for these critical medications?

[Jean-Yves Duclos, Liberal, Québec, QC]

There are two things. First, due obviously to the terrible viruses that are impacting our children and our young children in particular, the demand for analgesics has increased dramatically over the last few weeks.

Domestic production has also increased by about 100% in Canada over the last few weeks. That's good news. To make sure that families and children have access to the appropriate medication at the appropriate time, we have also approved emergency importations of a large number of medicines and analgesics from outside of Canada, which are currently filling the shelves and the stocks of community and hospital pharmacies across our country.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My final question is for Minister Bennett.

Minister Bennett, do you believe a one-stop approach will increase the likelihood of youth getting access to mental health or addiction support in the most appropriate and timely way? Can you expand on that?

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

Yesterday we had a very exciting announcement. We were able to demonstrate that all 13 jurisdictions have come together to understand that this model of integrated youth services that was led by the Foundry in British Columbia, the hubs here in Ontario as well as Aire Ouverte in Quebec....

The idea that you can get the most appropriate care by the most appropriate person at the most appropriate place and at the most appropriate time means that, all of a sudden, things such as peer support.... Those with lived and living experiences are able to make it feel safer for young people to come. They get primary care. They get a social worker, a psychologist or an addiction medicine person helping with their education, getting a job and housing, all in one place, with an integrated record.

The exciting thing is that yesterday we were able to announce that the CAMH and CIHR will not only be working on these evidence-based models but also creating the evidence as we go to be able to demonstrate what works and what doesn't. I think this is a huge leap forward in how we actually deliver integrated services to Canadians instead of this patchwork quilt of non-systems that was a huge challenge to youth in the past.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Sidhu, and Minister Bennett.

I now give the floor to Mr. Garon for six minutes.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you, Mr. Chair.

Ministers, welcome to the committee.

My question is for the Minister of Health.

To further optimize the resources of the health care system, Quebec has had, over the past 20 years, the Castonguay-Nepveu, Rochon and Clair commissions, and the Rochon, Couillard, Barrette and Dubé reforms.

Despite this, according to some Liberal parliamentarians on Parliament Hill, Quebec and the provinces have value-for-money problems and have not made all the required efforts, thus justifying the imposition of conditions for health transfers.

In light of these facts, is that also your position?

[Jean-Yves Duclos, Liberal, Québec, QC]

My position is based on the discussions with the 14 health ministers. Over the past year, we have held 11 virtual meetings. The last meeting was held in person in Vancouver a few weeks ago. We all agree on the same solutions and priorities, including those you are referring to. Having access to a family doctor for primary care is critical to ensuring that people who are sick receive care quickly, rather than waiting for their condition to worsen before going to a hospital emergency room.

Access to appropriate and timely mental health care is also a priority of every health minister in the country.

Access—