Health Committee on March 23rd, 2023

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

Thank you for your leadership. I think the work you did on the handbook for parliamentarians on mental health and mental health literacy is hugely important to all of us and our teams. It's been an example to so many stakeholder organizations to make sure we're using the right terms when we're talking about mental health and mental illness, and knowing the difference. Thank you for that.

On the six priorities that were identified in 2017, we know that some great work has been done on the integrated youth services. Across the country, in all 10 provinces and the three territories, they're really working on getting those young people aged 12 to 25 the kinds of wraparound services they need, from peer counselling and primary care right up to social work and psychology. It has been really impressive.

On increasing mental health supports in primary care, we're getting somewhere—in Hamilton and other places—in digital health. Being able to have your mental health visit virtually has been helpful. There are mental health supports and services and mental health HHR.

However, last week, in Kelowna and Penticton, it was very interesting. The area in which the municipalities are feeling we're not doing well enough is on the complex care, which was the sixth priority. People who have serious mental illness and substance use are the people most in contact with the justice system and most frequently in the emergency department. If we could get, in some of these communities, those, say, 20 people properly housed and with wraparound services, this would be a huge focus, I think, for so many of the communities that I've been visiting.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

Mr. Thériault, you have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I have a question about the announcement of $1.5 billion for rare diseases. One of the officials can surely answer me.

Last time, I brought up people suffering from illnesses like amyotrophic lateral sclerosis, or ALS, who are expected to live three to five years. These individuals can take drugs to extend their lives, but the approval process, up to and including possible reimbursement, takes far too long.

Do you have robust mechanisms in place to fast-track patients suffering from rare diseases specifically?

[Dr. Stephen Lucas]

I will ask Eric Bélair to answer this question.

[Eric Bélair, Associate Assistant Deputy Minister, Strategic Policy Branch, Department of Health]

Thank you for the question.

In yesterday's announcement, the focus was on increasing access to medicines for rare diseases. As you saw, about 90% of the funding will be transferred to the provinces and territories to enhance their coverage.

In addition to providing easier access to medications, we want to make sure that the different agencies making decisions about medications work together to ensure that patients have timely access to them.

That includes the regulatory arm of Health Canada, which is responsible for what we call the agile regulations project that launched this past December. This will make it easier once drugs get authorized, even when we have little data on them. These are medications for small groups of patients. This method will make it possible to get these medications authorized and then gather data on their safety and effectiveness.

It also includes working with the agency that assesses health technologies, to help the provinces and territories get drug coverage information. Parallel studies are currently underway at the regulatory and health technology agencies. The goal is to ensure that processes are not sequential, but that they run parallel, reducing the time it takes for patients to access medications.

Another key factor is provinces negotiating drug prices with manufacturers.

One of the goals is to ensure that various decision-makers can expedite the efficiency of their processes.

[Luc Thériault, Bloc, Montcalm, QC]

I also have a question about the dental care plan.

The Parliamentary Budget Officer is concerned with the lack of oversight and is worried about fraud, given that expenses are not reimbursed only upon presentation of a receipt.

Why was the program fast-tracked?

[Dr. Stephen Lucas]

First, the government introduced interim dental benefits legislation and it was adopted in Parliament. The Canada Revenue Agency administers this benefit with tools to strengthen alignment with [Inaudible—Editor]. It uses a compliance and enforcement system to check receipts among a portion of claimants, for example.

It's an interim program.

[Luc Thériault, Bloc, Montcalm, QC]

Yes, it's an interim program. Nevertheless, the funding envelope for health is the same for everyone. We don't have a penny to waste. We need to make sure that a full $650 worth of services have been rendered for the $650 we send. In some cases, parents may only need half of that amount to cover dental expenses for their child. We can't just send that money for nothing. Otherwise, there will be a problem: We would be wasting money that could be invested elsewhere, for other types of care. We have no money to waste in health care.

Doesn't this method feel rushed? I'm not saying it, it's the Parliamentary Budget Officer.

Have you warned the government that this might lead to fraud? That's what happened with the Canada emergency response benefit.

[Dr. Stephen Lucas]

As I said, it's an interim program targeting children from low-income families.

[Luc Thériault, Bloc, Montcalm, QC]

Yes, but does that mean we should waste money on an interim program?

[Dr. Stephen Lucas]

The Canada Revenue Agency uses tools to check people's information and enforce the law. In addition, they learned a few lessons on avoiding potential waste from the other programs set up during the pandemic.

[Luc Thériault, Bloc, Montcalm, QC]

The Parliamentary Budget Officer says that the Canada Revenue Agency has no plans to systematically check information under this program.

[Dr. Stephen Lucas]

That's not true. The Canada Revenue Agency has a systematic verification program.

[Luc Thériault, Bloc, Montcalm, QC]

We will let the Parliamentary Budget Officer know, then.

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

Mr. Thériault, as a former general practitioner, I feel that this measure to get parents to take their children to the dentist is really important from a prevention standpoint.

[Luc Thériault, Bloc, Montcalm, QC]

We don't dispute that.

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

It's a priority to promote prevention.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault. That's all the time you had.

Next is Mr. Johns, please, for six minutes.

Welcome back, Mr. Johns.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Thanks to the minister for being here and to all the public servants who are serving our country, especially health officials. We really appreciate the work you're doing.

Minister, will the Canada mental health transfer that you promised to Canadians—it's in your mandate letter—be in the budget next week?

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

Thank you, Gordon, and thank you for continuing to push the need for resources for mental health and substance use.

I think that in my opening remarks I was clear that what has been established is that the more effective way of delivering excellent and appropriate mental health and substance use care is by integrating it into primary care, into the support for health human resources, with free-standing mental health programs and substance use, as well as in the data. We will see in that $25 billion that there will be dedicated dollars.

All of the provinces and territories have established mental health as a priority—

[Gord Johns, NDP, Courtenay—Alberni, BC]

I have some questions around that.

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

—and we will work with them on their action plans, with indicators as well as targets, as well as being able to make sure that in that elevated Canadian health transfer, they will have more money for treatment in their—

[Gord Johns, NDP, Courtenay—Alberni, BC]

That's a no, then, in terms of the direct transfer, but we know that Canada spends a woefully low amount on mental health and substance use with regard to health care, below that of most of our G7 and OECD partners, and it shows.

In the absence of the Canada mental health transfer, can you guarantee, then, that the provinces and territories will allocate funds to mental health and substance use under the bilateral health agreements to the amount of 12%, which is around what our G7 and OECD partners are spending?

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

I think that Eric and, yes, I should have introduced both Shannon, from the—

[Gord Johns, NDP, Courtenay—Alberni, BC]

I wish we had time to do a big introduction, but I'm just asking, will we be at 12%?