Health Committee on March 23rd, 2023

[The Chair, Liberal, Sean Casey]

We are ending so that we can suspend to allow the next panel to get in here and also have 55 minutes.

Thank you very much. You're welcome to stay, but you're free to leave.

The meeting is suspended for about three minutes to allow the members on the next panel to take their places.

[The Chair, Liberal, Sean Casey]

I call the meeting back to order. For the second panel, please allow me to welcome the Honourable Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health. In addition to the officials who were with us during the first hour, she is joined by Eric Bélair, associate assistant deputy minister, strategic policy branch, Department of Health, and Shannon Nix, associate assistant deputy minister, controlled substances and cannabis branch. From the Public Health Agency of Canada, Candice St-Aubin, vice-president, health promotion and chronic disease prevention branch, is joining us by video conference.

Thank you all for taking the time to appear today. We're going to begin with opening remarks from Minister Bennett.

Welcome to the committee, Minister. You have the floor for five minutes.

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

Thank you very much, Mr. Chair.

Mr. Chair, honourable members, thank you for the opportunity to appear before the committee today.

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

I'm very grateful for the full team, Mr. Chair, that you introduced, but I want to just highlight for the members here that Heather Jeffrey was once the associate minister on this side and is now president of the Public Health Agency of Canada. We just want to congratulate her on that big new job.

Minister Duclos has already given an overview of the funds we are requesting through the supplementary estimates (C) and the main estimates, and I would like to speak to how our resource plans will improve and expand mental health and substance use support services for Canadians.

As the minister said, and as all of us know, Canadians have to be able to access timely, evidence-based, culturally appropriate and trauma-informed mental health and substance use services to support their well-being wherever they live. We've made significant investments to support this since forming government, including $5 billion over 10 years, beginning in 2017, to expand mental health and substance use support services through the direct bilateral agreements with provinces and territories.

There was also almost $600 million for a distinctions-based mental health strategy for indigenous people, $270 million to support the Wellness Together Canada portal, and a number of other key investments to support the mental health and substance use issues of Canadians.

We all know there is more to do, and we believe that mental health has to be an integral and integrated part of Canada's public health care system, as it was in the Canada Health Act, which refers to physical and mental health.

We are also fulfilling a commitment to transfer billions of additional dollars to the provinces and territories over the coming years to support mental health and substance use services through the combination of both increasing the Canada health transfer and through $25 billion for new 10-year FPT bilateral agreements. All premiers agreed to move forward with this federal investment.

Mental health and substance use are one of the four shared priorities in the new bilateral agreements. They are also integrated into the other three: family health services, the health workforce, and data and digital tools.

The new FPT bilateral agreements will include an integrated, inclusive approach to mental health and will require the provinces and territories to produce detailed action plans with indicators and metrics. This approach is the most effective way to integrate mental health and substance use services throughout the health care system, including in primary care, and to ensure transparency and accountability from the provinces and territories to their citizens in terms of how this funding is spent.

We also know that the toxic drug and overdose crisis continues to take a tragic toll on families, loved ones and communities. Since 2017 we have committed more than $800 million to address the overdose crisis, and we are taking concrete steps to divert people with substance use issues away from the criminal justice system.

Approving B.C.'s decriminalization proposal for personal possession of certain substances was an important step. The January 31 coming into force includes monitoring both the public health and the public safety aspects of this complex issue.

Harm-reduction measures save lives, and safe consumption sites have reversed over 43,000 overdoses since 2017. Our government has invested over $88 million to expand access to a safer supply of pharmaceutical-grade drugs and to increase the life-saving naloxone across the country.

We will use every tool at our disposal to combat this public health crisis, including working with British Columbia since 2018 on litigation on behalf of all Canadian governments against big pharma to ensure that they pay for the problem they created. Canada has also restricted the marketing of opioids and increased the maximum financial penalties to combat the predatory practices of pharmaceutical companies.

I look forward to expanding on my brief remarks through your thoughtful questions.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Bennett.

We're going to begin with questions now, starting with the Conservatives and Dr. Kitchen, please, for six minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair, and thank you, Minister, for being here.

My questions to you are going to be more in your role as Associate Minister of Health.

I'm sure you're aware that the Public Health Agency of Canada was started in 2004 as a proactive agency to deal with emergency preparedness, infectious disease, chronic disease and control and prevention, not to mention the National Microbiology Laboratory, as well as GPHIN, which eventually was shut down in 2019.

One other aspect of it is the NESS. We know that the National Emergency Strategic Stockpile was plagued with issues at the onset of the COVID-19 pandemic by government mismanagement. One warehouse was shut down in Regina and threw out two million N95 masks and 440,000 medical gloves.

My question to you is this: Has the NESS been fully restocked at this time?

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

Yes, and absolutely I think we can answer that question. I had a great conversation with Minister Blair this week about his visit to the NESS and how important it is that we keep that replenished with products that will not be outdated and that will be accessible for any future—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Minister. I'm taking that as, yes, it has been restocked. Is that correct? How much money has been spent on restocking it?

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

Maybe I'll let Heather answer that.

[Heather Jeffrey, President, Public Health Agency of Canada]

The NESS has been expanded greatly as a result of the response to the COVID pandemic, so we're seeing the specific supplies needed to respond to COVID in addition to the traditional stockpiles that it's always maintained. It is fully stocked with COVID-specific therapeutics, medical countermeasures, ventilators and personal protective gear and equipment. A large majority of those supplies have been procured domestically now within Canada, as our domestic manufacturing has increased.

I would say that the expansion in warehouses and supplies in accordance with the needs also goes along with a more sophisticated management system, including IT, inventory management and just-in-time delivery and logistics.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I did not hear a cost of how much was spent.

[Heather Jeffrey]

I do not have the total figure for that number, but I can—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Can you provide that for us, please?

[Heather Jeffrey]

I can provide it to the committee.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Furthermore, a 2021 report by the Auditor General recommends that Canada “should develop and implement a comprehensive [NESS] management plan with clear timelines that responds to relevant federal stockpile recommendations made in previous...audits and lessons learned from the...pandemic.” PHAC agreed with this, stating that the agency was “expecting to complete the...management plan with clear timelines for implementation within 1 year of the end of the pandemic.”

I've searched high and low for this plan. I cannot find it. My staff has searched high and low. They cannot find it. The question, really, is this: Is it available? With that, is it that PHAC is waiting for the World Health Organization to declare that the pandemic is over before implementing such a plan?

[Heather Jeffrey]

There is indeed a plan. We have been working in real time, incorporating the lessons learned from the COVID response as we've gone along in pandemic response. That includes some of the information management and information technology that I was speaking about earlier. It includes a risk management approach to ensuring that we have the appropriate stockpiles.

We have not waited while we continue to respond to the pandemic. Vaccines, countermeasures and equipment continue to be deployed in real time to those who need it, including internationally for key partners, such as in Ukraine and elsewhere, where shortages continue to occur. We are working with the plan that has been developed and are responding fully to all the recommendations in the audit report.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Again, is the plan available for public consumption?

[Heather Jeffrey]

We can provide the lessons learned that have been implemented and the approach that we are taking to restock the NESS and to—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Lessons learned do not show us a plan. The Auditor General clearly stated that the plan would be developed. The Auditor General not only presented that report to PHAC; PHAC also said that it would put it out within a year. Can we see that plan, please?

[Heather Jeffrey]

The plan that would be published in response to the Auditor General's report, as you mentioned, is within a year of the end of the pandemic, and we continue to be responding to the pandemic as we speak.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

There's no plan, then. We have no plan for an emergency organization.

The reality is that emergencies are going to be happening. They do happen. Just like COVID came out of the blue, emergencies come up. The whole purpose of PHAC is to be proactive, doing tests beforehand to make certain that we're prepared when those emergencies happen. Therefore, the Auditor General has clearly pointed it out. You've indicated that there's a need for that. Why do we not have that plan today?

[Heather Jeffrey]

I would say, Mr. Chair, respectfully, that we do indeed have a pandemic preparedness plan. It includes the NESS. It includes its organization, its management and its stocks. Those plans have been updated in accordance with the new lessons that we've learned throughout this pandemic, and they're being implemented in real time. We have put in place additional inventory management software; we've procured stocks, and we've worked on domestic supply. The NESS is functioning very well and delivering in real time to provinces. The Auditor General's report has been very favourable in that regard.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Jeffrey.

Now we have Mr. Jowhari, please, for six minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Minister and officials, welcome to our committee. Some of you have been with us since 11 o'clock this morning.

It's good to see you, Minister.

Minister, in your opening remarks you talked about the historic investment that our government has made in health care a number of times, specifically in terms of mental health. In 2017 we allocated $5 billion. I'm glad to be part of the advocacy group that managed to facilitate that; however, this year, with the $198.6-billion investment over 10 years, I think we're hitting another milestone in our investment.

The four pillars that you talked about, and the integration of mental health to each one of those pillars, whether it was data, whether it was parity in providing the help, and whether it is outstanding....

Minister, this year the budget included about $48 billion more in spending. Can you decouple the part in terms of the mental health services that the extra money is going to bring in?

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

As you know, increasing the Canada health transfer to almost $200 billion allows the provinces and territories to really focus on treatment and their delivery of health care.

Where the $25 billion will go in the bilateral agreements with provinces and territories means that everyone has an attachment to a primary care team with adequate mental health and substance use support.

On the HHR, and on having adequate health human resources without burnout, being able to maintain retention means there have to be appropriate mental health supports and substance use supports there to keep a robust health workforce.

On the third category, which is mental health and substance use, we're hoping all members of Parliament, the provinces and territories and the stakeholders working on the ground will develop the kinds of indicators needed to make sure that we will be measuring as we go and that there will be accountability and transparency beyond just wait times or unmet mental health needs from the Canadian health survey.

The last section will be on data and the ability to see in real time what's happening with the transfer of records and having citizens have access to their own records. This is particularly important in mental health, where mistakes can be made and where we don't want any more people's intimate mental health records being in offices with fax machines anymore. This has to be private.

It is, I think, a very exciting time for the transformation of health and health care that some of us have been fighting for 30 years, like doctor to interdisciplinary, hospital to community, and the patient at the centre of their care with the systems wrapped around them as opposed to people having to fit into a system that doesn't work for them. We will have accurate data and evidence to be able to do what works and stop doing what doesn't work.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

You covered a number of points, Minister. You touched on the $25 billon that's spread over 10 years around shared priorities. Thank you for highlighting the mental health aspect.

You also touched on the area of KPIs. One of the challenges we saw back in 2017 was around the fact that we did not have any KPIs. It is very hard for us to be able to correlate the historical investment we made to the actual delivery and improvement of the services.

Can you talk about accountability and transparency, which are much desired? I have five community councils. One of them is around health, and they specifically highlighted the fact that we really need to hold all levels of government accountable for that.

If you could touch on that, I would really appreciate it.