Health Committee on June 20th, 2023

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 75 of the House of Commons Standing Committee on Health.

Today, we meet to commence our study of Bill C-284, an act to establish a national strategy for eye care. We will then proceed to sit in camera to resume consideration of the draft report on children's health.

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

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

Before we begin our consideration of Bill C-284, I'd like to welcome the honourable Judy Sgro, the member for Humber River—Black Creek, and sponsor of the bill.

I would also like to welcome Emmanuelle Lamoureux, who is appearing from Health Canada to answer any questions about the bill.

In accordance with our previous discussion, colleagues, we're going to go right to clause-by-clause. Ms. Sgro will be available to answer any questions you may have with respect to individual clauses. We also have legislative counsel here for any technical questions.

With that, pursuant to Standing Order 75(1), consideration of clause 1, the short title, and the preamble are postponed.

(On clause 2)

Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

I would like to move LIB-1, which adds vision rehabilitation to the strategy. It was suggested in MP Sgro's consultation with the vision community to make the bill as comprehensive as possible, and to cover all possible aspects to vision health care.

I'm removing “clinical practice guidelines”. LIB-1 reads:

That Bill C-284, in Clause 2, be amended (a) by replacing line 5 on page 2 with the following: “the prevention and treatment of eye disease, as well as vision rehabilitation, to ensure” (b) by replacing line 12 on page 2 with the following: “disease and to vision rehabilitation;”

Here I'm removing “including clinical practice guidelines”. It continues:

(c) by replacing line 14 on page 2 with the following: “eye disease prevention and treatment and on vision rehabilitation;” (d) by replacing line 17 on page 2 with the following: “tion to eye disease prevention and treatment and to vision rehabilitation; and” (e) by replacing line 24 on page 2 with the following: “to the prevention and treatment of eye disease and to vision rehabilitation, including”

Thank you, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Sidhu.

The amendment is in order.

You will notice that when she moved the amendment, it wasn't exactly as per the amendment that was circulated. I would invite legislative counsel to comment on anything arising out of that.

[Émilie Thivierge, Legislative Clerk]

Thank you, Mr. Chair, and Ms. Sidhu.

I'm just confirming that in the English, “by replacing line 12 on page 2 with the following: “disease and to vision rehabilitation;”. That's where we stop.

I would like to confirm the following for the French, because there's a slight change in the line numbers.

The Bill would be amended by replacing lines 13 and 14 with the following: "des maladies oculaires et sur la réadaptation visuelle". Everything that follows would be replaced by a semicolon.

Is that correct?

[Sonia Sidhu, Liberal, Brampton South, ON]

Yes.

[Émilie Thivierge]

Thank you, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Thank you.

Dr. Kitchen.

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

Mr. Chair, just for clarification, can you repeat that again? This is changing what we were sent, correct?

[The Chair, Liberal, Sean Casey]

Yes.

What has been changed is in (b), the words “including clinical practice guidelines” and the comma immediately preceding that are not part of the amendment. That's the import of the change.

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

It is just a semicolon at the end.

[The Chair, Liberal, Sean Casey]

That's correct.

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

Thank you.

[The Chair, Liberal, Sean Casey]

Is there any debate with respect to amendment LIB-1?

Go ahead, Mr. Aboultaif.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Thank you, Mr. Chair.

I'm surprised. I know words around eye rehabilitation have been added to almost every line under clause 2, but “including clinical practice guidelines” is going to be removed completely, based on the amendment.

I'm wondering why this is just coming up now, at the last minute. We have the sponsor of the bill here. Could Ms. Sidhu or someone explain that to me?

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Chair, through you, it comes under provincial jurisdiction. Respecting the jurisdiction is why we are removing that.

Perhaps Ms. Sgro wants to add something.

[The Chair, Liberal, Sean Casey]

Do you have anything you want to say about Mr. Aboultaif's comments?

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

On a PMB, we have to be extremely careful of the language we use to make sure we are respecting jurisdictions and so on. That was the reason for deleting “including clinical practice guidelines”.

“Vision rehabilitation” is a specific request from the Canadian Council of the Blind and the CNIB, because the future is a lot about rehabilitation, research and change. All of the clauses in the bill were put together with the CNIB and all the various vision loss organizations. Anything in the amendments and the bill itself has been worked out with those various organizations.

As you know, I've been waiting since 2003 for the government at the federal level to start focusing on vision care.

[The Chair, Liberal, Sean Casey]

We have a speakers list. It's Mr. Thériault, then Dr. Kitchen, then Mr. Jeneroux.

Go ahead, Mr. Thériault, please.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, I would just like to tell Mr. Aboultaif that, yes, the words "réadaptation visuelle" have been added. As for the semicolon following the word "oculaires", that was already part of amendment G-2. It's my understanding that it won't be included in this amendment if amendment LIB-1 is adopted. It's already included in amendment G-2.

Is that correct?

[The Chair, Liberal, Sean Casey]

That's correct.

Go ahead, Dr. Kitchen, then Mr. Jeneroux.

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

Thank you, Mr. Chair.

Thank you to Ms. Sgro for the bill.

The important part is that, with all of the amendments that all of a sudden have been thrown at it, it is now changed. Where the bill was initially acceptable, we're now debating amendments that have changed what the intent of the bill was, unfortunately.

I understand some of it. Mr. Aboultaif brought up the issue of “including the clinical practice guidelines”. I agree with Ms. Sidhu, and it was a point I was going to bring up. That is an issue that deals with the regulatory bodies making the decision. It shouldn't be bureaucrats making a decision on what the clinical practice guidelines should be. I'm glad to see that part has been taken out.

My question is on the issue of adding “vision rehabilitation”.

I understand that, and I recognize the great value of the CNIB in what they do in providing vision rehabilitation to so many people with vision issues and challenges. Ultimately, my concern is what is being put forward indicates that the government is going to determine which people are going to make the decision, who is trained to make the best choice for that vision rehabilitation, in the sense of whether it is the ophthalmologist or the optometrist. Those are the people who are qualified. It's the professions that determine this. In reality, who is going to make the decision on which vision rehabilitation specialists are going to put that forward and on what skills they have? Ultimately, it should be the profession making that decision, not bureaucrats and government agencies doing that.

It is a concern I have about adding that, too. I'm wondering whether you or someone else could comment or add to that. I would appreciate hearing about that.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Initially, I had moved forward without the rehabilitation in it. It was introduced to me by a variety of the organizations that said how important it was to be moving forward with this bill that they've waited so long for and to also talk about the future. The future has a lot to do with rehabilitation for vision, and they asked that it be included.

I don't think it's the government that would dictate, but it needs to be part of the structure of the framework. What this will do going forward, with your support, is create a framework. Within that framework, it will move forward within the government. It talks continually about working with the provinces, stakeholders and the various partners to move forward with the framework. Ultimately, I believe the appropriateness would be done.

[The Chair, Liberal, Sean Casey]

Next is Mr. Jeneroux.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair.

Thank you to my floormate, and congratulations for making it this far with your PMB.

Mr. Kitchen had a lot of my questions about the vision rehabilitation. Before committee, you and I spoke a bit about that. I was hoping that maybe, just for the comfort of some members, providing.... I get that it's in the future and we're planning for that. Are there some examples of what exactly that scope would mean? It seems like something that is forward-thinking and progressive as part of this bill.

Again, is there something you can provide us that is a bit more tangible about vision rehabilitation and what it looks like and what it would mean? That would be great.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

I don't have a lot of examples, but I can say there was recently an apparatus, I will call it, that is new research that's being done for macular degeneration. It was recently approved by Health Canada. Again, that is going to change the way macular degeneration is dealt with in Canada. More importantly, it is going to ensure that more people are getting tests done early and becoming aware of eye disease. If one in five Canadians has an eye disease that possibly could have been prevented, we need to talk about it. We need to be doing whatever we can on the prevention side, right?

On the rehab side, helping people regain or maintain their sight makes them able to enjoy life, period. Otherwise, as you all know—I've talked with many of you—once a person loses their eyesight or it's severely diminished, it changes everything. They're subject to depression, isolation and so many things that make it very difficult for them.

Anything we can do that moves a framework a little farther ahead and that will encompass assistance for them I think is invaluable.