Public Accounts Committee on Feb. 10th, 2009

[Scott Vaughan]

Thank you.

On the ridership, the government said they will not know the uptake until 2011. That's when they can look at the tax returns to see how many Canadians have applied to use the tax fund to get a reduction in their annual passes. The information would be given to Finance from that, and they would actually do an analysis.

One of the things we mentioned is that Finance Canada has not yet identified a methodology they will use to figure out some causal link between the uptake on the $635 million and what that will be in terms of total tonnes reduced in greenhouse gas emissions.

On the second one, we reviewed a report that was done by a consultant in Finance Canada. They said that anything above $800 would be an excessive price per tonne on reducing greenhouse gas emissions. We have said that the probable range would be $2,000 to $3,000 or more under the change of $635 million to bring about a reduction of 35,000 tonnes.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Since you don't do the value-for-money audit, I will come back to the Auditor-General.

Is this value for money? Is it money well spent? The $635 million does not get any return in a reduction in GHGs and we have no idea what's going on.

And while we were going through this transit pass situation, the previous minister was killing a transit project in Ottawa. I'm trying to figure out how I balance it, especially from a public accounts perspective. How do you balance moneys that are going down the drain and there's no accountability?

[Sheila Fraser]

Chair, on the trust fund, as we mentioned, this is a policy decision and it is up to parliamentarians to make that judgment as to whether these are appropriate mechanisms. And on the transit as well, our role is really to provide you with the information so that parliamentarians can make the decision as to whether there's value for money.

We have indicated, and the commissioner has indicated, quite clearly that the expected results are negligible. But again, the measurement systems are not rigorous. No one will really know for two years what the actual cost of the program was.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Fair enough. Thanks.

[The Chair, Liberal, Shawn Murphy]

Mr. Young, for five minutes.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

Welcome, Madam Fraser. Thank you for all the great work you do.

I'm looking at chapter 8, on page 3, at the health indicators. You say in this report, “In the late 1990s, the Canadian health care system was generally seen as being in crisis. Public opinion surveys revealed that Canadians were very concerned about the quality and sustainability of the health care system.”

Of course we know that was when the Canada health and social transfer was first created, cutting about $2 billion to the provinces for health and social welfare. Mr. Christopherson and I were both members of the Ontario Parliament at the time, and it was a very difficult.

But a lot has changed. The Healthy Canadians report is an important tool to bring accountability and ensure that we're accomplishing our goals.

You have described some of the deficiencies in the report. Can you describe some of the aspects where the report delivers?

[Sheila Fraser]

Thank you, Chair.

As we mention in our report, the Healthy Canadians report was generated by a first ministers agreement in 2000. This followed up then in 2003-04. Additional funding of some $21 billion was put into health care across the country.

All of the provinces and territories and the federal government agreed to work on developing a series of indicators for the health care system and to publish these reports every two years. A set of indicators--27, I think--was developed and was agreed to by all the jurisdictions. The federal government, of course, has its own responsibilities—for example, first nations health—so they would report on that.

The provinces and territories issued the first reports and the federal government issued the first reports in 2002. The reports were subject to audit assessment by their legislative auditors. We assess the federal report. These have continued.

The federal government was the only jurisdiction to actually publish its report in 2008, so we do give them credit for actually continuing to give this kind of information on indicators. We just wish the reports had perhaps gotten a little better over time, had improved over time, had given more information to help readers actually assess what the statistics mean.

[Terence Young, Conservative, Oakville, ON]

I can see that on page 2, where you say, “The reports provide indicators, such as wait times for diagnostic services, without providing sufficient information....”

Well, I was in that position in my own riding of Oakville last year, trying to find out how wait times for emergency services had gone down. In fact they had gone down; I was able to get that information from the Canadian Institute for Health Information website, just by googling. There was also an Ontario government website.

It doesn't explain what are medically necessary wait times. For example, my friend Mike is having a hernia operation this week. His doctor had told him that he wouldn't operate until Mike lost seven pounds; he took six weeks and was able to lose seven pounds. So for a hernia operation, seven weeks might be perfectly appropriate. Or sometimes for knee surgery, a doctor might tell a patient that they should lose some weight before their knee gets replaced.

Is that the kind of information you're talking about that should be added in the reports?

[Sheila Fraser]

That would be an explanation around what the results actually mean, and as well the trends over time, so that people can understand and interpret what these indicators are actually telling them rather than just simply see a number on the page.

[Terence Young, Conservative, Oakville, ON]

Since it's the provinces that deliver health care, wouldn't it be appropriate to have a joint coordinated source of value-added information? Or is that something that has to be strictly done by the federal government because it's their money?

[Sheila Fraser]

No. In fact, one of the comments we're making is that there are other reports on health indicators across the country—from CIHI, as you mentioned—and we think it's certainly time for the federal government to look at the reporting on health information. Obviously they can perhaps coordinate more with CIHI and see how they can have, quite frankly, one really good report to Canadians.

They will have to work with the provinces as well, of course. As we mentioned, the provinces have not continued to issue these reports every two years. But I think there may be a solution through CIHI, working with them to get better information across the country.

[Terence Young, Conservative, Oakville, ON]

What recommendations do you have for Health Canada to ensure that Canadians get more aware of the Healthy Canadians report and the information that's in it?

[Sheila Fraser]

We indicate in the report that there has been little take-up, or disappointing take-up, of these reports. We indicate that they should be preparing a communications strategy to ensure that Canadians are aware of the reports and know where to go to get the information.

[Terence Young, Conservative, Oakville, ON]

Have you any idea of how that might take form?

[Sheila Fraser]

No, but they have indicated that they agree, and have said that they will do a strategy for the 2008 report. I would expect that after that they will do some kind of assessment on the effectiveness of that strategy.

[Terence Young, Conservative, Oakville, ON]

Do you have any suggestions for bringing first nations and Inuit information into the report?

[Sheila Fraser]

Yes. In fact, a large part of the federal government responsibility is for first nations health. That figures quite prominently in their report; again, there should be better information included in that, and they should continue to work with first nations and aboriginal groups to develop those indicators even further.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. Young.

Thank you, Ms. Fraser.

Colleagues, that concludes the second round. Since we do have a notice of motion, we'll go right down to the closing comments.

Ms. Fraser, on behalf of everyone on the committee, I want to thank you, and I want to thank Mr. Maxwell and Mr. Vaughan for being here today. The information was very informative.

Ms. Fraser, go ahead, if you have any closing comments for the committee. Then I'm going to turn it over to you, Mr. Vaughan and Mr. Maxwell.

[Sheila Fraser]

Thank you, Chair.

I'd just like to say it's always a pleasure to appear before committee. We thank you for your interest in our reports. We look forward to hearings, even this Thursday, on our audit reports.

[The Chair, Liberal, Shawn Murphy]

Mr. Maxwell, do you have any closing comments?

[Neil Maxwell]

No. Thank you, Chair.

[The Chair, Liberal, Shawn Murphy]

Mr. Vaughan, do you have any closing comments?

[Scott Vaughan]

No. I'll say thank you to you and all the members.

[The Chair, Liberal, Shawn Murphy]

Again, thank you very much.

Before we adjourn formally, I understand Mr. Christopherson has a notice of motion.

Mr. Christopherson.