Debates of June 12th, 2001

Points Of Order

[Bill Blaikie, NDP, Winnipeg—Transcona, MB]

As the member for Regina—Qu'Appelle said, it almost happened in 1984. I still want to call him the member for Yorkton—Melville. Twenty-five years is a long time for someone to have the name Yorkton—Melville, but we have to get used to the new one.

In the parliament of 1984 there were 40 Liberals and 30 New Democrats. It could well have been 20 New Democrats and 24 Liberals or something like that and then what would we have had if we had this kind of standing order? It was bad enough that we had that many Tories, I must say. The fact that we had that many Tories led us to the situation that we find ourselves in now. They became so full of themselves that they could not tolerate any kind of minority opinion or criticism so we have this standing order in front of us, a creation of the Conservatives.

We are glad to hear the contrition. We are glad to hear the confession. We are glad to hear that they now realize that this was wrong, but would it not have been wonderful if they had realized that the first time I spoke to this rather than 10 years later?

[Derek Lee, Liberal, Parliamentary Secretary to Leader of the Government in the House of Commons]

Mr. Speaker, I take it that we have had a bit of a fessing up about the genesis of Standing Order 56(1).

I want to bring to the attention of the House for your consideration four points in relation to this item.

This may be the third ruling the Chair will be asked to make today. It has been a busy day for the Chair and our sympathies to you for that.

On the face of this rule, which is really what the Chair has to deal with here, I think what the member opposite is alleging is that in some way the element of the order passed that provides for what we are going to be doing in voting later on tonight does not involve the management of our business, to take the words from the rule. That is the one element of Standing Order 56(1) that I think we are dealing with. We are dealing with the management of the House's business.

The member suggests that the business of supply is special and that it goes beyond the management of our business. The whole business of supply to be sure is special and unique in terms of the things that we do around here, but I suggest that we are not managing all the supply procedure here. What we are doing is managing the stream of voting that would occur in amendments to the supply bill. I point out that the order we have adopted does not prevent a vote at second or third reading of the supply bill tonight. It deals with all of the amendment motions.

What we are actually managing here is the voting. I would like to point out that the context that we are dealing with as we vote these days in the House is actually quite a bit different from the context that existed many years ago when this rule was put in place.

All members will recognize that when the House votes now, as we have been voting for a number of years, there are many applications of votes. Our whips in the House routinely, and I use that word advisedly, apply votes. That is a significant change in context for the House. When we as a House routinely apply votes, I suggest that the management of our business does include the management of the application of these votes. Like it or not we apply votes now.

Just a few days ago I think I noted the government whip actually applying a vote for a member who was not even voting with the government. This business of application of votes is now part of our routine and the motion that we have adopted intends to manage the flow of the application of votes. I suggest that is consistent with Standing Order 56(1) which refers to passing motions for the management of order of business.

The member for Winnipeg—Transcona has suggested that the minister had to consult before he moved the motion. The standing order does not require consultation. The standing order requires the denial of unanimous consent. That is precisely what was denied when the minister moved his motion earlier. He did not have to consult. He only had to find a denial of unanimous consent. Therefore the precedent for the application of rule 56(1) was certainly there.

The suggestion is that because we now have parties with less than 25 members that is somehow relevant to the interpretation. I suggest it is not. The rule is clear. The number of members required to force a vote or to deny the motion is 25, not 12. The fact that we have parties that have 12, 13 or 14 members is irrelevant. The rule is clear. We are not in the business of rewriting the rule here for the smaller parties. If we wish to do that later we can.

I suggest, Mr. Speaker, that the suggestion that this is out of order is not correct. It certainly raises an issue, but on the face of Standing Order 56(1), for the reasons discussed around the House, I suggest that this motion and this manner of disposition is in order.

[The Speaker]

I think the Chair has heard enough on this point at this time to deal with the matter before the House for the time being.

As the hon. member for Pictou—Antigonish—Guysborough himself, in his remarks at the outset, suggested, this is a matter that the Chair could take under advisement and deal with at some later time and that is exactly what I intend to do.

In so far as today's proceedings are concerned, the Chair is satisfied that the motion was adopted this morning without 25 members rising in their place and without objection at that time as to the procedural acceptability of the motion. The matter has come before the House at this late hour and, in my view, the motion has been adopted and will apply for tonight's proceedings, and we will leave it at that.

The Chair is quite prepared to review the terms of the standing order involved and the interpretation which might be given it in the circumstances because, as the government House leader pointed out in his list of occasions on which this rule has been used, some of the usages might appear at any reasonable glance to go beyond the terms of the standing order itself.

The Chair is prepared to have a look at the standing order, to look at the usage and to also look at the possibility that the modernization committee, which must have studied this matter, might have had something to say on it. I will examine its report again with interest, but I do not believe there was anything in it concerning this particular standing order.

The Chair is always concerned for the fairness of the applicability of rules to all hon. members in the House and of course will want to reflect on the submissions made today. I will take them under consideration and will come back to the House, since we are likely adjourning tomorrow, at some time in the distant future.

Main Estimates, 2001-02

[Allan Rock, Liberal, for the President of the Treasury Board]

moved:

Motion No. 1

That Vote 1, in the amount of $1,268,024,342, under HEALTH— Department—Operating expenditures, in the Main Estimates for the fiscal year ending March 31, 2002 (less the amount voted in Interim Supply), be concurred in.

Mr. Speaker, it is an honour to take part in the debate tonight with respect to the main estimates of the government, particularly as they relate to Health Canada.

May I say at the outset that as Minister of Health and speaking on behalf of my colleagues in government and those professionals with whom I work at Health Canada, we never forget that we in our own generation are custodians of an achievement of enormous value, the Canadian health care system.

It is an achievement that is more than simply a government program. It is a national undertaking that reflects the values and priorities of Canadians. We are committed to strengthening, to preserving and to promoting that system. That is the purpose for which we ask for the resources that are included in the main estimates.

As we discuss Health Canada and Canada's health care system, perhaps the most important point of departure and the matter I would first like to mention in addressing this issue in the House tonight is the agreement that was reached among the governments in the country just a few months ago with respect to the present state and the future of Canada's health care system.

A few months ago we negotiated with the governments of the provinces an agreement on the future of our health care system. Last September, the Prime Minister signed an agreement with the provincial premiers which contained two key elements, the first of these being more money.

We have added considerably to the federal transfer payments to the provinces so that they will have the resources on hand for health care delivery. In fact, we have added 35% over the next five years to the transfer payments to the provinces.

These considerable amounts will put the provincial governments in a position to meet their responsibilities in the coming years for providing on the ground health services throughout the country.

The second key element was the areas on which we reached agreement in order to improve and strengthen our health care system. Clearly, our system is facing major challenges at this time. As a government, we have agreed on some significant steps in order to face these challenges.

Whether it is with respect to the shortages of doctors and nurses, whether it is with respect to finding new and innovative ways of providing frontline services to Canadians in communities where they live, whether it is with respect to renewing equipment available in the health care system, or broadening the accessibility of home and community care, or increasing the use of information technology, or promoting health as opposed to simply curing illness, all of these key elements were included in the agreement reached among governments just a few months ago.

I can report to the House that since last September, as Minister of Health I have worked with my counterparts across the country to make sure that we pursue the common ground we have reached, that we act on the agreement of last September and carry forward toward its objectives.

Apart from the cash transfer, apart from the elements of agreement, apart from the work we are now doing in common, there are other aspects of last September's entente that I would like to draw to the House's attention and report upon.

There were three targeted funds where the Government of Canada committed specific amounts to particular purposes. The first was a targeted fund of $1 billion for new equipment.

We earmarked $1 billion for this. This amount was made available to the provinces to renew Canada's medical facilities. It was distributed on a per capita basis, and is now in the hands of the provinces.

Since last September $1 billion has been available to the provinces to purchase MRIs, CT scans, new X-ray equipment, lithotripters, surgical suites, whatever it is in the way of medical equipment that might be needed on the ground.

In Ontario, for example, my own home province, that amounts to almost $400 million that has been available since last September to be used by provincial governments in buying new equipment. It is ironic that we would have read recently about the shortages of MRIs here in Ottawa or elsewhere in the province when the provincial government has access to almost $400 million and has had for some months. Naturally we urge our provincial partners to use that money for the purpose for which it was intended and apply it toward the purchase of new medical equipment to meet the needs of Canadians wherever they may live.

The second targeted fund of the three was $800 million which we made available to fund innovative new practices in making frontline services available. What that means is access to doctors and nurses by Canadian families where they live and when they need those services.

We are used to the system of family physicians practising in private offices on a fee per service basis so that during business hours during the week they are there to see patients. However, we all know that the need for a physician when someone is ill or injured does not end at the close of the business day. We also need to have access for families in the evenings, overnight and on the weekends. It is for that reason that the country has been moving toward different ways of making primary care or frontline services available, such as community health centres, shared practices, looking at new ways of paying doctors, and having teams of doctors and nurse practitioners to respond to community needs.

The Government of Canada wants to encourage provinces to pursue these innovative new approaches. It is for that reason we have set aside $800 million in the primary care fund which we are providing to provincial governments to fund innovative new ways of meeting these frontline needs.

We have now blocked out the criteria with respect to how that money will be provided to provinces and the objectives we are trying to reach in making it available, and I believe it is going to be a source of improved services in the years ahead.

The third dedicated fund from last September is $500 million to encourage the adoption of new information and communication technologies in health care. What does this mean? It means two things.

First, it means telemedicine to make the services and the opinions of specialists available to Canadians in remote or rural areas. It means telemedicine so that there can be teleconsultation in psychiatric services. It also means teleradiology, taking an X-ray or an MRI in the northern part of a province and transmitting it digitally to an expert or a specialist in a major urban centre where it can be read.

The second purpose is electronic patient records so that no matter where we travel in the country our medical information is available to health care professionals who need it to provide us with services. If we are ill or injured, God forbid, and arrive at a hospital, information about our case which is taken by the emergency room physician, the admitting doctor, the family doctor, the specialist, the home care worker or the pharmacist can all be shared in one electronic record that is instantly accessible.

That way we would avoid the repetition of tests and the repetition of the history. We would avoid miscommunication between patient and provider. We would make sure that everybody is aware of things such as allergies that the patient might have.

This is the way of modernizing health care, of making it better for Canadians, and these targeted funds will help to do that.

The last element of the September agreement that I want to report to the House on has to do with accountability. I believe we are all in agreement on all sides of the House that we have to be accountable to taxpayers for the moneys we spend. In health care that is no less true, yet in health care there has never been a systemic way of looking at the outcomes in the health care system to assess whether taxpayers are getting their money's worth. It is for that reason that the agreement among all governments provides that starting in September 2002 there will be regular reports to Canadians that measure the performance of the health care system and tell Canadians in plain language on a regular basis how it is doing.

That means that on indicators such as accessibility of frontline services 24 hours a day, 7 days a week, accessibility of home and community care, and readmission rates of hospitals to test whether they are discharging patients too soon, we will be measuring what happens and reporting to Canadians regularly. That will provide a way for Canadians to know how this health care money is being spent, now at $100 billion a year in Canada, and it will provide a way for us to determine where the weaknesses are in the system so they can be addressed.

Let me add just one other matter. During the election campaign of last fall the government also undertook to create a citizens' council on quality care, which means taking the quality control function out of the hands of government and putting into the hands of Canadian citizens. It means creating a council to which we will appoint Canadians from across the country who will monitor the regular reports we make to make sure they are objective, complete, accurate, readable and usable by average Canadians in their homes. It means a citizens' council on quality care which will itself report on how the health care system is doing and will monitor quality in health care services. That is an important way in which we will make the health care system accountable to Canadians.

Before I conclude let me touch upon just a few other things we are working on at Health Canada which members will see reflected in the estimates before the House tonight.

Let me first touch upon health research. This is an area where the Government of Canada has long been seen to have a unique responsibility. Since the 1930s when we created the Medical Research Council, research has been a federal domain. Provincial governments are also active but the federal role has been recognized and respected.

Two years ago we replaced the Medical Research Council with the Canadian Institutes of Health Research. The House adopted Bill C-13 to create the institutes. Since the adoption of that legislation a year ago much has happened. We have appointed the president, Dr. Alan Bernstein of Toronto. Dr. Bernstein and his board of directors have been hard at work. They have named the first 13 institutes, the original slate of institutes. There are now institutes of health research on everything from cancer to mental health to diabetes. These 13 institutes each have appointed scientific directors. Those scientific directors, with their advisory councils of experts, are putting together strategic research plans.

At the same time as we have created these institutes, the Government of Canada has more than doubled the amount of money that we make available each year for health research. It is now over half a billion dollars and I can tell the House that it is on a trajectory upward, so that we can meet our commitment to Canadians to double in the course of the coming years the amount that this country spends on research and development.

The Canadian Institutes of Health Research are off to a good start. Around the world they are earning Canada a reputation for excellence. They are attracting the best and the brightest to stay in Canada or to return to Canada and do their health research here. I believe those institutes hold the promise of advancing the frontiers of medical and health knowledge and of accelerating the discovery of or treatments and cures for diseases and illnesses that afflict Canadians.

I might also report to the House with respect to some of the other initiatives in which we are now engaged.

The Speaker earlier tonight made a ruling with respect to Bill S-15 which has to do with tobacco. I would like to briefly mention what we are doing in that regard because tobacco is the number one public health issue in the country. Every year 45,000 Canadians die prematurely because of tobacco use. That is more Canadians than those who die annually as a result of car accidents, suicides, murder and alcohol combined. It is a tragic toll and we can do something about it.

Recent indications are that smoking rates are coming down in Canada but they are not coming down fast enough. There are troubling numbers about young people, especially young women, who are starting to smoke. We adopted a strategy with many parts.

The Tobacco Act, which the House enacted in 1997, increased taxes. Recently we brought taxes up on cigarettes because that helps, especially among youth who are price sensitive. We are making sure that the public is aware of the dangers of smoking by informing them of the health risks and about the strategies of tobacco companies that try to encourage people to smoke and continue to smoke.

We will continue to with the tobacco issue. Members will see that we are devoting $480 million in the course of the coming five years to this strategy, including major investments in media campaigns to increase the awareness among Canadians, especially young Canadians, of the dangers of smoking.

I would like to touch upon two or three other areas.

The availability and the quality of health services in rural areas has been a preoccupation of mine for some time. The fact is that almost one-third of our population lives outside the major centres. About nine million people live in communities of 10,000 persons or less. If we look at the demographics in rural and remote Canada, we find that the population generally is older than in urban centres. The health statistics are less encouraging. There are more illnesses and more injuries. Yet at the same time, where the needs are greater, services are often less accessible. Whether it is ambulances or emergency rooms, family physicians, nurse practitioners, specialists or equipment, rural Canadians do not have the same access as urban Canadians.

One of the grave concerns I have about two tier medicine in Canada is not between the rich and the poor, but between the urban and the rural Canadian. For that reason, two years ago I opened the office of rural health at Health Canada. Although we can say the delivery of health services is a provincial responsibility, and we respect scrupulously provincial jurisdiction, nonetheless it is a national challenge to ensure that the promise of the Canada Health Act is fulfilled for all Canadians, not just those who live in major urban centres.

We appointed as executive director of the office of rural health a physician who practised in rural Canada and a former member of the executive for the Society of Rural Physicians of Canada. We set about putting together a national strategy to deal with this challenge. We convened a national conference on rural health at the University of Northern British Columbia in Prince George. We set aside $50 million in budget 2000 to fund pilot projects at the rural level. We brought together people from across the country to work with us to find ways of making the accessibility of services more appropriate in rural Canada.

Part of the answer lies in telemedicine and using modern technology. That will help a great deal, but it is not the only answer. It is also a question of attracting physicians and nurses and keeping them in rural Canada. It is a question of overcoming the sense of professional isolation that often drives doctors away. This is something that we have to work on because we cannot abide a situation in which one-third of the population is denied access to quality care in Canada. Working with my provincial partners, I intend to continue in that regard.

In the few moments remaining I might simply mention the organs and tissues initiative with which members are familiar. The House committee on health made such good recommendations, all which I accepted. We are changing nutritional labelling to provide more information to Canadians about the foods they eat. We are making medical marijuana available on a compassionate basis for those who are ill.

Of course, we have the draft bill with respect to cloning and assisted human reproduction which I put before the health committee on May 3. That committee is working and will return with recommendations in the months ahead.

All of this is important, challenging and exciting work. I turn to it with a sense of obligation to the House and Canadians to make sure that we preserve and strengthen Canada's health care system.

[Diane Ablonczy, Canadian Alliance, Calgary Nose Hill, AB]

Mr. Speaker, our population is aging and I see two problems looming. One is that a lot of older people will either choose to be treated at home and to go through an illness in the comfort of their own home or in some cases there are no hospital beds for long term patients because a lot of illnesses suffered by elderly people are long term.

Does the minister have any plan or vision for how these individuals can be realistically treated without simply transferring the burden of their care to the family or having unqualified, or unsuitable or unreliable assistance that really does not meet the needs of the patients and families?

The second question is about patients who do not need to be hospitalized but do need some kind of care. Increasingly there are no facilities to which these patients can be moved, so hospital beds are taken up unnecessarily, and these patients simply have no where to go and no one to care for them. This is not only a problem today but will be an increasing problem.

Could the minister tell the House about his vision, plans and what he is doing about it?

[Allan Rock, Liberal, Etobicoke Centre, ON]

Mr. Speaker, the member for Calgary—Nose Hill is right. with an aging population and the differences in the way the practice of medicine is now being carried out, the focus of care is shifting from hospitals to the community. In fact, 25 years ago almost half of all health spending took place in hospitals. Today it is less than a third. We can see it for ourselves. People go in at nine in the morning for surgery and come out at four in the afternoon. We remember in our youth that people used to go into the hospital for a week or two when they had their appendix out, or some other such operation. That is one aspect.

The other aspect is that as people age, more of them want to stay at home. I can speak personally and say that in the last five years both of my parents died of cancer. They chose to die at home. In 1994 and 1995 my sisters and I had to find out about home and community care. We had to look in the yellow pages under H to find out what we could about home care. It was not easy. We found there were gaps in what was covered and what was not.

We have to rationalize this and accept that the Canada Health Act, which covers only services in hospitals and by doctors, was written at a time that was different. Now there is a whole range of home and community care that is unaddressed. The provinces do their best to try to cover it. Some have very elaborate home care programs, like Saskatchewan and British Columbia. With others it is less consistent.

In answer to the member's question, I can say that the Government of Canada has to work with provinces to find a way to make home and community care an integral part of medicare because it is just as medically necessary for aging seniors to get care at home as it is for people to get the care in hospitals. It may not be provided by doctors, but whether it is nurses or home care workers it is just as important.

I want to work with my provincial colleagues and partners to find a way to address this increasing need. I think it can be done. A couple of years ago I suggested a national home care approach which was not well received. Perhaps the atmosphere at the time was not very positive. Since the agreement of last September, I think the atmosphere has improved enough to continue those discussions.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, I have two quick questions for the minister.

He referred to last September's agreement, which was signed here in Ottawa. He neglected to tell us that all the premiers asked him to provide for indexing in the transfer payments. Why did he not agree to this request?

Second, I would also ask him if he could tell us the per diem salary or remuneration of the chair of the task force he set up to review the Canada Health Act, former premier Romanow? Could he tell us what he gets daily?

[Allan Rock, Liberal, Etobicoke Centre, ON]

Mr. Speaker, yes, I referred to the agreement we negotiated a few months ago here in Ottawa. I am very proud to have been part of this effort.

In my opinion, it was an important moment in history when all governments, including the government of Quebec, regardless of their affiliation, their ideology, agreed on a single substantial document and on health care priorities.

I remember well when the Premier of Quebec was there with the Prime Minister of Canada. After signing the agreement, Mr. Bouchard said “That was important, and I would like to thank the Prime Minister of Canada for his patience and for the agreement we have just reached”. I was very proud and I think it was something important.

As regards Roy Romanow, the chair the commission we set up, I cannot say this evening exactly how much he is being paid, but I can assure the hon. member that his work is vital to the future of our health care system.

He will examine thoroughly our needs for the next ten or fifteen years in the health care system. Mr. Romanow, as the premier of Saskatchewan, managed a system for 10 years. He is well placed to provide valuable advice.

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Mr. Speaker, I would like to ask the minister about the follow up to the September 11, 2000 accord. Today is June 12, 2001, nine months since the September accord was approved. If a woman can have a baby in nine months, then surely the government can produce something concrete in terms of promises made at that time. In particular, I would like to ask the minister about the commitment to deal with the critical shortage of health care professionals and nurses that is rampant across the country today.

The accord promised to ensure that each jurisdiction would have the people with the skills to provide appropriate levels of care and services and commits governments to work together to do just that.

Nothing on that front has happened since September 11, 2000. The government has made a lot of promises, but failed to act on a very fundamental issue for ensuring quality health care. When will we see action?

[Allan Rock, Liberal, Etobicoke Centre, ON]

Mr. Speaker, we have seen action on a number of fronts, and I am happy to respond in detail to my hon. friend's question.

First, this year's transfers to the provinces reflect the agreements of last September and the increased amounts. This year Ontario, to use my home province as an example, will receive an additional $1.2 billion from the Government of Canada in the transfers available for health. It is interesting to note that when the province of Ontario tabled its budget a few weeks ago, an additional amount of $1.2 billion was made available for health. In other words, the Government of Canada is contributing exactly what the Harris government is increasing for health spending this year.

Second, the member speaks about the availability of doctors and nurses, which is of course the very first thing that the Prime Minister and the premiers listed in the priorities that were identified for government action. I am happy to report that we have made progress there, two things among many.

First, the health ministers agreed and published a national nursing strategy some months ago which reflects the hard work of the nursing profession and the provincial governments in sorting out ways to deal with the shortages in nursing care in Canada: addressing the underlying problems of working conditions; increasing enrolment in the nursing schools; and addressing some of the grievances that the profession has had with respect to its position in the health care system.

In relation to doctors: Three years ago total enrolment in medical schools in this country was about 1,570 places. Next September it will be 2,000. We are going in the right direction. I could go on but I think my friend has the general idea.

[Elsie Wayne, Progressive Conservative, Saint John, NB]

Mr. Speaker, my question for the minister has to do with the fact that he wants to allow those who have AIDS to smoke marijuana.

I heard the minister speak tonight about tobacco and the effect it has on our health. Is the minister looking at legalizing marijuana? I did some research on marijuana. As soon as people smoke one cigarette it goes into their brain cells, stays there for nine days and then continues to build up.

If the minister is looking at legalizing marijuana, has he done any research on its side effects? Could he assure Canadians that we do not have to worry about it?

[Allan Rock, Liberal, Etobicoke Centre, ON]

Mr. Speaker, the member has been good enough to speak succinctly about her concern in this regard.

First, my focus has been on the medical availability of marijuana for compassionate purposes. As hon. members know, we have now published proposed regulations to govern the way in which those who are ill or dying can get access to marijuana if a doctor feels it can help relieve their symptoms.

On the subject of either decriminalizing or legalizing marijuana, as the member knows the House created a special committee by resolution some two or three weeks ago which I believe has now been named and which will soon begin sitting. That special committee has been asked to look at the whole question of Canada's policy toward the non-medical use of drugs. That issue will come before the committee. I think it is important not to prejudge the outcome. We must let the committee do its work and hear the various points of view.

It is a subject on which there are varied opinions, even within the hon. member's party. I think the committee should listen to the evidence, hear the various viewpoints and come back to the House with recommendations that can be debated here so that we can ultimately make a decision based on the facts.

[André Bachand, Progressive Conservative, Richmond—Arthabaska, QC]

Mr. Speaker, from the outset I want to elaborate on the points made by the Minister of Health in his speech. The minister refused, however, to answer a question from the Bloc Quebecois member about Mr. Romanow's salary. Even more strange is the fact that, during the some 20 minutes that he spoke, the Minister of Health did not mention the Romanow commission. He did not say anything about it.

He talked about his government's accomplishments, about rural communities, the September agreement, the citizen's council and the non medical use of marijuana. That was fine. I told myself “He is going to talk about the Romanow commission”. It is supposed to be the key to the future, the country's vision in the area of health. But nil, not a word.

We know, because we put the question to him several months ago, that the minister is not comfortable. It gives him a rash when we talk about the Romanow commission. He does not like it. I understand. This is a man who seems to have some vision.

They have imposed on him an unemployed premier who is too young to be appointed to the Senate, because the Prime Minister appoints senators whose average age is 72. Mr. Romanow must wait a few more years. So that he does not remain idle, the government put him in charge of a royal commission of inquiry. His salary is not known. He is on his own, looking after his own business.

In the meantime, the minister is talking about his vision of health care in this country. He seems to have solutions to the problem, yet it is entrusted to a royal commission. That is a waste of money. For 18 months or 2 years, there will be nothing forthcoming from this government in the area of health. What the Romanow commission will manage to do, once the Liberal Party has changed leaders, is to serve as the party's political commission in the next election, at the taxpayer's expense. Otherwise it is pointless.

The minister seems to be struggling with this. While not wishing to put words in his mouth, of course, I am not sure the Minister of Health was in agreement with that. If it had been one of the ideas he had come up with, he would have referred to it this evening. When the minister was talking health with his colleagues, did he mention the royal commission? Not at all, not a word, it must be forgotten if possible. We get the feeling there are little domestic squabbles on the government side. I thought the minister would refer to the commission when he spoke. The fact that he did not speaks volumes.

The minister probably senses a cabinet shuffle coming that will end up with him in Canadian heritage, instead of having to live with a royal commission of which he is not fond.

From the health point of view, we need a vision, but having a vision requires knowledge of what is going on in the field. In Ottawa we have the good fortune to have 301 men and women who have been elected by the voters in their ridings and who are, I hope, at least in this corner of the House, connected with the people in their ridings. If that connection exists, then one knows what the problems are. If one knows what their problems are, and if one is lucky enough to have been gifted with average intelligence, one can find solutions.

There is the House of Commons Standing Committee on Health, and there is one in the other place as well. The minister does not seem to be lacking in intelligence; he is capable of identifying the problem. He is someone who does not appear to be afraid of talking to his provincial colleagues, or so it would seem. He was asked about the water issue. He was told “There is a problem with water. Today, in many places in Canada, people cannot drink a glass of water without running the risk of being poisoned and without endangering their health”.

He was told “Keep pushing. The House passed a motion on this”. He seems to be pushing with his provincial colleagues, and we think it is fine. If the problem is known, let us get on with the solutions.

When the minister mentions the September agreement, he is putting a spin on things. I am sorry to use this expression, but it is very well known here. A spin is a way of presenting reality from a different angle. With the present Minister of Finance, we have got used to hearing that the government will invest $500 million, $2 billion, $300 million over five years and that the tax cut will be $8 billion or $5 billion over seven years. The timeframes are always long.

When the Minister of Health tells us that the government is going to invest $800 million in new equipment, this is not annually. This is what it would take annually to make up the ground lost. It is for the entire duration of the agreement, unindexed, as the NDP member pointed out.

The federal share of the cost of replacing medical equipment over a number of years is $800 million. We number more than 30 million in this country, so this is not much per capita. In the more remote or rural areas, medical care costs more because additional incentives are required.

This government has been out of new ideas since 1993. With a few exceptions, it does not know what it is going to do the next day. Why? Because the Prime Minister is like that. He has said “Bring me a problem, I will fix it”. That is it. Sometimes he fixes it, sometimes he does not. Most of the time it is fixed all wrong, and health is one of these problems. Things have been discussed in Canada for years, but for often political, reasons, they are totally rejected. The government refuses even to discuss them.

As regards the initiatives involving tax points, the government says “Ah, no tax points. We want nothing to do with that. We gave you your cheque. You have your money. Do your bit. When you run out, come back and see me. Knock at my door, and, if you are nice, I will give you some”.

We have long talked about tax points across the country, regardless of political stripe. What we are saying as well is that tax points assure the provinces of stable funding. Of course, once again, this does not resolve all the problems. We have to talk about equalization. We agree that it is less to the advantage of the poorest provinces to take tax points than to have an amount of money that is the same for everyone.

Enough of ad hoc funding for the country's health care system. That is what it is. When the provinces want to develop new initiatives, the federal government will tell them “There are five basic principles in the legislation we are thinking of changing. That is perhaps why we appointed a former premier, who could perhaps not be appointed to the Senate but could perhaps come up with solutions. So, wait for the commission to submit its report, that is in at least two years”.

This is not planning. In the meantime, people are tearing out their hair trying to find ways to keep cardiologists in the regions and to attract family doctors in the provinces. We see this in Quebec.

The Minister of Health does not seem to know what is going on in Quebec. The government introduced a policy concerning the principle of family doctors being available seven days a week throughout Quebec, but the Minister of Health said that anything outside normal store hours was perhaps excessive. He should perhaps take a look at initiatives such as those in Quebec.

The legislation should be reviewed and modernized. The government is afraid. It feels that five principles are enough and it would rather interpret. The government is afraid of talking about private sector health care. As far as the private sector is concerned, we will recall that the future former leader of the official opposition had held up a little sign during one of the debates in the last election campaign that read “no two tier health system” because he was not capable of explaining this clearly enough and people did not believe him. He therefore felt obliged to write it down on his little sign, thinking that then he would be believed, but it did not make much difference. The private sector is already a presence. It is a presence in both health and education.

Not very far away from here, to give an example of what is happening with increasing frequency in the health field and will continue to happen, a new school was recently opened in one of the municipalities in the Outaouais region. This happens because of heavy development in a given area. That school was built by the private sector. The school board and the government signed a 25 year lease and will operate the school.

The school's bricks and mortar were put in place with private sector funding, but its soul remains the responsibility of the school board and the department of education. We will be seeing more and more of this, yet the government is afraid to raise these questions and has struck a royal commission to find solutions to all our problems. Even if they are saying over on that side that they have solved a problem, there are still more unsolved.

However, I praise the Minister of Health's handling of the hepatitis C compensation issue. It is not working properly, however. I thank him because I want to give credit where credit is due. He is prepared to act on this but speed is of the essence.

We have a supposed agreement on financial compensation, along with a law practice that is supposed to be handling it, but there are still problems. The payments are delayed, 20% or 40% of them. Very few people have received all their money. The minister has some responsibility in this. The government and parliament have some responsibility in this.

No one better say the problem is resolved because the people are no longer on Parliament Hill with placards demanding compensation. It is not resolved or it is only partly so.

In this regard, I repeat, when the minister does something good, I tell him. When he does not do what he is supposed to, I tell him, as well, with respect. So it is important to resolve this matter.

There is another matter to be resolved at some point.

My colleague from New Brunswick raised the issue of marijuana. It is not enough to be for it or against it. The government has been talking about this one for years. They will settle it. The minister said “I will make marijuana available for medical purposes”. This is the compassionate element.

However, there is no pot on the market that meets the government's standards. There is none, and it have no system. It has given no thought to the criminal code. It has given no thought to the problems involving the various laws governing the country, the provinces and the municipalities.

So we have another problem. The government is forced to go to court, and the people it wanted to help are arrested by the police. So that is not resolved.

A committee on the non-medical use of drugs was just set up and I have the honour and the privilege to sit on it. I must say that I hope people will be patient. If we are ready to show compassion for the sick, we will have to show compassion for those who sit on that committee, because its mandate is very broad.

We will also have to target the problems. What is the committee's mandate? Its members will define it in the fall. We will work hard to ensure that this mandate is as clear as possible so that we can take a stand on the issue and on plausible and easily feasible solutions.

Will we deal with the drug issue by saying we will find solutions? The NDP member for Vancouver East sits on that committee. She represents, the poorest part of Vancouver.

It is the part of Vancouver that is not shown on postal cards. It is her riding. There are problems. We must tackle this and find solutions to the problems of heroin users.

Will this also be included in the committee's mandate? Maybe yes, maybe no. Some will say “Instead of legalizing other drugs, perhaps we should deal with those who have serious problems with existing drugs”. This is probably what the committee will look at.

This being said, I would like to talk a little bit about what will happen this evening. Unless something out of the ordinary or some miracle happens, this is the last evening of the first session following the election.

After an election, people thought, after all, it had only been re-elected for three and one-half years or I should say three years and five months, that the government would come up with some good ideas.

Once again, things are something like at an auction, going once, going twice, going three times, sold. It takes three times to get a bill passed. The first time, no go, then there is an election. Then there is the second time, and in mid-mandate, there is the throne speech. This puts everything back to square one. Then things start all over again for the third time, but now there is a general election. Going once, going twice, going three times.

How many times has the endangered species legislation come up? It is endless. Then there is the young offenders legislation. Here we go again, changes, modifications, then it gets blocked in the Senate. Then an election comes along. Soon another change will be coming: the Prime Minister. Then there will be another throne speech. We get nowhere.

In the health field, there is even less progress. This evening we in the opposition had the opportunity, with the means currently available to us I must add, to get some important messages across regardless, messages that open up some discussion. Perhaps we should vote for part of the night.

I will say what the public would say to us “At the rate you guys are getting paid now, it won't hurt you to sit overnight from time to time”. We stop, but at the same time we are getting a message across “The job is not over. Our work on important bills is not over. We would like to get on our way. No problem. I want to get home, but that is not the right idea”. However there are some important points that are not settled. Any MP will be prepared to stay here in order to solve a really important problem.

With that, I will wish you, Madam Speaker, as well as all members, a good summer, and a healthy one. As far as health is concerned, however, we are on our own. Unfortunately, I do not think that the government can help us on that.

We have to count on the provinces, and they have all the trouble in the world delivering services because of a government that hands over money for the health of all Quebecers and Canadians a little bit at a time.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Madam Speaker, I thank the member for the clarity of his remarks about the government. I appreciate what he said about the Romanow commission.

Does he share my point of view? I could provide him with a copy of the document, if he likes. I asked the Library of Parliament for information about what the provinces had done in the way of commissions of inquiry or task forces on the future of health care systems.

The House will not be surprised to learn that, between 1993 and the present, seven provinces have themselves formed commissions: New Brunswick, Nova Scotia, Saskatchewan, Alberta, Quebec and Ontario. So, seven out of ten provinces have already done what the federal government wants to do.

We understand that the provinces are doing this, because they are the ones providing the services. They are responsible for organizing the health care system so that care can be provided.

Does the member agree with me that we do not need a commission such as the one proposed by the federal government, because this is not its primary responsibility second, because we know where the needs are and how the health care system must be reorganized; and third, because money is a large consideration, but not the only one?

For example, in Ottawa last September, the premiers asked that transfer payments be indexed. Was the government willing to do this? Of course not. Does the hon. member share this point of view?

[André Bachand, Progressive Conservative, Richmond—Arthabaska, QC]

Madam Speaker, several provinces are experiencing that problem. They consulted the service providers, namely the doctors, nurses, volunteers, staff members and administrators. These men and women are familiar with the problem.

They must make hard decisions on a daily basis. At the same time, they have to come to Ottawa to beg. They are asking the federal government to restore at least the 1993-94 level. Perhaps tax points or a new equalization system might help some provinces.

The problem is known, and the provinces took their responsibilities. There may be some exceptions in various types of services, but I will talk about one province, mine, Quebec. I am not necessarily a friend of the government in office but the fact remains that regardless of political stripe some things that are done in Quebec deserve our attention. The federal government wants to reinvent the wheel with the Romanow commission.

Ask people on the streets, in Quebec and elsewhere in the country. They do not care at all about the commission. The Bloc Quebecois member is right. Money may not be everything, but the right choices must be made and it is a lot easier to implement them quickly with money. This is why we are asking for a fair redistribution.

That is right, we must talk about the Canada Health Act, but in the meantime, can we help with the financial situation of the municipalities? What credibility can the commission have when we do not even know how much Mr. Romanow's is paid to sit on the commission?

We parliamentarians may not have all agreed on our increase, but everyone did agree that the non-taxable part was not right and that it had to be transparent. A royal commission of inquiry is set up and we do not even know how much the commissioner is paid per day or what his expense account is.

The hon. member is absolutely right. At one point, the work was done and what we must do next is to implement the solutions put forward by those who provide the services, namely the provinces.

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Madam Speaker, I am pleased to ask a question of the Conservative health critic because we are dealing with a very critical issue, that is the future of medicare, and the appropriate level of expenditure by the federal government for support of our universal public health care system.

In that context it would be remiss of me not to note that the erosion of medicare and the slide to privatization actually began under the Conservatives and under the direction of Brian Mulroney where we were on a path of seeing all cash transfers to the provinces for health care dry up by the year 2001. The Liberals came along and put in a cash floor in terms of transfer payments but really levelled the playing field to the lowest possible denominator.

I would expect that the Conservatives have had a re-thinking around this issue of transfer payments and the need for cash to the provinces. I would like to know what the current position of the Conservative Party is with respect to the level of funding from the federal government to the provinces and whether that party would be prepared to commit some of the $15 billion in surplus, if it had a chance, to health care to ensure medicare is sustained and to actually move our system toward the revamped, reformed system we are all talking about.

[André Bachand, Progressive Conservative, Richmond—Arthabaska, QC]

Madam Speaker, I remind my colleague that Mr. Romanow, who is chairing the commission, was probably one of the worst premiers in terms of cutting health care and creating huge problems for the system in his province, as with labour relations and with other fields. On this I think that regardless of stripe choices were made.

As concerns the public health system, we want to keep a public system with the broad principles of the Canada Health Act. What we said in the election, in 1997 and 2000, is that this had to be brought back to the 1993-94 level, which had been agreed on, and then move to stable funding.

This is why we talk of tax points and renegotiating the system of equalization payments, so that the richer provinces, like the poorer ones, may have stable funding within the whole transfer system, be it in health care, education, social assistance or other areas.

Yes, they said they had to increase, but by how much. There is no question of drawing an amount out of a hat. The provinces have already identified criteria. First, there is the question of economic growth that accompanies equalization tax points. That is important. There are richer provinces and there are poorer provinces. This is why one of the elements in the transfer must be the aspect of economic growth.

Population is another important consideration. We are also saying that distances must be taken into account. Urban centres like Toronto, Ottawa, Montreal and Quebec City can afford different quality services. There should be a rating that takes the geographic and demographic dispersal of a region into account.

There is also the question of population aging. In some regions and in some provinces the rate of aging is much higher, requiring a more targeted inflow of funds.

To these transfers, but first to these transfers in terms of tax points and equalization, these calculations, should be added a different approach understood by all the beneficiaries of the health care system in Canada.

[Yvon Charbonneau, Liberal, Anjou—Rivière-Des-Prairies, QC]

Madam Speaker, I thank our colleague from Richmond—Arthabaska for sharing his comments with us. I was going to thank him for his suggestions as well, but I did not find any of those in his speech.

There are criticisms of the health system, as he says. He tells us that there are still problems and I think the Minister of Health has said the same himself, that not everything has been said or done in that area.

I thank my colleague because he has provided our viewing audience with an opportunity to make a comparison between the health minister's words and what our government has accomplished, as summarized in a sober yet eloquent manner by the minister, and the inconsistencies of the opposition critic's words.

He tells us we lack vision, yet at the same time he faults us for striking a royal commission to address the problems and come up with a long term vision of the ongoing problems.

This is totally inconsistent. We have indeed taken steps to meet this challenge of providing a long term vision for Canada's health care system. The opposition critic has carefully omitted any reference to research, an area of great success. Our government's investments in health research will make it possible for there to be a thorough renewal of our country's health services and health care in the years to come. That is vision.

I would like to hear the opposition critic fault us, if he is able, for our investments in research and in health in Canada.

[André Bachand, Progressive Conservative, Richmond—Arthabaska, QC]

Very briefly, Madam Speaker, I thank the Parliamentary Secretary to the Minister of Health and give him greetings.

It is easy for a government to cut an arm or a leg off the provinces and then offer them an arm or a few toes. This is pretty much what happened with the government.

Since the 1993-94 cuts, the total percentage of federal funding we are seeing today is not huge. The government cut because it wanted to fight the deficit. Perhaps it should have cut somewhere besides health care. Then the government found itself investing much more publicly than in the past.

We do not oppose health care research. We oppose people who waste time looking for solutions that have already been found. This is why we are asking so many questions on the idea of a royal commission of inquiry, when, if I listen to the parliamentary secretary speaking for his minister, I will not criticize him here, he surely has a vision and the tools he needs to find solutions to the health care problems we face. We do not need a royal commission to do so.

[Diane Ablonczy, Canadian Alliance, Calgary Nose Hill, AB]

Madam Speaker, I would like to advise the Chair that I will be splitting my time with my colleague from Yellowhead.

Believe it or not, we are debating the estimates this evening. The portion of the estimates we are debating is the portion allocated to the health department. The health department budget is $2.7 billion for the current fiscal year. I am sure it will go up because the department has a lot of work to do.

The estimates of $2.7 billions were examined by the health committee. There were no suggestions from the committee for a change in the $2.7 billion allocated to the health department. The accountability for the spending of those moneys of course continues to be a subject of some debate.

The health department has come under scrutiny in two areas: one by the auditor general and the other t through a series of fairly well-publicized missteps on the part of the department. I would just like to talk about those briefly.

First, last fall's auditor general's report had five chapters relating to the health department. It had a number of criticisms on how the department operated and a number of suggestions on how the department could be improved.

One of the problems highlighted in the auditor general's report was Health Canada's non-compliance with the Canada Health Act. There was also a problem of information on the federal government's total contribution to health care. The auditor general in fact said that the federal government did not know its exact contribution to health care because it was wrapped up in the health and social transfers. The auditor general recommended that the federal government find some way to identify exactly what the federal government spent on health. I suppose this would at least be helpful in election campaigns when the federal and provincial governments are running competing ads as to who pays what and how much. My hon. colleague who just spoke mentioned some of those issues as well.

The auditor general was also concerned about research and development. The minister suggested, and was very proud of the fact and well we should be, that the funding for research and development was growing and that it was scheduled to double. However the auditor general said that the collection criteria and evaluation for projects to be funded by government research money were not consistently applied and suggested that they needed to be worked on.

The auditor general also looked at first nations' health and found that although he had given a pretty bad report card to the federal government on its handling of first nations' health in 1997, he found that in the year 2000 the department had “not made sufficient progress to correct the deficiencies in any of the programs under review”. He recommended again a sustained effort to implement his recommendations. We have not seen a lot of improvement over the last three years.

Of course first nations' health has been a serious concern for our country. All of us feel that the federal government is certainly letting down first nations people in this very critical and important area. We could speak for 20 minutes just on the problems with first nations' health, its mismanagement and the problems there, but time does not permit.

The auditor general also reviewed federal health and safety regulation programs. There were concerns about the need for reliable risk assessment and sufficient allocation of financial and human resources.

With respect to the Canadian Food Inspection Agency, the auditor general found that it had not properly resourced its food inspection programs based on risk, that actual levels of inspection were lower than expected in some cases and that the department lacked important information on the incidence of food borne illness in humans. This was hardly reassuring in light of the fact that there have been concerns about certain food related illnesses that could affect our population.

The auditor general also looked at the regulatory regime of biologics. This is something that the committee is studying as we speak, and I believe that study is going ahead well. However the auditor general emphasized the need for the department to develop clear criteria in determining which approach would be appropriate for a given situation as far as regulating and supporting the work of the new biotechnology industry.

It is important that parliamentarians carry out their duty to provide oversight on the spending and administration of a great deal of money. In the case of the health department, that amounts to $2.7 billion each and every year. That is a lot of money. Since the government's total budget is well over $150 billion, it is important that parliamentarians do not just sleepwalk their way into approving these estimates.

However, in the nearly eight years that I have sat in the House as a parliamentarian, I have not seen one single line of any estimate changed in any way by the House of Commons.

Either it suggests that the officials of each and every government department, and there are many, are pretty much infallible in their allocation and administration of these billions of dollars, or it suggests that the House is somewhat remiss in not being more involved and more proactive in the oversight of the administration of the spending of these moneys.

I cannot imagine very many democracies where members have this kind of responsibility. For eight years, and I assume it has been even longer although I do not know because I have only been here for eight years, not one budgetary line of a single department has been altered, improved or changed made by 301 members of parliament.

My first response to that observation is that we need to do a better job in overseeing the administration and spending of this money, particularly when we see in practical terms the administration falling short of some requirements that were made clear by the auditor general.

There are deficiencies in our health system. We see it in mercury levels in fish, in approval of drugs, in water safety and a whole bunch of areas where Canadians expect some protection and help. When we see deficiencies we need to look at the allocation of moneys to correct those deficiencies rather than just hoping they will happen.

As we look at the estimates I suggest that we need to do a better job. There are things that we could do to better allocate funds than the way they are allocated today.

[Paul Szabo, Liberal, Parliamentary Secretary to Minister of Public Works and Government Services]

Madam Speaker, the member noted that the auditor general had indicated some concern about the amount of moneys transferred to the provinces. The member knows very well some of the mechanics that it goes through.

I am concerned as well that the combination of tax points and cash transfers are relative to specific computations. The provinces do not colour code dollars. They receive a bulk transfer and what they spend it on is in their domain. That is a matter of concern because the federal government has to be the protector of the Canada Health Act which has five principles: universality, accessibility, portability, comprehensiveness and publicly funded.

The member raised a very good point with regard to the estimates process. She indicated that the health committee had reviewed the estimates with officials and that no recommendations were made. Having been on the health committee and having served on other committees, I know how difficult the process is because it is a very specialized area of activity.

Would the member care to comment on a suggestion that has been made as part of the modernization of parliament that the review of estimates process be consolidated into one committee? This committee would be composed of people who were specifically interested and had the background, training and interest to review estimates. The main standing committee could then shift its emphasis to a review of the planning and priorities area which is more generally of interest to members of the Standing Committee on Health.

[Diane Ablonczy, Canadian Alliance, Calgary Nose Hill, AB]

Madam Speaker, with respect to money to the provinces, the auditor general's concern was not that the federal government sent money to the provinces or that the money then became the domain of the provinces, but that the federal government was unable, with any certainty, to indicate the amount of money it actually contributed to the health care program. He felt it was important for that to be quantified, and for obvious reasons, then there could be debates on whether it was sufficient, on how it was being spent or on any of those things.

There also has to be some accountability. If the federal government wants to hold itself out as the guardian of the Canada Health Act, then it needs to have some guarding capability and some accountability measures. An example of that would be the $1 billion being spent on new equipment, which the minister just mentioned. When asked about whether that money was actually spent on new equipment or whether provinces were simply using it to buy equipment they had already ordered, therefore being of no net advantage to patients or to citizens, all he could say was that the government was working on a report card from the provinces.

A shell game seems to be going on. The government says that it is guarding the act and giving out all the money but when we ask how much and how it is being spent, it passes the buck by saying that the money is going to the provinces. It cannot be both ways. Either there is a guardianship and some actual investment, which means that it can show something for its investment, or it is simply a loose arrangement and nobody knows the results of the investment. We need to be honest and not try to either claim credit or assign blame.

The other item is this idea of a review of estimates committee. I hate to agree with the member opposite, because it goes against the grain a little bit in this place, but on first blush it seems to be a very sensible suggestion for about three reasons.

First, not all of us are bean counter types. I know my hon. colleague is a very well respected and competent chartered accountant, so I use the term bean counter types in the most positive and complimentary sense. It is true that some people have those sorts of skills while others do not. Some people attend Harvard and others attend MIT.

Second, there is some coherence and consistency in attacking the estimates rather than having a kind of hit and miss depending on the time, the commitment and the agenda of a particular committee. All the estimates would presumably be given the same level of scrutiny.

Third, we could then hold someone's feet to the fire. Instead of saying that none of the committees really came up with much, we could look at the review of estimates committee and ask why everything was kind of waved through without so much as a critique.

I concur with my hon. colleague that it would be a very good proposal to look at. Unless someone educates me better, I will be supporting that.

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Madam Speaker, the member for Calgary—Nose Hill makes the important link between the estimates we are debating tonight, which deals with the Department of Health, and various reports by the auditor general relating to activities pursuant to Health Canada.

The question I would like to ask concerns the indepth investigations by the auditor general on the safety of our food supply in Canada today. The member will know that the auditor general has been fairly critical about both the Health Protection Branch and the Canadian Food Inspection Agency in not appropriately resourcing their programs to ensure the precautionary principle is applied at all times.

In the last few days we have heard concerns raised about mercury in fish, mad cow disease, salmonella and other major issues. Would the member support the idea of more money being taken from the surplus and being put into the Health Protection Branch to ensure adequate resourcing and an independent science capacity so that all attempts necessary to protect Canadians at risk in terms of the food supply can be taken?

[Diane Ablonczy, Canadian Alliance, Calgary Nose Hill, AB]

Madam Speaker, the answer is obviously yes. Canadians trust us and our government departments to protect their interests. They are buying food with confidence because they believe we know what we are doing. If there is a deficiency to any extent in protecting the interests of Canadians, particularly with respect to the safety of the food on their supermarket shelves, then we need to fix it.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Madam Speaker, it is really a privilege and an honour to be able to speak this evening to the main estimates on health. I have been involved in the health committee since I have been a member, which is a short time, but I have come to understand some of the problems and complexities of the system from being involved in it quite a while before that.

I am really taken by what I am hearing this evening, particularly from the Minister of Health with regard to the state of the health of our country. When I really assess what is going on in health, a very rosy picture is being painted, but clearly all is not well in the state of our health care in Canada.

Almost every day we can pick up a news report that shows disturbing problems that are happening. Some of them were just mentioned by the hon. member: mad cow disease, problems with our food inspection agency and the fears we have about some of our food.

Almost every day we can pick up something that will give us an example of the problems. Yesterday there was a report dealing with orthopedics and arthritis care. The average waiting time for hip and knee replacement surgeries in this country is six months, while some must wait well over a year. In fact I had a lady in my office yesterday, who is well known by many of the members in this place, who has been waiting for a year for knee surgery and now has to wait another 15 months.

All is not well. The reason for some of the shortages is that there is an obvious shortage of manpower in this area. One hundred and fifty orthopedic surgeons are required to supply the need that we have today, and that is without taking into account the demographics of our society. It takes 10 years to train a new orthopedic surgeon, so we can understand the dilemma that we are in and that it has not happened overnight. We are in serious problems with regard to human resources in health care.

I was a little alarmed when the minister suggested that all we needed to do was to put a few more dollars into health research and that would attract the best and the brightest minds to our health care system which would sustain the system over the long haul. I do believe that is true and I do not think Canadians are buying that as well.

Increasingly, Canadians are wondering if the medicare system will be there for them when they really need it. These hard questions are being asked about the long term sustainability of the system. We talked about some of the problems: the long waiting lists, the shortage of doctors and nurses and the obsolete equipment. We talked about the numbers of dollars that are going into the equipment, $500 million up to April 1 and then another $500 million.

When I talk to radiologists they say that none of this equipment is getting into their hospitals. They are using equipment that has to be taped up with duct tape. I have farmed for many years and I know the value of a good roll of duct tape, but I do not believe that it should be used on our medical equipment. They are telling me that they have to move switches up and down repeatedly before some of the archaic equipment can be turned on. Third world countries will not even accept some of this stuff.

Suggesting that we do not have a problem and that we do not have a crisis is putting our heads in the sand.

Dr. Peter Barrett, the outgoing president of the Canadian Medical Association, stated:

The serious problems facing medicare today can be labelled a health care crisis. For patients waiting for health care services, it is a personal crisis. Doctors and nurses on the front lines know it is a crisis.

It will increasingly become more of a crisis as the weight of the demographic age of the baby boomers hits the system.

As I said earlier, this did not happen overnight. The removal of the dollars in the mid-nineties has caused major problems that are now coming to bear upon a system that has been neglected for far too long. It is time we paid some attention to this because our health care system is about to pay the price for some of that neglect.

The problems with the federal government's overall leadership and the funding of health care in the country are mirrored by a number of problems within Health Canada itself. A more direct subject of debate could be added, as several problems within Health Canada have come to light just in the time that I have been in parliament or as more light has recently been shed on the problems.

Health Canada has mismanaged funding with regard to the Inuit. Aboriginal people are repeatedly highlighted in the auditor general's report. There are problems with the Virginia Fontaine Addictions Foundation that raise serious questions. We have raised this in the House. There are many problems with overprescription of drugs within our aboriginal communities, overprescriptions from which people have died.

The health minister talked about drugs. Many problems have also arisen from the diet drug Prepulsid. There was the Vanessa Young inquest. Sixty-nine recommendations came out of that inquest. The minister suggested in the House that he would implement all of them. It is definitely an acknowledgement that we have a problem in the system when every one of the recommendations will be looked at or implemented. That is what he said, so obviously there is a problem related to drugs and the process within Health Canada itself.

I could go on with a number of problems but I do not have much time so I will move on to another area of federal incompetence. It has to do with the compensation for hepatitis C victims. We know about the tainted blood. Members mentioned it earlier. We know that it is a major problem. We know that almost 50% of the money is left over and yet there are thousands of patients who were infected and who have not been able to access the funding for hepatitis C victims. They really need that funding.

However, we need to look beyond the problems. The hon. member across the way suggested that there are some problems but that solutions are what is needed. I would like to ask him and the entire House to start thinking outside the box when it comes to health care, because arguably we have some very serious problems. Just the introduction of the Romanow report is an acknowledgement that hopefully we will start to think about some of the solutions.

First let us talk about accountability within the system. If I asked Canadians who they think is looking after the dollars in the health care system now they could not tell me. I am saying to Canadians right now that they could not tell me. It is not the politicians, I can tell Canadians that, and it is not the regional authorities in most of our provinces because I have been there. They deal with the health care dollars within their global budgets, or the funding formulas and access to them.

However, we have some blank cheques in the system and until we address them the system will never be able to sustain itself over the next 40 years because of the baby boomers and the technology that is coming along. I am saying that we need to look at the accountability of both users and providers within the system. We need to stop playing games with the health care dollars that are so precious and dear and that the taxpayers of the country work hard to earn.

It is very important that we acknowledge what we can do about accountability by having users and providers more accountable. I hope I get a question or two on that because I will not have time to explain it as I want to get on to my other idea, which is something that that I think is very imperative. We have talked about it since the 1970s but have just paid lip service to it. It is the area of health care prevention and promotion, because health is much more than health care. We have been crisis managing health care in the country for so many years that we have to absolutely stop doing it or we will never sustain it.

In the long run we have to think outside the box and start asking ourselves questions. When we have an epidemic of obese students within our educational system, why are we not talking to the educators of this country? Why are we not talking to them with regard to solving some of the problems that are going to hit the system because of that?

This was talked about with regard to the tobacco industry. We know that if we can stop teenagers from smoking, if we can stop them before the age of 20, we will win the battle against tobacco addiction. Why are we not talking to them?

We know that the number one reason we hospitalize people in this country is mental illness. Why are we not talking to industry and thinking outside the box?

In closing, I would like to say that we do have a problem in health care. We can come up with some solutions if we work together. I would offer my assistance in doing that.