Debates of May 13th, 2003

Supply

[John Williams, Canadian Alliance, St. Albert, AB]

Madam Chair, I did think this was an opportunity to question the minister about the estimates of her department. We have been listening to this ad nauseam and I wonder where the question is.

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

I have Gravol for you.

[John Williams, Canadian Alliance, St. Albert, AB]

She has Gravol for me and a question for the minister, right?

[The Assistant Deputy Chair]

I want to thank the hon. member. The hon. member for St. Albert is of course within his right to bring that to the attention of the hon. member for St. Paul's but at the same time the hon. member for St. Albert would have to let the Chair hear what is going on in order to bring attention to the fact that the hon. member has not asked the question.

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

Madam Chair, there were many questions in there for the hon. member, but he was so busy talking he did not hear my questions.

What I think has been a very exciting time in terms of understanding that what is to be instead of the “gotcha” kind of politics which the member, who is still talking, is very adept at, is really to change the governance into--

[The Assistant Deputy Chair]

The hon. member for St. Albert on a point of order.

[John Williams, Canadian Alliance, St. Albert, AB]

Madam Chair, I want to point out that I am not proficient at all in gotcha politics, but I am interested in a question for the minister on the health issues of today.

[The Assistant Deputy Chair]

The hon. member for St. Albert will also have his chance. The next block of questions is for the Alliance.

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

Madam Chair, one of the things I think we need to learn is that we need a learning culture. I think there are simple things like knitting a sweater or following a recipe, there are complicated things like using physics to get a rocket on the moon and there are complex things like raising a child.

As the members opposite would understand, for every complex problem they have a simple solution that is wrong.

So it is in understanding the complexity of health care, understanding that Canada led the way on the social determinants of health, and understanding that it is only in our ability to view health as a complex adaptive system with feedback loops and continuous improvement that we are going to be able to provide Canadians with the quality of health care and the healthy quality of life we all know they deserve.

I hope that as we look to this council the ugly rumours that the council will have three or four staff members rather than the 30 or 40 staff members that the councils of the ministers of education have, I think that as we think of the kind of quality of chair that we are hoping for, Madam Minister, I am sure that the quality of chair we would want for this council would need a proper secretariat for support.

Then the secretariat must have the capacity to continue an ongoing dialogue with Canadians, as was evidenced by the Romanow commission. The idea that we have to be able to keep talking to Canadians about their priorities and their concerns will really allow us to be the learning culture, to be able to adapt the best practices for consulting and engaging civil society and to be able to also keep talking to the health professionals and the wellness and other practitioners, educators and other stakeholders.

I am wondering about a legislative framework. I am wondering whether there would be a way, by enshrining the health council, that we could begin to look at adopting Romanow's six principles of accountability. I think we actually have to move on carrots and sticks instead of sticks. We should look at the kind of clearing house that could be possible with all the great things that are happening across the country. Maybe once a year when the health council has its annual general meeting, we could have a conference, Madam Minister, where the best things that are happening across the country--

[John Williams, Canadian Alliance, St. Albert, AB]

Madam Chair, I rise on a point of order. I really appreciate and enjoy the intervention by the member for St. Paul's, but I would like to hear the response by the Minister of Health. I really would like to hear a question here so that we can--

[The Assistant Deputy Chair]

Order please. That was not a point of order. That was a point of debate. I may remind the hon. member for St. Albert that the hon. member can use her 20 minute slot in every which way she wants. She can ask or not ask a question as she pleases. Could we show some patience? The hon. member for St. Paul's has another six minutes.

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

Madam Chair, as we move forward and look to the area of health care for which we have the most responsibility, we actually are very embarrassed about our performance in aboriginal health, as the previous member talked about. If we talk about closing the health gap for our aboriginal people, if we think of bottling what we learned in the SARS episode, my main question for the minister would be how we could move to a public health infrastructure that would use all of the good hospices of a health council, use all of what we have learned from Marc Lalonde and forward. Does the minister see a place for CDC north? Is there a way that we could track how we are doing? How could we move forward as the Canadian Public Health Association has asked for in its meetings this week?

That is what Canadians want from us. They want a trusted voice that would be able to communicate to all Canadians but also provide the leadership that allows the kind of collaboration that is needed. We know that is the only thing that will work in this country.

It is too bad the member for St. Albert is going to miss my big question.

[John Williams, Canadian Alliance, St. Albert, AB]

I am back. Don't go away.

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

You are supposed to have a drum roll, but I just asked the question.

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, I want to thank the hon. member for St. Paul's for her very thoughtful and provocative discussion.

The member asked a series of questions which some hon. members missed because they came in late. Her series of questions get to the heart of some of the more important issues in terms of how we rebuild the confidence of Canadians in our health care system, what we are learning and how we use what we are learning, our research and innovation to have a fairer system. Are we striking the right balance between prevention and treatment? Are we listening to Canadians? They are very important issues.

If we have learned anything coming out of the Romanow report and other reports and discussions that have taken place in other places it is that Canadians value their public health system very much. They value their publicly financed health care system. Canadians want to know that their politicians and their health care professionals, but especially their politicians, are acting in ways that will renew and sustain that health care system for them in the future. Saying it is not good enough. We have to have mechanisms by which we can enhance that public confidence.

The hon. member spoke so eloquently about the health council, which is very important to her and very important to all of us who are committed to enhancing public confidence, to increasing transparency and accountability in our health care system. They are committed to answering some of those questions. Do we have a fair system? Can we make it fairer? What are we using all this new research and technology and innovation for? Are we getting better health outcomes? How is it distributed within our society? Does everybody have access to it and if not, on what terms?

A health council could help us answer a lot of those questions. It is not just about how many dollars we spend and where the dollars go. It is about some of the other issues in terms of the health outcomes. It is about what our dollars are being used for in terms of ensuring that we are learning and that we are rebuilding Canadians' confidence in a way that reinforces fundamental values.

The hon. member asked specifically about public health infrastructure. We have talked a lot about that this evening. This is very important. A number of reports have been done in relation to how we need to move forward in building a national public health infrastructure. It is not a federal public health infrastructure. The hon. member was very careful to talk about the importance of collaboration within our federation. It is not a federal public health infrastructure. We have a piece; the provinces have a piece; front line, local public health officials and workers have a piece.

It is how we in the federal government need to show leadership and take up the challenge. We have to show the lessons we learned from SARS, the lessons we learned last summer from West Nile, the lessons we learned from September 11. Those lessons will enhance our public health infrastructure.

We have learned from September 11, but we will learn much more from SARS. We will learn whether or not we need a CDC-like institution in this country, a go to place, where it does not matter whether it is a local government, a state government or a federal government, it is a place we can turn to for the assistance, advice and the answers to certain questions.

The hon. member asked very serious questions. She raised some very important issues in relation to the future of our health care system, the heart of which is the confidence that Canadians have in it.

[Monte Solberg, Canadian Alliance, Medicine Hat, AB]

Madam Chair, I want to pursue a line of questioning that started a long time ago but has since dropped. It has to do with what happened in 1995 when the government arbitrarily cut spending on health care.

I want to remind the minister that at the time when the government cut spending, it did so without consultation with the provinces. It just went ahead and did it. The provinces obviously did not agree, but the provinces are charged with the responsibility of providing health care services to Canadians.

The reason I want to raise this is I want to make reference to the fact that recently the member for LaSalle—Émard went out west and wanted to talk about western alienation. He was wondering why we have western alienation in Canada today. I wonder if it might have something to do with the fact that the government arbitrarily withdrew from agreements with the provinces to provide what is arguably the most essential service the province could provide, which is health care. The federal government just pulled out and left the provinces holding the bag.

I wonder if the minister might understand how this contributes to a sense of western alienation. It is not just western alienation. It happens in Newfoundland as well. I wonder if she might understand how this leads to a situation where provinces are openly talking about collecting their own income tax. In that way they could ensure that they kept the money that was supposed to go to them for things like health care services. They would get that first, take it off the top and send the remainder to Ottawa.

I wonder if the minister, and also the former finance minister, understand that they in fact are responsible for helping create western alienation because they do not keep their deals with the provinces.

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, as is often the case, it is not as simple as the official opposition and the hon. member would suggest. In 1995 as I have already indicated here this evening, the country was facing a serious deficit situation and a debt wall. That had to be dealt with and we did deal with it. In part we dealt with it with the urging from the official opposition.

I have already acknowledged that we were dealing with a deficit and a debt. We had to take measures to bring the fiscal house of the nation back in order.

I take umbrage with the suggestion that there were no discussions with the provinces at the time. I take umbrage with the suggestion that this was simply dumped on the provinces. While we knew the deficit and debt had to be dealt with, and that transfer payments would have to be cut back as well, there were discussions with provincial and territorial finance ministers and governments.

That was the time at which the CHST was crafted. The provinces received additional flexibility which was what they wanted to deal with the fact that yes, there were fewer dollars flowing to them. We know that. That was no secret. We did not hide that fact but it is wrong to suggest that there were no discussions with the provinces in relation to what happened at that time. We were all facing tough choices.

Today we have an economy that is the envy of the world. We have an economy that produces the revenues that permits us to reinvest, be it at the provincial level or the federal level, in health care and other important social services.

I really do take umbrage with the hon. member's simplistic approach to the complex challenge we faced in 1995 and in fact, that which actually happened. All of us, the federal and provincial governments, were fighting to deal with our deficits and debts. All Canadians sacrificed. Now we are reaping the benefits of those sacrifices.

[Monte Solberg, Canadian Alliance, Medicine Hat, AB]

Madam Chair, not all Canadians sacrificed. During that period of time the federal government continued to spend about $15 billion a year on grants and contributions. The big recipients were big companies. Corporate welfare continued to flow unbelievably during that period of time. I do not accept what the minister says. I think the government could have cut in a lot of other places. I also dispute that the provinces consented to this. They certainly did not.

[Anne McLellan, Liberal, Edmonton West, AB]

I didn't say they had consented.

[Monte Solberg, Canadian Alliance, Medicine Hat, AB]

Now she is saying they did not. She says that they consulted but ignored them because she knows very well the provinces would never agree to that. They would never agree to go ahead with big cuts without changes at the same time to the Canada Health Act, which is where I want to go now.

The truth is that over the last number of years waiting lists for critical surgeries of all kinds have been going up. The Canadian Institute for Health Information specifically points to some examples of that in its 2002 report. If one were to judge a health care system, one would have to judge it by how it serves patients.

I want to argue that the government has done a poor job of providing the provinces with the tools they need to improve health care because it adheres to this doctrine with respect to the Canada Health Act. It has refused to loosen up some of the strictures of the Canada Health Act which make it impossible for the provinces to truly address some of the problems that they face.

Yes, the government has put back some of the money it took out but it has come nowhere near addressing the real reforms that need to be undertaken to ensure those waiting lists go down and are dealt with.

Why is the government so doctrinaire on the Canada Health Act knowing that it is responsible for helping to drive up the waiting periods for people who are facing critical treatments and critical surgeries of all kinds?

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, far from being doctrinaire, the five principles in the Canada Health Act, if that is what the hon. member is referring to, are flexible principles that represent Canadian values and Canadian principles.

The hon. member accuses the Government of Canada of being doctrinaire, I would remind him that those five principles were reinforced and endorsed by all first ministers in September 2000 and in fact were reinforced and endorsed yet again by all first ministers in February of this year. It is not us who are being doctrinaire. All first ministers believe that those five principles in the Canada Health Act represent fundamental values that animate our health care system.

Now building on that, if we look at the principles, the principles are not straitjackets. The principles are flexible to reflect the fact that the health care system is large, dynamic and constantly changing, and one must encourage innovation and creativity. Nothing in the five principles of the Canada Health Act prevent that innovation or creativity. That is why the provinces are experimenting in so many different ways around a host of things, including different delivery mechanisms for publicly financed health care.

I would have to take real exception to the comment that the hon. member makes around the five principles of the Canadian Health Act because they seem to be embraced by all our first ministers, as well as most Canadians. In fact, some Canadians would suggest that we add a principle called “accountability”.

However the member is right. Health care systems are judged by how they serve their patients, which is why the health accord, and not only the new dollars but the structural change that is embedded in that health accord, is so important. It is only through that structural change that this system will be able to better serve its clients, its patients.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Madam Chair, I would like to change the subject to something that is really important, and that is be the SARS situation that we have been experiencing over the last couple of months in Canada and around the world. It continues to be out of control in China. I think we should consider that very carefully as we discern what we have learned over the last little while.

In a very non-partisan way, this all started on March 26 when I gave my questions to the minister prior to her coming into the House. I did not want to make this a political issue but an issue that was of most importance for Canadians. We need to do that when it comes to a crisis situation, which SARS certainly could have developed into in Canada, and some people thought it actually had.

On March 26 we asked the minister questions on this so she could get out in front of Canadians and convince them that everything was being done to contain SARS and to protect them from the virus. However, on March 27 a mistake was made when the WHO actually recommended screening at our airports on international flights out of our country. That recommendation was an eyeball to eyeball or direct interview as a screening prerogative or a screening measure at the airports. At that time when the question was asked of the minister, the answer was that it would clog up the system too much even though that was what the WHO had recommended.

I wonder why the minister did not, at that time, apply an aggressive approach rather than a voluntary single sheet of paper that people could pick up or not pick up. Obviously we were too lax and we ended up exporting SARS.

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, as I have said on a number of occasions in the House, we were, I believe, one of the very first countries to act upon the WHO recommendation in relation to screening. We acted immediately. The WHO has, throughout this entire process, indicated that it approved of the screening processes we put in place.

I will quote Dr. David Heymann from May 1, just two weeks ago, in Toronto. When he was asked directly, in relation to the travel advisory, he said:

We did not make our decision based on something that Canada was doing wrong. Canada was doing everything right, including screening passengers as they left.

The hon. member can make as much of this as he wants but we took the WHO recommendation seriously in relation to screening. We did a risk assessment on a daily basis as to what we thought was required, both for importation and exportation. Every day we addressed the question of whether our screening measures were sufficient in relation to the risk assessment on that day. Those measures were progressively increased as the public health challenge of SARS moved forward in the City of Toronto.

We continue to enhance those procedures because, first and foremost, after the great job Ontario has done on the front lines, we want to catch any individuals coming into this country. We do not want the importation of SARS into this country after our control and containment measures have worked.

The WHO is quite rightly concerned about exportation in terms of the rest of the world. We have progressively enhanced these procedures. We also have offered to share what we learn, in terms of our screening procedures, especially as it relates to technological tools of control and containment, with the WHO and the rest of the world.

We do not know how effective infrared machines will be as a matter of public health. Therefore we will be doing that analysis over the coming weeks and months and we will share that with the rest of the world. That is how we learn. We take our obligations seriously, which is why we perform the daily risk assessment and enhanced screening procedures, as needed, on the basis of the risk assessment.

[The Assistant Deputy Chair]

Just on a point of clarification. There is no rule that the answer or the question have to be a certain length of time or of equal weight. That is up to the individual speakers. It is not up to the Chair. Yes, I am here to balance it out but I will not be the one to tell the person asking the question or the person answering the question how long it should take. That would be presumptuous of the Chair, in my opinion.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Madam Chair, we had this debate earlier in the evening. The decision at that time was that if the question lasted a minute then the answer would be roughly a minute. It could not be disproportionate, within certain bounds. My challenge is that that has not taken place this evening.