Debates of May 13th, 2003

Criminal Code

[The Acting Speaker (Mr. Bélair)]

There are four minutes left. Is there unanimous consent to see the clock at 6:30 p.m.?

[Some hon. members]

Agreed.

[The Acting Speaker (Mr. Bélair)]

Pursuant to the order adopted earlier today the motion that Bill C-269 be not now read a second time and that the subject matter of the bill be referred to the Standing Committee on Justice and Human Rights is deemed adopted.

(Motion deemed adopted, order discharged, bill withdrawn and subject matter referred to the Standing Committee on Justice and Human Rights)

[The Acting Speaker (Mr. Bélair)]

Pursuant to Standing Order 81(4), the motion to adjourn the House is deemed to have been withdrawn. The House will now resolve itself into committee of the whole to study all votes under Health in the main estimates for the fiscal year ending March 31, 2004. I do now leave the chair for the House to resolve itself into committee of the whole.

[Editor's Note: For continuation of proceedings see Part B]

(Editor's Note: Continuation of proceedings from Part A)

(Consideration in committee of the whole of all votes under Health in the main estimates, Mr. Kilger in the chair)

Supply

[The Chair]

Order, please. House in committee of the whole on all votes under Health in the main estimates for the fiscal year ending March 31, 2004. The hon. member for Yellowhead.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chair, it is a great opportunity having the minister here to answer some questions with regard to the estimates. We tried to have her appear before committee over the last number of weeks but we were blocked. However since she will not go to the committee it is great to see committee go to her. She is here now with her delegation of officials and we certainly expect to hear some answers this evening.

I will start by talking a bit about the health accord and what has happened with it. I think Canadians have applauded the accord in the sense that we are finally giving some money back to health care. Health care has received a little breath of fresh air in the sense that the federal government has stepped up to the plate with some of the dollars it pulled away from health care in the mid-1990s.

We agree with a number of things contained in the accord. New cash infusion is great. We said that provincial flexibility to implement those new programs had to be there, and the accord agreed with that. We also said that restoring some of the funding to core health services needed to be there and that there had to be no restriction on alternative delivery within that public system. All of that was achieved with the accord.

We told the government that it had to stop the funny money and that it had to stop trying to discern how much money was going from the federal government to health care. We said that the CHST had to be separated so we would know exactly how many dollars were or were not going in, because that seemed to be a real sore spot. Every time we asked the federal government how much money it was putting in we always received mixed numbers. Hopefully some transparency will now be added to that. Canadians put in $112.5 billion last year, which is a horrendous amount of money, and they need to know and deserve to know where that money is being spent.

We have identified some shortcomings in the health accord. They are actually shortcomings from the Romanow commission's report as well as from some of the other commissions that dealt with this issue. Very little action was taken with regard to waiting lists and the shortage of health care workers.

We in the Canadian Alliance have been saying for a long time that Canadians need some guarantees. If Canadians have no trouble putting $112 billion into health care then they need some guarantee of services. They also need a guarantee that they will not die while on a waiting list.

The former finance minister, the member for LaSalle-Émard, made some interesting comments on CTV's Question Period with regard to the problems with the health accord. I get very nervous when I hear an individual, who could potentially become the next prime minister of this country, saying that the accord might be scrapped. This is the same minister who pulled the money away from health care in the mid-1990s. It makes me quite nervous to hear that the accord is not adequate.

I wonder if the health minister agrees that the accord does not address these problems. Has she been talking to the former finance minister about this? Was there any dialogue between them? Is this a recommendation coming from her or is this a recommendation just from him? I would like to start with those questions.

[Anne McLellan, Liberal, Minister of Health]

Mr. Chair, I think all of us on the government side see the first ministers accord reached on February 4 as a singular achievement in terms of making sure that our publicly financed health care system is here for Canadians for the future and is an efficient and sustainable system.

However before we go any further I would like to clarify one thing. I think the hon. member for Yellowhead suggested that the former finance minister, the member for LaSalle—Émard, said that he would scrap the accord. I want to go on record that no such statement, to my knowledge, has ever been made by the member for LaSalle—Émard. While he may very well have made comments in relation to health care, I think we need to keep the record as straight as possible here and not have allegations and things flying back and forth.

From the government's point of view, the accord is a singular achievement that speaks to not only an infusion of significant new dollars from the federal taxpayer, some $34.8 billion over the next five years to help the provinces and territories deliver health care, but it points us toward the structural reform that has to take place if our system is to be sustained and renewed.

For example, it speaks to the importance of primary health care renewal. It speaks to the importance of the inclusion of home care in the continuum of care. It speaks to the challenge that exists for some Canadians around catastrophic drug coverage. It speaks to the importance of technology and the assessment of that technology. It speaks to the development of a national human resource strategy that will deal with important issues in the provinces and territories around the number of doctors, the distribution of doctors, the number of nurses, the distribution of nurses, the nurse practitioners and the curriculum necessary to train them in this new multi-disciplinary team world of the 21st century.

Mr. Chair, in this process do I get to talk for as long as I want or will you tell me to sit down soon?

[The Chair]

Probably I would give you a little more time, but it would be my intention to--

[Anne McLellan, Liberal, Edmonton West, AB]

To tell me to sit down?

[The Chair]

It is probably not a bad idea. We have five hours so I would not want you to get foot weary so early in the session.

[Anne McLellan, Liberal, Edmonton West, AB]

I know we have a long way to go this evening so I will conclude by saying that the government stands behind the first ministers accord, not only do we stand behind it but we see it as an absolutely singular sign post in terms of the sustainability and renewal of our health care system.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chair, if we want to set the record straight, it was the former finance minister who pulled the money out in the 1990s and suggested that the accord did not adequately deal with a couple of the issues: the waiting lists and the shortage of physicians and health care workers across the country. Now the minister is saying that has been dealt with in the accord, and that $90 million is in there for a study on how to distribute those, but does not really address them.

I am wondering what is happening here. It was the former finance minister who actually gutted the system because of the shortcomings in the accord and now we have the minister saying that the accord deals with all those problems.

Is the minister agreeing with the former finance member, the member for LaSalle—Émard, that there are shortcomings in the accord, or does she see the health accord as being totally adequate?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, the health accord was a singular achievement of this government and first ministers at provincial, territorial and federal levels of government. In fact, the accord speaks to not only an infusion of new money, because we know that new money alone will not bring about the changes that have to take place, but it also describes the necessary structural change.

If the hon. member is suggesting that the challenges the accord addresses will not be resolved overnight, yes, of course he is right. We know Canadians have identified access as their number one issue. They want access to a family practitioner or the appropriate health care provider when they need that person, 24 hours a day, 7 days a week. We know that.

We also know that Canadians see waiting lists as part of that access, especially seniors who are on a waiting list for a knee replacement, hip replacement or other kinds of operations or treatments, such as radiation therapy or chemotherapy. However we will not be able to deal with those issues unless we bring about the structural change that is mentioned in the accord.

It is illusory to suggest that this large, complex, dynamic health care system can be turned around on a dime regardless of how much money we put into the system. It needed more money and we put more money in. It needs structural change and that structural change is set out in the accord. It will take time but that change will lead to addressing Canadians' issues around accessibility, including waiting lists.

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

Mr. Chair, the fact is that waiting lists are getting longer. We had the Canadian Institute for Health Information pointing out that in Quebec the waiting list for breast cancer surgery has gone from 29 to 42 days. Special note was made of that.

I think the concern Canadians have, and frankly what the former finance minister is saying, is that the health accord is not addressing these issues. It is fine to say that we are getting it on track, but in the meantime people are waiting for vital surgery and the lists are getting longer and longer. The question is, when the former finance minister becomes prime minister, as he almost certainly will, will she recommend to him that we change this accord to start to address some of those issues and some of the facts that the former finance minister himself has pointed out? That is the question.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, as far as I am concerned, this accord addresses the issue of accessibility, one part of which is the question of waiting lists, but in fact we have to get the structural change right. For example, there are waiting lists in terms of getting to a GP; people get to a GP before they can be referred to a specialist. How do we deal with that? There are a number of things. For example, we need more family physicians, so in fact that is why we are working with the provinces and the territories to create a national human health resources strategy. Then we will have in place the diagnostic material to help us know how many doctors are needed and where they are needed, how many nurses are needed and where they are needed.

Members can look at the accord and part of what we are doing around primary health care, practice and multidisciplinary teams, how much time is taken up by general practitioners, family physicians, in our health care system who are doing what I would describe as important but routine clerical work? How much of it is taken up in seeing patients who in fact should see a nurse or a nurse practitioner and do not need to see that GP?

In fact it is very short-sighted to suggest that the accord does not deal with important issues of accessibility, including waiting lists. Of course it does. I wish we could snap our fingers and magically turn this dynamic, complex system around on a dime, but what we need to do is identify the problems. Is accessibility, including waiting lists, a problem? Of course. Then we work back and ask how we deal with that. There are no magic bullets. We deal with it through structural change. We deal with it through an infusion of new dollars.

We deal with it through the application of technology and the better use of technology. There is a complex set of tools that we in this system need to use to deal with the question of accessibility. That is what the accord speaks to.

And, Mr. Chair, the last time I checked, you ran this place, not the member for Medicine Hat.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chair, that is interesting rhetoric about how to fix the system and the minister is in a perfect position to be able to impact that. I would challenge her to get on with the job and stop the rhetoric that we have seen over the last decade.

Let us talk about that last decade a little bit. There has never been a government in Canada, provincially or federally, that accepted to or recommended to or pulled money away from health care, except for one party and one minister of finance. That is the party over there, which actually gutted the health care system in the middle of the 1990s. This is my question for the minister. She sat around that cabinet table for the budget in 1995. I am asking her how she voted on that budget. Would she do it again if that same budget were here today?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, I am a member of the government. In 1995 we faced an enormous situation in terms of dealing with the deficit and the debt. In fact, there were some in the international financial community that described us as virtually a third world nation, thanks to 10 years of Progressive Conservative economic mismanagement. So yes, that was in 1995, and in fact the official opposition was one of the most strident voices in this place and across this country in terms of getting our economic house in order.

That is exactly what we did and everybody in this country sacrificed. Everybody in this country gave something up. If the hon. member is saying that as part of getting our house in order so that we are now this economic miracle that the rest of the world turns to, yes, everybody sacrificed, including cuts in transfer payments to the provinces. At this point, rather than focus on the past, because we knew what we had to do, we had the courage to do it and we did it, let us now move forward. Let us look to the future. We are reinvesting in health care and we started reinvesting in health care in a major way in September 2000.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, I would like to try to focus these questions and ask a relatively simple question so that the minister will not have to go on at length. The former finance minister said that loss of medical personnel to the states was not the biggest problem; it was in fact loss in Canada, with the Maritimes losing positions and nurses to other parts of the country. Does the minister agree with that statement?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, there is no question that health human resources is a very important issue and challenge for our health care system. That is why in fact in the health accord that matter was dealt with in relation to providing funding so that we can work with the provinces and the territories whose issue this primarily is, so we can work with them to put in place a national health human resources strategy. Part of that strategy is identifying how many doctors in the various areas we need and are likely to need, and the distribution of those doctors.

In fact there is no question, and it has been identified by small provinces, poorer provinces than our own, as the hon. member for Macleod knows, that there are issues around distribution, especially of health care specialists. We need to address that. We cannot turn a blind eye if the only pediatric cardiac specialist in all of Atlantic Canada is attracted away to another part of the country. We cannot ignore that fact. What we have to do is say that there are pressures as it relates to health human resources. Of course we cannot nor would we want to deny anyone mobility, as that is silly in our country, but on the other hand we have to acknowledge the fact that some regions and some communities find it harder to keep various kinds of health specialists than others and we have to address that as part of our health human resources strategy.

We may be able to do a little of it through tele-health and through robotics. Amazing things are happening, as we saw with McMaster in North Bay and robotic surgery. There are a host of things we can do to help communities, but if the hon. member is saying that the distribution of health human resources is an issue in our country, yes, of course it is.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, I did try to keep my question brief and hoped for a brief answer. Maybe if I ask a longer question I could get a short answer. Let me ask about one other issue. I am going to change topics here. One of the things that brought me to Parliament is that physicians in Canada pay GST and cannot deduct it. Does the minister think that that is fair?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, this is an issue that physicians have brought to my attention. I can only say that at this point the law is the way it is. I think what we will continue to do is discuss this issue with physicians. The hon. member knows that I am not the Minister of Finance and therefore I am not in a position to provide an answer to that question, but certainly we are well aware of the concern of physicians and I will continue to make the Minister of Finance aware of the concern of physicians as it relates to GST.

We have been able to make some changes in this budget as it relates to the GST around hospitals and those issues that have been brought to our attention by the hospital association in this country, but physicians, no, we have not dealt with that issue.

[The Chair]

The Chair would now recognize a member from the governing party if someone would choose to rise at this time.

[Anne McLellan, Liberal, Minister of Health]

Mr. Chair, does this mean that I get to speak now?

[An hon. member]

Don't forget the birthday.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, may we wish the hon. member for Hochelaga--Maisonneuve a happy birthday.

First, Mr. Chair and hon. colleagues, I do want to introduce my officials who are here this evening because this will be a long night for all of us. Let me introduce Ian Green, my deputy minister; Ian Shugart, assistant deputy minister of health policy and communications; and Patrick Borbey, assistant deputy minister of corporate services at Health Canada. I thank all three of them, as I know my colleagues do, for being here this evening.

This is an opportunity to focus on issues of profound importance to every one of us: our health and our health care system and the role Health Canada plays in protecting and sustaining both those things.

We know that Canadians are strongly committed to their health care system and they have told us that they care deeply about the basic values at the heart of this system: equity and fairness. Therefore, any actions we take must be measured against these values. This is what Canadians want and this is what the Government of Canada, working together with the provinces and territories, must achieve.

I will start with a description of the context within which the government addresses health issues in general, and will then move on to the key components of our strategic priorities for this fiscal year.

The point of departure is the mandate of Health Canada, which consists in helping the people of Canada to maintain and improve their health.

As we all know, this is not a role that we can fulfill alone. All levels of government have important and complementary responsibilities in health, as do communities, the people working in our health system, primarily those on the front line, and individual Canadians.

Before I go on, I would like to take a moment to thank the many doctors, nurses and other health care professionals who have worked tirelessly without hesitation and in some cases at great personal sacrifice during these past two months. Their heroic efforts have helped ensure that SARS has been brought under control in Canada. Since this week is nurses week, I would like to say a special thanks to Canada's more than 100,000 nurses for the significant contributions they make every day to our quality of life.

Let me also highlight the excellent work of Health Canada's scientists, microbiologists, epidemiologists and others working in Ottawa and across the country. The crucial work of scientists at Health Canada's National Microbiology Lab in Winnipeg toward identifying the SARS associated coronavirus and in isolating genetic material from the virus was essential to the subsequent sequencing of the genome by the Genome Sciences Centre. I cannot overstate the importance of the contributions of Health Canada scientists working with their outstanding colleagues across the country.

The Government of Canada has clearly defined responsibilities in health which are anchored in collaborative work with others. Health Canada carries out these responsibilities through five broad roles. Let me take a moment to review these roles before speaking more specifically about some of Health Canada's priorities.

In relation to time, and I realize that there are undoubtedly questions my colleagues want to ask, I will not go into a lot of detail in terms of our roles. First, clearly we are a leader and a partner and this is demonstrated in part through Health Canada's responsibility to administer the Canada Health Act.

Second, we also have the role as funder. As we know, the federal government is a major contributor to health care through the Canada Health and Social Transfer. In 2003-04 transfers for health and social programs will total almost $38 billion.

Third, we have a combined role of guardian and regulator. Health Canada has been mandated by Parliament to protect Canadians against risks to health presented by health products, food and consumer goods. Furthermore, the department is now taking into account the broader smart regulation strategy that seeks to enhance Canada's place as a home for innovation while maintaining our standards for safety and stewardship.

Fourth, we have a service provider role. Health Canada is responsible for delivering health promotion, disease prevention and health care services to Canada's first nations and Inuit, making the Government of Canada the fifth largest health care budget in the country.

Fifth, we have a role as information provider. Canadians expect their federal government to provide reliable health information that they can use to maintain and improve their health.

As hon. members here this evening will have noticed from Health Canada's report on plans and priorities, we have identified five corporate priorities for the next three fiscal years. These priorities respond to current and emerging health issues as well as to government wide commitments. They are: health care system renewal; first nations and Inuit health; safety and health protection; balancing the health agenda; and improving accountability to Canadians. Let me briefly turn to each and discuss some of their major elements.

We spoke already this evening about health care system renewal. Our medicare system reflects some of the basic values of Canadians: the belief that all Canadians are entitled to quality health care based on need and not ability to pay; the conviction that no one should risk losing his or her life savings because that person becomes ill; and a determination to share the cost of health care through a publicly administered system.

These values are fundamental to the Government of Canada, as well as to the governments of the provinces and territories. Governments agree that our medicare system needs to change to reflect new challenges and new opportunities. That need was at the heart of the first ministers' health accord of last February. We have already talked about aspects of that, so I will reiterate that as a result of the accord Canadians will see fundamental structural changes to Canada's health care system over the next five years. Canadians will see improved accountability and they will witness firsthand how their money is changing and improving the system.

I would be remiss if I did not point out the important role that the Romanow commission, the Senate committee, the Kirby committee, and the many other studies that individual provinces commissioned in recent years played in the accomplishments found in the accord. The work of those commissions helped to clarify the direction government should take to meet Canadians expectations of an effective, efficient and accountable health care system.

I do however want to say a few words about the health council which in fact I know many hon. members are very interested in. My colleague, Nova Scotia's Minister of Health, the Hon. Jane Purves and I recently announced that an unexpected combination of issues, in particular the outbreak of SARS, have led to a short delay in finalizing the work surrounding the health council. Having said that, I want to reassure everyone in the House that we are making serious progress and I expect the announcement of the shape and work of the health council to take place within a few weeks.

Let me briefly turn to a second key priority for my department and that is first nations and Inuit health. Closing the obvious and troubling gap in health status between aboriginal and non-aboriginal Canadians is a continuing priority for our government.

As I noted earlier, when it comes to expenditures, my department is the fifth largest provider of direct health care services in this country. That results in our having the same need to get the best results from finite resources that our provincial and territorial partners have within their own health care systems.

The first ministers' health accord recognized this role. The Government of Canada followed through in budget 2003 with $1.3 billion new dollars in funding dedicated to first nations and Inuit health programs. This will help ease the fiscal pressures on health services and programs for first nations and Inuit, and provide much needed new money for nursing and capital development on reserves. The funding will also support the development of a first nations immunization strategy for on reserve children.

Beyond these and other initiatives my department is working with our partners in aboriginal communities, other federal departments, and the provinces and territories to improve the quality of primary care, prevention and health promotion services. We will continue to be engaged with our partners through community based initiatives such as healthy child development and chronic disease prevention efforts.

I have talked about two of our priorities. The third priority is safety and health protection. Achieving positive health results for all Canadians requires efforts to protect Canadians against risks to health presented by consumer product and disease.

Accordingly, the third Health Canada priority is safety and health protection. There has been a great deal of attention to this area in the past few weeks as we have taken on the challenges of SARS and West Nile virus. The work here goes much further. For example, it includes our legislative responsibility to regulate the safety and efficacy of therapeutic products. This is a function that brings together varied commitments and responsibilities. We are working to respond to the needs of Canadians for quick access to new drugs, treatments and medical devices while at the same time protecting Canadians against the marketing of unsafe and ineffective products.

We are increasing our focus on emergency preparedness in a time that continues to be volatile so that we are prepared to respond to potential threats related to bioterrorism or an outbreak of an emerging or re-emerging infectious disease. This scope of responsibility is reflected in the wide range of activities undertaken in the federal government's response to the recent outbreak of SARS.

I want to say a few words about the work that Health Canada is taking in relation to West Nile virus. Health Canada was a key and instrumental partner with the provinces and local public health authorities in the fight against SARS.

Again, let me commend those on the front lines, especially in the city of Toronto, as we controlled and contained that outbreak and became a model for the WHO in relation to how other countries could go about controlling containment. However, in the world in which we live we now have a new challenge posed by West Nile virus.

In close collaboration with the provinces we are moving forward with national surveillance, attention to the safety of Canada's blood supply, and diagnostic testing. We continue to invest in public education, partnerships with first nations communities at risk, and the assessment of commonly used pesticides and insect repellants.

Let me briefly touch upon our fourth key priority in our three year business plan which is balancing the health agenda. This commitment is based on a simple reality that factors ranging from our living and working conditions to our community support networks and to our individual health practices all combine to affect the state of our health. The more we can effectively influence these factors and take action on disease prevention, health protection and promotion, the more we can improve the long term health of Canadians and reduce the burden on our health care system.

Accordingly, the 2002 Speech from the Throne included a commitment to encourage healthy living, physical activity and illness prevention. We are engaged in transforming that commitment into action with a particular focus on building a collaborative healthy living strategy. The resulting strategy will provide the support Canadians need to improve their health and reduce health disparities.

The final priority set out in the report on plans and priorities is improving accountability to Canadians. It is one that I have implicitly incorporated throughout my comments this evening. Accountability is critical in demonstrating to Canadians how well we serve them using their tax dollars.

The federal health agenda is based on partnerships achieving results. While there are clear and well known areas of direct federal responsibility in health, we are taking action across our agenda with a clear commitment to working with others: with the provinces and territories; with health professionals and workers; with colleagues in other countries; with researchers; and with communities and individual Canadians.

We have an ambitious agenda, but given the importance of health issues to Canadians and to the quality of life for everyone in this country, an ambitious agenda is precisely what we should have. I am confident that the plans and priorities described in this year's main estimates document will go a long way toward meeting the needs of Canadians.