[English]
EVIDENCE
[Recorded by Electronic Apparatus]
Tuesday, March 13, 2001
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[English]
The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Today we're welcoming our new deputy minister, Mr. Ian Green, and his team of assistants. The purpose of the meeting is essentially information exchange. We have many new members on the health committee who have been assigned this particular job for this term. We're looking for an overview of the department, plus answers to some of the questions the members have put forward.
I'd like to ask the deputy, Ian Green, to first introduce the people he brought with him and tell us what they do, and then proceed to the presentation.
I would also like to remind my colleagues on the committee that this is for us to absorb information. It's not for us to chat too much or ask too many questions, because questions have been submitted and there will be a second chance for oral questions when we meet next.
So, Mr. Green.
Mr. Ian Green (Deputy Minister of Health): Thank you, Madam Chair. I appreciate the invitation to appear before the committee to discuss Health Canada this morning.
You'll notice that we've turned out in force. This is because we would like to build a good relationship with the committee. So we have virtually all of our ADMs, our senior management team, here this morning to tell you a bit about ourselves.
My appointment to the department is quite recent. I have had a couple of months thus far on the job, and I can tell you, to this point, this is both a very challenging and a very exciting department.
You asked me to introduce my colleagues, which I would like to do: Mr. Bob Lafleur, who is our senior ADM corporate services; Ian Shugart, who is the assistant deputy minister, health policy and communications; Marie Fortier, who is my associate deputy minister; Diane Gorman, who is the ADM health products and food branch; Patrick Borbey, who is the associate assistant deputy minister for the first nations and Inuit health branch. His boss, Ian Potter, is taking French in order to meet his level, so he unfortunately could not be back today. He's just at the final stage, and I'm confident he will be successful and will be back with us shortly.
I also have four other senior managers from the department: Dr. Bob McMurtry, who is the assistant deputy minister, population and public health; Dann Michols, who is the assistant deputy minister, healthy environments and consumer safety; Mr. Denis Gauthier, who is the assistant deputy minister, information analysis and connectivity; Claire Franklin, who is the head of the Pest Management Regulatory Agency, the PMRA. That constitutes the senior management team that we have.
We also have in the department six regional directors general from across the country. They are not here today; we didn't think you'd have seating room for all of us. But they do play an important role in the department.
[Translation]
Before introducing my assistant deputy ministers, I would like to point out that we have been invited by your committee to appear here today. We have three objectives in mind. First, we will give you a brief overview of the department. Then, we will answer your questions: the ones that you have submitted to us in advance as well as any others that might arise during the discussion. And finally, as I have already said, we will try to establish solid working relations with the committee members so as to better serve you.
I will now take a few minutes of your time to give you a brief overview of our department. My colleagues will then each make a brief presentation, which will, we hope, give you a better understanding of our department while answering the questions that you have already submitted.
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We have also brought with us a document entitled The Health
Portfolio. I believe that members have already received copies. It
is a description of the powers granted the Minister of Health and
our organization, including the department, independent agencies,
and advisory agencies.
On page 21 of the document, there is an organization chart that is both specific and descriptive, and which you might find useful.
[English]
I've just pointed out that we have put around a document entitled The Health Portfolio in English, and it basically gives you a quick background concerning the department. On page 20 you have an organigramme of the department, which should help you as a kind of quick reference.
Let me briefly describe the mission of the department. It is a straightforward mission: to help the people of Canada maintain and improve their health. The mandate of the department is often explained in terms of three broad areas. The first is national health policy and systems, which includes health care; the second is health promotion and protection, including disease, illness, and injury prevention and control; and the third is first nations and Inuit health.
These are all underpinned in our mandate statements by a need for integrated information and knowledge in regard to how we work as a department. Also, to varying degrees, in each of these areas we have a leadership, funding, regulation, stewardship, and service provider role. They vary according to which of the areas you're in, but leadership, funding, regulation, and service are common across many of these different areas.
Members will be aware that, with the strong support of the minister, my predecessor David Dodge and Madame Fortier, undertook a major realignment of the department recently. The objective was simple: to have a strengthened department able to work cohesively and collaboratively in order to provide and improve services, and this realigned Health Canada has seven branches. It has a health products and food branch, which is headed, as I mentioned just earlier, by Diane Gorman; it has a healthy environments and consumer safety branch, which Dann Michols heads; it has the first nations and Inuit health branch, which Ian Potter heads; it has population and public health, which is headed by Dr. McMurtry. Those are what we call our line branches, the branches that, for the most part, deliver the services and the programs of the department.
We also have three corporate branches: health policy and communications, which primarily does the policy work, headed by Mr. Shugart; information analysis and connectivity, headed by Denis Gauthier, which provides, as I mentioned earlier, the integrated information and knowledge base; and corporate services, which handles issues like accommodation, human resources, administration, etc., headed by our senior ADM, Robert Lafleur.
We also have, as I mentioned, RDGs, regional directors general. We have six regions across the country: the Atlantic region, Quebec, Ontario and Nunavut, Manitoba and Saskatchewan, Alberta and the Northwest Territories, B.C. and the Yukon. We have one agency, the Pest Management Regulatory Agency. We have a chief scientist, who, if you read the National Post this morning, you'll know will be joining the department soon and will be a major addition. We have a legal services unit. We have three substantive arm's-length agencies, which report directly to the minister: the Canadian Institute of Health Research, the Hazardous Materials Information Review Commission, and the Patented Medicine Crisis Review Board.
There are also a number of important advisory functions, which are crucial in providing the minister with objective and independent views and advice. These include the Science Advisory Board, which up until recently was headed by Roberta Bondar; the Canadian Centre on Substance Abuse; the Ministerial Council on HIV/AIDS; the National Advisory Council on Aging; and the National Blood Safety Council.
What I've just covered very quickly is obviously the organizational superstructure of the department. Within that structure we have major business lines, which reflect the mandate I described earlier. We have business lines that deal with health care policy, with health promotion and protection, with first nations and Inuit health, with information and knowledge management, and, finally, with departmental management and administration.
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You will all be aware that as the estimates are
tabled, the report on plans and priorities with the
detailed plans for these business lines will be
available soon. Although we have modified our business
lines, last year's departmental performance report, which
is for the period ending March 31, 2000, details the
progress that we have made on a number of fronts.
I'd like to conclude my opening portion of our presentation by highlighting a couple of priority concerns, and I'd like to do that in two ways, if I might. The first is in terms of how we do and will carry out our mandate, and the second is a brief description of priority areas.
With respect to how we carry out our mandate, a major issue and preoccupation for me is risk decision-making. The goal of risk decision-making is scientifically sound, cost-effective, integrated decisions and actions to reduce or prevent risks and improve the quality of life. We use a formalized decision-making framework to ensure a multi-disciplinary approach is taken when identifying, evaluating, and determining how to best deal with risks to health.
We have a number of mechanisms in place across the department. Some examples include processes in the therapeutic products directorate, all three science branches, and the PMRA. A departmental executive committee on risk decision-making meets weekly, and I personally chair that committee. The identification, assessment, and determination of how to best deal with risks to health is fundamental and therefore one of the most important responsibilities I think we have at Health Canada.
In terms of accountability, which is the second major area that I think we have to deal with as a department looking to the future, we come at this issue in a couple of ways. The recent health agreement recognized the importance of being accountable to Canadians. By the recent health agreement, I'm referring to the September accord that was signed by the first ministers. It was agreed that each government would report to Canadians on health programs and services they deliver, on health system performance, and on progress toward key priorities. They also agreed to collaborate on a comprehensive accountability framework.
We also have—and this is crucial—responsibility on the delivery of our own programs and services. And through our grants and contributions programs, we are putting a significant effort toward improving our processes in this area.
[Translation]
With respect to priority sectors, the department of Health has a very long list of important issues and we are constantly trying to strike a balance among numerous competing demands.
These issues usually fall into one of four main sectors or themes, as I have already explained.
[English]
In the first nations and Inuit health area, we're going to have to continue to place a major emphasis on service provision and achieving the fundamental objective of narrowing health inequalities between first nations and the general population. We also are going to have to focus on accountability, not only in terms of that branch, but across the department. But financial accountability is going to be one of the important priorities we need to pursue as a department.
We also need to work on the implementation of the first ministers agreement, which I mentioned briefly. That agreement laid out eight priority areas for us to work on collaboratively with provinces and, in some cases, with respect to federal leadership. They included: access to care; health promotion and wellness; primary health care, which involves an $800 million primary health care transition fund which we're in the process of implementing; health human resources; home and community care; pharmaceuticals management; health information and communications technology, where we're in fact establishing in that context an information and communications technology corporation, which will help implement over $500 million worth of investments, we hope, in building an electronic patient-record backbone that can help in terms of the health care system and in areas such as tele-health. We've also established a $1 billion health equipment and infrastructure fund, which provinces are drawing down on.
And the agreement also raised a very important issue around accountability—namely, the development with provinces of performance indicators in three important areas: outcome, status, and delivery in terms of the health care system.
In terms of health protection, which is another important area, we also need to maximize the safety of drugs, food, natural health products, medical devices, biologies, related biotechnology products, and producer and consumer products. A keen, ongoing focus for us will be environmental protection and sustainable development. And, as I've said previously, our guardian or stewardship or regulator role is of paramount importance to the health of Canadians and therefore plays a significant role as we consider our program and resource priorities in the future.
Lastly, just before I conclude, I'd like to talk about investing upstream to improve health. Considerable attention is paid throughout Canada on health care—discussion around the system, medicare, the Canada Health Act. This is appropriate. And, as I've already discussed, the federal government continues to invest considerably in health care.
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[Translation]
However, the health of Canadians is our main interest and goes well beyond issues of simple health care. That is the reason why we have made considerable efforts to devise and analyze a health framework that would better incorporate the potential to invest in programs and activities that help Canadians improve their health status and remain healthy much longer. This means that in the long term, we will have to think about investing in global health sectors such as mental health, childhood development, injury and disease prevention, etc.
[English]
Thank you for your attention. I've covered a complex and interesting department in a very short period of time, but in the hope that I would give you an overview.
What I would propose, Madam Chair, is to introduce each of my colleagues, ask them to make a very brief overview in terms of their branch, and in so doing respond to some of the written questions that we have from you. We'll go through that today.
I'm at your pleasure, but I assume at some future point you may want to call me or others of us back to answer further questions the committee may have. My plan was basically to introduce my colleagues. Is that okay with you?
The Chair: That's fine. Just before you do that, Mr. Green, I should alert my colleagues to the fact that I'm hoping they will make note of any questions that come to mind as they're hearing these presentations. Once again, the clerk will collect these questions by the end of the day. We can forward them to the officials so when they come back on Thursday they will present more information to us based upon your direction through your questions.
This is essentially a working session for the members of Parliament, who are going to design what they want to hear about on Thursday through their questions. You can do it in two ways. You can hand in your written notes at the end of this, or, if they're not too legible, you might want to go back to your office, have your staff type it up, and send it to Mr. Sokolyk, the clerk.
Having said that, Mr. Green, you're giving us Mr. Shugart. Thank you.
[Translation]
Mr. Ian Shugart (Assistant Deputy Minister, Health Policy and Communications Branch, Department of Health): Thank you, Madam Chair.
As Mr. Green has said, I will be making a very brief presentation, an overview of the Policy Branch. I will begin with what I hope is a logical grouping of the questions put by the committee.
[English]
The policy branch is the primary location in the department for development of analysis and policy development in the area of health care. We have a specific responsibility for the administration of the Canada Health Act. Members will know of the tabling annually in the House of the annual report on the Canada Health Act.
We provided support to the minister and to the government leading up to the health agreement of the first ministers last September that Mr. Green mentioned. We're engaged all the time in an analysis of monitoring of the developments of health care in the country.
We work with provincial and territorial governments over the course of the year in assessing developments, responding to professional and community interests in regard to health care, and seeking to contribute to the development of policy in health care. Now, having achieved that agreement last September, we are working with our provincial and territorial colleagues on the implementation of the action plan in that agreement.
We also have a responsibility in the policy branch for the coordination of policy generally in the department, specifically for strategic planning. My colleague Mr. Lafleur and I work on the preparation of the report on plans and priorities, which you're familiar with, as well as the departmental performance report. Also, we're responsible for policy responses to emerging key issues on, for example, assisted human reproduction. I'll comment on that in greater length.
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There are two other general functions that round out
the work of the policy branch. The first is
coordination on behalf of the department for the
provincial-territorial relationship with the Government
of Canada in the health domain.
All branches are
involved in that, of course, but we have responsibility
for the coordination of the
federal-provincial-territorial machinery, and secondly,
the coordination of Health Canada's international
efforts, which are extensive, ranging from public
health and healthy environments, and so on, to
international collaboration on regulatory matters, and
that kind of thing, as well as health international
development.
So it seemed to me that I might pick up on the questions that had been put with respect to the federal-provincial division of labour in health—if I might begin with that—touch on the question that was put about the social union framework agreement, give a little bit of information on the funding of health, the Canada health and social transfer, and then move on to some issues related to the Canada Health Act.
One of the popular perceptions in Canadian federalism is that health is entirely a provincial domain. While certainly health care is the responsibility of the provinces, and members will know that we frequently refer to the responsibility of the provinces to make many of the decisions with respect to the delivery of health care, in fact the whole domain of health is a little bit more nuanced and complex than that.
The Constitution does assign to the provinces responsibility for health care, although over the last 40 years, since the development of medicare more formally in the country, the Government of Canada also has a very substantial role in the funding of health care services, more recently through the Canada health and social transfer, and through the Canada Health Act the essence of medicare, the principles of medicare in this country, are expressed.
In effect, what we have in the health care area is a partnership between provincial and territorial governments and the Government of Canada with respect to the funding and the rules of the road, if you will, in terms of the shape of our health care system. So we administer the Canada Health Act and work with the provinces in terms of facilitating their compliance with the act.
Moving beyond the health care area, the deputy minister has referred to the responsibilities of health protection, which in particular is a federal responsibility largely under the Criminal Code of Canada, the underlying principle being that the government, through the Criminal Code, prevents “public evil”—that's the technical term—which gives the basis to our work in health protection. As you know, that extends to issues of safety of pharmaceuticals, blood products and devices, and consumer products.
In addition to that, the role of health promotion and the use of health information to facilitate good health is something in which the Government of Canada has been involved, and we've seen again over the last 40 years in particular and in the last couple of years a lot of attention with respect to medical and health research that is funded by the Government of Canada. And then there are the direct responsibilities for the provision of health care services to aboriginal people on reserve and the Inuit in their communities.
[Translation]
In all of these responsibilities, there is, indeed, a partnership between the federal government and the provinces. Our health system is quite complicated.
[English]
So that's the division of responsibilities, and we'd be happy to come back to a more detailed description of how we work with our provincial and territorial colleagues in each of those areas.
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In 1999 the first ministers,
[Translation]
except the Premier of Quebec, signed a political agreement,
[English]
the social union framework agreement, which, as I say, is a political accord between first ministers and their governments on the operation of the social union in this country.
The question had to do with what it prescribes in relation to federal health care. I don't want to go too much into the detail of this or the semantics of it, but in fact it doesn't really prescribe anything. It offers a guideline for the conduct of collaboration between the Government of Canada and the provinces.
It does refer, for example, to health initiatives respecting the principles of medicare. It underlines the importance of the principle of accessibility of Canadians to health services. It does indicate that new policy, in our case in the health domain, should not conflict with the principle of mobility of Canadians, professions, and so on, across the country. Very significantly in terms of the new frontiers of policy development, the social union framework introduced the notion of developing outcome measures, the notion that we ought, as governments, to be reporting to Canadians on the performance of public services and of the system, and therefore encourages governments to develop outcome measures. Finally, it encouraged the governments, in social policy generally, to develop priorities and to work together on the operationalization of those priorities.
So we have been working with SUFA. For example, as we approached the health agreement last September we had the principles of SUFA very much in mind, and I think it is reflected in a number of key areas. Again, we could come back to that at greater length.
I believe, Mr. Merrifield, you asked about the CHST and federal funding in support of health and how that works, what the health component of the CHST is.
The Canada health and social transfer is a block fund, the purpose of which is to provide provinces and territories with the flexibility they need and wish to have to assign transferred funds to the different areas of health and social policy. So there is no precise health component. The provinces make the decision about what will be spent on health and education and social services, and so on.
The transfer is made up of what are called “tax points”, the ability to raise revenue, and that revenue raised by the federal government is in effect transferred to the provinces for their purposes, as well as a cash portion. The total amount in the forthcoming fiscal year is roughly $34 billion—that's the cash and tax. The cash portion of that is $18.3 billion in the forthcoming year, and that grows to $21 billion at the end of the period 2005-2006. The Minister of Finance is responsible for that particular area.
Federal direct spending in health, first nations and research and a variety of others, our own responsibilities, directly amounts to about $3.6 billion. That was in the year 2000.
So that's an overview of the funding picture and the health portion, which is really not a dedicated portion.
Mr. Merrifield, you also asked about changes to the Canada Health Act. The answer to that question is that since the act was passed by Parliament unanimously in 1984, there have been only technical amendments. They've been subsequent to other developments, such as the Canada health and social transfer, adopted in 1995. So there have been no substantive amendments since the act was introduced.
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It seemed to me that a related question was Mrs.
Ablonczy's question on the process relating to emerging
technology and on how this is being adopted into the
health system. As you know, Madam Chair, the system is
increasingly evolving, in particular in terms of how
the Canada Health Act relates to physician and hospital
services. Indeed, we're seeing a rapidly evolving
system, the change being largely driven by emerging
technologies. Not surprisingly, the provinces,
territories, and we ourselves in our own direct
responsibility are having to adjust to new
pharmaceutical products and new technologies.
The provinces determine what services will be insured under the Canada Health Act. Generally speaking, the acid test is whether a service is medically necessary. Provinces generally work that out with their health experts. In other words, it's kind of a joint decision-making process, between provincial medical associations and medical bodies on the one hand and the provincial ministries of health on the other, to determine what is an insured service on the basis of what is medically necessary.
I would suggest that this constitutes one of the major pressures the provinces are facing in this regard as, for example, they judge among new products coming on stream from the pharmaceutical sector. They also deal with issues of what conditions are presenting themselves in the system, what treatment options the medical profession is advocating, what is available, and under what conditions citizens will be covered by their health plans.
Now, the flip side of that was the question of what happens on the other side. New products and new technologies come on stream. There's a process to determine how they're paid for. What happens in regard to de-listing certain services?
Essentially, the same kind of process happens there, although not surprisingly the pressure is to add on and not to take off. But for provincial drug formularies, for example, there are committees of technical experts that deal with the removal and addition of items. What we do is monitor that decision-making process. Provinces are particularly asked under the new reporting system for the Canada Health Act annual report to inform us of products or procedures that are de-listed. There have been a number of these over the years.
The reason we're interested in that is because with regard to any major, significant procedures or treatment options that would be de-listed, we want to make sure that there's no fundamental breach from the point of view of the comprehensiveness principle of the act. These are matters of provincial priority setting and of provincial judgment. Examples of services that have been de-insured by provinces in recent years are reversal of sterilization, routine newborn circumcision, tattoo removal, and that kind of thing. To my knowledge, there have not been any major health procedures or technologies that have been de-listed. That's our interest in that particular issue.
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I think, Mrs. Ablonczy, you also asked about what
we're doing to prepare the health system for changes in
demography. Again, the perception is that
the health system is under enormous pressure as a
result of the aging of the population. Our own
analysis shows that we probably have about a decade or
so before the really major wave of the aging baby
boomers hits the system. That wave is expected to hit
in a major way between 2012-15, so it's important, as
you point out, that we be adjusting now to that
forthcoming significant demographic change.
There are number of issues, some of which were addressed in the accord last September. I would cite work that we're doing with the provinces and territories. They are the leaders in this, quite frankly, in regard to home and community care.
An area we're all working on very intently to try to develop it is the reform of primary health care. This is the whole collection of services, the first line of services people call on typically, led by family doctors, nurse practitioners and so on. Properly designed primary health care can be a kind of hub in the whole health system, so that people who need home care can be referred to an adequate degree of services, freeing up emergency rooms and long-term hospital beds for the acute care sector and so on.
The role of the professionals in primary health care is something that needs to be developed. The adequate supply of family doctors and nurse practitioners and so on is an important issue there.
There's the role of the electronic health record so that people can be dealt with. The follow-up to patients and that kind of thing—getting the right kind of care at the right kind of time—is the kind of model we have in mind. The principle behind that is that if the system is organized in an optimal way as this aging cohort moves through the population, people can be dealt with in the appropriate setting so that the health dollar is used in the most efficient way possible.
The health transition fund, which was brought in the 1999 budget, has been helpful in developing a pilot project that has been on-the-ground demonstration of new approaches to dealing with issues like demographic pressures, home care, pharmaceuticals and primary care. That project is winding up this year, and in the final year of that work, we will be emphasizing the dissemination of what has been learned from the results of that work. We'd be happy to share that kind of information with the committee.
Mrs. Diane Ablonczy (Calgary—Nose Hill, Canadian Alliance): When is that going to be?
Mr. Ian Shugart: Reports will be coming out over the course of 2001-2002. There will be regional meetings with professionals and stakeholder groups and so on. We'd be happy to provide you with a plan once that's formalized, and we'll make available to the committee information as it comes on stream. That will be coming out over the course of the next year.
I'll move to the Canada Health Act, if I might. Ms. Wasylycia-Leis asked about the current state of investigations in the department on CHA issues, as well as the use we're making of the additional resources announced by the Minister of Health with respect to compliance on the CHA.
Our approach, wherever possible—and this has been true over the history of the Canada Health Act since 1984.... As I mentioned, because the care portion of the health system is a provincial responsibility, we try to deal with these issues in a collaborative manner. We hear about things typically either through complaints raised by citizens or through media reports. When that kind of information comes to us, we are in touch with the provinces, who also tend to become aware at the same time. While it sometimes takes longer to do it this way, we try to work on these issues through informal consultation with the provinces and territories.
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At the moment there are 11 investigations under way.
Four relate to MRI services; three relate to user
fees—these are specific issues of the alleged
application of user fees; and four relate to the
provision of abortion services.
I might just remind the committee that the Canada Health Act deals with two types of potential breaches. Two relate to the application of extra-billing by physicians, or user charges, and the other category involves breaches of any of the five principles of the Canada Health Act. Those are discretionary matters. They're matters of investigating and seeking to understand and ultimately applying judgment about whether in fact the principles have been breached. Those dealing with user fees and extra-billing are non-discretionary. In other words, there's no room for interpretation or judgment once the facts are established. The act is clear.
So we're investigating working with Alberta, British Columbia, and Quebec on MRI and CT scan issues, and with Alberta, Ontario, B.C., and Quebec with respect to user charges. In all of these cases the information has been made available to the provinces. There are official-level discussions and in most cases we are awaiting confirmation from the provinces that they are taking the appropriate action.
On the additional funds with respect to CHA monitoring, we're adding primarily to our staff in—
Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Sorry. The four investigations about the provision of abortion services—what were they?
Mr. Ian Shugart: Yes, I'm sorry, those jurisdictions are New Brunswick, P.E.I., Nova Scotia, Quebec, and Manitoba. Those are the jurisdictions involved. Essentially the issue has to do with provincial policy regarding where the service is provided, which is to say, in clinics outside of hospitals. So the issue is common to those five jurisdictions.
So we have added staff in our regional offices, which were described by Mr. Green. We're also adding a few at headquarters. One of the things we're doing in headquarters is to develop the Canada Health Act information system so that in fact our database of developments in the country is more solid and better able to provide improved reporting through the Canada Health Act annual report. Members may have noticed that the report this year, tabled I think just at the beginning of the year, is an expanded, broader picture of what's happening in the country.
Ms. Judy Wasylycia-Leis: For clarification, I wonder if I can get some detail on the actual number of staff hired pursuant to the $4 million additional expenditure for compliance.
Mr. Ian Shugart: Yes, by the beginning of the new fiscal year we'll have completed the addition of about 18 additional staff.
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Ms. Judy Wasylycia-Leis: Could you give a breakdown on the kind of staff?
Mr. Ian Shugart: I believe that a dozen of those are in the regions and the remaining half dozen in Ottawa. Their task in Ottawa is to support this information system and just enhance our policy capacity with respect to interpretation of the act and so on. Those in the regions are primarily responsible for monitoring what's going on in the field and being able to work with their counterparts in provincial ministries.
Ms. Judy Wasylycia-Leis: Does that 18 staff account for the $4 million increase?
Mr. Ian Shugart: Plus the information system, the development of the database and so on and the costs associated with the improved reporting to Parliament. So we are expecting to expend the $4 million that Mr. Rock indicated.
Ms. Judy Wasylycia-Leis: Could we get a breakdown of the $4 million?
The Chair: Could you make that a written question and submit it?
Ms. Judy Wasylycia-Leis: It was a question. I'm just not getting much detail.
The Chair: You could maybe ask for the detail you want and it could come back in more detail.
Mr. Ian Shugart: We can provide that, Madam Chair.
The Chair: I'm trying to keep this format, Judy. Otherwise I don't know how to be fair about people asking questions. That's why I'm asking people to make notes as they're listening to ask for the further information or clarifications they need. Thanks.
Mr. Ian Shugart: Madam Chair, I think I'll turn now to the questions that Mrs. Ablonczy and Ms. Parrish asked with respect to assisted human reproduction. They asked about the status of the legislation.
I'll just point out that a year or two ago we engaged in another series of discussions with our provincial counterparts, went across the country, had detailed discussions with them on these issues as well as continued meetings with stakeholders and subsequently turned our hand to revising and developing the legislation further. We're at the stage, or very close to the stage, of being able to bring that forward.
The minister did indicate in the House that he would like to move on that in the short term and gave a signal that this committee might in fact have the opportunity to engage in discussion on a draft piece of legislation. So we're awaiting our instructions in that regard as to when and how to bring that forward, but we're in a position to do that in the short term.
There was a question about how the new legislation would be different from the bill introduced in 1997. I'm not able today to engage in a kind of briefing on the bill. I think that time will come. But let me just boil it down.
The former bill, Bill C-47, essentially dealt with prohibitions. As you know, those prohibitions were then put in the form of a voluntary moratorium when that bill died on the Order Paper. The new bill will deal with those prohibitions, but it will go beyond simple prohibitions to provide for regulatory authority for activities in this domain. Those could include, for example, the licensing of facilities that are engaged in assisted human reproduction. The regulations could deal with the collection and the use and disclosure of health information with respect to assisted human reproduction, the treatment by researchers as well as in facilities, the safety and so on of reproductive material—sperm, for example, and also the treatment of embryos for research purposes and so on. So the main difference is going beyond simple prohibitions to deal with the range of regulatory issues associated with that.
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Ms. Parrish also asked about the rules in place with
regard to this technology, pending new legislation.
Essentially there are three provisions on an interim
basis, if you will. I've mentioned the first, the
moratorium on applications of reproductive and genetic
technology. The second is that the two principal
professional groups, the Society of Obstetricians and
Gynaecologists and the Canadian Fertility and Andrology
Society, have guidelines that essentially are oriented
to the profession in terms of how they should conduct
themselves. Third, with respect to the research domain,
the Tri-Council Policy Statement for Ethical Conduct
in Research Involving Humans provides guidance to
the research community.
Now, it's not clear—and this is the reason for bringing forward a legislative package—that those three necessarily cover all professions, all domains, or all of the issues that are emerging continually in this field, but they do provide some coverage during this interim period.
I'll conclude by addressing a couple of general questions, Madam Chair. I was asked by Ms. Ablonczy about the timing and the substance of the next round of federal-provincial-territorial consultations in health. It's difficult to point to the next round because in fact these things are developing all the time. There are essentially four standing advisory committees. One is on population health, one is on health services, another is on health information, and the last is on health human resources. We can provide this in writing if it's useful to the committee.
Following last fall's health agreement, committees on primary health care reform and on performance indicators and reporting were also put in place. Those two in particular are meeting more or less every two or three months, whether in teleconference or face-to-face meetings, to develop the indicators that as governments we will bring in, in keeping with the accord, and also to move forward the development of primary health care.
So those are specific subject areas in which this month and next month and virtually every month there's some significant action between us and our colleagues.
Deputy ministers of health meet twice a year. The next meeting of deputies would be scheduled for June in St. John's. Typically the agenda for those meetings tracks the work of the advisory committees. I think for the foreseeable future deputies will be asking their colleagues, and then ministers when they meet annually in September will be asking deputies, for a status report of implementation of the health agreement last September. So I think that is likely to drive the federal-provincial agenda for some time to come.
Another area that is very active is health human resources. That committee is chaired by one of the provincial deputy ministers. The other one is health information, where we, the provinces, and the territories are working flat out to develop the capacity in the country on telehealth and the electronic health record.
Finally, Mr. Dromisky asked about the relationship, or the lines of authority, if you will, between our own Department of Indian Affairs and Northern Development, our department, and provincial ministries of health.
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My colleague, Patrick Borbey, can get into this in
further detail, but essentially we provide on-reserve
services and provinces provide health services to
aboriginal people in the general community. Because
health, particularly among our aboriginal people, is
determined by much, much more than health care
services, DIAND is responsible for the provision of
services, such as on-reserve housing and education and
so on, that influence the health status of the
aboriginal population.
Now, I might point out, that's the theory and that's the truth with respect to the formal responsibilities. The on-the-ground reality is that aboriginal people are frequently moving between the reserve and off-reserve communities. Indeed, what we have to do, much more effectively than has occurred in the past, is develop the collaboration among the aboriginal leadership and between the Government of Canada and the provinces so that, while we respect these basic responsibilities, the real needs of aboriginal people on the ground are met in a much more integrated way.
That's the policy branch manager.
The Chair: Thank you, Mr. Shugart.
Mr. Ian Green: I apologize, by the way, for my colleague's length, but in fairness to him, he had the large majority of the questions put by the committee. We felt it would be helpful to try to give you an answer to basically all of them.
The Chair: I think we'll be inviting him back rather frequently.
Mr. Ian Green: Oh, goody.
Mr. Ian Shugart: It'll be a pleasure, thank you.
Mr. Ian Green: The next area we'd like to talk about concerns the first nations and Inuit health branch, which is an area of interest, I know, judging from a number of the questions we got. My colleague, Mr. Borbey, is going to talk briefly talk about the branch. We've had some questions on specific audits and we've also had some questions on the accountability aspects, so in the process of talking about the branch I think Patrick will try to touch on those as well.
[Translation]
Mr. Patrick Borbey (Associate Assistant Deputy Minister, First Nations and Inuit Health Branch): Thank you. Good morning, Madam Chair. Good morning, members of the committee.
I am happy to be here with you today. I have only been with the Branch for the past two months. So it is all relatively new to me. I hope, nevertheless, to clarify certain matters for you and supply the information that you require.
[English]
The mandate of the first nations and Inuit health branch is threefold: to assist first nations and Inuit to improve their health; to ensure availability of or access to quality health care and the health services for first nations and Inuit; and to support greater control by first nations and Inuit over health programs and services.
Madam Chair, the first nations and Inuit health branch faces a number of challenges in terms of responding to the health issues facing members of the first nations and Inuit communities in Canada. I'll mention a few statistics that might be interesting.
First, 40% of the population is under the age of twenty, so there's a baby boom going on. Death by injury to children is three to four times higher than for the general Canadian population. Youth suicide rates are five to eight times higher. Smoking rates are nearly double the Canadian rate. As well, 42% of the first nation population depends on social assistance. Only 37% of the non-reserve population has a high school education. With regard to families, 23% are headed by a single parent. These statistics point to the tremendous challenges that we and first nations and Inuit leadership face.
How are our services delivered? They are delivered through seven regional offices, through a northern secretariat that includes the three northern territories. We have 82 nursing stations, and the rest of our communities, or first nations and Inuit communities, are served by more than 200 health centres across the country. There are four federal hospitals in Ontario and Manitoba.
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Our funding supports 800 community-based workers
providing addictions prevention, counselling, and
referral through 54 national native addiction and drug
abuse program centres and 10 solvent abuse centres.
We have more than 1,700 agreements with first nations
and Inuit communities with respect to health services.
[Translation]
Madam Chair, The First Nations and Inuit Health Branch manages a considerable budget totalling $1,279 billion. Of that amount, about 53%, or $678 million, is allocated to the community health program. An amount of $578 million, or 45%, goes to the Non Insured Health Benefits Program. About $24 million is allocated to the four hospitals that I mentioned earlier.
The community health programs include nursing care, communicable disease prevention, occupational health, community health representatives, the National Native Alcohol and Drug Abuse Program, and the Aboriginal Headstart Program.
In remote areas, the community health programs include emergency services and treatment. As for communities located within 90 kilometres of medical services, the programs target public health and prevention. Non Insured Health Services include pharmaceutical services, dental and vision care, and transportation for medical reasons.
The program also supports emergency intervention, mental health counselling, and covers the provincial contributions for health care in Alberta and British Columbia.
Some 653,000 First Nations members living on or off reserve, as well as Inuit, are eligible for these services.
I will now answer some of the questions that were submitted by the members of the committee.
[English]
The first question was addressed by Mr. Stan Dromisky with respect to roles and responsibilities of Health Canada and provincial ministries of health. Diane, I think Ian has covered that quite a bit. I would just like to make a couple of comments with respect to the first nations and Inuit health branch.
Services provided, such as hospitals and primary health care, are provided by the provinces to all their citizens, including first nations, whether they are on reserve or off reserve. Our branch, as I said earlier, supports community-based health services on reserve and provides the non-insured health benefits to all status Indians regardless of residence.
In addition, through the transportation component of the non-insured health benefits program, the branch helps ensure that status Indians living on reserve are able to access physicians, insured programs, and other specialists covered by the province.
Indian and Northern Affairs Canada, through its mandate for the provision of the majority of social services on reserve—education, housing, social services, infrastructure—also affects health status, as these are major determinants of health. As a result of the interconnections among the services provided by Health Canada, the provinces, and INAC, it is vitally important that we work together.
Examples of this collaboration are to be found in a number of different areas. For example, we're working with INAC on the care for the elderly and disabled, early childhood development, and special education. As another example, we have signed an MOU with Manitoba and the Island Lake Tribal Council to address health needs in that particular area of the province.
Also in Manitoba, with INAC and with a first nation organization called Awasis—I will not give you the full name, I'm sorry—we are conducting a pilot project on children with complex medical needs. We are also working closely with Newfoundland and with INAC on solutions to the Innu crisis that we all have heard of.
We work with other federal departments and with the Government of Alberta to better engage aboriginal communities in economic development, which of course is a key health determinant.
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I'd like you now to turn to the issue of the Auditor
General's reports for 1997 and 2000. Ms. Judy
Wasylycia-Leis has sent a question that raises a number
of different, though interconnected, issues with
respect to the reports. These issues all relate to
accountability, but for the purpose of this
presentation I'll first address the question and there
will be follow-ups in the next two sections.
In terms of the two Auditor General reports, the branch has responded in a tangible way to the recommendations. The accountability framework has been completed and will allow the branch to demonstrate value for resources expended, identify any gaps, manage risk to health status and programs, improve the capacity to deliver services, and improve overall management practices. As an integral part of the framework, a compendium of programs has been developed and is now being validated with first nations and Inuit communities. It will be in place for the 2001-2002 fiscal year.
The compendium of programs is an inventory of program information that sets out program descriptions, the goals and objectives for each program, program components, service providers and their qualifications, accountability indicators, reporting requirements, evaluation frameworks, and funding levels.
The branch has also invested in the management of contribution and transfer agreements at their regional level. A new contracts and contributions tracking system that will assist in the monitoring of reports and agreements is being piloted at headquarters and in our Pacific region, and will be introduced throughout the branch in the fall of the current year.
In the area of non-insured health benefits, a major concern of the Auditor General, I can advise you that the audit framework has been completed. It is composed of four parts, which are next-day quality assurance, client confirmation and complaints, provider profiling, and on-site audits. In addition, the management of the drug utilization messages includes the evaluation of the frequency of claims overridden, quarterly reports on the number of claims processed, the number of claims rejected, the number overridden and paid, and also the drug utilization review rejection type, DUR, override totals and type of override. Reports are now produced on top providers in a region overriding the largest proportion of claims. This information forms the basis to further actions, which can include contacting the provider and on-site audits.
The Chair: Excuse me, Mr. Borbey, could you explain to us what these “overrides” are? I don't understand.
Mr. Patrick Borbey: I have to admit that this is relatively new to me, as well. It's with respect to monitoring the use of services throughout a particular region or throughout the country of our non-insured health benefits. For example, if there are high costs to drugs associated with particular users in a region, we have certain measures that kick in so that we do analysis and review to make sure everything is appropriate. We also have, in some cases, providers that may be overbilling, whether dentists or other specialists. Also there are mechanisms that kick in for us to review and ensure that is controlled and taking place, and that recovery measures are taken if necessary.
These were weaknesses that were identified by the Auditor General in the last two reviews. They're very technical and very specific issues, but they were important to monitor and to review and implement changes. I wish I could give you more technical detail.
There are a number of other measures associated with the non-insured health benefits. I'll spare you all the other details, but one thing I would like to mention is we're also investing more in communications with clients. That includes the public service announcements that are going to be launched in the fall of 2001 on the Aboriginal Peoples' Network with respect to the effective use of drugs.
We also have some issues with respect to client consent of information with respect to drug and service utilization. That's an issue we have to deal with as well.
• 1220
These actions are a summary of how we're addressing
some of the criticisms and observations that were raised
by the Auditor General. I want to note that we will be
appearing before the public accounts committee on April 5
to discuss our response and our actions that have been
taken following the AG reports, and we'll be able to
provide greater detail at that time.
The next area of questioning that was raised was with respect to the Virginia Fontaine Addictions Foundation. I can advise the members of the committee that there are two audits that are taking place right now: an audit of the books and records of the Virginia Fontaine Addictions Foundation Incorporated related to the centre's compliance with terms and conditions of the agreements with Health Canada, as well as an independent review of internal Health Canada processes related to the signing of agreements with the foundation and with its predecessor corporations. Those are the two audits that are currently ongoing.
Kroll Lindquist Avey and KPMG are the firms currently auditing the foundation. That audit commenced February 9—just last month—after the court decision agreed that we had unrestricted rights to audit and confirmed that the department had the right to suspend funding to the foundation.
It is too early to be able to advise the members of the committee with respect to the timelines for reporting on this audit.
The second audit—the independent review, the internal review—is being conducted by Kroll Lindquist Avey and involves the Manitoba regional office and the national capital regional office as well. The first draft is expected shortly, and we will be applying standard protocols to ensure that the facts in the report are accurate.
If you will allow me, I'd like to come back, Madame Chair, to the accountability issue. There were questions raised specifically about the accountability framework for the first nations and Inuit health branch.
Further to the points I made earlier and consistent with the follow-up to the AG's report, I want to reconfirm that the first nations and Inuit health accountability framework has been completed and is being implemented. Work on the framework began right after the 1997 AG report in response to the recommendations contained in that report and in support of the federal government's Gathering Strength initiative.
The work has progressed in partnership with first nations and Inuit. The framework development was accelerated due to the Virginia Fontaine Addiction Foundation incident and has responded to, and incorporated as well, recent changes to Treasury Board policies with respect to transfer payments.
As a result of this extensive review, the number of standard agreements that we enter with our clients in first nations and Inuit communities has been reduced from 16 different agreements to four standard agreements, with enhanced enforcement and recovery provisions dealing with the right to audit, conflict of interest, intervention, and termination of the agreements. Regional staff has been trained in these new agreements. The standard agreements will be reviewed with communities and implemented over the next six months. In fact, we have just sent letters to all communities informing them of this new development.
While we can expect that some first nations and Inuit will criticize the branch for a lack of consultation relative to the development of the new standard agreements, we are optimistic that, once the communities see the changes, they will agree with them and sign new agreements. During the review period all services will continue to be provided to communities and their members.
I also want to make the point that all new programs that have been introduced over the last five years have substantial accountability measures built into their design. As well, the department's audit strategy provides the branch with another level of accountability measures.
Finally, within the branch we have established an office of accountability implementation, which will oversee the rollout of the accountability framework.
• 1225
[Translation]
Madam Chair, I would like to thank you, as well as the committee members, for having given me the opportunity to tell you about the important projects undertaken by our branch.
We have made considerable progress in dealing with the recommendations contained in the Auditor General's report and we have taken steps to ensure that our accountability framework is well established.
It is important to underscore the fact that we have done our utmost to carry out these measures, in partnership with the Native and Inuit communities, who also depend upon our support. In doing so, we ensure that our initiatives will be as successful as they possibly can. Thank you.
[English]
The Chair: Thank you, Mr. Borbey.
Ms. Judy Wasylycia-Leis: Can I have a quick clarification? Who or what is being reviewed as part of the internal independent review?
Mr. Patrick Borbey: The second review is being conducted by Kroll Lindquist Avey. It examines the actions of first nations and Inuit health branch staff with respect to funding for the Virginia Fontaine Addictions Foundation—both in Manitoba and in the national capital region.
Ms. Judy Wasylycia-Leis: Do you have a timeline for that?
Mr. Patrick Borbey: I can't commit to any timeline at this stage. We're expecting a first draft shortly, but there will probably be a lot more work required. I can't really commit to when we will complete it, but once the audit has been completed it will become a public document, posted on our website. Of course, it will still be subject to Privacy Act considerations.
Ms. Judy Wasylycia-Leis: Is there any liaison with law enforcement officials at this point?
Mr. Patrick Borbey: I don't think I can comment on that.
Mr. Robert Lafleur (Senior Assistant Deputy Minister, Corporate Services Branch, Department of Health): We have been in contact with the police, with the RCMP, since the beginning of the Virginia Fontaine event. We've been collaborating with them, and they are pursuing investigations related to the allegations referred to them. There is a full exchange of information.
Mr. Ian Green: In my opening remarks, Madam Chair, I mentioned that I think accountability is one of this department's most important issues and challenges. I know we're going to the public accounts committee in early April, but if committee members want to come back to this, we would be pleased to walk them through some of these issues. I think they're vital to the credibility of our programs, which are extremely important in terms of their impact on some of our client groups.
I should point out, though, that accountability is not just an issue for us in terms of the first nations branch. Accountability is a department-wide issue—not just when we have problems, but when we talk about grants and contributions and improving our administration of them. We're looking at doing that right across the department.
In fact, there is both a department-wide accountability initiative and also a specific initiative in terms of the first nations branch. We'd be pleased to take you through both, so that committee members are fully aware of what we're doing and can ask questions or give us input. We would be pleased to do that at your request.
The Chair: Thank you, Mr. Green.
Mr. Ian Green: The next area is Diane Gorman's, if memory serves me correctly—the health products and food branch. In addition to doing an overview, Diane will respond again to a couple of questions. I think one was on issues of TSE and BSE and the other was our relationship to other departments.
Diane.
Ms. Diane Gorman (Assistant Deputy Minister, Health Products and Food Branch, Health Canada): Madam Chair and committee members, thank you for the opportunity to brief you on the health products and food branch. This large science-based branch of Health Canada was created on July 1 of last year, in the realignment Mr. Green referred to earlier.
The branch has a twofold mandate. The first is to maximize the safety and efficacy of drugs, food, natural health products, medical devices, biologics and related biotechnology products in the Canadian marketplace and health system. The second is to promote good nutrition and informed use of the products we regulate. Our activities focus on policy development, on regulatory activities, and on research.
The branch has four major program areas: the therapeutic products directorate, the food directorate, the biologics and genetic therapies directorate, and the natural health products directorate.
• 1230
The branch also contains a number of offices that
provide coordination across the various program
areas. We have the office of consumer and public
involvement, the office of nutrition policy and
promotion, the office of regulatory and international
affairs, the office of biotechnology and science, and a
directorate dealing with policy and strategic planning.
For this fiscal year, the budget for the health products and food branch is approximately $150 million. We have approximately 1,400 employees, two-thirds of whom are scientists and professional and scientific support staff. We have programs across Canada, which are represented in five regional offices and at headquarters. The regional directors report directly to me, so we can ensure we have a standard approach across Canada for safety and inspection purposes.
We maintain our own lab capacity, and we have very important relationships with other Health Canada research lab facilities. We conduct surveillance of food-related microbial hazards, perform toxicology testing, validate therapeutic products, and carry out research. As well, we look forward to forging a strong relationship with the Canadian Institutes of Health Research.
I would like to highlight the responsibilities of the four main program areas I mentioned earlier.
Firstly, the therapeutics products directorate is the national authority that evaluates and monitors the safety, effectiveness, and quality of drugs, medical devices, and other therapeutic products available to Canadians.
[Translation]
Secondly, the Food Branch is mandated to create food safety standards in Canada and establish food supply policies. It must also protect the health of all Canadians by developing policies and programs of a scientific nature based on food health and nutritional value. It has the delegated responsibility to evaluate the effectiveness of the Canadian Food Inspection Agency Food Safety Program.
[English]
Thirdly, the biologic and genetic therapies directorate is responsible for regulating biological and radio-pharmaceutical drugs, as well as blood, blood products, viral and bacterial vaccines, genetic therapeutic products, tissues, organs, and xenografts.
Fourthly, the office of natural health products ensures that Canadians have ready access to health products that are safe, effective, and of high quality. The office maintains proper labelling standards for natural health products, and implements a regulatory framework that supports freedom of choice and cultural diversity.
With one exception, I won't talk about the other offices I described earlier, since they have horizontal functions within the branch. But I would like to talk very briefly about the office of consumer and public involvement, also known as OCAPI.
[Translation]
It is known, in French, as the Bureau de la consommation et de la participation du public.
Following a serious national consultation, Canadians expressed a wish for better information on matters relating to health protection and greater participation in developing policies and programs aimed at protecting their safety and their health. This office was created in response to these needs.
This office encourages the general public and consumers to take part in decisions involving the priorities, policies and programs of the Food, Health and Safety Branch as well as those of other branches with the same type of regulatory responsibilities.
[English]
Because of the importance of scientific evidence and the need for expert advice, the branch has approximately 60 external advisory bodies to call on. These provide scientific and policy advice on the full range of issues within our mandate. As well, we work closely with a number of our other federal partners.
I would like to focus now on one office that was mentioned in questions by several members and that is of fundamental importance. That is the Canadian Food Inspection Agency.
• 1235
[Translation]
At the federal level, the responsibility for food safety is shared between Health Canada and the Canadian Food Inspection Agency. Health Canada defines the food safety standards and policies, while the Agency ensures their implementation. The agency reports to the Department of Agriculture and Agri-Food.
[English]
Health Canada administers the Food and Drugs Act, which is the main federal legislation covering food safety. The Food and Drugs Act, which derives its authority from criminal law, prohibits the manufacture or sale of all dangerous or adulterated food products anywhere in Canada. The CFIA, in addition to enforcing the food provisions of the FDA, administers federal trade and commerce legislation that may refer to the act and impose additional requirements.
[Translation]
The Agency is responsible for all food inspection services, as well as compliance and quarantine checks ordered by the federal government. The Agency also negotiates partnerships with other levels of government, non-government organizations, and its partners in industry and trade, on matters relating to monitoring and observation. It also supplies laboratory support for activities related to monitoring, observation and quarantine.
[English]
Because this is a system of checks and balances, Health Canada is responsible for evaluating the effectiveness of the activities of the Canadian Food Inspection Agency with regard to its mandate for food safety.
There was also a question asked with regard to TSE's, beef safety, and I'd like very briefly to speak to this. It is certainly an issue we would be glad to come back and brief the committee further on.
Health Canada has created a science team responsible for transmissible spongiform encephalopathy, or TSE's. This includes members not only from our branch, but from branches of some of my colleagues here, including healthy environments and consumer safety, population and public health, as well as the Canadian Food Inspection Agency. This committee is responsible for the scientific assessment of the risk of human exposure to the agent that causes mad cow disease, or BSE, through the consumption of beef.
The criteria we work with are those established by the World Health Organization and the Office international des épizooties, which are both internationally accepted authorities on BSE issues. We continue to stay abreast of scientific advancements worldwide, as well as maintaining our presence in these international fora.
I was asked questions specifically with regard to authorities on surveillance. Domestic surveillance activity and monitoring for mad cow disease in cattle, as well as enforcement of BSE policies for meat and bone meal imports, are the responsibility of the Canadian Food Inspection Agency. Canada currently is recognized internationally as being free of this disease, and a risk management strategy to prevent the introduction of BSE into this country has been established. BSE was made a reportable disease in Canada in 1990. Any suspected case of BSE must be reported to a federal veterinarian at the Canadian Food Inspection Agency, who has the authority to order the animal destroyed and tested in a federal laboratory. In 1992 a national BSE surveillance program was implemented in Canada.
Canada currently tests all animals that present with clinical signs that could be compatible with BSE. Testing of mature animals without clinical signs is also currently being done. Samples are submitted by university and provincial laboratories, as well as federally inspected abattoirs. In collaboration with our counterparts in the United States Department of Agriculture, Canada is reviewing the BSE tests being used in abattoirs in Europe, striving to find the most appropriate and effective use for these tests in the Canadian situation.
As I said, it is a subject on which we would be happy to come back and brief the committee further.
The Chair: Thank you very much.
• 1240
I think, Mr. Deputy Minister, we're beginning to lose
our crowd, and it's been a tremendous amount of
information. I wonder whether, if you have further
speakers, we could lead off on Thursday with them. At
the same time you could provide answers to any further
questions the committee members have come up with after
listening to this morning's presentation. Would that
be agreeable?
Mr. Ian Green: Yes, that would be fine. What I would propose is exactly that, seeing that we have three or four branches left. We've answered most of your questions, so those presentations on Thursday could be quite quick. You could then turn to whatever other questions you want to give us that flow from today's discussion. Not all of us will be able to make it back, unfortunately.
The Chair: That's understandable.
Mr. Ian Green: Not all of us will be able to make it back for Thursday, at least. Mr. Lafleur, who is our senior ADM corporate services, has agreed he'll chair our group, if you will. We'll have these presentations made to you on Thursday, and then we'll have whoever we need to follow up on other questions you might have. Would that be all right?
The Chair: That sounds fine with me.
Madame Bourgeois.
[Translation]
Ms. Diane Bourgeois (Terrebonne—Blainville, BQ): Madam Chair, I found the interventions and presentations most interesting. However, as I am a visual person, I wonder if we could not ask the department's representatives to supply us with the text of the presentations that they made. Some were read rather quickly, and it was not possible to take copious notes. The same thing might happen on Thursday, when we have new witnesses. In the future, I would appreciate having a copy of the text in hand.
Mr. Ian Green: We will try our best to provide you with this morning's presentations in both languages. Thank you for your interest, dear colleagues. And we will do our best to have texts in both languages for Thursday. We will do so as soon as possible, Madam Chair.
[English]
The Chair: Thank you very much, Mr. Green and all your team members. I'd also like to thank my colleagues, who demonstrated, I thought, tremendous self-discipline by not jumping in. As you know, politicians really like to talk. I think they did really well in trying to absorb as much information as you were presenting. So thank you to our guests, and thank you to my colleagues for their cooperation.
This meeting is now adjourned.
