HEAL Committee Meeting

37th PARLIAMENT, 3rd SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Tuesday, April 27, 2004

Â

1205

The Chair (Ms. Bonnie Brown (Oakville, Lib.))

Hon. Pierre Pettigrew (Minister of Health)

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1210

Â

1215

The Chair

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1220

Mr. Rob Merrifield (Yellowhead, CPC)

Hon. Pierre Pettigrew

Mr. Rob Merrifield

Mr. Ian Shugart (Assistant Deputy Minister, Health Policy and Communications Branch, Department of Health)

Mr. Rob Merrifield

Mr. Ian Green (Deputy Minister, Department of Health)

Mr. Rob Merrifield

Hon. Pierre Pettigrew

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1225

Mr. Rob Merrifield

Hon. Pierre Pettigrew

Mr. Rob Merrifield

Hon. Pierre Pettigrew

Mr. Ian Shugart

Mr. Rob Merrifield

Mr. Ian Shugart

Mr. Rob Merrifield

Mr. Ian Shugart

Mr. Rob Merrifield

Mr. Ian Shugart

Mr. Rob Merrifield

Mr. Ian Shugart

Mr. Rob Merrifield

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1230

Mr. Ian Green

Mr. Rob Merrifield

Hon. Pierre Pettigrew

Mr. Rob Merrifield

Hon. Pierre Pettigrew

Mr. Rob Merrifield

Hon. Pierre Pettigrew

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1235

Mr. Rob Merrifield

The Chair

Hon. Pierre Pettigrew

The Chair

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

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1240

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

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1245

Mr. Réal Ménard

Hon. Pierre Pettigrew

The Chair

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

The Chair

Mrs. Bev Desjarlais (Churchill, NDP)

Hon. Pierre Pettigrew

Mr. Ian Shugart

Mrs. Bev Desjarlais

Mr. Ian Shugart

Mrs. Bev Desjarlais

Mr. Ian Shugart

Mrs. Bev Desjarlais

Mr. Ian Shugart

Mrs. Bev Desjarlais

Mr. Ian Shugart

Mrs. Bev Desjarlais

Mr. Ian Shugart

Mrs. Bev Desjarlais

Mr. Ian Shugart

Mrs. Bev Desjarlais

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1250

Hon. Pierre Pettigrew

Mrs. Bev Desjarlais

Hon. Pierre Pettigrew

Mrs. Bev Desjarlais

Hon. Pierre Pettigrew

Mrs. Bev Desjarlais

Hon. Pierre Pettigrew

Mrs. Bev Desjarlais

Hon. Pierre Pettigrew

Mrs. Bev Desjarlais

Hon. Pierre Pettigrew

Mrs. Bev Desjarlais

Hon. Pierre Pettigrew

Mrs. Bev Desjarlais

Mr. Ian Green

Mrs. Bev Desjarlais

Mr. Ian Green

Mrs. Bev Desjarlais

Hon. Pierre Pettigrew

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1255

Mrs. Bev Desjarlais

The Chair

Mrs. Bev Desjarlais

The Chair

Hon. Susan Whelan (Essex, Lib.)

Hon. Pierre Pettigrew

Mr. Patrick Borbey (Assistant Deputy Minister, Corporate Services Branch, Department of Health)

Hon. Susan Whelan

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1300

Hon. Pierre Pettigrew

Hon. Susan Whelan

Hon. Pierre Pettigrew

Hon. Susan Whelan

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1305

Hon. Pierre Pettigrew

Hon. Susan Whelan

The Chair

Hon. Susan Whelan

The Chair

Hon. Susan Whelan

The Chair

Hon. Susan Whelan

The Chair

Mr. Rob Merrifield

Mr. Ian Green

Mr. Rob Merrifield

Hon. Pierre Pettigrew

Mr. Rob Merrifield

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1310

Hon. Pierre Pettigrew

Mr. Rob Merrifield

Hon. Pierre Pettigrew

The Chair

Ms. Leslie MacLean (Director General, Non-Insured Health Benefits Directorate, First Nations and Inuit Health Branch, Department of Health)

Mr. Rob Merrifield

The Chair

Hon. Pierre Pettigrew

The Chair

Hon. Pierre Pettigrew

The Chair

Hon. David Kilgour (Edmonton Southeast, Lib.)

Hon. Pierre Pettigrew

Hon. David Kilgour

Mr. Ian Shugart

Hon. David Kilgour

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1315

Mr. Ian Shugart

Hon. David Kilgour

Hon. Pierre Pettigrew

Hon. David Kilgour

Hon. Pierre Pettigrew

Ms. Susan Fletcher (Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch, Department of Health)

Hon. David Kilgour

Ms. Susan Fletcher

Hon. David Kilgour

Hon. Pierre Pettigrew

Hon. David Kilgour

The Chair

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

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1320

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Dr. Karen L. Dodds (Acting Associate Assistant Deputy Minister, Health Products and Food Branch, Department of Health)

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

Hon. Pierre Pettigrew

The Chair

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

Hon. Pierre Pettigrew

Mr. Réal Ménard

The Chair

Mr. Gilbert Barrette (Témiscamingue, Lib.)

Mr. Ian Green

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1325

Mr. Gilbert Barrette

Mr. Ian Green

Mr. Gilbert Barrette

Hon. Pierre Pettigrew

Mr. Ian Green

Hon. Pierre Pettigrew

Mr. Gilbert Barrette

The Chair

Mr. Gilbert Barrette

The Chair

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1330

Hon. Pierre Pettigrew

The Chair

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CANADA

Standing Committee on Health

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NUMBER 012

l

3rd SESSION

l

37th PARLIAMENT

---

EVIDENCE

Tuesday, April 27, 2004

[Recorded by Electronic Apparatus]

  (1205)  

[English]

    The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Good morning, ladies and gentlemen. It's my pleasure to call to order this meeting of the Standing Committee on Health. This meeting has been called to consider the main estimates for 2004-2005.

    On behalf of the committee, I would like to welcome the minister, the Honourable Pierre Pettigrew, our new Minister of Health, at his first meeting with us, and to welcome the officials he brought with him.

    I will now call vote 1 in order to begin our review of the main estimates. As the first presenter, of course, we will call on the minister to make his opening statement.

    Hon. Pierre Pettigrew (Minister of Health): Thank you very much, Madam Chair. It is a pleasure for me to see you personally, and of course the other members of the committee as well.

    I'm very glad that we finally have the chance to meet as you conduct your study of the main estimates for this fiscal year.

    I would like to take this opportunity to thank you for the timely and thoughtful work your committee has already done in producing the prescription drug report. The changes your committee suggests in relation to clinical trials, adverse drug reactions, and direct-to-consumer advertising have been extremely useful in that they have helped to clarify some of the hard choices before us in this increasingly important area of public policy.

    Before I go any further, and with your permission, Madam Chair, I would like to introduce the officials from the department who are here with me today. Sitting with me here at the table are the deputy minister, Ian Green; acting associate assistant deputy minister, health products and food branch, Karen Dodds; assistant deputy minister, corporate services branch, Patrick Borbey; and assistant deputy minister, health policy and communications branch, Ian Shugart.

    With your permission, Madam Chair, I may ask for their contributions when we get to the questions a little later.

    I will keep my introductory remarks brief, as I know you have many questions for me in regard to this year's estimates, but it's important that we have time for a good exchange. This exercise of questioning me and my officials on the estimates for Health Canada is very important, because it is fundamentally about accountability and priority setting.

    With that in mind, I would like to begin my remarks by highlighting a few key spending initiatives reflected in the main estimates, followed by a brief presentation on my vision for a renewed partnership for health care sustainability in Canada.

    The estimates illustrate the importance we place on addressing the pressing health needs of Canada's aboriginal population through new investments in the first nations and Inuit health systems, the first nations water management strategy, and the overall growth of the first nations and Inuit health envelope. They also reflect increased investment in important initiatives such as the primary health care transition fund and Canada's drug strategy.

    Of particular interest to your committee, Madam Chair, the main estimates reflect a new investment in the therapeutic access strategy, an action plan that will help us improve regulatory performance so products get the reviews needed in timely and effective ways and allow us to pay more attention to post-market surveillance so problems can be better identified and acted upon.

    In short, the estimates for 2004-2005 describe a department that is managing its resources to reflect important priorities. However, I would like to stress that the main estimates do not include our most recent fiscal and policy decisions.

[Translation]

    In short, the estimates for 2004-2005 described a department that is managing its resources to reflect important priorities. However, I would like to stress that the main estimates do not include our most recent fiscal and policy decisions.

    The estimates for Health Canada, for example, do not include the federal health care transfer of an additional $2 billion that our government is providing to the provinces and territories through the 2004 budget for growing, predictable and sustainable funding in support of Canada's health care system. That will bring the funding provided under the 2003 Health Accord to $36.8 billion.

    The estimates do not incorporate the budget and Speech from the Throne commitment to establish a new Canada Public Health Agency, which will be a focal point of Canada's national network for disease control, health promotion and emergency response. This will involve the eventual transfer of approximately $400 million from the estimates for Health Canada to the new agency.

    The budget also allocates new funding of $665 million for this fiscal year and the next two years after that to improve Canada's readiness to deal with public health emergencies. Four hundred million dollars of this funding will go to support provincial and territorial public health activities and $165 million will go to the new Canada Public Health Agency.

    And finally, the main estimates, although illustrating many of our priorities, do not give you a complete picture of the direction we are moving in to address the changes faced by Canada's public health care system.

    On this note, I would like to take a few minutes to lay out for you the vision I have for a 10-year plan for health reform.

[English]

    My roles as Minister of Health and the Minister of Intergovernmental Affairs have helped guide my vision for health care reform. I am committed to working in partnership with the provinces and territories to restore Canadians' confidence in their health care system and to make the reforms necessary to revitalize the system and place it on a more secure financial footing for the future. Let me summarize what we will be doing to see that vision through.

    Canadians need to have confidence that the high-quality health care system they want will be there for them when they need it. Unfortunately, for some time now, confidence in the system and in its future has been eroding because of growing concern over timely access to care. Addressing the challenge of timely access on a long-term basis will require a deliberate, comprehensive, and multi-faceted response.

    There are no quick fixes or magic bullets. It will require governments and managers of health institutions to work together to address mismatches in the demand, supply, and distribution of health human resources and service delivery capacity. It will require further progress in delivering health care in the most appropriate setting, whether in the primary care clinic rather than an emergency room, or at home with the right support to recover from surgery.

    Appropriate home and community care can relieve pressure on the acute system, improve services to Canadians, and produce a more sustainable health care system. It will require national strategies for investing in the upstream of health promotion and protection in order to relieve pressure on the downstream of health care delivery.

    Our new public health agency will make a difference in that regard, and I would like to acknowledge here the most important words of my colleague, Dr. Carolyn Bennett, the Minister of State (Public Health), in shaping the nature of this agency, in defining the role of a chief public health officer for Canada, and in building a pan-Canadian public health network.

    It will also require support for strengthening health administration, for innovations that improve productivity, and for new mechanisms to share and adopt best practices. Indeed, Canadians do not just want better access to a 1960s health care system; they want access to a dynamic, state-of-the-art, patient-oriented system that quickly integrates the latest and best medical technologies and treatment options.

    Finally, it will require greater accountability and transparency throughout the health care system. I'll have more to say on this point shortly.

  (1210)  

[Translation]

    But before outlining our reform agenda, let me quickly dispel the idea that the Government of Canada is in a position of superior knowledge of what health care needs, or that we can or should dictate to provinces and territories what steps they should take to reform their services. Indeed, a successful partnership with the provinces and territories is a prerequisite for making durable progress. While provinces and territories have primary responsibility for the delivery of health care services in Canada, Canadians clearly expect the federal government to monitor in the national interest and ensure that the health care system continues to reflect both the letter and the spirit of the Canada Health Act.

    Just as the federal government must be respectful of the provincial role in delivering health care services to Canadians, so too should the provinces acknowledge the federal government's responsibility to ensure equitable access to quality health care services for all Canadians all across Canada.

    But good will alone is not enough, and that takes me to the second key component of a new health partnership: a system of predictable, adequate and stable funding.

    We need to put an end to the corrosive and debilitating debate over money. Canadians have a right to know exactly what the federal government's contribution to health care should be, and whether or not it is keeping its part of the deal.

    But Canadians expect us to be more than just a system bankroller; we are ready to take the next step forward to become a full system partner, to share in the risk of maintaining and enhancing the system over time and in shaping its future.

    In his Toronto speech, the Prime Minister also noted that any health care reform plan must include measures to support the evolution of home and community care services and the development of a national pharmaceuticals strategy.

    These are the new frontiers of the health care system, and pharmaceuticals are the fastest growing area of provincial health spending. We are already supporting efforts in these and other areas, but we are prepared to engage in discussions with the provinces on how we can do more.

    The third prerequisite for a new partnership is of course to modernize the system's foundations.

    The Canada Health Act has been and remains for Canadians a symbol of national solidarity and of shared values. Its five principles are as relevant today as they were two decades ago, when the act was unanimously supported by all political parties in the House of Commons.

    But in recent years, differences of opinion as to how to interpret the act's provisions, and inconsistent enforcement of its requirements, has resulted in growing confusion and uncertainty as to what the act does and does not allow.

    While I am not suggesting that the act be reopened, I do believe we have a responsibility to clarify its practical meaning in today's terms.

    And with growing interest among the provinces to experiment with new forms of health care delivery, we need to ensure that the ground rules for doing so are clearly defined, and that these experiments are closely monitored through a public interest lens.

    And finally, in that context, I believe we need to review existing CHA dispute avoidance mechanisms to make them more transparent and inclusive and to ensure enforcement is more consistent and evidence- driven.

    Health care in this country is now a $120-billion enterprise, comprising roughly 10 per cent of our economy. But we have really just begun to account for how effectively that money is spent. Too often, Canadians are asked to blindly accept assertion as fact, to simply trust governments and providers to do the job.

    We will not restore confidence in the system unless we give Canadians broader and better access to the facts. Canadians no longer accept being told things will get better; they want to see proof that they are.

    They have a right to know, for example, what's happening with health care budgets; what the number of hospital beds, doctors and nurses are; whether the gaps are being closed and home and community care services strengthened; and whether treatment outcomes are improving.

  (1215)  

    Better information will allow Canadians to discuss national objectives for quality care. It will let them answer questions like: how many MRI machines do we need? What should be the standard for the number and distribution of various specialists? What are the unique requirements for health professionals in rural and remote areas?

    Canadians need this information, not to make governments accountable to each other; but so that all governments and all providers are held accountable to citizens.

    Indeed, you cannot improve what you cannot measure.

[English]

    Improving our health care system will require a cooperative effort between all levels of government, health providers, and citizens, an effort based on the principle of collaboration, sharing, and respect. We are well on the way to building a better health system in Canada, one that guarantees timely access to quality care as a right of citizenship, not of privilege, a system that is more sensible and more sensitive, that focuses first and foremost on patients, a system where information is gathered and widely shared, where standards are set collaboratively, performance is measured objectively, and evidence-based decision-making is the norm, an accountable system where citizens are equipped to take control, to be partners in determining and acting upon their health and health care needs.

    We are well on the way to building a system with these attributes. With that, Madam Chair, I look forward to the committee's questions. Equally importantly, I want to benefit from your counsel as to what the federal government must do to make Canada's health care system more responsive, comprehensive, and cost-effective, and to mitigate potential threats to its integrity and sustainability.

    Je vous remercie beaucoup de votre attention.

    The Chair: Thank you, Minister, for that broad overview of your plans and priorities.

    We will move on now to the question and answer session. We will begin with the lead critic for the official opposition, Mr. Rob Merrifield. Mr. Merrifield, you have 15 minutes.

  (1220)  

    Mr. Rob Merrifield (Yellowhead, CPC): Thank you, Mr. Minister, for coming in and sharing your vision, your plan, and the idea that you have to work more cooperatively with the provinces. I think that is good news for health care in Canada, and I think all quarters of the country would applaud that.

    I want to talk a little bit about the five-year plan that's on the table right now and how that dovetails or conflicts with your 10-year plan. Before that, in your Toronto speech last week you mentioned that $55 billion has been allocated to health care. That number strikes me as a little odd. Maybe I'm missing something, but can you tell us where that number comes from?

    Hon. Pierre Pettigrew: Thank you very much, Mr. Merrifield, for your comments.

    I can assure you that the 10-year plan we are right now developing with the provinces is based on the health accord of 2000 and the health accord of 2003. We are, of course, not doing away with what has been done in the past; we are building on what we've learned from this accord. The $55 billion is the combination of the health accord of 2000 and the health accord of 2003. If you add the supplementary contribution of the Government of Canada, it comes to $55 billion.

    Mr. Rob Merrifield: That's where my confusion is. The number, if I'm not mistaken, on the 2003 health accord is $24.8 billion. Then you added the $2 billion, right?

    Mr. Ian Shugart (Assistant Deputy Minister, Health Policy and Communications Branch, Department of Health): It is $34.8 billion.

    Mr. Rob Merrifield: Okay.

    Then you go back to the 2000 accord, which was $20 billion. That was over a five-year period, but we are not really into the five-year period yet, so you can't just take those two numbers and put them on top of each other and come up with the $55 million. I'm a little confused on the numbers there. Maybe you need to clarify that somewhat.

    Mr. Ian Green (Deputy Minister, Department of Health): The $55 billion represents the cumulative total of the $20 billion that was allocated in the 2000 accord and the $34.8 billion. I don't have a breakdown by year with me, but we can get it for you. It represents the considerable sums the government invested over both of those periods in support of the health care system.

    Mr. Rob Merrifield: The $34.8 billion includes what was left of the $20 billion from the 2000 accord, if I'm not mistaken. I don't want to spend time debating the numbers with you. But if you could provide the committee with the actual numbers, I think that would clear things up on that front.

    Getting back to your health accord of a year ago, this was a historical accord. It was the first time in a decade that both levels of government, provincial and federal, set out a five-year strategy to put health care on a sustainable path. Specific things needed to transpire in the first year of the accord. Those things did not transpire. We saw no commitment from this government with regard to the accord when it met with the premiers on the Friday before the throne speech. There was nothing in the throne speech or the budget. I see no commitment to the principles of the accord in any of the things you've talked about. Now you're talking about a ten-year plan. But you have a five-year plan on the books. What I and the people who are watching are asking is, where are we at with the commitment to that five-year plan?

    Hon. Pierre Pettigrew: We have certainly delivered in terms of the financial contributions we were committed to make within this five-year plan. Some people say that all of the elements aren't there. The Health Council has been set up. It's led by Mr. Michael Decter. I participated in the first meeting at the end of January. I think it will make a very important contribution to the debate. We have established the Canadian Patient Safety Institute, which was announced on December 10, 2003, with an agreement on a pan-Canadian healthy living strategy to improve the health of Canadians through all stages of life. So elements have already been implemented and worked on.

    Individual provinces have also embarked on a number of reforms. Not all at the same pace, I acknowledge that. Some jurisdictions are further ahead than others in dealing with reforms--for instance, the strengthening of home care services or pharmacare. When we discuss with them why they haven't done as much as we had committed to in 2003, some say they don't have enough money to actually implement those reforms, but they know it is the direction in which we should be going. Provinces have already embarked on the reforms. Let's not think that we are reinventing the wheel here.

  (1225)  

    Mr. Rob Merrifield: Under the accord, the Health Council was supposed to be set up by May. That didn't take place until December. Nonetheless, it's in place now.

    Hon. Pierre Pettigrew: It's there.

    Mr. Rob Merrifield: Fair enough. I talked to Mr. Decter last week. He's a little nervous about whether the accord is actually going to work and the commitment to it. Let's hope that comes along.

    But there are two other major failures of the accord. First of all, the common health care indicators were supposed to be there in September. The accord outlines the details as to what was supposed to be there and what was to be worked on. I talked to a number of the health ministers last week about this, because I think both sides have to do their work to make this happen. They said they were there. They said the commitment wasn't lacking on their side. I see no commitment to those performance indicators from the federal side and no commitment to the health accord and the obligation that was there. Are we going to continue with that? Is that part of your 10-year plan? I don't hear you talking about those in your 10-year plan.

    Hon. Pierre Pettigrew: We are committed to the development of those indicators.

    Mr. Shugart.

    Mr. Ian Shugart: That's right, Minister. The 2000 accord committed all governments to the publication of the first set of indicators by the fall of 2002, which was done. Those have been published by all jurisdictions. We have been working with provinces collectively to develop the next set of indicators and to bring on stream some new ones that were discussed in the 2003 accord. We fully expect that all jurisdictions, the federal government included, will be in a position to issue the next set of reports on indicators in the fall of 2004, as committed to under the accord. So our view is that project is in fact on track.

    Mr. Rob Merrifield: The commitment under the accord was for September 2003.

    Mr. Ian Shugart: Yes.

    Mr. Rob Merrifield: But not 2004.

    Mr. Ian Shugart: Yes.

    Mr. Rob Merrifield: But you're saying it will be a year late.

    Mr. Ian Shugart: No, the commitment in the 2003 accord was that the next reporting date would be 2004, and we believe we're on track to do that.

    Mr. Rob Merrifield: That's interesting. I have the details of the accord here in front of me and it says this work is to be completed by September 2003.

    Mr. Ian Shugart: I think I can clarify that, Mr. Merrifield. The agreement on the content of the indicators was targeted for 2003, with the first public reporting on those indicators for 2004. In other words, the first step was to discuss and develop and agree on what indicators would be covered, and then subsequently there's a period of time needed to start collecting the data under those indicators and then report on them in 2004.

    So there is an agreement on the kinds of indicators that would be included, and jurisdictions are developing the data now.

    Mr. Rob Merrifield: Ian, with all due respect, that's fine, except that the accord had the agreement of what was to be there initially. I don't know what more you were going to do in September 2003 than what was laid out in the accord as far as what was going to happen, other than to actually comply with it.

    Timelines can be missed, that's fair enough. My discomfort is that I hear no language about commitment to what was missed in the accord. Also in September there was the basket of baseline standards for home care that was supposed to be there. I've heard no language, no talk, about the commitment to that as well.

  (1230)  

    Mr. Ian Green: I'd like to clarify something in regard to the performance indicators. We have substantial agreement on the part of deputies and their ministers in terms of what performance indicators with respect to access, quality, and sustainability need to be agreed to, to provide the foundation for the reports Mr. Shugart spoke to.

    So in fact throughout the fall we finalized the agreement as to the kinds of performance indicators, with a little bit of fine-tuning with some of the provinces around them. But substantially they're agreed to, and were agreed to in the fall. So we don't feel we're lagging on the issue of performance indicators.

    On home care, that remains, obviously, as an outstanding issue. The accord basically spoke about the need to, on the basis of assessed need, provide first-dollar coverage for a robust basket of services that covered acute, mental health, and end-of-life home care. We have been in discussions with provinces. We have not come to an agreement on what would constitute the elements of that basket. It's a very complex area. Many provinces, I want to underline, are in fact moving ahead in terms of home care and the provision of home care services. Those discussions continue.

    To go back to your point about whether they're built into the vision for the future, both the Prime Minister and the minister have made it quite clear that we will be returning to the issue of home care as part of the ongoing discussion with the provinces about a long-term plan for health care.

    Mr. Rob Merrifield: So you committed to the accord the way it was laid out.

    Really my frustration is when we see no language about the accord, that the accord was not even talked about, as I said, in the three meetings: the throne speech, the budget, or the meeting. In the first meeting you had with the provinces, all that was really talked about coming out of that meeting was the $2 billion extra that was part of the accord, which everyone knew was going to be there at any rate. That's my frustration.

    Hon. Pierre Pettigrew: In my speech last week I referred to it. It was present in my speech last week in Toronto, and the Prime Minister as well has referred to it. We've referred to the health accord--

    Mr. Rob Merrifield: In a very passing way, and that's my frustration as well. When you don't meet the deadlines...you would have thought when you got together that the first thing you would have talked about is why you did not meet the deadlines and what you are going to do about it.

    That leads me to the catastrophic drug coverage as well as the aboriginal health reporting that were part of the accord--

    Hon. Pierre Pettigrew: But we do that. We are aware that some of the deadlines have been missed. When I toured the country in January, meeting all of my counterparts, I raised this issue of what elements have not been met in terms of deadlines. That is what I meant to tell you when.... Their answer is, yes, Pierre but there's not enough money to do the reform; there's not enough money to actually implement these reforms.

    Yes, we agreed to the health accord of 2003. We are beginning, and we're doing our best for some of those elements, but we need to revisit, basically, and build on that accord.

    Mr. Rob Merrifield: It's so important because for the first time in a decade we have the provinces and the federal government—both orders of government—laying out a five-year plan that will fail in the first year in some of the areas. My discomfort is the lack of commitment from the federal government to that accord.

    But my time has just about gone—and we've gone around that one a little bit.

    I do want to bring up the dispute settlement mechanism, which was actually established in April of 2002. It has never been challenged or tested, and now I hear you talking about perhaps changing the criteria and the way you're looking at it. I don't exactly know where you're coming from on the dispute mechanism, but I have heard a lot of language about it in the last few days, and I wonder what your commitment is to the dispute mechanism panel, the way it was struck.

    Hon. Pierre Pettigrew: I think the dispute avoidance mechanism, developed in an exchange of letters between Madam McLellan and the Government of Alberta, is a fine contribution to understanding this better.

    I am saying here that if we want to enforce the Canada Health Act, which is our intention.... Our government wants to better enforce the Canada Health Act than has been done in the last 20 years. What I'm saying is that if we want to do that, we have to sit down with those who deliver the services all the time.

    Since I came to Ottawa many years ago, I have always adopted the same work method: I believe consensus leads to compliance.

    There are new elements on the health care horizon that we need to sit down on. Canadians believe in the five principles of the Canada Health Act, and they want strong, consistent enforcement of the act. At the same time, you have to make sure you adapt some of the vocabulary to today's technologies and today's understanding—to what is medically necessary, for instance. I don't believe the federal cabinet alone should decide that, as they deliver the services--

  (1235)  

    Mr. Rob Merrifield: My question was, was there a problem with the dispute mechanism?

    The Chair: I think Mr. Merrifield's time is up.

    Hon. Pierre Pettigrew: No, no, no, there's not a problem. It was a solid exchange of letters between Madam McLellan and the Government of Alberta, and it is certainly something that is useful. But I want to go beyond that, because I believe in the enforcement of the Canada Health Act.

    The Chair: Thank you, Minister.

    Thank you, Mr. Merrifield.

    We'll now move on to Mr. Ménard.

[Translation]

    Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): Thank you, Minister, for being here with us.

    Just to make sure that we're talking the same language, according to the documents that your officials provided when they last appeared regarding the breakdown of the federal government's contribution, the $36 billion in transfers that you referred to includes tax points too. There is $24 billion in transfers per se, and another $10 billion in tax points, for a total of $36 billion. But the actual contribution in transfers to the provinces, as we speak, is $24 billion.

    I can only say that I find this quite regrettable, but I'm counting on you to rectify the situation. We're a long way from the 25 per cent that Mr. Romanow requested for transfers to the provinces.

    So here's my first question: when do you expect your health transfer payments to reach 25 per cent, when you know that they should be 50 per cent under the Hospital Insurance Act? We can't forget, Minister, that when the Liberals were elected, transfer payments totalled $18.7 billion. You then cut back unilaterally, without consultation—the word “consensus” wasn't very big, back then—and you brought the transfer down to $12.7 billion. It took until 2003 for it to go back up to $24 billion.

    When the provinces are having a tough time, the federal government is largely responsible, because there was a 7 or 8-year period in which you cut transfers, without negotiating with the provinces and without any warning. In order to maintain the health care systems, it took all provinces, irrespective of their political stripes... You are a bit older than me, but in federal-provincial diplomacy, you don't often see all of the provinces forming a united front, mobilizing their public services and providing you with a report saying that health care spending was going to go up by 5 per cent per year. And in spite of everything, for years, you have under-invested in the system.

    So I'm putting three questions to you quite cordially. You like to quote from the Romanow Report: you did so four times in your speech in Toronto. Can you give us your word of honour that next year, for health transfer payments—not tax points, because that's another matter—you will be consistent and bring that back up to 25 per cent?

    Secondly, Minister, I'd like you to explain something to me about accountability. It's important. Everyone wants to know what the money is being used for. Do you have any indication that any province has misused any funds? Do you have any indication that any province lacks accountability mechanisms? Why should the federal government be the accountability watchdog, when you consider what its financial contribution is?

    Third, could you tell us some more about the Primary Health Care Transition Fund? It's $800 million; that's nothing to sneeze at. I'd like you to provide us with a list of projects to be supported in Quebec.

    So I'm asking you to give your word on the 25 per cent, I'm asking you to tell us why you're so skittish, so suspicious about existing provincial accountability mechanisms, and I'm asking you to tell us about the $800 million for the Primary Health Care Transition Fund.

    I will have three other questions for you.

    Hon. Pierre Pettigrew: First of all, the $34 billion, that's just the cash, in the figure that you see. That doesn't include the tax points that were given some years ago. That's what my colleagues are telling me. I don't know which document...

    Mr. Réal Ménard: It comes from your department; it includes the tax points. I'll make you a copy.

    Hon. Pierre Pettigrew: Anyway, you'll agree with me that if you want more tax points transferred to you, you should, and this is just a little piece of friendly tactical and political advice, if you want to encourage us...

  (1240)  

    Mr. Réal Ménard: I know that you are a great strategist.

    Hon. Pierre Pettigrew: If you want to encourage us to transfer tax points, you should acknowledge them when you get them. If you tell us to transfer tax points, but then that doesn't count, you start over from scratch and no longer want that included in the calculations...

    Mr. Réal Ménard: That's not the transfer.

    Hon. Pierre Pettigrew: No, but when we've given up tax points, we no longer have access to the tax base that has been transferred. So it's still a federal contribution.

    Mr. Réal Ménard: But it's not part of the transfer. Don't say that it's part of the transfer.

    Hon. Pierre Pettigrew: I meant "give up" tax points.

    What I'm told is that the $34 billion is cash. You say otherwise, but my people are going to examine that more closely with you.

    I don't want to get into a numbers war over what the "Romanow gap" of 25 per cent covers, etc. Does it just cover basic health services? When you talk about 50 per cent for the health system, that was for medical services and hospitals. I don't want to get into a numbers debate here. First of all, I don't have the authority to do that, because I'm not the Minister of Finance. So I can't give you my word of honour.

    You asked me to give you my word of honour. I cannot speak for the Minister of Finance and the Government of Canada here and tell you what the numbers will be. What I will tell you is that as Minister of Health, I am going to use all of the influence that I can muster to develop a health plan that will ensure the long-term viability of our health care system and commit the Government of Canada, on an ongoing basis and through discussions with the provinces, to the federal government being there permanently, not just for a three or four-year period that is constantly under review. This will give us a formula that will show whether the government is there, and it will have been discussed with the provinces.

    All that the provinces are telling me about the reforms that they need to carry out is that they need foreseeability. They need to know that the Government of Canada, after 2007-2008, will be there and what its contribution will be. I'm not saying that the amount of money is unimportant. Clearly, it is, but just knowing that it will be there makes it possible to make more judicious commitments. So we'll be there, and we'll be there forever, with a transparent and known formula.

    Mr. Réal Ménard: And you will no longer take the cavalier approach of unilaterally cutting back without respect for the provinces.

    Hon. Pierre Pettigrew: That is precisely the commitment that I hope our government will take as part of a health plan involving a solid commitment from us. I don't want to rehash the debate that we had back in...

    Mr. Réal Ménard: Talk to us about accountability.

    Hon. Pierre Pettigrew: I should also mention that Canada was under review by the International Monetary Fund.

    Mr. Réal Ménard: I know that speech. Talk to us about accountability. Why are you so suspicious?

    Hon. Pierre Pettigrew: I'll talk about accountability once I've finished acknowledging that the zero deficit, which benefits every jurisdiction and which every jurisdiction tells me is extremely important, in Quebec and elsewhere...

    Mr. Réal Ménard: But you didn't cut back your own programs, Minister. Your cuts affected transfers more than your own programs. Go have coffee with Mr. Léonard, that will do you some good. He's a man whom you hold in high regard.

    Hon. Pierre Pettigrew: Let's not get partisan; go see Mr. Léonard...

    Mr. Réal Ménard: Don't tell us that the deficit... You annihilated the health care system, you put the provinces in unacceptable positions. I like what you said about your willingness to cooperate, but don't get holier-than-thou about the past.

    Hon. Pierre Pettigrew: No, but what I'm saying is that you have to be careful and put things in their proper perspective.

    Mr. Réal Ménard: The perspective is that you cut back drastically without consulting the provinces, and in a cavalier manner.

    As for accountability, what makes you think that you're in a better position to hold the provinces accountable?

    Hon. Pierre Pettigrew: First of all, who said that? You have a preconceived idea, and I'm always truly amazed to hear something like that. Your concept of federalism is that the Government of Canada has to be a superior government.

    Mr. Réal Ménard: There is no faith without works! You know your theology, there is no faith without works.

    Hon. Pierre Pettigrew: Réal, you've just said, once again, that all of the decisions that have been made in Quebec City are merely the product of decisions made in Ottawa. I find that this way of letting the provincial governments off the hook does not reflect my philosophy of Canadian federalism, according to which both orders of government are equal. Both governments are sovereign, each within its own jurisdiction.

    Mr. Réal Ménard: And how does accountability work into that?

    Hon. Pierre Pettigrew: Just a minute, I'm getting to that. You're telling me, once again, that all of the decisions that were made in Quebec City in the 1990s when your Party Québécois friends were in power are Ottawa's doing. I'm telling you: wait a minute.

    Mr. Réal Ménard: That's not what I said. I'm a subtle man.

    Hon. Pierre Pettigrew: No level of government should be let off the hook. I believe that governments must be accountable to citizens. I personally negotiated the National Child Benefit a few years ago. No one believed when I began negotiating the National Child Benefit...

    Mr. Réal Ménard: You're using up my time talking about history, and I won't get any more time to make up for it. Get to the point.

    Hon. Pierre Pettigrew: So where's the accountability with the National Child Benefit?

    Mr. Réal Ménard: Talk to me about health. What form does the accountability take?

    Hon. Pierre Pettigrew: I'm telling you that the model is to set goals together and for these goals to be made known to citizens in a transparent way. It's not Quebec City reporting to Ottawa.

    Mr. Réal Ménard: Who is going to announce them?

    Hon. Pierre Pettigrew: The Government of Quebec is going to announce them to citizens of Quebec.

  (1245)  

    Mr. Réal Ménard: But that already happens, with the reports to the regional board. You're acting as if accountability didn't already exist.

    Hon. Pierre Pettigrew: Well, if it already exists...

[English]

    The Chair: When you interrupt the minister, we lose the translation. So we're hearing the minister as they're finishing up his words, and we're not hearing your intervention. That's why I'm suggesting one at a time. I'd also remind you that you only have 20 seconds left.

[Translation]

    Mr. Réal Ménard: Yes.

    Hon. Pierre Pettigrew: I'm not saying that there's no accountability. If you say that it's already being done, then there's nothing to be afraid of. If you're telling me that it's already being done and that the government of Quebec is fully accountable, then I'm telling you not to worry, it's already been looked after. So why are you so scared of greater accountability?

    Mr. Réal Ménard: Pierre, I'm going to tell you something. And I'll end on that.

    Can I finish?

[English]

    The Chair: Thank you, Mr. Ménard. I'm sorry, your time is now up. You're over 10 minutes.

    We'll move now to Madam Desjarlais.

    Mrs. Bev Desjarlais (Churchill, NDP): Thank you, Madam Chair.

    My first question requires a one- or two-word answer, depending on what the number is. The Canada Health Act contains two enforcement regimes, one for extra billing and user fees, another for non-compliance with the five criteria of the act. Under the latter the Minister of Health must take a first step when a province is not complying with the criteria of the act. He must issue a notice of concern to the province. Given that there are numerous examples of the provinces implementing for-profit health care services, how many notices of concern have been issued to provincial governments since the Canada Health Act came into force in 1984?

    Hon. Pierre Pettigrew: I'll ask Mr. Shugart.

    Mr. Ian Shugart: I don't have the exact number at my fingertips, but we can provide it for you. They're also contained in the annual report of the Canada Health Act.

    Mrs. Bev Desjarlais: You have no idea of the number? Would it be 1 to 10, 10 to 20? This is since the beginning of the act.

    Mr. Ian Shugart: You're talking about--

    Mrs. Bev Desjarlais: The notices of concern.

    Mr. Ian Shugart: The mandatory ones or the discretionary ones?

    Mrs. Bev Desjarlais: How many notices of concern have been issued to provinces regarding for-profit health care services, roughly? Is it 1 to 10, 10 to 20, since the beginning of the Canada Health Act?

    Mr. Ian Shugart: The basis upon which the administration of the act--

    Mrs. Bev Desjarlais: In your time, how many, 1 to 10?

    Mr. Ian Shugart: It wouldn't be done that way, on the basis of for-profit health care.

    Mrs. Bev Desjarlais: Would it be a fair statement that no notices of concern have been issued?

    Mr. Ian Shugart: There wouldn't be notices of concern issued on the basis of concern about for-profit health care. There would be a concern about instances of extra billing or user fees.

    Mrs. Bev Desjarlais: And for non-compliance with the act?

    Mr. Ian Shugart: Under the discretionary, which speaks to the five principles, there have not been any penalties levied on provinces, but there have been under the mandatory, which speaks to the user fees and extra billing.

    Mrs. Bev Desjarlais: That would be the answer I was looking for.

    Second, Minister, there's no question that Canadians value their health care system. You've commented a number of times that Canadians want the Canada Health Act upheld. The reality is that Canadians see our system as a universal, not-for-profit, publicly provided system. Most Canadians, I would wager, do not know the five principles of the Canada Health Act, but they have come to expect that through our governments, federal and provincial, they will receive universal, not-for-profit health care services in Canada. That's what they want to see. The government has not made a statement that they will not support for-profit health care in Canada. They have not made a statement that they will look in whatever way possible to support universal, publicly-funded, not-for-profit health care. In light of numerous comments in the minister's and Prime Minister's statements in regard to the private, for-profit, three-P approaches and the private sector within health care, I would like the minister to indicate one way or the other whether he and the Government of Canada are going to support for-profit health care delivery in Canada.

  (1250)  

    Hon. Pierre Pettigrew: Our government certainly supports every one of the five conditions. You insist a lot on “not-for-profit”. What I'm saying is that we're committed to a public administration with a single public payer to make sure the Canadian citizen gets the services he or she--

    Mrs. Bev Desjarlais: So what you're saying, if I may interject--

    Hon. Pierre Pettigrew: You may interrupt me.

    Mrs. Bev Desjarlais: I have only so many minutes, so I have to, if you're leading into something.

    What you're saying is that you would support the use of taxpayers' dollars to fund for-profit health services, which have proven to be a more costly, less effective form of delivery of health care.

    Hon. Pierre Pettigrew: Well, I am saying that it is important, it is imperative in my view, that any Canadian citizen have access to the services that are medically necessary--and “medically necessary” requires some further definition and discussion with the provinces. Not everyone agrees on what is medically necessary.

    But in my view, public administration does not mean there's no room whatsoever for....

    Mrs. Bev Desjarlais: Profiteering on someone's ill health?

    Hon. Pierre Pettigrew: Well, there was a time when in the hospitals you had the cafeterias, the laundry, and a number of services that were given differently....

    Mrs. Bev Desjarlais: So you're not suggesting there would be for-profit health services, just aspects of the health service delivery that would be for profit--not the medical aspects, but the maintenance aspects of the facility. Are you differentiating between--

    Hon. Pierre Pettigrew: No, I'm saying that the Canada Health Act does not preclude delivery of services by private elements as long as there is a single public payer.

    Mrs. Bev Desjarlais: Okay.

    Will you acknowledge that most Canadians believe their system is a not-for-profit health care system, and that's what they support? Will you acknowledge that's what Canadians want to see?

    Hon. Pierre Pettigrew: Public administration is the key here. There needs to be a single payer--

    Mrs. Bev Desjarlais: I would disagree.

    Hon. Pierre Pettigrew: Well, you disagree, but you're asking me if the act prohibits or precludes anything, and I'm saying no, not necessarily. I'm saying we're committed to the five principles of the act, not what it is in your mind, with all due respect, or what some people may think of it. We're committed to public administration, comprehensiveness, universality, portability, and accessibility.

    Mrs. Bev Desjarlais: But you're not committed to opposing for-profit health care service delivery? Yes or no? You are not committed to not-for-profit health service delivery?

    Mr. Ian Green: I think what the minister is saying is that the Canada--

    Mrs. Bev Desjarlais: I think the minister should probably tell me himself. If he's here, he should answer on his own.

    Mr. Ian Green: I think he's quite prepared to do that. I just want to underline that I think what we're saying is the Canada Health Act does not preclude services from being delivered by private facilities as long as insured persons are not charged for insured health services.

    Mrs. Bev Desjarlais: Okay. I think what needs to happen is there needs to be real, outright honesty with Canadians then. The government should just come out and say they are going to promote for-profit health care service delivery.

    Hon. Pierre Pettigrew: You choose your words and I'll choose mine, Madam Desjarlais. I have been making my position very clear, and I am as honest with Canadians as you are. I know you like to be virtuous. I like to be very frank and honest as well. And I am telling you that the provinces have a role to play in this country. I know NDP people don't understand that. The provinces deliver the services to Canadian citizens and Canadian patients. We believe that every service that is medically necessary has to be given to Canadian citizens, not looking at his or her needs in terms of what they can afford, but looking at whether they need it or not.

    I believe it is important that we sit down with the provinces to look at how we can best deliver it. You say when it's private, it's bad. Fine. I'm saying that some private delivery options...as long as the single payer, the public payer, is there. That is what is in the act.

    Now, you can go on with your slogans and say if it's profit, it's bad. Fine. But I'm telling you we will work with the provinces to clarify these things, and if Canadians get to be better informed, that will be all the better.

  (1255)  

    Mrs. Bev Desjarlais: Do I have a bit more time, Madam Chair?

    The Chair: You have one minute.

    Mrs. Bev Desjarlais: I was not for one second suggesting the provinces aren't partners in this agreement. But I think there's been an indication from the provinces that had the federal government held up to their share, as Mr. Ménard commented, and were there an effort to at least meet the 25% recommended in Romanow, the provinces would quite willingly continue to provide not-for-profit health care service delivery.

    The reality is that you have, I think, made it more clear in your last statement that you are going to support for-profit health care. I would not for one second suggest that all private service is bad, but there is documented evidence that for-profit, private delivery of health care service results in greater incidence of death and in less care being provided to everyone. It is not the best system.

    If you have contradictory evidence that says for-profit private health care delivery is better, I would request that it be put before this committee today.

    Thank you.

    The Chair: Thank you, Ms. Desjarlais.

    We'll now move to Ms. Whelan.

    Hon. Susan Whelan (Essex, Lib.): Thank you very much, Madam Chair, and thank you very much, Minister, for coming to appear today on the estimates. I think that is why we're here today.

    I do want to just preface my questions by saying that I'd love to have this debate on our health care system, but I think we are here to talk specifically about the estimates, particularly given where I come from, which is Windsor and Essex County, Ontario. For many years this area has been underprovided for and underserviced by the province. The NDP government of Bob Rae forced the first amalgamations in the city of Windsor, with no extra funding. We're still recovering from that and have finally turned the corner. We now have a new Liberal provincial government, so we have great expectations.

    However, I would like to talk about the estimates very specifically. Maybe you can clarify something for me. I'm having a hard time when I look at the transfer payments.

    When I look at the main estimates for 2003-04 and for 2004-05, particularly the grants and contributions, under what is called “Health Promotion and Protection”, I see a column and a line that says, “Grants to persons and agencies to support health promotion projects in the areas of community health, resource development, training and skill development, and research”, which decreases from $26 million to about $21 million, give or take. I see under that same line for contributions a decrease from over $41 million to about $8 million.

    Perhaps someone can clarify that for me.

    Hon. Pierre Pettigrew: These are the three programs we have been able to maintain for this year. We've obtained the financing for each of those three projects for this year.

    I will let Patrick give you further explanation.

    Mr. Patrick Borbey (Assistant Deputy Minister, Corporate Services Branch, Department of Health): There are three programs for which funds were sunset for March 31, 2004. They are the hep C prevention strategy; the diabetes strategy; and the Labrador Innu healing strategy. The government has decided to renew those programs for one year. The funding is in the fiscal framework. We do need to go to Treasury Board to get approval, and they will then subsequently be reflected in supplementary estimates A.

    The amounts are approximately $46 million for those three programs combined, so that explains the decrease in that line. There are also a couple of other lines where those funds would normally be shown.

    Hon. Susan Whelan: It causes me great concern when I see that kind of decrease in the main estimates. Health care and health prevention and promotion are things we need to be able to do in a very timely fashion. If we're going to try to prevent and promote, I think it's important we try to do this as proactively as possible.

    One of the things I would ask you, Mr. Minister, is when we talk about that very thing, about promotion of health care and of preventing problems.... Something interesting happened in Ontario in the last few weeks. There was a discussion on whether or not they should add the PST, provincial sales tax, to meals under $4.

    Throughout that discussion with my constituents, what was suggested and what I suggested to a number of those in the food industry is that both the federal and provincial governments come together and try to promote what I call healthy meals--nutritious meals. I don't know if there are standards we can come up with for meals costing under $5 or $6 to encourage people to choose healthy meals that have no tax--no provincial tax, no federal tax--on them.

    I don't know if you look at these types of ideas or suggestions within your ministry or if you talk to the Minister of Finance about them, but one of the big things we know is that the cost of health care is going up. Why? Because as Canadians we don't necessarily take care of ourselves as well as we should. How do we change that? We need to change the lifestyle of Canadians. We need to change our activity level. We know the obesity report that just came out is horrendous. So when I see the dollar numbers in front of me that show promotion is down, I think promotion dollars should not only be where they were in 2003-04, but they should be up, and I think we should be looking at what aspects create a healthy lifestyle. What are those choices?

    We don't seem to educate and explain to Canadians the importance of taking that responsibility for themselves. I'm just throwing this out there as an idea. You may have other ideas that you want to share with us today.

·  (1300)  

    Hon. Pierre Pettigrew: I absolutely agree with you, and I'm very pleased about the progress we're making on the public health agency front. I do believe public health is absolutely important, an important determinant in the future of our public health services and care.

    I was seeing that, in most of our jurisdictions, dialysis costs increased 16% last year, or over the last few years. That's 16% in dialysis costs, all related to a form of diabetes that we can avoid if we do the right level of activity and if we eat the right things.

    So I hope very much that with a stronger emphasis on public health, we'll do better campaigns. Right now we have the tobacco funding, at more than $13 million, that has done...a $13 million increase. This has done so well that...or, well, it's not that good, but obesity is now beating tobacco as the number one difficulty and challenge we have. But the drug strategy has an increase of $16 million. The therapeutic access strategy has more than $29 million going there. On immunization, it's $9 million more.

    So I absolutely agree that we have to do healthy living work with the provinces and territories, and I certainly agree that we must do better to inform Canadians on better nutrition.

    Hon. Susan Whelan: I hope we will in fact do that. When we look at the costs of our health care system and at where they're escalating, where the problems are, and we know that we can take some ownership of it, as Canadians, then I think the government has a responsibility to try to step in and assist in those areas. I mean, I see the studies on obesity, and they scare me. I'm sure they frighten every Canadian. They're horrific; they're not good.

    How do we change that? How do we get Canadians--

    Hon. Pierre Pettigrew: As you know, we have the food guide, which is more and more consulted. People are using the food guide more and more.

    But you're right, we have to--

    Hon. Susan Whelan: It's a combination. We used to have the ParticipAction program, which, I believe, we may or may not be reinventing, or have reinvented, from that point of view. But when I was a young student, it went through all the grade schools. It was a motivating factor to do certain things and to get involved and to get more active. I think it's important that our elementary school children or high school students have that same motivation, and that we do more in our communities to get people out, whether it be walking or other activities for exercise, or that we have some type of sporting facilities. A lot of our communities don't have these facilities. Obviously, it's not just your responsibility as Minister of Health. I think there has to be a broader discussion amongst different departments.

    I also have a question on the Canadian Institutes of Health Research and the transfer payments. We talked about grants for research projects and personnel support and what's happening there. I think there's a lot of good work being done there, no doubt about it, but how do we broaden that sphere a bit to include those organizations or the types of research that many people don't necessarily relate to health?

    For example, the largest cause of death and injury of children in this country is not any disease, it's automobile accidents. Yet when the automobile companies come to us and try to get dollars for research, we turn them down.

    How do we change this so that we're working together with our health professionals and with our industry so that in fact we recognize the needs and the importance of doing these types of things and understand the cost implications for our health care system? There are long-term costs for those types of injuries, and these types of things can be preventable.

·  (1305)  

    Hon. Pierre Pettigrew: On the research and innovation front, we've invested massive, significant amounts of money. We're now at two-thirds of a billion dollars for the Canadian Institutes of Health Research. That is a significant amount of money. It was an extra $40 million, I think, this year, or an extra $39 million in the last budget. That's not yet shown in the figures of the main estimates we're discussing here, at this time.

    CIHR officials are here, I understand, and could speak to the breadth of the research right now, if you like.

    Hon. Susan Whelan: Well, I'm talking about a very specific type of research. I'd be happy to follow up with them on that, because I know it hasn't been funded and I know the application has come forward a couple of times.

    My third area concerns patient care. You said in your opening remarks, “We need to put an end to the corrosive and debilitating debate over money”. I couldn't agree with you more, but when it comes down to patient care, there is an issue about dollars that we're going to have to address, that we need to address.

    Again, I look at my own hospital system in Windsor--Essex County, where I come from, and I also look at the challenges in terms of rural communities, as you further talked about. On Pelee Island, which is the most southern-inhabited island in Canada, they have been using nurse practitioners for a couple of decades now. No one has gone over to talk to them about how it's been operating or to look at the health of their citizens. So we're talking about this in a bit of an interesting vacuum.

    When I look at Windsor--Essex County, I--

    The Chair: I'm sorry, Ms. Whelan, your time is actually up.

    Hon. Susan Whelan: Oh, is it?

    The Chair: Yes. You're over your time.

    Hon. Susan Whelan: I was just going to finish my question about patient care, Madam Chair, and then--

    The Chair: I wonder if the minister might be willing to answer you either in a second round or at the end of the meeting.

    Hon. Susan Whelan: Yes, you can put me down for a second round.

    The Chair: Thank you very much.

    We'll go back now and start the second round with Mr. Merrifield for five minutes. Then we go to Mr. Kilgour, Mr. Ménard, and Mr. Barrette, all for five minutes only, and I ask you to be succinct in your questions so the minister has time to answer.

    Mr. Rob Merrifield: Thank you.

    I'd just like to change the course of the questioning a little bit and ask you something specific about an area I support, our party supports, and I think most parties around this table support. That is the work of Infoway, where medical records follow the patient. There's been $1 billion-plus put into Infoway, but I don't see a lot of performance coming out of it. I'd like to know where the money is being spent and what's actually happening when it comes to Infoway.

    I notice the Nova Scotia deputy minister actually had a problem with this; he's been having trouble with the red tape when trying to access dollars. As well, the money for Infoway is only going to software application. That's a lot of money for software. Can you explain to me what's going on here?

    Mr. Ian Green: Infoway has been providing funding for us to move towards the electronic health record and to build on telehealth. In fact, Mr. Merrifield, it was provided with additional funds to work with provinces and territories on public surveillance as it relates to public health, so it has a very interesting and broad mandate.

    It has a business plan. The business plan is based on the five key components of an electronic health record. I don't have the exact amounts in front of me today, but significant amounts of money are in fact rolling out. Infoway was not designed for anyone to spend money indiscriminately but was designed for us to spend money in consultation with provinces and territories and other partners on building the foundations for an electronic health record. It's doing that in five areas, including a patient registry, building on pharmaceutical information, etc. The money is flowing, and there is another significant tranche of money that is about to go out. It has a business plan that has been well published and is widely known across the country, and that's the basis on which it's doing it.

    I don't know about the Nova Scotia deputy, but I do know that the deputy ministers of all provinces and territories are members of Infoway and that they unanimously approved the last business plan.

    Mr. Rob Merrifield: Maybe instead of our taking time up here, the minister would commit to giving us a bit of an update on that in a briefing at another time so we know exactly what's going on. That would satisfy my concerns with regard to that.

    I'd like to get on to another--

    Hon. Pierre Pettigrew: I'm particularly pleased that Quebec is now participating in the Infoway program.

    Mr. Rob Merrifield: I know Réal will like that.

    The other question relates to a concern this committee has looked at pretty seriously over the last year. It's about reporting on aboriginal health information, and actually it was backtracked. It was supposed to be complied with last September; then it was going to be March 1, and now it's been pulled back. Can you tell me what's going on there, and is this government committed to getting--

·  (1310)  

    Hon. Pierre Pettigrew: We resolved this issue of the consent forms to--

    Mr. Rob Merrifield: You've resolved it?

    Hon. Pierre Pettigrew: Madame MacLean will respond.

    The Chair: Madam, if you could, identify yourself as you begin to speak, for the transcript.

    Ms. Leslie MacLean (Director General, Non-Insured Health Benefits Directorate, First Nations and Inuit Health Branch, Department of Health): Hello; bonjour.

    As you remember, at our standing committee appearance in September we did speak to the consent issue. At that time, you would remember, we explained that the three goals for the initiative were to maintain access for first nations and Inuit to health care benefits, to protect and respect privacy, and to protect people's safety as well.

    You're right that a lot of water has moved under the bridge since then. In early February the minister was able to announce a new approach to consent, because, very simply, a lot of things had moved in the privacy context, including the excellent feedback and suggestions we'd gotten from first nations and Inuit clients of the program. The minister was able to announce a targeted approach to consent, so consent would only be required in a very few cases, for those people for whom either patient safety or inappropriate use of the system was a question.

    I hope that responds to your question.

    Mr. Rob Merrifield: Yes, thank you.

    The chair just told me I have about 30 seconds, so I just have a couple of quick questions.

    First of all, before the election, are we going to get a chief medical officer of health now with SARS breaking out again in China? There's the potential for it to be here, so are we vulnerable without that happening? The agency...I know we've talked about the number of dollars allocated in the budget. We want to know about the performance and actual timing of getting this up and going.

    As well there's the hep C file. Are you going to revisit that and do the right thing there? Maybe it would be a good time for the government to purge their conscience on that one.

    The Chair: Thank you, Mr. Merrifield.

    We just have time for a very quick answer from the minister, perhaps, on the medical officer of health.

    Hon. Pierre Pettigrew: We will not reopen the compensation package on hep C at this moment.

    As to the chief medical officer, I cannot give you the date of the election--I don't have it myself--but we are going to move as fast as possible on the chief medical officer.

    The Chair: Thank you, Minister.

    Hon. Pierre Pettigrew: It will be in the next few weeks.

    The Chair: Thank you, Mr. Merrifield.

    We'll move now to Mr. Kilgour. Mr. Kilgour has the floor.

[Translation]

    Hon. David Kilgour (Edmonton Southeast, Lib.): Thank you, Madam Chair.

    Thank you for coming, Minister.

[English]

    I'd like to ask some questions about foreign-trained professionals. There's a joke in Edmonton that if you want a doctor, you call a taxi. I suspect that's true in a lot of places in Canada, but it's not really much of a joke. Do you happen to know how many foreign-trained medical professionals in Canada are not working in their field? What kind of progress are we making on that?

    Hon. Pierre Pettigrew: We don't have that information, but we can try to find it. It is certainly something, as you know, we are discussing very much with the provinces at this time because most of the levers in that area really belong to the provinces, and as well there are the collèges des médecins and equivalent institutions.

    Hon. David Kilgour: Well, there's talk about the federal government financing residencies. What's happening on that front?

    Mr. Ian Shugart: Mr. Kilgour, what we're doing is an accelerated process on credential recognition for foreign-trained graduates. We believe that the time will be about three years between now and when that process is complete and people are coming on stream in the Canadian health system, when that initiative is fully realized.

    We're also working with provinces now to extend that same process to nurses and other allied health professionals.

    Hon. David Kilgour: Tell me if I have these figures right. For example, I gather we graduate about 2,000 doctors a year across Canada, and about 1,000 of them leave almost immediately, mostly to go south. Britain, which has about twice the population we do, graduates about 6,000 a year, I'm told. Does that not suggest that we have a real problem with doctors and, I'm sure, other medical professionals as well?

·  (1315)  

    Mr. Ian Shugart: There is an ongoing debate about what the right number of doctors to train in Canada is. A number of provinces have in fact increased the enrolment at their medical schools. There is, I think, a recognition that we are probably graduating too few physicians, and there are some sector studies going on now to try to identify the demographic trends and so on to narrow that number down more.

    Similarly, in general provinces have increased the number of nursing spaces across the country by about 40% or a little more. Again, as this comes on stream, we will be graduating more nurses.

    There's also a greater inclination to make use of the full range of health professionals, to make greater use of nurse practitioners, nurses, and pharmacists, in primary health care teams and so on.

    But enrolment is increasing gradually across the country.

    Hon. David Kilgour: I'll move to a different subject. Mr. Merrifield and I both have a problem with methamphetamines in our cities, your cities. Can you tell us how much you're doing to try to promote youth education on substance abuse aside from that of alcohol and tobacco? I'll give you a specific--

    Hon. Pierre Pettigrew: What is the substance?

    Hon. David Kilgour: A friend of mine tells me that as of a couple of years ago Alberta was getting about $7,000 a year from your department, Minister, to promote programs like DARE and other substance abuse programs for young people.

    Hon. Pierre Pettigrew: We have increased our strategy budget by $60 million to help the young to better understand the consequences of what they do there. Madam Susan Fletcher is in charge of that strategy in our department.

    Ms. Susan Fletcher (Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch, Department of Health): Thank you very much.

    We at the Healthy Environments and Consumer Safety Branch actually spend a fair amount of money on promotional activities related to drugs and controlled substances. In fact, in the last year we've spent around $18 million. Much of that is done through grants and contributions. We work with the provinces and we work with NGOs to promote education of the youth and others about the improper use of drugs.

    Hon. David Kilgour: How much would it be, for example, in the case of Alberta, to deal with drugs like ecstasy?

    Ms. Susan Fletcher: I'm sorry. I don't have a provincial breakdown, but I could find out what we spend in each province.

    Hon. David Kilgour: Please do so.

    Finally, I have a very short matter. It has been suggested that rather than call it the Canada Public Health Agency and the Chief Public Health Officer, we should call it the Canada Health Agency and the Chief Health Officer. Have you given any thought to deleting the word “public” in the titles of these two institutions?

    Hon. Pierre Pettigrew: Public health is important per se. I think that part of it is an important element. There is health and there is public health. I think it is important to continue to stress that aspect of things, but I haven't given it much thought. It's the first time I've heard that.

    Hon. David Kilgour: Thank you.

    The Chair: Thank you, Mr. Kilgour.

    We'll return to Mr. Ménard. I will ask Mr. Ménard to let the minister answer and not interrupt him, so I can have the full benefit of all his comments.

[Translation]

    Mr. Réal Ménard: Of course, the minister is my friend, make no mistake about it. So, I have a short comment and three questions.

    To come back to your call for consensus, let's not forget that Quebec is opposed to the Canada Public Health Agency—and I understand that you will be going ahead with that project—just as it was opposed—and even Minister Couillard took your predecessor to task—to the new reproductive technologies bill. It's all well and good to talk about consensus, but if you go ahead with things even when the provinces don't agree...

    Correct me if I'm wrong, but the Liberal government of Quebec is fiercely opposed to the Canada Public Health Agency.

    Hon. Pierre Pettigrew: That's not true.

    Mr. Réal Ménard: I'm asking you. It has taken a position publicly. Quebec was opposed to that.

    Can I ask you my three questions all at one go? I won't say anything more after that.

    Hon. Pierre Pettigrew: Okay.

    Mr. Réal Ménard: Second, can you tell me exactly how much there will be for the Canadian Diabetes Strategy? It's good news that it's being renewed, I think, for one year.

    I'd also like to know what you think about drugs. It looks like there are situations in which innovative pharmaceutical companies are applying for patents repeatedly. Have you thought about that? What do you think could be done?

    I promise to listen to you, and not to say anything more, but don't be too hard on me or on the Parti Québécois government, because I am very sensitive about that.

    Hon. Pierre Pettigrew: I will be mindful of your sensitivity.

·  (1320)  

    Mr. Réal Ménard: Be mindful of my sensitivity.

    Hon. Pierre Pettigrew: I will be mindful of your sensitivity.

    With respect to diabetes, I'm told that it's $30 million per year for this strategy for the next year. It was supposed to end on March 31, but a one-year extension was obtained from the Minister of Finance. We'll see, there will be an evaluation of the effects and impact of this strategy, and the situation will have to be revisited.

    As for public health, I can assure you that Dr. Couillard, on the contrary, invited me to visit the Quebec laboratory, which is the core of their public health institute; I spent a Friday afternoon there with him. He is fully aware of the importance of having a Canada public health agency, because viruses don't stop at borders, and this coordination among various jurisdictions and territories is extremely important.

    Mr. Réal Ménard: But he stated that he was opposed.

    Hon. Pierre Pettigrew: Well, I'm just telling you what he told me. What can you do? I even spent a whole Friday afternoon with him. But he wants the Canada Public Health Agency to rely on existing provincial and territorial expertise and not to be, if you will, a duplication of Ottawa's efforts. But on the contrary, he said that he was completely willing, along with Dr. Massé, to participate in and contribute to the Canadian public health effort.

    As for drugs, Dr. Mowatt, who's with me, can give you some information on that.

    Mr. Réal Ménard: But what do you think about the patent renewals? It's as if the innovative pharmaceutical companies were pill pirates, capsule bandits or tablet thugs. Through renewals, they have virtually perpetual patents. You and I are going to have to work on that together.

    Hon. Pierre Pettigrew: Karen Dodds is going to answer that question.

    Mr. Réal Ménard: I would have liked to hear your answer, you disappoint me.

    Hon. Pierre Pettigrew: I will give you an answer after, but first I'm going to listen to the person who is familiar with the technical issues. You used such strong words that I cannot agree.

    Mr. Réal Ménard: Not strong, manly.

[English]

    Dr. Karen L. Dodds (Acting Associate Assistant Deputy Minister, Health Products and Food Branch, Department of Health): Thank you.

    When we review drugs for putting them on the market in Canada, there is an obligation on us to notify the patent office. It's the patent office that's responsible. We notify the patent office.

[Translation]

    Mr. Réal Ménard: Do you think that I don't know that?

    Hon. Pierre Pettigrew: Listen, it's important to make sure that there's no abuse. It's important that patent renewals be well-founded. I'm going to look more closely into that.

    Mr. Réal Ménard: We'll talk about this again, you and I. The better we know each other, the better it will be.

    Hon. Pierre Pettigrew: Okay.

[English]

    The Chair: You have one minute, Mr. Ménard.

    Mr. Réal Ménard: One minute. All right.

[Translation]

    I'm going to talk to you about the Canadian Strategy—

[English]

    The Chair: You see, when you keep quiet you get a lot more time.

[Translation]

    Mr. Réal Ménard: I need you, Minister, to convince everyone that the budgets for the Canadian Strategy on HIV/AIDS need to be increased. You know that they haven't been increased in ten years.

    Hon. Pierre Pettigrew: I agree with you, it's still $42 million. We have $42 million per year, which is still a significant amount, but it's been the same amount for over ten years, since 1992-93. So I think that an effort needs to be made there. Some very good work has been done with that $42 million. Solid partners have been identified all across Canada. People are doing very solid work, and I'm really going to work with my people to identify some sources. Right up until the last minute, I had hoped that this year something could be done in the last-minute negotiations. I wasn't able to obtain that, but I'm fully conscious of the excellent work that has been done with our partners in those areas and I really hope to be able to increase this budget which hasn't budged in ten years.

    Mr. Réal Ménard: Thank you.

[English]

    The Chair: Thank you, Mr. Ménard.

    Mr. Barrette.

[Translation]

    Mr. Gilbert Barrette (Témiscamingue, Lib.): Thank you, Madam Chair.

    Thank you, Minister, and thank you to your colleagues for your willingness to take part in this exercise. I'm sure that if you were even more available, that too would be greatly appreciated.

    Now, I have a few quick questions. I didn't see anything in the report about telemedicine or telehealth. Both have the same objective, at any rate. Last year or two years ago, there was a telemedicine project in Abitibi-Témiscamingue. Health Canada invested nearly one million dollars to see how areas that are far from a health centre could be connected, and the results were marvellous, both for aboriginal people and for seniors, who didn't need to leave their homes to go for a checkup at the health centre.

    Is there going to be any follow-through on that, in Quebec and in Canada, in terms of investment or further study?

[English]

    Mr. Ian Green: In terms of the funding for that, I don't know the particular project. It's quite likely that the funding for it came under our infostructure program or the health transition fund, which were designed to provide seed funding for projects in order to develop them.

    Part of the funding we mentioned earlier that has gone to Canada Health Infoway was in fact to expand telehealth initiatives across the country. They will be looking at what kinds of initiatives that support building a broader telehealth platform across the country they'll support. And obviously for provinces, in terms of when we talk about primary health care, which is in fact one of the areas where progress is being made in terms of the accord, the ability of provinces to use primary health care and to build on telehealth initiatives, that funding in fact can help reinforce those kinds of initiatives.

    If you want the details in terms of the project, I can find the program, but that's the kind of range of support that we have been providing.

·  (1325)  

[Translation]

    Mr. Gilbert Barrette: Okay, thank you.

    Now, your report refers to regional offices; there are six in Canada. I'd like to know what is or will be the role of these regional offices, and what links will there be with the various provincial directors or departments.

[English]

    Mr. Ian Green: We have six regional offices across the country. They basically are designed for the department to have a regional presence in each of the areas across the country. We have regional staff in all of those offices that reflect many of the major programs we have. In fact, on an overall basis the department is probably split about 70-30 in terms of staff in Ottawa versus the regions, so we have quite significant numbers of staff across the country. They work closely with provincial and territorial governments.

    In fact, in the last couple of years we have bolstered some of their resources to enable them to work more effectively with provincial and territorial governments. They also work with other federal government departments in terms of the federal councils across the country. So they provide an ability to get a regional perspective in terms of what we do, pull our programs together in terms of the regions, and also deliver them on a regional basis.

[Translation]

    Mr. Gilbert Barrette: Okay, thank you.

    In several places, there is reference to support for the Inuit, aboriginal people and first nations. This is in connection with public health.

    Does housing enter into public health when it comes to aboriginal affairs?

[English]

    Hon. Pierre Pettigrew: We don't do housing. It is not part of this department. We do it through other departments, but it is not among the services we deliver in terms of the health care of aboriginal citizens.

    Mr. Ian Green: That is absolutely the case. But we're quite conscious of the fact that if you look at health promotion and take a broad approach to determinants, there's housing, income, and a range of other conditions or factors.

    So while we don't actually administer the programming for it, as the minister said, we're quite conscious of the fact that a broad and effective approach to health promotion has to be based on looking at the long term and working with others on housing issues.

[Translation]

    Hon. Pierre Pettigrew: We do of course inspect houses to see whether they are sanitary or whether there is any mould that could be a human health risk.

    We do have responsibility for water quality on reserves.

    Mr. Gilbert Barrette: I just have one comment to make.

[English]

    The Chair: Yes, you have about ten seconds.

[Translation]

    Mr. Gilbert Barrette: I was involved in the field of health in Quebec as the head of a regional board for 15 years, so I had the opportunity to see and experience some quite interesting things, and occasionally some more painful things. But the comment that I would make to you is mainly to ask you to provide support—and I know that you can easily provide it—for integrated services. Very often, it's not a lack of money, it's a lack of communication, not out of any ill will, it's a question of culture. People operate in silos and often the patient or client—call him what you will—falls between the cracks because people haven't shared the information. That's the beauty of integrated services. Whether it's among the smaller players or with the professionals, I can tell you that there is a quality of service that is no more costly but that is highly appreciated by people on the receiving end.

[English]

    The Chair: Thank you, Mr. Barrette.

    I see that the minister's time has come to an end, but before we let him go, on behalf of the committee I'd like to thank all the officials of Health Canada who came today and either answered or were prepared to answer questions. I'd like to thank you for the work you do every day in your jobs, as you work for Health Canada and therefore for the health of Canadians.

    I'd like to thank the minister for coming and giving us some of his time. We hope to see him again soon.

    Minister, I want to thank you for stating your commitment to the Canada Health Act and its five principles. It's something we share with you--everyone around the table. I thank you for clarifying what the Canada Health Act empowers you to do as minister and what you cannot do under the Canada Health Act. I thank you for being honest about the problems of the enforcement of the Canada Health Act, the problems in the past, and your plans for a more collaborative mechanism in the future.

    We stated our concerns today about things like obesity, the use of illicit drugs in our communities, and our shared view. I think all of us around the table really see the connectivity between social problems and the health problems that often result. We hope that will be helpful to you, and we hope our study on prescription drugs will be helpful to you. We plan to do more on that topic. We may be able to give you some insight into the way prescription drug costs are rising as a component cost of the health care system. That will help both you and the provincial ministers as you try to make the best use of tax dollars while you're guarding Canadians' health.

    So on behalf of the committee, thank you very much for coming. We hope to see you again soon.

·  (1330)  

    Hon. Pierre Pettigrew: Thank you very much.

    The Chair: This meeting is now adjourned.