HEAL Committee Meeting

37th PARLIAMENT, 3rd SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Thursday, February 26, 2004

Á

1105

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

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

Á

1110

Mr. Scott Broughton (Assistant Deputy Minister, Population and Public Health Branch, Department of Health)

Á

1115

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

Á

1120

Ms. Diane Gorman (Assistant Deputy Minister, Health Products and Food Branch, Department of Health)

Á

1125

Ms. Wendy Sexsmith (Executive Director, Pest Management Regulatory Agency, Department of Health)

Á

1130

Mr. Ian Potter (Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health)

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

Á

1135

Mr. Patrick Borbey

The Chair

Mr. Rob Merrifield (Yellowhead, CPC)

Á

1140

Mr. Ian Shugart

Mr. Rob Merrifield

Mr. Ian Shugart

Mr. Patrick Borbey

Mr. Rob Merrifield

The Chair

Mr. Rob Merrifield

Ms. Diane Gorman

Á

1145

Mr. Rob Merrifield

Ms. Diane Gorman

Mr. Rob Merrifield

Ms. Diane Gorman

The Chair

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

Á

1150

Mr. Patrick Borbey

Mr. Réal Ménard

Mr. Ian Shugart

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

The Chair

Ms. Susan Whelan (Essex, Lib.)

Mr. Ian Shugart

Á

1155

Hon. Susan Whelan

Mr. Ian Shugart

Hon. Susan Whelan

Mr. Ian Shugart

Hon. Susan Whelan

Mr. Ian Shugart

Hon. Susan Whelan

Mr. Ian Shugart

Hon. Susan Whelan

Â

1200

Mr. Patrick Borbey

The Chair

Mr. Rob Merrifield

Ms. Diane Gorman

Â

1205

Mr. Rob Merrifield

Ms. Diane Gorman

The Chair

Mr. Gilbert Barrette (Témiscamingue, Lib.)

Ms. Susan Fletcher

Â

1210

Mr. Gilbert Barrette

Ms. Susan Fletcher

Mr. Gilbert Barrette

Ms. Susan Fletcher

The Chair

Mr. Rob Merrifield

Ms. Susan Fletcher

Mr. Rob Merrifield

Ms. Susan Fletcher

Mr. Rob Merrifield

Ms. Susan Fletcher

Mr. Rob Merrifield

Ms. Susan Fletcher

Mr. Rob Merrifield

Ms. Susan Fletcher

Mr. Rob Merrifield

Ms. Susan Fletcher

Mr. Rob Merrifield

Ms. Susan Fletcher

Â

1215

Mr. Rob Merrifield

The Chair

Mr. Ian Potter

Â

1220

Mr. Rob Merrifield

Mr. Ian Potter

Mr. Rob Merrifield

Mr. Ian Potter

Mr. Rob Merrifield

The Chair

Mr. Rob Merrifield

The Chair

Mr. Gilbert Barrette

Mr. Ian Potter

The Chair

Mr. Rob Merrifield

Mr. Ian Potter

Mr. Rob Merrifield

The Chair

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CANADA

Standing Committee on Health

---

NUMBER 003

l

3rd SESSION

l

37th PARLIAMENT

---

EVIDENCE

Thursday, February 26, 2004

[Recorded by Electronic Apparatus]

Á  (1105)  

[English]

    The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Good morning, ladies and gentlemen. This meeting has been called to consider the supplementary estimates (B) for 2003-04. It's my pleasure to welcome our friends from the Department of Health.

    I will now call vote 1b in order to start our review of the supplementary estimates, and I will invite the officials to make opening remarks.

    I don't know who is going to begin.

    Mr. Borbey.

    Mr. Patrick Borbey (Assistant Deputy Minister, Corporate Services Branch, Department of Health): Good morning, Madam Chair. Thank you.

    We are very pleased to appear here today to discuss the final supplementary estimates for Health Canada for the 2003-04 fiscal year.

    Before I go any further, I should take a few moments to introduce my senior colleagues from the department who are here with me. Since these estimates cover a range of detailed activities for which they are responsible, with your permission, Madam Chair, they will provide additional explanations during the session and answer questions that may be raised.

    I have with me today Scott Broughton, assistant deputy minister, population and public health branch;

[Translation]

    Ms. Susan Fletcher, Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch;

Á  (1110)  

[English]

Diane Gorman, assistant deputy minister, health products and food branch; Wendy Sexsmith, actingexecutive director, Pest Management Regulatory Agency;

[Translation]

    Mr. Ian Potter, Assistant Deputy Minister, First Nations and Inuit Health Branch;

[English]

and finally, Ian Shugart, assistant deputy minister, health policy branch.

    First I should provide a bit of background on these supplementary estimates, and then their major components. I know your committee, like others, is increasingly interested in the operations and resources of departments.

[Translation]

    As you know, we start developing our financial plans for a forthcoming fiscal year several months before that year starts. Those plans are finalized as Main Estimates and are tabled in the House of Commons in February.

    While we are doing that work, the budget decision-making process is simultaneously underway across the government.

    Since the budget usually comes down in February or March, we are not normally in a position to adjust our fiscal plans in time for the Main Estimates which are tabled at about the same time.

[English]

    In any event, the announcement of budget commitments by the Minister of Finance does not translate automatically into allocations for specific departments under specific votes. The budget is normally followed by the process of clarifying all the terms and conditions for those funds and the timeframe for expenditures. This can take months, even when the funds are essentially allocated to just one department.

    When a budget commitment has implications for a number of departments, the process can be even more complex. Those terms, conditions, and resource allocations are resolved through Treasury Board decisions throughout the spring and summer, and often the fall or even later, which leads to the need for supplementary estimates. Supplementary estimates are therefore the vehicle for departments to access additional resources required to deliver on these new commitments.

[Translation]

    Madam Chair, you will recall that the Deputy Minister of Health, accompanied by many of the same officials who are here today, appeared before this committee last fall to answer questions on the first round of Supplementary Estimates. Much of these related to commitments agreed on through the First Ministers' Accord on Health Care Renewal, in February 2003, and reflected in the 2003 Budgets. One of the items presented for your consideration in these Final Supplementary Estimates also relates to commitments in the Accord. I am referring to the grant to the newly established Canadian Patient Safety Institute.

[English]

    There are also changes in our estimates that relate to unforeseen events and expenditures that can occur during the course of a fiscal year. Examples are the additional costs that were incurred to mitigate the impact of severe acute respiratory syndrome.

    Altogether, these supplementary estimates project an increase of $404.8 million over our approved estimates for fiscal year 2003-04. There are eight changes that we will touch on briefly.

    The changes are assistance to deal with SARS;

[Translation]

    Canada's Drug Strategy; Food Safety and Food Quality initiatives;

[English]

building confidence in pesticide regulation; mental health services under the national Indian residential school dispute resolution process; preparatory work for the proposed assisted human reproduction legislation;

[Translation]

    a grant to the Canadian Patient Institute;

[English]

and the department's operating budget carry-forward.

[Translation]

    If you agree, I would like to invite my colleagues to provide a bit of context and to describe each of these items.

[English]

    Mr. Scott Broughton (Assistant Deputy Minister, Population and Public Health Branch, Department of Health): Thank you very much, Patrick.

    Good morning, ladies and gentlemen.

    As Patrick mentioned, my branch is the population and public health branch. We're responsible for the policies, programs, and research that relate to disease surveillance, prevention, and control, to health promotion, and to community action.

    I'd just like to take a very short moment to give you some context in terms of public health. Public health deals with both communicable and non-communicable diseases. It includes everything from public health events like SARS, severe acute respiratory syndrome, and others like West Nile and BSE, to a broader view most people have of ongoing chronic diseases, such as cancer and heart disease.

    Typically, all jurisdictions, including the federal government, have in the past focused on individual and specific diseases, which has tended to lead to separate programs for distinct conditions such as cardiovascular disease, diabetes, cancer, and so on. This approach, however, is evolving as the department and others, like the provinces and territories and numerous stakeholders, are considering ways in which we can deliver more integrated public health strategies.

    Last spring, with the outbreak of SARS, attention was diverted to public health capacity, Canada's collective ability to handle such major events. This of course became an area of concern with both the acute care and the public health care systems in our country.

    In terms of numbers internationally, just to remind you--I know you have all seen these in the past--there have been a total of almost 8,100 cases of SARS reported since it was first found last spring. That resulted in 774 deaths internationally. In Canada our portion of those numbers was 438 cases of SARS, of which 44 resulted in death. There have been various estimates of the costs beyond the costs of mortality and morbidity in terms of economic costs, and they tend to range fairly significantly in the $500 million-plus range.

    In terms of the response to SARS, the federal government, principally through Health Canada but with help from many of our colleagues across other departments, responded to SARS and West Nile, and this was founded on our mandated responsibility in the area of public health. Typically, we describe our role in public health in the categories of detection, diagnosis, response, and information.

    The purpose of the supps here today is to represent the incremental costs, which were borne for new types of activity we performed over the last few months with events like SARS. It involves the hiring and training of new staff, surveillance and disease monitoring, investigation, research and development, airport screening, and obviously the development and dissemination of significant public communication products. We are continuing to implement a series of risk reduction measures aimed at the longer term. These include nationally and internationally coordinated surveillance and monitoring, a strengthened quarantine capacity, and the creation of multidisciplinary rapid response teams to support public health authorities and hospitals.

    In responding to SARS, Health Canada undertook a series of rapid and strategic steps to secure the safety of the Canadian public and international visitors, to enhance domestic and global public confidence, and to strengthen Canada's capacity to respond to these and other infectious disease outbreaks. That SARS or another infectious disease could strike again obviously remains a possibility. For these reasons we believe that continued vigilance is necessary in terms of protection of Canadians' public health.

    Obviously, a significant portion of the supplementary estimates includes the financial assistance the federal government is proposing as help to the Province of Ontario for extraordinary costs they incurred during the SARS event.

    I'd be happy, if members have questions later, to get into more practical and concrete examples of the kinds of things we're doing with respect to our infectious disease preparedness.

    Thank you very much.

Á  (1115)  

[Translation]

    Ms. Susan Fletcher (Assistant Deputy Minister, Healthy Environment and Consumer Safety Branch, Department of Health): Thank you. Madam Chair, members of the committee, I'm the Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch.

    The Drug Strategy and Controlled Substances Programme is one of five programmes into which our branch is organized.

[English]

    The other four are very diverse programs: tobacco control, safe environment, consumer products, and workplace health and public safety.

    The drug strategy that was renewed in May of this past year provides $245 million over five years to various departments in the federal government. This is over and above the $340 million that is spent annually on drugs and controlled substances.

    The other departments that are involved in our collaboration are the Department of Public Safety and Emergency Preparedness, the Department of Foreign Affairs and International Trade, and the Department of Justice. In the public safety and emergency preparedness department there are three agencies we work with: the RCMP, the corrections service, and the new border agency.

    The aim of the strategy is to have Canadians living in a society that is increasingly free of harms associated with substance abuse. It seeks a balanced approach to address both the demand for and the supply of drugs, and it focuses on the use of narcotics, controlled substances, alcohol, and prescription drugs that are used inappropriately.

[Translation]

    The need for a renewed strategy has been widely documented in the reports of the Special Committee on the Non-Medical Use of Drugs and of the Special Senate Committee on Illegal Drugs. These two parliamentary committee held broad cross-country consultations and heard testimony from Canadians, law enforcement officials, representatives of international, national and local associations and governments as well as from individual Canadians.

[English]

    Canada's drug strategy is based on the four pillars of prevention, treatment, enforcement, and harm reduction. The $245 million over five years is split among the four departments, with Health Canada having $121 million--$7 million in the past year, as you can see from our supplementary estimates--the Department of Justice around $50 million, Public Safety and Emergency Preparedness Canada somewhat over $60 million, and the Department of Foreign Affairs and International Trade about $3 million.

    Some of the specific initiatives that Health Canada has been able to introduce this year, as a result of the additional $7 million, include setting up an FPT committee specifically to look at issues relating to drugs and to develop a national framework for action on drugs; getting ready for the first biennial conference with partners and stakeholders, which is to take place in November of this year; and enhancing information and data collection. We've already polled youth attitudes on marijuana use, and we've been working with the Canadian Centre on Substance Abuse to create baseline data on the prevalence of addiction in Canadian society. That data will be available in June of this year. In fact, it's in the field now.

    We've also been working with the Canadian Centre on Substance Abuse on a research strategy that started with a forum in the fall of last year, which brought together the various key partners. We've also been preparing to launch, in the next fiscal year, a new communities initiative fund that will fund community projects aimed at reducing substance abuse, especially in vulnerable populations. These projects will start in the next fiscal year, or 2004-05.

    We've also been developing public education campaigns that will focus on youth and marijuana use. The main purpose of these campaigns will be to clarify among youth that marijuana use continues to be harmful and illegal. We will be initiating a website in the spring of this year.

    We've also nearly completed the development of an accountability and evaluation framework that will measure the success of all aspects of the strategy. This will be important input into the biennial report that we've committed to make to Parliament on the drug strategy, with the first report coming in 2005-06.

    Finally, the first nations and Inuit health branch of the department has begun work to create training programs to enhance the skills of health care workers who work in first nations and Inuit communities.

    Those are the general kinds of things we've been able to do this year as a result of the additional $7 million.

    Merci.

Á  (1120)  

    Ms. Diane Gorman (Assistant Deputy Minister, Health Products and Food Branch, Department of Health): Thank you, Madam Chair, and members of the committee.

    I am very pleased to be here to speak briefly to Health Canada's supplementary estimates that address enhancing the safety of Canada's food system.

[Translation]

    I would like to begin by giving you a brief overview of the role of Health Canada, and more specifically, of the role of the branch for which I am responsible, the Health Products and Food Branch. As the federal authority responsible for regulating health and food products, Health Canada assesses and monitors the safety, quality and effectiveness of thousands of drugs, vaccines, medical instruments, natural and other therapeutic products sold on the Canadian market as well as the safety and quality of our food products.

    In accordance with its legislated mandate, Health Canada is also responsible for ensuring the veterinary drugs sold in Canada are effective and safe for animals and that food products derived from animals treated with these drugs are safe.

[English]

    Health Canada promotes the health and well-being of Canadians through a broad range of activities linked to health products and food, including nutrition policies and standards, such as Canada's food guide to healthy eating. As the organization within Health Canada responsible for delivering on this mandate, the health products and food branch takes an integrated, science-based approach to the management of risk and benefits for health products and food and nutrition, including maximizing the safety provided by the regulatory system and enabling Canadians to make healthy choices and informed decisions about their health.

    This approach recognizes that the health of Canadians is a shared responsibility, shared with the provinces and territories, with health care providers, with industry, and with Canadians themselves, whose individual choices and circumstances must be respected.

    In order for Canadians to be able to make responsible decisions about their health, they must be assured that the systems are there to support them. In the context of food, this is particularly important.

[Translation]

    According to a recent survey, over 80 per cent of Canadians trust the safety of food products available in Canada. This high level of trust is the result of concerted government and industry efforts over many years. It is imperative that this high level of trust be maintained.

    The goal of the branch responsible for food safety in Canada is to be the world leader in this field in the 21st century through promotion of research and monitoring, risk assessment, policy formulation and implementation of standards and regulations.

[English]

    Of course, food safety issues exist within a dynamic environment, and in order for food safety systems to work effectively they must be able to adapt to new challenges. The discovery of a single case of BSE in Canada in May of last year, and the subsequent discovery of a cow with BSE in the United States in December of last year, has shown that we cannot take for granted the safety of our food supply, that we must remain constantly vigilant in ensuring that we have all the tools in place in Canada to protect the health of Canadians.

    An important part of our work on food safety is being delivered through the agricultural policy framework, led by the Minister of Agriculture. Health Canada's work--on food safety, food quality, and environmental components of this agricultural policy framework--is aimed at protecting human health by reducing exposure to hazards, increasing consumer confidence in the safety and quality of food produced in Canada, and reducing agricultural risks to the environment and providing benefits to the health and supply of water.

    As outlined in the supplementary estimates, Health Canada is receiving $4.6 million in 2003-04, or $27.7 million over five years, for food safety and food quality activities. These activities include working with the agrifood sector, Agriculture and Agri-Food Canada, and the Canadian Food Inspection Agency on standards, policies, and actions at the farm level that address food hazards, and undertaking related research.

    Health Canada, as you know, has the statutory authority to establish food safety standards that provide a baseline for industry-developed on-farm food safety systems to meet; to undertake surveillance to link human exposure to pathogens, from animal or food sources, to the occurrence of human enteric illness in the population; and to study the human health impacts of on-farm antimicrobial use. For example, how much is antibiotic use on farms in Canada contributing to the bacteria found in human infections that no longer respond to antibiotic therapy?

    Under the agriculture policy framework's environment component, Health Canada will also spend $0.3 million in 2003-04, or $4 million over five years, to better understand microbiological pathogens in agricultural runoff and effluent, especially at locations that may potentially impact drinking water sources and bathing beaches.

    Health Canada will lead the development and implementation of the water quality surveillance component of this program. This project will also provide valuable data toward the treatment component of the guidelines for Canadian drinking water quality and the guidelines for Canadian recreational water quality.

    Agriculture and Agri-Food Canada will use the data to measure the efficacy of on-farm management practices and to develop more effective control strategies in order to reduce the prevalence of pathogens in agricultural runoff.

    Working closely with Agriculture and Agri-Food Canada and the Canadian Food Inspection Agency, this new investment will help us tie together the work being carried out by industry and government, both jointly and independently, to reinforce the importance of food safety at the on-farm level and throughout the food chain.

    Thank you.

    I'd like now to introduce Wendy Sexsmith, acting executive director of the Pest Management Regulatory Agency.

Á  (1125)  

    Ms. Wendy Sexsmith (Executive Director, Pest Management Regulatory Agency, Department of Health): Thank you, Diane.

    Thanks very much, Madam Chair, and members of the committee, for giving me an opportunity to speak about building public confidence in pesticide regulation.

    The Pest Management Regulatory Agency within Health Canada is responsible for the regulation of pesticides--that is, the assessment of new and existing pesticides to minimize health and environmental risks associated with these products under the Pest Control Products Act.

    PMRA also establishes maximum residue limits for pesticides used on food under the Food and Drugs Act, and carries out compliance and enforcement activities related to that same act.

[Translation]

    The additional resources requested in these Supplementary Estimates are directly tied to the implementation of the Pest Control Products Act and its related provisions.

[English]

    The new Pest Control Products Act received royal assent in December 2002, as part of the government's commitment to ensure that Canadians are better protected from health and environmental risks from pesticides. The new act strengthens health and environmental protection, makes the registration system more transparent, and strengthens post-registration controls.

[Translation]

    PMRA is currently developing the regulations needed to implement the legislation by the fall of 2004.

[English]

These are regulations that will require companies to report amounts of pesticides sold on an annual basis, and also to report adverse effects of pesticides. Additional regulations that are underway include regulations related to the workplace hazardous materials information system, and the reconsideration of registration decisions.

    In addition, we're currently working on updating existing regulations in order that they will fit with the new act prior to its proclamation.

    The proposed expenditures are also intended to support activities that complement the new legislation, such as an updated process for the regulation of formulants within pesticide formulations; the re-evaluation of older pesticides; improved public and stakeholder involvement in the regulatory process, through the development and implementation of mechanisms to make the process more transparent; the development of risk reduction strategies; and supporting the coordination of research in the area of pesticide surveillance and monitoring, in order to feed better into the regulatory decision-making process. This important government initiative will increase public and stakeholder confidence in pesticide regulation and will provide funds necessary to implement the new act as well as the supporting activities.

[Translation]

    Thank you for your attention.

Á  (1130)  

[English]

    Mr. Ian Potter (Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health): Madam Chair and members of the committee, I will speak to the item of the mental health services under the national Indian residential school dispute resolution process.

    As part of the government's initiative to resolve residential school disputes, the office of Indian Residential Schools Resolution Canada asked Health Canada to provide a comprehensive system of mental health and emotional health counselling to individuals and their families who are in the process of resolving their claims, either in the system of alternative dispute resolution or through the courts.

    The mental health support program ensures that the Indian residential school claimants who are resolving their claims against Canada can have access to an appropriate level of mental health counselling and emotional support services that will allow claimants to safely address the broad spectrum of mental health issues related to the disclosure of childhood abuse. The program provides a telephone line for support; the assistance of resolution health support services, who are emotional counsellors prepared to assist persons in court, or through the process; individual mental health counselling for claimants and their families; and transportation for claimants to mental health workers.

    Thank you very much.

[Translation]

    Mr. Ian Shugart (Assistant Deputy Minister, Health Policy and Communications Branch, Department of Health): Madam Chair, I'd like to talk about two things: first, what's happening while we await the passage of legislation respecting assisted reproductive technologies; and the Canadian Patient Safety Institute.

[English]

    There is $11.2 million for the fiscal year 2003-2004 in preparation for the possible eventual law on assisted human reproduction. This work involves the preparation of background information for Canadians and policy work related to the necessary regulatory framework that would accompany Bill C-6, should it be passed by Parliament and receive royal assent.

    Given the timeline the bill has followed, the amount for 2003-2004 has been reduced to $4 million and the remaining $7.2 million was reprofiled to future years. Pending the continuation of that bill's progress through the parliamentary process, work will continue into 2004-2005.

    On the second item, the Canadian Patient Safety Institute, this is an initiative that follows from the first ministers accord on health care renewal and the budget in 2003. Members of the committee may be aware that there will be a forthcoming study, co-sponsored by the Canadian Institutes of Health Research and the Canadian Institute of Health Information, on the extent and nature of adverse events in Canadian hospitals. This is a serious issue that has been documented in the United States, Australia, the United Kingdom, and is soon to be documented in Canada.

    The first ministers accord made provision for the establishment of a Canadian Patient Safety Institute, and the supplementary estimates detail those amounts: in 2003-2004, $2.2 million is provided; in 2004-2005, $8 million; and ongoing. The Canadian Patient Safety Institute is a new, non-profit corporation incorporated under the Canada Corporations Act. It involves an array of stakeholders and the federal and provincial governments. It reports independently through a board of directors.

    It will be dealing with the coordination and dissemination of best practices regarding patient safety, both internationally and in Canada; coordination of research and the monitoring of adverse events and patient safety initiatives in this country; education and training initiatives with respect to the health professions; promoting culture change within health care institutions; and so on.

    The institute is now established with a founding board. They have, indeed, held their first meeting. The institute will be headquartered in Edmonton, Alberta.

    Those are the two items in my area, Madam Chair.

Á  (1135)  

[Translation]

    Mr. Patrick Borbey: Madam Chair, there is one final item in our Supplementary Estimates which I would briefly like to touch on, namely the Operating Budget Carry Forward.

    Treasury Board allows departments and agencies to carry forward up to 5% of unspent operating budgets from one fiscal year to the next.

[English]

    Last year, Health Canada did not spend an amount of $15.7 million in its operating budget. This represents less than 1% of our operating budget, well within the Treasury Board limit. These savings are reinvested by the department in priority areas.

    For example, we were able to fund the requirements for our new natural health products regulations. We are also investing in improved security measures for our clients and employees. Another example is maintaining and improving our information technology infrastructure.

    Madam Chair, in conclusion, there's a lot of information here. Our department has been asked to take on important new and additional work that the supplementary funding will support.

    May I also add that in all of its activities the department ensures the greatest possible prudence and probity in managing the funds entrusted to it by Parliament. This is accomplished through a comprehensive system of training, oversight, and accountability.

[Translation]

    We would be pleased to answer your questions.

    Thank you very much.

[English]

    The Chair: Thank you very much.

    I'd like to congratulate all of you, because we're all aware of what short notice we gave you, but we were under constraints too because we have to report by March 8 and next week is a break week. So thank you so much for your cooperation and the excellence of your presentations.

    We'll move now to the question and answer period, and we'll begin with Mr. Merrifield, who may take up to 10 minutes or he may decide to share his time. We'll move from there to Mr. Ménard and then to Ms. Whelan.

    Mr. Rob Merrifield (Yellowhead, CPC): Thank you.

    I think I will take all 10 minutes. My problem is, I have more questions here than I think you'll have time to answer, but let's start with a few of them.

    We'll start with the money. There is $310 million more in 2003 and 2004, so the obvious question is, where is that all going? You've explained perhaps some of it, but there's $87 million more to grants and contributions alone.

    You've said that the $15 million in grants for the health care strategy and policies, the partnershipping between the provinces and territories in the grant program...now that's up $13 million from the previous year. I need some explanation of that.

    Also, you have $24 million for the primary care transition fund. In the health accord that was signed last February there was an announcement for $15 million over five years, and part of that was primary care reform for the three programs under that. So I'm wondering where you're at on that. What's going on? Why is the fund still needed on that side of it?

    I'm going to throw one more in and then I'll let you start answering some of these.

    There was $2 million for health care strategy and policy, a contribution program. That has a little more than doubled now to $5.4 million. Can you explain what that money is for and why the increase?

Á  (1140)  

    Mr. Ian Shugart: Madam Chair, I'll start on Mr. Merrifield's question on the primary care funding, and my colleague may want to speak about the actual numbers.

    The initial primary health care transition fund was provided to facilitate provinces to move on a larger scale to primary care reform. Initially, the previous health care transition fund had been oriented to research and to documenting best practice in primary care, and then given the growing trend to move to primary care, the government had provided in the 2000 health accord some funding to provinces that would allow for large-scale development of primary care reform.

    I would describe the move in the accord and the budget last year to going even beyond that process of giving undifferentiated funding in the health reform fund for provinces to provide primary care services. But the initial five-year period of the primary health care transition fund is still running. It has another two years to go and then that program sunsets. So it really is the continuation of the program that had been put in place to facilitate primary care transition in jurisdictions, whereas in the 2003 accord and budget that was done through transfers and not through a grants and contribution program.

    Mr. Rob Merrifield: Okay, so there is money in addition....

    Mr. Ian Shugart: In the 2003 budget through the form of transfers to provinces, which they could use according to their own priorities in the areas of catastrophic drug support, acute care in the home care sector, and support for primary care.

    Mr. Patrick Borbey: On the financial issues, I recognize you're asking questions with respect to our main estimates, which were tabled a few days ago. We did come as prepared as we could to talk about our supplementary estimates. However, we have to look at the main estimates by comparing them with our main estimates last year. We have to add the supplementary estimates that have already been approved in the first round and then the supplementary estimates that we're proposing now, and then compare those final estimates with the new main estimates proposed for 2004-05.

    If you compare the two, there's very little increase. In fact, there's a decrease, most of it associated with the fact that the $330 million payment to the Province of Ontario is a one-time payment. So there is in fact very little change from this current year to next year.

    Mr. Rob Merrifield: Let's get on with some of the issues I have with regard to the--

    The Chair: Proceed, Mr. Merrifield, as long as it's the supplementary estimates you're addressing, not the new estimates, because we'll have a meeting on those a little bit later.

    Mr. Rob Merrifield: That's right, and that's why I'm going to leave the numbers alone.

    Let's get on to some of the issues. Last week in the House there was a motion that was made and passed by the House with regard to mandatory reporting of adverse drug reactions. I'm wondering, how are you as a department going to proceed to fulfill that mandate?

    Ms. Diane Gorman: Mr. Merrifield, I'll answer your question.

    Certainly, the department is very interested in having good quality information with regard to adverse drug events. The motion is one piece that certainly supports the various areas the department is looking at.

    Mandatory reporting, as you may know, occurs in several countries internationally. We're looking at their experience because in fact they have not found that even with mandatory reporting they are having increased instances of reporting. So if we go to mandatory reporting, we need to understand from those countries why they have not had greater reporting in terms of numbers, learn from them, and see what we can introduce into Canada.

    Another very important element of this is the quality of the information we receive, and we are taking a number of initiatives in order to improve the quality. One, for example, is to provide more information to practitioners. We do have inserts in the CMHA monthly, educating them about the need for us to have good quality information. We also have an initiative with the Canadian Pediatric Society to focus more proactively on pediatric event reporting. All of these, I would say, are pieces of improving not only the quantity but also the quality of reports we receive in Canada.

    The other thing that is important for us to recognize is that given the size of our population, Canada wouldn't necessarily generate statistically the number of reports one would need in order to really know there is a signal. So we do work internationally; we work on the basis of sharing information internationally. We have regular teleconference calls with a number of different countries internationally, and we've been working over the last several years very aggressively at having access to the United States adverse event reporting system, which again will give us more information than our own population might generate.

Á  (1145)  

    Mr. Rob Merrifield: Even in the United States and Canada it is projected that 1% to 10% will be reported. Are you telling me that if we go to mandatory reporting we won't have enough information to give us a trend as to whether an adverse reaction should be looked at?

    Ms. Diane Gorman: No, I'm not saying that. You cannot depend solely on those reporting systems either. There are a number of different mechanisms we use in order to have good information with regard to adverse reporting.

    Mr. Rob Merrifield: I understand all of why we are where we are. I'm looking ahead and saying, how are we going to accomplish the mandate of what the House of Commons said as far as mandatory reporting is concerned? The motion wasn't to say, well, we have to have mandatory reporting instantly. It was that we should raise awareness and collaborate with the professionals to make sure we don't have the same results as in France, where they haven't had an increase in reporting or in the quality of reporting.

    I'm saying, how are we planning as a department to accomplish the ultimate goal, which is to have good reporting, factual reporting, and all of the reporting?

    Ms. Diane Gorman: I absolutely agree with you in terms of the goal; there's no question about that. Therefore, what we need to do is to work through the various partners who are able to make this happen, which include the provinces and the professional associations.

    Ian Shugart spoke earlier about medication incident reporting, which is also an important element of this. We have been doing a fair bit in terms of raising the profile of the issue and educating professionals in terms of their responsibilities. We have increased the number of reporting centres we have in Canada as well as providing more information to individuals about how they can report to us through a 1-800 number.

    The Chair: Thank you, Mr. Merrifield.

    Mr. Ménard.

[Translation]

    Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): This is the second time in less than one year that we're being asked to approve additional funding for the Canadian Institutes of Health Research. My stand on this issue is unqualified. I was on the committee when the draft legislation establishing the 13 institutes was introduced. We were somewhat concerned at the time because Quebec had always received 30% of the funding through the Medical Research Council of Canada and we were hoping that this would continue to be the case.

    You haven't said much about this subject. Yesterday evening, I reviewed the expenditure plans of the institutes. I would like you to explain some things to me. I've met with researchers who claim that despite the funds awarded, eminent researchers are leaving Canada. Mention was made of one well-known cardiologist, among others. Despite the efforts being made, shortages continue to be a problem. A mere 20% or so of projects receive funding.

    I'd like you to begin by explaining to us the purpose for which these funds have been earmarked. I understand that you can't go into specifics because your director isn't here, but I would appreciate a breakdown of the funding sought by province and by institute.

    With respect to the supplementary estimates in general, can you give us some assurances as to how these funds are utilized? Is it a fact that eminent researchers are being driven out of Canada?

Á  (1150)  

    Mr. Patrick Borbey: First off, Mr. Ménard, as I said to you earlier, Dr. Bernstein heads up this independent agency and reports directly to the minister. We're here to discuss Health Canada's request for supplementary estimates. Dr. Bernstein could provide you with more direct answers to your questions. We could always forward these questions to him and to his agency for follow-up action.

    Let me also say that the votes seen here were already listed in last fall's supplementary estimates. Cabinet is therefore seeking an additional $55 million in next year's budget. The supplementary estimates provide for only very minor adjustments. For example, the $1 million item represents a transfer of funds to the agency to assist in the fight against SARS and for research in this area.

    Mr. Réal Ménard: I can appreciate that officials may not be privy to every single detail. A written response would be fine. Obviously, we understand that the institutes fall under the umbrella of the Health Minister. These institutes operate independently, but they are accountable to Health Canada. Nevertheless, I understand that you cannot get into the specifics with us.

    Earlier, you spoke about the Canadian Patient Safety Institute. Could you refresh my memory as to this institute's specific mandate and purpose? I'm somewhat surprised to see that the federal government which, with the exception of first nations and the military, is not responsible for providing direct care to patients through contribution or transfer agreements, has established a Canadian Patient Safety Institute. I appreciate that this is a political decision and I'm not asking you to justify it, but could you be more explicit about how these funds will be used?

    Mr. Ian Shugart: First of all, the federal government plays a direct role in patient safety, in that it is involved in regulating medical instruments and drugs, both of which are very important to patient safety. We work with a number of partners to improve the situation in this field across Canada.

    Secondly, the funds to establish the Canadian Patient Safety Institute represent a direct contribution and joint efforts by the federal government, the provinces and professional bodies. All partners have agreed on the need for an institute that would be jointly administered.

    Mr. Réal Ménard: Quebec didn't [Editor's note: inaudible] to that.

[English]

    The Chair: You've used your five minutes.

    Mr. Réal Ménard: I'm finished? Would you like a kiss, Madam Brown?

    Some hon. members: Oh, oh!

    The Chair: Well, I can't be bribed, if that's what you mean, but you may get a second round.

    Ms. Whelan.

    Ms. Susan Whelan (Essex, Lib.): Perhaps, Madam Chair, to continue on the line of questioning of Mr. Ménard, I'm trying to understand the relationship of the Canadian Patient Safety Institute to the government and who they're accountable to.

    Maybe Mr. Shugart can continue a bit.

    Mr. Ian Shugart: I'd be happy to, Ms. Whelan. Thank you.

    The institute is incorporated under the Canada Corporations Act as a non-profit organization, so it has a board of directors. It does not report to governments. It reports, under the principles of that law, to the public, ultimately. There is a contribution agreement between Health Canada and the institute for the money we are providing--excuse me, it's actually a grant to the institute.

    They are independent. They make recommendations to governments, or at least they're able to make recommendations to governments, but they also work independently of governments to promote the dissemination of best practices. They will have an interest in developing the performance reporting framework on patient safety over time on adverse events.

    The study I referred to being led by the Canadian Institutes of Health Research and the Canadian Institute of Health Information is a good example of the kind of initiative that in the future the institute would be interested in--for disseminating the results and developing the kinds of indicators that would help us to understand patient safety trends over time.

    The Government of Quebec has an initiative in this regard, as do other provinces. The minister of health in Quebec made it very clear that the agency and the ministry in Quebec would be very anxious to collaborate with the institute. Indeed, all provinces have made the same kind of expression of interest and commitment.

    I would only add one last thing. In Australia, in particular, what was learned on patient safety in that jurisdiction was that unless you actually created an organization that would be charged with leadership and the promotion of a culture change in patient safety, the efforts would continue to be fragmented among the many players.

    They created such an organization, a national steering committee on patient safety, which comprised the professions, the provincial colleges of the professional groups, and so on, that called for the creation of an institute in a report they did in September 2002. This is a result of that recommendation.

Á  (1155)  

    Hon. Susan Whelan: To clarify for me, then, when you say it's a grant...I see it's vote 5, $2.2 million. Am I reading that correctly?

    Mr. Ian Shugart: Yes.

    Hon. Susan Whelan: But for 2003 the total amount was $10 million, if I understood correctly.

    Mr. Ian Shugart: Given that the institute has only been founded during part of the fiscal year, disclosing the full amount provided for in the budget has not been planned for 2003-2004. That grows to $8 million in 2004-2005 and ongoing.

    The remaining $2 million that the budget provided for patient safety is in fact going to fund the initiative that Diane mentioned a moment ago, the Canadian medication incident reporting and prevention system. It's $10 million on an ongoing basis for patient safety, and the grant will grow to $8 million beginning in 2004-2005.

    Hon. Susan Whelan: When you talk about accountability, though, I'm trying to make sure that you said they don't report to government.

    Mr. Ian Shugart: No.

    Hon. Susan Whelan: They report to you and then you report to government on their behalf?

    Mr. Ian Shugart: No. They report independently in the same way as any non-profit organization. They would have the reporting status of, for example, a health charity that is independent of government. The institute will work closely with government, and the federal government is funding the operations of the institute through this grant, but it is entirely independent of government.

    Hon. Susan Whelan: Perhaps lastly you can clarify this for me. We are in a time of great questions of accountability and stewardship. Perhaps you could explain to me how the department has strengthened that accountability and the issues around it so that Canadians can be assured that we are responsible for the money that flows through the federal government to different institutes and for the money that is spent within Health Canada.

  (1200)  

    Mr. Patrick Borbey: In terms of strengthening accountability, there are a lot of measures that we have taken over the last few years. We have obviously had some difficulty and problems that have been well documented, unfortunately, and we're still dealing with the aftermath of some of those incidents. We did have to tighten up our grants and contributions quite substantially a few years ago.

    In grants, the accountability is quite different. A grant is an unconditional payment. So we cannot impose conditions and reports. We do it through influence and through ongoing relationships with the organizations. Most of our grants and contributions are in fact contribution agreements where there are very strict conditions, reporting requirements and controls, and where there is oversight in place to ensure that there is no problem in accountability. That includes issues such as ensuring that there is more than one signature and one sign-off for a contribution agreement so that there are those checks and balances. We have put in place new systems and also new processes, such as the creation of a quality assurance unit, where there are staff members in Ottawa and in the regions who have that mandate to keep an eye on processes, to do some sample reviews, and to report on any problems. We have also reinforced our audit capacity within the programs in terms of compliance audits. We do it on a sample basis, based on a risk assessment. As well, we have strengthened the departmental internal audit capacity, which then looks at broader issues, and it can take on a very substantial review of particular programs for contributions or particular areas of those programs.

    We have an audit and evaluation committee that meets on a regular basis, chaired by the deputy minister, where these issues are reported. We post all of our audits on the Internet. We make sure those results are transparent and we thoroughly follow up on any issues, any problems, that are encountered.

    Those are some of the items. I could speak at length about a lot of the other things we've done in areas like contracting, travel and hospitality, making sure that all those areas have the right kind of oversight, training, and accountability.

    The Chair: Thank you, Ms. Whelan.

    Mr. Merrifield, and then Mr. Barrette.

    Mr. Rob Merrifield: It gives me great comfort to know that the Virginia Fontaine situation won't happen again.

    You are all here. You talked about the safety of foods, the safety of pesticides, and natural food products.

    There is a major issue that many of us as members of Parliament have been dealing with, with regard to a product that is coming in from the United States. I'm sure some of you have heard about Empower Plus. It's a product that has been used for people who suffer from depression. It has had some remarkable results. The problem is we're not able to get this product in and it is being held up at the border.

    I'm really having a difficult time understanding where, as a department, you are coming from on this product. I don't believe there has ever been a case of anyone becoming ill, or having an adverse reaction, or having any kind of concern with the use of this product. Yet a number of individuals are telling me they have a very difficult time getting this product into Canada. I know we had a briefing on it here a year ago, or last fall, saying this wouldn't happen. It is still being held up at the border and individuals are in some serious situations at times.

    I wonder if you could give me your take on exactly what's going on there.

    Ms. Diane Gorman: I'd be happy to answer that one, Mr. Merrifield. I'm well aware of the product.

    I think what we first need to establish is that this particular product makes claims that are of a very serious nature in terms of its ability to treat, for example, bipolar depression, anxiety, or schizophrenia.

    The natural health products regulations are not intended to deal with products that have those levels of claim that haven't been subject to clinical trials. One of the discussions we have had with proponents of that product is that if the product is effective in the way they describe it to be, Canadians should have access to that product and it should be subject to the same regulatory scrutiny as other products are, and certainly products that make those serious claims.

    We are in discussion with an individual who may wish to sponsor a clinical trial with regard to that product.

    You may also know that the department is in litigation with the proponent of this product and that the RCMP has been involved. Therefore, there are elements of this particular case that you'll appreciate I can't speak about freely.

    However, when you talk about adverse events, we do have information about those and we do have information about at least one individual--and it's not isolated to this one individual--who behaved in some very serious fashion while on this product.

    So our concern is, first of all, that the health and safety of people using this product is important, and if this product does have value in terms of the claims it makes, that it be tested, that it be subject to clinical trials. The fact is, it is coming in from the United States but it is not approved in the United States. It is being imported through mechanisms that are outside Canadian law, and that's the reason the department is involved.

  (1205)  

    Mr. Rob Merrifield: I understand that. If it's commercially sold in Canada--and I think this is what your department has said--it should follow the rules of any other product licensed in Canada. But if it's individual choice, they should be able to import that and use it, for their own use, as just the freedom of being able to do that.

    You say there are some individuals who had some adverse reactions and reacted erratically on this, but there are many others I've heard of having the same situation when they were not on it, in the sense of some claims of a number of suicides because they were not on it. I know we're talking about a difficult issue when dealing with this illness.

    It is just something that I can't get my head around, because there was a clinical trial going on in Calgary, as you are aware. It was shut down, and some of the data I've seen coming out of even that trial, as far as it went, are pretty significant. But I just don't understand why there is such resistance to this product? The gain outweighs the pain, in my estimation. But maybe I'm not getting the whole picture and maybe you can clue me in on it.

    Ms. Diane Gorman: Right, and again, I don't want to repeat myself, but if that is true, then that should be known and the product should be available through the legal mechanisms that exist in Canada.

    The clinical trial, for your information, was not a trial approved by Health Canada, and certainly Canadians hold us to a standard that they do not want clinical trials undertaken in Canada if they have not been approved and are not monitored by Health Canada.

    So there are a series of issues here, all of which should be dealt with within the law, so that the health and safety of Canadians is respected and individuals are not caused harm by this product, either in terms of the health issues or in terms of the financial issues.

    The Chair: Thank you, Mr. Merrifield.

    Monsieur Barrette.

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

    I have three little questions.

    About substance use and abuse, do you have any prevention education plan, in the schools or wherever, in accordance with the decriminalization that is going on?

    Ms. Susan Fletcher: Absolutely. In fact there are a number of different aspects of the work we are undertaking across government. In Health Canada, as I mentioned, we are developing a website, and we have a mass media campaign we've put together that will be taking place in the next year about the harm caused by marijuana so that people who do use it understand that it is a harmful substance.

    The police have increased their operations so that we have now three teams that are going after illegal grow operations.

    If the bill goes through, it's not to say that we are changing the legal status of the use of marijuana, but just that we are changing the kinds of fines that are available, because what's happening right now is that youth aren't being fined and there is no notification of parents and so on. There will be regulations we will put in place as well to make sure that in case the new law is in place, we will continue to ensure that Canadians, especially Canadian youth, have proper information, and that we monitor and control the use of marijuana as best we can.

  (1210)  

    Mr. Gilbert Barrette: Will your plan be with the provinces or directly with the schools?

    Ms. Susan Fletcher: We actually have some work ongoing with the provinces. There is an FPT committee where we are looking together at how we can work collaboratively, not only on marijuana but on all controlled substances, and on what we can be doing to build on what each other does in the area of media and public education in the schools. Obviously, we don't go into the schools directly.

    I have a colleague here from the program. If you're interested in the actual details, I could ask her to come to the table, if that would be appropriate, and she could perhaps give more detailed information about our mass media campaigns. Would you like that?

    Mr. Gilbert Barrette: If you would provide me with a paper on it, that would be fine.

    Ms. Susan Fletcher: Certainly.

    The Chair: Thank you, Mr. Barrette.

    Mr. Merrifield.

    Mr. Rob Merrifield: This is a thing that really amazes me, and I'm referring to our last subject when we talked about Empower Plus and the attack on that product. Yet we have medical marijuana that is now being grown and legally used under licence in Canada. We have no scientific proof that it is the product of choice whatsoever, unless you have more on that.

    I'd like to know if you are doing research on at least ingesting marijuana as a method of use as a healthier way than smoking, even for those who are licensed. How far is that research going? Are we expecting that marijuana will jump through the same hoops as we say the rest of the natural food products have to?

    Ms. Susan Fletcher: We actually have started a clinical trial on the use of smoked marijuana. You will remember that we got into the business of providing medical marijuana because of decisions taken by the courts, so we've tried to make it available in a way that is least harmful and most controlled.

    Mr. Rob Merrifield: I would say it was by the government, but that's all right. If you want to be whipsawed by the courts, you go ahead.

    Ms. Susan Fletcher: Indeed, we have tried to ensure that the product we supply is supplied in a way that is very controlled. As opposed to individuals supplying their own, this is a very controlled situation: we know who the growers are, we know how much they are growing, and they can only grow a certain amount.

    Mr. Rob Merrifield: Do you know that the THC level in the product has grown? The minister was here last year and said that even in the Flin Flon test there were 165 or 185 different varieties that came out of the seeds that were grown there. They range from 3% to 25% or 40%.

    Ms. Susan Fletcher: Indeed, at the beginning we had some difficulty getting a stable product, but of course the longer we keep at it the better the product becomes and the more consistent it becomes. We now have a few plants that we use as the mainstay, which have a fairly consistent content.

    Mr. Rob Merrifield: In regard to these people who are being licensed, I have had reports coming to me that say some of these individuals who have a licence to grow under Health Canada licensing are now trafficking. I know one individual is supplying five other individuals on a weekly basis with marijuana. How are you curbing that? What are you doing?

    Ms. Susan Fletcher: That is illegal.

    Mr. Rob Merrifield: I know it is illegal.

    Ms. Susan Fletcher: The regulations say one approved user, one grower.

    Mr. Rob Merrifield: How do you find out? I'm a farmer as well, and I know that some years you have good crops and some years you have bad crops.

    Ms. Susan Fletcher: When it comes to the government's attention, the RCMP certainly looks into it. I mentioned that the RCMP now has three teams across the country whose purpose is to get rid of illegal grow operations.

    Mr. Rob Merrifield: Yes, it's certainly a concern both on how to ingest, if you're going to use it as a drug of choice, and how you're going to control the licensing of it. These are serious problems.

    Ms. Susan Fletcher: Absolutely.

    I want to go back to something. You mentioned briefly at the beginning about other forms of taking medical marijuana. We are looking into that as well.

    There are some studies out of England where people are using it sublingually. We're looking at what that would mean here in Canada. Certainly it's the smoking of marijuana that's another difficulty for us. If there are other ways it could be administered as effectively and in as controlled a way, we would certainly be a proponent of that.

  (1215)  

    Mr. Rob Merrifield: I have another question on another topic. Last year in September, when it comes to the non-insured health benefits program, there was the form that the natives were supposed to fill out with regard to their medical information and their health records. It wasn't complied with by September. It was put off until March. Only 20% were complying, so you yanked the program. Where is that going and what's going to happen?

    The Chair: Ian.

    Mr. Ian Potter: I'd be quite pleased to respond to that, Mr. Merrifield.

    We started that program, the consent or privacy program, about three years ago. At that time, it was in the context of the advice we had from the Privacy Commissioner and from our own legal services, and in expectation of the application of the new PIPEDA law that governs the electronic transfer of information. On the basis of that information, we started a process that sought a consent form from all of our non-insured health benefit users. We initiated that process about two years ago, with the expectation that we would have people filling out that form and registered by the beginning of March of this year.

    As time went on, a number of things occurred. One, there was concern from the first nations and Inuit about the nature of the process and what they were signing. A lot of time and resources were spent on providing information and education. Second, the environment around privacy legislation changed and there were new interpretations of what was required to meet the law, particularly in terms of the PIPEDA law, and the view that there was the notion of implied consent. For individuals who accessed the program and for the purposes of the day-to-day operation of that program, there was not an expectation that they sign or actually have a manifest consent.

    In light of that, and in light of our discussions with first nations and Inuit organizations, the government changed its approach, an approach that is still consistent with the Privacy Act, PIPEDA law, and the charter implications. The approach is one in which we will not require express consent for the day-to-day transactions or management of that program. This will allow us to use the information within the context of the fundamental part of the program, which is the provision of the benefits, verification of the benefits, and working with professional organizations and health professions.

    One of the obligations is to provide education, to inform people what their information is being used for, and to that extent we have put out a new and revised privacy code saying how we're going to manage your information and what use it will be. For those situations where there may be an abuse of drugs or where people are at risk—a patient safety issue—which was one of the preoccupations of this committee and other committees, we are putting in place measures that will observe the behaviour with respect to use. We've put in place limits on the number of drugs, for example, for Tylenol 3, which has codeine in it. We now have limits on it, and if people exceed them we look into the situation.

    In those circumstances where we believe there may be a person at risk, i.e. they're taking drugs that may be too much or there may be the possibility of professional misconduct, we will inform the individual that we will require their express consent to examine their file and share their file with other professional organizations, such as the physicians they may have been visiting, in order to address that problem. If the problem is dealt with, if there's no issue there, if it's medically necessary, then we will just continue. If there is a problem, we will then try to address it.

  (1220)  

    Mr. Rob Merrifield: What if they don't comply?

    Mr. Ian Potter: If they don't comply, in those situations we're saying that the program will no longer provide benefits. We'll be telling the client, “Until you contact us and allow us to deal with you directly or with your physician, we will no longer provide benefits”.

    Mr. Rob Merrifield: That's probably the way it should have started originally.

    But what has been the cost of the program until now?

    Mr. Ian Potter: I can't give you that precisely. I do believe I have that number, which I could provide to you, but I think we were spending about $2 million on it this year. Most of that, as I said, is around education, which is an obligation we would have under the law irrespective of whether all people signed an express consent form or whether we use the program in the new way we're doing it, which is to have express consent only in an exception.

    Mr. Rob Merrifield: Just on a point of—

    The Chair: No, you're finished.

    Mr. Rob Merrifield: I didn't get the answer, though.

    You can give me the answer in writing.

    The Chair: Maybe he can give it to you after the meeting.

    Monsieur Barrette.

    Mr. Gilbert Barrette: For my own information, probably, are there still many residential schools in Canada?

    Mr. Ian Potter: No, none that the federal government operates—not Indian residential schools, if that's the question.

    The Chair: On behalf of the committee, I would like to thank you very much....

    Mr. Merrifield wants to have a longer meeting.

    Go ahead, Mr. Merrifield.

    Mr. Rob Merrifield: No, it's not a longer meeting. This is a different question, but it's on the same sort of thing, with the non-Insured health benefits program.

    There is a product—Remicade—that is on most provinces' formulary but is not on yours yet. I'm wondering why, and whether it is going to be there shortly.

    Mr. Ian Potter: We are trying to finalize our review of that program. Like other drug insurance programs, we do a review of the cost-effectiveness, whether the program can build that drug or benefit into its established budget and whether there are other available remedies that are more cost-effective or efficacious.

    We've been working on Remicade because it's a fairly major drug in terms of its cost. There were some issues initially with respect to its particular impact on first nations individuals. If I recall, it had to do with susceptibility to tuberculosis. This is an issue that has been explored with our medical panel, and my expectation is that we will be trying to come to a conclusion on it in the next few months.

    I could, by the way, answer your other question, because I've found the answer. In the four years since we began the program on privacy or consent, we've spent approximately $5 million—over the four years.

    Mr. Rob Merrifield: Thank you.

    The Chair: Thank you, Mr. Merrifield.

    On behalf of all of the committee, I'd like to thank our witnesses who came today, generously and under short notice, and I think they answered all of our questions in a full manner. Thank you very much.

    I'd like to welcome some of the new faces to the joy of coming to the health committee. I hope we can continue to have the cooperation we have enjoyed over the last few years, with your accommodating our sometimes sudden need to hear from you. Thank you for a good meeting, and thank you to my colleagues.

    This meeting is adjourned.