HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, April 5, 2001

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[English]

The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Good morning, ladies and gentlemen. I'd like to call the meeting to order.

We have two items on our agenda this morning. One is the budget, which was delayed yesterday because we didn't have quorum to vote, and the other is the main purpose of the meeting, which is an information session on the estimates, part III. This is the verbal part of it, essentially, which is plans and priorities.

We have a number of witnesses, led by...

Mr. Ian Shugart (Assistant Deputy Minister, Health Policy and Communications Branch, Health Canada): Ian Shugart.

The Chair: Ian Shugart is assistant deputy minister for the health policy and communications branch.

Before I ask Mr. Shugart to begin, I'm going to mention that the minute we get quorum I'm going to interrupt the proceedings in order to have this motion on the budget. Then we'll return to the main subject of the day.

Go ahead, Mr. Shugart.

[Translation]

Mr. Ian Shugart: Thank you, Madam chair.

[English]

I'll introduce my colleagues at the table, many of whom you have already met: Bob Lafleur, a senior ADM in the department; Orvel Marquardt in the corporate services branch; Ian Potter, the assistant deputy minister, first nations and Inuit health; and Dann Michols, assistant deputy minister, healthy environments and consumer safety.

We also have other colleagues from the department. I won't take the time to introduce them all, but they're prepared to assist with questions subsequently. You've met a number of them as well.

[Translation]

Today, our three objectives are to give you a brief overview of the department's Report on Plans and Priorities, to answer your questions and to maintain a strong working relationship with the committee, in order to serve you as best we can.

As you know, our minister will appear before the committee over the next few weeks in order to explain the Main Estimates to you, as well as the strategic priorities that he has set out for the department.

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[English]

I'll briefly reiterate for you our mission, which is to help the people of Canada maintain and improve their health. That mission statement matches the vision, as set out in the report on plans and priorities, of a country in which all citizens enjoy the best possible health throughout their lives, and we engage in that mission.

The Chair: Thank you, Mr. Shugart, for your introductory remarks. I'm going to interrupt the proceedings now, because I see we do have quorum.

Ladies and gentlemen, I think you will see in front of you the budget submission as prepared by the clerk. This is the operational budget, which is just to keep us afloat. It is not the whole budget for the year or anything like that.

I would accept a motion to approve it as presented.

Mr. John O'Reilly (Haliburton—Victoria—Brock, Lib.): So moved.

The Chair: Seconded by Mr. Ménard.

Any comments?

(Motion agreed to)

The Chair: Thank you very much.

I also want to thank the visitors who came to replace members who couldn't make it. Thanks very much, Mr. Price and Mr. O'Reilly.

I'm sorry to have interrupted you, Mr. Shugart.

Mr. Ian Shugart: That's fine, Madam Chair. We interrupt a lot of our activities to secure resources for the department, so we understand.

The department, of course, operates under a number of legislative instruments to carry out its mandate. The committee is familiar with the Food and Drugs Act, the Pest Control Products Act, the Canada Health Act, and so on. Our functions, as we mentioned in our introductory session with you, include leadership; the development of policy frameworks; funding of various activities in partnership; regulation, which is a substantial part of what we do; and the provision of services.

[Translation]

As the deputy minister explained to you two weeks ago, Health Canada has modified its organizational structure over the course of the last year. Basically, this reorganization guarantees that Health Canada in the twenty-first century, has the internal structure needed to deal with factors affecting the health of Canadians, and to improve the health of Canadians as much as possible.

As you know, there are seven new branches. In listing them for you, we are also giving you a quick overview of the main lines of our structure. We have the following branches: Health Products and Food; Health Environments and Consumer Safety; First Nations and Inuit health; Population and Public Health; Health Policy and Communications; Information, Analysis and Connectivity; and finally, Corporate Services. There are also the six regions and the Pest Management Regulatory Agency.

[English]

We have four corporate priorities that regroup a number of activities in the department. Those are laid out for you on page 12 of the RPP. The first is support for the renewal of Canada's health care system. The second is the development of new strategies for health protection, linked to products and devices that Canadians use and we regulate. The third is the development of a health framework that addresses the full range of both factors influencing the health of Canadians and supports consistent with sustainable development. Finally, there is the elaboration of first nations and Inuit health promotion and prevention strategies.

In developing the RPP, we necessarily have to be selective. My colleagues and I would expect that you will have, today and subsequently, particular issues suggested by the RPP but not given in full detail. The RPP therefore might be the basis for further discussion with you.

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The RPP follows what's known as business lines. I should stress that the formula we follow in our report on plans and priorities adheres to the formule de présentation that is set by the Treasury Board Secretariat and that applies to all government departments and agencies. Mr. Lafleur can provide further detail for you.

With our new departmental structure, we now have five major business lines as laid out in the RPP: health care policy; health promotion and protection; first nations and Inuit health; information and knowledge management; and departmental management and administration. I'll just say one or two very brief things about each of those business lines.

Health care policy is a business line that incorporates our activities to provide leadership across Canada and to work collaboratively with provinces and territories to renew the health system in Canada.

Health promotion and protection incorporates Health Canada's proactive work to preserve and protect the health of Canadians. That business line is divided into four important service lines: population and public health; health products and food; healthy environments and consumer safety; and pest management regulation.

For those who will be familiar with this or who have some history with the department, I think it's important to say that too often in the past our thinking has been segmented between regulatory or protection activities and health promotion. In the realignment of the department we have tried to bring together groups of scientists, and those who use science, to make health protection and promotion decisions so that they're working more shoulder to shoulder and the promotion of health is working hand in hand with the protection of health. Too often these have been separated into different worlds.

Actually, while it may seem very bureaucratic, the development of business lines can be quite helpful in bringing together, for planning and evaluation purposes, these different types of activities in the department.

[Translation]

We can give more details on any of the main features of our areas of activity.

[English]

The next business line, first nations and Inuit health, is one in which we work with first nations and Inuit to help them attain a level of health comparable with the health of other Canadians. As you know, the great challenge is to bring that subpopulation of the Canadian population up to a standard more in keeping with the general population.

In collaboration with provinces and territories, we actually provide access to quality services and programs. Our goal is higher-quality services that address health inequalities and disease threats in a manner that supports first nations and Inuit autonomy and self-government.

We also provide, as you know, on-reserve health services as well as primary care and emergency services on isolated reserves where provincial services are not readily available.

[Translation]

Finally, let us speak to information and knowledge management. This area of activity supports the objectives of the other sectors, as well as the health system overall. This is the area in the department where we are pushing the envelope in research, where we provide support for the federal government's academic research, etc.

What is equally important is the management and administration of the department. This sector offers efficient support for Health Canada's program delivery.

[English]

I would just add that the policy branch and the corporate services branch work in collaboration to prepare the report on plans and priorities. Every part of the department is involved in this, of course.

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In terms of the process we follow, and how it occurs, three basic elements go into preparing the RPP. The first is building on and describing, hopefully in a better way year over year, the continuing activity in the department.

You will notice, if you look at the old part III of the estimates documents, and now the report on plans and priorities, that from year to year many of the activities will simply be a continuation of previous activity. That is because there is in fact no fundamental change from year to year, but it's still important that we describe what our plans and priorities are. For example, the regulatory role we have in pest management or drug approval—and there are others as well—is in effect a continuing activity. We're simply building on that and describing it in the RPP.

The second basic element is to incorporate into those continuing activities any new approaches or adjustments in our planning, whether from improved planning itself, new resources that have been made available by Parliament, or indeed stakeholder input.

Let me give you the example of food labelling, where in fact the regulatory activity in relation to food additives and so on goes on from year to year. In the last year—longer than that, actually—we've seen bearing fruit the process of working with stakeholders to develop the labelling of food products. That's incorporating into continuing activity any new approaches, and describing for Parliament and the public those new approaches.

The third element would be any new initiatives the government has undertaken, or new situations in the country that require the development de novo, of new approaches. I would give as an example of that the agreement last September of first ministers in relation to the health system. In this year's report on plans and priorities you would see elements that were not there in previous years that came out of that agreement.

So I think it is helpful for members to understand that the RPP is reporting of continuing activity, the refinement of continuing activity, and new activity that has come on stream in the previous year.

[Translation]

Mr. Lafleur will add a few remarks to put the Report on Plans and Priorities into context, in the planning process of the government as a whole.

Mr. Robert Lafleur (Senior Assistant Deputy Minister, Corporate Services Branch, Health Canada): Thank you very much.

Madam chair, in order to allow the members of the committee to better situate this instrument, I would like to bring you back to the fiscal year preceding the present one. I will briefly describe the process that brought about the creation of the report that you have before you. This began at Treasury Board.

[English]

Every year there is work done between the department and the Treasury Board to establish the level of budget the department will have, based on everything approved so far by the cabinet, for the following year. That work is done in the fall, and it leads to a document called the “Annual Resource Level Update”, which is basically the intended budget for the department for the following year.

That is the basis upon which the Treasury Board then, again with the assistance of the departments involved, prepares the estimates that are tabled in Parliament.

The third part of the estimates, which is the part we have before us, goes a little further than part II, commonly known as the “blue book”. That contains merely the estimates for the year without the benefit of additional information pertaining to new initiatives that have been approved by cabinet but have yet to be voted on by Parliament. Those are usually done through supplementary estimates.

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There are two supplementary estimates during the year, supplementary estimates A, which come in December, and supplementary estimates B, which come in March.

So in terms of the documents that contain financial information, and on which Parliament is invited to vote, you have the main estimates, parts I and II, provided to Parliament at the end of February in anticipation of the new fiscal year, and when we get into the new fiscal year, two sets of supplementary estimates that come to Parliament.

The plans and priorities document, which is the third part of the estimates, comes in March. It contains not only all of the information pertaining to the estimates tabled in February but also the information pertaining to what cabinet has approved but won't be coming formally for a vote to Parliament until the first supplementaries are tabled in September.

So it is essentially an information document to enlarge on the information that Parliament will ultimately have when all of the main estimates and the two supplementary estimates have been voted on. It gives Parliament an indication of what the department intends to do with the moneys that have been voted and the moneys that have been approved by cabinet and will be voted on in the supplementary estimates.

It is a bit complicated, but it is a process that keeps providing additional information regularly to Parliament as the process of decision-making takes place through the cabinet.

Mr. Ian Shugart: I think that's all we need to say, Madam Chair, by way of introduction. We're at your disposal.

The Chair: Thank you very much.

I'll remind the committee that this meeting is scheduled for just an hour, so we have a few minutes more than thirty minutes. About five minutes each is all we can manage.

We'll begin with Mr. Merrifield.

Mr. Rob Merrifield (Yellowhead, CA): Thank you. I won't be very long.

You have, as I understand it, about $2.7 billion for this next year. There was $2.375 billion last year, I believe. Can you give me an outline of where these moneys are supposed to be directed? I'm talking about the extras.

Mr. Orvel Marquardt (Director General, Departmental Planning and Financial Administration Directorate, Corporate Services Branch, Health Canada): Yes, you're quite right that the report on plans and priorities contains about $344 million over the reference levels that Mr. Lafleur talked about.

A number of items are in that $344 million. Enhancing regulation and control of veterinary drug residues, which amounts to about $8 million, is one item, as is funding for the quality care citizen engagement, which is about $2 million. There is a substantial amount for the look-back/trace-back initiative to identify individuals infected with hepatitis C virus and for the transfer of payments to provinces and territories for improved resourcing for hepatitis C health care services, at $71 million. There is also strengthening of Health Canada's enhanced blood safety program for about $2 million.

Those have gone through the approval process of cabinet. We have received, in most cases, approval of the board for the funding.

Items yet to be approved by cabinet are Canada in the Americas, at $0.8 million; some funding for first nations; some funding for capital rust-out, which is for repair of buildings, replacement of equipment, and so on; and another large item announced as part of the September agreement of first ministers on primary health care, about $200 million.

Although the items are announced in a budget, a February budget or whatever, we don't automatically receive the money. We have to prepare memoranda to cabinet to explain the programming behind that initiative and to indicate where and how that money will be spent.

Once cabinet approves those memoranda to cabinet, we have to prepare a Treasury Board submission to further justify and explain how those resources will be spent. Only at that time can they get into the supplementary estimates, which Mr. Lafleur talked about, that are tabled in the House in December and March. Only then do we really get our money to run those programs.

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The Chair: Two minutes left, Mr. Merrifield.

Mr. Rob Merrifield: Okay. There's a lot pressure on me, so this will be a quick one.

With regard to the 1999 social union reporting framework that was set out by, I think, the provinces, territories, and federal government, on health status, health outcomes, and quality of life, can you tell us a little bit about when that's going to happen and be finalized?

Mr. Ian Shugart: Yes. The social union framework agreement introduced more explicitly into health policy-making the principle that we should be doing, as all governments, a much better job measuring the performance of the health system generally.

In the first ministers agreement last September governments made some specific undertakings, with targeted commitments for September 2002, at which point governments will begin to report to Canadians, on a continuing basis, on three categories of indicators—the health status of the population; the health outcomes of various indicators or interventions in the health system; and finally, the performance of the health system itself, including such things as waiting times and access to primary health care services.

We're now working with provinces to develop the indicators, to begin to collect the data, to standardize the data, and to prepare for reporting.

Mr. Rob Merrifield: And September 2002 is what you're saying. That's the first one.

Mr. Ian Shugart: That's right.

Mr. Rob Merrifield: Okay.

The Chair: Thank you, Mr. Merrifield.

Mr. Ménard.

[Translation]

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): I have four short questions that I will ask all in a row so that you can answer them afterwards.

Could you tell us what the entrance requirements are, and the expenses incurred for Quebec, for the Adjustment Fund for health care and for the Adjustment Fund for health services that were announced in the previous budget?

Secondly, your report starts out on a pessimistic note; it states that Canada could have a shortage, over the next few years, of qualified personnel in the area of health care. Could you tell the committee what information you have?

On page 13, you also refer to a conference on indicators that will be sponsored by the OECD and Canada. Madam chair, I hope that we will be invited. Perhaps you could tell us more about this.

And my final question: on page 40 of your presentation, in the French version, under related activities, you talk about consulting the provinces, the territories and stakeholders in order to target the priority issues and to develop strategies for the renewal of health systems. I would like to know what that means, practically speaking.

Mr. Ian Shugart: The initiatives indicated by the Canadian Prime Minister in September was the block transfer, the Canada Health and Social Transfer.

Secondly, primary care funding is allocated at 70 per cent, on a per capita basis. We can provide exact figures for Quebec and each of the provinces, and we can do the same for funds established to support reinvestment. Equipment is also on a per capita basis, according to formulas defined in the agreement concluded by the first ministers in September.

As for personnel resources, a number of studies have been conducted across Canada.

[English]

Particularly in the nursing sector we face shortages that have been documented by the various professional groups and that in fact have been covered substantially in the media. That, of course, is a lengthy discussion.

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Health ministers and officials have discussed a number of times the need for coordinated efforts so that one jurisdiction is not recruiting in another jurisdiction the same limited number of professionals. Governments have begun to put in place a variety of strategies to increase the number of professionals in the system.

That, of course, takes some time, but enrolment in some of the professional schools has already been increased in various jurisdictions, Quebec included.

[Translation]

You talked about the international conference, coordinated by the OECD, which is scheduled to be held here in Ottawa in November of this year. The idea for the conference was discussed with the OECD on our initiative. We are the ones who made the arrangements, in co-operation with the OECD in Paris. I'm very pleased to see how interested you are in taking part in the conference. The theme for the conference is the development of performance indicators for health care systems in participating countries.

Lastly, consultation with the provinces in the development of common objectives within the health care system

[English]

occurs mostly with the conference of ministers of health and deputy ministers of health. A variety of advisory committees take the various issues, whether it's health human resources or health information, and primarily in those committees officials of governments work to develop plans. For example, in the health information sector, an actual blueprint has been developed collaboratively by provinces and territories to work together on common objectives.

The Chair: Thank you very much.

Mrs. Parrish.

Mrs. Carolyn Parrish (Mississauga Centre, Lib.): Thank you, Madam Chair.

I have a couple of questions on drug approvals. You mentioned in passing that you do drug approvals and testing. I have a particular interest there for two reasons.

One, you obviously can't predict how many drugs will be brought to you in any one year for approval. What happens to your budget when you suddenly have a boom of great new drugs and you have to run them through the process?

Second, I'm curious to know what is the average length of time from when you get a drug to when you approve it.

As well, do you set a limit, based on your budgets, where you say you're not going to exceed so many in a particular year?

Mr. Ian Shugart: I will answer the first question, and if he will accept to offer some information, I'll turn to my colleague, Mr. Michols.

The fact of the matter is, we have targets for approval times. The reality, when we face a volume greater than what is manageable within those resources, is that those approval times slip. We have a process that has been studied and where in fact there has been external advice. We do a lot of comparison with other advanced countries in terms of their process and so on.

So we have what we believe is a very modern and up-to-date system in terms of the process, but at one point the money does run out. We will not distribute across all of the volume in order to achieve the time lines without doing the quality review. So the only elasticity in a circumstance like that is that the approval times have to be adjusted.

Now, the reason I turn to Dann is that although he is the ADM of the healthy environments and consumer safety branch at the moment, his previous responsibility in the department was as director general of therapeutic products. So perhaps, if we could be a bit informal, Dann could provide that even though it's out of his area.

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Mr. Dann Michols (Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch, Health Canada): In terms of how many, the drug review process in Canada is cost-recovered. If there is an increase in the number of submissions that come in, there is also an increase in the revenue that comes into the organization. As Ian says, it's not connected. There's no relationship between the revenue that comes in and the actual review, but that does help with an increase in the resources.

There are targets set, and the actual performance of the regulatory process against those targets is published quarterly. That could be made available to the committee if it's so interested.

The system in Canada is quite competitive in terms of the times that are registered in the United States—

Mrs. Carolyn Parrish: If I might interrupt, what is an average time for approval?

Mr. Dann Michols: That's a question that's a little more simple, perhaps, than the answer, because there is a range of different types of submission. A submission that is a new drug, one that has never before been seen on the market, would have a lot more data within the package that came forward to us and would take longer to review.

It's been a couple of months since I was involved, but it takes in the order of about a year for the most complicated new products coming on line. Products that are already on the market, for instance, where the manufacturer is looking for a new indication, would be considerably quicker because we already have experience with that product.

But as Ian said, those are targets that we attempt to aim for. They are averages. With each submission it takes as long as it takes, depending on the complexity of the submission and the product that's involved.

Mrs. Carolyn Parrish: Just so I'm clear, then, the companies pay you to do the testing—

Mr. Dann Michols: No.

Mrs. Carolyn Parrish: —and therefore, if you have to hire extra people...

Mr. Dann Michols: No, the companies pay a fee to have the submission reviewed.

Mrs. Carolyn Parrish: Right.

Mr. Dann Michols: That's right.

Mrs. Carolyn Parrish: Do their patents still run while you've got it?

Mr. Dann Michols: Yes. Well, the patent is usually sought long before we actually see a submission, because they want to patent the substance as soon as they have discovered it. Through all of their testing and clinical trials and so on the patent is running.

Mrs. Carolyn Parrish: And then through all your testing the patent is running.

Mr. Dann Michols: Then through our review the patent is still running, so obviously there is some interest from the manufacturers in having the least amount of time possible. That is an incentive for them to put in the best submission possible so that we don't have to continually go back and ask for more information.

Mrs. Carolyn Parrish: Very good.

Thank you, Madam Chair.

The Chair: Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you, Madam Chair.

Before I begin my questioning, Madam Chair, one hour seems hardly enough time to deal with something so significant as the department's estimates and planning and priorities, and I wonder whether we could agree, either by consensus or a motion, to invite the witnesses back at our first session after the break.

The Chair: We can do that at 1 o'clock, when I'll see what the committee thinks.

Ms. Judy Wasylycia-Leis: Okay. Thank you.

The Chair: You've already used half a minute now, so...

Ms. Judy Wasylycia-Leis: The first question pertains to the long promised and eagerly awaited amendments or replacement of the pest control act. I know it's listed here as something that may be introduced in Parliament in this year. I'm wondering if the act is ready and when we might see it.

Related to the question of the environment and children, there's been, I think, a commitment to introduce regulations dealing with lead and other toxins in children's toys. I'm wondering where that is at.

The next question pertains to health protection. Ian will be able to answer this, hopefully. A couple of years ago he headed up a lengthy consultation process on HPB transition with the understanding that all acts—I think there are something like eight acts—would be reviewed and renewed and brought back to Parliament.

Where is that process at, and what's the delay? What happened to Bill C-80, which was introduced as part of this whole package, I assume, with changes to the whole food safety area? It was introduced to Parliament and then pulled.

What happened to the water bill that was introduced early on in the last session pertaining to standards for plumbing and piping for transmission of water? It was introduced, we had second reading, and it was pulled. Is that coming back in a new form? What are the plans with respect to water quality and water standards?

Regulations for drugs that are approved under notice of compliance with conditions have not been forthcoming. Can we expect to see such regulations? I don't see them listed in the package anywhere.

I'll leave it at that, although I have lots more.

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The Chair: Thank you.

Now, it'll be a challenge to answer all that in two and a half minutes.

Mr. Ian Shugart: I'll try, Madam Chair, by grouping the questions about legislation first, and then I'll ask Dann to pick up on the ones that were in his area.

On the PCPA and the health protection legislation, the PCPA is in a further state of advancement. As Ms. Wasylycia-Leis will know, it's the House leader of the government who makes the decisions about timing of introduction. I can't speak to that except to indicate that, on the substance, the pesticides bill is well advanced, given the work that was done through the other standing committee.

On the health protection legislation, our commitment to proceed with that remains. In fact, our commitment to proceed with a second round of consultation, whether as part of the legislative process or in advance of it, still remains as well.

I would indicate that we are, I think, reasonably prepared to bring forward that bill, although a number of questions remain where the policy implications are not entirely settled. Ultimately, of course, the department will await instruction from Parliament on which way to go.

With reference to the food bill, while it abutted the food components of the health protection legislation, it was in fact a separate piece of legislation, and with respect, that would have to be followed up with the Minister of Agriculture, who had responsibility for that.

I personally am not aware of the status of the drinking water bill, but perhaps Dann could answer that and the other question. I don't know if any of my colleagues here can provide information on the NOC regs. If not, we could provide a written answer to that question.

Mr. Dann Michols: We are in the process of analysing the lead in a range of products and developing regulations under the Hazardous Products Act. The Hazardous Products Act, as you may know, is a particularly difficult piece of legislation to work with. It is one of the acts being looked at in terms of the health protection activities you alluded to in terms of transition. We will proceed to develop the lead regulations such that it could work under either act.

The Drinking Water Materials Safety Act was previous to my involvement, I think, but it actually was in the House twice and ran out of time. Rather than bring it back a third time, we are also looking at whether or not we can use the health protection act, in its development, in that particular regard as well.

So that's under review pending the development of the health protection act.

The Chair: Thank you very much.

Mrs. Scherrer.

[Translation]

Ms. Hélène Scherrer (Louis-Hébert, Lib.): Thank you, Madam Chair.

My question will focus on First Nations and Inuit health. In reading the document you provided, I note that this component accounts for 50 per cent of Health Canada's total budget.

I also note that an insert, included several pages further on, simply states under the heading "Miscellaneous Facts":

Though progress has been made recently, a number of indicators show that the health status of First Nations is lower than the average for the general population.

This still accounts for 50 per cent. First of all, I would like to ask whether the budget has been increased this year, and on the basis of what criteria. Before allocating such a large sum to a specific component, have existing results and services been assessed in depth? Has a timetable been established for getting acceptable results at last, so that further down the line we do not read or hear—as we do now—that First Nations' health is compromised? Can we still say that the health status of First Nations is below average, when Health Canada allocates 50 per cent of its entire budget to that component?

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My second question will be very brief. I note that your brief mentions smoking a number of times. Yet nowhere do I read that the department has made a decision to establish a specific program and allocate a specific budget to fight smoking. I would like to know if this has been provided for in upcoming budgets.

Mr. Robert Lafleur: I will answer the first part of your question, on budgets. For two years now, the budget of the First Nations and Inuit Health Branch has been reviewed on the basis of the increase of the number of people receiving the services, the demand for some services, and associated costs, for example the costs of drugs. We have initiated an in-depth review of the program, which should be completed in the next few months. Once that is done, there will probably be a general review of the entire budget.

As to the way in which those funds are used, and the result that we all want, which is good health in First Nations and Inuit communities, I will give the floor to Ian Potter, who can provide more details.

[English]

Mr. Ian Potter (Assistant Deputy Minister, First Nations and Inuit Health Branch, Health Canada): Thank you, Madam Chairman.

In the last while we have had a number of new initiatives for first nations and Inuit. We've had a new program for home and community care. We've had a new program for aboriginal diabetes. We've augmented the program for Aboriginal Head Start on reserves. We also are working with first nations on some amelioration of the types of services we deliver.

At the more global level, we are working with the first nations and Inuit on what we call a renewal plan. We've engaged with them, and we have started discussions on the development of a long-term and sustainable program for first nations and Inuit that would try to achieve the three goals we have set for the program.

The first goal is to improve the overall health outcomes of first nations and Inuit. The second is to assure that they have access to quality care in their communities. The last goal is to support greater control by first nations and Inuit over the health programs. That process is ongoing, and it would, we expect, identify the programs, initiatives, and management changes necessary.

At the same time, we have been taking steps to deal with the administration and management of the programs. We have developed a framework, in consultation with first nations and Inuit, that sets out characteristics of a well-run administration. That includes a framework on reporting of defining the criteria for the various programs within the branch. We have recently introduced new contribution agreements that strengthen our ability to manage that program area. We are also putting greater emphasis on reporting and evaluation of the programs.

[Translation]

Ms. Hélène Scherrer: The budget for the First Nations has been very high for a long time. Have your programs generated positive results? Have you established a timetable to ensure that your programs do lead to positive results?

When I'm told that money has to be put into health or medication, that might also indicate that the health system is not necessarily in better shape. Perhaps the fact that more investment is required because of greater needs, means that the system is in a worse situation. Have we managed to address the specific requirements? Have we identified these issues or are we simply throwing money at the health service without getting any results?

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[English]

Mr. Ian Potter: The purpose of the process I had talked to, the renewal process we're in discussions about with first nations and Inuit, is to ensure that the effectiveness of our programs is achieved and we can actually improve the health outcomes of first nations and Inuit and not just spend money, year after year, maintaining a poor level of health.

But it has to be underlined that health outcomes are not just consequences of what Health Canada does, or what the health services are. Health consequences of the population depend on such things as employment, their social situation, the supports they have in communities, the leadership, their housing situation, and many of the social and economic infrastructures. Those are so important to health outcomes.

Health Canada is working in partnership with other departments, and with provincial governments, to see if we can deal with that in a more global way. That is part of the health renewal program. It focuses on the service element in terms of health care services, but it also tries to engage other agencies and departments and the private sector in improving the living conditions so that the long-term health outcomes of first nations will improve.

The Chair: Thank you very much.

Ms. Judy Wasylycia-Leis: Madam Chair, could I just ask for a point of information?

The Chair: No. We are committed to finishing at 1 o'clock, and I want to put a couple of questions before the committee about their future plans.

First, this is meeting two of our three-meeting plan to review the estimates. The next one, in my mind, was to have the actual estimates before us, with the minister. Of course, that document you have is also a blue book.

It would be two weeks before we could have a meeting on the estimates. I'm going to suggest that, as we did once before, you look at that document and perhaps submit some questions ahead of time. That would guide the people presenting as to what it is you want to hear about.

Madam Scherrer, for example, has suggested she wants to know, in some detail, about any new spending on the first nations section of the budget.

So I would invite you to do that, but I need your approval to move on in terms of the choices you have. The one suggested by Mrs. Wasylycia-Leis is that we have another session on this book, with these officials. The other idea would be to move on to meeting three, with the minister and probably some of these officials, to go more into the numbers.

Would anybody like to make a motion based upon those two choices?

[Translation]

Mr. Réal Ménard: Madam Chair, I think that I should delay tabling a motion. We have a lot to deal with and it's important that we have the necessary facts. If I'm not mistaken, the minister is to testify to the committee on his department's estimates by late April. Do you have any information about developments in new reproductive technologies?

If we have a lot of time, we could first adopt the estimates when we meet the minister, and then we could meet with senior officials again to discuss priorities.

However, if the new reproductive technologies bill is referred to Committee right after Easter, we will have less time.

Do you have any idea of when the bill will be ready or when it will be tabled?

[English]

The Chair: I don't have a clear picture of when the reproductive technology draft legislation is coming, but I'm pretty sure we have at least one week after the break. If you like, we could have these officials back at the meeting on Tuesday and ask for the minister to come on Thursday with the estimates. Alternatively, we could ask for the minister first.

An hon. member: No, no.

Mr. Yvon Charbonneau (Anjou—Rivière-des-Prairies, Lib.): Questions first, minister after—your first suggestion.

The Chair: Have these people back for Tuesday and then the minister on Thursday?

[Translation]

Mr. Réal Ménard: Yes. I would like to move that.

A Voice: I second that.

[English]

The Chair: Mr. Ménard moves that we have another day with this book, because one hour turns out not to have been enough, really. It may not take us any more than another hour—who knows?—but we'll start off with a very brief presentation, just a quick review.

In the meantime, I would suggest that people could submit questions to the clerk, who in turn would pass them over, so that we make the very best possible use of our time.

I'll also ask the clerk to invite the minister to come on the Thursday of our first week back.

Is that agreeable?

Some hon. members: Agreed.

The Chair: Thank you very much.

I thank my colleagues for the succinct nature of their questions and our guests for their very succinct answers. I think we covered a lot of ground this morning.

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Mr. Réal Ménard: Even me?

The Chair: Yes, you were just excellent. You get an A.

Thank you very much for coming. We look forward to seeing you again.

This meeting is adjourned.