HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Tuesday, April 24, 2001

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[English]

The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Good morning, ladies and gentlemen. I now call this meeting to order.

This is the second of our meetings around the estimates. We're still on the plans and priorities documents, the blue book. I would remind my colleagues on the committee that this meeting is at their request because they felt that they were not sufficiently finished when we concluded the last meeting.

I would like to welcome the officials from Health Canada for a second time to talk about plans and priorities. Mr. Shugart is leading this delegation.

Would you like to begin, Mr. Shugart?

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

I'll briefly introduce my colleagues again for you. With me is Bob Lafleur, the senior assistant deputy minister, corporate services branch; Orvel Marquardt, who heads our departmental planning and financial administration section; Diane Gorman, assistant deputy minister of the health products and food branch; Patrick Borbey, the associate assistant deputy minister in the First Nations and Inuit health branch.

In the audience we have Dann Michols, who was at the table the last time, the assistant deputy minister, healthy environments and consumer safety branch; Bob McMurtry, the assistant deputy minister of public and population health; Claire Franklin, the executive director of the Pest Management Regulatory Agency; and Denis Gauthier, qui est le sous-ministre adjoint of the information, analysis, and connectivity branch.

Depending on where your questions go, we'll come up to the table and leave, and so on.

We're back to continue to discuss with you the report on plans and priorities. We have tabled with you a little document, “QuickFacts”, or “Synopsis”,

[Translation]

which gives you the highlights of our Main Estimates and other relevant information as it applies to Health Canada.

[English]

As you know, the minister has accepted your invitation to be here on Thursday, and at that time he will explain his vision for Health Canada and answer any questions regarding appropriations in the main estimates, and your policy interests.

[Translation]

When I last appeared before you, I explained the structure of the activity sectors within the department. I will remind you briefly of our five areas. Firstly, health care policy; secondly, health promotion and protection, which includes four sectors of activity, namely the population's health, public health, health products and food, environmental health, consumer safety and pest control regulations; thirdly, the health of the First Nations and of the Inuit. These three areas relate to the general orientations within departmental programs. They are supported by two others: information management as well as, finally, management and administration of the department per se. Several initiatives are underway in each of these areas.

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[English]

We mentioned these last time. We talked, for example, about the implementation with partners, principally the provinces, in regard to the irst ministers agreement last fall. You have heard, as has the public accounts committee, from Patrick and his colleague, Ian Potter, about work with First Nations and Inuit. This was dealt with substantially in the throne speech.

Promotion and protection are ongoing activities in the department. They are fundamental to what we do in relation to the environment, food, health products, tobacco control, and so on. Our budget, which you can see in the quick facts, for the current fiscal year is $2.7 billion.

With this brief reminder of the ground we covered last time, Madam Chair, we're at your disposal for questions.

The Chair: Thank you very much, Mr. Shugart.

Mr. Merrifield.

Mr. Rob Merrifield (Yellowhead, Canadian Alliance): Thank you for the introduction.

You're working with the provincial health and education departments on these shortages, the crisis we're seeing because of shortages of nurses, doctors, practitioners—whether it's radiologists, ultrasonographers, and so on—across Canada. What exactly are you planning to do? Are there significant numbers of increased enrolments for this fall? If there are, what areas are they in?

Mr. Ian Shugart: We can provide you with the information we know of, province by province.

Our information—and I'm estimating here, Mr. Merrifield—would be in the order of about a 25% increase in medical school enrolment over the next couple of years. This is across the country. There are sixteen medical schools, whose enrolment levels are determined by the provinces.

There is increased enrolment. A number of provinces have made those announcements. We anticipate this will be a continuing trend in the next while. Other provinces have not yet indicated their intentions, but chances are we'll see this in those jurisdictions as well.

It's not only an issue of supply of physicians or nurses and other health professionals; it's also a matter of distribution. All governments agree that a necessary strategic objective for the health system is the whole feild of the renewal and reform of the primary care sector. This needs to be done so the utilization of professionals can be more appropriately delivered in the context of primary health care services and people's access to them.

There are significant supply issues. During the nineties, the total health workforce was substantially downsized as governments dealt with fiscal issues. We lost a significant portion of the nursing workforce in this country. Provinces, regional health authorities, and health institutions themselves have made significant efforts to try to bring nurses back to Canada who have either left the nursing workforce entirely or have gone to the U.S. to work.

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In the longer term, it's important for us to build the kind of information base that allows governments to plan for workforce requirements in the future without the peaks and valleys that lead to shortages, waiting lists, and those kinds of things. We're working with people from Human Resources Development Canada who are in the process of developing a sector study on nursing. We are in discussion with them as well about expanding this approach to the other elements of the health profession. Then the data could be built and made available to all jurisdictions in the country for improved planning.

Finally—again in the nursing sector in particular—we have developed with the provinces the Canadian Nursing Advisory Committee. Its membership was just recently announced. Addressing the working conditions of nurses is its primary orientation, issues such as supply and remuneration. The nursing associations take up with the provinces issues pertaining to the negotiation of salaries, but there are also significant workplace issues, like injury on the job, stress, morale, and so on, needing to be addressed.

There are a range of activities, some dealing with data, some—like recruiting—in the provincial domain, and some collaborative, longer-range reforms of the system to make the distribution of professions more optimal in the long term.

Mr. Rob Merrifield: I want to follow up a bit more.

You're trying to tell me then that there is to be a 25% increase across Canada over the next two years. Since you are only talking about nursing, do we know what the shortfall in nursing is today in Canada?

Mr. Ian Shugart: The 25% increase I cited was for medical school enrolment—that would be physicians.

Mr. Rob Merrifield: Okay. That's doctors.

Mr. Ian Shugart: Is that number accurate as far as you are aware, Bob?

Dr. Robert McMurtry (Assistant Deputy Minister, Population and Public Health Branch, Health Canada): Probably.

Mr. Ian Shugart: We think it's in that order, but I will verify this for you.

And the nursing shortfall is estimated by some of the studies done by nursing associations to be in the order of 10,000 across the country, and that's predicted for a period of years. So to get where we should be we need to be recruiting across the country in that order over the next several years. I can verify that for you as well.

Mr. Rob Merrifield: So you really don't have the numbers then.

Mr. Ian Shugart: Not at my fingertips. My recollection is that it would be of that magnitude, but we can provide you with numbers quite quickly. We have this data in the department.

Mr. Rob Merrifield: You moved from 1,600 to 2,000. The projections we have are 2,500 doctors needed per year. Do you have plans to address this shortfall?

Mr. Ian Shugart: Where the 25% increase in enrolment across the.... My guess is this probably represents half of the sixteen medical schools that have announced increased enrolment. They haven't all come in, so we expect this number to increase. At least in the initial cut, the number doesn't go the full distance to cover the estimated need.

But as you know, the number itself is debated within the health community. Mr. Fyke, in his report in Saskatchewan announced within the last two weeks, was of the view that it is not fundamentally an issue of supply; it's an issue of the distribution and utilization of the physician workforce. Some of those numbers would themselves be the subject of debate.

Mr. Rob Merrifield: Are you addressing that as well?

Mr. Ian Shugart: The issues of distribution?

Mr. Rob Merrifield: There's always been a problem of distribution. It's not new.

Mr. Ian Shugart: That's absolutely true. There are certain parts of the country where recruitment is a particular challenge. The provinces really have to wrestle with those issues. But in the longer run, governments generally believe in the strategy of primary health care reform as our best opportunity for evening out imbalances and having the total health professional team working optimally. This would see physicians doing the high-end work they've been trained for in medical school, and nurse practitioners doing some of the work physicians are currently doing, and so on. In the longer run, this is definitely part of the solution.

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The Chair: Thank you, Mr. Merrifield.

Mr. Dromisky.

Mr. Stan Dromisky (Thunder Bay—Atikokan, Lib.): Yes, I have two areas of concern. I'm sorry, Madam Chairperson, but I missed the last session. Maybe some of this information has already been presented. I don't know.

I'd like a better picture and a better understanding of the relationship between the Ministry of Health on the federal level and all the ministries of health in the provinces. We hear a lot about the provinces and their needs. I would like to have a better picture of the kinds of communication patterns and strategies you use in this relationship. How are they implemented? The whole question of accountability comes in if we were to do something to help the provinces to meet the needs we have been discussing. Could you give me, in a thumbnail sketch, a clearer perception of your relationship with the provincial levels?

Mr. Ian Shugart: Yes, I would be happy to. I'll keep my eye on the chair so I'll know if I go too long.

First of all, I'll start with the issue of jurisdiction. The widespread perception is that health is entirely a provincial domain, a provincial field of responsibility. That needs to be clarified. Provinces do have the responsibility for the delivery of health care services. The regional health authorities, the health institutions and so on, are accountable to provincial legislatures.

The Government of Canada, of course, through its spending power, supports financially the delivery of health care services through the Canada health and social transfer. Over the years, the system of medicare—single-payer, public health insurance—has been agreed to and matured under all governments, and it's the Canada Health Act that describes the conditions upon which the Government of Canada will transfer resources for health care.

Because it provides financial support, the Government of Canada obviously has an interest in the health care system. We work collaboratively on issues of common concern, such as health human resources, primary health care reform, and a variety of issues relevant to health care delivery. That's health care. But looking more broadly, beyond that particular part of the health field to things like public health, population health, health protection, and so on, the Government of Canada has direct responsibilities, constitutional responsibilities.

Our whole apparatus for health protection, for example, is founded on the criminal law power. This goes back to the last century, when the first public health laws in this country had to do with the adulteration of beer and alcohol: it was a criminal offence to deliberately adulterate beer. That was a commercial transaction and it had to do with public health and safety. Ever since then the development of public health responsibilities and so on has evolved. Our Food and Drugs Act and the Hazardous Products Act, for example, are federal legislation. They're very important to provinces. This is a field where we are both involved.

Provincial chief medical officers of health are provincial employees working at the local level to ensure the public health capacity and infrastructure is in place. We collaborate with them by providing assistance in terms of epidemiology and the tracking of chronic and infectious diseases, as well as regulating products, drugs, foods, and so on. It's Diane, in the health products and food area, and Dann in the healthy environments and consumer-safety area, implementing the legislation.

Health promotion is a third area where an efficiency argument exists for the Government of Canada to develop some of the tools and data across the country, to do some of the analysis useful to all jurisdictions as they promote health and make interventions that apply to the whole level of the population. In other words, we try to invest upstream to prevent disease and promote good health before these problems emerge in the health care system.

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Fourthly, both orders of government have been very much involved in health research over the years. Some provinces, for example Alberta, Quebec, Manitoba, and B.C., have health research institutions, but they all rely very substantially on the Canadian Institutes of Health Research, its predecessor, the Medical Research Council, and other vehicles for the Government of Canada to support health research across the country. Again, there is a good efficiency argument for that, and it's part of the objective of the Government of Canada to keep this country competitive internationally in terms of health research.

That's the jurisdictional picture. As you can see, it's very much interwoven and interdependent in that sense. There are a series of advisory committees of professionals and policy-makers, both at the federal and provincial level. The four main ones have to do with population health, health information, health services, and health human resources. Those advisory committees, which form an infrastructure that you would get in virtually any field—environment and labour market and so on—work collaboratively, and they advise on key issues. The conference of deputy ministers of health meets face to face, typically for a couple of days at a time, twice a year, and then the conference of ministers of health meets at least annually, and periodically there are teleconferences and so on.

That's the overall approach. It's a collaborative field, which is supported by these advisory committees, and ministers and deputy ministers interact. The best example of that collaboration came to a culmination last fall, as the first ministers themselves met on health issues and developed that action plan and agreement that has been tabled here.

Mr. Stan Dromisky: Just to follow through on that, I want to bring my second issue into play.

In light of all the agreements that have been settled over the years between the federal and provincial level, my concern is about the administrative level, where you have to do what you have to do based on all the agreements that have already been established, signed, and so forth. You do your work with the province and the provincial levels in operation, cooperatively, and so forth.

Then there's another level, and that's the political level. What I'm always concerned about is that political level interfering or in some way having an effect on the administrative level in light of, and contrary to, or ignoring completely those administrative agreements that have been established by past governments or the government in session at the present time. In other words, who the hell cares, what the hell, it has taken place. When the politicians step in they can interfere and screw up the entire relationship between the two levels as far as the bureaucracies are concerned. You might get orders from the political level saying stop, don't answer those letters, don't do that, don't cooperate, or you might get the reverse: cooperate, do this, do that, do everything in your power to be positive and constructive. I'm just worried about those kinds of relationships and that's why I ask this question about your relationship between the two levels.

Mr. Ian Shugart: I appreciate the concern. You will appreciate that I would never endorse the proposition that the political level screws up life for us in the department. There's no question about the importance that Canadians attach to health, and that has been consistently identified, as you know better than I, in public opinion research, in correspondence that comes into departments, in website hits, for example, for information, and all of that. Inevitably that means that you as members of this committee and our minister and provincial ministers are going to be intensely interested in this relationship and sometimes, candidly, a little impatient with the federal-provincial dynamic and the bureaucracy of good federal-provincial relations and so on.

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All I can say, members, is that we are increasingly aware, as governments, that the health system is best managed when we have good data upon which to make decisions and when that data—that information or analysis—is open and transparent. That's why we created a division—a branch in our department—a couple of years ago, which Denis heads, to build the knowledge base, the information base, the analytical capacity. It's why the Canadian Institute for Health Information was established collaboratively between the two orders of government a few years ago. It's why first ministers agreed last year to build some solid commitments on performance measurement and reporting to the public, so that at times when individuals say they don't care which order of government is responsible for this, just fix it, because they're concerned, we at least have the evidence base. The appropriate level of government is then able to report consistently to the public—to their residents—saying here's the status on access to primary care, or this is what's happening; this is a trend with regard to the health status of the population.

I think that offers our best hope to acknowledge the politics and the creative tension that is present in the health field, but still try to introduce a basis of rational decision-making that both orders of government can rely on.

In my brief summary of the jurisdictional landscape I should have mentioned First Nations and Aboriginal health, because that is really vital. It is again an area where we need to collaborate more between the two orders of government. We have responsibility generally for the delivery of service to Canadians on reserve and Inuit people. Provinces have responsibility for delivering service to all those residents, including aboriginal people, but because of the intricate interplay of on-reserve and off-reserve in the future—and we've been working towards this—we have to work more harmoniously together.

I hope that addresses the issue you raise. We do our best, and your interest is actually welcome.

Mr. Stan Dromisky: You're like a ballet dancer dancing on your toes.

The Chair: Thank you, Mr. Dromisky.

We'll now hear from Mr. Lunney.

Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance): Thank you.

I would like to pick up on a question that was raised earlier. When I came in a little bit late, you were discussing the shortage of personnel and the increase in medical school enrolment across the country and also the shortage of nurses and the exodus of nurses to the somewhat more lucrative market south of the border. I am wondering if any consideration is given to provisions.... And maybe this isn't a question for Health Canada officials, but it was suggested to me recently and may be worthy of consideration. Foreign students pay a different rate coming into our university system. Perhaps our professionals—our nurses, our doctors—who are trained in our publicly funded or subsidized educational system could be required to sign at the beginning that they would spend four or five years in our country before they would be eligible to leave with the education they received here, or alternatively they could simply pay the foreign rate and leave when they wanted.

I don't know if that's an appropriate question for this forum, but since it comes up in terms of the students leaving the country, I wonder if any consideration could be given to such a notion. If not here, maybe there's somewhere else the question could be asked.

Mr. Ian Shugart: That's a fairly complex area, because it relates to the procedures that provincial institutions—the universities—put in place. It relates to the immigration area and the rules or framework in which foreign students train here and are qualified, if they've trained elsewhere, to work here and so on. So it does have a number of strands. I'm not sure we can give you a full answer at the moment.

I wonder if Dr. McMurtry, who spent a number of years as dean of one of our medical schools before joining us at Health Canada, would be able to offer a perspective on that, if not a complete answer.

Dr. Robert McMurtry: Thank you.

It's an interesting question, and it's one that's been raised many times over the years—the notion of return of service. It has been done in other countries. It means that if you do graduate from a publicly funded or subsidized university, you should have a return of service. It's stated that if that were done at the outset of medical school and it was understood upon entry, that would be a fair thing to do. Like all things, it has two sides.

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The fees that were charged to international students were about $30,000 to $32,000 per year. We were at $4,000 when I began my deanship, and currently, in southern Ontario at least, we're up to $14,000. So the gap is disappearing, and there is an issue. That's a problem, but it also is an opportunity, because with fees being so high, those individuals could possibly be subsidized and have an exchange of service, which is another option. In other words, there is a lot of student debt. It was averaging nearly $100,000. That's a program that might be considered.

It seems on the face of it to make a lot of sense, but another critique of that particular approach is that when people have to do obligatory service, the communities that receive them don't always feel completely positive. Although it solves the problem in the short term, they don't want to have a sense that they have a captive physician who isn't there by choice. They don't want to have a sense that the person is there for the short term but not the long term, with continuity being so important. I'm not saying that's an insuperable hurdle, but those are the sorts of issues that would have to be overcome.

I think it's a very interesting question that could be posed from the standpoint of all students or some students given the rise in tuition fees in medical schools. I hope those comments are of some help.

Mr. James Lunney: Thank you. Yes, those are helpful comments, and the details are useful.

Taking it in a different direction—again, I came in late and I missed the other discussion on main estimates—I'm curious about the Office of Natural Health Products. I don't see it here in the budget information. Can you give us an update on the consultation that was going on in 2000 and where we are at in the development of the Office of Natural Health Products?

Ms. Diane Gorman (Assistant Deputy Minister, Health Products and Food Branch, Health Canada): Yes, I'll answer that question. The Office of Natural Health Products does appear in the report on plans and priorities. It has a relatively small budget at this point in time.

It has now gone into its second round of consultations with regard to its regulations. It was a very positive consultation the first time out. A variety of stakeholders came out to the consultations and provided excellent input, which ranged broadly but which was extremely helpful to us in revising the proposed regulations. That is now being consulted on again. Depending on the result of that, we'll see whether a third round is necessary.

We have also established an expert advisory committee, which brings to us the scientific perspective with regard to natural health products. Some of the challenges we are addressing now are what should be the standard for good manufacturing processes and for labelling and some other issues in terms of the coherence between a natural health products regime and other products that are regulated within the branch so that there is a level playing field for the industry and standards of information for consumers as well.

Mr. James Lunney: Could you give us an indication of the timeframe and where you're at in the consultations?

Ms. Diane Gorman: We are now out on the road and consulting. We're expecting that to be concluded before the beginning of the summer. The information will be assessed. Then, as I said, we'll determine whether or not it's necessary to have another round, depending on the level of differing opinion that might come back this time around. Our thinking is that if we were to go to a third round, we would focus on those areas where there are differing views.

Mr. James Lunney: Thank you.

The Chair: Thank you, Mr. Lunney.

We'll move to Ms. Sgro.

Ms. Judy Sgro (York West, Lib.): Thank you very much.

It's always very informative when you're here.

I have a couple of questions, and if they're in the wrong jurisdiction, just point it out to me. I want to ask about the issue of alternative forms of treatment, which are having varying degrees of success, that are not conventionally and currently covered under our health coverage in the country, whether we're talking about acupuncture or other forms of treatment for various diseases that are out there. Are you looking at any of those in particular as any points to be included in our health coverage systems?

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Mr. Ian Shugart: Yes, this issue comes up. Indeed, the association of teaching hospitals and medical schools is taking the issue as their theme for their annual meeting in Toronto next week. So it's highly topical for a couple of reasons, one of which is a natural follow-up to what Diane was just saying in regard to natural health products.

In that domain, it's of real interest in terms of public health and clinical practice because of the potential interaction of conventional medical therapies with natural therapies, which are sometimes self-prescribed.

From a health insurance point of view, some jurisdictions do in fact cover some of these alternative therapies. Acupuncture in some cases, for example, is covered, and it would probably be, I think, for specific conditions and so on. Provinces have the responsibility entirely to make that kind of decision.

In the long run, I think increasingly those decisions will be based on research, applied research, clinical research, what works, what doesn't, what are the known facts, what projects can be launched to go after and develop facts in areas that are perhaps disputed. And on the basis of information, the range of professions needs ultimately to get together and identify common ground where they can agree on what kinds of therapies are appropriate.

It's my sense that the medical schools and teaching hospitals, even a fairly short while ago, would not have taken this kind of a topic for a meeting. It simply would not have had the kind of professional legitimacy. The fact that it does and that it is increasing augurs well, I think, for a future where we systematically evaluate what we do in the health system, conventional and so-called unconventional, so that this distinction becomes a little less artificial. Increasingly we make decisions on the basis of distinguishing what works and what doesn't for the good of the patient. So it's a highly topical question involving primarily provinces, but we do have an interest in that as well.

Ms. Judy Sgro: The issue of the ability to see how the different provinces are performing when it comes to implementation of the Canada Health Act, I understand that we're supposed to get a first report card on the Canada Health Act in the provinces this fall.

Mr. Ian Shugart: We tabled our report at the end of the last calendar year, the annual report to Parliament, on the Canada Health Act. That's the report we provide annually with respect to the Canada Health Act per se.

The performance reporting that the first ministers agreement calls for has the first round of public reports in September 2002.

Ms. Judy Sgro: So we'll have to wait another year to find out how things are proceeding.

Mr. Ian Shugart: But this is not starting from ground zero. The Canadian Institute for Health Information has been reporting; Statistics Canada has been reporting on some dimensions of health and the health system. The CIHI tabled its first report card last April or May on the health system. That will be an annual product.

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The first ministers committed to extend and expand that and to develop a comprehensive framework in three indicator areas. From the time of the agreement, they gave themselves two years to develop that kind of comprehensive reporting, but already the health system is putting a lot of performance information out, and I think that will just continue to grow.

Ms. Judy Sgro: I have one further question, on the Province of Ontario. My concern is monitoring just how much of our money that we're transferring to them is getting put into health care directly. I might as well be as blunt as I can with the question. How are you monitoring that and staying on top of them when I continually hear the issues or the pressures the cities are under, for instance, with tuberculosis and others. They aren't getting the funding for a lot of those issues, and we're passing it down. Will it be five years before we start finding out how much is actually going into those programs and having to put pressure on them to make sure they're fulfilling their end of the program?

Mr. Ian Shugart: As you know, the Canada health and social transfer is what's called a block fund. The policy rationale for that is that because the delivery of health care is a provincial responsibility, provinces should be free to make the decision about how the financial support is allocated. It's delivered in a block. There is no allocation for health as opposed to social services, and so on. So in fact we do not track what portion goes to health, and so on; the province is accountable to its legislature for that.

In areas of public health, we go beyond that transfer and also provide direct services to Canadians. That's often done in collaboration with the provinces through various programs, everything from the food inspection agency to our own public and population health branch, to Environment Canada.

On the ground it's very difficult to attribute program expenditure to the various sources of funding, whether federal or provincial, or the different departments. What we can do in the report on plans and priorities, and then in the department's performance report, is describe the services and the funding for those services that are delivered on the ground, and of course, report on the amounts year to year in the CHST. But we don't track a particular portion of the transfer for health.

Ms. Judy Sgro: But you have a responsibility.

Mr. Ian Shugart: Well, the Government of Canada does support health care services, and our responsibility is to make sure the principles, the conditions of the Canada Health Act, are respected. But that is not a monitoring that involves dollar-for-dollar expenditure or tracking. As I say, the policy premise is that the provinces should make those decisions, and the Government of Canada provides an overall level of support for that activity.

The Chair: Thank you, Ms. Sgro.

We'll go to Mr. Charbonneau.

[Translation]

Mr. Yvon Charbonneau (Anjou—Rivière-des-Prairies, Lib.): I would like you to talk to me about the scientific capacity within the Department of Health, about its scientific expertise. You have several objectives or priorities which require constant and high-level scientific expertise.

When I look at your action plan, on page 26, I see a list of priorities which all require a good knowledge and a good expertise in several areas. How do you evaluate the scientific capability within your department? We know that around 1995, there were cutbacks, there was some downsizing and program review which affected the scientific capabilities of your department as of other departments. Are you turning that situation around? Do you feel that you are properly equipped or do you need to enhance your scientific capabilities in order to face these challenges and objectives that you are announcing?

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Mr. Ian Shugart: That's a rather complicated question and I would ask my colleagues to support me in responding to the questions which affect their particular areas of responsibility.

It is true that during the years of budgetary cutbacks, there was quite a severe impact on the scientific side of the department. Over the last few years, the last decade, we have replaced or increased our scientific capability in areas such as, for example, blood regulation. We also added capability in the area of infectious diseases. The creation of our laboratory in Winnipeg, which is one of the first in the world to study virology, is a good example of this.

The most important questions are the following. How can a department such as Health Canada adapt to scientific trends, which never remain static? How can we make decisions in order to balance the scientific resources in the different scientific areas given the emergence of new problems, etc.?

[English]

This is something that calls for a human resources strategy in science, which we are always trying to deal with and develop and adjust to. The issue is not just the addition of new scientists, it's the training and retraining of our existing scientific personnel, and we do that through mechanisms like international conference attendance and sabbaticals. Our plan would be to increase the number of studentships and fellowships within the department so that fresh ideas and knowledge can be brought on a continuing basis into the existing scientific cadre that we have.

When we develop a new program or respond to emerging needs, typically, a significant portion of it will be for scientific personnel. This may be in the form of laboratory scientists. It may be people who are trained scientifically, who are involved in regulatory science and who make decisions about premarket approvals of pesticides or food additives or what have you. We include those in our scientific community.

So at a very general level, as we've invested in things like blood safety and our laboratory facility in Winnipeg, as we have enhanced our food safety programs and included a greater capacity to understand and track and respond to food-borne illnesses, for example, yes, we have substantially recovered some of the earlier reductions. But the real challenge is in keeping current the scientific personnel we have in the department. I'd invite Bob, Diane, or Claire to add any perspective or deal with any specific areas you might be interested in.

Diane, do you want to add anything?

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[Translation]

Ms. Diane Gorman: Yes, I would like to add something for my division, because it is really a challenge in our area where our mandate is to create the regulations that will ensure product efficiency. It's truly a challenge for us to decide what we have to do within the department and who we will have to have as a partner. As example, can we maximize our relationships and the information that we can obtain from other countries?

Therefore, we look at the issue of capability from all angles, not simply as a human resource issue within the department, but also as to the other possibilities of adding to our information base or to the data which we already have.

The investments which were allocated to us in the 1999-2000 budget did help us to alleviate this problem because there was some investment in biotechnology and in the regulatory system. Furthermore, we have to make strategic decisions regarding our investments within the division. We have now put in place a process to identify what we have to do, within the department, to decide to what extent we can depend on the information we receive from the outside.

I also feel that it's not simply a matter of resources, but also a matter of where we work. I think that

[English]

the announcement that was made recently by the President of the Treasury Board

[Translation]

can also help us in this regard because we have to demonstrate enough flexibility in order to attract people. The rate of pay and the workplace must be flexible because the people that we have to hire are doctors, pharmacists. It is difficult to offer them an attractive pay package. Therefore, we have to have other areas of flexibility. It truly is a challenge for us.

[English]

The Chair: Dr. McMurtry, do you want to comment too?

Dr. Robert McMurtry: Thank you.

[Translation]

I would like to say several things, particularly as regards changes. There are five things.

[English]

We are in a competition with universities, who will be hiring some 30,000 new academics, not just in size, but broadly in the next ten years. The issue my colleagues Diane Gorman and Ian Shugart were raising is very real in terms of recruitment.

We also have emerging issues that relate to such things as migrant health. With globalization and the migration of populations, we are within 24 hours of an exposure to an outbreak like Ebola. We have, as well, issues of emerging pathogens. These are on the upswing, and that has an importance for our scientific capacity.

There really hasn't been a new class of antibiotics invented or found in 25 years. We are importing foods and increasingly food importation is international. Agricultural practices are changing and that can have an impact on water supply. Of course, there is the issue of climate change and the changes that brings about.

The fourth thing is the possibility of change as it relates to our security and the possibility of bio-terrorism, where not just the U.S. but the United Kingdom and Australia perceive a growing threat.

Finally, in view of these changes, it emphasizes our need to very carefully monitor the known threats and, as well, the unknown threats in relation to such things as the 5,000 chemical products and their derivatives that may enter the market each year. We may know the details for some of what the potential threats are. About others, we'd know less well.

• 1200

So I would like to emphasize, as we stand here now, that we need not only to think of where we need to be in 2001, but also to focus in particular on the emerging trends and be sure that we're abreast of them.

The Chair: All right.

Madam Scherrer.

[Translation]

Ms. Hélène Scherrer (Louis-Hébert, Lib.): I have three short questions. The third is the longest, but I will get back to that one on the second round.

In terms of salary, we were saying earlier that there was a staff shortage. I think that there is also a shortage of doctors and specialists. Some provinces, geographically, have taken some measures. I believe that in Quebec, for example, measures were taken to ensure that specialists could practice in regions that would not necessarily be their first choice. They took measures in terms of the pay scale to ensure that doctors would want to cover those regions. When that didn't work, they took some more aggressive measures to ensure that these regions were covered. Is that in any way the responsibility of Health Canada, the department?

First of all, we want to make sure that health services are free for everyone. However, we don't intervene in any way nationally to ensure the distribution of doctors, because we know that in some provinces, specialists are paid much better. Therefore, it's much more attractive, for example, to work in Ontario, in Toronto, than to go to work in the Maritimes or in even more remote areas. Is this the responsibility of Health Canada and is there anything that's being done in that area?

Mr. Ian Shugart: That is solely the responsibility of the provinces and the territories, except for the specific situation of Patrick's directorate, namely as regards services to the First Nations and to the Inuit, where we employ nurses and doctors, primarily nurses.

Mr. Patrick Borbey (Delegated Assistant Deputy Minister, Directorate of First Nations and Inuit Health, Department of Health): As regards the nurses, I think that there are over 500 nurses throughout the country, but if we take into account the nurses who work in the organizations which were transferred to the First Nations, it's probably double that. Therefore, we have some common problems in terms of recruitment and the retention of nurses.

In 1999, we put in place a strategy in order to work with the First Nations to see how we could attract and retain these professionals. We took several initiatives. In certain cases, we subsidize the final year of study in exchange for an undertaking to work, and unfortunately, usually only for the short term. Sometimes, the First Nations are not very accepting of people who come to work among them. As Mr. Shugart said, these people are not necessarily working there because they want to build a career there, but it is a way to breach some of the gaps.

There are probably some 40 to 45% of the nursing positions which are vacant during the year. So it is a problem. We have to work continuously in order to find ways to retain them, to place them, etc.

As well, Treasury Board has negotiated new salary agreements which include a signing bonus and monthly bonuses during the first two years of employment, I believe. We are negotiating a new agreement which we hope will add other incentives.

Therefore, there are several initiatives of this type. We also want to work with the schools of nursing, for example, with universities where nursing is offered to see how they could encourage more First Nations members to study and to succeed and then work in their community.

As to doctors, it is even more complicated because we don't necessarily employ within our program. Doctors are paid by the provincial insurance programs or territorial programs. However, we do have agreements, for example, for Northern Ontario with McMaster University and with Queen's, where a certain number of doctors are available to work in these communities for a given time. Therefore, it is a way to breach some of the gaps.

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Ms. Hélène Scherrer: I'd like to come back to my question. We're talking for example about tertiary care, which requires an ultraspecialization. The people with the specializations are attracted to the major centres in part because of the salary. I'm not referring to the First Nations, but rather to tertiary care. In that case, it is the pay scale that becomes a criterion in the selection of a location.

Given that Canadian legislation states that services must be accessible and that everyone has the right to the same services, should we not intervene? I know that it's a matter of provincial responsibility and I feel that each of the provinces is trying to distribute the staff available throughout its territory, but our territory is Canada. Should we not have policies which will ensure that tertiary services are available everywhere? Should we not adopt incentive measures in terms of pay which would mean that highly specialized doctors would not all be concentrated in one single region, but distributed throughout Canada?

Mr. Ian Shugart: Honestly, I don't think that the federal government could impose a solution upon the provinces where the pay scale would be decided otherwise than through negotiations between the province and the profession, but we could support the provinces until they accept to adopt a certain number of inter-jurisdictional solutions. I believe that there are opportunities for co-operation between provinces and territories, but for the large provinces in particular, it is difficult to meet the needs of a neighbouring province without compromising the service available to their own residents to a certain extent.

It is quite complicated, and we don't have instruments to impose a solution. It is up to the provinces to determine the needs of their population and of their professionals.

Ms. Hélène Scherrer: May I ask another small question?

In the brochure that we received today, which is called Synopsis 2001-2002, under the heading “Forecasted initiatives” (in millions of dollars), there is an initiative which is called “Primary health care services” and where there is an allocation of $200 million. I'm wondering whether that is found under the heading of initiatives, whereas I think that it should be an activity sector. What will be the primary health initiatives taken during the next few years?

[English]

Mr. Orvel Marquardt (Director General, Departmental Financial Planning and Administration Directorate, Corporate Services Branch, Health Canada): The amount of $200 million for primary health care is an amount yet to be approved through the cabinet process and then the Treasury Board. When it finally has been approved, it will become part of the main estimates or budgetary expenditure levels for the government and will be tabled in the House for supplementary estimates. The figure is part of the first ministers agreement of last September. The amount extends over four years: $200 million each year for four years.

[Translation]

Mr. Ian Shugart: We had decided to distribute the funds throughout the country for the provinces in order to facilitate innovation and adaptation of primary health care.

Ms. Hélène Scherrer: No one specific project was identified. It simply indicated that sum of $200 million, and the province still has the latitude to choose the project which best suits it or which it deems appropriate.

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Mr. Ian Shugart: Yes, but the plan is the result of a collaborative effort between the department and the provinces to ensure that the funds will be properly used in order to advance the adaptation of the primary care sector.

[English]

The Chair: Thank you, Madam Scherrer.

If I could follow up on that question, you've explained to us how the Canada health and social transfer essentially is a block fund. We can't track how the provinces allocate those moneys. With this $200 million outflow from the first ministers conference, does it fall under the Canadian health and social transfer? Because it has a specific purpose of the reform of primary health care, are the provinces required to report in a more specific way on how they spend it?

Mr. Ian Shugart: There are two answers to that question.

You're right that it is not part of the CHST. It's a departmental appropriation and administered by Health Canada with the provinces directly.

In terms of reporting, 70% of the fund will be allocated on a per capita basis to each jurisdiction. There will be no mystery about where the funds went, in what proportion, and so on. We will have agreements with provinces where their plans, what they do with the funds, will be known. They will be reporting to their own residents in terms of progress in primary health care and so on. We will carry out our responsibility to report to Parliament on the utilization of the fund. I think there will be a substantial overlap in the two kinds of reports.

The Chair: Excuse me. Do they have to report through this planning document you mentioned on their plans for where the money will be spent?

Mr. Ian Shugart: That would be the vehicle. It is also for the purpose of accounting for the funds so we can assure the Treasury Board and Parliament on how the funds have been used. They're not reporting to us in the sense of the rightness, or otherwise, of the decisions they're making as jurisdictions with respect to primary care. Because it is an appropriation and a departmental program, we have indicated to the provinces that we have to be in a position to report to Parliament on how those funds have been used.

The Chair: Do they have to submit the plan before we issue the cheque?

Mr. Ian Shugart: Yes. They will have to tell us what they propose to do with the funds. We're working out the details about the kind of detail and so on that would be appropriate.

The Chair: Okay.

Following up on Mrs. Sgro's questions, and feeling the helplessness we feel around the Canada health and social transfer particularly as it relates to health care spending, does this seem to be a better route for us to get a handle on what they're doing with the money? In other words, in addition to the question, I want to express my own dismay that they're only reporting on health outcomes to their populations after they get the money and make the decisions on to how to spend it.

The report card is not going to report on how many dollars went into which pot of health care spending, but rather on the health outcomes they think can be related to that new spending. I think a lot of us are more interested in how much money went there. What did they do with it? We don't care if they top up existing budgets or if they create new initiatives. We'd just like to know where it went.

Considering those two vehicles, this particular $200 million is a good example of something outside the CHST, compared to things within the CHST, giving us more of an idea as to where they are spending our money. It would be better to do more of this, as opposed to topping up the CHST.

• 1215

Mr. Ian Shugart: I understand that perspective, Madam Chair. The vast majority of federal support for health is of course through the CHST. It is a very fundamental policy question in terms of the fiscal arrangements in the Canadian federation that involves principally the Minister of Finance and indeed the whole government. It has been, as you know, a continuing debate and a theme of the evolution of Canadian federalism.

In terms of the relative merits of the two kinds of programming, the fund for primary health care was developed along those lines specifically because we face a short-term and medium-term policy objective of reforming primary health care. We did not want that to be lost. It is one of those areas of health system reform where it is all too easy to be subservient to the day-to-day urgent priorities of emergency room crowding, shortages of nurses and equipment, and so on, all of which are legitimate.

It's the same issue with respect to the money that was allocated for the information, communications, and technology adaptation by the health sector of information technology. It's one of those things where it's all too easy to go to the bottom of the list. Yet the medium-term and long-term health of the health sector depends on those kinds of innovations.

Because there was a very specific policy objective, we designed that particular approach. Will it become characteristic of how federal support is provided for the health system in general? As I say, certainly in the short term that's not very likely, but it is a fundamental policy question for the government as a whole.

The Chair: Thank you.

Dr. Castonguay.

[Translation]

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.): Thank you, Madam Chair.

I am very happy to see that we are talking more and more about primary health care. When you get right down to it, one of the challenges we are currently facing is access to health care, and primary health care is, in my opinion, the gateway to the health care system.

I am increasingly convinced that we need to examine, at this point in our evolution, other ways of providing health care, and I am very happy to see that we are making an effort in that direction. I believe that the multi-disciplinary approach is definitely an important consideration if we are to integrate the various health care workers, including not just doctors and nurses, but also everyone else involved in other areas of health.

However, I wonder who will take the lead across Canada, and that worries me a little bit. I would like to know whether it is Health Canada's role to take the bull by the horns, as we say, and make sure that the various professional interests are set aside to make way for the consumer interests, the interest of the patient awaiting treatment, and that the various provincial political interests are pushed aside to give priority to the interests of Canadians who need access to health care. Doesn't Health Canada have to take the lead on this? I would like to hear your comments on that. I would like to have an answer, Madam Chair.

Mr. Ian Shugart: I agree fully, Doctor Castonguay, that reforms to primary health care are crucial to the health of the system itself.

The leadership issue has evolved over the history of our federation. Today's challenges are as great as those of the past. We need to strike a balance between the provinces' rights and each jurisdiction's responsibility for providing services to citizens locally.

• 1220

The government closest to the public is most sensitive to local needs, but in Canada, there is also a country-wide consensus that there should be one single, uniform health care system. The federal government is responsible, up to a point, for supporting and maintaining uniformity in our health care system, but providing that leadership is at times rather tricky. We play this role through research and analysis, and transparency in releasing the data. It is the responsibility of my colleague, Mr. Gauthier, and his colleagues from the Canadian Institute for Health Information, Statistics Canada, etc., but the leadership ultimately depends on a consensus among first ministers and health ministers, who share certain common goals, namely reforms to primary health care and the needs of Aboriginal people in Canada. There are more and more opportunities for co-operation between both levels of government in the areas of public health and health protection.

[English]

It's in the area of direct health care delivery that the headlines are the most obvious about conflict between the Government of Canada and the provinces, but in fact there is an enormous degree of collaboration that goes on day in and day out behind the scenes. It's in an attempt to build on those common objectives that the first ministers established their agreement last fall and that the government in the last few weeks has asked Mr. Romanow to lead a national discussion, including provinces, to find the long-term basis upon which our health system will continue to be that pan-Canadian system that at the end of the day everyone is very attached to.

[Translation]

Mr. Jeannot Castonguay: I am going to ask you a question you may not wish to answer, and I will understand. We know that at times, it gets very political. Provincial agendas may change from one election to the next, as in my home province. It is not always clear where we are headed. Shouldn't we consider setting up some kind of Canada-wide structure that would be above politics and focus our concern on the interests of Canadians who need access to health care? Let's stop playing games to the detriment of the patient. You may be uncomfortable with the question. Perhaps Mr. Romanow will be able to answer once he has consulted Canadians, but if you have any comments on this, I would appreciate them.

At times, intentions that are good to begin with may change because of political agendas that may vary from one election to the next. It is very complex because we are dealing with several provinces and several health professions, each of which has its own interests. At times, they protect their church, so to speak. Is there any way to eventually get around that? Can you suggest any approaches for us to take?

Mr. Ian Shugart: Mr. Romanow is a very wise man. As Premier of Saskatchewan, he often encountered his own challenges in dealing with his colleagues across Canada.

• 1225

From where we sit, federal-provincial tension is the inevitable result of a free society and dynamic federation, but I hope that in the coming months, we, senior officials from Health Canada, and the committee will be able to discuss specific areas where federal-provincial interaction is essential. This will make the details of our co-operation clearer. It's a big challenge, but the situation is not all gloom and doom.

Mr. Jeannot Castonguay: Thank you. Thank you, Madam Chair.

[English]

The Chair: Mr. Merrifield.

Mr. Rob Merrifield: I find the discussion to be quite interesting.

I'll ask you a question that won't take long to answer, and then I'll follow up with another one.

How many Canadians have been compensated from the hepatitis C compensation fund?

Dr. Robert McMurtry: I believe it's about 12,000. The tracing back is incomplete. The minority have been approved. The process continues.

The government has committed $1.4 billion in total, as you know. The amount of $875 million has been paid to fulfil its financial obligations to the clients.

Mr. Rob Merrifield: So we have a little under half left.

Dr. Robert McMurtry: The joint committee has advised that 4,700 claims have been received, 97% of those have been reviewed, and 1,200 claims have been paid.

Mr. Rob Merrifield: There's a little under half of the money left in the fund.

Dr. Robert McMurtry: Right.

Mr. Rob Merrifield: Thank you.

I have another question. One of your priorities is a health framework that strategically addresses the factors that influence the health of Canadians. Can you tell me when that framework is going to be complete and how it's going to be implemented? Have the provinces had input into it?

Dr. Robert McMurtry: The framework of which you're speaking, which we have called the wellness or well-being framework, is a work in progress. It's something we've worked on over the past year. It has been presented on 60 occasions, both within our department and, perhaps more importantly, as many as half of them in the six Health Canada regions. We have also presented it to the advisory committee on population health, first to their strategic planning group and then to the committee as a whole. That, as you know, is a federal-provincial-territorial group. They have responded positively. We've also had the opportunity to present it most recently, for example, to the premier's quality health council in New Brunswick. I would say that in about six provinces we've made special presentations to either the government more broadly writ or to their ministries of health. Sometimes they're called ministries of health and social services and sometimes ministries of health and wellness.

It is a work in progress. Each time we present it we invite their input and their direction as to where it should go. In the meantime, as we bring forward initiatives from the standpoint of the population and public health branch, we make sure that they are compatible with the rationale behind the framework in which we say here is a mechanism with which to view the possible scope of interventions and here's what makes sense according to a certain set of priorities. How much is contributed to morbidity? How much is contributed to mortality? What are the gaps in what we're currently doing? What is the role of the federal government? What is the likelihood of success for our making a difference?

• 1230

So that is the nature of the framework. We're making use of it within our branch. We're also making some use of it in cooperation with our other branches—for example, working with Dann Michols' branch in healthy environment and consumer safety on the tobacco file and doing some analysis in that regard.

In terms of when it will be a final product, I would hope that's something we would have done in the next three to six months. It depends on the feedback.

Mr. Rob Merrifield: What about the provincial input?

Dr. Robert McMurtry: The provincial input, as I've indicated, has been principally through the federal-provincial-territorial committee, the advisory committee on population and health, which reports to the council of deputy ministers. That is in addition to several individual presentations.

Mr. Rob Merrifield: Okay.

The Chair: Thank you, Mr. Merrifield.

Mr. Owen.

Mr. Stephen Owen (Vancouver Quadra, Lib.): Thank you.

Thank you for your attendance and very useful briefing. It's especially useful to those of us who don't have health service backgrounds.

My question relates to the provincial-federal collaboration you've spoken of, particularly in the aboriginal health field.

There have been very disturbing reports of recent studies of the dramatically increasing incidence of HIV and AIDS infection among native people, both on reserve and off reserve, particularly in impoverished urban settings. I'm wondering how you deal with that interrelationship or joint responsibility, in particular around the phenomenon that seems to be exhibiting itself, that of increasing heterosexual transmission and infection, which is equaling some of the rates in sub-Saharan Africa. In the states in sub-Saharan Africa that have been most successful in dealing with this issue, which seems to be related to transience between rural, in that sense, and urban areas—here it's on-reserve and off-reserve transience—the most successful approaches seem to be in prevention, particularly in public awareness and education.

I haven't noticed in Canada any such aggressive public education programs as you might see in Uganda or Senegal or Thailand, which have been particularly successful. I'm wondering how you collaborate, both with areas of financial and policy responsibility as well as effective joint presentation of programs to deal with this increasing problem.

Mr. Ian Shugart: I think Patrick should respond to the issue, but I have just one very brief comment.

The work between the Government of Canada and the provinces in support of aboriginal health was addressed by first ministers and is referenced in their communiqué. I think it's true that we've been putting greater priority on working with provinces on that transience on and off reserve. We've increasingly realized over the last several years that while there is a foundation in principle that the federal government is responsible for on reserve and the provinces for off reserve, the reality on the ground is that it's the individuals and the communities they're from and go back to and so on that really count, and that has to drive all our policy interventions.

So that's a general statement about the degree of collaboration and the broad strategy we have to follow. Could you try to deal with the application of that, Patrick, in AIDS in particular?

Mr. Patrick Borbey: I'm not sure I can really enlighten you with respect to AIDS in particular. We do have a strategy and some modest funding that goes into the issue of AIDS prevention directed at aboriginal Canadians. You're absolutely right, it's not just an issue on reserve, it's also off reserve. It's an issue of transient population.

I think increasingly we have to look at aboriginal health problems as being not simply on reserve and off reserve. In the diabetes strategy we also recognize that there are some cross-linkages there.

• 1235

I can't really answer your question. If you want more details as to how we're approaching the AIDS issue, I can provide that separately in terms of our programming. I do have to say though that there's still some controversy as to what is the nature of the problem, what are the levels of infection, and whether we should use comparisons with other places like Uganda. I think this is a little bit of hype. There have been some recent conferences and speeches that have probably not been helpful in putting the debate in perspective.

The issue of rates of infection and whether we're getting into talking about epidemic proportions is still very much up for debate.

Mr. Stephen Owen: I can follow up with you after.

The Chair: Mr. Charbonneau.

[Translation]

Mr. Yvon Charbonneau: I would like to come back to the issue of hepatitis C and the settlement that was reached for contaminated blood victims from 1986 to 1990.

The federal government set money aside to deal with these issues, both for 1986-1990 victims and for people infected before or after. There were very intensive negotiations involving a number of groups, victims and other organizations, leading to the establishment of this period from January 1, 1986 to 1990. At the time, the outlook was very bleak. The figures were in the order of many tens of thousands of people, perhaps even 50,000, 60,000 or 100,000 people. All kinds of numbers were being bandied about, including numbers from the Department of Health, to the point that from a public finance perspective, the Minister of Finance and the Minister of Health eventually had to set a time period in order to make the situation financially manageable.

But in reality, the situation is quite different. According to the figures Mr. McMurtry gave us earlier, there are only a few thousands cases, not tens and tens of thousands of cases. Also, what we now know, but did not really know before, is the number of people infected before or after 1986-1990. We now have a better idea, given that the provinces can provide services to those people. We know the numbers are small.

Is there some way to redirect the unused portion of the money set aside for people infected from 1986 to 1990 and to use it for people affected by the same problems before or after 1986-1990, but for whom other provisions were made? People said "care instead of cash" and so on, but those people have real needs too and have not been satisfied. Can we redirect the unused money for the benefit of people infected before or after 1986-1990, who have received nothing, for all practical purposes? How could we accomplish that?

Is there anything in that agreement that provides for it to be reopened for the benefit of people infected before or after 1986- 1990? Is there anything that would allow the government or Health Canada to say that fewer people than expected fall into the target period and that it would like to take back some of the money and put it to work for other people? There would be no additional costs to government, but the money would go where the problem is.

[English]

Dr. Robert McMurtry: I'm going to ask Mr. Shugart to comment about the agreement in a few moments, but I have just a comment or two.

One of the challenges with hepatitis C is that there are many people who are infected and who don't know it. Regarding the very high figures you quoted—for example, 160,000 to 170,000 people may be infected through various means—most of course have not come as a consequence of the blood supply. Our biggest concern is that our trace back and look back will be completed and we will cover all the people before we consider alternative expenditures. There is a gap between those we've identified and those who may still be infected but are as yet unidentified. That would be the first piece.

• 1240

In terms of reopening the agreement, I understand this is very complex and would require the agreement of provincial and territorial partners. There are issues, not only of compensating outside the 1986-1990 period, but also of challenges to be more inclusive of other people.

For example, we have heard of cases in which people with congenital conditions where their bone marrow isn't producing blood normally have received large blood transfusions. From other groups we've heard representations involving children who were excluded from the original discussion and debate and now they are making representation and wish to be included.

As we speak, those of us at Health Canada are discussing whether we should contemplate reopening the agreement, one potential option you suggested. It's a challenge. It's complex. It was difficult to reach agreement at the time; but it was, as you said, vigorously debated, and we did get there.

Another option to consider is to stay the course until we are sure we've compensated all the people who were eligible under the original conditions. And a third option is to contemplate the possibility of particular targeted payouts for people infected during the 1986-1990 period who were not among the group identified to be compensated.

So we have issues we might reflect upon, both about the inclusion of people within the 1986-1990 period, and then about the question of going outside that period. The first priority is to be sure we've identified all those who have hepatitis C from the blood supply and to be sure they've been compensated and cared for.

Is there anything you'd want to add to that?

[Translation]

Mr. Ian Shugart: Madam Chair, allow me to add a technical answer.

Officially, I understand the rationality of the suggestion, but strictly speaking, the arrangement has gone before the courts and been approved by them. In a way, the money is not in the hands of the federal and provincial governments, but rather in the hands and under the control of a trust for those people covered by the arrangements. So strictly speaking, there is no mechanism that would allow such redirection.

[English]

The Chair: Mr. Lunney.

[Translation]

Mr. Yvon Charbonneau: But is there not another question? In 2001...

[English]

The Chair: You've now had eighteen minutes at this meeting.

[Translation]

Mr. Yvon Charbonneau: Okay. In 2001, there will be three judicial reviews. There will be reports. In the wake of those reports, we will have new possibilities.

Mr. Robert S. Lafleur (Senior Assistant Deputy Minister, Corporate Services Branch, Health Canada): May I say that we can only act under the agreement reached for those people. Obviously, if we wanted to go beyond the agreement, we would need agreement from victims represented by lawyers representing these groups of people; that is very unlikely. But basically, in the current context, we would have to consult the agreement itself to see whether it allows for activities beyond those with which we are currently dealing.

• 1245

We could clearly file the agreement itself and ask people to explain it to committee members, if they are interested. The short answer is that the agreement has already been reached and the money is already beyond government control. The money is now held in trust.

[English]

The Chair: Thank you.

Mr. Lunney, please.

Mr. James Lunney: Thank you. I would like to pick up on a comment by Dr. McMurtry.

Earlier you spoke about the challenges of migrant workers and the prospect of bio-terrorism and the rapid response it often necessitates. We had an example here recently when a mysterious substance arrived at the immigration office.

But taking it another way, there was a very interesting example not long ago of a woman who came into the country with a mysterious illness that was thought to be Ebola. I believe she ended up at McMaster University, and very extensive testing was carried out on her: she was in isolation, and the hospital went to extreme measures trying to monitor the situation, sending material off to the testing facility in Winnipeg. The last thing about this I remember hearing was the rather alarming response from the provincial government. Her mysterious illness turned out not to be Ebola, and at the end of the day the provincial government did not want to pay for the expenses in the hospital.

Would you have a comment on this? When a rapid response was required and great measures were undertaken to try to protect the public, we are left here with a challenge to authority. Is there any comment you might make on this?

Dr. Robert McMurtry: Yes. You're quite correct.

The case involved took place in the Hamilton Regional Hospital. It was, from all appearances, a viral hemorrhagic fever, of which Ebola is an example. The patient was seriously ill; she was bleeding from all orifices, IV sites, etc. Sometimes in a practice considerable frustration arises when you can see this and diagnose it clinically, but never be able to identify the causative organism. And this was the case. All the tests—and a considerable number, a battery of tests were run by the Winnipeg laboratory—identified nothing, just as you suggested.

In terms of the payments, hospitals have dealt with international travellers for a long time who don't necessarily have insurance. We don't require it. And then we, as practitioners and as hospitals, end up footing the bill. It's a Canadian value; there might be some parts of the world where ability to pay might determine whether or not one was treated, but certainly not in our country. People possibly becoming ill when visiting Canada is not an unusal event; we have hundreds of millions of visitors, if you include the cross-border crossings between the U.S. and international visitors.

When we talk about migrant health, we're trying to find out about the increasing mobility of people and the risks this represents, because a case like the one that occurred in Hamilton seems more, rather than less, likely to occur in the next decade, as compared with the last decade. And we do have to have a readiness to respond.

Financing this is a question to be discussed at an FPT level, determining how this should be handled. But there were considerable expenses incurred, certainly by the caregivers in Hamilton, as well as by all who were involved in the management of it.

Mr. James Lunney: But given the extraordinary expenses involved and hospital budgets being strained as they are, if we don't find a means of funding these incidents when they come up, are we not setting the stage for a real problem where hospitals just don't want to deal with mysterious illnesses?

With hospitals having to scramble on their budgets as seriously as they do, we really need to find a way of making sure hospitals are going to be funded when they take extraordinary measures to protect us.

Dr. Robert McMurtry: I agree with you: either provincially or federally, or by agreement, there does need to be a mechanism by which we fund the extraordinary circumstance.

• 1250

An example that would support your contention is that we are planning for a pandemic influenza. A pandemic flu is going to incur anywhere between five and fifteen times the cases. We will have to be sure we have a mechanism by which we can deal with these extraordinary demands. Similarly, we ought to have a discussion about these sorts of instances. To this date at least, as these cases are occurring one by one, extraordinary intervention hasn't been required. But that may change and not only be discussed.

Thank you.

The Chair: Thank you very much.

Thank you very much, ladies and gentlemen. I'd like to thank my colleagues for trying to be....

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): I've been waiting for a turn.

The Chair: I didn't see your hand.

Ms. Judy Wasylycia-Leis: I'd be happy not to take up the time of the committee and have written responses to the questions I submitted in advance per your instructions, if that's appropriate.

The Chair: My understanding is the officials have assured the clerk that any questions not answered during the meeting will be responded to in writing.

Ms. Judy Wasylycia-Leis: Fine.

The Chair: Thank you very much.

Thank you very much, ladies and gentlemen. Thank you to our public officials, who have answered well and not in any shallow way. I think we gained some really good understanding today of some of the issues that have been bothering us. So thank you for the two meetings' worth of information you've given us. We look forward to meeting with you again when the occasion suggests it's appropriate.

Mr. Ian Shugart: Maybe even Thursday.

The Chair: You might even be back Thursday.

Mr. Ian Shugart: Yes.

The Chair: We could start going steady, Mr. Shugart.

Mr. Ian Shugart: Fine.

The Chair: Thanks very much.

This meeting is adjourned.