HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, April 26, 2001

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[English]

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

I would like to welcome into our midst the Minister of Health, the Honourable Allan Rock, with a particularly warm welcome, because not only is he returning to the health committee, but his presence indicates that he has returned to a state of good health, which is most appropriate for the national minister, I think. We're glad to see him bright-eyed and bushy-tailed, as it's his usual presentation self.

So I think we will begin with the presentation by the minister, and then he and his officials will be open to your questions.

Mr. Rock.

Hon. Allan Rock (Minister of Health): Merci, madame la présidente.

I would like to start by introducing the officials I have with me from Health Canada at the table. Some of them will be familiar to you by now, because I know the committee's had the opportunity to have officials before it in these past several weeks. I'd like to also provide a brief summary of some of the things we've been working on over these past 12 months at Health Canada. But most of all, I'm anxious to receive your questions and to engage in interaction with colleagues who I know are very interested in and knowledgeable about the issues we're grappling with.

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I have here Deputy Minister Ian Green, Associate Deputy Minister Marie Fortier, Associate Deputy Minister Ian Shugart; and then behind me and around me, arrayed for protection and support, are a variety of ADMs from Health Canada, who bring their expertise to the table.

I think it's only right for me to begin, Madam Chair, by expressing thanks to the committee for the invaluable work it has done over the past few years during which it's been my privilege to serve as Minister of Health in the Prime Minister's government. I can think of many subjects on which you have presented thoughtful and constructive recommendations, in which you've assisted with public understanding of issues, in which you've advanced public policy in the domain of health.

For example, I can recall in the fall of 1999 asking this committee to take on the subject of the regulation of natural health products, which was in disarray. As a result of the hard work and extensive hearings of this committee, you produced some 54 recommendations, which I accepted in full and without change. The practical result of your work has been the opening of an office of natural health products at Health Canada and the preparation and publication of draft regulations to govern its work, creating, I think, a historic first in the world, an enlightened, progressive, and sensible approach towards the regulation of natural health products, neither as a food nor as a drug, but as a separate category of substances.

I think also of organ donation, about which I'll have a little more to say later, where this committee conducted hearings, looked at practices in other countries, and provided us with a blueprint, which we adopted without change and have now put into place, to increase the rate of organ donations in Canada.

[Translation]

The past year was really an outstanding one for Health Canada. Although we still have important challenges to meet, we have also accomplished some major achievements. Over the past 12 months, we have worked closely with our provincial partners in order to improve the quality and accessibility of health care services for Canadians across the country.

As I begin this morning, I would just like to mention the main achievements of my department and indicate the challenges which remain.

[English]

I begin with the reorganization of Health Canada itself. In the course of the last 12 months we've had what we call a realignment, where we have done two things. We have reorganized the way we do business inside Health Canada to make our service to Canadians, we believe, more effective, to make better use of the taxpayers' dollars we spend. The second thing we've done is to make better use of the talent we have. We have brought in some new faces and we have put some of our existing personnel in more important positions. And I can tell you, Madam Chair, having been at Health Canada now since June of 1997, I don't think we've ever been in a stronger position to respond to the mandate Health Canada has to provide leadership on the subject that is rated number one by Canadians time and again in the polls. Their principal concern is to have access to quality health care. Health Canada has an important role to play in that, and I believe we have a team in place that puts us in a better position than ever to meet that challenge.

The second thing I want to touch upon is the accord that was reached last September by the Prime Minister and the premiers. It was a single-day meeting on September 11, but it was a culmination of many months of work.

[Translation]

I have to admit that sometimes it was difficult. There were many factors which made the process quite difficult: meetings with the provinces, pressure from the provinces to obtain more federal funding, disagreements between governments, and the complexity and difficulty of health care matters. I feel however that we have accomplished something of historic importance in that thirteen governments have accepted a framework.

This was an agreement which did not simply involve a greater financial contribution on the part of the federal government, although that was in large part what was discussed on September 11, but in addition, we all accepted a framework to deal with the current problems of our health care system.

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[English]

To tackle shortages of doctors and nurses, waiting lists, access to equipment, changing the way primary health care is delivered—all these things were identified and we had an actual written plan accepted by all governments, a work plan that was given to ministers of health, and we're following through on that now.

Let me also stress that the agreement of last September created three targeted funds to deal with some of the most pressing challenges. The first was $800 million of federal money, available as of April 1 of this year, to fund innovative ways of delivering and organizing front-line services, primary health care. We have now come to the conclusion of a protocol with the provinces as to how that money will be invested. We are soon going to start putting that money on the ground with provinces to make front-line services, 24 hours a day, seven days a week, more accessible, taking pressure off emergency rooms and doing something about waiting lists.

The second targeted fund was for equipment, as you know. One billion dollars has been made available to provinces on a per capita basis. It was available as of last September 12 to purchase new equipment, everything from MRIs to CT scans, to lithotripters, or surgical suites.

The third targeted fund was for information technology, $500,000,000 for an effort in common with the provinces to modernize health care delivery by putting in place, finally, an electronic patient record, allowing us to share information among health professionals about patients, and to develop the enormous potential of telemedicine for Canadians, particularly since we have to overcome such distances in meeting the challenges of access.

There are two other things of importance arising from that historic agreement. The first had to do with measuring the performance of the health care system, which we'd never before done on a systematic basis, and reporting to Canadians with respect to its performance. We're now working with common indicators and common methods of reporting, so that Canadians will see, apples to apples across the country, how the health care system is performing on everything from access to 24-7 primary care to waiting lists for various services, to readmission rates to hospitals, to accessibility to specialists. All of these things will be reported, and the first report will be available by September of 2002.

Finally, we added to that ensemble, in the course of the election campaign, an undertaking to create a citizens' council on quality care, so that we would have some way for consumers, for citizens, for patients to participate in the process of monitoring quality in our health care system. So we'll have a citizens' council to make sure we're reporting on the right things, that the reports are comprehensive, that the reports are coherent, so the person on the street can pick up the report and see and understand—not just a book of facts and figures that are in technical jargon, but in everyday language bringing home the strengths and the weaknesses of the health care system, so that politicians like me, like us, will be more directly accountable to Canadians for quality care.

Let me briefly touch upon another element of that, the creation of the Romanow commission. The way we see it, Madam Chair...

[Translation]

Last September's agreement was for the current system, for current short and medium-term challenges and problems. But in the long term, there are still questions to be answered about the viability of our health care system. How can we be sure that 10 or 15 years from now all Canadians will have access to high-quality services everywhere in Canada? How can we ensure a viable public insurance system covering essential services for everyone? Now that is the question. We have asked Mr. Roy Romanow, who was premier of Saskatchewan for 10 years and who himself managed Saskatchewan's health care system, to see how these questions could be dealt with in a public forum and do come back with concrete recommendations within 18 months.

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[English]

These are the long-term questions with which we have to come to grips. How can we reconcile the values and principles that underlie a public health care system that we now regard as part of our national identity with the hard fiscal realities of an aging population, increasing costs of drugs and technology, and expectations, certainly among people of my age group, with respect to future services and their accessibility.

We have to find some way, if we're going to be a responsible government, of managing all of this. Mr. Romanow will frame those tough questions, he will encourage a public discussion, and he will return with recommendations by the end of next year.

In this short list I'm going to complete before inviting your questions, let me also touch upon aboriginal health, for which I bear such an important responsibility.

You will see from the documents in front of you, particularly this very useful summary we have provided, that the total budget of Health Canada is now very considerable, and a very large part of the budget is devoted to aboriginal health. This means I am a participant in providing services on the ground to first nations and Inuit communities across the country, a very heavy responsibility, a very difficult one to meet, given the challenges of distance and remoteness and the shortages we face in the health professions.

But, Madam Chair, I'm able to report today some reason for encouragement and optimism. The statistics show we are making progress in some of the intractable problems: we are improving access in some of the more remote communities; the rates of infant mortality and life expectancy are turning around, through interventions such as the aboriginal head start for children and the prevention of FAS/FAE. We can and we are making a difference.

In connection with this, I want to draw attention to the motion adopted by the House of Commons only the other day, which was presented by my colleague, Madam Wasylycia-Leis. Her initiative, supported as it was by Paul Szabo and members of our own party, has focused attention again through another means on this challenge of FAS/FAE. I want to assure the committee—and particularly my friend, the member for Winnipeg North Centre—we shall follow through with a sense of urgency on this issue.

May I pass briefly to organs and tissues to say only this: the message coming from this committee after it had spent time looking at the rate of organ donation in this country was that this issue deserves a higher place on our national agenda. The committee pointed out how we are falling behind, how at a rate of about 14 per 100,000 in Canada, we do not have the organ donations required to meet the need.

Last year, 147 Canadians died waiting for an organ transplant. Right now there are 3,700 Canadians on waiting lists for an organ. And this committee said we're simply not doing a good enough job. What we need is a national strategy, a coordinated effort. We need to increase awareness and to improve our means and methods, and we have to do it soon.

As a result of your work, I was able to announce two weeks ago in Edmonton that there is going to be a national strategy, that all governments have agreed to create and appoint the members of a national council to organize and administer this strategy. We've chosen as its head Professor Philip Belitsky from Dalhousie, who is internationally recognized in this field. We're devoting $20 million in the course of the coming five years to make sure the secretariat—which we're establishing in Edmonton, not in Ottawa—provides the support it should to the council, and we've launched an intensive effort to raise public awareness of the need to sign an organ donation card and discuss this decision with families.

Last Monday I was very proud to be present at Rideau Hall when Her Excellency the Governor General, who has agreed to become patron of the awareness effort, received families of people who have donated organs and people who have received donated organs and have been able to continue living as a result. It was a moving ceremony. It was a good start. We're going to follow through on the committee's recommendations.

I mentioned very briefly the steps we've taken on nutritional labelling. We've now published proposals. I hope before the end of the year they will see labels on all food products in Canada, giving consumers important information about nutritional contents.

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I mention also the steps we've taken to render medical marijuana more readily available to those who need it on compassionate grounds to relieve symptoms of serious or terminal disease.

There are two other things before I end. The first is tobacco. For any minister of health, tobacco has to be one of the most major issues in the portfolio. Forty-five thousand Canadians a year die prematurely because of tobacco use. It adds an enormous burden of cost, but more importantly of human tragedy, to the Canadian life experience. And it can't go on.

We have had increasing rates of youth smoking in the last eight years, and we have to—as a matter of conscience, let alone as a matter of political responsibility—do something about it. Everything I've learned about this leads me to believe the answer lies not in a single step but in a whole series of measures needing to be undertaken in a coordinated way. I believe we've finally reached the position where we have each of those areas active and moving in the right direction.

They are as follows: first, an increase in taxes. Kids particularly are price-sensitive and we have to get the taxes up. As you know, the Minister of Finance and I announced just two weeks ago an important increase in taxes that helps us along the road. We have to continue, but it's a good first step.

Second, we have to make sure we have the people and the money to enforce compliance with the Tobacco Act. Our anti-tobacco legislation is one of the strongest and smartest in the world, but it doesn't mean a thing unless we bring it to life every day through enforcing compliance. We're going to do it. We now have the funds to do it.

Third, we have to have a strategy for youth. We have to be able to persuade them that smoking is not cool, whether it's through the use of peers in the classroom, or mass marketing, or education, or leading by example in our own homes; we have to persuade them that it's not something they want to do.

And fourth, Madam Chair, we have to continue our work in research, in understanding the tactics of the industry, and meeting those tactics at every turn, so we don't lose the war to those who are better marketers.

Finally, two weeks ago when we made the announcement on taxes, we also announced $480 million to be made available in the next five years to support this effort. By the fifth year Health Canada will have $110 million annually to fund our efforts to get compliance with the Tobacco Act, to fund a tough and effective mass-media campaign, and to permit us to go into communities and support local community action, which, you know as well as I do, is sometimes the most effective.

My 16-year-old daughter is not terribly interested in what her father, even if he is the Minister of Health, has to say about what's cool and what's not, but if we walk a 17- or 18-year-old into her classroom to tell her smoking isn't cool because it makes you smell, it would grab her attention a lot better than anything I could say.

We have to find out what strategies can work. We have to support community measures to get the attention of those kids. We have to make sure they understand that if they smoke, they're being a sucker to an industry trying to hook them. This is what we have to do, and this is exactly what we're going to do, Madam Chair.

The last thing I want to mention is research. When the record of this government is written many years from now, and we look back at the health sector, one of the principal achievements for which we will be remembered—and I don't just mean us, I mean the committee, because you were part of this—is the creation of the Canadian Institutes of Health Research.

Three years ago, the Medical Research Council was demoralized: it felt marginalized because its budget had shrunk to $237 million a year; it was being surpassed by other countries; researchers were leaving Canada; there was a sense we were falling behind and no longer had a national agenda for health research. As a result of the efforts of brilliant people like Henry Friesen, who was then the chair of the MRC, people like Bob McMurtry, now the ADM for Health Promotion at Health Canada, who is in this room today, the research community came to us and said “Look, let's turn this thing around. Let's acknowledge that health research is so important we're prepared to work to save it in Canada.” They presented a proposal to abandon the Medical Research Council model and take a bold leap into a new approach.

I needn't tell you about it, because you worked on the legislation. It involves moving from medical research to health research. It involves moving from isolated pockets of inquiry into a coordinated national effort to connect investigators in a coordinated way. And it involves significantly more money, from $237 million three years ago to over $530 million a year today, through institutes that have captured the attention and the imagination of the research world.

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Recently, Nature magazine, one of the premiere science publications of the world, had a long feature on CAHR, describing it as the model for 21st century health research for the world to copy. It's something of which we should be very proud.

The thirteen institutes have now been created, as the initial slate. The scientific directors have been appointed. They are now preparing strategic plans. Last week in Toronto, along with President Alan Bernstein, I announced this year's initial allocation of $235 million in research grants. That's less than half of what they will allocate this year, and it's already almost equivalent to a full year's allocation under the old MRC.

I think we should be very proud of what we've done together. This was not a partisan issue. It was something upon which we all agreed. It's another reason why I'm grateful to this committee for its work.

[Translation]

It is clear, therefore, that the remaining challenges are enormous. We have major problems with respect to the organization and delivery of our health care services throughout Canada. But I think the time is right to improve the system, work with our partners and make a real difference.

[English]

Madam Chair, I expect to be back soon with more specific proposals in relation to assisted human reproduction, but I'm grateful for this opportunity to make a brief report on what we have been doing and to invite your questions. I look forward to questions that members of the committee will have.

The Chair: Thank you, Minister.

I'd like to remind my colleagues of the work we have to do today. In addition to your questions for the minister, we will have to go through the votes on the estimates, and I would like to try to have the minister out by, say, 12:20 p.m. or so.

There are eleven of us present today, so I think I'm going to have to be fairly strict on the time. To get him out of here in a little more than 45 minutes, that would restrict each of you to four minutes each. Is this agreeable? Yes? Well, let's see how it goes. I would ask that when your name is called you just glance up at the clock so that you are alert to the passage of time, which is easy to forget when one has the floor.

We'll begin with Mr. Merrifield.

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

I only have four minutes, so I'm going to try to make the best of them.

I want to thank you for your presentation. I see health as very non-partisan in a sense, and I agree with what you had to say about a lot of it.

Very quickly, I'll give you quick questions. If you can give me quick answers, we can make the best of it.

On genetic reproductive research, obviously we have some legislation coming forward. Is that going to come to this committee before it goes to the House?

Mr. Allan Rock: That's the plan. The proposal I would make is that I come here before we table legislation. We'd give you a draft bill so that you know what we have in mind. We would take positions on the major issues, but we'd put it in front of the committee in order to conduct hearings, to look at what happens in other countries, to assess reactions here in Canada in order to see if we have it right, and to make recommendations on how we should proceed. So the answer is yes.

Mr. Rob Merrifield: Do you know when that's coming?

Mr. Allan Rock: Within the next couple of weeks, God willin' and the crick don't rise.

Mr. Rob Merrifield: Okay, on all of that.

While we're on research, the CAHR has thirteen different institutes, and one of those is genetics. When I look at the criteria there, it almost seems like the one institute on genetics is very similar to Genome Canada. I guess my confusion is whether Genome Canada should be under Industry or Health. Is there a duplication in what this one is doing and what Genome Canada is doing? I'm really quite confused as to where that's going.

Mr. Allan Rock: First of all, let me just tell you what the institute is, before we go on.

The institute for genetics is intended to support research on the human genome, but also aspects of genetics related to human health and disease, including interaction of genes with physical and social environments.

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I'm not familiar with the precise terms of reference of Genome Canada, but my first reaction to your question is that there's obviously an overlap. I think they're going to be working in collaboration with each other. Genome Canada may be more focused on the actual sequencing, the technical sequencing of DNA in the genome, and in the commercialization of the process. It's more basic research through CIHR. It's more commercial research through Genome Canada.

I think you've raised a good point. If you'll permit me, we'll take it under advisement and give you a written response. I'll be happy to talk to you in the House about that once you have it.

Mr. Rob Merrifield: I'd appreciate it. I'm a little concerned with the overrun there.

I don't know how much time I have left.

The Chair: You have about a minute.

Mr. Rob Merrifield: Okay. If it's only one minute, I'm going to leave that one.

Actually a ruling on Vanessa Young came out this week. There were 59 different recommendations with regard to Vanessa's case. There were a couple of suggestions with regard to mandatory medical personnel and a report on drug advisory reaction to Health Canada. I'm sorry, let me get this straight.

Any reaction to a drug needs to be reported within 48 hours. That's one of them and there's another one there. Have you taken those under advisement? Are you going to do anything about them? Where are they and what's the status?

Mr. Allan Rock: The first thing I want to do is say it's not lost on me, nor on us, that the death of Vanessa Young was a tragedy for her and her family. We're talking about a 15-year-old girl, who in all innocence took a drug she was prescribed and died as a result. Our hearts go out to her family in those tragic circumstances.

I followed the inquest with great interest. I received the recommendations yesterday, or the day before, and have read them. Many of them are directed at Health Canada. Most of them have to do with information, such as, after we approve a drug, finding out what happens to it in the field, making sure physicians and others are aware of any difficulties or adverse reactions, and following up quickly when information comes to us. It should question the continued safety of the product.

We take those very much to heart. I've asked the deputy minister to make sure we're in a position to respond to each and every one of those recommendations. We will do so as soon as we've had an opportunity to examine them in greater detail.

Mr. Rob Merrifield: One of the recommendations was to have a new national body to oversee drug safety information. Are you planning to do that?

Mr. Allan Rock: I don't know.

Mr. Rob Merrifield: You can't answer that right now?

Mr. Allan Rock: I don't know today, Mr. Merrifield, whether that's exactly the way we will go. I can tell you we have taken on board the recommendation that we have to improve the information tracking and reporting when it's relevant to health. We will do everything we can to meet that standard.

The Chair: Thank you, Mr. Merrifield.

Mr. Dromisky.

Mr. Stan Dromisky (Thunder Bay—Atikokan, Lib.): Thank you very much, Madam Chairperson.

Let's go back to that historical document that was signed on September 11. A great number of statements have been made. They're very positive, very encouraging, and kind of “motherhood” statements. Each and every one of us listening to those statements would possibly have a different interpretation regarding exactly what they really mean.

We talk about something that is very unique in the agreement, which is the whole question of accountability. Can you be more specific regarding this whole area or this realm of accountability pertaining to strategy that might be used?

For instance, are there going to be auditors? Will there be some form of evaluation? Will there be any guarantees? Will there be an evaluation pertaining to effectiveness? I can go on and on.

Can we get some more information pertaining to some of these very specific strategies that may have been incorporated within that agreement?

Mr. Allan Rock: Madam Chair, accountability is being recognized more and more as the missing part of health care systems.

I was in Washington last October. Perhaps some colleagues may have been there too. We had ministers of health from Australia, New Zealand, Great Britain, the United States, and Canada, who met and talked about common problems. One of the main features we talked about was, how do we account to the public for what we're doing in trying to provide health care?

In Canada, we spend almost $100 billion now on health care and almost $70 billion publicly. Yet it's remarkable how little we know about what we get for that money.

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When we go to talk about how to improve the health care system, the first thing we want to do is have hard facts about how it's performing at the moment. Too often we don't have those. The Canadian Institute for Health Information has helped, but theirs is still a very partial and periodic report.

What first ministers agreed on last September was that we would institutionalize a method of measuring and reporting on health care performance, and we devote significant sums of money to doing that. We're uniquely positioned to do that in the world. You couldn't do this in the States because a lot of the information you need to aggregate is proprietary. It's owned by Blue Cross, the Acme Health Insurance Corporation, or whatever. They don't want to give it up because it's proprietary to them. It's a competitive tool.

In Canada we have a public health care system, so that information is much more accessible to a public body that wants to aggregate it, analyse it, and publish the results.

In November of this year Canada is hosting an international conference sponsored by OECD on the whole subject of accountability and performance measurement in health care systems. I'm going to leave this with the chair. I urge members of the committee, if they're available, to attend this conference. We're hosting it because I think we're recognized as world leaders in this.

To come to your question, what the health accord of last September did was to get all governments on the same page. We agreed on common methods of measuring and on common indicators of quality, and we agreed to produce a public report by September 2002.

On your question about third parties, each government will verify the information it contributes to the common report by resorting to a third party, whether it's the auditor general in the province, a separately retained auditor, or whatever the case may be.

Lastly, the Citizens Council on Quality Care will provide us with another safeguard to ensure that we're talking about things that are meaningful to Canadians and that we're doing it in an objective way and in a way that's readily understandable. I'm quite excited about this feature of the agreement. I think it's unprecedented. It gives us a chance to provide better value for the Canadian taxpayers' dollars.

Mr. Stan Dromisky: Just to follow through, we have to get enforcement in this agreement. Is it possible for any of the parties to withdraw totally or partially from any aspect of that agreement? It's the whole question of enforcement. Some federal or provincial government in the future could say to hell with it all.

Mr. Allan Rock: Let me first say that there has been no indication that anyone would do such a thing. We've only had enthusiastic participation by all governments so far. I think all governments recognize that the public is strongly behind this. When they're paying that much through taxes, Canadians expect that they're going to have accountable governments.

I think Canadians also know from their own experience, whether they're at home or at work, that if you're going to improve something, the first thing you need to know is what's going on right now on the ground. We've always measured inputs in health care, that is, how many dollars we spend, how many hospitals we create, and how many doctors we graduate. We've never measured outcomes. Are we getting any healthier as a result of all this money? Are these interventions being successful? Are there other methods that are more effective? We don't measure outcomes. This will finally allow us to do that.

When you talk about governments withdrawing, Mr. Dromisky, I can report to you that from our experience the trend is quite the opposite. Governments are enthusiastically participating in this process and are looking forward to producing meaningful reports.

The Chair: Mr. Lunney.

Mr. James Lunney (Nanaimo—Alberni, CA): Thank you, Madam Chairman.

I'm pleased to see the minister and officials here again today.

Because time is short, let me go right to the point. I wanted to pick up on the Royal Society of Canada report on biotechnology, which came out a few months ago now. There the Royal Society rejected the use of substantial equivalence or, shall we say, its use as a decision threshold, as a sole criterion to exempt GM foods from extensive testing. They rejected that as scientifically unjustifiable and inconsistent with the precautionary principle. I'm wondering if the minister can say whether you are prepared to respond to the input from the ministry and tell us where we are with that. I haven't seen anything in terms of allowance for testing of this type for GM products. Again, there have been recent concerns about StarLink, which is not approved for human consumption, getting into the human food chain. Now there's canola being recalled by Monsanto because of plants cross contaminating, and so on. Is there some response from the minister in that regard?

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Mr. Allan Rock: First of all, let me point out that we commissioned the Royal Society report; we ourselves asked that panel to examine these things.

It produced some very useful recommendations and helped us learn better how to respond to the needs of Canadians in relation to genetically modified foods. Obviously it's a very long and technical report. We've had it now for some time, and we've been examining its recommendations.

On the subject of substantial equivalence, we have actually already responded in a way. The deputy minister wrote to the chair just about the time the report was received to make clear what our position is on this issue. As the deputy minister explained in some detail in his correspondence, we take a very careful approach to measuring the effects of novel foods before approving them, and we do not simply accept substantial equivalence without going very deeply into the data. Perhaps Mr. Green would like to elaborate on the points he made in his letter on that in order to respond to your question.

Mr. Ian C. Green (Deputy Minister, Health Canada): I may have to refresh my memory in terms of the letter. Can I do that, Minister, if that's okay, and then come back?

Mr. Allan Rock: Of course.

Mr. Ian Green: I don't have it with me, but I would be pleased to get back to you, if that's okay.

Mr. James Lunney: Because time is short, I'll move on to another issue, but I'd appreciate a response on that.

Another issue I raised the other day when Dr. McMurtry was here had to do with the issue of diseases coming in with travellers. There was an incident just recently of a foreign visitor coming in with a very serious hemorrhagic illness that was undiagnosed, and very extensive testing was done in Hamilton General Hospital. After extensive testing, including testing at the lab in Winnipeg, at the end of the day the hospital was kind of hung out to dry because the individual wasn't a Canadian citizen. The government refused to pay for the hospital testing, the time, and so on.

With hospital budgets being as strained as they are, does the minister have a plan for such contingencies, where the hospitals go to extensive measures to protect the public and are then forced to find the money somehow in their own budgets to deal with this kind of crisis? Is there some kind of plan in place?

Mr. Allan Rock: Hospital funding, as you know, is made by the provinces. Our responsibility is to make sure that we reflect in our cash transfers to the provinces the priority of health as an expense. We've increased by 35% in the last couple of years the cash transfers to the provinces available for health. We believe we're doing the right thing in making those increases available, and we expect the provinces will meet their responsibilities.

On the subject of responding to such risks, I think it was Minister Caplan who observed at the time the case arose that it's increasingly difficult for Canada to control the migration of viruses and diseases. There are 200 million arrivals in Canada every year, whether Canadians going abroad and coming back or visitors coming in and going through the country. We're a highly mobile population, and Canadians travel the world because that's where our markets are. Whether it's for business or for vacation, we do go to the four corners of the world and come home. We also happily receive visitors from elsewhere. It's very difficult to put ourselves in a little sealed bubble to protect ourselves from disease.

What we can do is make sure that our surveillance systems operate well, that we track outbreaks around the world, and that we take precautionary measures.

I was also very proud to be part of a health care system that responded as well as the Hamilton community did to that threat last January. What we saw were three levels of government, federal, provincial, and municipal, working very well together. We saw health professionals from Health Canada and from public health in the province and the city all on the same page and working very effectively to explain the situation, to control it, and to provide treatment. It had a happy ending. The point is, we're not sure that the next case will have one. All we can do is monitor things very closely and work together to try to respond to these risks.

The Chair: Thank you, Mr. Lunney.

Madam Scherrer.

[Translation]

Ms. Hélène Scherrer (Louis-Hébert, Lib.): I have several questions but I will start with one which is more general in nature. I am referring to the act which states that all Canadians should have access to free services of very high quality, at the top of the scale. I really wonder, because medicine is not practiced the way it was 50 years ago, in fact it is not practiced the way it was 10 or even 5 years ago either.

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It used to be very unusual to undergo an MRI or a CATSCAN. Now these are carried out regularly. X-ray therapy, MRIs, dopplers, scans and ultrasounds are performed routinely. We know that these procedures are very expensive, that the equipment involved costs millions of dollars and requires highly specialized personnel, technicians and nurses, and this despite the fact that telemedicine does enable people to have access to such examinations everywhere. What measures are being taken at the present time to insure that all Canadians may have free access to top-of-the-range services in the short term?

I am not talking about what will happen in 20 years' time. Even five years from now it will cost a great deal to promote this sort of thing. At the moment we define top-of-the-range by the fact that I or anyone else can have access to an MRI, a doppler or other procedure, because they are becoming everyday medicine. What can Canada do to maintain these services so that they will be free and accessible for everybody?

Mr. Allan Rock: First of all, I would say that it is necessary to adopt approaches and measures which will enable us to do things more efficiently and affordably. As a government, we are now examining changes to the delivery of front-line services.

For the most part now, we have a fee-for-service system for services provided by doctors in their private offices during the day, but not at night or on the weekend. That is the approach of the 70s and the 80s. After 18 or 19 hours, therefore, or on the weekend, services are not accessible to everyone and the emergency rooms become overcrowded. That is quite a costly method to meet these needs.

As ministers of Health at the federal and provincial levels, therefore, we decided to study other approaches which would be less expensive and more efficient, such as the model of the CLSCs in Quebec or community centres open 24 hours a day, seven days a week. As I mentioned earlier, the federal government has already earmarked some $800 million to fund pilot projects and transition projects to change the way front-line services are delivered in order to save money and improve accessibility. That is only one example.

Another important example is the use of information and communications technology to improve the cost of service delivery. We do not have a great deal of time, but I would like to give you one example. Recently I was speaking to someone who had to have a test repeated because he had changed hospitals. The diagnosis was carried out in the first hospital and the treatment in the second. And the test had to be repeated. That is ridiculous. We now have the technology which makes it possible to communicate and share this sort of information between institutions so that costs like these can be reduced. With electronic files on patients, it will be possible to share patient information, integrate services, avoid repeating tests or the taking of histories, and make services more efficient and less costly.

That was not a complete answer to your question. There are difficult subjects which must be dealt with. Have we included all necessary services under public insurance? Have we included services which are not necessary? We must constantly review these questions.

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I think that the first challenge is to make the system more affordable through measures which the governments have identified.

[English]

The Chair: Thank you, Minister. Thank you, Madam Scherrer.

Mr. Bachand.

[Translation]

Mr. André Bachand (Richmond—Arthabaska, PC): Thank you, Madam Chair. I would like to welcome the minister.

First of all, I do not want to seem disrespectful, but I have to leave in five or six minutes. There are so many of us in the Conservative caucus that we each have to split ourselves four or five ways. And this is likely to continue for some years to come.

I have two short questions. First, who came up with the idea of a royal commission on health?

My second question is more important, in my opinion. It has to do with the problem of hepatitis C. As you know, you sent out a letter last January, I believe, to improve the efficiency of the program. There are many, many problems all across the country. There are cases where compensation has not been settled and for years only percentages have been paid. It just is not working.

Sometimes it is due to the firm which was chosen, other times to provincial agencies. I would like to ask what power you have. Each member receives complaints from individuals who have not yet received any compensation. In some cases files have not even been completed.

As you know, in Quebec, some medical records were even destroyed, and this makes the investigation even more difficult. It does not affect you and it does not affect me, either, but it does affect other people. What power do you have as Minister of Health? What action can you take to ensure that people finally receive their compensation before dying?

Mr. Allan Rock: With respect to your first question about Mr. Romanow's commission, I think that there is a consensus in Canada at the present time for an in-depth study of the long-term viability of our system. Polls consistently indicate that Canadians are concerned about the future. Eighty or 90% of people who have received treatment under our present system, and this includes the Minister of Health, are very satisfied with the quality of the service. Only 20%, however, feel confident that we can be sure of having the same system in 20 years' time, given the increase in costs, as mentioned by Ms. Scherrer. It was because of this concern, therefore, that we decided to appoint Mr. Romanow to study the long-term aspects of these questions. I think that Canadians support this approach. Whose idea was it? I think that we were answering a public need.

As to your second question, I share your concern about the administration of this program. As you have mentioned, I have already written to the committee to express my own concerns on this matter and, in the meantime, I have received more complaints and fears about this program. It continues to cause problems. I hope that these are only teething problems, but if they continue, as Minister of Health, I have the authority to require the federal government's lawyers to go back to the court and suggest that the necessary measures be taken to ensure that objectives are respected and that people receive their compensation before dying. I will do so if it is necessary.

[English]

The Chair: Thank you, Mr. Bachand.

Mr. Owen.

Mr. Stephen Owen (Vancouver Quadra, Lib.): Thank you, Minister, and we appreciate the information provided previously by your officials.

• 1200

I'm interested in the obligation, as represented in almost 50% of the Health Canada budget, as you've indicated, toward the health needs of aboriginal people. I'm wondering, as we look into the future, as first nations assume more and more responsibility for self-government, what the expectation is and therefore what the plans are with respect to transferring this responsibility.

Mr. Allan Rock: The trend has been to transfer the responsibility to communities. The trend has been, as you know, to enter into agreements, and I think it's now with about half of the first nations and Inuit communities in the country—more than half. It's even more since I last looked. There are about 600 first nations and Inuit communities of which we speak and 80% are transferred now—80% manage their own health services.

But the point is to do that in a way that gets them the resources they need to do the job locally, and also makes both the community and us accountable to the public for the money we transfer.

Mr. Stephen Owen: I'm thinking particularly about the responsibility of the federal government, in addition to the responsibility to ensure the funds are extended appropriately and the services are provided, for the appropriate and adequate outcomes that you've spoken of more generally for our relationship with the provinces. Will the new aboriginal governments act, for instance, include accountability for the health outcomes of aboriginal people? Is that the expectation?

Mr. Allan Rock: What we have done in that regard is in the budget of 1999 we asked for and received some tens of millions of dollars for a first nations health information system to do in our own backyard what we're asking the provinces to do in their health services, which is to say to put in place information systems allowing us to track what dollars are spent and what outcomes we're getting as a result.

When the first public report is made available in September 2002 by governments reporting to the public on health systems outcomes, one of the things the Government of Canada will be reporting on is how we're doing on health outcomes in aboriginal communities.

The Chair: Thank you, Mr. Owen.

Ms. Wasylycia-Leis.

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

Let me do a quick follow-up on first nations health.

I understand that the audit of first nations and Inuit health branch and the investigation of allegations of wrongdoing by Paul Cochrane has been completed. I'm wondering if you could tell us when you will release that audit and whether or not criminal charges are being laid against Paul Cochrane.

Mr. Allan Rock: Criminal charges are a matter for the police. We are not involved in that and that will be for the police to respond to.

In terms of the audit, perhaps the deputy can give us up-to-date information about where that stands.

Mr. Ian Green: Are you referring to the Virginia Fontaine audit?

Ms. Judy Wasylycia-Leis: Yes, and the audit pertaining to the branch in Health Canada, not the actual centre itself.

Mr. Ian Green: The Virginia Fontaine audit, as I understand it, is still under way in the sense that we have two auditing firms looking at it. I don't know the release date at this point, but obviously, we will process it as quickly as we can.

Ms. Judy Wasylycia-Leis: I had understood it was done and we were waiting for it.

Mr. Ian Green: The Virginia Fontaine audit, to the best of my knowledge, is not done at this point.

Ms. Judy Wasylycia-Leis: Is that the internal one at the Health Canada branch.

Mr. Ian Green: The internal review, I believe, is complete and is being reviewed by the people who are impacted by it, and that has yet to be finally processed in terms of the department. I would expect that release to be within the next few weeks.

Ms. Judy Wasylycia-Leis: Okay, thank you.

In the couple of minutes that I have left, there are so many issues to focus on, but one of the biggest concerns I have, as you know, pertains to health protection. I think, frankly, Mr. Minister, that's an area of serious problem in your department.

I think there are immense difficulties and some chaos within that branch of your department. I think about the fact that under your ministry we've had the biggest outbreak of a food-borne illness in the history of this country. We had, under your ministry, the loss of the only independent drug research bureau in the country. We've seen, in the case of Propulsid, that adverse reactions were known long before the death of Vanessa Young, yet there has been no action taken. We have evidence of your department not moving on standards recommended by the WHO with respect to by-products from animals going into feed, which then cause the possible conditions for mad cow disease. We have serious concerns in the public about genetically modified organisms and no movement on labelling. And I could go on.

• 1205

So I'd like to just ask you generally about the difficulties in the department, what you're doing to get order in that branch of government: if you would review that branch to see that the precautionary principle is being upheld; if you would agree to mandatory reporting of adverse drug reactions; if you would restore in some way the independent drug research capacity within Health Canada, because it did do work on adverse reactions; whether you would look at implementing the WHO standards pertaining to mad cow disease; and what your timeline is for independent research on GMOs and labelling of all GMO food products.

Mr. Allan Rock: That's quite a list.

The Chair: We have a little under two minutes, so maybe you should pick one of those subjects.

Mr. Allan Rock: Well, I—

Ms. Judy Wasylycia-Leis: One of these responses would be appreciated.

Mr. Allan Rock: I admire the thoroughness of the question, although not the accuracy of the premise. There are many statements with which I take issue, as I hope you know.

On Propulsid, the record speaks for itself, but we were very much aware that there were adverse reactions. We sent information to physicians, which we expected them to deal with on a professional basis. We struggled long and hard about taking that drug off the market, and I want to tell you that after we took it off the market, I had many entreaties from members of Parliament on behalf of constituents, as well as letters from patients across the country, pleading with us to make it available, because it was the only drug capable of dealing with some disorders from which those Canadians suffered. We've had great difficulty getting it available on a compassionate basis because the manufacturer, concerned about liability, has not even made it available on a compassionate basis through extraordinary access. So it was not a simple issue, and we were aware of difficulties, and we let the medical profession know about those difficulties, as the record shows.

On mad cow, I think this committee has already had a briefing on that subject. If not, we'll be happy to provide that, but—

Ms. Judy Wasylycia-Leis: No, no. The question to be addressed is about the WHO standards, feeding ruminants to ruminants. There's been no action and we're waiting to see when you might act.

Mr. Allan Rock: You know what we don't do is allow ruminants that are fed to ruminants to go into the food supply.

Ms. Judy Wasylycia-Leis: Yes, we do. We have had that verified at committees. Your officials indicated that... through wild deer and elk.

Mr. Allan Rock: We're quite content that we comply with all international standards of safety in that regard. If you need more information about that, we'll be happy to provide it.

Mr. Ian Green: My understanding is that we do not feed ruminants to ruminants, and I would like to double-check that.

Ms. Judy Wasylycia-Leis: You can check the record when we had the officials here.

Mr. Ian Green: I will.

The Chair: Thank you, Ms. Wasylycia-Leis. Your time is up.

Mr. Allan Rock: Hang on a second, if I may just for another moment, Madam Chair. I'm sorry.

The Chair: Okay.

Mr. Allan Rock: Let's be frank. I knew there were difficulties in the health protection branch the moment I arrived. There have been problems to overcome, and I'm not saying we've overcome them all so far, but we've made a damn good start.

We have some good people in there now, working very hard. We have more money restored after the budget cuts in the mid-1990s. We don't have all the money we need, especially on things like drug reviews and rebuilding our scientific capacity, but we're going in the right direction. Under this deputy and the last, we've taken some very bold moves to strengthen our capacity in health protection. We take those responsibilities very seriously.

I don't think this is the time to get into a detailed response, but I will provide you with a written response to the subject you've raised, because I don't think it's fair to the professionals who are working very hard to make it a better place to take a broad-brush approach and talk about difficulties in the past and food outbreaks. They work very hard and I think they've improved enormously the quality of that branch's work.

I will provide you with a written response to the issues you've raised.

The Chair: Thank you, Minister.

Thank you, Mrs. Wasylycia-Leis.

Mr. Binet.

[Translation]

Mr. Gérard Binet (Frontenac—Mégantic, Lib.): Thank you, Madam Chair.

Minister, as you know, there is a great deal of talk about pesticides in relation to agriculture and health. There is really a connection to health. Some work has been done on this subject in committee. Can you speak to us about the essence of the report and tell us when you expect to table a bill on this subject?

Mr. Allan Rock: We have already replied to the recommendations made by the committee before the end of last year. I think it was before the election, in October. We still have to prepare a bill and reach a consensus within our caucus and Cabinet on the details, but we indicated the government's position in our formal reply to the committee, particularly with regard to the re-evaluation of pesticides already on the market and the resources necessary to establish safety standards, particularly for vulnerable populations such as children, and to ensure that these standards are observed.

• 1210

As far as timing is concerned, it is hard to say, but we are now preparing a bill and developing a consensus within our government.

[English]

The Chair: Thank you, Minister. Thank you, Mr. Binet.

[Translation]

Ms. Bourgeois.

Ms. Diane Bourgeois (Terrebonne—Blainville, BQ): Thank you, Madam Chair. As you realize, I am replacing my colleague Réal Ménard.

I only have one question, Minister, but there are three parts to it. First of all, you mentioned the Romanow Commission a little while ago. I would like to know how you intend to include the provinces in the work of the Romanow Commission.

As well, not that long ago, we had a National Forum on Health. Can you tell me what your government has done to follow up the recommendations from this National Forum?

Finally, you spoke earlier about a fund for modernizing medical equipment. Can you tell me how this fund will be used or if it is already being used? Could we have a little more information on the way this fund is being used?

Thank you.

Mr. Allan Rock: Yes. I will start with the third part of your question regarding medical equipment. As you no doubt know, last September 11 we announced that we had decided to make a billion dollars available to the provinces, to be distributed in terms of the number of inhabitants. In the case of Quebec, the amount was around $270 million, something like that. In any case, the money was available as of September 12. I believe that Quebec has already accepted its share of this funding, and under our agreement of September 11, the provincial governments undertook to make a public accounting of the way they spent this money, in other words to publish the results and say what equipment they had purchased. To date, I have not received any reports. I am in the process of writing to my counterparts, therefore, to ask them how they have used this money to renew medical equipment in their provinces, and I will share this information with you and make it public.

As for the second part of your question, the National Forum on Health reported in February 1997. We immediately agreed to the recommendation that transfer payments to the provinces be kept to 12.5 billion dollars. As a priority, we agreed to integrate front-line health services, and also agreed to study recommendations on home care and pharmacare.

As recommended by the Forum, we and our provincial partners discussed a Canada-wide process for home and community care. At present, our partners have refused to go ahead with this before adjustments are made to transfer payments. As of last September, dialogue with the provinces on home care can in my view be continued. However, there is clearly still a great deal to do before the recommendations are implemented.

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With respect to the Romanow Commission, I am certain—as Mr. Romanow said when he established the commission—that he has every intention of including provincial perspectives. First of all, he intends to appoint an advisory board within a few weeks, and will ensure that the provinces are included. He will also be talking directly with premiers and provincial health ministers. He pointed out that, in his view, it is very important—even crucial—that provincial views be taken into account during the process, and he will be working closely with them.

[English]

The Chair: Thank you, Madame Bourgeois. Thank you, Minister.

We'll go to Mr. Charbonneau.

[Translation]

Mr. Yvon Charbonneau (Anjou—Rivière-des-Prairies, Lib.): Minister, I do have questions for you, but I would like to hear your views on mental health in particular. As you know—and committee members will remember—during the previous Parliament this committee decided to consider the issue. Then the election came, and mental health was not put back on our agenda because other, more pressing issues appeared. Mental health tends to be a taboo subject we hear little about. Though we may discuss health for hours, mental health is mentioned only rarely, almost never.

Obviously, health services delivery to mental health patients is a provincial matter, as are other health care services. However, in your view should we be giving mental health a higher priority? In what way could the federal government or Health Canada become involved? After many years of experience as Minister of Health, what sort of commitment would it be appropriate for the federal government to make?

Mr. Allan Rock: As you know, Mr. Charbonneau, last year I asked this committee to examine the mental health issue because it does tend to be ignored. We talk about overcrowding in emergency rooms, waiting lists, surgery, lack of physicians and nurses, hospital services and acute care, but we almost never talk about mental health services, though there are many deficiencies in the system. There are also too few psychiatrists, and psychiatric nurses. At present, we are unable to meet people's mental health needs. Moreover, not only is mental health all-too-often ignored by people like me, the Minister of Health, but as you have already stated, Mr. Charbonneau, it is a taboo issue. Mental health patients carry a stigma. People only talk about mental health if they have someone in the family with mental health problems.

Last year, I thought it might be appropriate for this committee to raise public awareness about mental health, draw public attention to problems in the system, and put the issue on the Canada-wide agenda in order to formulate recommendations. How can the government of Canada contribute to the development of a Canada-wide strategy to improve access to mental health services? Today, I am still of the same view. I would be very happy if this committee examined the mental health issue, if you have the time and if you wish to do it, and if you have the opportunity in the months to come.

• 1220

Madam Chair, I am well aware that in a few days from now I will be putting some very complex legislation before you: assisted procreation. It will take up a great deal of your time, but if at the same time you could find the opportunity to examine the important and difficult issue of mental health, it would be a very good thing indeed. I hope you can do it.

[English]

The Chair: Thank you, Minister. Thank you, Mr. Charbonneau.

I've had two requests for a short question, one from Mr. Merrifield and one from Ms. Wasylycia-Leis. I think if they're succinct and you're succinct, we could fit those in and still have you out in time for your next meeting.

Mr. Merrifield.

Mr. Rob Merrifield: Thank you very much.

I'd like to ask about the portability of the system, which is one of the principles of the Canada Health Act. According to the Auditor General, provinces have a reciprocal agreement with other provinces with regard to dealing with problems province to province. Quebec has not complied with that since 1988. Are you planning to enforce that or do anything about it?

Mr. Allan Rock: We're aware of concerns on the part of some provinces about their reciprocal arrangements. Our tendency has been to leave to the provinces the task of sorting them out between them. Most of them come down to billing or collecting for services rendered to, say, a resident of New Brunswick who was in Manitoba when he became ill and was provided with service. The arrangements typically deal with the accounts rendered for the service being settled in the other province. For the most part, it works pretty well around the country. Our tendency has been to leave it to the provinces to develop reciprocal arrangements with which they are comfortable.

Mr. Rob Merrifield: So you don't feel that challenges portability.

Mr. Allan Rock: Portability is a national principle that must be respected. On those occasions when issues cannot be resolved, we do make an effort to see how the Government of Canada can be helpful in trying to ensure that the principle is respected. If you have any particular instances you'd care to bring to our attention, we'd be happy to let you know if we feel we can help.

Mr. Rob Merrifield: Okay. Thank you.

The Chair: Thank you, Mr. Merrifield.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: I don't expect a complete answer right now. I'm still looking forward to an answer from you on that disgusting du Maurier tobacco ad saying only smokers need apply. I think it's against the law as it now stands, and I'd love to get an answer.

The other area we really haven't touched on this morning is the serious shortage of physicians and nurses in the country today. I know you've appointed Roy and there will be this royal commission, but it seems that the situation is so critical right now, it begs for immediate action. I'm just wondering if you have any immediate plans to put some money on the table and to work with the CMA, the Canadian Nurses Association, and the nurses unions to address that problem as soon as possible.

Mr. Allan Rock: Yes, very much so. We're doing many things. When you look at the agreement of last September between the governments, you'll find that the shortage of doctors and nurses was ranked as the first, second, or third of the issues we've agreed to tackle together.

It's an issue that requires a national strategy, because it doesn't make much sense for one province to try to lure nurses from the other. We end up with shortages being worsened in the place they're taken from. Nor does it make sense for communities to try to lure doctors from other communities, because, again, you're just robbing one to pay the other. What it needs is a short- and long-term strategy that's coordinated nationally.

In terms of doctors, I convened a meeting of health ministers in November 1999 to listen to the Canadian Medical Association, the Canadian Nurses Association, and the unions. They made a presentation to us about the shortages and what to do about it. One of the key elements was to increase enrolment.

But there were many other complaints, particularly in relation to nurses, with working conditions being high among them. Nursing as a profession has the highest incidence of work-related illness and injury of any of the professions. Their working conditions are often appalling. They have to cobble together part-time jobs, working for long hours. They've lost the sense of team, because all the teams have been broken up, and a sense of continuity in their work. They lose professional fulfilment as well as being exposed to very difficult working conditions.

• 1225

Anyway, the point is this. After the agreement of last September, health ministers met in Winnipeg to decide where we go from here on all these priorities. The first one we tackled was the nursing shortage. We developed and adopted a national nursing strategy, which is intended to deal with the issues of workload, working conditions, salaries, the involvement of nurses and nurse practitioners in the development of health policy, as well as sheer numbers, increasing enrolment and trying to lure nurses back from the United States.

I opened at Health Canada some two years ago an office of nursing policy, because I believe the Government of Canada has a positive contribution to make in this process. And we hired a nurse of national reputation to help us. She was a large part of developing this national nursing strategy, which has now been adopted by all governments. I'd be pleased to provide you with a copy so you can see what we're doing.

On the subject of doctors, I urged provinces to increase the enrolment in medical schools and provide funding for that. I'm happy to report that we've gone from about 1,585 places in 1999, which is where it was when we had this report from the CMA, to almost 2,000 this coming September. That's a pretty good increase.

What also has to be looked at is not simply the raw numbers but also the numbers of residency positions you're making available so that people can get the proper training after graduation. I think the provinces are going in the right direction there too. The announcement this week by Ontario that they're going to open a medical school in the north, as well as satellite training in Windsor, is very welcome. That's wonderful news. We welcome that.

I opened the Office of Rural Health to help develop a national strategy on rendering services more accessible in rural and remote Canada where the shortages are most acute, and we've identified short- and long-term strategies there. An important part of that, quite apart from increasing enrolment, which is long-term because it takes seven to ten years to train a doctor, is accelerating the accreditation of foreign-trained physicians when they arrive in Canada.

I'm sure everyone in this room has had the experience of being in a taxicab or in a restaurant and seeing someone who's driving a cab or serving tables who says they're trained and experienced as a physician in a foreign country but can't get accredited here. We're leaving all this talent on the table. I've been urging governments and professions to streamline and accelerate the accreditation in Canada of those foreign-trained professionals. That's a large part of the solution, in my respectful view. We're not doing a good enough job yet.

So to come to the bottom line, improving working conditions, demonstrating respect for these health professionals, involving them in decision-making and formation of policy, increasing enrolment, creating in Canada a country where they want to practice by having up-to-date equipment and well-funded and organized health services, and taking advantage of the talent that comes across our frontier every day in the form of immigrants and refugees—those are the steps we have to take. And no one government can succeed. It has to be a team effort, and that's why I've been working so closely with my provincial counterparts in this regard.

The Chair: Thank you, Minister. Thank you, Ms. Wasylycia-Leis.

First, I would like to thank my vice-chair, Madam Sgro, who gave up her time to question in order that the opposition members might get in two more questions. I'd like to thank all the members of the committee, who I feel were very disciplined about the time, and as a result everybody had a chance to have a conversation with the minister. But most importantly, I want to thank the minister for his allocation of time for us. I think you've put him through his paces, but he seems to be up on all these various topics you brought forward.

So thank you, Minister, for coming, and thank you for bringing your team. We're starting to get to know them rather well. They've been here quite frequently, and we always look forward to seeing them again.

Mr. Allan Rock: I'll be back soon.

The Chair: I understand that.

Mr. Allan Rock: Thank you all very much.

The Chair: Thank you very much for coming.

I would remind the committee that we have a couple of items of business to take care of. I believe on your notice of the meeting—

Mr. Ian Green: Madam Chair, can the rest of us leave or do you want us to stay?

• 1230

The Chair: There might be a question on the estimates.

Mr. Ian Green: We can certainly leave our experts on the estimates in terms of the finances in case there are any questions on the numbers.

The Chair: I think that's a good idea. Just the financial people will do.

Mr. Ian Green: Thank you.

The Chair: Mr. Marquardt in particular.

Mr. Marquardt, do you want to remain seated at the table so that you can help us if we need you? If the others could get out quickly, I'd be grateful.

Ladies and gentlemen, there is a formal order that we're responding to and it is that the main estimates for the fiscal year ending March 31, 2002, that is, votes 1, 5, 10, 15, 20, and 25 under Health, laid upon the table in the House on February 27, 2001, be referred to the Standing Committee on Health.

That is what we're responding to. We've had this referral made to us, and you have a list of the votes that are on this chart. You will notice that while there is a large amount in the estimates, a certain amount has already been adopted by the interim supply bill of March 20, so essentially it is the balance before the committee.

HEALTH

Department

Vote 1—Operating expenditures ...... $1,268,024,000

Vote 5—Grants and contributions ...... $954,627,000

Canadian Institutes of Health Research

Vote 10—Operating expenditures ...... $19,748,000

The Chair: We'll begin with vote 1, and I will accept a motion to approve that vote.

Ms. Judy Sgro (York West, Lib.): I so move.

The Chair: It is moved by Ms. Sgro to approve the amount in vote 1. Is there any discussion? Are there any questions around that amount?

Shall vote 1, less the amount under interim supply, carry?

(Vote 1 agreed to)

The Chair: Moving to vote 5, in the second row, you'll see the amount is $238 million. I'll accept a motion to approve that.

Ms. Judy Sgro: I so move.

The Chair: Any questions around that vote? Seeing no one wishing to speak, I will call the question.

Shall vote 5, less the amount adopted in the interim supply bill, carry?

(Vote 5 agreed to)

The Chair: I don't like to do it too fast because $238 million is a lot of money to pass in 10 seconds.

The next one is vote 10, which is about the Canadian Institutes of Health Research. Are there any questions about that vote? I'll accept a motion.

Ms. Judy Sgro: I so move.

The Chair: That is $14,800,000 this time. Are there any comments on the motion? Any questions of the staff?

Seeing none, I will ask the question. Shall vote 10, less the amount in interim supply, carry?

(Vote 10 agreed to)

The Chair: I note that that was a unanimous vote to approve. Thank you.

The Canadian Institutes of Health Research, vote 15—it's their grants—in an amount of $306 million. I'll accept a motion to approve that. Would anybody else like to make a motion? Ms. Scherrer will move that.

Are there any questions to do with—

[Translation]

Ms. Diane Bourgeois: Madam Chair, I have a question, if I may. These votes are for grants, if I understand correctly. What kinds of grants are we talking about? Are they grants to research institutions and universities?

• 1235

Mr. Robert S. Lafleur (Senior Assistant Deputy Minister, Corporate Services Branch, Health Canada): First of all, this is not a Health Canada responsibility. This is an institute that reports to the minister. We therefore do not have the details here. These are basically grants to all sectors described by the minister in his statement at the beginning of this meeting, to enable all institutes in the sector to conduct research.

Ms. Diane Bourgeois: Could you please be more specific? Is the word "institutes" in the plural because there are institutes in a variety of sectors, or because there are a number of research institutes?

Mr. Robert Lafleur: Yes, there are 13.

Ms. Diane Bourgeois: I see.

Mr. Robert Lafleur: They have been organized on the basis of sectors in the field of health, and are separate entities.

Ms. Diane Bourgeois: That is much clearer. Thank you. Thank you, Madam Chair.

[English]

The Chair: Mr. Merrifield.

Mr. Rob Merrifield: I'd just like a clarification on it.

You have $408,885,000 plus the $102 million. Is that what the total is?

The Chair: The total amount is $408,885,000. We've already voted in the House for $102 million, $312 million, and there's $316 million left.

Mr. Rob Merrifield: Under these 13 institutes, am I reading this right, $540 million is now planned?

Mr. Orvel Marquardt (Director General, Planning and Administration, Health Canada): Yes, indeed.

If you looked at their RPP—Mr. Lafleur says they produce their own—I think it's $540 million for this coming year. That's probably because of the increased funding that was announced in the February 1999 budget. This thing was created from MRC from the national health research and development program in Health Canada, supplemented by announced increases that take place over the next three years. That growth is probably the increased funding going to the organization.

Mr. Rob Merrifield: Didn't we start with the $430 million this year and then have a $110 million increase?

Mr. Orvel Marquardt: There probably was. That's probably an item they got through supplementary estimates.

Mr. Rob Merrifield: What's the $110 million for?

Mr. Orvel Marquardt: As I said, we don't produce their RPP, so I don't have the details. I know they did receive announced increased funding in the 1999 budget. I would suppose that's the reason for the increases over the years. I just don't have the numbers.

The Chair: Staggered increases, he means.

Mr. Orvel Marquardt: Yes.

The Chair: Not just in 1999, but rather an increase of this for 1999, this much for 2000, and this much for 2001. So some of that increase is what we already passed in the 1999 budget legislation.

Mr. Rob Merrifield: That's what the adjustments are here on the budget?

The Chair: Probably. Although I—

Mr. Rob Merrifield: That is ninety-two point four last year—

Mr. Orvel Marquardt: But I'm quite sure that's what it would be.

Mr. Rob Merrifield: Next year is $110 million and the year after is $110 million.

Mr. Orvel Marquardt: Yes.

Mr. Rob Merrifield: Okay.

Canadian Institutes of Health Research

Vote 15—Grants ...... $408,885,000

Hazardous Materials Information Review Commission

Vote 20—Program expenditures ...... $2,485,000

Patented Medicine Prices Review Board

Vote 25—Program expenditures ...... $3,617,000

The Chair: We have a motion on the table. We've had some questions on that motion. Are you ready to vote, ladies and gentlemen?

Shall vote 15, less the amount already voted in interim supply, carry?

(Vote 15 agreed to)

The Chair: Thank you.

Are there any questions on vote 20? Seeing none, I will accept a motion. It is moved by Madame Scherrer that we approve the amount not already approved in the interim supply.

(Vote 20 agreed to)

The Chair: Our last vote is vote 25, the Patented Medicine Prices Review Board. I'll accept a motion. It is moved by Mr. Charbonneau. Are there any questions on this particular amount? Seeing none, I'll ask the question. Shall vote 25, less the amount approved in interim supply, carry?

(Vote 25 agreed to)

The Chair: Ladies and gentlemen, I thank you very much. You have now approved the estimates, which I will report on your behalf to the House.

Shall I report the estimates to the House?

Some hon. members: Yes.

The Chair: Thank you. I will do so.

• 1240

There's one other thing I wanted to ask you about. As you know, and as the Minister mentioned briefly this morning, we are expecting to get this rather complicated piece of draft legislation. I understand it will be going before full cabinet on Tuesday, and the earliest the minister can come before us would be next Thursday. That is the tentative plan that is being laid, that the minister will be back next Thursday, provided it's approved at cabinet.

I'm wondering if you agree with me that a single meeting on Tuesday is not going to allow us to plow into any other subject very deeply, and whether you would agree to cancel the meeting on Tuesday and get ourselves prepared for the minister on Thursday to launch this new study.

I have to also say there is a possibility cabinet may not approve it, in which case we'll have to come up with something for Thursday. I was going to go back to the list you presented when you presented your interests—remember, we developed a list of things to do, and they're here. There are some from Mr. Ménard, Mr. Merrifield, Mr. Lunney, Ms. Ablonczy, Mrs. Wasylycia-Leis—a set of subjects. So I thought if the minister could not come on Thursday, perhaps we could begin work on some short-term measure on this list, and the clerk and I would try to find out who could come to lead us in that discussion.

So I have two questions for you. Are you agreeable to not having the Tuesday meeting? Is that okay with people?

Some hon. members: Yes.

The Chair: And are you agreeable... well, I think you know when the minister wants to come with legislation, it's just automatic, we take him. But if he can't come, are you agreeable to the clerk and I working together from this list to try to find somebody else for Thursday?

Some hon. members: Yes.

The Chair: Good, thank you.

I would point out to you that on Tuesday at noon, Stephen Lewis is going to talk about pharmaceutical prices on the international level. As our former ambassador to the United Nations, he seems to know a fair bit about it. I think he's speaking at some luncheon. I'm sure you all have an invitation, if you ask your staff about it. We might be as well educated about an international health problem by doing that as by having a meeting here.

I want to thank you again for your discipline today in sticking to your time. You really did well and we got the minister out in good time. I always think it's a big success when we get out at a quarter to one.

Thank you very much.

The notices on Tuesday for the meeting Thursday will be late because the clerk can't put them out until he has the decision out of cabinet. So you won't have a notice on Monday, or early Tuesday—you'll get it late Tuesday. Or you may not get it until Wednesday morning, but there will be a meeting Thursday.

Thanks for your participation everybody. The meeting is adjourned.