HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, March 15, 2001

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[English]

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

Once again, we have guests from the Department of Health—guests with whom we're trying to establish a good working relationship. We heard several witnesses from the department last week, and the deputy minister hosted that meeting, or was the lead witness. Today, he was unable to come, so we have Mr. Lafleur, who is the senior assistant deputy minister for the corporate services branch. I believe the plan for the meeting is that Mr. Lafleur will start, and others will present their pieces of the puzzle. They will try, in their presentations, to answer the submitted questions that were put forward both prior to the last meeting and since. We'll then move to a round of oral questions.

[Translation]

Mr. Lafleur.

Mr. Robert S. Lafleur (Senior Assistant Deputy Minister, Corporate Services Branch, Department of Health): Thank you, Madam Chair. I'm pleased to be back here today to help the members of the committee have a better understanding of the activities of Health Canada and to answer their questions.

I would like to suggest you to change the order of presentations. There is today a special event at Health Canada, a special day on science. As nearly all my colleagues are working in that area, I would like them to be able to retire after their presentation. To this end, I would like to propose you to hear them before me. I'll keep my presentation for the end, if you allow me.

[English]

I would like to introduce my colleagues. With me are Claire Franklin, executive director of the Pest Management Regulatory Agency; Dann Michols, ADM for the Health Environments and Consumer Safety Branch; Dr. Robert McMurtry, visiting ADM from the Population and Public Health Branch; and Denis Gauthier, ADM for the Information, Analysis and Connectivity Branch.

If you will allow it, Madam Chair, I'd like to start by asking Dann Michols to speak to the committee.

[Translation]

Mr. Dann Michols (Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch, Department of Health): Good morning, Madam Chair. Good morning, ladies and gentlemen.

As Mr. Lafleur told you, I'm the Assistant Deputy Minister for the Healthy Environments and Consumer Safety Branch.

[English]

The Healthy Environments and Consumer Safety Branch—or HECS, as we fondly refer to it in English—exists to help the people of Canada maintain and improve their health by promoting healthy living, working, and recreational environments, and by reducing and eliminating, if possible, the harm caused by a range of products such as tobacco, alcohol, controlled substances, environmental contaminants, and unsafe consumer and industrial products.

We have a very diverse mandate. We manage the application of some eleven different acts and their regulations, and we use the full range of health promotion and protection interventions to reduce the risks presented by drugs, alcohol, tobacco, and unsafe products, while ensuring the benefits offered by healthy environments and safe workplaces. In effect, we regulate everything from soothers to scooters and from tobacco to hemp.

The branch is organized into five program areas, each with responsibilities for a wide variety of activities and services coordinated and delivered by approximately 800 staff located across the country.

The mandate of the safe environments program is to assist in reducing the health and safety risks associated with natural and man-made environments. For example, we work with partners to set national standards for air and water quality, we assess and regulate toxic substances under the Canadian Environmental Protection Act, and we work with Environment Canada, Indian and Northern Affairs, and others to help clean up the north under the northern contaminants program.

Our product safety program is tasked with reducing health risks by regulating and promoting the safe use of many products Canadians may have or may be exposed to in their homes, workplaces, and recreational environments. We assess and reduce the health and safety risks associated with more than 200,000 consumer and industrial products, using the Hazardous Materials Information Review Act, the Radiation Emitting Devices Act, the Canadian Environmental Protection Act, the Food and Drugs Act, and the Hazardous Products Act.

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The tobacco control program is mandated to reduce the use of tobacco and to reduce or prevent the harm that stems from tobacco use. We administer the Tobacco Act; we regulate the manufacture, sale, labelling, and promotion of tobacco products to protect Canadians, especially young people, from the health consequences of tobacco addiction; and we work with national partners, including the provinces and non-governmental organizations such as Physicians for a Smoke-Free Canada, the Non-Smokers' Rights Association, and the Canadian Cancer Society to develop and deliver educational material on the hazards of tobacco use.

The drug strategy and controlled substances program works to reduce or prevent the harm associated with the abuse of alcohol and pharmaceuticals and with the use of illicit and controlled substances through their regulation under the Controlled Drugs and Substances Act, the narcotics regulations, and the industrial hemp regulations. We have developed and managed the regulatory process, which allows individuals with legitimate scientific and medical reasons to possess various controlled substances for research or medical purposes, and the research process to determine if marijuana has legitimate medical benefits. In addition, we manage five drug analysis services labs across the country that perform substance testing and identification services for all of the law enforcement agencies across Canada.

Our fifth program, occupational health and safety, helps public and private sector employees in Canada to maintain and improve the health of their workers, and also to protect the health of the travelling public. Under Treasury Board's delegation, we provide occupational health and safety services to federal departments and agencies, and to others, including provincial governments and private sector operations. We also provide an employee assistance program to federal public servants. And finally, we provide health services both at major events such as G-8 summits and to foreign dignitaries on official visits to Canada.

One of the questions put forward earlier in preparation for this briefing had to do with Canada's drinking water system. While water in Canada is considered a natural resource and as such falls under provincial jurisdiction, our safe environments program has a history of successful collaboration with the provinces in the research and development of guidelines for Canadian drinking water quality that are used by provinces as the basis for their regulations in this area.

Occupational health and safety provides protection and public health services through food and sanitation inspections, and while there is no regulatory requirement for water quality assurance inspectors on federal lands, it has been the practice of Health Canada for the last forty years to require that drinking water quality on federal property be assessed by certified public health inspectors. Health Canada has also followed the practice that federal drinking water system designs and assessments be conducted by a certified public health engineer. Finally, environmental health officers from Health Canada are responsible for inspecting and advising on water quality on reserves in Canada.

As I said at the outset, our responsibilities are wide and diverse, but it should be said that very little in the HECS mandate can be accomplished by HECS staff working alone. To accomplish our ends, we work collaboratively and in consultation with many partners and stakeholders, such as the other branches within Health Canada, and other federal departments, including Environment Canada, Agriculture and Agri-Food Canada, the Department of Justice, the RCMP, the Solicitor General's offices, the Canada Customs and Revenue Agency, the National Research Council of Canada, and the Department of Indian and Northern Affairs.

Provincial and territorial health departments we collaborate with regularly, along with municipalities, certainly the health care and research community, many consumer interest groups, industry—particularly the industries we regulate—and the Canadian public.

[Translation]

Thank you, ladies and gentlemen, for giving me the opportunity to speak to you.

[English]

The Chair: Thank you, Mr. Michols.

Mr. Robert Lafleur: Madam Chair, if you will allow it, I would like now to ask Denis Gauthier to address the committee. Again, he is the ADM for the Information, Analysis and Connectivity Branch. It's a new branch—not brand new, but fairly new—at Health Canada, and it is growing in importance.

[Translation]

Mr. Denis Gauthier (Assistant Deputy Minister, Information, Analysis and Connectivity Branch, Department of Health): Good morning, Madam Chair. I'm the Assistant Deputy Minister for the Information, Analysis and Connectivity Branch at Health Canada. Our branch is part of the area of knowledge information management to which the Senior Assistant Deputy Minister alluded in his opening remarks.

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Our mandate is essentially to facilitate access to the right information to the right people at the right time, by giving them the appropriate tools so that our health system is more responsive to the needs of Canadians and operates on a decision making model based on evidence and facts.

Maybe the French words sum up best our mandate. It is simply

[English]

to favour the access to the right information by the right people, at the right time, and using the right tools, so that we're more responsive to the needs of Canadians, and to do all of that based on a model of evidence-based decision-making.

[Translation]

How do we succeed in fulfilling our mandate? As suggested by our name, that of Information, Analysis and Connectivity Branch, we fulfill our mandate by gathering information which we analyse carefully and share, and by promoting the connectivity of the health sector in Canada.

So, in the area of information, we are building a robust database on the state of health of the Canadian people and on the cost-effectiveness of the health system. For example, we are working with the CIHI and Stats Canada on the implementation of the Roadmap on health information, in order to help put in place a robust infrastructure for the information on health and health care in Canada. Those two organizations will publish in April and in May, in their second annual report, the outcomes on the state of health of the Canadian people—Stats Canada—and on the performance assessment of the health system in Canada—CIHI.

We are also working with the provinces and territories and with some other federal departments on performance indicators and public reporting in order to fulfill the commitment made at the first ministers meeting of September 2000, namely to start submitting public reports on the performance of the health system in the Fall of 2002.

To that effect, we are working with our provincial and territorial colleagues in order to develop a comprehensive framework enabling to inform Canadians through indicators which will have been agreed on. At this time, we are developing a series of 14 general indicators concerning the state of health of the Canadians, the impact on their health and the quality of the services provided to them during the assessment.

The information we are developing with our partners is at best descriptive of the situation of a health system now valued at more than $90 billion in Canada. As this type of information remains descriptive, the analysis, the research and the assessment play an important role in helping us to understand the different correlations between the characteristics, the actions and the expected results as far as health policy is concerned.

So, we are undertaking broader analyses of the health system performance such as impact of ageing, globalization, technology and other cost drivers. The knowledge so acquired enables us to clarify and to strengthen policies and programs at Health Canada.

Within the department, we are also responsible for program evaluation. We are coming now to the next step, namely performance or outcomes measurement of our own programs on the health of Canadians. Our branch has recently been a leader in the development of the legislation for enabling of the CIHRs with which we are maintaining ongoing ties acting as coordination.

As far as connectivity is concerned, our branch provides some leadership in the design and engineering of the Health Infostructure of Canada across Canada. Maybe I would like, at this point, to define the term infostructure which was created a few years ago. It is a combination of the words information and infrastructure which includes both concepts: the infrastructure which is essential to the transfer of the appropriate information to the health system, both the container and the content.

We are playing a leadership role by coordinating federal, provincial and territorial efforts to define the vision and the plan for such a health infostructure.

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We have also defined such a plan with the help of an advisory committee reporting to the federal minister of Health. A report was tabled in February 1999. That plan became the federal-provincial- territorial vision on the health infostructure. It is a common vision which is accepted by all the partners and which is focused on four main issues.

The first issue concerns the empowering of the population by giving them access to reliable information, in the area of health, on the possible treatment options and on other subjects of interest.

The second issue relates to the strengthening and the integration of health care services in Canada by using appropriately modern information and communication technologies such as telehealth and EHR for patients.

The third issue relates to the creation of strategic information resources in order to meet the growing demand for electronic information.

The fourth issue relates to the enhancement of the privacy level of personal health information.

Following that report, we created a fourth advisory committee on Health Infostructure which reports to the deputy ministers Conference. I am copresident of that committee. We continue to play our leadership role by managing a very effective federal- provincial-territorial cooperation process. In the 18 months since the creation of that committee, we developed a Blueprint and a preliminary Tactical Plan for a health infostructure across Canada.

We coordinated the efforts of the different jurisdictions, across Canada. This plan will be implemented, in part, by Canada Health Infoway, a key organization which was created following the agreement on health between the first ministers. In fulfilling the commitment made at the first ministers meeting, the government of Canada, in their last budget, committed $500 million to create an independent information and communication technology corporation to accelerate the development of the adoption of the modern information technology system.

The priorities of our provincial and territorial partners have been established and Canada Health Infoway was incorporated. We have now reached the stage of the formation of a Board of directors and of the selection of the members of the corporation.

The governance structure and a MOU between the minister of Health and this corporation will ensure that the activities of the corporation are consistent with the federal government priorities, which are to have a Canada-wide approach to the development of a health infostructure, based on strategic investments and benefits- sharing.

Apart from those activities at the level of Canada Health Infoway, we are supporting the development of telehealth and EHR applications through CHIPP. The objective of this incentive program of $80 million, over two years, is to promote cooperation, innovation and renewal in the area of health benefits through ICTs. The program mainly supports large projects in contrast with pilot projects, in the areas of telemedicine, home telecare and the electronic health record. Those projects bring together several partners and will be the basis of a Canada-wide health infostructure.

We have also started announcing some of those projects. Among about 180 proposals, we selected 29 projects which will receive financial support.

We are also using ICTs within the context of three large initiatives within the department, in order to better fulfill our mandate.

The first one is the First Nations and Inuit Health Information System. It is a community system, designed by the First Nations, in order to provide direct information to improve case management, program planning and monitoring in the area of health. Since its modest beginnings in 16 pilot areas in Ontario, the system has become a network covering now more than 327 sites across Canada.

As a second initiative, we have also reinforced the National Health Monitoring Infostructure so as to contribute to the gathering and analysis of public health information. This information coming for example from public health laboratories, provincial and territorial governments and poison control centres, will be of great value since it will help us decide whether, for instance, the appearance of food poisoning symptoms within a given community is only a coincidence or whether it indicates a serious risk for the health.

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Thirdly, we met the need of Canadians to have access to a reliable Canadian source of information by creating the Canadian Health Network. It is an Internet service which connects the people to the present health networks, both government ones and non- government ones, and which provides information on health promotion and disease prevention.

Through the Web site of the CHN, it is possible to consult our partners' sites which provide information on diseases, prevention advice, assessments of alternative treatments as well as information on support groups in different areas. With all this information and in consultation with your physician, it is then possible to make a much more enlightened decision on the required treatment.

Since its launch in November 1999, the home page of the CHN received more than 20 million visits and receives now several million visits every day. Of course, the branch is also responsible for the information technology and telecommunications support within the department, in addition to the development of the Government On-line project.

In conclusion, I would say that every day, hundreds of thousands of decisions are made in the area of health. Whether it is a parent who is concerned about a bout of fever of a child, an individual being diagnosed for a certain type of cancer or a doctor who must prescribe a treatment, whether it is in an emergency room, or a pharmacy or at the level of the development of health policies, hundreds of thousands of decisions are made every day in the areas of health and public health. Hopefully those decisions are made in a knowledgeable manner and on the basis of reliable information.

The real function of our branch is to promote access to this information, whatever the level of partnership or whatever the type of partners who need to have access to that information. Better information, a better analysis and new and enhanced applications of ITs throughout the health system make it possible to access better information, therefore allowing for a more enlightened decision- making by health professionals and by the Canadian people as a whole, and, in the end, a better health.

Such is, in a few words, the mandate of the Information, Analysis and Connectivity Branch. I'll be pleased to answer, today or later, all the questions you may have concerning our programs. Thank you, Madam Chair.

[English]

The Chair: Thank you, Mr. Gauthier.

Mr. Lafleur.

[Translation]

Mr. Robert Lafleur: Madam Chair, we may now go on to Dr. Robert McMurtry.

Mr. Robert McMurtry (Assistant Deputy Minister, Population and Public Health Branch, Department of Health): Thank you, Madam Chair. It is a pleasure to be with you. I'm delighted to be here today to talk to you about the activities of the Population and Public Health Branch.

[English]

The mission of the Population and Public Health Branch is to promote health and reduce health risk to Canadians. We accomplish this through a wide range of activities, including population health, health promotion, and disease prevention, which includes both infectious and non-communicable diseases. In addition, the branch has a national emergency preparedness response capacity, of which we'll say more in a moment.

We also have the national public health surveillance system that correlates with my colleague Denis Gauthier's remarks in terms of keeping a finger on the pulse of the health of Canadians. In addition, there is a laboratory and research facility in Winnipeg called the National Microbiology Laboratory, which is a reference laboratory for Canada and indeed internationally. It is among the most advanced facilities of its kind in the world. Its design, for example, has been referenced by CDC as they move forward to develop laboratories of a similar kind. We also have the Guelph laboratory, which relates to food-borne zoonoses or food-borne diseases.

We are responsible, too, for the development of a framework for public health that promotes an upstream approach before people have need for the health care system.

[Translation]

I would like to illustrate how my branch is involved in emergency preparedness and response activities by briefly describing two recent incidents that received substantial media attention.

[English]

There was a great deal of media attention and you may recall these events.

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On January 30 of this year, an envelope containing an unknown powder was sent to the Minister of Citizenship and Immigration and was reported as a suspicious package. The discovery set in motion a cascade of responses. Early on, our Centre for Emergency Preparedness was involved. It provided on-site assessment and advice of the potential hazards, communication to the CIC employees through briefings, and a 1-800 number for the approximately 1,100 employees we're engaged with.

Testing of the powder at the Winnipeg laboratory was done within 24 hours, and having ruled out a microbiological threat, the building was reopened on February 1.

In a second event, the centre's contingency plan for viral hemorrhagic fever was activated on February 5 in response to an African visitor in Hamilton who became acutely ill some 24 hours after arrival in Canada.

Activation of the plan involved local, provincial, and federal agencies, and indeed coordination with the Center for Disease Control in Atlanta, as the plane that she had been on had also landed within their territory. It called for specific measures to contain the disease. Within 60 hours, the Winnipeg lab, which tested patients' specimens, reported that the patient was not infected with any agents covered by the contingency plan. As a result, the centre recommended to local authorities that the plan be deactivated, and it was.

[Translation]

At the other end of the branch's spectrum of activities, we deliver disease prevention and health promotion programs.

We are now developing a Framework for a new public health, which recognizes that major health gains will be based on our ability to invest upstream to influence factors that create a healthy society, reduce disparities and ensure the sustainability of the health system.

[English]

Upstream investments, in short, may be the most important thing we can do to ensure the future of a publicly funded health care system.

[Translation]

My branch will lead the work on the Framework, elements of which are articulated in the recent Speech from the Throne, with other branches, departments and provinces and territories, advancing a dynamic, integrated approach to health. Thank you, Madam Chair.

[English]

The Chair: Thank you, Dr. McMurtry.

Mr. Lafleur.

Mr. Robert Lafleur: Thank you, Madam Chair.

I'd ask Claire Franklin now to address the committee.

[Translation]

Mrs. Claire Franklin (Executive Director, Pest Management Regulatory Agency, Department of Health): Thank you, Madam Speaker. Thank you for giving me this opportunity to describe the Pest Management regulatory Agency.

[English]

When PMRA was created in 1995, staff, resources, and expertise for pest management regulation from four departments, Agriculture and Agri-Food Canada, Environment Canada, Natural Resources Canada, and Health Canada, were consolidated into a single agency within Health Canada.

The agency staff—presently 358, of whom 231 are scientists—concentrates expertise in the area of toxicology as it relates to human health and the environment, as well as expertise in environmental issues, agriculture, and chemistry.

The Pest Management Regulatory Agency was given sole responsibility for regulating pesticides under the Pest Control Products Act and the Food and Drugs Act. Our mandate is to protect human health and the environment by minimizing the risks associated with pest control products.

Primary considerations are children's health and food safety as well as environmental safety with respect to pesticides.

[Translation]

Responsibilities for research, monitoring, and development of pest management products and practices remained with the four sectoral departments.

Data from these departments are integrated into registration and re-registration decisions on pesticides.

[English]

A key issue for the department is renewing the Pest Control Products Act. When a new act is introduced in the House, the department will have the opportunity to provide more detailed information about the pest management regulatory program to the Standing Committee on Health prior to its consideration of the bill at committee stage.

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[Translation]

With regard to the question on interaction with other departments posed by Mr. Charbonneau,

[English]

the PMRA interacts with three departments primarily, as well as with other branches of Health Canada, in particular, the Health Products and Food Branch, through a variety of memoranda of understanding, committees, working groups, and bilateral and multilateral projects.

One interaction is with the Canadian Food Inspection Agency. My agency sets the acceptable level of pesticide residue for food, using the Food and Drug Act to promulgate that standard. The Canadian Food Inspection Agency conducts inspections on residues of pesticides on food and is responsible for removing food from the market if it is considered unsafe or contravenes these established legal limits with respect to allowable levels. The PMRA provides advice to CFIA on the health impacts of residues that are detected. In addition, PMRA and CFIA cooperate in planning inspection activities.

Then there is our interaction with Environment Canada and Fisheries and Oceans Canada. Environment Canada and Fisheries and Oceans Canada conduct environmental research and monitoring on pesticides. We use their available research and monitoring results when we're re-evaluating existing pesticides. We also seek advice from these departments on specific risk assessment methodology and related issues. We interface with them on the Fisheries Act as well. There's an interface between Fisheries and Environment Canada with regard to the Fisheries Act also.

We interface with Agriculture and Agri-Food Canada and Natural Resources Canada. We've undertaken partnerships involving Agriculture and Agri-Food Canada and Natural Resources Canada in projects to develop and promote the use of integrated pest management to reduce risks from pesticides and contribute to sustainable pest management. We also work closely with Agriculture and Agri-Food Canada on pesticide issues that are affected by agricultural trade concerns.

So that, I hope, addresses how we interface with the other departments. Thank you very much.

The Chair: Thank you, Ms. Franklin.

Mr. Lafleur, there are two other names on the list today. Are those people here as presenters or simply to answer questions?

Mr. Robert Lafleur: Madam Chair, they're here to answer questions the committee puts to us to the extent that those questions can be answered orally and today. As you may know, we got a series of additional questions after our appearance on Tuesday. We've attempted to deal with them, but some are quite complex and may require more extensive answers than we can give today.

The Chair: I see. So I guess the next speaker is you.

Mr. Robert Lafleur: Yes, if you'll allow me.

The Chair: Thank you. Go ahead, please.

Mr. Robert Lafleur: I'd like to talk to you briefly about corporate services and some of the challenges the department is facing in the area of administration.

The Corporate Services Branch essentially provides the same kind of services one would find in all government departments. These are centralized services for dealing with financial transactions, recruitment, retention and development of employees, acquisition and utilization of physical assets, and other related administrative activities. One of the other areas I am particularly concerned with is providing advice and direction to the department on prudent and effective management of resources, and in that regard, like colleagues in other departments in my kind of position, I deal with the Treasury Board and convey the intentions and the policies of the Treasury Board to the department.

For that activity my branch utilizes about 5% of the resources of the department and about 6% of its people. It's quite small, if you like, a fairly efficient organization. It was extensively downsized during program review, and now we're struggling to deal with a suddenly growing department and all the issues that brings to bear on administration.

I'd like to point out a couple of the major activities of Corporate Services Branch that have been very successful and have attracted recognition for us in the public service. We have a very comprehensive learning program, which we developed after a program review. It is now being emulated by other departments, and we are sharing the operation of that program in many places across Canada with other levels of government and with the private sector.

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We've had an increasing use of new technologies to support administration, the most important of which is the implementation of a new financial system, made necessary because of the move of government as a whole to accrual accounting, which is going to take place for our department and a number of others on April 1.

We've been working with the Treasury Board on the development of the universal classification standard and preparing for its application in the public service. That has been quite substantial work. It is not often that government changes a whole classification structure, and the federal government is in the process of doing that.

We have continued to work hard to support the department in the implementation of new program initiatives resulting from two important additions of resources from the federal budgets of 1999 and 2000.

In the last two and a half years we have had over 1,500 new appointments to the health department, and that has put an exceptional burden on the people who occupy themselves with that activity, primarily the staffing officers and the classification officers in the department, and obviously the managers who have to deal with the influx of new staff.

One of the big areas of pressure has been to find accommodation. Not only in Ottawa, but across the country there are accommodation pressures. Canada's economy has resulted in expansion of the use of office space by the private sector, and we're in competition with the private sector for new space, most of which is leased by the federal government. In Ottawa it has been particularly severe, because of the growth of the technology industry in Canada.

One of the very fundamental areas of work we have been attending to for the last year and a half is the implementation of modern comptrollership into Health Canada. As you may recall, Madam Chair, the government adopted in 1997 the report of a panel of experts on comptrollership. It contains a series of recommendations dealing with the implementation of modern concepts of comptrollership, which you can, for purposes of discussion, interpret as modern management.

The Treasury Board selected a number of departments to be pilot departments in this effort, to explore the new approaches, and to develop new tools, methodologies, training programs, and so on, to facilitate the implementation of modern comptrollership. There were two groups of pilot departments, a first group of five, then enlarged to include a number of others. Health Canada joined the pilot department group in the second stage, and we've been working with Treasury Board to address the implementation of modern comptrollership.

Among the activities in the field of modern comptrollership the department has been focusing on is a financial management improvement plan. We've developed an ADM/RDG accountability framework, with MOUs to clarify rules and responsibilities. The department has developed a risk management framework and is now extensively using a risk management committee to deal with, among other things, important scientific issues.

We have developed a framework for integrated resource management, which will be making use of the modern equipment we have installed in the department to deal with accrual accounting and the other elements of the integrated initiative of the government called the financial information strategy.

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More recently we have developed a management control framework for grants and contributions. That work started early last summer in anticipation of the Treasury Board tabling its new policy on transfer payments. That work has been greatly focused on in recent months, in the aftermath of the events we've all read about regarding the first nations community in Manitoba. It links up with work relating to accountability that was already underway in the First Nations and Inuit Health Branch.

We also have extensive challenges in the regions. We have just gone through a departmental reorganization, a realignment. I think it's starting to bear fruit—it was an important change, and very timely. We're still in the process of sorting out the roles and responsibilities for carrying a number of these programs further out to the regions, to have more local implementation.

If I can just refer back for a moment to our review of grants and contributions, the review will focus on some critical areas, including a clarification of roles and responsibilities. Some of these are: to address some deficiencies we've noted in the accountability framework; to identify training needs for program managers, especially with respect to new people who have joined the department in the last two and a half years; to identify tools and procedures required for more integrated risk assessment and management; to ensure full compliance with all government regulations involving transfer payments, in every case; and to generally strengthen the department's policies and procedures dealing with grants and contributions.

If I might, Madam Chair, I'd like now to just turn very briefly to a few of the questions put to the committee, which I can address directly.

Some questions were regarding the resources of the department and their deployment—what the various branches have as resources. I refer the committee first to the main estimates for this year, and the report on plans and priorities, which contains some information.

There is also some financial information on page 26 of the document we tabled on Tuesday, entitled “The Health Portfolio”. We have also provided the clerk of the committee with three documents that go into more detail on our resources. Two of those documents deal with this year's budget.

In one, there is a small table—which I should explain to the committee, so that members can better understand it. I hope it's been distributed. It's

[Translation]

in both languages.

[English]

To the left of the table is information from the main estimates. Because of our reorganization, some branches have been amalgamated, some new organizations have been created, and some branches have changed names. The Treasury Board has also approved us for a new instrument called a PRAS, which is a formal instrument for changing the structure of an organization's departments. That will change next year's estimates to reflect the new organization. But this year, we're still using the old structure and the old estimates, as they have been.

On the right-hand side of the table, we have transposed the figures into the new organizations, which you have heard addressing you during these two days of hearings. That shows you what resources the various branches have.

The first column is the number of people, then the salaries attributed to them, and then the operating expenses. In the middle are the department's transfer payments, which you can see are quite substantial—close to half our resources are used for transfer payments. Then there's the total.

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The third document—again in response to a member's question—explains the growth of $220 million from the 1999 estimates to the 2000 budget. We've provided that information.

However, I would like the members to understand that the published figures made available do not include the supplementary estimates provided at the end of the fiscal year. As we say in the financial field, we're comparing mains to mains. If we include the money obtained through supplementary estimates, I think the growth between 1999 and 2000 is not $220 million but closer to $114 million. It's substantially less.

If the committee requires more detailed information about these increases and decreases, the director general of finance is here with me and he could explain it.

If I might pass on to a couple of other questions raised by members, Madam Chair, one question concerned the chief scientist and whether or not his reports to the department would be made specifically to the minister.

Dr. Kevin Keough will be reporting to the deputy minister on April 1. The office of Health Canada's chief scientist was created on the advice of the arm's-length science advisory board. His role is to bring greater leadership, coherence, and expertise to the overall strategic direction of the department's scientific responsibilities, activities, and needs.

As the chief scientist, Dr. Keough will provide expert scientific advice to Health Canada officials on national and international scientific trends. He will also report on public and private sector developments and on established partnerships that build on scientific strengths. The document we tabled on Tuesday also has some notes on the chief scientist position.

To my knowledge, he will not make specific reports to the minister. But he will, of course, contribute to various reports. A number of these go to the minister and others are tabled by the government in the House.

Turning now to Judy Wasylycia-Leis's questions about the Virginia Fontaine Addictions Foundation, some of these questions will require written answers, because there are more details than I can provide today. But I'd just like to briefly address some of them.

The first question was, what problems were identified during the Health Canada audit of the solvent abuse centres funded under NNADAP. Our major audit of the Sagkeeng Solvent Treatment Centre was done in 1996 and made available in 1997. The issues identified by the auditors were inappropriate billings, questionable expenditures, and issues regarding governance. The department undertook to implement the auditors' recommendations and prepared an action plan.

In smaller audits of other solvent centres, as part of the audits we do every year, there were smaller issues such as incomplete administrative documents. All of those were addressed.

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I should note for the committee that we now publish all these audits on our website, and we have published back to 1998 the audits that were done. We do about 40 audits of various organizations in First Nations and Inuit Health Branch every year.

There have been no further audits of the Virginia Fontaine centre specifically since 1997, except for the one that was announced by the minister on October 18, which is a forensic audit and which is again underway, after the matter had been referred to court for a decision. We can't give a specific date on when we expect the report, but we know the work is being done and we hope to have a report soon from the auditors on that.

Regarding which contribution agreements are identified by First Nations and Inuit Health Branch regional directors for audit, usually there is a discussion that takes place at a series of meetings during the year, and the regional directors identify the communities where they think audits would be beneficial. Out of that, 40 are selected, and the plan is usually finalized then by the Audit and Accountability Branch, which carries out the audits.

We're now working on a more structured, more sophisticated risk-management framework to address with greater precision our decision-making with respect to audits, and it is possible that we might be increasing the number of audits we carry out.

With that, I'll stop here. If there are further questions regarding Virginia Fontaine that we could usefully answer, if I can I'll do that now, and if not, we'll provide the answers in writing.

When the committee is ready, I'd like to go to some other questions that were put to us, particularly those pertaining to the Canada Health Act. As you have mentioned earlier, I have two other colleagues with me who can address some of those questions.

The Chair: Mr. Lafleur, would you like to have Mr. Fedyk and Mr. Glover join you at the table now?

Mr. Robert Lafleur: Yes, thank you.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Madam Chair, could I ask a few questions pertaining to Virginia Fontaine, very briefly, pursuant to the response to my questions?

The Chair: It's a little unusual, but seeing as that is the last topic that was addressed, you should go ahead.

Ms. Judy Wasylycia-Leis: Thank you.

I appreciate the fact that you've answered in part my questions and that you will get more information as you have a chance to do so.

In getting back with more information, I wonder if you could address the question that is really the overriding concern in terms of these specific questions posed to you. That is, if in fact Virginia Fontaine centre, or Saugeen centre, or Saugeen in general, were identified in terms of having particular concerns or problems in the audit of 1996, is there no mechanism for then pursing those concerns through the audit system? Why were no audits taken in the years 1998 and 1999—which you have indicated to us do not show audits for Virginia Fontaine—especially given the fact that, by your own information provided to the public, the regional directors can identify agreements if there are problems identified, not only in terms of illegalities or misappropriations or financial irregularities, but in terms of general need to strengthen the accountability process?

Can you answer that question now, in terms of why, if a risk or problems were identified in one year, steps weren't taken to ensure subsequent audits year after year?

Mr. Robert Lafleur: I think the answer to that is that we have a certain level of audit capacity within the department and a very large program to audit, and so we try to be careful in our use of those audit resources.

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I should say that a decision was made last spring to double the audit capacity, and we have done that at Health Canada. We provide services to over 700,000 first nations individuals across Canada. We work in partnership with over 600 communities, and we have thousands of agreements for contributions to support the expenditures on health in those communities.

When we do audits, there is obviously a follow-up mechanism. The main stage of that is for the branch to take note of the recommendations and to prepare an action plan to address those. That action plan is reviewed by an audit committee that is chaired by the deputy minister. It is then the responsibility of the branch, of the ADM, to carry out that implementation plan. Very rarely will we go back and look at what the ADM has done, relying on their responsibility to carry out the work they've committed to doing. Sometimes it happens that we have the resources to go back, but usually we want to pass on to other areas that have yet to be audited, and we focus primarily on that.

In this particular case, something happened. It was unfortunate. We're not very happy seeing what has happened in that community, and we're quite concerned with allegations of how federal money might have been used. That's why the minister announced the forensic audit, and all these issues will be looked at through the forensic audit. But I'm sure you'll recall that the minister undertook in the House that if any moneys were not properly used, we will seek to obtain the return of those moneys, and that is still the position of the department.

Ms. Judy Wasylycia-Leis: I have one last question on this.

I think the concerns are as much about what might have gone wrong in your department for this to happen. If we knew about some problems in 1996 and didn't take any steps over a five-year period to address those concerns, and then signed a five-year, $7 million-plus agreement in July 2000 without undertaking any kind of an audit or a thorough review of the situation, something seems to be wrong in your department. Regrettably, the way things have been left, I think it's the first nations communities that are taking the heat and the blame for the problems that have emerged, yet it seems every time we try to get to the bottom of this, really the question is lack of accountability from within the department, a lack of resources to help the first nations community administer the programs, and a lack of assistance in terms of best management practices. I think that's the part that needs to be addressed for this committee and for Parliament, so that we don't put in jeopardy the whole pursuit of first nations and Inuit communities being able to deliver programs in the health care field.

Mr. Robert Lafleur: I believe in my remarks I spoke about the follow-up action that the department normally follows in cases of audits. That there was no action taken—those were the words of Madame Wasylycia-Leis, not mine.

There are, in fact, two audits being carried out. One is a forensic audit of the activities and expenditures of the centre, respecting federal moneys that were provided to them, and the other one is of internal procedures related to the centre, within Health Canada. That report also is not in final form. When it is, it will be made public, as all the other audits have been made public.

The Chair: Thank you, Mr. Lafleur.

Judy.

Ms. Judy Wasylycia-Leis: Is there any sense of a timeline at all as to when we can expect to see-

Mr. Robert Lafleur: No, I don't. I'm sorry.

Ms. Judy Wasylycia-Leis: Is it days, weeks, months, years?

Mr. Robert Lafleur: It's in the hands of the auditors, and one does not impose deadlines on auditors. They have to do their work thoroughly.

Thank you.

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

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I think we'll go on now to Ms. Ablonczy, and, just before she begins, I should say that with only five members present I think we can be pretty casual, and we have essentially 55 minutes. I think you can probably ask questions until you're blue in the face, if I can say it that way.

Ms. Ablonczy.

Mrs. Diane Ablonczy (Calgary—Nose Hill, Canadian Alliance): I certainly have no intention of doing that, Madame Chairman.

I did provide, through Mr. Sokolyk to Mr. Lafleur, some of my questions—11 in total—and rather than wasting time in asking them individually, perhaps I could just ask him to take a run at them, and I guess if we need clarification we can do that later.

Mr. Robert Lafleur: I think a number of them can be addressed by my colleague, if I can introduce him to you.

Mrs. Diane Ablonczy: I'm sorry, Madame Chair, I haven't given these questions to other members of the committee, but I do have extra copies if anyone would like to follow along. It might be helpful.

The Chair: I think we'd enjoy that.

Mr. Robert Lafleur: Madame Chair, I am here with Frank Fedyk. He is Acting Director General, Intergovernmental Affairs Directorate, Health Policy and Communications Branch.

A number of your questions, Ms. Ablonczy, deal with the Canada Health Act and our administration of it, so we'll turn it over to Mr. Fedyk, who'll try to answer as many of those as he can.

Mr. Frank Fedyk (Acting Director, Canada Health Act Division, Intergovernmental Affairs Directorate, Policy and Consultation Branch, Health Canada): Thank you, Madame Chair.

Unfortunately, I don't have answers to all of the questions. We've received a number, and I do have a series of answers both to the Canada Health Act questions and some of the other ones. At least some of my responses will touch on ones that a number of members proposed, so perhaps I can deal with each of those in turn.

There was a specific question in terms of what specific mechanisms are in place to deal with any concerns that delisting of insured services by provincial governments doesn't compromise the comprehensive criteria of the act.

In response, Health Canada monitors provincial and territorial decisions to remove services from their list of insured services on an ongoing basis to ensure that there are no breaches of the requirements under the act. When a conflict or a disagreement arises, our approach is to resolve these issues by emphasizing transparency, early consultation, and dialogue.

In most instances, these issues are resolved through assessment and discussion at the officials level, based on a thorough examination of the facts. The application of penalties is only considered when means of resolving issues have failed.

A second question dealt with the imposition of penalties when alleged violations of the five principles of the act occur.

The refusal of a province or a territory to comply with one of the five program criteria of the act can lead to application of discretionary penalties under the act, sections 14 to 17. In addition, the refusal of a province or a territory to comply with the extra billing or user fees provisions can lead to the application of mandatory penalties, which is under sections 18 to 21 of the act. To date only mandatory penalty provisions of the act have been applied.

A third question dealt with what is considered medically necessary—

Mrs. Diane Ablonczy: Madame Chairman....

Sorry, which question were you replying to?

Mr. Frank Fedyk: They're not all of yours.

The Chair: Let's start with Mrs. Ablonczy's questions, please.

Mr. Frank Fedyk: Okay. I'm sorry, Madame Chair.

In terms of the definition of medical necessity...delisting, number 2: the comprehensive criteria of the Canada Health Act require that provincial and territorial health insurance plans ensure all medically necessary hospital and physician services.

We at Health Canada do not maintain a list of medically necessary physician or hospital services for the purposes of administering the act, although the definition of hospital services is in the act.

The federal government's position is that, with respect to determining medically necessary services, it has always been the responsibility of the provinces to decide, in conjunction with the medical profession.

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Question 3 asks, what are the national standards relating to insured health services, and what are the identified national standards as they relate to the applied—

Mrs. Diane Ablonczy: Sorry, you've skipped over reasonable access. Can you explain what is meant by that?

Mr. Frank Fedyk: Yes. Under the act, reasonable access is related to the criteria of accessibility. In terms of the act, reasonable access is in terms of where and as available, and it is up to the province to decide where the services are provided.

For example, not all provinces have cardiac care at every hospital. Under the act, what we would require is that every resident of that province would have access where that service is available.

Mrs. Diane Ablonczy: So what you're saying is that it's not reasonable to expect access to medical services if the provinces decided not to provide the resources necessary to deliver those services. Couldn't that lead to a result where it's not reasonable to expect access to any medical services because the provinces have decided not to give them? In that case, it makes a farce of the whole principle of accessibility.

Mr. Frank Fedyk: Accessibility applies to the where and as available criteria. The provinces determine what are medically necessary physician and hospital services to provide, and it is their responsibility to decide where and how these services are to be delivered.

Under the Canada Health Act, in terms of reasonable access our concern would be that, where these services are provided, they should be provided on the same terms and conditions for all residents of the province. Again—

Mrs. Diane Ablonczy: Or not provided as the case may be.

Mr. Frank Fedyk: The province determines what services are to be provided.

Mrs. Diane Ablonczy: So there are no consequences that flow from a failure to meet reasonable access.

Mr. Frank Fedyk: If a resident is denied access to insured physician or hospital services, we would investigate and follow up with any complaint or issue brought to the attention of the department or the minister to determine whether the individual had been provided access to that on uniform terms and conditions.

Mrs. Diane Ablonczy: But with the delisting, the number of insured services is continually being eroded, so presumably you could get to the point where there's a very small package of services that are insured. What happens to the other services that are clearly needed for people?

Mr. Frank Fedyk: At Health Canada we monitor the provinces' decisions both to add or delist services and make a determination of whether this affects the comprehensiveness criteria of the Canada Health Act based on two factors.

The first considers how this service may be provided by other provinces or territories. Is it an insured service in other provinces or territories? The second criterion considers whether there is consensus in the medical community that the service is effective for the treatment or maintaining of an individual's health.

Mrs. Diane Ablonczy: Okay.

Mr. Frank Fedyk: Question 3, in terms of the Canada Health overview, states that there are national standards relating to insured health care services. What are the identified national standards, and how do they relate to the five principles of the act?

Actually, the words “principles”, “criteria”, and “standards” are used interchangeably, so the standards are the five criteria of the act: public administration, comprehensiveness, universality, portability, and accessibility.

All provincial and territorial-provincial health insurance plans deal with these five standards.

Mrs. Diane Ablonczy: So what you're saying is that there is no objective definition of these standards; they vary from time to time and place to place?

Mr. Frank Fedyk: The Canada Health Act defines each of these five standards, and we can provide written responses, and I can also give you a brief oral summary.

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Mrs. Diane Ablonczy: Yes, I would really appreciate the written definitions of both, because I'm getting the sense that we're on quicksand here, without any solid benchmarks to work with. But there are solid benchmarks, you're saying?

Mr. Frank Fedyk: Yes, the act includes specific definitions of what each of those criteria are.

Question 4 dealt with the evolution of the health care system, that the Canada Health Act has not changed since it has passed: Has there been anything identified where the act doesn't effectively meet the needs of the evolving system? If so, what are the plans to deal with them? If not, what supports the conclusions...?

This one I do not have a written response to yet, but in general the evolution of the health care system has occurred since the act was proclaimed in 1984. The act has been both flexible enough to accommodate the change, as well as solid enough to maintain the criteria and the principles for those insured services for which the act applies, which is insured physician and hospital services. We can provide further elaborations in a written response.

Mrs. Diane Ablonczy: I'd appreciate it.

Mr. Frank Fedyk: Actually, question 5 asks us to please ensure the results of the ongoing discussions in the issue of primary health care and measures designed to deal with the coming demographic changes are provided promptly to members of the committee. I do have an update on that. We will certainly provide all documents as they are completed.

In terms of the current status on primary health care reform, it is as follows. Members will recall that the federal government established an $800 million primary care Health Transition Fund to help accelerate primary health care reform in Canada by building on provincial and territorial initiatives in this area.

An FPT advisory group on primary health care has been formed to provide advice on the design and criteria of the fund as well as to discuss ways to move the broader reform agenda forward. These discussions are ongoing, and further details will be provided over the coming months.

I'm sorry, Madam Chair, I don't have a response to question 6 in terms of outcomes and waiting times. We'll have to submit a written response.

Question 7 deals with how it is that health care premiums levied by some provinces are not deemed to be in contravention of the provisions of the Canada Health Act extra billing and user charges. Premiums are a source of funds raised to help finance a provincial health care system. Premiums are currently being charged in two provinces, the provinces of Alberta and British Columbia.

Extra billing and user charges refer to charges to the patient at a point of service. Extra billing refers to a physician billing over and above what the provincial health plan would determine is his or her fee, and user charges are associated with a service being provided at a facility, or often a clinic, or it could be a hospital.

So there is no relationship between the premiums, which are a source of funds, and extra billing and user charges.

The Chair: Can I have a clarification? What kind of premiums are we talking about?

Mr. Frank Fedyk: Both provinces—I'm sorry I don't have all the details at my fingertips—have both family and individual premium bases. There is premium assistance for those with low or modest incomes. The Canada Health Act would require that the payment or non-payment of premiums cannot be used in terms of denying individual access to insured services under the act.

The Chair: Insurance premiums that a family would pay annually—is that what you're talking about?

Mr. Frank Fedyk: Yes, that a province uses as a source of revenue to finance their health care systems.

The Chair: So it's for their own insurance scheme.

Mr. Robert Lafleur: No. It would be to provide Canada-Health-Act-insured services, but instead of taking the money, or all of it, from general tax revenues, they would do part of it through these fees.

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The Chair: And is this fee levied in a bill that goes to a family once a year? Do you run into the problem when you try to take your child to, say, emergency? Which way is it?

Mr. Frank Fedyk: The premiums are paid monthly in both provinces. There is, as I said, premium assistance for those with low and moderate income. When a family member took an individual to a hospital and the hospital administrator found the individual was in arrears on their premiums, they could not be denied emergency care in terms of.... That would be of concern under the Canada Health Act. The payment and collection of premiums are separate from the provision of essential medically necessary health services.

A voice: Did you get rid of OHIP in Ontario?

Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance): OHIP used to have premiums from families until about 10 years ago when the employer health tax came in.

Mr. Frank Fedyk: 1995.

Mrs. Diane Ablonczy: It seems to me a fine distinction when you characterize one as a source of funds and the other one as—

The Chair: Fees.

Mrs. Diane Ablonczy: —we're not quite sure what.

The Chair: People are still paying in those two provinces.

Mr. Frank Fedyk: All provinces raise revenues to finance their provincial health insurance plans through a different means of sources.

Those two provinces use premiums, and it does not cover all of the expenditures. All provinces use general revenues. Saskatchewan uses a proportion of their sales tax, notionally targeted to support health and educational programs. Ontario has a payroll tax. So there's a number of means that are used as sources. Those two provinces continue to use premiums in terms of.... I believe part of it is to ensure that the individuals know there is a cost associated with the provision of insured health services.

Question 8 of the Canada Health Act overview states that the provinces must insure all insured services. That was in point (d), insuring of insured services consistent with any commonly held definition of comprehensiveness. That one I believe I have addressed during my earlier comments in terms of the fact that what we do is monitor the addition and delisting of insured services.

What we do when we do the monitoring is assess how this service is being provided in other provinces and territories and whether in fact the medical community is saying the service is effective for the purpose of maintaining one's health or preventing disease, injury, or illness.

It's really the provinces that review and make a determination, often in consultation with the medical society, of what services to add or what services to delist. The services that have been delisted tend to be very minor: newborn babies' circumcision, or tattoo removal except when it refers to tattoos from imprisonment in concentration camps.

Mrs. Diane Ablonczy: It's not quite that fringe.... In some provinces, for example, I know checkups are covered; in other provinces they're not covered. I don't think that's quite on the same par as tattoo removal.

As I understand it, delisting is actually increasing. It's certainly not going the other way. In other words, I don't believe there are any provinces—and you'll correct me if I'm wrong—actually adding services that are covered by insurance. They are actually going the other way, and more services all the time are being delisted. It seems to me we need some strategy to not just monitor it but to deal with it.

Mr. Frank Fedyk: Actually provinces do report in the Canada Health Act annual report all services that have been added: medical physician services, hospital, and dental-surgical. Services are more often added than removed. Again, there may be changes in the service availability for targeted groups, but when a service has been deemed medically necessary at the point of service by the physician, the province pays for that service. So even if some services have become normally uninsured for a particular age group, as you were mentioning in regard to annual checkups, when a physician for another consultation purpose sees the individual and the individual needs a full checkup for a proper diagnosis, that is paid for.

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The Chair: So you're saying an individual physician's own decision-making can actually overrule the listing or delisting of things as decided by the medical association with the government.

Mr. Frank Fedyk: It is the physician, in negotiation with the provinces, who determines the fee schedule for all medically insured physician services. But it is he or she, at the practice level, who determines that this service is medically necessary for me, but not may not be medically necessary for you.

The Chair: Okay.

Mr. Frank Fedyk: So the physician has autonomy in determining what services to provide. The province and the physician association determine the range of those services, but it's the physician at the point of service who determines what services may be required. So it's a balancing. They all agree on the full range of services, but the individual physician at the individual level determines what package of services you may be getting.

Question 9 dealt with the Canada Health Act overview and states that the provinces and territorial governments are to appropriately recognize the federal contribution towards health services. What form of recognition is deemed to be appropriate?

The provinces do it in a number of ways. They include in their main estimates the recognition of the federal contribution, which is paid through the Canada health and social transfer. Not all provinces table annual reports on the health care system, but those that do, that include financial statements, more often acknowledge the federal contribution in terms of, again, the Canada health and social transfer. So the provinces have used a number of forms in recognizing the contribution the federal government makes towards the provision of these insured health services.

Ms. Judy Wasylycia-Leis: Madam Chair, while we're on the Canada Health Act, I have three supplementary questions from Tuesday. I was wondering if I could get answers to those now.

Mr. Robert Lafleur: We have those, Madam Chair. We also have questions from Mr. Merrifield regarding them, I believe. Mr. Fedyk will try to answer those now.

The Chair: Okay.

Mr. Frank Fedyk: There was one question concerning the mention, during the Health Canada presentation, that there were 11 investigations into alleged violations currently underway—how long have these investigations been ongoing?

The committee will recall that of the 11 investigations, four concerned MRI-CT services, three involved user fees, and four abortion services. The MRI-CT services investigations are into MRI services in Alberta—that was launched in July 2000; MRI in British Columbia, December 2000; CT in Quebec, November 2000; and charges for MRI services in Ontario, first launched in December 1999 and renewed in May 2000.

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The three user charges involved investigations in Quebec and Alberta, which were each initiated in March 2000, and in British Columbia, which was initiated in June of last year.

Finally, in January 2001, discussion on abortion services was renewed with New Brunswick, P.E.I., Quebec, and Manitoba.

These are similar questions of the delisting of government services, of the services provided by provincial governments and Health Canada ensuring that the principle of comprehensiveness is upheld: what specific mechanisms are in place to resolve conflicts or disagreements as they arise; whether the federal government imposes penalties when alleged violations of the five principles occur; and whether Canada has a list of what is considered medically necessary hospital and physician services.

As I said, in terms of investigations under the mandatory or discretionary provisions of the Canada Health Act, we strive to work with the provinces in a transparent, open dialogue, bringing the issue of concern to their attention and asking them to investigate and report back. We often resolve issues of concern without implementation of penalties.

Do we have a list of what we consider medically necessary services? No, there is no such list that we maintain. With the evolution of medicine, services are often added. What we actually do maintain, as I've indicated and reported through the annual report, is a list of what services have been de-insured or what services have been added to the programs during the past year. So over time, you could see what marginal services have been added or what services have been removed, but we do not maintain a list of services.

Did I answer all of your questions?

Ms. Judy Wasylycia-Leis: I'm sorry, but I don't think my three questions on the Canada Health Act have been addressed.

The first has to do with the additional money and its breakdown, the process around getting staff in place.

The second has to do with—it's part of those 11 investigations—what communication has officially gone from the Minister of Health to the provinces, and is it pursuant to the act.

The third is about the 37 cases that I understand were registered with your department from the Friends of Medicare in Alberta.

Mr. Frank Fedyk: Yes, actually we've not been able to assemble all the material for the copies of the correspondence from the minister. So that will have to be provided in response after.

Similarly, in terms of the investigation underway with respect to the Friends of Medicare, I can indicate that Minister Rock did send that material to his counterpart in Alberta after he had received it in July. He has received a response from Minister Mar, October 31, 2000, which indicated that due to the large volume of the material, some time would be required for a thorough review. We are awaiting that response from him.

In terms of the—

Ms. Judy Wasylycia-Leis: They're not considered an official complaint then before the department? They're not part of the 11 investigations?

Mr. Frank Fedyk: Yes, they are. These are payment for MRI services—

Ms. Judy Wasylycia-Leis: They're all lumped together as one.

Mr. Frank Fedyk: Yes, they are in one investigation.

Ms. Judy Wasylycia-Leis: Okay.

Mr. Frank Fedyk: I can provide details on the $4 million additional increase of funding.

In general, the increased resources have been spent on new staff in our regional offices and headquarters and associated operating expenses. By early in the new fiscal year, 18 staff will be working on CHA monitoring assessment, information gathering, and reporting. This includes 12 individuals in our regional offices, two in each of the six offices that my colleague described, and six individuals at headquarters. It's the intention to have a total of 25 new positions in place before summer.

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In terms of duties, these positions are enhancing Health Canada's capacity to better monitor and assess compliance with the act. The total salaries and benefits associated with those staff will be approximately $2.5 million of the $4 million. The operating budget of about $1.5 million is being used to develop and implement a CHA information system, expand and improve the CHA annual report and its accountability, and enhance policy capacity on the management of CHA issues and CHA interpretations.

The Chair: Are you satisfied that you have either an answer or a promise for a written response on the questions you submitted?

Mrs. Diane Ablonczy: I have them for all except numbers 10 and 11, Madam Chairman. I know that number 10 was dealt with yesterday and that in fact there is no regulatory requirement.

My question really relates to testimony at the Walkerton inquiry, which suggested in fact—if I heard correctly—the federal government's complement of water inspectors or personnel to monitor water quality in lands under federal jurisdiction was, shall we say, lacking. I just wondered if you had any comment on that or if you see it as an issue, and if that's being addressed.

Mr. Robert Lafleur: Madam Chair, Dann Michols, who was here earlier today, addressed this question, but not specifically this particular aspect of the question. I think we don't have anyone here who can answer that question. So with your support, we'd like to provide the answer in writing.

Mrs. Diane Ablonczy: Sure, that would be fine.

The Chair: And there's one more.

Mr. Robert Lafleur: For question 11, may I come back to that in a minute?

I would like to just finally resolve the remaining questions from Ms. Wasylycia-Leis, six questions regarding food safety and surveillance of beef products.

The first three really pertain to the jurisdiction of the Canadian Food Inspection Agency, so the answers would have to come from them. We can certainly, on behalf of the committee, convey the questions to them, but the answers would essentially have to come from them.

With respect to the other three questions, they are rather complex and we'd like to provide answers in writing to those.

Ms. Judy Wasylycia-Leis: With respect to the last three, I'm just wondering if you've got a sense of how much time it would take you to provide written answers.

Mr. Robert Lafleur: We'll make our best effort at being efficient; that is what I can commit to. I can't give you a specific time, but we certainly have been responsive to the committee in the past and we intend to continue.

Ms. Judy Wasylycia-Leis: Okay. Now, with respect to the first three questions, I hear what you're saying in terms of the role and responsibility of the Canadian Food Inspection Agency. But I'm confident that, based on previous presentations by the department and public overviews of the role of the department, in fact the minister has responsibility for the health side of the food inspection system. In fact, your department sets the standards that are then administered by the agency.

In light of that, would it not be possible for you to answer the first three questions? Basically I'm asking what is the standard of this government with respect to ruminants being fed to ruminants? What is the exact number of animals being tested for diseases? That in fact was referenced by the officials on Tuesday, so I was just looking for a follow-up to precise figures around cattle being inspected.

Third is the whole question of products that are now permitted in Canada around which there are huge questions in terms of the transmission of mad cow disease. We're talking about human health; we're talking about the role of the department in setting standards. I know the agency reports to both the Minister of Agriculture and the Minister of Health. Can I get answers on those aspects that pertain to human health and food safety?

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Mr. Robert Lafleur: I can certainly appreciate your interest, and you can certainly get answers to the extent that Health Canada can provide them with reference to human health issues, but the questions I have before me are really program execution issue questions. They relate to the mandate of the Canadian Food Inspection Agency, and we wouldn't want to attempt to answer on their behalf. I'm sure they would be willing to provide the answers to the committee, but they have to be informed that the committee would like those questions answered.

The Chair: Can you informally relay those questions to them so that we can expect an answer, or do we have to get into some big thing of writing them a letter?

Mr. Robert Lafleur: We'll certainly do that, Madam Chair.

The Chair: Thank you.

Ms. Judy Wasylycia-Leis: I just wanted to say I may not have phrased the questions properly. I'm not looking for program execution; I'm looking for the standards and the studies and the science that is then used for administering the programs and for ensuring surveillance of our food system. I think something as basic as Canada's response to the World Health Organization's recommendation for a ban on animal feed being fed to animals is something in the purview of the health minister. That's policy, it's standards; it's not implementation of standards that are already predetermined. I think that should fall within your jurisdiction, and I hope we can get answers. If we can't, I'm little worried about the state of our food safety.

Mr. Robert Lafleur: All the information we have is your information and it is the public's information. We'll certainly make our very best effort to answer as many of these questions as we can, and, should the committee so wish, we'd like to come back to address these. Perhaps a briefing on BSE and TSE, our relationship with the Canadian Food Inspection Agency, and our roles might be useful to the committee at this stage.

The Chair: Perhaps you could also—

Mr. Robert Lafleur: There are certainly many issues on which we work in very close collaboration, and the line of distinction is often difficult to see.

The Chair: Perhaps you could relay to the senior policy person in the department Ms. Wasylycia-Leis's opinion that it certainly should be part of our health policy that then is implemented by the agency. The Health Policy Branch should be able to articulate the policy statements upon which the agency is expected to act. If they don't want to do that, I think we'll want to know why.

I thank you now for those answers, but I'm looking at the clock and I understand that Mr. Lunney hasn't had a chance yet, so I'm wondering if we could turn to his questions. I believe he submitted some.

Mr. James Lunney: I did submit four questions. I think they went in a little bit late, and the response I got...did you not receive them, Mr. Lafleur?

Mr. Robert Lafleur: No, we didn't, but if you want to restate them, there may be some that we can answer. If not, we'll certainly—

Mr. James Lunney: There were four questions, but a couple of them have been addressed already. I understood the department was going to undertake to respond in a written manner.

The first two were in regard to first nations and audits and so on, but I think they have been addressed already. There was one on the Canadian Food Inspection Agency. Another one addressed primary care, which was touched on just briefly here, and there was a fourth one on genetically modified foods.

GMOs are a safety issue. I think one of your officials talked yesterday about risk management, which is certainly part of Health Canada's mandate. In terms of risk management, there's a big concern here about the effect of some GM foods on human biology—viral genes, bacterial genes being found in human liver and in other human tissue, even in brain cells. The implications of this have potentially staggering implications for health. From a risk management aspect, I think the Canadian Food Inspection Agency alone should not be the only one concerned about that. I think our health policy....

I would be interested in what is being done to address those concerns. Do you have the written version of my question in front of you?

Mr. Robert Lafleur: No, I'm sorry, I don't. All I can say is that it is certainly an area of great discussion. There is a lot of science being looked at in the context of that, so perhaps the committee might want to invite back the officials for whom this area is the one primarily being worked on. That certainly would include I think Diane Gorman, who is the ADM of food products safety.

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Mr. James Lunney: The other issue that I don't think has been addressed, but rather just touched on very briefly, is the issue of primary care. Under the issue of effectiveness and cost-effectiveness, which I think are related to it, I was curious as to where they're going in terms of reviewing primary care and as a committee in discussing it. In terms of effectiveness and cost-effectiveness, since the Canada Health Act came in, there has been a tremendous expansion of services available to Canadians. There are many health care dollars being spent now currently outside the system.

In particular many of the provinces partially fund programs for other services in a very limited manner. One of the most notable is chiropractic care, where almost all provinces I think partially fund services of this nature.

In determining what services Canadians really want, is there not a role for the federal government to give some assistance, as perhaps where the whole definition of medically necessary services is left in the hands of one particular interest group in health care delivery? There's a lot of interest from Canadians in determining the health services they consider very important and perhaps primary that they're not receiving right now, or are having to pay large sums of money in some cases to access.

I'm addressing this particular question on behalf of chiropractors. They're the third largest primary contact health profession in Canada, numbering about 6,000 practitioners. This discussion of two-tier came up during the election campaign. Patients using chiropractic services who have to pay out of their pocket to access them wonder what you're talking about. These are services that they feel are very important to them and relieve very serious conditions. They're finding that they're getting relief from this avenue of service, which they haven't found under traditionally funded services.

So is some consideration being given to expanding or perhaps redefining essential health services? Perhaps we could have some input from health care economists and other aspects of society that may have something to say about which services are cost-effective.

Mr. Robert Lafleur: Madam Chair, these and other issues are regularly discussed at federal-provincial-territorial ministers of health meetings. I think most of those questions would be better addressed to the minister. They are of a policy nature and I think are not with respect to how the department is currently functioning, which are the areas we're most prepared to talk about to the committee.

The Chair: If I may comment, Dr. Lunney, it's an interesting concept. We've had explained to us how medically necessary services are at this moment the purview of the provinces. But this committee is not precluded from discussing things that might allow the federal government to show some leadership. That might be one of the things we want to talk about. I know a few years ago the committee did look into—I forget exactly how they called it—essentially alternative products, which were not really included in much government action at any level. We did look into it. It was a new way of looking at health care, and they were successful. The committee was successful in broadening.... Well, we'll find out in another meeting how successful the committee was, but certainly they did their work and did it well. They presented a report and it caused the creation, I believe, of a directorate or something or other that the government is now working on.

Dr. Lunney.

Mr. James Lunney: I would just like to make a comment there. There are also some other medical services that are considered alternative that are not covered and funded in various significant implications for health care funding. In our province, and in my particular riding, there's a lot of interest in intravenous chelation, for instance. The implications for cardiac care are staggering, but their patients are paying thousands of dollars to receive treatment. That is according to evidence from other countries and evidence from people locally receiving such treatment. Various places across the country are receiving very effective care that saves the system a whole pile of money, but in fact they're having to pay to access those services outside the system. So that's one issue.

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The Chair: I think Mr. Lafleur is correct that it might be something to bring up when we first have the minister here.

Ordinarily we would have the minister, probably, as our first witness, but, because he has been ill, this of course has been delayed. But I believe after Easter he will be available to us, and we are free to ask him questions on a broad range of topics, whereas the officials are really here to discuss the mandate their department and the sections of the department have received. So they can't go into these broader topics.

Mr. James Lunney: I realize I covered a lot of territory there. Could I just ask to come back to one thing—that's perhaps the primary care? Is it possible to expand on what's being done with those discussions on primary care or redefining primary care?

Mr. Frank Fedyk: I'm sorry, we'll have to get back with further written responses. The focus, in terms of the work on the primary care health transition fund, has been to iron out the criteria with respect to access of that by the provinces and territories. I know there is a large amount of other work that has been done in terms of the effectiveness and cost-effectiveness. Unfortunately, we'll have to provide written responses or invite other officials to elaborate.

Mr. James Lunney: Thank you.

[Translation]

Mr. Yvon Charbonneau (Anjou—Rivière-des-Prairies, Lib.): Madam Chair, as we are at the beginning of our mandate, it is important that the members of the opposition can have all the time they want to discuss, with the officials first, and then with the minister, when he is available, about the questions they are willing to raise. I can tell you that, on this side, we do not object at all to having other working sessions with the appropriate officials if there are questions which cannot be answered today, because they are not exactly under the jurisdiction of our witnesses.

I heard some questions from members of the opposition, on which we could certainly have some interesting exchange with the appropriate deputy ministers or directors in the next few days. Of course, when the minister is back—we don't know exactly when but probably in a few weeks—, he will be able to take over himself a number of those big questions. In order to clear the road and to enable the honourable members of the opposition to have the best possible lighting, as early as possible, on those important matters, we don't object at all to an extension of this exchange as soon as you see fit, in the course of the next few days.

[English]

The Chair: Thank you, Mr. Charbonneau. I think Ms. Ablonczy has a comment.

Mrs. Diane Ablonczy: I'd just like to thank the witnesses here. I know sometimes we, especially the opposition, go at these things with probably a little more vigour than we need to, and we need to bear in mind the chair's observation that you people are here to orient us into the department and to its work. We appreciate the tremendous patience you've demonstrated in responding to us. We really appreciate it, and thank you very much. I know Mr. Glover is feeling very left out here, but—

The Chair: He's still smiling.

Mrs. Diane Ablonczy: We appreciate him being here, too.

The Chair: Thank you, Ms. Ablonczy, and that eliminates the necessity for me to go into a big thank you. But be assured that I'm very grateful to you and speak for all members of the committee on that account.

We will expect the clerk to keep a list of those questions, the answers which are going to come back to us in written form. As Mr. Charbonneau has pointed out, we reserve the right to invite you, or other members of the department, back to discuss further with us.

We have not made our—even short term—work plan, and when that evolves we will keep you apprised of it so that you will have an idea of when we might need certain people to come back. But for today, I thank you very much.

For the other members of the committee, as I said, there are several issues of business we haven't talked about. We haven't talked about either a short-term or a long-term planning exercise. We haven't talked even about some of the more detailed rules. I promised I'd come back to you with speaking times and minutes. Now we had the luxury today of only having a few of us, and I think a committee of five is supposed to be perfect, and I think today it was.

Mrs. Diane Ablonczy: Great restraint on the government side, too.

The Chair: So I think we have to sort out some of these details.

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I was going to suggest to you that, with your permission, we could have that planning session on Tuesday. That's because I think people were talking about accountability in one of the earlier meetings. If it was not at one of our meetings, it has certainly been part of the discussions around parliamentary reform in terms of the need for committees to do their accountability function.

I wondered if you might like to have the Auditor General next Thursday, before this month winds down and he's gone. We might have the acting Auditor General apparently, but I asked the clerk to inquire about that. He or she is not available on Tuesday, but might be able to come on Thursday. Would you like us to confirm it so that we have something to do on Tuesday and something valuable on Thursday? Do I see a concurrence?

Some hon. members: Yes.

The Chair: Thank you very much. The meetings will be held at the usual time on those two dates, and the clerk will get your notice out to you.

I'm hoping the answers to the questions come to the clerk, who will dispense them to all members of the committee. If by chance that doesn't happen and Mrs. Ablonczy gets an answer to her question—

Mrs. Diane Ablonczy: I'll share.

The Chair: Yes, you will alert the clerk to that. Thank you very much.

Thank you for your cooperation and your restraint. I think we're off to a good start from the point of view of courtesy and respect for one another, so I hope we can continue that.

This meeting is now adjourned.