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37th PARLIAMENT, 1st SESSION

Standing Committee on Health

COMMITTEE EVIDENCE

CONTENTS

Tuesday, February 26, 2002

1145

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

Ms. Maria Barrados (Assistant Auditor General, Office of the Auditor General of Canada)

The Chair

Ms. Sheila Fraser (Auditor General of Canada)

Ms. Sheila Fraser

1150

1155

The Chair

Mr. Rob Merrifield (Yellowhead, Canadian Alliance)

Ms. Sheila Fraser

Mr. Rob Merrifield

Ms. Sheila Fraser

Mr. Rob Merrifield

Ms. Sheila Fraser

Ms. Patricia MacDonald (Principal, Office of the Auditor General of Canada)

Mr. Rob Merrifield

Ms. Sheila Fraser

Mr. Rob Merrifield

Ms. Sheila Fraser

Ms. Maria Barrados

1200

Mr. Rob Merrifield

Ms. Maria Barrados

Mr. Rob Merrifield

Ms. Maria Barrados

Mr. Rob Merrifield

Ms. Sheila Fraser

Ms. Maria Barrados

Mr. Rob Merrifield

Ms. Sheila Fraser

Ms. Maria Barrados

1205

Mr. Rob Merrifield

The Chair

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

Ms. Maria Barrados

Mr. Réal Ménard

1210

Ms. Maria Barrados

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

1215

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Sheila Fraser

Mr. Ménard

Ms. Sheila Fraser

The Chair

Ms. Judy Sgro (York West, Lib.)

Ms. Sheila Fraser

Ms. Judy Sgro

Ms. Maria Barrados

Ms. Judy Sgro

Ms. Maria Barrados

1220

Ms. Judy Sgro

Ms. Sheila Fraser

Ms. Judy Sgro

Ms. Maria Barrados

The Chair

Ms. Hélène Scherrer (Louis-Hébert, Lib.)

Ms. Sheila Fraser

Ms. Hélène Scherrer

Ms. Sheila Fraser

Ms. Maria Barrados

1225

Ms. Hélène Scherrer

Maria Barrados

Ms. Hélène Scherrer

Maria Barrados

Ms. Hélène Scherrer

The Chair

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP)

1230

Ms. Sheila Fraser

Ms. Judy Wasylycia-Leis

Ms. Sheila Fraser

The Chair

Mr. Jeannot Castonguay (Madawaska--Restigouche, Lib.)

Ms. Sheila Fraser

1235

Mr. Jeannot Castonguay

Mr. Peter Simeoni (Principal, Office of the Auditor General of Canada)

The Chair

Mr. Rob Merrifield

Ms. Sheila Fraser

Mr. Rob Merrifield

Ms. Sheila Fraser

Mr. Rob Merrifield

Ms. Maria Barrados

Mr. Rob Merrifield

1240

Ms. Maria Barrados

Mr. Rob Merrifield

Ms. Sheila Fraser

Mr. Rob Merrifield

Ms. Sheila Fraser

Mr. Rob Merrifield

Ms. Sheila Fraser

Mr. Rob Merrifield

Ms. Sheila Fraser

Mr. Rob Merrifield

The Chair

Ms. Judy Wasylycia-Leis

Ms. Sheila Fraser

Ms. Judy Wasylycia-Leis

Ms. Sheila Fraser

Ms. Judy Wasylycia-Leis

The Chair

Ms. Judy Wasylycia-Leis

1245

Ms. Sheila Fraser

Ms. Maria Barrados

The Chair

Mr. Réal Ménard

Ms. Sheila Fraser

1250

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Réal Ménard

Ms. Sheila Fraser

Mr. Peter Simeoni

Mr. Réal Ménard

Some hon. members

The Chair

Ms. Sheila Fraser

The Chair

Ms. Sheila Fraser

Ms. Maria Barrados

1255

The Chair

Ms. Maria Barrados

The Chair

Ms. Maria Barrados

The Chair

Ms. Maria Barrados

The Chair

Ms. Maria Barrados

The Chair

Ms. Maria Barrados

1300

The Chair

CANADA

Standing Committee on Health

NUMBER 059

1st SESSION

37th PARLIAMENT

COMMITTEE EVIDENCE

Tuesday, February 26, 2002

[Recorded by Electronic Apparatus]

Á (1145)

[English]

The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Good morning, ladies and gentlemen. It's my pleasure to call the meeting to order and to welcome our honoured Auditor General and her staff, who have responded to our invitation to come before us and speak to that part of their latest report that affects the Department of Health.

I'll now invite Ms. Barrados to begin her presentation.

Ms. Maria Barrados (Assistant Auditor General, Office of the Auditor General of Canada): Mrs. Fraser, the Auditor General, will be doing the presentation.

The Chair: Thank you.

Mrs. Fraser.

Ms. Sheila Fraser (Auditor General of Canada): Thank you, Madam Chair.

We are pleased to be here today to have this opportunity to appear before the committee to discuss our work at Health Canada.

Accompanying me today are Maria Barrados, assistant auditor general, and Patricia MacDonald, principal, both of whom are responsible for our audit work at Health Canada, as well as Peter Simeoni, the principal who is responsible for our recent audit work on the management of grant and contribution programs.

Our office conducts various audits at Health Canada, including the following: value-for-money audits of Health Canada's programs, issues of environmental and sustainable development, and government-wide management issues; a financial audit as part of the annual public accounts; and an annual audit of the financial statements of the Canadian Institutes for Health Research.

Today I would like to talk about three value-for-money audits that our office reported in December of this past year. The first deals with population health programs. Chapter 9 of our last report dealt with population health programs. Through the population and public health branch, the federal government provides leadership and support for preventive health activities.

In 2000-2001, the branch managed 12 population health programs directed at such issues as HIV/AIDS, prenatal nutrition, and diabetes. Using grant and contribution agreements, the branch spent $225 million on about 1,800 different projects across the country for the delivery of population health activities.

We highlighted two major areas of concern in our December 2001 report. First, while we found a clearly defined management process for grants and contributions, it was not consistently applied. We identified a number of cases where there was chronic disrespect for and ad hoc use of the management process. Second, we found that the branch had failed to measure and report on the impact these programs have had on the health of Canadians. I will briefly comment on each of these areas.

We reviewed a sample of projects selected from three population health programs and found inconsistent management practices. The projects in the Canada prenatal nutrition program were generally well managed, but many projects in the HIV/AIDS strategy were poorly managed, regardless of the dollar amount involved. For example, we found projects that were approved despite concerns that had been identified during the selection process. We also found several cases in which the branch had failed to take timely action to remedy identified problems with projects that were under way.

Six large national projects in the population health fund suffered from specific and significant problems. In particular, management did not have the proper authority to fund projects for prostate cancer research and enhanced fitness activities. Further, these projects were not subjected to the required selection and approval processes. We believe the branch should take corrective action to ensure that the procedures for selection, approval, monitoring, and evaluation of all projects follow the established project management process.

[Translation]

Ms. Sheila Fraser: We found that the evaluation of population health programs is generally weak. Objective information on the effectiveness of the three programs that we looked at was limited, and little progress has been made in developing performance indicators.

The Branch does collect some national data on individual projects in the Canada Prenatal Nutrition Program, which provides information on Health Canada's investment in infant and maternal health.

However, the information that Parliament receives on population health programs does not provide a clear picture of the extent to which the $225 million spent on programs has improved the health of Canadians.

We believe that the Branch needs to improve the measurement and reporting of program results. We made recommendations for dealing with each of these problems, and I am pleased to note that Health Canada accepted all of them. In fact, management began working on some of these issues before we had finished the audit.

In Chapter 5 of the 2001 Report, we presented a government-wide look at the management of grant and contribution programs, which included an audit of the Canadian Institutes of Health Research. We examined the organization's operating grants program, which in 2000-01, the period covered by our audit, provided $190 million in funding to medical researchers in Canadian universities and hospitals.

We were impressed with the rigorous way that the organization selected the research projects that it funded. I uses a peer review system, and we concluded that this system is working well.

However, while project selection was rigorous, other aspects of the management of the program were not. We found that the organization did not track how quickly grant recipients were spending the money or take action on large, unspent balances. Nor was it systematically tracking the results of the research it funded.

We also found that the organization had few results measures for the operating grants program, despite the amount of money it handled every year. Not surprisingly, scarce performance information meant that reporting on performance to Parliament was also limited.

I am pleased to note that the Canadian Institutes of Health Research accepted all of our recommendations. Similar to Health Canada, management began working on some of these issues before we had finished the audit.

Let us now talk about illicit drugs.

Illicit drugs are an important issue for Canada because of their significant negative impact on the health of Canadians and our economy.

In chapter 11, we examined the issue of leadership and co-ordination among the players.

Since 1987, Health Canada's role is to provide national leadership and co-ordination in efforts to control illicit drugs. It has chaired the two key interdepartmental committees on illicit drugs, and it provides co-coordination through the Office of Canada's Drug Strategy. However, most of the federal government's related activities are in law enforcement. the federal government's changes to legislation relevant to illicit drugs over the past five years have largely focussed on reducing supply (enforcement) rather than on reducing demand.

Á (1150)

For Health Canada, the illicit drug problem is secondary to a great many other health issues. The Department's authority and role as coordinator of the Drug Strategy is limited to providing secretarial services.

[Translation]

We understand that the renewal of Canada's drug strategy is under way, and we recommend that the government review the current mechanisms for leadership and coordination within the federal government.

Finally, I'd like to take a few minutes to discuss future audit work. I have recently identified five priority areas to address during my term as Auditor General. One of those priorities is the well-being of Canadians, which includes health. Plans on how to address this priority over my term are being developed. I would be pleased to present to the committee a copy of my long-term plans once they are finalized, and I would welcome any suggestions you may have on areas of interest.

In September of this year, we will be tabling a progress report on “Federal Support of Health Care Delivery”, a follow-up to chapter 29 of our 1999 report, as well as “National Health Surveillance: Diseases and Injuries”, which was chapter 14 of our 1999 report.

We will also be auditing in September the accuracy of Health Canada's report on health indicators, as agreed to by the first ministers.

Finally, in December of this year, we will be reporting on Statistics Canada's handling of health statistics.

Madam Chair, we thank you for your interest in our work at Health Canada. My colleagues and I would be happy to answer your questions.

Á (1155)

The Chair: Thank you, Ms. Fraser.

I forgot to apologize for the fact that we kept you waiting. It was beyond our control, but we still felt badly that you were sitting here waiting for us.

We'll move now to questions, beginning with the lead opposition critic, Mr. Merrifield.

Mr. Rob Merrifield (Yellowhead, Canadian Alliance): Thank you very much.

It's interesting, as always, when you have the auditors here and you can take a look at exactly what's happening, on a third-party view of health care.

The first question--and I think you alluded to it--is, was Health Canada very cooperative in the audit? There were no problems that way?

Ms. Sheila Fraser: Yes, Health Canada has always been very cooperative with us.

Mr. Rob Merrifield: With the first group, talking about the grants and contributions in the population and public health branch, my questions are, why do you think the problems were in the administrative side of that, and where did that come from?

Ms. Sheila Fraser: Well, Madam Chair, it's actually quite difficult for us to give a reason, because we did find some programs that were very well managed. So there seems to be an inconsistency in management practices in the department. We found good examples of management, and on the other hand, we found some that were actually very poorly managed. I don't know that there's anything systemic.

Mr. Rob Merrifield: Was it lack of information, was it lack of human resources, or was it political interference?

Ms. Sheila Fraser: I don't believe it was a question of lack of information. There was, as we mentioned, in one program a disregard for authorities that had been put in place for the program. In another one, I think there was just a general kind of sloppy management.

Perhaps Ms. MacDonald would like to elaborate a little more.

Ms. Patricia MacDonald (Principal, Office of the Auditor General of Canada): I would just confirm what Ms. Fraser has said, that we certainly found that the management process was in place. There was a good process in place. In some cases, there was a failure to follow it because of lack of capacity, lack of training, and lack of understanding.

Mr. Rob Merrifield: That's a lot of “lacks”.

The other concern I have is that you just took a sample of the grants and contributions to audit. Do you feel it is systemic throughout all of the grants and contributions portfolios?

Ms. Sheila Fraser: Actually, we looked at the government-wide audit on grants and contributions, grants and contributions throughout government, and we did find problems in, I would say, all of the programs to varying degrees and nature.

Within Health Canada, we focused on the major areas in population health, so I don't think we can generalize to the rest of Health Canada.

Mr. Rob Merrifield: You're not willing to guess--that's what you're saying. But would you think there's anything in the other areas that's different from the ones you audited that would show there's not a problem there or there may be the same problems in other areas?

Ms. Sheila Fraser: I'll let Dr. Barrados answer, because she has done a fair bit of work with Health Canada over the years.

Ms. Maria Barrados: We also did audit work on first nations health, and we did come to this committee on those reports. In that area there were also problems with the management of grants and contributions.

I think one of the other things I'd like to add in terms of the comments about managing these programs is that an area like population health has a really broad mandate; there are a lot of issues, a lot of topics, that are of interest and concern. The real challenge for the department is to focus, and to focus the priorities. What we saw in those programs was that where there was a clear consensus on the priority, they really went at it, such as in the prenatal nutrition program. But in the others, you had other priorities that came in and they didn't really fit, and that caused a big problem.

Â (1200)

Mr. Rob Merrifield: There were other priorities. So that gets back to my other question then. Is it political considerations perhaps that you're referring to?

Ms. Maria Barrados: In our audit work we go through all the audit files. We look in a lot of detail in terms of how these things are approved. At the end of the day it's the minister who approves all these grants and contributions. So there is a responsibility on the part of the minister.

Could we say who put these agendas on the table? No, we couldn't say that from all the files we looked at.

Mr. Rob Merrifield: You've alluded to it, so I'll ask the question in regard to first nations. You've reported before that with the Virginia Fontaine Addictions Foundation there are certainly considerations in terms of the problems there; it's under an audit. Can you tell us, in your opinion, has there been progress in that file? Have things changed? Are we improving there, or do we still have systemic problems?

Ms. Maria Barrados: My understanding is that the department is pursuing that vigilantly. They have done detailed audit work and they have turned things over to the RCMP.

Mr. Rob Merrifield: Let's change focus a little bit then and get into the illicit drug side of it. While we're on first nations, I'm wondering if you did anything specific on first nations with regard to illicit drugs. Are the problems you see there, with the concentration being strictly on enforcement rather than looking at supply and demand, you might say, worse, or is it the same?

Ms. Sheila Fraser: In this audit we focused mainly on the role of Health Canada and the other federal departments, how well that was being coordinated, and what kind of information was available for decision-making. At that level we did not go down and look at specifics, for instance, of first nations or other people to see how they are coping with this problem.

We did recognize in the report that there had been many changes in society and that the drug problem is becoming more prevalent and more important; that a lot of environmental factors have changed this. One of the issues we raised is the lack of information for the whole drug strategy, the incidence, and how it's being dealt with. The last report in fact is a report based on data that's almost 10 years old, so there's a serious lack of information. But we didn't get into specific communities or groups.

Ms. Maria Barrados: If I could add to that, in fact, specifically for chapter 11 we did exclude Health Canada's national native alcohol and drug abuse programs in the effort to try to capture what the total government expenditure was on that. We did look at that package of programs in the other audits.

Mr. Rob Merrifield: On that as well, we talk about illicit drugs, and the problem with that is across Canada. I think we're all aware of it, and I think you're very accurate in suggesting that just enforcement isn't going to solve the problem; we have to look much deeper than that.

But I'm wondering, when we speak of illicit drugs, if we're speaking as well about the overlap with prescription drugs and of perhaps dealing with the impact of the misuse of prescription drugs and asking if that is out of hand. Some of the figures coming through my office indicate that numbers of people are actually losing their lives to prescription drugs and the inappropriate use of those. You ask for suggestions perhaps of areas to study. Is this one you might consider?

Ms. Sheila Fraser: I would just add, Madam Chair, that the only area I know we've worked on...we did look at prescription drugs as they refer to first nations people. Perhaps Dr. Barrados could.... Other than that, I am not aware that we have done any other work.

Ms. Maria Barrados: In the first nations area, we looked at prescription drug usage and raised a number of concerns. There are limits set by provincial systems, and the use of some of these drugs, particularly some of the narcotic-type drugs, was way above what one would expect. So we have had a number of recommendations to Health Canada, because they have a clear role in controlling that program. They have a responsibility for delivery.

The issue for Health Canada, and what we can do in our role, is what the federal government's responsibility actually is. It's not really obvious to me where the federal role would be in dealing with that, apart from the whole management of the drug and the drug approval process, and the whole system that is in place for monitoring what occurs once a drug has been approved. That is different, I understand, from the point you're raising.

But I'll certainly make a note of it and take a look when we're doing our planning.

Â (1205)

Mr. Rob Merrifield: I just want to emphasize that I think it's an area where there's a tremendous vacuum. From the letters I'm getting, there is certainly a significant problem in that area that needs to be addressed. So I would encourage you to consider that.

The Chair: Thank you, Mr. Merrifield.

Mr. Ménard.

[Translation]

Mr. Réal Ménard(Hochelaga--Maisonneuve, BQ): Thank you, Madam Chair. I would like to ask three questions.

I would like you to remind the committee of the project approval process. You have talked about the population's health and the Canadian Institutes for Health Research, on which the committee had gambled much two years ago when they were created. I would therefore like you to remind us of the project approval process. There is a Regional Branch. Then there are the auditors, the deputy ministers and the Minister.

How can we end up with the kind of permissiveness that you describe when there are normally three levels of approval? Do we have reason to be worried about the fact that there are people who have not done their job and would you go so far as to place the responsibility at the deputy minister level?

Ms. Sheila Fraser: I may ask my colleagues to give more detail about the process. There are in fact projects that have been approved, especially in one of the programs we examined, despite the concerns that had been raised during the file review.

Mr. Réal Ménard: By whom? By the first level?

Ms. Sheila Fraser: I assume they were raised at the first level, but problems were raised during the file reviews.

Mr. Réal Ménard: Based on your understanding, the approval process has a first level, at the line manager level. As a Montréal MP, I am in contact with the Regional Branch managers in Montréal. they are more aware of the field work. In your mind, if we exclude the Minister, is the deputy minister ultimately responsible, at the administrative level, for the approval of functional projects that respect the intent of the law?

Ms. Sheila Fraser: I believe that in our Parliamentary system the Minister is always responsible.

Mr. Réal Ménard: Yes, but let us exclude the Minister because it has to be resolved at another level. I am talking about the administrative channel.

Ms. Sheila Fraser: Yes, obviously it is the deputy minister who is ultimately responsible for management in his department.

Mr. Réal Ménard: On what basis can you explain the fact that projects have been approved outside channels or raised concerns at the first level? Did you think about political interference?

Ms. Sheila Fraser: As Dr. Barrados mentioned a while ago, we have looked at the files. Obviously there was not always an explanation of why certain projects were accepted despite the concerns expressed previously.

I remember one case where we noted that the amount granted was much larger that the amount suggested or approved. The reason for that was obviously not documented and that is why we raise it as an issue.

Mr. Réal Ménard: Your audit was of national scope, covering all provinces. Did it seem to you that there were geographic areas that stood out more than others in terms of administrative permissiveness?

Ms. Sheila Fraser: No, I think it was fairly general.

Ms. Maria Barrados: It's national.

Mr. Réal Ménard: So, in terms of explanation, it's clear that it is at the deputy minister lively that there is a lack of rigour that causes some programs to be outside the standards and that monies have been unjustly spent.

Â (1210)

[English]

Ms. Maria Barrados: The issue is that when government sets up rules and conditions for what you spend the money on, as the auditors we expect the rules and conditions to be followed.

On the example of funding of projects for prostate cancer, we do not want to imply that they were not valuable projects. But when we looked at the terms or rules that said how you could spend the money in the population health fund, that didn't apply. As auditors we're saying you didn't follow the conditions you set out for the population health fund. Then it leads us to the question of whether you are really doing what you intend to do with the population health fund.

[Translation]

Mr. Réal Ménard: I have two other questions.

We understand that in the case of the Population Health Fund we wanted the program to be broader than the others. I understand that this was because we wanted to avoid the trap of too-sharply focussed programs. It happens that as members we ask the government that there be some maneuvering room in program interpretation.

I am coming back to the drug issue. You know that there is a specific committee, before which you have in fact testified, that is reviewing our colleague Mr. Randy White's motion. In fact, what you are saying is that at this time the government doesn't know how much money it is investing in the struggle against illicit drugs. In other words, the government is not at all in control of its policies in this area.

Ms. Sheila Fraser: It's true that the government doesn't know how much money is being spent in this area. In fact we have compiled our own statistics and they are in our Report. We noted that some $500 million were spent in this area. I would point out to you, as we told the committee, that only 5% of this money is for prevention and demand reduction activities.

Mr. Réal Ménard: On the other hand, can we put in the balance the fact that in terms on the struggle against illicit drugs there is a good part of the budget that goes to the Solicitor Genera. and that if there were a specific responsibility centre to be negatively identified it is not obvious that it would be Health Canada? It would be the RCMP or the solicitor General, would it not?

Ms. Sheila Fraser: Obviously there are a lot on intervenors, as you mentioned: the Solicitor General, the RCMP, and also the Customs and Revenue Agency, which has prevention activities at the borders; the Justice department and the Correctional Services are also active in this area. I would however point out that a decision was taken to give the co-ordination responsibility to Health Canada.

Mr. Réal Ménard: So it is ultimately the Health Minister who should see to the coordination of all the intervenors in the question of illicit drugs.

How do you explain that we have no control? You mentioned that there are 11 or 14 decision centres I believe. Is it because there are people making decisions that don't go all the way to the ministerial level or is it because the ministers just don't have control over the bureaucratic apparatus?

Ms. Sheila Fraser: When we talk about illicit drugs, we have to say that it is a very complex issue, with a lot of intervenors at the federal level, but also at the provincial and even municipal levels. So there are a lot of players. What we deplore in our report is the lack of information about whether the program is successful or not. There is very little data that allows us to be aware of program performance. we also raise the issue of coordination between the intervenors.

Mr. Réal Ménard: So there is a problem: there is no real program evaluation policy in the Health department. There was one for the National Strategy on AIDS, but for drugs, for which there are other types of intervention, there is no real evaluation policy.

Ms. Sheila Fraser: I assume that there is a general evaluation policy. Health Canada has the coordination responsibility but, as we indicated in our audit, we doubt that it is as high a priority for the department as it is for other intervenors.

Â (1215)

Mr. Réal Ménard: here is a last question. When you get up in the morning and read your report, are you a little discouraged, very discouraged or totally discouraged? what is your state of mind in terms of Health Canada? Don't be afraid to answer. Are you a little, very or totally discouraged?

Ms. Sheila Fraser: You know, las auditor General, one cannot be too discouraged.

Mr. Réal Ménard: You must answer Parliamentarians' questions. A little, very or totally?

Ms. Sheila Fraser: The were cases of management weaknesses that in my opinion were unacceptable.

Mr. Réal Ménard: So you are pretty discouraged.

Sheila Fraser: I think there were really cases that were not acceptable from our point of view.

Mr. Réal Ménard: Don't be afraid to speak.

Ms. Sheila Fraser: But I don't become discouraged. The Department has indicated its intention of solving the problems. It agrees with our recommendations and has put in place a process to improve the situation. So I am not discouraged.

[English]

The Chair: Thank you, Mr. Ménard.

Mrs. Sgro.

Ms. Judy Sgro (York West, Lib.): Thank you, Madam Chair.

It's always interesting when we get the auditors in. I think one of the things that always concerns me is the government is so big. It's so difficult to track the thing. So I'm always glad that an auditor goes around and double-checks those things and tries to help guide the departments to stay in focus.

You've used the word “coordination” and “the lack of coordination” a variety of times in this report. I hear this a lot, that there's a need for more coordination among many of the departments in pursuing their objectives. And the drug strategy is one that definitely needs a variety of departments at the table.

How do we overcome those challenges as parliamentarians to help our ministers achieve that, and to help the government to achieve that goal throughout the system? Do you have any suggestions on that?

Ms. Sheila Fraser: I think you've raised an excellent issue. I think we've noticed in many of our audits that there is too much stovepiping. It's how one deals with the horizontal issues in government especially. If we take an issue like illicit drugs, there are many players just at the federal level, and not even including the provinces and the municipalities.

I would hope that there could be stronger focus given to the coordination role. I think many departments become so caught up in their own day-to-day handling of issues. I think the illicit drugs one is one case where that coordination role is seen as not as high a priority as other files Health Canada has to deal with. But I agree that it is a challenge. I think it's a challenge that government will have to come to address as it goes forward. We will have to get much better at doing that.

Ms. Judy Sgro: In the 1999 project program impact assessment, there was reference made to mental health as being the costliest part of expenditures. There still doesn't appear to be any action plan put forward. You raised it in your audit work.

Ms. Maria Barrados: That's a point of fact. The reason we cited that particular example was because it was an example of an effort the department undertook to do the kind of analysis we were saying is so very important here. It was important that there be a survey, a looking around and seeing what all the needs were and the risks were, and then focusing on areas where there could be a meaningful population health intervention.

When the department undertook that, they identified mental health. But as we note, they didn't follow through in their response. That is an issue we find with Health Canada. They will identify a problem, they will commit to responding, but then the response is actually a little slower in coming than we would like.

Ms. Judy Sgro: Is there any method to put timelines on some of these responses that are needed in order to keep feet to the fire and keep agendas moving forward?

Ms. Maria Barrados: We come back. We do annual monitoring on where the recommendations are, what progress is being made. If we feel, and the Auditor General feels, that we need to do more work, we will do another full report.

Â (1220)

Ms. Judy Sgro: So we should see something coming forward at some point soon. If not, I guess we'll hear back from the auditor that nothing has happened.

Ms. Sheila Fraser: That's right.

Ms. Judy Sgro: Thank you very much.

Ms. Maria Barrados: It might also be interesting to ask the department how they are moving along in developing their wellness framework, and how they are moving the notion of that wellness framework to look at their current interventions and review all the lists of interventions possible.

There's a much greater demand for population health activities than the department has the funds or capacity to do. It might be a very good set of questions to the department.

The Chair: Thank you very much.

Thank you, Ms. Sgro.

Madame Scherrer.

[Translation]

Ms. Hélène Scherrer (Louis-Hébert, Lib.): Thank you very much.

I would like to continue with prevention and health promotion. What bothers me a little at that level is the setting of priority selection criteria.

We spoke a while ago about mental health. I get the impression that in the last few years there has been an extremely rapid evolution in society's needs. We now talk a lot about obesity, sedentariness, smoking, which for me are all very important.

As for the setting of priorities, is the ponderousness of the machinery such that it takes an incredible amount of time before we say that we have an obesity problem? We have chosen certain programs, we have invested in these programs without performance indicators and we don't know if our programs are no longer relevant or are no longer a priority. Is it because we lack information? How is it that we cannot remold our priorities or come back to those that people live by now in terms of health?

I get the impression that you seem to be saying that we are not necessarily aiming at the right priorities now, that we are all over the map and that our resources are too spread out.

Ms. Sheila Fraser: Yes, Madam Chair, we indicated in our audit that there were no programs to evaluate priorities properly. There was a start at a process, but it was never tested or implemented. As long as there is no framework to prioritize issues, it's difficult to know if we are doing the right things. At the end of the process, the information compiled is just as inadequate, in our opinion, especially for Parliament to be able to evaluate whether the programs are reaching the desired goals.

I believe it may also be a question of finalizing the framework. We can come back again to the issue of priorities that the Department gives himself. We also have to admit that the Department deals with a lot of issues and a lot of demands, and that it is somewhat difficult to manage all that.

Ms. Hélène Scherrer: What are the sources of information? Is it Statistics Canada, for example, that publishes a report every five years. What are the information sources used?

Ms. Sheila Fraser: I will ask Ms. Barrados to answer.

[English]

Ms. Maria Barrados: There is a range of information sources, and that is very much one of the problems they face. They just don't have the kind of information they would like to have.

But there are different sources. You have statistics from Statistics Canada that they collect on a national basis. There will be arrangements made with some of the registers. For example, cancer statistics will flow from the registries to Statistics Canada, and Statistics Canada will provide them to Health Canada. You also have all the surveillance systems that are part of the laboratory centre for disease control.

We looked at those systems a few years ago, and they are not strong enough. There were a number of problems that we identified in those areas. The department made a lot of commitments to strengthen those systems, which will be the point of our audit for the fall. That is the only way you will get a national picture of what the problems are, in terms of disease, disease prevention, current disease, and injuries.

In addition to that, the department doesn't have a good enough system for performance measurement and evaluation of their own programs. You will have things that are spotty, but you won't have things that are systematic enough to allow them to put the information in the kind of framework they have.

Â (1225)

[Translation]

Ms. Hélène Scherrer: You have made good recommendations in many areas. What was the recommendation to deal with this problem?

[English]

Ms. Maria Barrados: We made a specific recommendation that the department should get a formal agreement for their framework.

They had done the PIAP process and then they developed another framework.

From our point of view, what's most important is you start working with a framework and you move forward on it.

So we made a recommendation that they finalize this thing and get this thing approved, and they agreed to do that and they did that.

We also made a second recommendation that they should ensure that they collect and coordinate the necessary evidence-based information they need, because the only way to make real progress in this whole area is to do it in an evidence-based manner.

Again, the response was that the department agreed. It is one of their priorities and they have a joint development project with Statistics Canada.

[Translation]

Ms. Hélène Scherrer: You seem to be saying that we are also lacking information on program performance. We don't have enough for evaluation and priority setting, and also on system performance. We can't evaluate whether or not we were aiming correctly.

Do the recommendations foresee a follow-up that will go beyond data collection and program evaluation? In the end, if the program didn't get results, it's crazy to repeat it.

[English]

Ms. Maria Barrados: Yes. We also made that kind of recommendation in the report and we did that specifically in the context of the programs we looked at. We had made the general statement that there wasn't the information they needed. In the particular programs, we looked at the kind of information and the kinds of evaluations they had in place.

The good news is there were a lot of commitments that are now being met. The bad news is they weren't being met when we did the audit.

[Translation]

Ms. Hélène Scherrer: Thank you.

[English]

The Chair: Thank you, Madam Scherrer.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): I would also like to add my congratulations to the new Auditor General on her position and to thank her and her staff for appearing before us today.

I have a number of questions not only on the reports before us today but also on some of the past ones.

Before I do that, I would like to follow up on the letter I had written to the Auditor General at the end of last year.

I asked you, Madam Fraser, to investigate allegations that a staff of a former health minister were actually working on a political agenda, on a leadership campaign, while on the job as staff of the minister.

You wrote back to me on February 1 and you suggested that the staff in question, around whom there were allegations, were not on the departmental payroll. They were not part of the bureaucracy of Health Canada, but they were in fact political staff and therefore beyond the purview of your investigatory powers.

I guess that raises a number of concerns for me, given that we have these allegations that are out there and around which there has been no clarification from the minister himself.

Are there any circumstances when you as the Auditor General can investigate the use of public funds--because we are still talking about public funds--for partisan political purposes? Not the political work of a minister in terms of doing his job and being the eyes and ears out there on a political basis...but in terms of doing very deliberate political partisan work.... Is there no time when you can be involved? How bad does it have to get? What if there are allegations of corruption? What if there is evidence of expense money being used to buy drugs or purchase the services of a prostitute? When is the line drawn and when can you get involved? And if it's not you, then who can, because we can't get this information anywhere?

The government has decided to change the Treasury Board requirements, according to some earlier Supreme Court decision, so we can't get access to anything pertaining to a minister and what he does on the job as a minister, or to his political staff, ministerial staff, or special staff, even though they're all getting paid from taxpayers' money.

So I guess that's my question. It's a frustration. How do we do this, and if it's not you, who is it? How do we get to the bottom of this and clear the air?

Â (1230)

Ms. Sheila Fraser: I do appreciate that our response was probably frustrating to you. I think the newspaper article, among other things you forwarded to me, talked about funds that had been collected in the public but were not actually funds that had ever come into a government department. This is one of the issues we are obviously limited to, auditing expenses in government departments. So if there are funds collected in another manner, we obviously have no mandate to audit that. As you mentioned, this person is what we call an “exempt staff”, and I'm afraid there's really not very much we can do.

I don't know that we have much to suggest in the way of other mechanisms.

Ms. Judy Wasylycia-Leis: Just to clarify, my concern is mainly with the allegations that staff in the minister's office were working for a leadership campaign while on the job, and were alleged to have been there, having made use of the government's budget for covering expenses. There were real questions about the staff. I know there are questions about how these memberships were purchased and whether government funds were used, but I'm mainly concerned about staff, because it's a question of government funds and Health Canada staff, in whatever capacity, being used for very specific partisan political purposes.

My question is really on that level. Can you not investigate somehow any allegations pertaining to political staff in terms of what they're doing on the job, how they got to those events, what money was used, how they travelled, what per diems are involved?

Ms. Sheila Fraser: I'm afraid not. As I mentioned, they're exempt--what we call exempt staff--and are not part of the department per se. My mandate does not cover those activities.

I would perhaps suggest that the political--

Ms. Judy Wasylycia-Leis: Is that the only way?

Ms. Sheila Fraser: --arena is an area where those questions should be asked. I'm not sure that an audit role is.... Anyway, I know we don't have an audit role that we can exercise in that regard.

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

We'll now move to Dr. Castonguay.

[Translation]

Mr. Jeannot Castonguay (Madawaska--Restigouche, Lib.): Thank you, Madam Chair. Thank you for being there.

You told us that the Canadian Institutes for Health Research have fairly rigorous criteria for peer program evaluation before providing grants, but that things seem to worsen somewhat afterwards and that the accountability is not always there.

Do you believe that the Institutes for Health Research, after approving grants, should be more rigorous during the course of the work, up to withdrawing the grants if the work progress is not satisfactory in terms of the stated objectives? Do they have the right to do that? Should they? Do they have the means?

Ms. Sheila Fraser: In fact, we have pointed out problems in the control of the use of funds and the follow-up on results. When it comes to taxpayer dollars, we expect results that justify the program.

I can ask my colleague to talk about the specific mechanisms for these agreements, but I would expect that there would be a mechanism to stop payments if we believe that the projects are going nowhere.

Our other concern is the amount of unspent balances. The annual budget for grants and contributions that we examined is in $350 to $400 million range. As of March 31, 2001, $100 million remained unspent. the amount increases every year.

We therefore wonder if there is really a follow-up. We can understand that a researcher does not necessarily spend all the money in one year, but for us that is an indication that is not enough control over research expenditures and financing. In government, the theory is to not spend the money before the need exists.

Â (1235)

Mr. Jeannot Castonguay: Do the Institutes for Health Research have the authority to monitor this closely and even to cut funds if they feel that things are going nowhere? Do they have the means, in time and money, to do so?

[English]

Mr. Peter Simeoni (Principal, Office of the Auditor General of Canada): Madam Chair, the answer to both questions will be yes.

On the first question, subsequent to our audit, the CIHR undertook to review all of its existing grants in the operating grants program, and sent out, we understand--this was after our audit, and therefore we don't have firsthand evidence of it--700 letters to grant recipients, all of whom had been slow in spending the money, so the money had been piling up in university bank accounts. They asked a couple of questions: Do you plan to spend the money in the time foreseen, and why have you been so slow? They are currently compiling that information. They're trying to understand why they've accumulated a balance of over $100 million, which we think is a wise thing to do. It may not be a big problem; we wouldn't want them to do anything that was too drastic in response.

Their next step, we understand, is to hold back funds for those projects where progress has been slow and will continue to be slow. If a project has been discontinued, they always have the ability to cancel the funding. Researchers may leave the university. Researchers may die. There are a lot of people they're funding out there, so there are a lot of possibilities. And they've always had the opportunity to remove the funding.

What we were concerned about was why they were continuing to send money for those projects that were ongoing but slow. They've taken action on that and we're pleased with it.

The Chair: Mr. Merrifield.

Mr. Rob Merrifield: You're very right in being politically correct in some of your answers. I don't want to put words in your mouth, but I want to clarify. When it comes to your management of grants and contributions, you say there are two problems there: the consistency of the management style and not having report cards. That is fair enough, but when it comes to the management side of it, you're suggesting there perhaps may be some political interference with regard to the priorities of grants and contributions.

Then I want to relate that back to Ms. Wasylycia-Leis's question with regard to who's exempt from your audit and who isn't. When you look at some of the grants and contributions, like to the Virginia Fontaine foundation, you might be going as high as the deputy minister.

Can you tell me who is exempt and who is not exempt from your audit, and how high does that go?

Ms. Sheila Fraser: We have authority to audit in any department and we can request expenses incurred by any public servant, if you will, or employee of a department. The case that was mentioned was political staff, and political staff are not employees of the department, so they are what we call exempt.

Mr. Rob Merrifield: Are they the only staff who are exempt?

Ms. Sheila Fraser: To my knowledge, those are the only ones. I mean, obviously, any organizations that are outside government we don't have a mandate to audit. We do not audit political staff of ministers, no.

Mr. Rob Merrifield: Okay, so--

Ms. Maria Barrados: What we do in our audits of grants and contributions is trace the file and the signatures on the file right up to the final place of authority. In this case, it was the minister. We asked for the documentation and the signatures from the minister, because that's how that management was structured. So wherever the minister is the most senior manager, we get all the files and information.

Mr. Rob Merrifield: And his political office, maybe? Or would it be the department only?

Â (1240)

Ms. Maria Barrados: Well, it goes to the minister's office. We usually do this direct through the deputy minister's office and through the bureaucrats, but we assure ourselves that we have all the information that was part of that package of material that was the approval process for a grant and contribution. If there's information that comes from the minister's office at that point, it should be on those files. It's something we ask for and we get.

Mr. Rob Merrifield: Okay. So do you have a suggestion on how you would get an audit on the ones that are exempted from your audit?

Ms. Sheila Fraser: Well, we--

An hon. member: [Inaudible—Editor]

Mr. Rob Merrifield: I realize that. I'm looking for a recommendation.

Ms. Sheila Fraser: It's not part of the mandate that has been given to me, so I--

Mr. Rob Merrifield: So you wouldn't have...but as an auditor you'd--

Ms. Sheila Fraser: It would be like saying, Mr. Merrifield, that there's an allegation against someone, a contractor who's received money from government. I do not have a mandate to go in and look at what's happened there either. I have a very prescribed limit as to how far I can go and audit.

Mr. Rob Merrifield: So when it comes to political staff then, it would be in a political realm and this would be a political decision.

Ms. Sheila Fraser: That's right.

Mr. Rob Merrifield: Thank you.

The Chair: Okay.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: On this last point, in the Offence Act--and some of the allegations around Alan Rock and this whole episode were with respect to people on contract with the department who were actually working all out on the leadership campaign.... This begged questions about whether they were just getting paid in the form of these contracts so a way could be found for this activity to happen at the leadership level.

If there were serious allegations with respect to contracts from Health Canada to individuals, in this case in Winnipeg, would this be a matter you would be able to investigate?

Ms. Sheila Fraser: If there were contracts paid by the department, we could audit those. I would just raise a caution that we try to address concerns of committees and members of Parliament, but we will not necessarily conduct audits at the request of a specific member.

Ms. Judy Wasylycia-Leis: That's fair enough and I appreciate that. The broader question for us that we have to come to grips with as a Parliament is who is actually accountable when it comes to public funds for political staff? As you said in your letter to me:

...certain staff in a Minister's office are not members of the public service and thus may engage in activities of a political nature. These activities, of course, are not paid from public funds voted for the running of the department.

But they are funds voted somewhere for purposes of the minister being able to do his or her job. So there is a line of responsibility somewhere, and obviously you haven't been delegated the authority over this.

Shouldn't you have that authority? And what can we do to help shed some light on this and try to open up the information flow so we can at least get to the bottom of something like this to see that it doesn't happen again, if there was any truth to it?

There's no way through the Access to Information Act. The ministers can choose or not choose to release information. And you're not able to go in and do anything, so who can, and what can we do to make sure there's some accountability somewhere in the system?

Ms. Sheila Fraser: I'm afraid, Madam Chair, I really can't be of much help on this question. As I mentioned, we're limited in our mandate to actually auditing the expenses within departments. I would suggest that there might be other mechanisms, question period and so on, which might be able to resolve some of the questions you're raising.

Ms. Judy Wasylycia-Leis: Could I ask a separate question or do you have a list, Madam Chair?

The Chair: Well, you still have two minutes. I'd remind you that you were the one who moved the motion that we have the Auditor General.

Ms. Judy Wasylycia-Leis: I have lots of questions so I'll go on from there.

Before we touch on the current reports you have brought to us, I first want to go back to some old ones--chapters 14 and 15 in particular.

Chapter 14, as you know, was a much appreciated report in terms of the whole drug surveillance issue. And since the tabling of this report there have been reported incidents about adverse reactions and some real concern expressed about the lack of mechanisms within the department to monitor drug safety. In fact, it's at the point where the Canadian Medical Association has said it feels compelled to bypass Health Canada and issue its own set of warnings. So I'm wondering if you have any plans to follow up the 1999 report with a more in-depth look at the efficiency of Health Canada's drug monitoring system.

That's one question. The other is with respect to food and chapter 15, a very significant report about probably the greatest outbreak of a food-borne disease in the history of Canada. Major recommendations were made by the Auditor General at the time. But since then all kinds of incidents are popping up where there are problems in the system, whether we're talking about transgenic pigs getting ground up and into the feed supply that's then fed back to animals and then to humans; or toxins in eggs and maple syrup and honey; or the levels of steroids and other drugs in pork products.

It seems we still have some real problems trying to hold the government to account, and I'm wondering if in fact you will be revisiting this 1999 report on food safety, taking into account these more recent events.

Â (1245)

Ms. Sheila Fraser: Thank you, Madam Chair. We are planning to do a more extensive follow-up audit than we may have done in the past on chapter 14--on health surveillance--which we will be reporting in September of this year. I do not believe we have a follow-up planned for chapter 15 immediately. We just did an audit last year on the regulatory program in food inspection. So we may come back at some later time and combine the two of them together.

But I could perhaps ask Dr. Barrados if she has some additional comments.

Ms. Maria Barrados: The follow-up on chapters 14 and 15 will focus on the surveillance systems. We'll look at the recommendations that we made and the commitments that Health Canada made in response to that audit. There were a number of specific recommendations in chapter 15 that had to do with the way Health Canada and the CFIA work together, and we will follow up those as part of the surveillance systems. But as the Auditor General said, there would be a larger follow-up on food safety issues as part of that series of work.

I have a comment on the adverse drug reaction. The surveillance systems audit did not deal with the monitoring of adverse drug reactions. We did make a comment about the biologics area and the weaknesses of those systems, and there we also made the comment about how difficult Health Canada was finding it to get the kind of staff--the expertise--they needed to do the work.

The area of drug adverse reactions is one that I think we have to take into account when we're doing our planning, because several people have raised that one.

The Chair: Mr. Ménard.

[Translation]

Mr. Réal Ménard: Well, it's gong badly. We are not very well governed in the end.

I am asking you questions about the Institutes for Health Research. I want to understand correctly. You said that as of March 31, about $100 million was about to lapse. That is an amount that was voted and that could be unspent. It is too soon to say that it certainly will not be because we are not at the end of the fiscal year, but you fear that the appropriations voted by Parliamentarians may not be used for the purposes approved.

Could you be more specific in terms of the kinds of Institutes involved? Ar we talking about neurology for example? Give us a little more information about the programs involved. Do you have that information?

Ms. Sheila Fraser: Thank you, Madam Chair.

I will ask my colleague to provide details about the program, but I would first like to clarify our concern over the $100 million. It's not that the budgets will lapse, because once the money is given to a researcher or an institution, it is accounted for as an expense in terms of budgetary appropriations. It is money that is in a researcher's or a university's bank account and that has not yet been used for the purposes for which it was granted.

We can understand that it is almost impossible that all the money has been at the end of the year and that one starts again at zero on April 1^st. We were concerned because the amount of unspent money at the end of the year was growing.

Â (1250)

Mr. Réal Ménard: I have met with directors, and many people are complaining about the evaluation mechanism by peers because the project approval rate is very low. The institutes approve about 20% of the projects and reject the other 80 per cent.

I don't know if you can confirm this bit of information, but it would be even more worrisome that we not spend all the money when many projects are proposed and few are approved.

Ms. Sheila Fraser: That can be attributed in part to the rate of spending by the projects. A project may not have started when forecast but the Institute did not have the information necessary to explain that. That is what we deplored.

Mr. Réal Ménard: Do you prorate this $100 million? What does it cover exactly? Do we have that information?

Ms. Sheila Fraser: I will ask my colleague to answer.

[English]

Mr. Peter Simeoni: Madam Chair, we could provide the committee with a breakdown, as of the end of last fiscal year, for each of the 60-odd research institutes and hospitals that would have received the money.

But let me back up a bit. It's true that there is quite an extensive rejection rate at CIHR. I think that's proof of the demand for the grants they provide and the vitality of the Canadian medical research community. It's probably a good thing that they have to pick the best of the best in providing grants.

What we're hoping will happen is that in slowing down the payments to projects that are not proceeding as planned, they'll be able to move farther down their list of projects and fund people who wouldn't have otherwise been funded. That's going to require them to manage their payment streams a little bit better than they've had to in the past, but we understand they're gearing up right now to do exactly that.

Hopefully in the end they'll be managing their money better and more Canadian researchers will see their projects funded.

[Translation]

Mr. Réal Ménard: So at this time you don't have any information you can give us. You are optimistic because there are many rejections because of the number of requests. There are not 60 institutes. There may be 60 proposed projects but you know that eight institutes were created under the this bill, including three in Quebec. We were expecting five because historically 20 per cent of the funds for the Medical Research Council, which was abolished when the Institutes were create, but that's another debate.

It is very important to understand the rejection rates and the families they belong to. Naturally you could not provide us with that during the question period. It's a joke, Madam Chair.

You understand it's importance to us.

[English]

Some hon. members: Oh, oh!

The Chair: Thank you, Mr. Ménard.

I'd like to ask a couple of questions, if I may, with the committee's acceptance.

I'm looking at the planning for the future. You're planning to table a report on federal support of health care delivery. I assume that has something to do with the transfers to the provinces.

Ms. Sheila Fraser: Yes.

The Chair: I don't know what you're going to comment on there, unless you perhaps have the cooperation of provincial auditors general. Is that what you're looking at? Is the money being spent where it's supposed to be spent? Are you going to comment on whether you think the federal government is transferring an appropriate amount of money?

Ms. Sheila Fraser: Madam Chair, in 1999, we did an audit of the application of the Canada Health Act. I'll ask Dr. Barrados to perhaps give a little more detail.

I do remember that one issue we brought up was the lack of information the federal government had on health care costs, how much of the funding was actually being used for health care. We will be going back to the report we issued in 1999 to see what has changed in the intervening period and whether the recommendations we made at that point have been acted upon. I know information was one of the big issues we had then.

Perhaps Dr. Barrados could elaborate a little more.

Ms. Maria Barrados: That's quite correct. The questions we posed then, and are asking again, were intended to find out what kind of progress there is and how much clarity there is around the conditions in the Canada Health Act. Under what conditions does Health Canada intervene? How does it maintain surveillance of what is going on to get compliance with the Canada Health Act?

So we are coming at it, saying this is the legislation and asking what is being done against that legislation. Have they made improvements in the reporting? Have there been improvements made in taking a look at the transfer and notionally dividing up that transfer so you know what part is headed towards health and what part is headed towards post-secondary and social services?

Â (1255)

The Chair: With respect, I don't know how you can ask those questions when in fact we've agreed to a block transfer. Unless the provinces share that information, how can the federal government be required to know? This is a huge federal-provincial issue. It seems to me that we can't find out necessarily, because we can't withhold funds if they don't give the information. The only way I think it can be found out is if you had some kind of a conference of auditors general and the provincial auditor general provided you with the information, and you in turn told the government.

Ms. Maria Barrados: I just have a couple of comments, and perhaps the Auditor General would like to comment about the way we work with the provincial auditors general.

On the issue of the transfer, it is a block transfer, but the Department of Finance has in fact been notionally dividing it and posting it on their website.

The Chair: But they're just guessing, aren't they?

Ms. Maria Barrados: No. They take the division of the transfer at the point at which the CHST came in, and they're projecting the same proportions.

The Chair: Exactly.

Ms. Maria Barrados: The point of that discussion is that if the federal government is engaged in a discussion that says they are contributing so much money under the Canada Health Act, there has to be some information that gives some form of a notional number so you can have an intelligent discussion. The way we expressed it the last time was that it is not telling the provinces that they must use that money that way, but it's an intention on the part of the federal government that this is the amount of money we have and this is how we see it going.

Of course, as you know, there are additional moneys that have been put on top of that. We'll describe all that. There have been new amounts of money that have been dedicated only to health and that have the accountability reporting going with them.

You are quite correct; there are issues in terms of how you get information to seek compliance, but the whole move to get the health performance indicators as agreed by first ministers is a big step and a good step in that direction.

The Chair: This leads me to my second question. In September we will also be auditing the accuracy of the report on health indicators, as agreed to by the first ministers. Are you going to be judging the accuracy as to whether those health indicators really do give a good indication of health status, or are you going to be commenting on the accuracy of the information the provinces submit?

Ms. Maria Barrados: Most of those health indicators, in fact, don't come from provinces; most of them come from Statistics Canada or CIHI.

The Chair: Yes.

Ms. Maria Barrados: The vision is that there are going to be separate reports, so each province will have its own report and there will be a national report.

We are working very closely with the provincial auditors general; many of them will be doing work in the provinces. We will not be questioning the agreed to indicators, because that was agreed to by first ministers, but what we will be looking at is the report itself, how it is lined up with what was agreed, whether there is comparability, as was agreed, whether the information is correct, and whether there is enough information and explanation so people will use these numbers properly and understand them properly.

· (1300)

The Chair: Okay. That's going to be very good. I think it's really going to help the discussion of health care in Canada if you can tell us that the reports we're getting from the provinces about expenditures are accurate or not, and whether they're fitting into a national report, which is then accurate because the pieces are accurate.

Ms. Maria Barrados: It would be an issue that might be very interesting for this committee, Madam Chair, because I am not sure there is an agreement on a national report. There is agreement on having a separate report. And there isn't full agreement that the auditors general will be doing work throughout the country. There is also not yet agreement on how they put the dollars in there, but there are a lot of other indicators on health outcomes and health results. I think it's a good start, and hopefully we can keep the momentum going.

The Chair: Thank you very much.

It's now one o'clock. We apologize for the 45 minutes of your time we wasted. We hope we made the next 45 minutes worth your visit. Certainly, it was for us. On behalf of committee members, I'd like to thank you and reserve the right always to ask you to come back again when we have more questions. Thank you for today.

This meeting is adjourned.