HEAL Committee Meeting

37th PARLIAMENT, 1st SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Tuesday, May 7, 2002

Â

1210

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

Ms. McLellan

Â

1215

Â

1220

The Chair

Mr. Rob Merrifield (Yellowhead, Canadian Alliance)

Â

1225

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Â

1230

Ms. Anne McLellan

Mr. Ian Shugart (Assistant Deputy Minister, Health Policy and Communications Branch, Department of Health)

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Â

1235

The Chair

Mr. Réal Ménard (Hochelaga--Maisonneuve, BQ)

Ms. Anne McLellan

Mr. Réal Ménard

Ms. Anne McLellan

Â

1240

Mr. Réal Ménard

Ms. Anne McLellan

Mr. Réal Ménard

Ms. Anne McLellan

Mr. Réal Ménard

Ms. Anne McLellan

Â

1245

The Chair

Mr. Réal Ménard

The Chair

Ms. Hedy Fry (Vancouver Centre, Lib.)

Ms. Anne McLellan

Â

1250

The Chair

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

Ms. Anne McLellan

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Â

1255

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Mr. Ian C. Green

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Mr. Cliff Halliwell (Director General, Applied Research and Analysis Directorate, Department of Health)

Ms. Judy Wasylycia-Leis

Mr. Ian C. Green

Ms. Judy Wasylycia-Leis

Ms. Anne McLellan

Ms. Judy Wasylycia-Leis

·

1300

Ms. Anne McLellan

The Chair

Ms. Scherrer

Ms. Anne McLellan

·

1305

The Chair

Mr. Ian C. Green

The Chair

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Mr. Ian C. Green

Mr. Rob Merrifield

Mr. Ian C. Green

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

·

1310

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

Mr. Rob Merrifield

Ms. Anne McLellan

The Chair

Mr. Reg Alcock (Winnipeg South, Lib.)

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1315

Ms. Anne McLellan

·

1320

The Chair

Mr. Ian C. Green

The Chair

Mr. Réal Ménard

Ms. Anne McLellan

Mr. Réal Ménard

Ms. Anne McLellan

Mr. Réal Ménard

Ms. Anne McLellan

Mr. Réal Ménard

The Chair

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

·

1325

Ms. Anne McLellan

Mr. Jeannot Castonguay

Ms. Anne McLellan

The Chair

·

1330

Ms. Judy Wasylycia-Leis

The Chair

Ms. Judy Wasylycia-Leis

The Chair

Ms. Judy Wasylycia-Leis

The Chair

Ms. Judy Wasylycia-Leis

The Chair

Mr. Réal Ménard

The Chair

Mr. Jeannot Castonguay

The Chair

Mr. Jeannot Castonguay

The Chair

Mr. Reg Alcock

·

1335

The Chair

Mr. Rob Merrifield

Mr. Reg Alcock

The Chair

Mr. Réal Ménard

The Chair

Ms. Hélène Scherrer

The Chair

Ms. Judy Wasylycia-Leis

The Chair

Ms. Judy Wasylycia-Leis

The Chair

·

1340

The Clerk of the Committee

The Chair

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CANADA

Standing Committee on Health

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NUMBER 076

l

1st SESSION

l

37th PARLIAMENT

---

EVIDENCE

Tuesday, May 7, 2002

[Recorded by Electronic Apparatus]

  (1210)  

[English]

    The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Good afternoon, ladies and gentlemen. I will call this meeting convened to examine the main estimates to order.

    It has been ordered that the main estimates for the fiscal year ending March 31, 2003, that is votes 1, 5, 10, 15, 20, and 25, laid upon the table on February 28, 2002, be referred to the Standing Committee on Health. This is an extract from the Journals of the House from Tuesday, February 28, 2002.

    I will call vote 1, and then the minister will give her remarks that are part of the debate on vote 1.

    Welcome, Minister. You have the floor.

[Translation]

    Hon. Anne McLellan (Minister of Health, Lib.): Thank you, Madam Chair and committee members, for inviting me to speak to you today. This committee makes an important contribution to the work of the government on health issues. We all understand and share the priority that Canadians place on health care and so, I am glad to be able to take part in this discussion which supports our shared objective of providing Canadians with a health care system that meets our needs now and in the future.

[English]

    Before I go any further, Madam Chair, let me introduce the officials here with me today: Ian Green, deputy minister; Munir Sheikh, associate deputy minister; Patrick Borbey, assistant deputy minister, corporate services branch; and Ian Shugart, assistant deputy minister, policy and communications branch.

    Madam Chair and members of the committee, several of the department's other assistant deputy ministers and senior officials are with us. They line the walls of this room and the seats behind us.

    During my first appearance before you in February, I set out my views on Health Canada's plans and priorities for the current fiscal year. By now it should be clear that my top priority is to work with Canadians on the renewal of our health care system so that the changes we make have a real impact on things that matter the most: timely access to care and high-quality care.

    The health care system involves many elements and many stakeholders, but, at a minimum, it should ensure that Canadians have reasonable access to high-quality health care services when and where they need them. In addition, I am hopeful that during my time as minister I can encourage Canadians to improve their own health through increased physical activity, healthy nutrition, and a reduction in tobacco use.

    Today I would like to expand briefly on these issues and raise other issues in the context of the departmental report on plans and priorities for 2002-2003. As you know, the federal government plays numerous roles when it comes to promoting and protecting the health of Canadians, including providing leadership in establishing, monitoring, and enforcing national standards in the delivery of health care under the Canada Health Act, promoting healthier lifestyles for Canadians, delivering health services to aboriginal peoples on reserve and in Inuit communities, supporting health research and the development of health information, working to prevent and reduce risks to health through the regulation of food, drugs, and other products, and by making a contribution to global health.

    These roles define and guide Health Canada's policies, programs, and services; however, we share many of these roles with others. Accordingly, our approaches to the issues within our mandate often involve cooperation with partners across Canada and around the world. In particular, we work with the provinces and the territories because of their responsibilities in the health care system and in many aspects of health promotion and protection.

    Beyond that, we work closely with health providers, with first nations and Inuit communities and organizations, with the research community, with individual Canadians, and many others.

    An example of what we can achieve through cooperation is our recent agreement with the provinces on how to avoid and, if a dispute cannot be avoided, how to resolve disputes under the Canada Health Act.

    The federal and provincial governments agreed to a process. The process is based on working to avoid disputes in the first place, collaborating and negotiating to resolve disputes, and, if negotiations prove unsuccessful, calling on a third-party panel to offer advice and recommendations to the federal Minister of Health and the provincial or territorial government involved in the dispute.

    It should be underlined, however, that nothing in this dispute avoidance and resolution process undermines the authority of the federal Minister of Health to interpret and enforce the Canada Health Act. It does not change the final authority with respect to the act. What it does give us is a transparent process through which we can work to resolve issues.

    While the Canada Health Act is one of the best known pieces of legislation for which the federal Minister of Health is responsible, it is actually only one of many. Some of our legislation is under review now, and we plan to review other pieces of legislation in the months ahead.

    For example, as you are all well aware--and I thank you for your very good and timely work on Bill C-53--the new Pest Control Products Act is an important renewal of our pesticide regulatory regime and legislation, and the work you're doing there is important and timely, as I'm sure you've heard from many.

    As well, you are aware that legislation dealing with assisted human reproduction will be introduced very soon as part of the government's response to this committee's report, Assisted Human Reproduction: Building Families.

    Beyond that, I am considering how we could modernize the statutes that govern our health protection responsibilities. I think some of you have written to me about that.

    By way of example, let me point out that the Department of Health is responsible for the Quarantine Act, a piece of legislation that has been on our books since 1872. Our Food and Drugs Act dates back to 1953.

    While these statutes have been amended over time, we need to ensure that they provide us with adequate and appropriate legislative authority to regulate today's and tomorrow's products, and the concerns with those products we will inevitably encounter despite our best efforts to avoid them.

    As you know, the process that could lead to this modernization began a few years ago. The first phase of consultation was held across Canada to identify issues that may be addressed by new legislation in this area. At the end of that process a commitment was made to undergo a second round of consultations. These consultations will solicit views on a detailed proposal for new health protection legislation. Once that has taken place we will determine when and how to present legislation to Parliament for its consideration.

    This is obviously a work in progress and it will require time and expertise. I think all members will agree that it is incumbent on us to ensure that our legislation is relevant, modern, and that as society changes our health protection legislation does not have gaps or omissions.

    While non-exhaustive, this is a brief snapshot of the legislative changes on which we are presently working within the Department of Health, and obviously, to some extent, on which you are also working at this time.

    While legislation defines some aspects of our health care system, legislation is but one aspect of our ongoing work to modernize the Canadian health care system. Another important aspect is the work of the Commission on the Future of Health Care in Canada, chaired by the former Premier of Saskatchewan, Roy Romanow.

    I spoke at length about this when I appeared before you in February. Rather than use time to reiterate those points, let me simply address one issue today. Some people are saying that we should make wholesale changes without waiting for the commission's results. They are saying that we should not wait to hear the results of the commission's discussions with Canadians, that we should not wait to see the final recommendations.

    These comments missed an important point. An essential component of the commissioner's mandate was to engage in a dialogue with Canadians. The commission's report asked Canadians to, and I quote:

Tell us what kind of a system you want, what kind of a system you need and what kind of a system you are prepared to pay for.

    The commissioner is still engaged in the all-important task of listening to what Canadians have to say in response to these questions.

    Clearly an issue as important as this one deserves a fulsome debate. We want to hear those answers before we act. Indeed, that is the only responsible way to proceed on such an important issue.

    In fact, as I understand it, members of the House will have the opportunity to meet with Mr. Romanow and to participate in a take-note debate on this issue in the coming weeks.

    So far I have mentioned a series of important issues that relate to our relations with the provinces and territories, our possible legislative agenda, and the work that is being done on the future of health care. All are important to our plans for 2002-03. Another area of importance is health research and the potential impact this research will have in the long term.

    Across Canada, researchers and research teams are exploring a diverse range of health issues. In fact, at the beginning of April I joined Dr. Bernstein to announce the results of the most recent CIHR research funding competition. The competition allocated approximately $180 million to 488 projects across the country. Many are detailed investigations of proven or possible disease and illness factors. Some will examine community and public health issues. Others will explore potential improvements and innovations in our health care system and its policies.

    It is worth pointing out that many of these projects will benefit from the same cooperative approach that I have already mentioned. I say this because funds from CIHR are often complemented by contributions from health charities, voluntary organizations, and the private sector.

  (1215)  

    Along with these partners and other departments, Health Canada is working toward a new science and technology vision that supports the health of all Canadians. This funding teamwork means added support for our research community. It is creating opportunities for researchers, both Canadians and those who come here from other countries to build strong careers in Canada. The ultimate result is that Canada is developing and applying knowledge that will mean a healthier population and a sustainable health care system.

    Madam Chair, before I end my remarks today, I do want to discuss briefly another dimension to our partnerships. This is our partnership with Canadians on personal and community health matters. If you were to read through the report on plans and priorities, you would see that the role of Health Canada as an advocate, an information provider, and a catalyst for good health among Canadians is something we have tried to stress. We do this because we believe the more we can inform and support Canadians about the steps they can take to improve their health, the healthier we will all be, and as a result, the stronger and more effective our health care system can be.

    While the department carries out these responsibilities in many ways, let me highlight one area in particular: the importance of physical activity, an area that was highlighted by the member for Louis--Hébert when I appeared before you in February. Studies suggest that three out of five Canadians are risking their health and quality of life due to physical inactivity. Canada saw a tripling in the level of obesity among its children between 1981 and 1996. That and much more evidence tell us that the need for action is clear.

    One way of encouraging action is through effective research and information. Last month I released Canada's Physical Activity Guides for Children and Youth. This is one of three guides. The others are Canada's Physical Activity Guide to Healthy Active Living, aimed at adults, which was released in 1998, and Canada's Physical Activity Guide to Healthy Active Living for Older Adults, which was released in 1999. Each guide offers advice and information on how to get children and young people active for life.

    None of this advocacy, information, and support is about dictating choices. It is about encouraging and helping people to understand the benefits of a healthy lifestyle. It is about helping them understand what they need to do to improve their health through regular physical activity so that they not only strengthen their own body's ability to deal with a range of illnesses and diseases, but also improve their physical and mental health on a day-to-day basis.

    We need to engage all Canadians as individuals, volunteer and community groups, and our municipal and provincial colleagues in a partnership to make healthy, active choices, easier choices, for everyone. To do that we will continue to develop helpful information materials, and we will work with our partners to get the message out in positive ways.

    I would like to take a moment to highlight two examples of how we are working with our partners. Last Friday my colleague the Hon. Ethel Blondin-Andrew marked National Aboriginal Diabetes Awareness Day by launching a campaign about prevention of type II diabetes among aboriginal people. By working in partnership with aboriginal and non-governmental organizations and provincial and territorial governments, we hope to lower the incidence of diabetes and encourage Canadians to shift from a passive lifestyle to a more active one.

    This week the SummerActive 2002 campaign will get under way across Canada. SummerActive is a joint federal, provincial, and territorial initiative to encourage Canadians to become more physically active. It promotes six weeks of physical activity events in hundreds of cities, towns, and neighbourhoods across Canada. Information about this campaign will be sent to all of your offices, and it will be distributed across Canada by provincial and territorial governments.

    Madam Chair, let me conclude my remarks this afternoon. As you have heard today, we do have a full agenda for the coming months, which means that you as a committee will also be busy in the coming months. At the top of that agenda is my commitment to working with the provinces and territories and other health stakeholders to ensure that Canadians have access to quality health care based on need.

  (1220)  

    Madam Chair, I take very seriously my role as Minister of Health and my responsibility to ensure that the decisions taken by my department are guided by what is in the best interests of Canadians with respect to quality health care.

    I thank you all for inviting me here this afternoon, and I look forward to answering questions, dealing with your concerns, and responding to any comments you might have.

    Thank you.

    The Chair: Thank you, Minister.

    We'll proceed to the next phase of the meeting and let the members enter the debate. We'll begin with Mr. Merrifield.

    Mr. Rob Merrifield (Yellowhead, Canadian Alliance): Minister, I want to thank you for coming and sharing this with us.

    Indeed, you tweaked on a number of different issues, so many that I'm not sure exactly where to start. I wanted to say, to start with, that your commitment to do something with the health care system is to be applauded. In a way it seems kind of shallow to say that health care has been reduced to what many people are saying is a crisis position. We look forward not so much to Mr. Romanow's report but to what will be implemented out of that report. I'm sure you'll look at that with great interest and apply what comes out of it in the best interests of Canadians.

    With respect to your dispute panel, it's very frustrating from where I sit that this took four years to finally come to fruition, but thank goodness it's there. Provinces are moving ahead on their own agendas. Obviously, this is an important piece that should have been there long before now, but it's good that at least we're seeing it now.

    I want to draw attention to the piece of legislation that you've committed to this committee will be here by Friday. I'm wondering if it's going to come Friday or Thursday.

  (1225)  

    Ms. Anne McLellan: That is actually up to the government House leader, and my office has been in discussions with the government House leader. I think it would be inappropriate for me to give a certain day or date at this time, but let me say to you that the number of days possible are limited. We're down to three, and I've made it very plain that I will be--

    Mr. Rob Merrifield: I'll rephrase the question. Is it going to be tomorrow?

    Ms. Anne McLellan: I can say that it will not be tomorrow.

    Mr. Rob Merrifield: Now we're down to two. Are you going to be here Friday?

    Ms. Anne McLellan: I will be here on Friday.

    But seriously, I will be responding to the committee report, and obviously the key part of that response will be the introduction of legislation many in this country have been awaiting for at least 10 years. That legislation will be introduced this week.

    You just have to understand that it is finally the government House leader's call, and while we have been in discussion with him, things happen in the House, as you are well aware. Schedules change pretty quickly around here in terms of House business. I wouldn't want to say something today that our friends from the media or members of the committee would take and then somehow be misled in relation to that. But it will be this week.

    Mr. Rob Merrifield: I appreciate that, but I knew that much before I asked.

    At any rate, we are eagerly anticipating that. I think Canadians are eager to have the opportunity to debate that very serious issue. We worked hard as a committee on that, and we look forward to it.

    Further to that, though, is there funding in this year's budget for the regulations that will come following that piece of legislation?

    Ms. Anne McLellan: Mr. Merrifield, I have to be very careful here because I cannot pre-empt the role of Parliament in terms of the laying before the House of Commons of that piece of legislation. What I will say is that we listened very carefully to the recommendation of this committee and the recommendation of others in relation to the regulatory structure that should be put in place to deal with assisted human reproduction.

    At this point I cannot--and I just want to put this on the record--talk to you today about the specifics of legislation that will be introduced this week because--

    Mr. Rob Merrifield: You talked about budgets, and the budgets are there as a forecast to what we expect to happen. I'm wondering if the dollars are there for the regulations.

    Ms. Anne McLellan: What I can say is that we will have the resources to do that which is necessary to implement whatever regime is finally adopted by Parliament.

    I'm being very circumspect because, based on my experiences as Minister of Justice, I do not want to pre-empt the role of Parliament and indicate what may or may not be in the legislation.

    Mr. Rob Merrifield: Let's move on to another question, which is related but is a little different. I'm not sure you caught it yesterday. I'm going to repeat it here. It's a question I had in the House that was more for the industry minister, but you jumped in and that leads to the question. Why is Genome Canada under Industry instead of Health when it's dealing with so much of health?

  (1230)  

    Ms. Anne McLellan: I do not know, but maybe my deputy, Ian Green, might know the answer to that question.

    Quite truthfully, I don't. I see that obviously it deals with aspects of both health and industry. There are many industrial applications of the work that is being done, for example, with the prairie genome emphasis on the agricultural sector and how one adds value and develops new products. I can certainly see a very clear industrial connection, but clearly you're right, there are also health aspects to this. But I will turn it over to my deputy or someone else who might know the answer.

    Ian.

    Mr. Ian Shugart (Assistant Deputy Minister, Health Policy and Communications Branch, Department of Health): I think I can help, briefly. The broad domain of science and technology has been assigned to the Minister of Industry. There are a number of initiatives related to science primarily, some that affect health but broadly speak to science policy that have been assigned to the Minister of Industry.

    Mr. Rob Merrifield: We're so concerned with that because they're doing a study on the ethics and the social impacts of embryonic research. Yet they're also allocating funds--$5.5 million--towards it prior to the report even coming forward on the ethics of whether they should be going ahead on this research. That to me shows the cart before the horse if you ever saw one. So I'm very concerned with that happening. You're fully aware of how concerned we were with the CIHR doing a similar thing. I think it's a valid question, and if you could get to the bottom of that....

    Ms. Anne McLellan: Well, it's certainly a question that I will take up with the Minister of Industry. You have heard his responses in the House to your questions.

    Mr. Rob Merrifield: That's what they were--his responses.

    Ms. Anne McLellan: I certainly have had discussions with Senator Morin, who was--he is not now--a member of the board of Genome Canada and expressed the views of some of what had been expressed to me. I do believe that Genome Canada is fully aware of the concerns that have been expressed, but you would have to take up with the Minister of Industry where that agency is at in terms of developing guidelines or waiting for legislation.

    Mr. Rob Merrifield: This is something that I'm bringing to your attention and that I think you've addressed, but--

    Ms. Anne McLellan: And I have taken it up with some...

    Mr. Rob Merrifield: There is one other point that I'd like to bring forward. Last year--in fact April 24 of last year--we had in front of us Dr. Bob McMurtry. At that time we were asking him questions with regard to the hepatitis C fund. I believe $900 million is left in that fund. His comments at that time were that the discussion was taking place within the department as to whether they would open up the years of compensation and that it looked as if it was a possibility.

    We certainly know that the numbers now look as if there are ample funds there to deal with those. We know that the provinces have a handle, for those provinces that did open it up, for all outside of that four-year window period to be compensated. I'm wondering if you've had further discussion on that. I've asked you a few questions in the House. Your comment to me was that it's not your policy. I'm wondering if that's something your department is looking at now.

    Ms. Anne McLellan: No. We've been quite clear that we are not looking at individual compensation for those who acquired hep C either pre-1986 or post-1990. Just let me explain for everybody, so you're absolutely clear.

    A legal trust has now been put in place that in fact was accepted by all parties and sanctioned by the court. A court-ordered administrator is now running that trust. It has $875 million from us, the federal government, and the provinces also contributed to that fund. Those moneys will be used, we estimate, over the next 70 years. Hep C is a progressive disease, and we wanted to ensure that as the disease progressed, those who needed additional support and help would be able to come back to the fund and apply to the administrator. That was part of the court-ordered agreement.

    So in fact when you talk about a surplus, it's not really possible to say there's a surplus. There's a surplus today, in the sense that in fact the administrator has received some 5,500 applications and has approved in some form or fashion only 1,400 or 1,700 of them at this point. He is receiving more applications. This fund was put in place to deal with a challenge that will exist for those who suffer from hepatitis C for a very long time, so it's not appropriate to say there's a surplus in this account.

    Pre-1986 and post-1990, my predecessor put in place a program that I believe is the responsible approach, and it was called “care, not cash”. It involved some $525 million in federal dollars to provide care and assistance. Some $300 million of that is now available to the provinces and the territories, because we know those people will use the health care system probably to a greater degree than the average resident in the province. We wanted to assist the provinces in being able to deal with that increased demand on the health care system. We thought that was the most responsible way to assist the provinces, ensuring that those who acquired hep C before and after that 1986 to 1990 period were supported. But we are not looking at the prospect of individual compensation.

  (1235)  

    The Chair: Thank you, Minister.

    Thank you, Mr. Merrifield. It's now Mr. Ménard's turn.

[Translation]

    Mr. Réal Ménard (Hochelaga--Maisonneuve, BQ): I'm astonished to hear you talk about hepatitis C. I find you rather ill-informed and heartless, considering that the first recommendation put forward by the Krever Commission was a no-fault compensation system. The public will never forget how heartless and unfeeling your government was in this whole affair. However, that's not the issue. I'll come back to this later on.

    I'd like you to confirm one very specific fact. When it comes times to set the amount of transfer payments to the provinces for health care...For example, in the case of Quebec, the Séguin Commission found that the federal government did not follow any criteria or use any indicators. Rather, its actions were totally discretionary. Moreover, the Prime Minister's own words were cited. How much did Quebec receive last year by way of transfer payments for health care? What specific criteria were followed? Can you tell us what these criteria were? If not, do you agree with the Séguin Commission's assessment that these actions are completely discretionary and that this is the most negative form of federalism at work in that federal administrators act arbitrarily and show a total lack of imagination? What specific criteria are used to determine transfer payment amounts, particularly in the case of Quebec?

[English]

    Ms. Anne McLellan: I don't think we have the numbers with us, but we will provide them to you. In fact, the Department of Finance is responsible for transfer arrangements, the CHST, but we will get the exact amount for you.

[Translation]

    Mr. Réal Ménard: I want to know what criteria are followed, not just the amount of these transfers. Do you confirm the Séguin Commission's findings, namely that no criteria are really followed and that in fact, government action is totally discretionary? Why does one province receive $3 million instead of $2 million? In determining transfer payment amounts, do you follow criteria clearly established either by Health Canada or the Department of Finance, or do you act in a totally discretionary fashion?

[English]

    Ms. Anne McLellan: It is a question, I'm afraid, that would be more aptly addressed to my colleague, the Minister of Finance, who in fact deals with provincial and territorial finance ministers in relation to transfer payments.

    You are aware that the provincial and territorial ministers met with my colleague, the Minister of Finance, two weeks ago in Corner Brook, Newfoundland. I was not at the meeting. I understand the CHST transfer payments were very much at the heart of the discussions.

    The Minister of Finance was made aware of the concerns of the provinces and territories in relation to their funding pressures. He is the minister responsible, as are provincial and territorial finance ministers, in relation to the form of the CHST and the amount of the CHST.

    We will find out. I will contact my colleague. We will provide you with the most precise, complete information that the Department of Finance is able to provide us with.

  (1240)  

[Translation]

    Mr. Réal Ménard: I have another question for the minister. Can you confirm the following facts? Your predecessor, Mr. Rock, had unveiled a national strategy to combat diabetes. A total of $115 million had been earmarked for this strategy, with $58 million targeting aboriginals, and $57 million going to national initiatives. It seems the forms for the fiscal year just ended were not available in time in Quebec. Therefore, no initiatives were funded, even though $889,000 in funding was available.

    As you no doubt know, diabetes is the fourth leading illness after heart disease. Earlier, you spoke of a campaign targeting aboriginals. In your opinion, it is acceptable for $889,000 to go unspent in Quebec simply because the government bureaucracy was slow in getting off the mark? First of all, can you in fact confirm that the $889,000 available for Quebec was not spent? I have here a letter from the Diabetes Society of Quebec.

[English]

    Ms. Anne McLellan: In fact, first of all, let me say my department has enjoyed a lengthy and very productive relationship with organizations in the province of Quebec that deal with the challenge of diabetes.

    You are correct to the extent that in fact negotiations are ongoing with the Province of Quebec. They are negotiations the province asked for in relation to certain terms and arrangements regarding the funding and transfer of dollars to organizations in the province of Quebec that work with communities and individuals as it relates to diabetes. The discussions, as I understand it, are still going on with the Province of Quebec.

    Would I like them concluded? Absolutely. Do we want money to flow to the groups that have a history of doing good work in the province of Quebec? Absolutely.

    I would ask you to go to the Quebec government and ask them to come to the table so we can move this forward.

[Translation]

    Mr. Réal Ménard: Careful now. Don't get carried away with flowery rhetoric. We may no longer recognize you. The Quebec government signed on and the regions supported the initiatives. The problem, as brought to our attention by the Diabetes Society of Quebec, lies with the forms which were not available on time. What should have taken three months in fact took six months. But we can discuss that later in private. I won't waste time on the subject now. However, you do confirm that the $889,00 have not been spent.

    This brings me to my third question.

[English]

    Ms. Anne McLellan: I can't confirm it.

[Translation]

    Mr. Réal Ménard: What I understand is that there is money available, which brings me to my third question.

    Many people are concerned about the cost of drugs, an issue which puts genuine pressure on health care systems. It is estimated that drug costs are the main reason why the provinces' health care costs are rising. Therefore, my question to you is as follows. I realize it's important to respect provincial jurisdiction over such matters as deciding which drugs should be included in the list of drugs eligible for cost reimbursement. However, some people feel that the mandate of the Patented Medicines Prices Review Board should be reviewed because one of the problems has to do with the many new drugs on the market that in terms of new therapeutic or curative properties, have very little that is new to offer people.

    Have you already given the matter some thought from a federal perspective? It's not a matter of intervening in areas under provincial jurisdiction. Do you think the mandate of the Patented Medicines Prices Review Board should be re-examined? What are your views on the cost of drugs?

[English]

    Ms. Anne McLellan: You obviously identify a key concern for the health care system. In fact, the escalation, or I suppose the increase, in the total percentage of health care costs arising from pharmaceuticals is growing, I would think one would have to say, at a very fast pace. It's an issue that's been identified as one of concern by the Prime Minister and first ministers. In the accord they signed in September 2000, this issue was flagged. There were some agreements entered into in terms of federal and provincial cooperation around, for example, working to things like a common drug review process, working and trying to get better research in terms of not only the utilization of drugs--how many drugs are prescribed and in what circumstances--but also the effectiveness of drugs.

    I do think you raise an important point. As new drugs come on the market, they tend to be more expensive than drugs that have been on the market for some time. But do they lead to a better health outcome for the people for whom they're being prescribed? If it is proven that there is not a better health outcome, then I think some tough questions need to be asked. The provinces are asking those questions and we are working with them.

  (1245)  

    The Chair: Merci, Monsieur Ménard.

[Translation]

    Mr. Réal Ménard: We were just starting to have some fun, Madam Chair.

[English]

    The Chair: Again, it was terribly interesting, Mr. Ménard, but other people have other topics to pursue.

    We'll move now to Dr. Fry. It's Dr. Fry's turn, Mr. Ménard.

    Ms. Hedy Fry (Vancouver Centre, Lib.): Thank you very much, Madam Chair. I actually have three questions, so let's see if we can get through them.

    The first one is about organ transplantation, Minister. As you know, between 1991 and 2000 the number of patients awaiting transplantations have increased by more than 100%, and it's projected to rise by about 152% over the next two decades. We know that organs available for transplantation are only increasing by 12%, so we'll have a huge discrepancy between the number of organs available for transplant and the number of people who need them. What are you doing to address this particular crisis situation?

    Ms. Anne McLellan: You have used the word “crisis”, and I don't think that is misapplied. I think, in fact, the numbers you have suggested speak to this growing gap that, unless we put in place some effective national strategy, will continue to grow. There are approximately 4,000 people right now on organ and tissue donor waiting lists all over this country.

    My predecessor put in place, with his provincial and territorial colleagues, with other stakeholders, a new national strategy. Part of that involved the creation of a council on organ and tissue transplantation. I had the opportunity to meet with them at their meeting on Saturday. They met in Edmonton, because Minister Rock decided the national secretariat for this new initiative would be in Edmonton because of the approach the Province of Alberta has taken and the success they've had in increasing organ and tissue transplantation rates. They also have a very large organ transplant program within the province.

    I met with them on Saturday. They are in the process of putting together their business plans. They've been in existence for a little less than a year. They're putting in place their business plans that they will then share with provincial and territorial deputy health ministers.

    Do they share it with you too, Ian, or are you excluded?

    Mr. Ian C. Green (Deputy Minister, Department of Health): Sometimes.

    Ms. Anne McLellan: Oh, just sometimes.

    But it will be shared with deputy ministers of health across the country. If those work plans are approved, it will move this whole area forward in terms of really starting to develop a national strategy, an integrated strategy.

    The council has set up three committees, and two of the three are absolutely key. One is the whole area of donation. Members of the committee, you might be interested in this--I hadn't thought a lot about this--in terms of the donation of organs, that all takes place in ICU units, usually, intensive critical care units, where people are, for whatever reason--sometimes very tragic--coming to the end of their lives. You need what are called intensivists--and you would know a lot more about this than I do, Hedy, but you need those people involved in those units because that is where the bulk of your donors will come from. So that committee is working very much on making sure the right people are involved at the right time and in the right place in hospitals across this country on the donor side of things.

    One of the committees is actually dealing with the whole area of transplantation. The doctor responsible for this described it to me as a longitudinal approach. From the moment you identify that someone needs a transplant and that there is an organ and tissue available, then that person is followed, as he says, for sometimes years or for the rest of that person's life, in terms of anti-rejection drugs, follow-up, and all sorts of things. His committee is, again, working to try to bring all the key people together to understand the continuum of care and the critical periods along that transplantation continuum. Their work is moving forward, and I think everybody understands the nature of the challenge.

    One of the things I can do, one of the things you can all do--that we did during Organ and Tissue Awareness Week--is make your constituents aware of this. Send out ten percenters in your householders. Remind people that they need to sign those organ and tissue donation cards and, even more important than that, is to talk to your families.

    I hadn't realized that. I signed my card years ago. It's on the back of the Alberta health card. Until somebody told me, I hadn't realized. I'm dead, the critical care doctor comes out and asks, “Do you want to donate her organs?” Depending on the nature of the situation, this would be a very stressful and difficult time, and they say, “No, we can't think about that”, and then my card is overridden. Even though I've signed it, it's overridden. So you have to tell your family that this is something you want to have happen and it helps them in this very stressful time.

  (1250)  

    So education and information are also key parts of this, but this will be a national strategy. It's not a federal strategy; it's a national federal-provincial-territorial strategy with many of the NGO volunteer organizations out there as well.

    The Chair: One question, Ms. Wasylycia-Leis.

    Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you, Madam Chairperson. I have five minutes, correct? I have five minutes for a year's worth of questions saved up.

    Ms. Anne McLellan: I've only been here four months, Judy.

    Ms. Judy Wasylycia-Leis: There's a lot of unfinished business, as I've said before.

    Let me try, in five minutes, to focus on a couple of important areas around accountability and transparency. The first problem we have with these estimates is that you've now redesigned the presentation of the information, lumping in management and administration spending and making it very hard for us to even scrutinize. I want to note that and hope that you'll correct it.

    With respect to some of the big issues where we're finding lack of accountability in terms of Parliament, let me ask about some areas where we've tried to get answers before. One is with the $1 billion fund set aside for provinces to invest in new equipment. I tried to get the breakdown from you--I put a question on the Order Paper--and I had no success. Is it not possible for you to give us at least a breakdown of that $1 billion, of where the shortfalls are and how much money has actually gone into some private sector initiatives as opposed to the public sector? Just say yes or no.

    Ms. Anne McLellan: We can provide you with the information with which we have been provided. I would be happy to do that. In some provinces' cases it is very detailed, down to the penny. In others, it goes into a much larger fund. For example, in the province of Quebec, the federal dollars go into a fund, which they double, but they do document where those funds are spent, so we will be able to provide you with the information we have.

    My predecessor wrote twice to his provincial colleagues. He received very positive responses in almost all cases.

    Ms. Judy Wasylycia-Leis: Anything you have would be useful, as opposed to our having to go through the Order Paper route and getting some broad statement like, “The Government of Canada has established a $1 billion fund”, and getting no information. We're getting more from the media. At least we could get that much from your department.

    Ms. Anne McLellan: I would be happy to provide you with the letters and information that I've received.

    Ms. Judy Wasylycia-Leis: Number two, in terms of basic accountability to Parliament, when will you implement the motion almost unanimously passed by Parliament a year ago on fetal alcohol syndrome and warning labels on alcohol beverage containers?

    Ms. Anne McLellan: Mandatory labelling for me...and I'll be absolutely honest. What I want to do is find the most effective way to deal with fetal alcohol syndrome and the effect. I want to figure out how you target, how you identify groups most at risk first, because I do believe that's where your priority has to be placed. We know who some of them are. And then I want to develop programs that in fact are effective at reaching them, helping them, and following them.

    Mandatory labelling may be one part of a strategy, but I have to tell you that I hope there's no one here who thinks mandatory labelling is going to deal with the pervasive effects of drinking while pregnant. What you have to do is be on the ground in communities where people are at risk and you have to follow those people and work with them and help them.

    Ms. Judy Wasylycia-Leis: I appreciate that answer, but I am really just trying to get at the motion that was passed almost unanimously by--

    Ms. Anne McLellan: I'm not ready to move on mandatory labelling.

  (1255)  

    Ms. Judy Wasylycia-Leis: So that's my answer; you're not moving on that motion passed by Parliament.

    Ms. Anne McLellan: Yes, because I am looking at those strategies that will be most effective.

    Ms. Judy Wasylycia-Leis: Number three, about a year ago we dealt here at committee, and the Auditor General had references again, with the lack of accountability and the problems we ran into with the Saugeen treatment centre. Could you just tell us, yes or no, whether you will table for the committee the two studies that were undertaken into that scandal, the internal audit and the RCMP investigation into the Saugeen treatment centre?

    Ms. Anne McLellan: My deputy minister is telling me that at this point the audits are part of the ongoing RCMP investigation. At the end of that investigation, and whether the RCMP chooses to lay charges or not at the end of that process, I don't see any reason why those audits would not be made available. In fact, they might very well be part of the evidence in open court.

    Mr. Green, you tell me that they are still part of an ongoing RCMP investigation, and therefore they could not be released, as we understand it at this point.

    I certainly would have no problem releasing them at the end of the investigation.

    Ms. Judy Wasylycia-Leis: Could you give us a breakdown of the $11.59 million that your predecessor announced on October 18 for new health security initiatives. I don't want the full answer now, and I'm sure you don't have it. Perhaps you could just commit to tabling with the committee a complete breakdown of that initiative, how much has been spent, where it's been spent, and what the plans are.

    Ms. Anne McLellan: Yes.

    Ian, do you want to add anything?

     Mr. Ian C. Green: The answer is yes. It went to supplies, labs, training, and organization. It's public, and we'll make it available to you.

    Ms. Judy Wasylycia-Leis: Great.

    Again, this is something we had to learn through the media. Back in December your department announced that it was carrying out a study of privatization of health care in Canada, a $600,000 study, a two-year research project. That obviously begs the question of why, when the Romanow commission had been appointed and so on. I would like to know who received the contract for this study, when it will report, why it's being done, and whether or not it will have any impact on the decision-making within the department to slow down the slide towards privatization.

    Ms. Anne McLellan: We're a little nonplussed here. Who knows about this study?

    Ms. Judy Wasylycia-Leis: I can reference it. It was in the Ottawa Citizen on December 7: “Ottawa to examine health privatization of health care: $600,000 project”. Perhaps you can get back to us on that.

    Ms. Anne McLellan: There's someone here, Judy, who can probably tell you right now.

    Mr. Cliff Halliwell (Director General, Applied Research and Analysis Directorate, Department of Health): Well, not quite, but I can promise to get the information. What was put out on the web was a request for proposals. I don't know what stage of evaluation of proposals from researchers we're at now and whether researchers have been selected for that or not, but once the selection is completed and approved by the minister, all the information is made public.

    Ms. Judy Wasylycia-Leis: We look forward to receiving that. Of course, it begs the question why, but perhaps that will become apparent as we proceed.

     Mr. Ian C. Green: We'll get you the why, but you should know that we do research across a range of health care issues and we do it on an ongoing basis.

    Ms. Judy Wasylycia-Leis: Sure, but the why is really more rhetorical, given the extent of privatization we've seen in the last year alone.

    This brings me to a question pertaining to initiatives in B.C. The Specialist Referral Clinic is a private clinic established in British Columbia, which many would argue is perhaps a contravention of the Canada Health Act. At least it falls in the grey area of being contrary to the spirit of the act. My question to you, Madam Minister, is whether you will take that issue up and put it before the new dispute resolution mechanism you've established to deal with questions around abrogation of the Canada Health Act.

    Ms. Anne McLellan: It's premature to do that. In fact, as I have said, we try to avoid disputes. What we're doing is monitoring that situation. As I understand it, my officials are meeting and talking to the officials in British Columbia. This has been flagged. We are well aware of the situation. We are well aware of the concerns. This issue has been flagged with B.C. officials. My officials are working with B.C. officials. We are monitoring the situation.

    Ms. Judy Wasylycia-Leis: Sure, but the dispute resolution mechanism is only as good as--

·  (1300)  

    Ms. Anne McLellan: At some point it potentially could be used for that purpose, but we do want to try to avoid disputes, as opposed to going through a formal process, wherever possible.

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

    We'll have Madam Scherrer now.

[Translation]

    Ms. Hélène Scherrer (Louis-Hébert, Lib.): Thank you very much, Madam Chair. Since there's no guarantee we'll have a second go round, I'll put my two questions right now, and you can take the time you need to answer them.

    I'll start with my first question. I was very pleased to hear you talk about physical activity and so forth and to see that you have decided to take the bull by the horns and invest in this field. Considering that the only way to lower health costs is to invest in prevention, I think we need to focus our efforts and money in this area. I've read the guide that you produced and found it to be an excellent publication. Can we expect any more tangible initiatives in the near future?

    My second question relates to an issue that is somewhat more timely, namely the medical use of marijuana. At one point, there was some confusion over this program. Allegations or rumours were swirling that the department had changed its guidelines or regulations. Could you bring us up to date on this program and on how the department is handling matters?

[English]

    Ms. Anne McLellan: Madam Chair, I am going to answer the second question, because I do think there's been a fair bit of confusion in this area and I want to take the opportunity, with your indulgence, to clarify what I think has become a bit of a confused situation around our department's policy and approach in relation to medical marijuana.

    First of all, let me say that the department has not changed its policy on this issue. We remain committed to ensuring that eligible Canadians have access to a standardized supply of research-grade marijuana for medical purposes. But while our policy has not changed, our timelines have, and I want to explain to this committee why those timelines have changed.

    In December 2000, Prairie Plant Systems was selected through a competitive process to provide Health Canada with a reliable source of quality, standardized marijuana to meet Canadian needs. In early July 2001 we expected Prairie Plant Systems to be able to deliver that product by January 2002. So last summer we thought they would be in a position to deliver the first crop in January 2002.

    This projection, Madam Chair, was based on the assumption that PPS, Prairie Plant Systems, would get the seed they needed from a known source, which would then lead to the production of a crop with known characteristics as it related to strain and potency. Madam Chair, that did not happen. In late July 2001, Health Canada officials learned that Prairie Plant Systems would not be able to obtain seed from the source expected, which was a U.S. government agency. As a result, steps were then taken to identify an alternative source of seed.

    A decision was taken to use seeds confiscated through law-enforcement activities. Because the characteristics of this seed were unknown, additional steps in the production process have been and continue to be needed, so that we can ensure, to the best of our ability, that PPS is producing quality, standardized product for medicinal use.

    For example, the first harvest from the confiscated seed yields approximately 185 different varieties of marijuana, some with possible medicinal value, some without. Health Canada and PPS are now in a process of determining which of those 185 varieties of plant have the right characteristics to form the basis of our research-grade supply.

    As for the way the product will be distributed, as my predecessor said on more than one occasion, and before this committee, we expect that marijuana produced by Prairie Plant Systems will be used for research to gather scientific information on the safety and efficacy of marijuana for medical purposes and will be made available to those authorized Canadians using it for medicinal purposes who agree to provide information to Health Canada for monitoring and research purposes.

    So I hope this helps explain some of the confusion out there in terms of timelines that may have been asserted at different times over the past year, and why in fact those timelines have changed.

    This government's policy has not changed. The policy, as articulated by my predecessor, remains the same. There are numerous quotes I could give you in relation to what that policy is and was. But timelines have changed, and I wanted to know why, because you may be asked about it.

·  (1305)  

    The Chair: Thank you, Madam Minister.

     Mr. Ian C. Green: On the first question, which I think dealt with physical activity, there are three things, Minister, that I could add quickly.

    One is we obviously develop approaches to common risk factors in consultation with NGOs, so we have ongoing discussions with them in terms of what other products would make sense. We do have about $4.5 million invested in terms of fitness activities this year. Under the diabetes strategy that we were talking about earlier, we are in fact looking at an update of physical activity guidelines that are involved with that as well. So there are a number of activities that are in play.

    The Chair: Thank you, Madame Scherrer.

    Mr. Merrifield.

    Mr. Rob Merrifield: To get back to that question on the marijuana, is it true that there are 106 people who have a licence to grow marijuana in Canada?

    Ms. Anne McLellan: You will remember that in light of various court decisions, in July 2001 the department introduced the medical marijuana access regulations, and in fact that does permit people to apply under those regs, with the support of their physicians, to possess and in some cases to cultivate marijuana for medical purposes.

    As of April 5, 2002, 205 authorizations to possess marijuana for medical use have been issued under those regulations promulgated in July of last year. Some 137 licences to produce for personal consumption have been issued, and 10 licences to produce have been issued to people designated to produce on behalf of users who cannot do it for themselves.

    Mr. Rob Merrifield: So we have some 130 you say who can grow then.

    Ms. Anne McLellan: There are 137 licences to produce for personal consumption.

    Mr. Rob Merrifield: What are they growing then? The seeds you have brought in...you have about 165 different varieties.

    Ms. Anne McLellan: In fact, you raise an interesting and somewhat troubling issue. Part of our goal is that once we work out a standardized high-quality research--

    Mr. Rob Merrifield: What are they growing now, though?

    Ms. Anne McLellan: Ian.

     Mr. Ian C. Green: Let me start while my colleague gathers his--

    Mr. Rob Merrifield: Really quickly, because my time is--

     Mr. Ian C. Green: I can answer your question quickly. The interesting issue is it's not illegal to purchase marijuana seeds. It is illegal, however, to sell them. What we are doing at the moment is we are in the process of looking at options to allow for exemptees, under the regs, to obtain marijuana seeds in a safe and efficacious manner. What they're actually growing at the moment, I'm not sure.

    Ms. Anne McLellan: On that point, what we want to do from this operation, Prairie Plant Systems, is to be able to provide seeds to those who've been authorized under this program, so that we know the strain, the potency, and that in fact it is a medical research quality product.

    Mr. Rob Merrifield: That's fine. The problem and the point here is that we're getting ahead of the medical research on this. We said that right from day one. It proves that. If you thought you had a pure strain of seeds that you were growing for last year's crop and you found out there were 185 different plant crops in there, then what are the ones that you licence and allow in their backyard who think they're getting medical marijuana for treatment? That's the issue there.

    But let's move onto another one, because we have problems there that you admit to.

    Ms. Anne McLellan: We're in the process of dealing with it.

    Mr. Rob Merrifield: Going back to the hepatitis C, Minister Rock last year told us that 98% of those who applied during that four-year period, and I think your number is about right there at 5,500--

    Ms. Anne McLellan: Applications.

    Mr. Rob Merrifield: --applications, that's right. There were 98% of those paid out at that time. Then he went on to say 99%. So you might as well say 100% of them were paid out. That comes up to the 1,700-and-some that you say were paid out in that four-year period. Are those numbers accurate?

    Ms. Anne McLellan: Off the top of my head, when you use the language “paid out”....

    Mr. Rob Merrifield: Compensated, went through the court system, applied--I think there were 1,700 of them.

·  (1310)  

    Ms. Anne McLellan: Yes, who applied to the administrator.

    Mr. Rob Merrifield: There were 1,700 of them who actually the courts... you went through all of the 5,500.

    Ms. Anne McLellan: Depending on the progression of the disease, I think they could come and re-apply to the administrator.

    Mr. Rob Merrifield: At that time, we had people coming to us saying that there were such delays in their applications. Mr. Rock came out and said that 99% of them were paid out, and they went through the court system, so that means they looked at them all. Some of them had applied, some of them did not--1,700.

    Ms. Anne McLellan: I have the numbers here, but these are based on March 31, 2001, where an administrator is required to provide an annual report every year. His report for this year will be forthcoming very soon. It ended fiscal March 31, 2002. So the best information we have is from the administrator's annual report of March 31, 2001. That was the initial 16 months of operation. Approximately 1,700 claimants have received compensation. At that time, approximately 3,300 claims were still awaiting adjudication, requiring the submission of further information by the claimants or the completion of a trace-back search or both.

    Mr. Rob Merrifield: When we see what has happened in this last 12 months... And you have no indication by now? You must have some indication.

    Ms. Anne McLellan: We anticipate that the administrator's report for 2001-2002 will be forthcoming in July, which will give us much better information in relation to at least the 3,300 claims that were still awaiting his consideration, and in some cases further information to be provided by the applicant.

    Certainly when the report comes, it's a public report. It will be available to you and to all of us to determine how the administrator has moved forward with his work.

    The Chair: Thank you, Mr. Merrifield.

    Mr. Alcock.

    Mr. Reg Alcock (Winnipeg South, Lib.): Thank you, Madam Chair.

    Health, as you well know, Minister, is the number one issue on the minds of Canadians, if you ask what is the most important issue the government should be dealing with both provincially and federally. I can't think of a department in the federal government that has greater scrutiny or greater pressure or gets caught more in that web of relationships.

    Through you, I want to congratulate the staff. I think they do a first-class job. I think it's a very difficult area and one in which the federal government has maintained a leadership role for a long time, and I think it's due to the work that people do.

    I'm going to go further. I saw two articles recently criticizing the online health information system. One was in The Sun here, which pretends to be a newspaper, and then the other one came out of Calgary, I believe.

    Ms. Anne McLellan: CHN, the Canadian Health Network.

    Mr. Reg Alcock: I think the reporter had it exactly the wrong way around.

    As someone who spends a fair bit of time looking at these sites around the world...you can go into any good search engine and type in any kind of disease and get an absolute range of possible solutions with all sorts of wonky advice.

    We desperately need what that network provides, that is, branded, reliable information. You can get information that you can actually use in the management of your own personal health. I would be very concerned if anything happened to diminish the department's support for that.

    And I will come back to the numbers in a second.

    The third thing is in this debate about health care. It strikes me that a good portion of it gets driven by ideology. We end up having an ideological debate disguised as a policy debate. What's lacking is a hard information base that gives you a real sense of where the pinch points are and where the problems are in the management of this system.

    Over and over again, experts in the system have said that the development of the electronic individual patient record is a key to unlocking that, a key to giving us the kind of quality of information that allows us to really understand where the pressure points are and how to manage it.

    Mr. Mazankowski, who did the Alberta report, mentioned that. It's coming into the literature now. The OECD's been talking about it. There needs to be work focused on that to help build public understanding and public support for it.

    It seems to me we've been very timid, in part because we have some sort of weird cowboy as a privacy commissioner right now who runs around destroying things whenever he can.

    In light of all that, I look at the planned spending here in business line number four for information and knowledge management. It's dropped substantially. Now some of that, I understand, is because of the existence of a one-time grant. Can you give us some sense of what's going to happen there in those two important areas, the health information network and the work towards finally sorting out the electronic patient record?

·  (1315)  

    Ms. Anne McLellan: I think you identify a key issue, which is that information of many different kinds is going to be key to moving the health care system in this country to the next level, if you like--not only in terms of efficiency but in terms of delivering better quality care and using the human resources in the system better than they're presently used.

    The Canadian Health Network has been in the papers recently. I'm not going to shy away from this; the Auditor General had some fairly critical things to say. I think we have worked those out. We have brought the network in-house. It is being run from within the department. Regarding her concerns around equipment that was paid for and not being used, I have been reassured by the department that all that equipment has been brought in-house. It is now being used in-house, and we have worked with the Auditor General to ensure, as related to that specific contracting process but more generally in the department, that these things will not happen again. I have indicated to the department that I do not want these things to happen again; therefore, we're putting in place some new management structure, if you like, in terms of how we deal with these processes.

    The substance of the network itself is absolutely key. It gets, I think, five million hits a month or something, which makes it the third most-used health data bank or website in the country, after Yahoo and our own Department of Health website. In fact it's gaining adherents every month. It speaks to this tremendous desire on the part of the public for good, reliable information as it relates to their health care, new developments, new discoveries, new this, new that--all this sort of thing. We work with an awful lot of other organizations--non-profits and others--to make sure the links to their websites and what they're doing are updated and available for Canadians and others who would access them in a timely fashion. That information is going to be absolutely key for people.

    I can provide you the information, if you want, about the external reviews we've had at CHN, the reviews of client satisfaction. I think you would be interested especially, Reg, in that information. We're trying very hard to deliver a product that people can use, that they can have confidence in, and that is run in an efficient and responsible fashion.

    There's no one you talk to in the health care system who does not say that to move up to the next level in the health care system you need an electronic health record. Everybody agrees with that. The question is around the modalities--how we get there. The federal government put in $500 million in an arm's-length organization, Canada Health Infoway Inc. It too has attracted some attention, because we're all aware that the Auditor General does not like these arm's-length bodies. But this one was created, and there are good reasons in terms of policy and in terms of its work plan why it is an arm's-length organization. It has been given $500 million to work with the provinces, the territories, the private sector, and other stakeholders to move the work forward on the electronic patient record or health record.

    Some provinces, all provinces, are working on this. There is no health care system, be it a regional health authority or a provincial health care system, that isn't working in some way, large or small, on the whole question around health records. It is absolutely key to our ability to deliver better patient care and to avoid duplication and unnecessary medical procedures, such as tests and wastes of time on the part of health care professionals.

    There are some privacy issues. We're working hard to try with other partners to deal with those privacy issues. I can't express strongly enough how important this initiative will be to the long-term efficiency and sustainability of our health care system.

    Mr. Ian C. Green: Madam Chair, let me make just a ten-second correction.

·  (1320)  

    The Chair: Mr. Ménard is next.

     Mr. Ian C. Green: I'll talk to you after, then, about... The numbers didn't go down overall.

    The Chair: It's Mr. Ménard's turn.

[Translation]

    Mr. Réal Ménard: That wasn't a question. The minister was giving a timeline. I have a genuine question for her.

    All provincial health ministers, conservatives and separatists alike, are calling on you today to back them up on this matter and to provide adequate federal government funding. You can't tell them that this is the Finance minister's responsibility. Do you agree with us that over the next few years, the provinces will be called upon to invest an additional 5% of their budget annually in health care? At a recent first ministers' conference, it was estimated that costs would rise from their current level of $55 billion to close to $100 billion in the coming years and that if transfers were not increased to an appropriate level, the provinces would no longer be able to provide services.

    Wasn't your government being somewhat arrogant by setting up the Romanow Commission to study how health care services can be funded, whereas the truth of the matter is that it helped create the situation by slashing transfer payments to the point where the provinces can no longer provide the services they should be providing? When will the hypocrisy end? Will you answer the provinces' call for appropriate levels of funding?

    Earlier, I was concerned by something you said. You're a very nice person, and it's nothing personal, but it worried me to hear you say that you are unaware of the specific criteria used to allocate transfers to the provinces. If, as Minister of Health, you can't say why $6 million is allocated to meet health care needs, then I think we have a problem somewhere. Perhaps you need to take an interest in these matters because the provinces need funding to meet the public demand for health care. You know as well as I do that health care eats up an additional 5% of provincial budgets each year. Your government has slashed transfers from $18 billion to $2 billion. Now, the Romanow Commission has been given a mandate to determine how health care services could be funded. Can we count on you in Cabinet to take an interest in funding so that the provinces get what they need in terms of health transfers? Will you be the provinces' ally, yes or no?

[English]

    Ms. Anne McLellan: You raise a lot of important and complex issues.

    First of all, let me say this. The CHST is a block transfer. That decision was made by finance ministers in this country some time ago.

    What I do know is, in terms of those moneys that have been agreed to and targeted by first ministers over the past number of years, for example, the $21.1 billion new dollars in transfer payments that the provincial and territorial premiers made a commitment would be spent on health care, that is targeted health care dollars. There were also targeted health care dollars in terms of various funds, whether it is the $1 billion for medical equipment, the $800 million for primary health care renewal, or what have you. So I am very much aware of those funds that are in fact specifically targeted in one way or another in relation to health.

[Translation]

    Mr. Réal Ménard: Are you prepared to fight for more funding? I have a second question for you. Could you provide me with a list of projects funded under the Population Health Fund for Quebec? I'd like a copy of that list, if at all possible. Are you prepared to show a little more leadership on this issue, to be more aggressive and to show more initiative in terms of supporting the provinces' demands for additional resources?

[English]

    Ms. Anne McLellan: The reality is, we all know that the provincial and territorial health ministers and finance ministers are asking for more money for health. This money was dealt with by finance ministers in Corner Brook. I deal with my provincial and territorial colleagues on a regular basis; I know their concerns.

    Money alone is not going to renew our health care system. More needs to be done. But if you are asking me whether--

[Translation]

    Mr. Réal Ménard: I'm asking you to do your part.

[English]

    Ms. Anne McLellan: --in the future we are likely to require additional funds to sustain a high-quality, accessible health care system, the answer to that question is yes.

[Translation]

    Mr. Réal Ménard: Yes, but you're not going to accomplish that with Mr. Romanow's commission. Will you be providing a list of projects initiated under the Population Health Fund for Quebec?

[English]

    The Chair: Mr. Ménard, your time is up.

    Dr. Castonguay is the last speaker.

[Translation]

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

    I know that she will cooperate with the provinces. It's in her nature to be cooperative.

    I'd like to focus on a topic that comes up often. It seems to have something to do with the phases of the moon. Depending on whom we talk to, as far as transfer payments are concerned, we hear figures such as 14%, between 30% and 40%, and even 50%. Transfer payments are a frequent topic of discussion and comments about them vary widely. I'd like to hear your views on the subject. Do they in fact represent 40%, or is it 60%? What are we talking about here?

·  (1325)  

[English]

    Ms. Anne McLellan: Thank you very much. This, too, is a very important question that requires clarification. The provinces and territories use the number of 14¢. Let me say that we in the federal government categorically reject the 14¢. Let me explain to you why.

    Provinces, when they use that number, are comparing only the cash portion of the CHST to their total social spending, not their health care spending exclusively. In fact, they compare our cash contribution to the CHST to their total social expenditures. That includes not only health, but that includes post-secondary education; it includes social assistance and other kinds of social service programs. We have to understand, are you comparing apples to apples or are you comparing apples to oranges?

    As I've said, they include only the cash transfer. You must include the tax points. There is absolutely no....

    Some hon. members: Oh, oh!

    The Chair: Order.

    Ms. Anne McLellan: Why wouldn't you include the tax points? This was something that was given to the provinces some years ago. In fact, you must include the worth of those tax points in your total CHST transfer.

    The other thing, ladies and gentlemen, the provinces do not include is equalization, which applies in all but two provinces. What is that proportion of equalization payments made to eight of our provinces--

    Mr. Réal Ménard: That's a Paul Martin statement.

    Ms. Anne McLellan: --that in fact goes to health care? You have to include that. I don't mind having a debate around the federal contribution to health care, but let's put all the facts on the table fairly and honestly. Let's put all the sources of revenue on the table.

    I believe the federal contribution to health care, through equalization and CHST cash and tax points, is probably about 36¢ of every dollar spent on health care. We also, in addition, spend on direct health care expenditures, in terms of things like aboriginal health, veterans' health, the armed forces, another $4.2 billion a year. That also includes funding on research through organizations like the CIHR.

    When you actually look at the expenditures of this government as they relate to health care and health in this country, there is no way that the 14¢-per-dollar contribution is accurate. I would like the record to show that.

    An. hon. member: Are you serious?

[Translation]

    Mr. Jeannot Castonguay: The fact remains, Madam Minister, that when the Canadian health care system was initially set up, the agreement was that the federal and provincial governments would share the cost equally. Now you're saying that the federal contribution is in the 36¢ range. What was the basis for that cost-sharing agreement?

[English]

    Ms. Anne McLellan: Again, the 50-50 discussion is one that is often misguided and ill-informed. Keep in mind that the original cost-sharing arrangement only ever applied to physicians and hospitals. Those were the only health services that were cost shared.

    What we have seen, not surprisingly--and no one is blaming anyone here--is a growth on the part of the provinces in terms of those things that are covered in their health care system. It is quite appropriate to engage in a discussion around what the appropriate federal level of funding should be in a renewed, modern health care system. But let's not distort the historical record. I think it's important to get all the facts out there so that everybody can have an informed discussion.

    The Chair: Thank you, Dr. Castonguay, and thank you to all the members of the committee: I'm trying to get the minister finished at 1:30.

    I think the Minister of Health should put in her next budget a lion tamer's whip for the chair of the standing committee. They get more excited, though, when you come, Minister, I have to say. They're usually pretty well behaved.

    I would ask the members to stay beyond the minister's exit because we should do some voting on the estimates so that we can report back to the House.

    On everyone's behalf, thank you, Minister, and thank you to all your staff for being here.

·  (1330)  

    Ms. Judy Wasylycia-Leis: Could I raise a point of order?

    The Chair: Yes.

    Ms. Judy Wasylycia-Leis: I just want to ask, Madam Chairperson, how we, in all conscience, can actually now have a vote after having barely an hour of dialogue with the minister on the estimates for a department of this size with so many burning issues? I just can't imagine how we can leave here today, voting on the estimates and going into the House and giving any credence to this process. It's just unacceptable and irresponsible.

    The Chair: That was going to be my first question. We have had just under an hour and a half--five minutes under an hour and a half--with the minister. The idea was we needed at least one meeting and could proceed to a vote today and report to the House. That is not written in stone, Ms. Wasylycia-Leis. If you'd like to make a motion at this point that we arrange another meeting with the minister to go further into the estimates, then the committee can vote on whether they feel they have actually had time.

    In fact, not all the members on the government side even had a chance to ask questions. I didn't have a chance. Two opposition members had two short chances and you only had one. So I think your position is very reasonable. The question is, the people have to weigh whether or not they can fit in another meeting. We have to have this done by the end of May, I believe.

    Ms. Judy Wasylycia-Leis: I'll so move.

    The Chair: Okay, you're moving that we schedule another meeting before we vote on the estimates. Is that right?

    Ms. Judy Wasylycia-Leis: At least another meeting. At least another meeting of two hours alone.

    The Chair: Do you want to talk to her again, or would officials be sufficient?

[Translation]

    Mr. Réal Ménard: Only the minister.

[English]

    Only the minister. She is responsible for what is done, as minister.

    The Chair: The motion is in order. This is our first discussion on the estimates as a committee, and that motion is in order.

    Are there any comments?

    Mr. Jeannot Castonguay: When would it be?

    You know that will change things. You're pushing us to get that pesticide legislation through. We're off next week; then we're coming back, and we have to get that done.

    It's nice to say let's have meetings. I understand all of this, but there is a tough reality: we have to decide when it is going to be.

    The Chair: Well, first of all, Dr. Castonguay, I am not pushing the committee to do anything. I am the servant of the committee.

    Mr. Jeannot Castonguay: I didn't say you were pushing--

    The Chair: Yes, you did; you said, “You're pushing us.” I'm not pushing. You choose. I'm trying to help you move forward.

    Mr. Alcock.

    Mr. Reg Alcock: Yes. I agree actually. Judy and I come actually from the same legislature and the same legislative experience before coming here, and one thing the House of Commons does not do well is the review of estimates. It's something that has fallen into disuse for a number of reasons, and it's partly because I think we--not this committee but as an institution--have allowed this whole process to fall into some disrepute.

    So I would agree with more time. I would say one thing, though, because both Rob and Réal commented on this: if we're going to do this right, yes, it would be nice to have the minister here. In our experience, it was often the minister who defended the estimates in all meetings, but given the breadth and the size of these departments it would be equally useful to have staff here to ask the detailed questions.

    Judy was asking an awful lot of good questions that the minister could not answer, and at times just getting that information would be very helpful to the debates that go on here. If we're just bringing the minister here to have a repeat of a Question Period dialogue, I think it's less useful than actually spending some time looking at the expenditures of the department. There's an old saying that a dollar paid is a policy made. Understanding the spending would help us understand this department.

·  (1335)  

    The Chair: Mr. Merrifield.

    Mr. Rob Merrifield: I want to say I agree 100%. Bring the minister here, and she can bring whoever she wants from her department. She's responsible for that, and absolutely, I agree with you 100%.

    Mr. Reg Alcock: My only comment, Rob, is that given the shortness of time, because they do have this guillotine here that comes down, if the minister--I don't know what her schedule is--doesn't know what's happening, and there's about two sitting weeks left before the guillotine comes down, and let's say she's in the EU at some big meeting or something, it may not be possible to do it.

    I would still argue to go ahead with it. I wouldn't tie it just to the appearance of the minister, that's all.

    The Chair: Mr. Ménard.

[Translation]

    Mr. Réal Ménard: First of all, this must be given priority consideration. When the committee invites the minister to come, it's important that she free up her schedule. This takes priority over other bills. Our work as parliamentarians requires us to review the estimates thoroughly. The minister failed to answer our questions, whether general or specific, very clearly. She needs to put in another appearance and to take the time to answer our questions. That needs to be our top priority. If we haven't concluded our study of the pesticides legislation, we can do that later. Now is the time to pay close attention to the estimates. It's important that the minister come before the committee and make herself available sometime in the next two weeks. She has no other choice. She can't tell us that she doesn't have the time. She needs to find the time. She's the minister and as such, she has a responsibility to this committee. As legislators, we too have responsibilities.

[English]

    The Chair: There's a motion on the table. Are there any other comments to the motion?

    Madame Scherrer.

[Translation]

    Ms. Hélène Scherrer: Does the motion pertain to Ms. Wasylycia-Leis' proposal?

    The Chair:Oui.

    Ms. Hélène Scherrer: I totally agree that the minister should return because I sensed that we were pressed for time today and that we weren't able to get to the bottom of certain issues. Perhaps if she didn't make a presentation, and stayed for 90 minutes, we would have considerably more time to ask questions. However, I disagree that the minister should come alone. While the minister is capable of responding to policy questions, I think she needs to have other advisors with her.

[English]

    The Chair: No. That is, I think Mr. Ménard was.... We have a motion that we invite the minister back for a second meeting on the estimates and, in the same motion, that we authorize the clerk to work that out with her office until we can find a date that's okay for both.

    Ms. Judy Wasylycia-Leis: But the spirit of the motion is that if the minister is just not available we go ahead anyway with departmental officials.

    The Chair: I don't know if you should give her that option at this point.

    Ms. Judy Wasylycia-Leis: But if you come back and say we can't get her at all--

    The Chair: Well, I think that's an instruction to the clerk, but in effect the motion should say that the committee expects to see her again.

    (Motion agreed to)

    The Chair: Thank you. We know what we're doing next.

    We have quite a busy schedule at the Thursday meeting, I believe, according to the clerk. It's quite a heavy one, both Wednesday and Thursday; no evenings--not tonight, not Wednesday night--but heavy schedules.

    In lieu of those evenings, I'm wondering if on Thursday we might have 20 minutes to half an hour at the end of the meeting, let's say from 1 to 1:30. We can get the witnesses out quickly and talk a little bit about if we're ready to give any kind of instruction to the researchers at all, who in turn could begin to give instructions to the lawyers who draft amendments.

    In other words, there are three or four ways amendments can come in. You can hand amendments to the Pesticide Act to the clerk today or tomorrow, or any day you want. Your political staff can write them and you can hand them in. Some of you may wish to take the amendments suggested by witnesses you agreed with. You can give those to the clerk. Or what we can do on Thursday is try to see where there's a little bit of unanimity and instruct the lawyers, who are part of the staff, to draft amendments that at least the majority of us are in favour of.

    The clerk will send you the name of the legislative clerk and legislative counsel. Those are the two people who in fact will assist.

    But can they not give you their amendments?

·  (1340)  

    The Clerk of the Committee: Yes, they can, and I'll just pass them on.

    The Chair: Yes, they like you. They know you. Let them deal with you.

    Okay, is everybody happy?

    Thank you. This meeting is adjourned.