Thank you very much. Members of the committee, bonjour
, good afternoon.
l'm here today with Morris Rosenberg, Deputy Minister of Health Canada, and Chief Financial Officer Alfred Tsang; and from the Public Health Agency of Canada, Chief Public Health Officer Dr. David Butler-Jones and Chief Financial Officer James Libbey.
Please let me begin by congratulating you, Madam Chair, on your re-election as chair. Being elected chair means being honoured by your colleagues, and I was very honoured to meet with some of you this afternoon as well. In my opinion, among this group of dedicated members, that's indeed a high honour to be selected by your peers.
While l've been meeting one on one with opposition health critics, today marks my first time at this table. Let me say what a pleasure it is to be together with you around this table instead of being seated across and divided by an aisle. It is in times like today that Canadians need cooperation among their elected representatives, rather than division, more than ever.
Let me tell you, as health minister, it is my intention to be open, to listen, and to build effective relationships with stakeholders and colleagues, as well as with my critics. While I may be new in this role at the federal level, I come to this table as an experienced health minister from my time in the government of Nunavut.
As minister responsible for the north, I bring to this table and this House a very unique perspective. I believe that national strategies need to be truly national in scope. Our vision needs to extend north of 60 if we want it to be truly national.
In my time as Nunavut's health minister, I was proud to work toward establishing community-based health programs, advancing a territorial public health strategy, developing a long-term health human resources strategy, and expanding culturally relevant training programs for traditional midwifery, social workers, and nursing, just to list a few.
Having worked on these issues, I know that working for a healthier population means a combined effort among governments at all levels, with first nations and Inuit and with the medical and research communities. Of course, l'm proud to be here before you today, just weeks after our government made important investments in Budget 2009.
As health minister, l'm enthused about new investments in health care across Canada. For example, an additional $1.4 billion is being invested in the Canada health transfer, for a total of $24 billion. This meets our commitment to increasing the transfer by 6% annually until 2013-14. In addition, $440 million was announced to improve health care delivery and infrastructure for first nations and Inuit. And $500 million was announced to make greater progress toward a future where health care for all will become safer, more effective, and affordable, thanks to greater use of electronic health and medical records.
In both these cases, I know that investment serves only part of what's needed and that partnerships with stakeholders are ultimately what will drive us to the health care success we wish to achieve. But of course as a former and current health minister, I know full well that health means more than health care. For too long the focus has been on treating illness and constantly increasing health care spending. Rather than focusing so much on treating the sick, we need to focus more on keeping people well.
Without question, treatment can, must, and will always be there for people who are sick, but imagine our country if people worked more to keep well. That means people maintaining their personal health by living healthier lifestyles and health professionals being better educated on how to help people do that.
While we can't make choices for Canadians, it is our role as government to inform the choices and encourage conditions that lead to healthy choices. That's why our government has renewed Canada's Food Guide to Healthy Eating. That's why we publish the physical activity guide for Canadians, fund the child fitness tax credit, and work with partners to eliminate barriers to healthy choices. And it's why we remain dedicated to restricting tobacco marketing and other inducements aimed at youth, to continue driving down smoking rates even lower than where they sit today.
As health minister and as a parent, I sincerely commit to working with you and other governments, first nations and Inuit, and all stakeholders so that the next generation of Canadians grows to be healthier than their parents and not less.
For Canadians who want to live healthier, let it be clear that our government is here to help; and for Canadians who have concerns about the safety of products on store shelves, in their medicine cabinets, or in their kitchen, our government is here to protect.
We remain committed to an approach where we make legislative changes based on active prevention, targeted oversight, and rapid response. For example, on January 29, I tabled Bill C-6, the proposed Canada Consumer Product Safety Act. With this legislation, we are proposing a change to an existing law that is outdated and out of step with modern times.
We want to provide for better oversight of consumer products in Canada, including toys and cribs. We want to be able to act sooner and order recalls when necessary to protect Canadians from potentially harmful products that could cause injuries.
We want to encourage compliance, with higher fines and penalties for violators. For example, the bill proposes increasing the maximum fine from $1 million to $5 million. To make it work, we are committed to doubling the number of consumer products inspectors.
In proposing these improvements, we are listening to the views of stakeholders to ensure our approach is clear, balanced, effective, and fair.
In addition to taking action for safer products, our government is also committed to ensuring the safety of our food supply. That's why, alongside the Canadian Food Inspection Agency, the health portfolio stands ready to support the independent investigator into last summer's listeriosis outbreak. We are eager to receive her report, to increase our knowledge and put it into action as needed for the benefit of Canadians.
Making good on our commitment to translate knowledge into action is also exemplified by the progress we're making through the chemical management plan. So far, our researchers have examined 70 chemical substances that were in use long before the dawn of our modern regulations. Industries have the challenge to show that the chemicals they use do not pose health concerns and are being managed appropriately.
As a result of our reviews, several new actions have been proposed to better protect the health of our families and our environment. I want to take the time right now to thank my predecessor, the Honourable Tony Clement, for the leadership he brought to this plan. This of course included moving forward to ban the sale, importation, and advertising of polycarbonate baby bottles containing bisphenol A. Through this regulatory decision, our government put families first. It represented a world first, and it clearly showed how the chemical management plan has made Canada a world leader in the safe management of chemical substances. Through our action, we're protecting the health of Canadians.
This is the same goal we're seeking from the drug safety and effectiveness network, funded by $32 million, as I announced in January. Thanks to this network, Canadian researchers will be supported in working together to examine safety and effectiveness of drugs being used by Canadians. The network's coordinating office will be housed at the Canadian Institutes of Health Research. Through CIHR, the health portfolio is making strong contributions to the government-wide commitment to science.
Science helps inform policy and establishes priorities for our future, and to make sure we train the next generations of health researchers, I'm happy to note that Budget 2009 provides an additional $35 million for the CIHR, for the Canada graduate scholarships program. This comes in addition to new support from these estimates for leading-edge research into hepatitis C and childhood obesity, which I know is a subject on which many members of this committee have worked hard in the recent past.
Indeed, these estimates reflect our government's seeking to achieve, through the actions of the health portfolio, safer products for Canadians, stronger research for more effective policy, and stronger support for improved health care and healthier choices, all for a healthier population today and an even healthier generation tomorrow in communities across Canada, including first nations and Inuit.
As health minister, and along with you, I commit to strive toward this goal.
Thank you all for the time to speak, and now I look forward to your questions.
Thank you very much, Minister. Your amazing reputation as someone who truly understands the difference between health and health care precedes you. My line of questioning will be about the problem you've inherited in a government that has chosen health as part of this strategic review and that now has a reputation for having put many community organizations and programs at huge risk. Given that all of the grants and contributions are now sitting somewhere where the Prime Minister's Office can look at them, we are particularly concerned that the ideology and other interests are not exactly.... Or perhaps “strategic review” is just code for the Prime Minister's Office getting to pick and choose. All of this means that community organizations and programs have never been more insecure.
In fact there is a reputation in your department, Minister, for things being promised year after year, going through the proper channels, going all the way up through the department, and then being killed on the desk of the previous minister. This has created huge insecurity, and it means there are tons of programs out there right now for which people do not know whether or not they will be getting money on March 31. So I would like to go through a little checklist, and maybe you would be able to say yes or no to whether these people would be able to expect their money. It seems to me everything in your estimates that has the word “grant” or “contribution” has big brackets, with millions of dollars now missing because of the strategic review, as it is there on page 138, grants, “(4,873,071)”, with a big bracket.
I think you must be upset that the healthy eating program is gone. The aboriginal wellness program is gone. The centres of excellence for women's health seem to be on some lifeline, having maybe extracted one year. The centres of excellence for children's well-being we still don't know about. The Health Council of Canada still does not have any funding after March 31. HIV/AIDS groups across this country don't know if they're getting their money or not. You got a terrible report on the national pharmaceutical strategy.
What are you going to do to make the people who actually do the work in the communities feel secure that you as the new minister understand the importance of these things like women's health, children's health, and particularly research? It is astounding that in the name of increasing efficiency and effectiveness, granting councils can end up with less money when their only job is to get money out the door. I would like you to tell us how you're going to make the community organizations feel more comfortable about what their life after March 31, 2009, or March 31, 2010, will be like.
Thank you, Madam Chairperson.
Thank you, Madam Minister. Congratulations on your election and your appointment to this very important portfolio in the Government of Canada.
I want to start by talking about what you consider to be the core responsibilities of the department. It seems to me that nothing is more important and central to the core of your department than the preservation of our national public health care system. Yet, as you know, we are facing a serious erosion of that system, with user fees popping up all over the place and private for-profit clinics multiplying before our very eyes.
I would like to know from you, Madam Minister, how you intend to.... I would imagine that having been a minister in the Nunavut government, you're aware of the importance of having access for all people in this country, so that they are not denied services they need because of money or geography. So you probably understand the importance of a non-profit health care system. I would like to know what you are doing to ensure that.
So my questions on that front are threefold: number one, have you sent notices to the provinces whose transfer payments for health care were cut back in this budget? Have they been assured that in fact that money has been put back and they don't have to worry about meeting the difference this year?
Number two, are you prepared to come before this committee and actually talk with us about the Canada Health Act, which must be reviewed by this committee? It is something on which we had great trouble in the past getting the minister to address before this committee—yet it goes to the heart of everything that we believe is important in terms of our medicare system.
Number three, would you analyze and go over this extensive report by the Canadian Health Coalition, entitled, Eroding Public Medicare, which documents, over several hundred pages, just how deeply our system is being eroded and how people are being denied access?
Finally, would you just comment on whether or not your government's previous commitment to P3s is now being reassessed by your department, given the most recent information showing that the Brampton Hospital will actually cost $194 million more than what had been stated publicly, costing at least $200 million more over its 25-year lease?
Those are four questions just on that issue. Then I'd like to ask something on pharmaceuticals.
Thank you very much for your question.
The issue of the natural health products process, the whole backlog of the process, is one that our government has been trying to address. Our government is committed to eliminating the backlog by March 2010. As it is right now, I believe, tomorrow or this week we're releasing a report on the progress made in the natural health product application process.
I'm just going to read the notes as to where we are with that.
There have been no backlogs in site licences, or establishment licences, and there were 804 establishments licensed as of February 4. We're on target to reduce the backlog in licence applications by 2010. More than 10,000 licences have been issued. The rate at which product licences are issued is steadily increasing, and progress is continuing in that area.
We've also made a number of business process improvements to reduce the backlog. We're launching a natural health product online system shortly, where licences will be issued within days—a fast-track approach for review of low-risk natural health products. That will be online.
We're batching applications of similar product types to allow for faster processing. Also, we're simplifying and streamlining the applications and review process by working with the industry. We're delivering workshops to assist industry in improving the quality of applications, standardization, labelling requirements, and standardizing general claim requirements.
We're providing a quarterly progress report on backlog reduction to be posted online--October-December 2008, as an example. It will be posted this week.
We're launching a database for consumers and users of natural health products, so that they know which natural health products have been licensed by Health Canada. The rate of licensing is greater than the rate of review, and it's important information.
That is where we are at. We're making progress in the area and will continue to work with industry to ensure that we're addressing their concerns.
Thank you for that question.
The experience we had in Nunavut was that it was a challenge for us to address the shortage of health care professionals. Nunavut faced the same challenges as any other jurisdiction in Canada to address the whole issue of the shortage of health care professionals, recognizing that the approach we took was to try to train our own within our own territory and reflect programs that were culturally relevant to the people who would be served in that territory, to try to deliver programs and services in the home, in smaller communities, and to develop some mobile programs where we were able to take the training to the community level.
In the last four years we've made a lot of investments in Nunavut to train in Inuktitut, to train using traditional practices such as midwifery programs, to incorporate the knowledge of traditional midwives into the health care system, to train in the area of nursing programs in our territory reflective of the model of health care delivery that we use in the north.
We have one hospital in 25 communities. The jurisdiction of Nunavut is huge. How we deliver health care is quite different from other jurisdictions; we have limited access. Technology was also introduced as part of the teaching tools, with telehealth investments in every community.
So there are different models, but it involved the design of a health care system with the health care delivery people. The nurses were there at the table to design it along with us to address some of the challenges they face in remote communities in the delivery of health care. Nurse practitioners are our front-line workers, so trying to design programs that would support keeping them at the community level was very important to us.
So it was not a top-down approach; it was a bottom-up approach, a 15- to 20-year strategy involving tapping into high school graduations, supporting the students through the school system, maintaining them once they got into the system. It was quite long term.
We're facing the same challenges as every province and territory face in their jurisdictions in competing for a very small pool of skilled people in our country today, whether it be nurses, doctors, and so on. In my work and travels to various jurisdictions, we're struggling with this. My view is that, collectively, provinces and territories need to tackle this head-on. How do we come up with a strategy at a national level that would support each other instead of having provinces and jurisdictions compete against each other with that small pool?
We need to recognize the issues and concerns that have also been raised by provinces relating to credential recognition and to the lack of mobility within Canada of our health care professionals because of the processes that are in place. Some have expressed an opportunity to look at that, that there are ways to make it easier for our health care professionals to move around in our country, and at the same time to support our students and our nurses to have that choice to travel to jurisdictions.
So it's a huge challenge, and I'm open to discussions on that. I look forward to working with my colleagues, as well as stakeholders, on how we can perhaps address that, to address the issue of the shortage of health care professionals in our country.
Certainly. Thank you, madame la présidente
I'll start on those questions, and then...because it's a partnership between us and Health Canada on this--and CIHR, for that matter, on the research and evidence side.
The short answer around the public health funding and the Olympics is that we're very much involved in issues of health security and preparation for the Olympics around both bio-terrorism as well as other events. If there were a pandemic, say, or even a seasonal flu or an outbreak during the Olympics, we would have our portable lab on site and be working very closely with the provincial health authorities around dealing with such broad-scale public health events. It's for those kinds of purposes that we're engaged.
On the health promotion side, a number of things are going on. Again, most of this, obviously, is in partnership with the provinces and territories. Specifically in B.C., there's ActNow BC, which has a whole-of-government approach to physical activity, nutrition, etc.
We have agreements with the provinces around healthy living. Most now are in place and are being talked about and worked on. There's funding for ParticipAction, and there's also the work generally that we're doing around fitness, lifestyle, and even the kind of community approach as to how we deal with it.
In terms of childhood obesity, that's clearly an issue. I've said it before, and it continues to be a challenge, that the risk is that if we're not successful in this, this generation of children may be the first to not live as long or as healthily as their parents. Fundamentally, it's a multi-sectoral issue in terms of the roles we play, working with both the food industry, etc., as well as with the provinces and territories. There are a number of mechanisms in place in terms of trying to address this more effectively across the jurisdictions. It's not like there's any one part of a system that can address it effectively.
Really, it's gratifying that people are actually talking about this. We kind of lost ten years, but people are actually starting to pay attention. Every jurisdiction now has an initiative or a focus on this. When Morris and I go and meet now with our P/T colleagues and with deputies, or at ministers meetings, these kinds of public health issues are on every agenda. Five years ago, it was rare to see that even talked about.
Thank you, Madam Chair.
As the committee will know, mental health is a complex multi-faceted problem that is the concern of all governments in Canada and I would say the concern of lots of other folks in Canada.
I think the Mental Health Commission, just to speak a bit more about that, has been a unique opportunity coming out of the report of the Senate committee on social affairs, and then of course the former chair of that, Mike Kirby, became the first head of the Mental Health Commission and has worked with all jurisdictions and with stakeholder groups to bring them on side.
As you know, one in five Canadians has a mental health issue. That means that just about every family in Canada is touched by mental health. And it touches us with respect to children and youth. It touches us in the workplace--workplace mental health. Depression, for example, is one of the major causes of loss of productivity, not just absenteeism, but what is called by some people “presenteeism”, that is, people who are coming to work who aren't really working because they're not able to do that.
There's also the issue that has to be dealt with of reintegration. If you look at the long-term disability claims in this country across all industrial sectors, including, I would say, the Government of Canada, a larger and larger percentage of those claims relate not to physical illnesses but to an inability to work for mental health reasons. One of the real challenges is not only to pay those claims, but then to find a way to get people to reintegrate, because statistics have shown, research has shown, that if people are away for an inordinately long time...the longer they're away the more difficult it is to ever get them back into the workplace.
The Mental Health Commission, as you may know, has set up a series of expert advisory groups. It has a very elaborate structure, with a board of directors, but also with all sorts of people who are really interested in every aspect of this. There is, for example, an expert advisory group on workplace mental health. There's an expert advisory group on child and youth mental health. There's a group on aboriginal mental health. There's a group on mental health and the justice system, from two aspects. One, the justice system is sometimes used as a way of housing people who have mental illness who may act out violently, and on the other side there are justice system issues in terms of contract and civil law issues that need to be worked out.
There's an awful lot of work going on through the Mental Health Commission. As I mentioned, there are the homelessness projects that are being carried out across the country to determine the specific comorbidity around homelessness and mental health, and it manifests itself very differently in different cities, so we hope to get a lot of good research coming out of that.
The Mental Health Commission is also involved in a number of key activities, the most pressing of which I think is the creation of an anti-stigma campaign. If I were to ask people in this room if they had a mental illness, they probably wouldn't volunteer it. If I asked you if you'd ever had cancer, probably people would say yes. A few years ago people wouldn't talk about cancer either. We've come a long way with physical diseases. We have a long way to go with mental illness.
The other thing the Mental Health Commission is doing that's very important is developing a knowledge exchange, a place, whether it's web-based or otherwise, where people can go to actually get information about mental illness with respect to caregivers, families, and patients, information about the conditions and information about the resources to help.
And finally, the commission is developing a national mental health strategy. They have a 10-year timeframe to do their work. They're off to a very good start.
I'd like to get some more detail about Bill C-51. The minister mentioned that it would be coming back in front of the committee. In her remarks she demonstrated a strong commitment to keeping people well and to disease prevention, and that's what natural products practitioners and industry believe their products do. Mr. Rosenberg, I'm sure you're aware that despite the reassurances that natural products would remain available, there was great concern across Canada about Bill C-51.
I have a series of questions that will be pretty quick to answer. With your indulgence, I'll read them all out. The perspective I'm most familiar with is the practitioners'. I know you've consulted with health products industries, but the practitioners of traditional Chinese medicine, the naturopathic physicians, and other complementary health practitioners were concerned that they would lose access to some of the products that they believe are essential for their patients.
I have five questions. One, has Health Canada consulted with the associations representing the complementary health practitioners?
Two, if Health Canada has not consulted these associations, is Health Canada planning a fuller consultation before reintroducing this bill with its amendments? I think they need to address the complaint that little consultation was done regarding an extensive rewrite of a very complex act.
Three, will Health Canada be removing natural products from the same category as pharmaceutical drugs? I know this was one of the key requests, but there were many other concerns.
Four, is Health Canada investing in research into natural products and complementary medicine modalities? Unlike the products of pharmaceutical companies, primarily natural products and natural medicine are a public good. There isn't a private benefit from that research, so there isn't the incentive for the private sector to do it, and we need more of it. I know that the natural and complementary practitioners would like this, too.
Lastly, how is the $12 million of additional voted appropriation being allocated? Thank you.
Thank you, Madam Chair. I will attempt to answer all of those questions with a little bit of help from Meena Ballantyne, who is the assistant deputy minister for the Health Products and Food Branch.
First of all, the first question was, did we take into account the practitioners' perspective on this? I think the short answer is yes.
On natural health products, there was a regime put in place several years ago by regulation under the Food and Drugs Act to regulate natural health products. There is nothing in Bill C-51 that was ever intended to change any of that.
We recognize that there's a very broad range of products that are natural health products, from the most benign products—olive oil, let's say, might be a natural health product in that context—to other products at the other end, where there may be significant interactions with pharmaceuticals, or where the evidence for claims needs to be ascertained if these products are being used, for example, as remedies for serious illnesses.
We recognize that there's a broad spectrum of risk that needs to be dealt with and that what is appropriate at one end of the spectrum might be a very, very light touch, almost nothing, while at the other end of the spectrum you would want significant evidence, recognizing that the evidence in the case of natural health products is different from the evidence you would have with pharmaceuticals. So for Chinese or Indian traditional natural health products that have been used for decades or, in some cases for hundreds of years, there are a lot of traditional sources of evidence that are available, and we recognize legitimacy of that evidence.
The second question was, have we consulted complementary health practitioners? Yes, we have done some consultation of complementary health practitioners. Is there going to be fuller consultation? Yes, absolutely, there will be fuller consultation, and I think on all aspects of Food and Drugs Act reform.
Remember, the reform isn't really about NHPs. The NHP regime was largely in place. It was our intention to basically just import that. What we were doing was a more fundamental reform of food and drug regulation in this country, recognizing, in light of some of the food-borne illnesses we had seen, that Canada's legislative regime had somewhat fallen behind where our trading partners were, including the United States.
We're often criticized for harmonizing to the United States, but this is a case where we're actually harmonizing up to the United States. They have stronger powers, the ability to recall, and tougher fines and penalties. Canada's Food and Drugs Act dates back to the 1950s. All modern jurisdictions have moved ahead. It was time for us to move ahead. That was the crux of the amendments.
You asked about the amendments. Last year, Bill C-51 died with the dissolution of Parliament. It's not currently before Parliament, so in a sense we're really not talking about Bill C-51. The government still has to finalize the package it's going to put forward. But at that point, in response to the concerns of natural health product practitioners, a number of amendments were proposed by the government that I think would have assuaged the concerns of those practitioners. I think they would have made it quite clear that we are not treating natural health products in the same way that we're treating pharmaceuticals. We made quite a clear definitional distinction between natural health products and pharmaceuticals.
As far as research is concerned, I guess the answer I would give is that the research we would do would be research within a regulatory context. As I mentioned, we are going to be taking a risk-based approach. We will be looking for evidence of safety and efficacy of products. Again, the evidence is different, and we will use traditional sources of evidence. But to the extent that we have this regime, which is really no different from what was there before, we would be doing that kind of regulatory research to satisfy ourselves that the products were safe and efficacious.
Finally, on the $12 million, I'll turn it over to Meena Ballantyne.
Thank you, Madam Chair.
To speak to the $12.5 million, when these regulations came into force in 2004, there was no stable source of funding associated with the regulations. What has happened with these supplementary estimates is that we now have a program of natural health products. The bulk of the money, about $8 million of it, is going to go to the natural health products directorate so that we can clear the backlog by 2010, which is what the minister talked about.
We have a variety of business process improvements in place—the natural health product online system—whereby industry can come in with pre-cleared information. This is like having a recipe, whereby we say that if we know something about this product and it conforms to this recipe, then companies can make these submissions online and can receive their application and their licence within a few days. For those low-risk products on which there's a lot of information, we can do this. In the case of other kinds of products, we'll have to work on them.
We're doing a lot of business process improvements, and that's what the natural health products directorate will use that money for.
We now also have in place, with the marketed health products directorate, a system to monitor adverse events that happen or adverse reactions to natural health products. As we all know, “natural” doesn't mean it's no risk; it's really low risk. With the increasing problems of contamination and counterfeiting, this is an area we need to really pay attention to, by monitoring the adverse reactions and events that happen with the use of natural health products. As the deputy said, sometimes they're used in combination with pharmaceutical products as well, so there are a lot of reactions we need to be on the alert for.
Part of the money will be used to put in place a compliance and enforcement regime as well. The inspectorate in the Health Products and Food Branch will also get part of this money to make sure that we work with industry to help them with compliance promotion with respect to these regulations and also to take enforcement action whenever necessary and reasonable.
Let me add, Madam Chair, on the point of consultations, that Canada is hosting an international conference on the harmonization of complementary health products, with the WHO, China, India, Australia, the Europeans, the United States. It's on February 24 and 25 in Montreal.
Thank you, Madam Chair.
I have two questions I'd like to ask the department officials today.
First, to build upon what Mr. Uppal was raising in regard to foreign accreditation, I've met a number of foreign doctors in my riding who have explained to me the difficulties in the process, and I'm pleased to hear that there's enthusiasm and interest in addressing the problem.
One aspect of the problem that I've been alerted to is the cost of equivalency exams. I know of a couple, Kizi and Sokol Mberry, doctors from eastern Europe, who had four kids and were working minimum wage to pay for their equivalency exams. They said the books and exams would cost them $2,000 apiece.
Are there any discussions with the respective provincial bodies about how we can reduce the stigma associated with these costs at a time when new doctors do not have a supply of funds available?
My second question has to do with electronic health records. In the 2006 budget there was an incredible commitment to electronic health records, and more recently there's been an even stronger commitment. I was talking to the CEO of my local hospital, Royal Victoria, and they mentioned that in other provinces some of these funds are trickled down. But in Ontario it appears that it has not trickled down to a hospital level.
Are there any measurements being done to show how electronic health records are being disbursed? Are any provinces needing more of a nudge to get moving on it?
Thank you, Madam Chair.
I'll start with the electronic health records first.
As you are aware, there was an additional investment in Canada Health Infoway in this year's budget. Canada Health Infoway is, I would say, a very prudently managed enterprise and will release money as they have assurances that projects meet a strict set of criteria. Not everybody started at the same time. I think Ontario may have gotten off to a bit of a slow start on this. We have some variability in the country. It's not an even raising; not all boats are going up at the same time. We recognize that, so Infoway, which is an arm's-length organization, will consider the pace at which the health record has been implemented across the country and you may see some differentiation, as there has been up until now, in the next round of disbursements. But that will really be up to Infoway, working with the jurisdictions, based on the soundness of the projects that are put forward.
With respect to medical professionals and barriers to entry for foreign-trained professionals, this is a concern that I think we're looking at in two ways. We have, through the internationally educated health professionals initiative, supported work with the provinces, territories, and stakeholders to facilitate the integration of medical graduates. There have been a number of initiatives that include a central pathfinding website for international medical graduates so that they can have one stop to understand what the opportunities are, the ongoing development of a harmonized national assessment of the international medical graduate process, and a faculty development program being developed to better prepare physician teachers to work with international medical graduates.
The point you raised is not one that we've specifically dealt with. It is an important point and it's one that I will undertake to raise with the committee of federal, provincial, and territorial officials that is looking at this.
There's also work going on under the auspices of Human Resources and Skills Development Canada to try to harmonize requirements across the country. It's work that very much dovetails with the work we've been doing on international medical graduates, and that's another forum in which to raise the issues of reducing, as much as possible, barriers to mobility both within Canada and for people coming into Canada.