Mr. Speaker, I am very pleased to rise in the House today to begin the debate on the NDP motion dealing with the current very difficult situation with drug shortages. I will be sharing my time with the member for .
As members know, this motion follows an emergency debate on Monday. I would like to thank the Speaker for allowing that debate to take place. It was a very important opportunity for members of the House to express their concerns and perspectives on the issue of the current crisis of drug shortages and, more important, to put forward suggestions and ideas about what we should do to deal with that shortage. The fact that we had the debate on Monday was a very good first step.
I am very pleased today that the NDP is presenting the motion, which will be voted on later. We are very much hoping that all members in the House from all sides will come together. As the said today in question period, we must work together to protect patients in our country. That is certainly the intent and the belief contained within the motion.
The motion states:
|| That, in the opinion of this House, the government should: (a) in cooperation with provinces, territories and industry, develop a nationwide strategy to anticipate, identify, and manage shortages of essential medications; (b) require drug manufacturers to report promptly to Health Canada any planned disruption or discontinuation in production; and (c) expedite the review of regulatory submissions in order to make safe and effective medications available to the Canadian public.
We have had an enormous amount of information in the media. I also know we have all been receiving emails and phone calls about the impact of what the drug shortage is doing in Canada. We know that the crisis we face today specifically was triggered by the shutdown of the Sandoz drug production facility in Quebec.
What really concerns us, and the reason we wanted to bring this forward, is we believe this production shutdown and this crisis could have been prevented. If there had been an adequate plan in place by the federal government, we would not be here today debating the motion. Nor would we have had the emergency debate on Monday.
We know that Sandoz supplies 90% of all the injectable medications in Canada, and 100% of the narcotic painkillers and sedatives. This is obviously a very important facility and its shutdown had a very immediate impact.
I want to spend a few minutes talking about that impact. We know that the shortage is having the most serious impact on patients who are in intensive care units and those who are dying and are in need of pain management. We can only begin to imagine the stress and anxiety that places on patients who are in very difficult circumstances, but also on their families and loved ones. This is something that is very compelling.
We also know that injectable opioids are the main method for pain control for surgery, post-operative care and for any hospital admission. With the hospitals running low on these drugs, they are now being forced to cancel elective surgeries in order to save these medications for severely ill patients. We can see the domino effect that is beginning to take place in hospitals across the country.
We have also heard from nurses who work in palliative care. These people are on the front line. They have noted that for many people in palliative care, they are dependent on injectable opioids since they cannot take medications orally.
One of the things I was just horrified to hear was the reports from the Canadian Pain Society. It has told us that it has seen an increase in people who are putting out calls for help because they feel suicidal. They are very concerned that they will be unable to manage their chronic pain without the necessary medications.
We have also heard that people dealing with epilepsy are facing shortages and are very concerned about whether they will be able to have access to drugs. As well, individuals going through transgender surgery are also facing very difficult circumstances.
Although this immediate crisis was triggered by the shutdown of the Sandoz plant, I want to make it very clear that this, unfortunately, is not a new situation. As far back as September 2010, there were many reports across the country about drug shortages. In fact, the Canadian Pharmacists Association did a survey of its members and astoundingly 93.7% indicated they had trouble locating medications to fill a prescription in a week and 89% of the pharmacists surveyed indicated that drug shortages had greatly increased in the previous year. Already we were seeing a very difficult situation.
It seems pretty incredible that people can go to a pharmacy thinking they will get their prescription refilled only to find out the drug is not available and everyone is put into a scramble. Just imagine the time and resources that takes.
I want to make the point that although we have had a particular situation right now with Sandoz, this has been a more structural and systemic problem in Canada, and indeed globally. Unfortunately, it has been a problem, and now a crisis, to which the federal government has not responded.
We know the federal government set up a working group in 2010. It has eight organizations in it, largely made up of industry. There is no patient representative organization on the group. However, the big problem is it was to come up with suggestions for a voluntary system. As we know, that has been completely ineffective. If it were effective, we would not have had an emergency debate on Monday and we would not have this debate today.
I know there are different perspectives, and I will get into the jurisdiction question, but the fact is the measures that the federal government put in place have simply not worked. They have failed and we have pointed that out repeatedly every day in question period and in the debates that we have had.
What happened was the provincial jurisdictions, in the absence of effective federal leadership, took it upon themselves to try to solve the problem. I applaud them for that, but they are left scrambling to try to figure out what to do. We know that health ministers from B.C., Alberta, Saskatchewan, Manitoba, Ontario and Quebec have been working together, through calls, working groups and so on, to determine how they can share the current supply and obtain a new sustainable supply. The health minister from Alberta, Mr. Fred Horne, put it best when he said, “We're not going to stand by and simply wait to hear from Sandoz or the federal government”. They could not. They had to jump in and do something in the absence of any plan or action.
We need to reflect and acknowledge that the responses the federal government gave, particularly from the , have been absolutely inadequate and have fallen far short of what needs to be done.
Umpteen times now in the House, in question period and in committee, I have heard the deal with the jurisdiction question. It seemed like the Conservatives were blaming everyone else for the problem, rather than looking at what they could proactively do.
I do not believe this debate is about jurisdiction. It is not about the federal government delivering health care services or treading on provincial jurisdiction. It is about the federal government's responsibility, under the Canada Health Act, to deal with this crisis. Therefore, let us get off the jurisdiction thing and figure out what we will actually do about it.
We have put forward some very concrete proposals in our motion that we believe will deal with both the short-term immediate crisis as well as long term. We want to see a nationwide strategy, in co-operation with provinces and territories and industry. We want to have reporting required. This is a key point. The voluntary reporting has not worked, so many people are now calling for mandatory reporting. That is very important.
In closing, I appeal to all members and all parties in the House to work together on this issue. I am very hopeful that this motion will pass. We will be voting on it tonight, so it is very immediate. We can show the goodwill of the House to deal with this problem in a non-partisan way and also that we can take action at the federal level, working with our provincial and territorial counterparts and with industry as well both on the short-term immediate crisis and on a plan for the longer term. If we have that commitment, we will restore some credibility and faith with the Canadian public that we can deal with this crisis.
Mr. Speaker, I thank my colleague from for her very pointed speech. She has a great deal of compassion, and she quickly realizes what needs to be done and what action the government should take to effectively ensure Canadians' health and safety.
I am very proud to speak today about the proposals in the opposition motion to find a permanent solution for and to resolve the current drug shortage, which has also occurred on a number of occasions in the past. Canadians, health experts and patients are asking the federal government to take action to ensure the safety of the health system. A federal plan is needed and is long overdue. At present, there is no plan, hence the crisis at the Sandoz plant and Monday night's emergency debate.
Falling ill or waiting for surgery already creates a great deal of stress. Imagine how patients across the country feel as they wonder whether their hospital will have the drugs needed for their surgery. Not to mention that patients in Gatineau, Quebec, will have to wait longer for surgery because of the Canada-wide shortage of injectable drugs. It is unbelievable that the shutdown of production at a single plant, the Sandoz plant in Quebec, could affect all Canadian provinces and territories.How has it come to this?
The provinces of Quebec, Ontario, British Columbia and Saskatchewan recently established a plan to manage the current shortage. They are working with the hospitals to verify drug inventories and identify alternative products. Some injectable drugs can be replaced by tablets or other products. However, changes in medications always pose risks. We do not know how the patient will react or if there will be any adverse effects. In short, it is truly a temporary solution.
At this time, Sandoz has resumed partial production of medications. However, the shortage could last months, or even a year, before supply is able to meet demand.
What is the federal government doing? It is reacting to the crisis instead of being proactive, and it is reacting too late. Yesterday, in a CBC interview, the director general of Health Canada's Biologics and Genetic Therapies Directorate confirmed that the agency was speeding up the licensing process to import essential drugs quickly. Health Canada must nevertheless ensure that these products comply with Canadian quality and safety standards. How will Health Canada inspect drugs and factories? Will it have enough people to do that?
Let us not forget that, in his fall 2011 report, the Auditor General found that in 2009 and 2010 the department was not proceeding with regulatory activities quickly enough and that it could take up to two years for new drugs to get through the review process. When the federal government is slow to approve new drugs, that has an impact on the entire supply chain.
Our motion calls on the government to expedite the review of regulatory submissions in order to make safe and effective medications available to the Canadian public. We are asking the federal government to play its part and ensure that, going forward, all Canadians have access to essential medications. This is particularly important for individuals waiting for cancer drugs; their lives are on the line.
These drug shortages occur regularly. In Quebec alone, in 2008, 38 drugs were out of stock; 63 were out of stock in 2009, and 116 in 2010. It makes no sense. It is only increasing; the situation is getting worse year after year. Contrary to what the government has said since the beginning of the crisis, it is responsible for some aspects of health care. The federal government is responsible for protection and regulation in health care, for example, the regulation of pharmaceutical products, food and medical devices. That is precisely what this crisis is about. The federal government is also responsible for consumer safety and disease surveillance and prevention.
The Canada Health Act is clear: Health Canada has a duty to regulate drugs and monitor their safety and quality. That comes under federal jurisdiction. Need I remind the House that, in our federation, both custom and the Constitution compel the federal government to co-operate with the provinces?
This government seems to have forgotten the basic principles of our country and the of Canada Health Act. Instead of blaming the provinces, it should sit down with them and with the pharmaceutical industry in order to establish a national strategy to anticipate, identify and better manage shortages of essential medications. That is exactly what we are proposing here today. And the official opposition is not the only one saying this. I would like to quote Dr. John Haggie, President of the Canadian Medical Association:
|| We need the federal government to use all of its leverage with pharmaceutical manufacturers, including economic inducements, to ensure Canadian patients get medicines they need.
The Canadian Cancer Society agrees:
|| The Canadian Cancer Society urges the federal Minister of Health to provide leadership to address this critical health care issue by:
||ensuring there is mandatory listing of unavailable drugs by drug manufacturers;
|| developing early warning systems to identify potential drug shortages;
||assisting hospitals and provinces in dealing with drug shortages.
Why does the federal government not want to legislate this? It is so quick to interfere in labour disputes, at Canada Post and at Air Canada, as it did yesterday.
Take, for example, the isotope shortage in 2007. The shutdown of the Chalk River reactor created a shortage of isotopes, products that are needed in the treatment and diagnosis of diseases such as cancer.
At the time, the Conservative government took immediate action to address the shortage. The federal government's inaction with regard to the current shortage flies in the face of the law and the government's jurisdiction, not to mention the 's commitments. Yesterday, in the Standing Committee on Health, the minister said that sustainability will come from innovation and co-operation and that providing Canadians with the information they need is key to optimum population health.
I do not know whether she was listening to her own words, but she is not practising what she preaches. If all those principles are important to her, what is she waiting for to establish a mandatory reporting system in which pharmaceutical companies must disclose information about the supply of essential drugs. Patients' quality of life depends on it. It is all well and good for her to say that the mandatory registry is not a miracle solution—and that is true—but her current plan is completely ineffective.
Her answer therefore gives me the opportunity to say that the federal government needs to develop an effective and sustainable long-term plan to address the current shortages. The Ordre des pharmaciens du Québec is of the opinion that the federal government must also play a role to better manage drug supplies, and that this information is essential in order to prevent other shortages from happening in the future. Drugs are different from other consumer goods. No one chooses to be sick nor what the appropriate treatment will be.
In light of this crisis, it is urgent that the federal government finally demonstrate leadership to protect Canadians' health in the long term. The solutions are clear and simple. They are the three parts of our motion, which I will repeat: in co-operation with the provinces, territories and industry, develop a nationwide strategy to anticipate, identify, and manage shortages of essential medications; require drug manufacturers to report promptly to Health Canada any disruption or discontinuation in production; and expedite the review of regulatory submissions in order to make safe and effective medications available to the Canadian public.
This is the constructive, sustainable and concrete proposal being made by the NDP to eliminate the problem of drug shortages. I hope that the government will listen to reason and support this motion today.
Mr. Speaker, much debate has taken place in the House this week regarding drug supply issues. It is a very important debate not only to members but many Canadians and those who care for them. The current supply issues we are facing arose from a business decision made by Sandoz Canada that, unfortunately, lacked planning early on. It created a decrease in supply that we are all working together to fix.
Last November, the U.S. Food and Drug Administration notified Sandoz of concerns it had about one product at its Boucherville plant in Quebec that was not produced for the Canadian market. Similar FDA findings were also made about two Sandoz plants in the United States. It is important to note that at no time did the FDA find that its concerns were of such gravity to require Sandoz to stop producing at any of the facilities. The FDA simply warned Sandoz about concerns and wanted to know what plans Sandoz had for addressing those concerns.
Following up on the FDA findings, my department inspected the plant and found it to be compliant with our rules for safe quality production for the product it was providing to the Canadian market. My officials held discussions with the company about how it planned to address the FDA findings. The size and scope of the company's production cutbacks were never fully revealed until last month. Its officials informed my department and its customers that it was cutting some production, including products that were medically necessary. Sandoz made this decision without first finding alternative sources for its customers who need these drugs. To make things worse, a couple of weeks ago my officials became aware of a fire at the Boucherville plant.
Sandoz made a business decision, but its impacts are far reaching. We know that our health system relies on safe, secure and reliable supply chains for drugs. Access to medications involves many people. It only works when all work together to ensure the right drugs are available at the right time, when patients need them.
Health Canada is this country's regulator with regard to the safety, quality and effectiveness of the drugs available in Canada. Doctors prescribe the drugs and pharmacists dispense the drugs. Provinces and territories are responsible for the delivery of health care. They know the needs of the Canadians they serve, they know what drugs are consumed and in what quantities. They know what to order when entering into contracts with the pharmaceutical industry. They are also responsible for the terms of these contracts. They make the decisions to enter into sole-source contracts and should be aware of the consequences. Finally, it is the drug companies that manufacture and supply the drugs to their customers, namely, the provinces and territories, as per the contract they have negotiated.
In order for the system to work, each player must do its part. We all must work together. Canadians can rest assured that our government is doing its part. We are doing everything within our power to help minimize the supply issue for hospitals and patients. We have been working around the clock to provide support to the provinces and territories as they manage their drug supplies for their jurisdictions. Let me take a moment to highlight some of those activities.
We are bringing the provinces, territories and federal care providers together on a regular basis with Sandoz Canada. This is to ensure they have critical updates on information. We are making sure they have the information they need to help make informed choices about supply decisions. We have provided the provinces and territories access to information on those companies that are already licensed to produce drugs identified as being in shortage. This information is also on Health Canada's website and is open and accessible to all Canadians.
I have been in contact with some of my provincial counterparts to discuss the challenges we are facing and met with some members of industry to discuss their role in resolving this current situation and a long-term solution. We have contacted our regulatory partners in the U.S. Food and Drug Administration, as well as in Europe. They have provided us with a list of potential suppliers. We have shared this information with the provinces and territories in an effort to help them secure alternative supply arrangements.
We offer 24-7 emergency service to help facilitate access to critical medicines so that physicians are able to provide the care and treatment patients need as soon as possible. This is what Canadians want and we are delivering.
However, we have not stopped there. We are fast-tracking approvals for products, including those produced abroad and approved by trusted counterparts. We are working with our international partners to share safety data to help speed up our reviews. While we are quickly authorizing these approvals, Canadians can rest assured that Health Canada is not taking any shortcuts when it comes to protecting their health and safety. Alternative products and alternative suppliers of these critical drugs must meet our safety standards. Drugs we approve must be effective and meet quality and safety standards.
We have been in constant contact with Sandoz, working with it to ensure company officials appropriately and safely resolve any concerns. In addition, I wrote to Sandoz urging it to improve the information it is making publicly available on drug shortages. Sandoz has responded. I information on current and projected supply is being communicated. Canadians and the health system they rely upon are getting the information needed to plan for and adjust accordingly.
These efforts are paying off. Sandoz is working to come up with a plan to solve problems that interrupted production and created the supply issue. The company is also working to find alternative suppliers to make up for the shortfall from its production line.
My department is currently reviewing approximately 15 submissions that could create an alternate supply. My officials are fast-tracking these reviews so we have solutions for the weeks and months ahead.
Under normal circumstances, we usually complete authorizations for similar generic drugs within six months. However, to help health care providers get access to replacement supplies of drugs that they normally get from Sandoz Canada's plant, we have committed to expediting all phases of the drug review process as much as possible. We anticipate being able to make decisions on some of those applications within a matter of a few weeks.
We are doing our part. By working within our regulatory framework, we believe that we have the tools that can help ease the shortages as they arise.
Industry, the provinces and the territories also have tools at their disposal that can help deal with the current supply situation. They need to step up and fulfill their roles and responsibilities so patients get the care they need.
While these actions respond to the current situations, Canadians should know that we are not stopping there. Drug supply interruptions are seen worldwide. However, our health system is resilient. It has some of the most creative, passionate and caring professionals working to provide the highest level of care to Canadians. We must not take that for granted. The health system needs information in advance so that it can plan and adjust. Given time and information, our incredible health care professionals can adapt.
That is why I initiated a process with industry early last year to provide a long-term solution for adequate drug supply. I wrote to industry with a request to find an efficient way to inform those who are purchasing drugs of current and potential supply interruptions and to work to reduce the number of shortages.
Through this process, we continue to work with industry to ensure that the health system gets enough advanced notice so that treatment plans can be smoothly adjusted. On this point, notification is essential for planning. Advance warning in the system can help pharmacists and hospitals use measures to prepare for upcoming periods of tight supply.
Without notification, we all recognize that this creates a challenging situation for all. Patients may not get the drugs they need and health care professionals may have to adjust treatment plans. Without question, lack of planning and notification creates a difficult situation for many.
Industry and health care professional associations have come together and responded to my call for action. The plan they tabled provided for a phased approach to responding to this complex issue. The first phase, which was completed this past fall, was the posting of drug shortages on two public websites. These websites provide the health system with the information provinces, territories and the health care system need to plan for and respond to impending supply issues. However, these sites are only effective if used properly.
I expect nothing less than timely, accurate and comprehensive reporting of all supply shortages. That is why I have continued to meet with industry and I have insisted that it speed up the implementation of the plan it has tabled with me. Canada needs one website, not two. In addition, I have conveyed my expectations that it must contain timely information on current and anticipated drug supply issues, along with information on alternatives and more information to help the health system plan for and cope with disruptions in supply.
I am pleased to report progress. In response to my calls for increased transparency and acceleration of the tools to inform the health system, industry has responded positively.
Sandoz has committed in writing to improve its transparency. In fact, Sandoz officials responded to my letter for advance notification of shortages in a very positive manner. They agreed to post information about the current drug shortages online on the public website and to give 90 days notice of any drug shortages that arises in the future. They also have resumed partial production. This is encouraging and I expect they will live up to their commitment.
With proper notice, we are able to use our tools to help reduce the consequences of drug supply interruptions for patients, their families and health care professionals. As I said earlier, that is exactly what we are doing.
I am pleased to announce that last Monday two industry organizations, the Rx&D and the Canadian Generic Pharmaceutical Association have made a commitment to support the long-term solution. These two industry associations, representing both the brand and generic manufacturers, have also made a public commitment on behalf of all their members to using the public website to post information on drugs that are currently or anticipated to be in shortage. They have also committed resources to accelerate the development of the website.
Given that it is industry that not only makes but profits off the sale of these drugs, I believe it is appropriate that it contributes to the long-term solution. I am pleased to report that it now has made that commitment.
This work will bring industry and professional health care associations closer to doing their part and continue to work on information sharing. It will bring the transparency needed to ensure they create stability in their supply chain to prevent drug shortages from occurring in the first place.
As members can see, In just a short time there is already proof that by working together, industry, provinces, territories and health care professionals, we have already made a difference. Members can rest assured that as we work our way through this, the well-being of every patient will always be our priority.
I will now address an issue that the opposition has repeatedly raised in the House over the past few weeks. In fact, both the NDP and the Liberal Party put up members who repeatedly asked for mandatory reporting by regulation.
Our top priority is getting the information into the hands of the doctors and patients so they can make informed decisions. The quickest and easiest way to do that is if industry and governments can agree on what information is needed and simply make it public in a voluntary way. Giving advance notice, whether it is a voluntary or mandatory activity, only really helps when a drug company plans to shut down production of a drug. No regulation can provide 90 days' notice of a fire in a plant that halts production.
If a drug company is caught making drugs in a plant that compromises the health and safety of Canadians, we cannot let it continue making drugs in that facility for 90 days. A mandatory system of reporting will not change the fact that there is only one company providing over 95% of these drugs to the entire country. It will not solve the root cause of the drug shortages we are currently facing.
The NDP, led by the member for , said on CBC yesterday that the NDP wanted to let the provinces and territories continue to sole source purchasing but then, in the committee, her colleague, the member for , said that the federal government should interfere with provincial operations and pass laws that protect the provinces.
Is the NDP calling on the federal government to pass regulations or laws that would interfere with the provincial jurisdiction for health care? Does it want Ottawa to pass laws that tell provinces and territories how to purchase their drugs?
Our government does not believe that provinces and territories need protection. We have confidence in them. They are the ones that understand the health care needs of their jurisdictions the best.
I am encouraged by the commitment and the willingness of all governments, as well as industry and health care professionals, to work together to improve our current supply issue. I would like to stress that our government will use every tool at our disposal to help minimize the impact of any shortages. As such, we will work to help get access to high quality, safe and effective drugs.
We have obtained a commitment from industry to be more transparent and forthcoming about shortages. We have obtained industry commitment to contribute to the funding of a long-term solution. We will continue working with Sandoz to keep on top of the supply levels at the Boucherville plant so that we can have a better sense of the impact any change might have on the Canadian supply chain.
As I have said, the federal government has acted in the interests of Canadians and it is working. We will continue to provide ways to help the provinces and territories create a drug supply system that does not leave Canadians vulnerable to changes on a single production line. In fact, all of the players in our drug approval supply system have to be sure they are thinking and their planning is always in the best interests of their patients and their needs. We are keeping all options open. Canadians deserve nothing less.
At this time, I would like to move an amendment, seconded by the . I move:
|| That the motion be amended by inserting after the words “report promptly to Health Canada” in section (b) the words “and the provinces and territories”.
This would more accurately reflect the important role of the provinces and territories, not only regarding drug supply but to honour their responsibility for the delivery of health care to their Canadian jurisdictions.
I look forward to the comments from the NDP health critic, the member for .
Mr. Speaker, I will be splitting my time with the member for .
I stand here today to support the motion brought forward by the New Democratic Party which calls for the setting up of a co-operative mechanism, “co-operative” being the operative word, with all of the provinces, territories and stakeholders requiring the manufacturer to report promptly to the government about the distribution, et cetera, of drugs and to expedite review of new drugs that could replace old ones.
This is a comprehensive motion and I support it, but I do not think it is enough. If we look at best practices in other jurisdictions, there are other things that could be done that would also help, but the motion is a good start and I support it.
I intend to move an amendment at the end of my speech to add something which I think would enhance the motion.
There has been a lot of misinformation and misunderstanding about this problem. I want to talk about the scope and nature of this problem, why it is so important, and why there was an emergency debate two nights ago, and I thank the Speaker for allowing the emergency debate.
This is not a new issue. In 2006 shortages began to escalate at 400% the number of shortages there were prior to 2006. As a result, many countries immediately took steps to ramp up their ability to anticipate and track shortages, and to find substitutions and ways of ensuring there was the necessary supply of drugs.
It has been mentioned that we continue to compare ourselves to the United States. Many of us who have been around here for quite a long time actually understand the way government works. We understand provincial and territorial jurisdiction. We understand the Constitution of Canada. We also understand there are parallel systems that can be looked at with regard to best practices.
We have heard the government say that the U.S. Food and Drug Administration mirrors a lot of what Health Canada is supposed to do in terms of making sure that there is a safe, reliable supply of medically necessary drugs for Canadians to use. In 2006, a drug shortage program was created within the U.S. Food and Drug Administration. The Canadian government could easily have set up a similar program within Health Canada to anticipate shortages, to work with the provinces, territories, manufacturers, et cetera, to prevent those shortages from causing risk to the lives and health of Canadians. This is what most of us are concerned about here. It is not about being political, pointing fingers and saying the government did not do this or that. The point is that because very little has been done, every single day in this country the lives of patients are being put at risk because of drug shortages.
The Liberal Party flagged this back in the summer of 2011. We suggested that the government should take a similar approach, to anticipate and to flag shortages and to ensure that there is a supply. This did not happen and we therefore took it to the health committee to investigate. We did what we thought were the appropriate things to do. We felt there was an inappropriate response from the government. We held a round table in September last year in which we brought together the stakeholders to discuss what should be done and to determine the nature and scope of the problem.
Of course, the stakeholders told us the same thing, that there needs to be an urgent investigation into the problem and a look at best practices. We were told that the federal government has a key role to play, a leadership role, in coordinating all of the stakeholders, the provinces, the territories and the health care providers in order to anticipate and identify shortages and manage the system.
Today we heard in the news that two major hospitals that conduct open heart surgery in British Columbia, St. Paul's Hospital and Vancouver General, have actually postponed all of their elective cardiac surgery. Those are the two major centres in British Columbia. They have postponed elective cardiac surgery because they only have one week's supply left of protamine, a drug that is absolutely necessary for open heart surgery. They are holding that supply in case an emergency cardiac surgery needs to be done. Everyone is waiting.
At the heart of this problem is the fact that they do not know when there will be a supply, how long there will be a shortage, or what other drugs that are necessary for open heart surgery will be in short supply in the future. Therefore, they are concerned. It is fine for the government to say it knows that everyone will care for their patients. Yes, they can care and yes they can wish to do something, but if they do not have the required drugs for intervention, surgery, or to keep someone's chronic disease from getting worse, or to save someone's life, what will they do? Wishing will not make it happen. All the best intent in the world will not make it happen.
I have brought forward that bit of history to let members know why we are concerned about this. When other jurisdictions in other countries saw this four years ago and began taking steps, we wonder why the government continued to pretend it was not a problem.
Two years ago we found there was a rapid increase in the shortages, even from the shortages that existed four years ago. They doubled. We found that in the month of March alone there was a shortage of 250 new drugs.
The Food and Drug Administration in the United States, which has a lot of the same capability, capacity and mandate as the health department here, actually doubled the number of people working on their drug shortages program. It upped the ante in terms of making sure that it moved forward. We saw that the President of the United States and Congress were so concerned that they immediately began to bring forward three new bills to deal with the issue and to strengthen the hand of government to deal with the issue. In November 2011, we saw the president himself issue an immediate order to avert shortages and to have departments work together and do what they needed to do because, as he said, “it is the belief of this administration...that we cannot wait”.
Yet Canada's has shown no such leadership. Canada's has shown no such leadership. They waited until everything fell apart with the Sandoz problem here before paying attention. Then, instead of saying, “Let us see what other jurisdictions are doing, let us find out what we can do, let us move quickly now and say that we're sorry that we didn't pay attention earlier on, let's work with provinces and territories”—understanding that they had already got contractual obligations with other suppliers and that they could not break those contracts—“let's see what we can do to help them, let us work together with the stakeholders, and let's become very proactive”. Instead, there was blaming.
This is what bothers me. It is one thing to suggest that one now cares. It is another thing to say, “Don't look at me. It's not my fault. By the way, we're going to wait and see what we can do if something else happens”.
That is unacceptable. Canadians, physicians, and the Canadian Medical Association have all issued directives for the government to take the same kind of proactive stance in anticipation of and looking at shortages and managing them well.
There is a real problem here. If we want to talk about what the government could have done in taking a proactive stance in terms of identifying shortages really early and anticipating them, here is what jurisdictions have done within their own drug departments. I want to use the Food and Drug Administration's drug shortages program, which I think the government could have set up within Health Canada. They looked at manufacturing problems. They worked one on one with manufacturers, knowing that they could not make manufacturers make different business decisions and that they could not force manufacturers to create new jobs. Instead, what they did was to work with the manufacturers. They let other manufacturers who were making similar drugs know that they could actually speed up production, that they would help them to have the capacity to quickly produce more drugs. They looked at how some firms were only producing one drug and when they found out that the largest firm among that group was going to stop, they asked other firms, “Can you speed up production? Can you increase your capacity? What can we do?” That is called anticipation. It is a proactive management solution to a problem.
We need to look at Sandoz. The minister and the Department of Health inspect the manufacturing plant. If they had seen that the manufacturing plant was having problems with one set of drugs, they should have known that there was going to be a problem. They should have worked with Sandoz to help them deal with that.
I could go on. There are lots of incentives that could be provided to help create a proper supply chain, but at the end of the day, the problem has occurred at Sandoz. There is a crisis. There are some good ideas coming forward here from those of us in the House. We want to work with the minister. We want to make sure that patients are not harmed or hurt. If that is the bottom line and if the government agrees with us that this is in fact something we should care about, let us come together and pass this motion and move on. Let us work together to find the right kinds of solutions.
Mr. Speaker, I want to thank my colleague from Vancouver Centre for very generously sharing not only her expertise but also her time with me this afternoon.
This is an important subject. I wish the resolution had been a little stronger, and I will explain why. I do not think the resolution goes far enough in setting out what the legal requirements really are for both hospitals and insurance plans across the country and the federal government with respect to access to what are necessary health services. When we look at the drug shortage, this is the context in which we have to see it.
It is absolutely no accident that this crisis is happening on the watch of this particular government, a government whose philosophy does not include support for the Canada Health Act. It campaigned hard and long against the Canada Health Act when it was first introduced in 1984. It campaigned against medicare when it was first introduced in 1968. The 's vision of the responsibilities and jurisdiction of the federal government is the most limited view that we have ever had in the history of the country. The members opposite repeat over and over again that the federal government has no responsibilities in health care, that the provision of insured services is in the exclusive jurisdiction of the provinces. The only problem with that is it is not true, because it ignores the clear statements in the Canada Health Act that are set out as follows. Section 3 of that act states:
|| It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.
The provision of medication in a hospital for the purposes of an operation is a necessary health service. The fact there is not sufficient access to medication required for anaesthesia and the control of pain, because those drugs are not available due to a shortage, or for whatever reason, is as much the responsibility of the federal government as it is of the provinces.
The hon. member for has always told me that it is not true that the federal government has no responsibilities in the area of health. Nowhere is it written that health falls completely within the jurisdiction of the provinces. Yes, the provinces are responsible for managing hospitals and for health insurance. Yes, the provinces have a huge responsibility in the area of health. Health care represents between 35% and 60% of their budget. Yes, it is their responsibility. However, the federal government has its own responsibilities. That is why we have the legislation against which they fought. I can say this on behalf of the Liberal Party of Canada. We think that the government has obligations in the area of health. It is clear and the government cannot deny it.
Section 12 says:
|| In order to satisfy the criterion respecting accessibility—
Which is one of the five key criteria that is set out in the Canada Health Act:
||—the health care insurance plan of a province
||(a) must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons...
Everyone has to understand that, yes, the provinces have a responsibility, but the federal government has a responsibility for enforcement as well. To suggest that the federal government has no responsibility in this area is the old Reform ideology. It is so deeply ingrained in the heart and mind of the that he is not prepared to accept responsibility. I almost feel sorry for any minister of health in his administration. He is constantly going to be asking the question, “Why are we getting involved? It is not up to us. It is all about sole suppliers. It is all about the provinces. It has nothing to do with us. It's not our problem”.
We can look at other jurisdictions around the world: the federal government in the United States, issues in the European Union, countries in Europe. This shortage issue is not simply a matter of sole suppliers. This shortage issue is caused, as much as anything, by the fact that the generic producers are constantly telling the authorities that the more the authorities negotiate tough on price, the more the generic producers are going to say, “Sorry, we are not making that drug any more”.
There are issues of collusion worth analyzing, which is why President Obama asked that it be done. This problem did not arise last week. It did not arise because of a fire in Boucherville. It did not arise because of one incident. It is a general problem that has become increasingly serious. The government's response is to simply repeat the mantra that it is all about sole-source suppliers, it is not its problem and some of the provinces were wrong. If the government believed in 2006, 2007, 2008, 2009, 2010 and 2011 that the provinces were wrong to have sole-source contracts, why did it not say so over the last five years? Where was it? I can say where it was. It was asleep at the switch and hiding behind the fact that it did not have any responsibility. It did not want to own this problem.
It is the problem.
Hon. Bob Rae: It is the problem because it is not addressing the problem. The federal government cannot hide behind its lack of jurisdiction. It has jurisdiction, but not exclusive jurisdiction because the provinces have their responsibility. Of course the provinces have responsibility. However, what does it tell us when the health minister of the Province of Ontario says, for example, “The federal government knew about a problem and did not tell us for a matter of weeks”? It tells us there is a regulatory failure. There is a regulatory issue that is not being addressed. I do not think it is good enough for the federal government to simply say it is now going to provide some kind of early warning system. It has to go further than that.
The federal government could establish a task force. It could get the provinces together and ask how to address this issue, how to solve the problem and how to deal with it more effectively. The federal government has had a long time to do all of those things. When we try to understand why it has not acted, the answer is very simple. It has not acted because the does not want, in any way, shape or form, to own any aspect of the health care issue.
Let us not forget the federal government is the fifth largest provider of direct health care services in our federal system. The federal government is a player, bigger than New Brunswick, Prince Edward Island, Nova Scotia or Manitoba. It is a big provider of services to aboriginal people, veterans and others. The government has now decided it can beat up on Sandoz because it is the one company everybody is singling out as being the problem, People might like to know that Sandoz is also a major supplier of drugs to the federal government. The company provides over 100 drugs listed on the first nations drug benefit list.
First nations people who are receiving cardiac surgery or cancer care surgery or other serious surgery, by and large, do not receive it in hospitals that are run by the federal government. They receive it in hospitals that are in the provincial jurisdictions that are then paid by the federal government for those services.
If first nations people are being denied health care services because of a drug shortage, that is the responsibility of the federal government. If it knew about this problem, as a party that is paying millions and millions of dollars to the provinces to provide health care to aboriginal people who are receiving serious surgery, that is a responsibility of the feds.
When the federal government and this minister turn around and say that it is all about sole-sourcing and provincial responsibility, that is an abdication of responsibility on the part of the administration.
Mr. Speaker, it is with great pleasure that I rise in the House in support of the motion tabled by my colleague, the member of Parliament for . I commend her for bringing forward this motion, the only action that has come forward in response to the complete inaction by the government. I also commend her for bringing forward the emergency debate in the House, which gave elected members an opportunity to express their concerns and propose constructive action.
The supply of drugs is indeed a critical issue. I found it profoundly disturbing during the emergency debate to have our federal continually refer to “clients”. This is not an issue of pharmaceutical companies and supply to clients and continuing the supply and profitability of the pharmaceutical industry. This is an issue of patient care. I found the whole approach taken by the senior official in the Government of Canada, who is supposed to be upholding the protection of health care for Canadians, absolutely astounding.
The Conservative government desires to be government but it denies or ignores its duty to govern. We have seen this in environment and we now see it in health care. Canadians have been clear that it has long been the number one issue for Canadians. People are concerned about the continuance of quality public health care. Now we have, yet again, another crisis.
Was it earlier this week or last week that we had the crisis of OxyContin? Again, the federal government said it was nothing to do with the federal government and there was nothing the federal government had to do. As my colleague in the House stated, we continually hear denial from the federal government, that it is a provincial issue. We had one of the representatives of the Conservative Party again remonstrating, suggesting that it is absolutely not an area of federal jurisdiction.
I concur with my colleague who spoke before me that one of the most obvious sources is the Canada Health Act. I would like to bring to the attention of the House that it is not the only federal statute which prescribes a duty and a power for the federal government to intervene in the protection of Canadians' health. As the hon. member mentioned, section 3 of the Canada Health Act very clearly states:
|| It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.
Clearly, this is exactly the situation we have come into. We have a one-source supply. Regardless of whose fault it was or who signed up to provide the drugs, this is the scenario. The Government of Canada's mandate under the statute is to ensure this law is abided by and enforced. So if there is a scenario where provinces are inappropriately relying on unreliable suppliers of drugs, it is the federal government's obligation to intervene and work co-operatively with the provinces.
There is a second statute that lays out the responsibilities and mandate of the . As a lawyer, the first thing I do in determining whether there is a federal mandate is go to the law. I would encourage the government to actually looking at the mandate for the portfolios it delivers. In this case, that is the Department of Health Act. This is similar to the whose mandate is under the Department of the Environment Act and so on. What does the Department of Health Act say? It very clearly states:
|| The Minister’s powers, duties and functions relating to health include the following matters:... the promotion and preservation of the physical, mental and social well-being of the people of Canada... the protection of the people of Canada against risks to health and the spreading of diseases... cooperation with provincial authorities with a view to the coordination of efforts made or proposed for reserving and improving public health.
Very clearly, additional power is given to intervene. Section 11 of that act states:
|| The Governor in Council may make regulations to give effect to and carry out the objects of this Act.
There are very clear regulatory powers to ensure that Canadians across this country have equal, fair access to quality health care for an affordable cost.
I have heard from constituents. I have also heard from constituents who are oncologists and they are gravely concerned at the inaction of the government in this crisis. These oncologists have to make a choice between reducing their patients' pain or conserving medicines that might be more critically needed. It is an absolutely reprehensible scenario and the government should be stepping in.
I give full credit to the Alberta minister of health who has stepped up to the plate and said that he will lead the charge and try to find the drugs that are necessary for Canadians. Kudos for him stepping in and doing that. He has admitted that he is looking far afield and it may be difficult. He is projecting a long-term shortage and has stated that we are in a critical scenario. This is all the more reason for the government to step up to the plate and take the action specifically laid out in the motion put forward by my colleague from .
I would like to close with some of the statements from the doctors in my riding, who are calling on the government to take action on ensuring that the approval of alternative drugs is expedited. The Auditor General of Canada has indicated there is a problem in this area. That is a measure that is included in our motion. We call on the government to step up to the plate and take action on what the Auditor General has recommended.
On behalf of the people of Canada, could the government please be seized of its mandated responsibilities and take action on this critical matter facing the people of Canada?