SSPD Committee Meeting

SUB-COMMITTEE ON THE STATUS OF PERSONS WITH DISABILITIES OF THE STANDING COMMITTEE ON HUMAN RESOURCES DEVELOPMENT AND THE STATUS OF PERSONS WITH DISABILITIES

SOUS-COMITÉ SUR LA CONDITION DES PERSONNES HANDICAPÉES DU COMITÉ PERMANENT DES RESSOURCES HUMAINES ET DE LA CONDITION DES PERSONNES HANDICAPÉES

EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, April 22, 1999

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[English]

The Chair (Ms. Carolyn Bennett (St. Paul's, Lib.)): We should call the meeting to order. We assume the members will trickle in, but I think it's important that we let the Minister begin, in that he has a plane to catch.

So in order to leave a lot of time for questions, we welcome Minister Dhaliwal, the Minister of National Revenue, to our committee. To begin, we will say that there are a lot of members of the community who feel that the report card on taxes is one of the better parts, but we have a lot of room. We're dying to hear what you're going to do for us next.

Hon. Harbance Singh Dhaliwal (Minister of National Revenue): Madam Chair, thank you very much for inviting me.

Fellow colleagues, it's a real pleasure to be here.

With me today is Maureen Tapp. She is the director for special programs and partnerships within our benefit programs.

First, Madam Chair, I thought I'd just speak for about five to eight minutes and then take questions after that, just to speak about some issues that I think are important to all the members here.

Madam Chair, ladies and gentlemen of the committee, good afternoon. This is my first opportunity as Minister of Revenue to appear before you. I want to say at the beginning how proud I am to be representing Revenue Canada here today. My department has a long history of helping persons with disabilities undertake a full role in Canadian society.

Today I want to talk about Revenue Canada as a part of a team that is striving to improve the lives of persons with disabilities. I will talk about a number of changes we have made to bring this about.

I will talk about measures such as implementing recommendations contained in the report of the 1996 federal task force on disability issues, headed, of course, by our colleague, the honourable Andy Scott. Certainly he did a tremendous job of that and deserves a lot of credit for the work that was done by the task force on disability issues.

I will talk about how we're calling on persons with disabilities to join with us in improving the information we provide. I'll also talk about important changes that were made to the administration of the disability tax credit and about other tax and customs measures designed to help persons with disabilities.

Let me explain some of the things we are doing.

I'm sure most of you are familiar with the disability tax credit. It provides tax assistance to individuals who have a severe and prolonged mental or physical impairment that markedly restricts the basic activity of daily living. We have made improvements in the way we administer the credit. I will return to this a little later on.

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In June 1997, Revenue Canada established the People With Disabilities Advisory Committee. This committee provides to people with disabilities a forum to express their views on the way we administer disability tax programs. The committee has said that it would like to, in the context of interdepartmental working groups, address wider issues facing persons with disabilities.

I support that view, and that's why we've been working with other colleagues of mine to see if we can develop an interdepartmental group instead of just having a disability group talking to me. Some of the issues are horizontal. We are working with our colleagues on how we can develop this interdepartmental committee. Pierre Pettigrew, who has appeared before you, Madam Chair, might include the advisory committee in the initiatives his department is undertaking.

We've also created a home page on our Internet site to provide easy access to our forms and publications. As you may already know, Revenue Canada provides tax and customs information in several alternative formats, such as Braille, large print documents, audio cassette, and computer diskette. For people who are hard of hearing or have a speech problem, we provide a tele-typewriter service. As well, specially trained Revenue Canada operators provide a relay service through our inquiry lines.

Canada's senior citizens and persons with low incomes, as well as those with disabilities, can turn to the community volunteer program. Under this program, individuals with simple tax situations are helped by volunteers to complete their income tax return. Let me say that the volunteers do an excellent job. I've had the opportunity to visit with and talk to many of our volunteers across the country who help people fill out their tax returns. They certainly deserve a lot of credit and do an excellent job.

Under another change, the customs tariff provides for duty-free entry of certain goods for persons with disabilities. Also, an excise tax refund is available to persons certified as suffering from a permanent impairment of locomotion.

Within Revenue Canada, I can tell you that we take pride in reducing barriers encountered by persons with disabilities in meeting the requirements of their jobs. My deputy minister, Rob Wright, has established a departmental advisory committee for persons with disabilities. All of the committee members are employees of Revenue Canada who have disabilities. They are making recommendations that help us to ensure that the department meets its commitment to the hiring, retention, promotion, and career development of persons with disabilities.

To help ensure that managers are more sensitive to the needs of people with disabilities, Revenue Canada has established an awareness course called Ability in Disability. Managers attend workshops to improve their skills in communicating and interacting with employees with disabilities. The goals are to reduce physical barriers and change attitudes towards persons with disabilities. We have also established guidelines for customs officers on communicating with travellers with disabilities.

Earlier, I spoke about the federal task force on disability issues. The Honourable Jane Stewart, my predecessor as Minister of National Revenue, was one of the four ministers who sponsored the task force. I can tell you that Revenue Canada played a very active role in the task force meetings and discussions. Officials of the department were present at every single public hearing across the country. We listened to the concerns of people with disabilities.

One of the recommendations that came out of the task force report addressed the need for comprehensive information that describes tax laws and programs for persons with disabilities. We responded to this recommendation quickly by first consulting with a broad range of persons with disabilities and with groups representing them. Their experiences, opinions, and viewpoints greatly enhanced the guide we issued last spring. The guide, which is reviewed and updated each year, is called Information Concerning People with Disabilities, and we'll be able to provide that for all the committee members so that you can see how we've put all the information together to form one guideline.

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Previously, the department would accept a claim without review in regard to the disability deductibility. We would take the claim, review it, and, in some cases later on, disallow this tax credit, which was seen as not appropriate. We have changed that. What we do is that right at the beginning we determine whether that tax deductibility for disability is acceptable or not. We had a lot of excellent feedback on that. I'm happy to report now that we provide that and make a decision on it immediately so that there's no retroactivity involved. The decision is made at the original point as opposed to going back. I think that has been very much welcomed.

My honourable colleague, Pierre Pettigrew, also appeared before this committee recently. He described how his department is taking the lead federal role in enhancing the participation of Canadians with disabilities in the economic and social life of our country.

You all know that in June 1996 the first ministers made disability issues a priority item on the agenda for social policy renewal. That led to federal, provincial, and territorial governments consulting with persons with disabilities. The product of those discussions was a report, In Unison: A Canadian Approach to Disability Issues, which I'm sure you know of.

I support the comments made by Minister Pettigrew before this committee. In Unison establishes a blueprint for full citizenship for people living with disabilities. It focuses long-term policy development on three interrelated building blocks: disability supports, employment, and income. In Unison tells us that persons with disabilities consider themselves independent individuals with the ability to control all facets of their lives.

Federal, provincial, and territorial governments are now committed to working together to develop a co-ordinated Canadian policy. Revenue Canada recognizes the importance of partnerships that help to ensure full citizenship for persons with disabilities. The officials of my department and I are working closely with other federal departments and agencies to develop a national disability strategy and to identify measures that remove the barriers to full participation in all aspects of Canadian society.

Ladies and gentlemen, we know that persons with disabilities still face barriers and discrimination. These barriers prevent them from participating and contributing as equal partners. As a society and as a national government, we are learning together how to be more perceptive and sensitive in dealing with these issues. I believe these efforts will usher in new measures to give citizens with disabilities a fair chance to share equally in the rights, responsibilities, and opportunities of all Canadians. At Revenue Canada, as throughout government and society, we are trying to change perceptions of persons with disabilities and, by this process, make us all better citizens.

Madam Chair, I think one learns a lot about the challenges that people with disabilities have when one has family member who faces those barriers. I've had that experience, and maybe other members have as well. My own father, through glaucoma, lost his vision at the very young age of 40. I've seen the challenges he faces.

I want to tell the committee a story about what happened to him one day. He's a very active individual. He has been blind for 25 years. The CNIB helped him become mobile when he first became blind, and they did an incredible job. He's very mobile. He goes everywhere on his own. He travels everywhere.

One day, he went to go to the bus as he usually does every morning to go to the CNIB or to do other charity work. There had been a car accident the day before in that area, and the fence that he used as a guide as he walked along had been torn down as a result of the car accident. He was walking as usual, but as he made the turn, the fence that guided him was no longer there. He made a right turn, fell about four or five feet, and was injured, because nobody ever thought that there would be a blind person walking down the street. He was badly injured because people weren't thinking about the challenges that people with disabilities have.

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I'm very much aware of the challenges they have. I know that we as a society can work to help people to get the right training in order to be full participants in Canadian society.

Let me quickly tell one other story that reminds me of the situation of a young boy I met in India. He was about seven years old and wasn't able to speak at all. The family thought their boy was deaf and dumb, so he became marginalized. I remember this boy who couldn't communicate. He came to Canada as a young boy. They did a lot of tests with him and found out that he just had a hearing problem. There was no other problem, but he couldn't hear, and if you can't hear, you can't talk. They were able to give him hearing assistance and special school training.

Last summer, Madam Chair, I went to this boy's wedding. He was 24. As a result of what we were able to do and as a result of the proper training, he's now a productive, working citizen, along with his wife. We helped them make sure that this person developed the skills and the training he needed in order to be a strong, participating Canadian citizen. We, as a society, will all benefit from that. If he had been in another country, where he didn't get that training, he would have been totally marginalized. He would never have been, in any way, a full participating citizen of that country; he would have been a burden.

I think those two stories show how important it is for us to make sure that we provide the resources for the people in the disabled community and how important it is for all of us to be sensitive to those individuals. Sometimes we're even scared to talk. My own father is someone who talks to everyone, but often people are afraid to even approach him. Like every other individual, he wants to talk to people and meet people, but often people are a little shy to talk to people who are blind.

I've learned a lot from my own father who has gone through this, and I've learned a lot about how important it is to make sure we support agencies such as the CNIB, which give them a huge amount of freedom and let them fully participate, even with the difficulties they have. They can play a very important role and be full participants in every part of Canadian life in all parts of our society.

I thank you very much for giving me this opportunity to come before you and relay some of those personal stories that I've experienced in dealing with the challenges that persons with disabilities have.

The Chair: Thank you very much.

Mr. Bailey.

Mr. Roy Bailey (Souris—Moose Mountain, Ref.): Thank you, Madam Chairman.

Mr. Minister, I think what you had to say about how far we have come in this particular field is a credit to the country. In my particular vocation before I came here, I was able to witness decades of it, and I'm proud of what we have done.

One of the difficulties that I face in my work at the present time is the attempt to explain to people the disability tax credit from Revenue Canada and the disability allowance from the Canada Pension Plan. For some reason, I don't do a very good job of articulating that, because it takes sometimes a lengthy time with an individual in order to explain to them what that difference is.

I know that you have to work very closely with the human resources department on this issue, but have you ever given consideration to doing a booklet, such as we have here, with half of it being from Mr. Pettigrew's department and half from yours? We could have that available so that we wouldn't have to go through these lengthy details in trying to distinguish between the two. I just throw that out as an observation.

I have a question, Madam Chairman, if that's all right. If I get an answer to that observation, I'll throw my question out.

Mr. Harbance Singh Dhaliwal: First of all, thank you very much for that question.

The disability pension under the human resources department has criteria that are different from those of the disability tax credit.

Mr. Roy Bailey: Yes, I know.

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Mr. Harbance Singh Dhaliwal: The two aren't the same. Sometimes people say they were able to get a disability tax credit but not the disability pension.

Mr. Roy Bailey: That's the point.

Mr. Harbance Singh Dhaliwal: They are two different things and two different criteria exist for them. The disability tax credit that we have provides additional tax assistance for individuals who have a severe and prolonged mental or physical impairment that markedly restricts the basic activity of daily living, whereas, I believe, the human resource development pension is based more on whether people are employable, on whether they are able to carry out employment. That's their criteria.

The criteria are different criteria, but your point is that perhaps we can have one information guide that covers them both—and maybe we can include it in some of ours. That's something that we'll take back. I think that if we're able to get this interdepartmental committee to raise that issue among the departments, that we can do it together collectively in this area.... It is something that I think could be brought forward as one of the issues that we can talk to them about, as to how we can maybe bring different departments together in one information package. That may make it easier. It's something that I think could possibly be considered.

Mr. Roy Bailey: Thank you for that, Mr. Minister. I have a question now.

As you deal with the provinces and your government, you also deal at the provincial level with different human rights codes. I mention that because in different provinces people with disabilities can expect different features or special attention from that province. Because there is not similarity among the provinces, people with disabilities who move from one province to the other often run into some obstacles.

Although I know you're working on this, is it not time that...? I know you wouldn't want to dictate a human rights code to a province, but when it comes to those things within the human rights codes of each province that deal with disabilities, they could be standardized. Do you understand what I mean? I'm talking about access to buildings and things like that. I could give you a list of 20 things. It isn't the same in all provinces. It's federal, and yet there are differences created at the provincial level.

Mr. Harbance Singh Dhaliwal: I guess you're referring to it in terms of appropriate access—

Mr. Roy Bailey: That's right. That's one of them.

Mr. Harbance Singh Dhaliwal: —and different programs.

Each province does have its own programs. Some have greater benefits than others. I know that in the province of B.C. they provide bus passes and transportation to some of the people who have disabilities.

I know there's one transportation issue that's very important and is often brought to me. My own father brings it to me. He says that when he has to travel on a plane it's sometimes not possible for him to travel alone. Sometimes he has to have someone with him, which requires an additional fare for another person. There might be something on a national basis.... I could ask the committee here if you could look into that and get the airlines involved. If someone needs someone to accompany them, perhaps they can charge them for just one person. I think that's something—the airlines—that may be worth looking at. There are some national things we can do.

In terms of standardizing some of that, I think it would be difficult to dictate to the provinces what they can and cannot do. Sometimes even in municipal governments they have different standards—

Mr. Roy Bailey: Yes.

Mr. Harbance Singh Dhaliwal: —set up with regard to the building code and what sort of access is required. It does vary, and maybe that's a point in terms of some national standards that could be put in and that we as a government would expect people to abide by.

Mr. Roy Bailey: National minimum standards.

Mr. Harbance Singh Dhaliwal: It may be looked at and considered. Or maybe there could be some minimum standards in terms of access and things like that, which could be required of all municipalities as well as provincial governments.

The Chair: Thank you.

In view of the brief amount of time, maybe we should just go around with all of the questions. Then, Mr. Minister, maybe it would be okay for you to draw some themes together and give us an answer, because I think a lot of us are hopeful that with the social union and with the consensus there seems to be within this sector we could move quickly on these things.

As a physician, I would like to say that this disability tax credit makes me nuts, in that somebody with cystic fibrosis who spends two hours a day getting ready to breathe but is able to go to work somehow doesn't qualify. It's a difficult, rigid thing. I think people hate it when government has rules but has no idea of what their real life is like every day.

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Maybe we could just keep the questions like Question Period or something like that—a minute and a half or something.

An hon. member: Oh, no!

Some hon. members: Oh, oh.

The Chair: Except that you have to behave.

We'll see how quick and clippy the questions can be, because there are five, and then we would.... If there's a maximum of a minute and a half or something to go around, then the Minister can have some time to draw his answers and themes together.

[Translation]

Mrs. Madeleine Dalphond-Guiral (Laval Centre, BQ): First of all, I'd like to thank you for coming here. In your presentation, you referred to services provided by telephone operators to persons with a hearing or other type of impairment. I imagine these individuals are not very happy these days, what with the strike by telephone operators, but that's another story.

Tax credits are a very real problem. Firstly, has the definition of daily activities, which serves as a reference point for determining eligibility, been revised recently, and if so, who was involved in this review process?

Secondly, I'd like to know, if possible, how many persons with disabilities applied for the disability tax credit and how many were rejected, ultimately appealed and won on appeal? That would be interesting to know.

Thirdly, is it true that families caring for a disabled child under the age of 18 are not eligible for the natural helper credit? If that's true, I'd like to know why. At first glance, this doesn't seem to make a great deal of sense.

I have to say that I greatly appreciated your referring to your own personal situation. I think people become more attuned to persons with disabilities when they are confronted with a difficult situation. I believe you will be a very formidable spokesperson indeed for this community.

[English]

The Chair: Thank you so much.

Mr. Mancini.

Mr. Peter Mancini (Sydney—Victoria, NDP): Thank you, Madam Chair. I'll try to be brief.

I, too, will go to the different definitions in the disability tax credit and the Canada Pension Plan disability definition, both of which require severe and prolonged mental or physical disability. It just seems to me that it is almost impossible for people to distinguish between the two, and it seems to me that it gives rise to tremendous frustration. I know that it does in my riding for a number of the people who come in to see me. It just seems to me that when work is one of the basic activities of daily living, if we can't work because we're disabled and if we qualify for Canada pension, then surely the tax credit should kick in. That would be my first area for a theme.

The second one would be, I suppose, more simple. I don't know the answer to this. What tax assistance is available for attendant care for parents or caregivers of people who have disabilities? I know that there's a tax credit for caregivers who come into the home. Is that extended where a parent has a child with a disability? I don't know that.

There. I've been brief.

The Chair: Thank you, sir.

Mr. Muise.

Mr. Mark Muise (West Nova, PC): Madam Chairman, thank you.

Thank you, Mr. Minister, for being here today. I have one little question, and then I have something to share with the committee. I know that it doesn't have to do directly with the minister we have before us today, but it has to do with CPP, which we talked about last time.

Mr. Minister, in preparing for this committee back in December, I had the pleasure of reading through about four or five reports that were done over the past 10 or 15 years, maybe, and there were really good recommendations in those reports. What bothered me most was that many of those were not acted on, and I'm hoping and wondering, and my question to you is, when we come to the end of our work with a report, will at least some of these or most of these recommendations that we put forth be looked at?

The point that raised the—

The Chair: Can we do that after the Minister leaves?

Mr. Mark Muise: Yes.

The Chair: That would be great.

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Mr. Mark Muise: There's one other thing. It shouldn't take long

The Chair: Okay.

Mr. Mark Muise: This week something happened to me that really put up the hair, sharp, on the back of my neck. There's not much there, but what was there was sharp.

There's a CPP disability case that has been ongoing for about five years. This individual was finally approved, and we received this somewhat ambiguous letter saying that this person was approved for disability benefits back in January. We phoned this person and told her so. Two weeks ago, we received a call: no money yet. We phoned CPP. To make a long story short, what has happened is that they owe her benefits back to 1994, and they're in the process of putting together an offer for the back pay, and then they will put her “in pay”.

The Chair: Does she have to pay tax on it?

Mr. Mark Muise: That's not the issue. The issue is that they owe her x dollars, but they are going to offer half of x, and she will probably accept it because she needs the regular monthly pay. Now, that, in my opinion—this could not be said in the House, but I can say it here—is either blackmail or coercion.

Some hon. members: Oh, oh.

Mr. Mark Muise: What I did with this is that I spoke with the minister, who is looking into it, but my gosh, this just re-emphasizes all that we've talked about over the last little while.

Thank you.

The Chair: Thank you.

Mr. Scott.

Mr. Andy Scott (Fredericton, Lib.): If we go forward with a provision for attendant air fare on your behalf, then, we have some things that we could perhaps get out of you.

Some hon. members: Hear, hear.

Mr. Andy Scott: One of the things has to do with alternative formats and the availability of information in those formats. I'd like to know the level of your satisfaction with what you make available, so that we can test that against the community we're meeting with next week in order to make sure that the things that need to be available from a highly technical department, if you like, in the areas of tax and so on.... I think that's a very important thing for Revenue Canada. Maybe it's just a question of not being aware of dissatisfaction—if, in fact, dissatisfaction exists—in terms of the availability of information in alternative formats.

I'm curious about consultation questions. You mentioned the advisory committee. I know of its existence. We went through the setting up of the agency, and I am curious to hear about the role that advisory committee played in the context of that particular very important change in the nature of the way the department operated.

One of the recommendations of the task force had to do with the blending of the disability tax credit and the medical expense credit and the fact that it might become refundable. I'm curious as to what investigation of that possibility has been undertaken since the task force's report.

Also, Mr. Minister, when Mr. Pettigrew was here, he committed to an expenditure of $7 million, I believe, to help pay for the cost of HALS. This was to at least get us started. It was recognized that it would just get us started, but we wouldn't lose time. Would the Ministry of Revenue also be prepared to contribute to that survey as, certainly, guiding information for decisions that would be taken by your department?

The Chair: Thank you.

Mr. Harbance Singh Dhaliwal: Thank you very much.

Let me first respond in terms of recommendations coming from this committee. Let me speak to the recommendation that came from the federal tax force. There were four recommendations that came forward, two of which we have responded to in terms of combining all of the information together. One is in terms of making a decision immediately on the tax credit as opposed to doing it retroactively...and those two.... The other two recommendations are being reviewed by the finance department because those are finance decisions.

One thing is that from my point of view, I'm an administrator, and the finance department is responsible for all of the legislative changes that come about in the Income Tax Act or in the Financial Administration Act. Some of the questions you have put forward really don't affect me from my national revenue basis, but they do affect Paul Martin and the finance department. That's something you'll have to put to him. If he's willing to make the legislative changes, I have no problem in administrating them. I would happy to administrate some of the changes that have been suggested here today.

On the question of caregivers, perhaps, Maureen, you could answer that question, which was also asked by Peter in terms of what the benefits are and also what the age limit is. What if there's someone at a younger age? Can you respond to the question of attendant care?

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Ms. Maureen Tapp (Director, Special Programs and Partnerships Division, Department of National Revenue): There is a provision for an attendant care deduction on the tax return, and there's also a provision now—which is still proposed but will be effective for 1998 on the 1999 return—for a new caregiver amount. If a person has a child or a sister or a brother or so on to whom they're providing care and that person qualifies for the disability tax credit, that additional caregiver amount is allowed on the tax return in addition to the attendant care expense.

Mr. Harbance Singh Dhaliwal: I could just comment in terms of the definition, of whether we could have one consistent definition, both from the pension or from the deductibility tax credit.... That's something we can look at. I think the two programs are totally different, but I agree that there may be something that can be looked at. I'll pass that on to my colleague, Mr. Pettigrew to see what possibilities there are, to see if there can be some consistency. Also, if someone gets a disability pension, should they automatically be able to get it? We can certainly take your view into consideration as an option, but the two programs now are totally different.

I know that a few people have that view: if I'm getting a disability benefit, why can't I get a tax deductibility? The other thing in terms of getting the CPP disability is that it's a huge commitment, because it may go on for 10 or 15 years as a cost to government. They would have a much more rigorous process because it's a huge cost in the long term. They have to be sure that the person is in fact deserving of that disability benefit.

I can tell you from my own experience that when my father applied for CPP disability, it took us four to five years, even though he was totally blind. We went through many appeal processes and many doctors' reports before we were finally able to get him a disability pension—and he was totally blind, he couldn't do anything, he couldn't carry out his job or anything else. Still, I was surprised at that time that we had to work so hard to get his pension. We were able to, in the end, by going to appeal. We were successful in the appeal.

In terms of the question about how many people apply for the tax credit and how many are rejected, I don't know if Maureen has that figure, but we can certainly try to get that information.

The Chair: Maybe, Mr. Minister, the clerk can send you a list of the questions.

Mr. Harbance Singh Dhaliwal: Yes. I apologize for not having those figures with me right now, but we certainly will get those and bring those back, along with the figures on how many people appeal and are successful or not successful in the appeal.

The Chair: Maybe we'll just compile the list of questions, and if there is anything that the committee feels needs further attention, we will add that.

Andy?

Mr. Andy Scott: I have just a couple of comments, Mr. Minister. One had to do with your response to your level of satisfaction with the availability of the department's information in an alternative format. The second had to do with progress with regard to the merging. I think you referred that back to finance as an unfulfilled.... I appreciate that, but I also would be interested in your own views, not unlike your views on CPP and the disability tax credit.

Mr. Harbance Singh Dhaliwal: First of all, in terms of information and more opportunities to be accessible, as indicated, we have it in Braille, we have it on the Internet, and we have this tele-typewriter service. We can look to see if there are other ways to provide better accessibility in terms of information. Certainly we'll look. If there are, we can go beyond this in terms of maximizing the technology that exists out there today to provide that information.

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We are trying to use the electronic media as much as we can. Let me give you some examples in terms of tax. We have introduced what is called TELEFILE, whereby people can send in their tax return by telephone if they have a very simple tax return, all within a five-minute or ten-minute timeframe. It's very easy and very simple if you have a simple tax return. I think that would be very helpful for those people who have a problem with mobility.

Also, pretty well all the forms that we have can be accessed through the net, so a person doesn't have to phone our office or wait for the mail. They can go right to our web site and get the available information. That's one of the mediums we're trying to utilize as best we can. We use the web as much as possible for information.

We are trying to use all the technology that's available today in order to provide as much service to Canadians.... They can get it right in their own homes. Eventually, within a year, Canadians will be able to send their tax returns from their home computer directly to us. They won't have to go to a tax preparer and they won't have to mail it; it can be done right on their home computer.

We are attempting to do everything possible to use technology and to use as many alternative methods as possible to provide services, and certainly, if there are new ways in which we should be doing that, we would be happy to look at them. If there are any recommendations that come out of this committee with regard to us providing new mediums and new ways to provide that information, we certainly would be happy to pursue that.

The Chair: Thank you very much. I think we're all hoping that with the national disability strategy there will be more collaboration in terms of looking at the issues of persons with disabilities. The CPP disability versus the disability tax credit is, I think, the best example of how it doesn't yet make sense to Canadians in regard to how they can qualify for one and not for the other. Also, it doesn't make sense to them that they seem to get cut off CPP disability if their tax return is a certain way. I think we need to have some transparency in information, but basically, if we have a really good national disability strategy, we hope that we will get you a lot more taxpayers.

Thank you.

Mr. Harbance Singh Dhaliwal: Thank you very much for giving me this opportunity to come before you and talk about a very important issue. It is something that's very close to my heart, as it is, I'm sure, to many of you. We have to make every effort possible to make sure that we provide accessibility, that we provide the appropriate information in an appropriate medium, and that we do everything we can to reduce the challenges that exist for persons with disabilities.

The Chair: Thanks very much.

Just briefly, while we are changing witnesses, Mark, I want to say that in mid-May, I think, we will be hearing from Mr. Rabinovitch, the ADM for income security programs, and from the CPP commissioner, so get your questions ready for them.

Mr. Mark Muise: Thank you.

But did you understand what I was trying to say, Madam Chair?

The Chair: Yes.

Mr. Mark Muise: This is happening.

The Chair: Yes.

Mr. Mark Muise: I had heard horror stories, but I experienced it and it just...anyway....

The Chair: Mr. Minister, we welcome you to the Sub-committee on the Status of Persons with Disabilities. We think this is a great committee because everybody is very keen to make this work. What we've found, as you know, is that many ministers deal with this issue. We're thrilled to have you here.

Hon. Allan Rock (Minister of Health): It's good of you to say that.

As Minister of Health, as you would imagine, I'm one of the members of government who is particularly interested in your work. As you say, it requires the work of all of us to achieve full citizenship for persons with disabilities, and I like the way you put it, “to produce a lot more taxpayers”, because opening the doors to the workplace for people with disabilities....

Madam Chair and colleagues, the mission statement of the Department of Health is very simple. Its mission is to improve the health of Canadians. In order to achieve its mission, the department works closely with other federal departments and with provincial governments, territorial governments, and others.

• 1605

[Translation]

If we want to succeed, we must recognize that many factors such as health, income level, education, social support networks, the environment, employment and working conditions combine to determine a person's overall health and welfare.

To ensure that all Canadians are well-served, the department is focusing on a wide range of personal and collective circumstances with a view to promoting health and illness prevention strategies.

Health Canada was involved in the In Unison exercise. We wholeheartedly support the principles set out in this guidance framework. We are also continuing to work with HRDC on the formulation of a federal strategy on disability which will be presented to the Cabinet committee on social policy in the spring.

While some Health Canada initiatives target persons with disabilities, generally speaking, the needs of members of this community are addressed through the broad range of departmental initiatives and programs.

[English]

This, I think, is a point that is essential: not just to have initiatives for persons with disabilities, but to recognize that the perspective of those persons must influence everything that we do.

In 1991, 16% of Canadians—4.2 million people—reported some level of disability.

Among aboriginal persons, that percentage was 30%, and because Health Canada has direct responsibility for the delivery of health services in first nations communities, the responsibility that I bear is particularly heavy with regard to addressing the needs of these Canadians.

I think the best piece of work done since 1993 at the federal level in relation to persons with disabilities was the report resulting from the task force chaired by Andy Scott, who is here as a member of this subcommittee. I think the reason that report is of such enduring value and provides an excellent starting point for this subcommittee's work is that it recognizes the need to have an interdepartmental and totally integrated approach to this issue. Forget about where the jurisdiction of one department ends and the other begins: join them, and look at all programs and activities within government through the prism of disability.

Before inviting your questions and those of your colleagues, Madam Chair, let me just touch upon a few of the ways in which Health Canada tries to do that.

The first is to strengthen health services generally.

[Translation]

Recently, an additional $11.5 billion was earmarked in the federal budget for transfers to the provinces to strengthen and improve our health care system. This issue is important to all Canadians, especially to people with disabilities.

[English]

One of the purposes in our joint effort with provincial governments to use that money to strengthen health care services is to integrate services—which can only be to the benefit of persons with disabilities—such as home care. Home care and community care is one of the key priorities on the agenda shared between the federal government and the provincial governments.

Whether it's maintaining the independence of a person with a disability in their home, providing long-term care to those with chronic disabling conditions, or providing respite to parents who care for a disabled child or to children who care for disabled parents, we all have work to do together. Health Canada, through the health transition fund and through pilot projects with the provinces in home care and in pharmacare, is trying to learn more about how we can serve.

The disability perspective also influences our children's agenda. I co-chair, with Minister Pettigrew, the federal involvement in the creation of a national children's agenda. We're making sure, Madam Chair, that children with disabilities are very much part of that agenda, both in programming and in policies. I can also say that as we create the centres of excellence for children, we are bearing in mind the needs of children with disabilities.

• 1610

We are also increasing the amount of money available for health research, which will accrue to the benefit of us all but particularly to the benefit of those for whom research may hold the key to overcoming physical disabilities. I think, for example, of the initiative I announced in Vancouver with Rick Hansen, the money we're putting towards the Canadian Neurotrauma Research Program, so that, one day, persons who have lost mobility because of injury to the spinal cord may find themselves again able to walk.

I can close by referring to the effort we're making and must continue to make with respect to the prevention of injuries. We're working towards the development of a national strategy on injury prevention and control. We are undertaking broad consultations in order to know how the Government of Canada can provide leadership to achieve this objective, and we hope to arrive at a national strategy sometime within the next 18 months.

[Translation]

In conclusion, let me say that as Minister of Health, one of my priorities is to ensure that disabled persons are always included in our agenda. I am committed to seeing that all of our efforts, programs and policies address the needs of persons with disabilities.

[English]

I'd be delighted to receive any questions or suggestions that you or your colleagues might have, Madam Chair.

The Chair: Thank you very much, Mr. Minister. I think all of us who were copied on the letter from the CACL in terms of the centres of excellence are relieved to hear that you feel that children with disabilities will be included in that really important initiative.

Members, will you be brief?

Mr. Bailey.

Mr. Roy Bailey: Mr. Minister, I am sure you didn't intentionally mean to omit something that, to me at least, is of great importance. You mentioned the integrated services between the various departments and the federal and provincial co-operation.

When I think of Canada and I think of disabilities, I think of the hundreds of organizations out there, from the community level to the provincial level, that step in to assist all of us, including your department. It's one of the biggest volunteer systems in all of Canada. They come in and assist with this general area. I'm sure you didn't want to miss that, but, boy, when I think of it, those are the people I think of, because we see them on a daily basis within our community, and we fail sometimes, I'm sure, Mr. Minister, not to recognize the great service that they provide.

Of course, having said that, we get people who are lucky to live in an area where we have such a degree of volunteers; we benefit more than those who don't. That's no fault of your department or of anybody else's. I just had to say that, Mr. Minister, because it seemed that by just mentioning government we're leaving out something that is truly Canadian.

I have one question, very quickly, Mr. Minister. You just touched on it. I want to know what your department is doing in the prevention area. Some of the sights that I see and that of course always touch my heart and make me shake are the children with disabilities, who are born that way but for whom this could have been prevented. I know that we have human rights and everything else, but it really breaks my heart to see a child who is deformed or whatever when that terrible sight could have been prevented with maybe some actions that border on the line of being dictatorial. I think we have to recognize that government has a responsibility to do something in that area.

Mr. Allan Rock: Mr. Bailey, first of all, you make a very good point. Any summary that doesn't make reference to the voluntary sector is incomplete. You're quite right. I should have mentioned the Canadians who donate their time and effort to do a large part of the work involved in caring for or advancing the interests of persons with disabilities. In fact, perhaps that's because I thought it too obvious to do so, but I should have mentioned them.

• 1615

I can tell you that along with Minister Dhaliwal, who was just here, and with Pierre Pettigrew, I co-chaired an evening a few weeks ago with the voluntary sector. About 35 representative of national volunteer organizations were present. It was part of an effort that we're making to renew the relationship between the Government of Canada and the voluntary sector: how can we best encourage and permit them to do their essential work?

There are three tables, one of which is the relationship, which is the one I'm involved in. A second has to do with financial matters, with tax status, with deductions for contributions. The third has to do with issues of governance.

We're very keenly aware of the essential role the voluntary sector plays. I have an enormous respect for it and I thank you for having reminded us of its significance.

In terms of prevention, the short answer is that we're not doing enough.

Mr. Roy Bailey: That's right.

Mr. Allan Rock: We're simply not doing enough.

I had in my office the other day a pediatrician from Montreal Children's Hospital, who pointed out to me that injury is the leading cause of death and disability of persons below the age of 19. He told me that we lose 6,000 people a year through accidents. He feels that we could save a third of those people by taking steps that are within our means now, without further legislation, to prevent death through injury, and the same goes for disability.

He has urged me—and I told him I would—to accelerate our work on the preparation of a national strategy for injury prevention in order to get at some of the tragedies you've referred to. It's heartbreaking enough to see someone who started from birth with a disability and must overcome it, but when we see that it happened through an injury that might have been prevented, it causes all the more anguish.

There are some things we are doing which I would report. First, the Laboratory Centre for Disease Control has an elaborate tracking and surveillance system for injuries to children. Practically all injuries to children are recorded and examined. That information provides a good basis for research, which in turn feeds into prevention. I don't think we do enough with the information once we get it, but the fact that we track it is very good and is a good start. It will be an important part of our national strategy.

We also have early intervention with children through the Canada prenatal nutrition program. Many young women, in particular, are at risk of birth defects for their babies because they're not aware of the link between their diet and their behaviour on the one hand and the outcome for their child on the other. No mother wants to hurt her baby, but sometimes through—

Mr. Roy Bailey: Ignorance.

Mr. Allan Rock: —ignorance or misadventure or lack of attention, these things happen.

Whether it's fetal alcohol syndrome or a variety of other difficulties, we've tried to intervene with a prenatal nutrition program that is more than just food; it's counselling, it's support—sometimes emotional or social—and it's advice provided by a more experienced person to a young pregnant woman who might be frightened or intimidated. It's also providing help after the birth in learning how to be a mother and how to look after the baby in the early months.

In the recent budget, I was very happy to see that we put $75 million toward expanding that program. At the moment, we touch the lives of about 20,000 women in Canada who are deemed to be at risk because of social or economic circumstances. That will move to 35,000 women as a result of the increased money in the prenatal nutrition initiative. Part of that money will also go to surveillance of and research in fetal alcohol syndrome and fetal alcohol affect.

There's also the community action program for children, which all of you know about and which I think really is terrific, in partnership with provinces and communities. It is providing support for mothers and young children. That's perhaps a bit farther afield, but coming back to your question, we must do more. We don't do enough. I think that developing a national strategy is probably a good place to start.

Mr. Roy Bailey: Thank you, Mr. Minister.

The Chair: On the CAPC, Mr. Minister, there again there were some questions in terms of incorporating children with disabilities. Do we have any evaluation of that? Maybe that's something you could just send to the committee—

Mr. Allan Rock: I'd be happy to do that.

The Chair: —with respect to the inclusion of children with disabilities in the CAPC programs.

Mr. Allan Rock: Yes.

The Chair: Thank you.

• 1620

[Translation]

Mrs. Madeleine Dalphond-Guiral: Mr. Minister, you are the nth minister to appear before the committee.

Mr. Allan Rock: I beg your pardon?

Mrs. Madeleine Dalphond-Guiral: The nth minister. We have heard from six, seven, eight, nine or ten before you. Everyone in Cabinet has had his or her turn, and everyone has said that persons with disabilities are a priority on their agenda. And yet, after the Finance Minister brought down his budget in early March, disabled persons wrote to the Prime Minister expressing their grave disappointment over the fact that the lack of serious funding in the budget seemed to point to a lack of concern about the status of persons with disabilities. I believe this is one oversight that should be correctly in the short term. That concludes my comments.

Now I have a question for you. You talked about centres of excellence. I believe they have an important role to play, but I would like one piece of information. An advisory committee has been set up to examine this issue and to determine how we can establish centres of excellences to meet people's needs. I'm assuming that some members of this committee had experience in the health field. Did any committee members have any recognized expertise in dealing with children with disabilities?

Mr. Allan Rock: I don't believe so. We had persons on this committee with a general background in this field, but I would have to turn to my officials for a more detailed response. To my knowledge, there were no such persons on this committee. I will look into it and get back to you.

You mentioned the government's most recent budget. I wish to remind you that our actions were aimed at strengthening the overall health care system. We provided additional funding to the provinces which have responsibility for delivering services to the public in general, and to persons with disabilities in particular.

The Government of Canada has also acted within its own jurisdiction. We have committed to spending $1.4 billion over the next three years and to making a substantial investment in health research. We will be establishing health research institutes which will certainly be focussing on disabilities issues. We will be working with people like Rick Hansen on spinal cord injuries and with other disabled or hearing impaired persons. I'm confident that this will prove to be a very significant investment for members of this community.

I've already mentioned the money that we have committed to the prenatal nutrition program and to other early intervention initiatives for youth and children. I disagree with the statement that there were no concrete measures in the February budget for disabled persons. I've mentioned several initiatives.

I will check with my officials and get back to you with an answer about the people involved in establishing the centres of excellence initiative.

Mrs. Madeleine Dalphond-Guiral: Specifically, your department is responsible for aboriginal health issues.

Mr. Allan Rock: That's correct.

Mrs. Madeleine Dalphond-Guiral: As everyone knows, the proportion of aboriginal peoples with disabilities is significantly above, if not twice, the Canadian average. Have you devised any strategies to lower this rate? For example, it's common knowledge that alcoholism, among other things, can have disastrous consequences for children. Have you devised a special strategy to assist aboriginal peoples to bring them closer to the national average? Their situation is horrendous.

• 1625

Mr. Allan Rock: You're right. I've already mentioned the statistics which show that the disability rate among aboriginal peoples are nearly twice the rate for all Canadians. My department has a special responsibility toward aboriginals living on First Nations lands. For example, I will be travelling to northwestern Ontario tomorrow to visit the native community of Pikangikum to see firsthand what living conditions are like there.

I stated earlier that health was a function of various factors such as employment, education, social and economic conditions. All of these factors directly affect people's health and the status of persons with disabilities.

Aboriginal communities present a formidable challenge, not just to governments, but to parliamentarians as well. Quite frankly, the prevailing social and economic conditions in these communities are unacceptable. Overcoming this challenge is a task that must be taken on not only by the Health Minister, but by all ministers and members of all parties. This is a shared responsibility. We must work together to find effective ways of improving living conditions within aboriginal communities.

I'm committed to this initiative. I hope that in the months and years ahead, we will work together to improve this situation. I don't have any easy or complete answers for you today. All I have is the sincere will to contribute to this effort. Thank you.

[English]

The Chair: Mr. Mancini.

Mr. Peter Mancini: Minister, I have just two questions. With regard to the prenatal nutrition program, I'm advised by a pediatrician—I'm a lawyer, not a doctor, like yourself—

A voice: But he is a lawyer—

Mr. Allan Rock: You've just complimented me enormously, Mr. Mancini.

Mr. Peter Mancini: Perhaps I'll put this in some legal language. I'm advised that there is a growing body of evidence to suggest that the simple addition of folic acid in flour would go a long way to prevent a number of birth defects.

The Chair: Neural defects.

Mr. Peter Mancini: Thank you, Doctor.

I'm advised that this in fact would go some distance towards eliminating birth defects that result in disabilities. I don't know why we don't do that. I wonder if your department has looked at it.

The second question I have deals with the Canada Health Act, which is there to provide basic services for Canadians. I'm also told that some provincial governments in the country have delisted medical examinations or medical services associated with applications for Canada Pension Plan, for disability, or for the disability tax credit that we just questioned Minister Dhaliwal on. How did we let that happen with provincial governments and what can we do to stop it?

Mr. Allan Rock: On the question of folic acid, the reports to which you refer are indeed being examined by Health Canada. I think they're going to propose a policy response as soon as they've completed their studies.

On the question of provincial governments, as you know, under the Canada Health Act, it's required that all medically necessary services be included in public insurance, but it's left to provincial governments to decide what is medically necessary. The definitions of medical necessity are not identical throughout the country, although for the most part they're pretty comparable. I'm not aware that some provinces don't provide coverage for the examinations to which you referred, but I'll be happy to look into it and find out.

• 1630

Mr. Peter Mancini: Okay.

Mr. Allan Rock: May I, Madam Chair, come back to one point that was raised by the previous questioner, Madam...?

[Translation]

Mrs. Madeleine Dalphond-Guiral: Madeleine.

Mr. Allan Rock: Madeleine. Thank you.

You ask me whether there were people at Health Canada with experience dealing with children with disabilities who were involved in the establishment of centres of excellence for children. It would appear that the answer is yes. According to information just given to me, it would appear that...

Mrs. Madeleine Dalphond-Guiral: Then it was a good question.

Mr. Allan Rock: A good question, and a good answer.

Mrs. Madeleine Dalphond-Guiral: Yes.

Mr. Allan Rock: Apparently, Dr. Leslie Richard Atkinson...

[English]

These are people on the organizational committee. Dr. Atkinson is on the editorial board for the Journal on Developmental Disabilities and is a reviewer as well, and he is a reviewer for the American Journal on Medical Retardation. He received a research award from the Ministry of Community and Social Services to conduct a survey of persons with developmental disabilities living in Ontario.

Dr. Carol Krill Russell works in a hospital for neurologically and physically impaired children and in a centre for developmentally disabled children.

Dr. Robert Armstrong completed specialty training in pediatrics with specific expertise in child development and disability.

Dr. Patricia Canning was assistant professor at Mount Saint Vincent University, teaching courses in developmental disabilities. Her research has focused on developmental psychology, child care and children with special needs.

[Translation]

Therefore, the answer to that question is a resounding yes. There are people within our department who...

Mrs. Madeleine Dalphond-Guiral: I'd like to thank the member for her question.

Mr. Allan Rock: I very much appreciate the opportunity to...

Mrs. Madeleine Dalphond-Guiral: To learn.

Mr. Allan Rock: That's right.

Mrs. Madeleine Dalphond-Guiral: Good.

Mr. Allan Rock: ...to praise the abilities of the individuals involved in this initiative. Thank you for that opportunity. I will leave the rest to the committee.

[English]

We'll get it in both languages and we'll file it with you, Madam Chair.

The Chair: Merci.

Mr. Muise.

Mr. Mark Muise: Thank you, Madam Chair.

Welcome, Mr. Minister.

Some weeks ago, the subcommittee passed a motion requesting that the government fund the HALS report for the year 2001. I'm wondering if your department is prepared to fund such a survey.

Mr. Allan Rock: I'm aware of the request. I think it's a question of which department should most properly fund it.

Mr. Mark Muise: We've been asking all of them.

The Chair: All of them.

Mr. Allan Rock: It's not good enough for me to say that it should be somebody else.

Mr. Mark Muise: No.

Mr. Allan Rock: I think I have to confer with my colleagues and see which of us or if perhaps all of us should be involved in that. I'll be happy to do that. I know that it has come up among officials. I have not yet discussed it with my colleagues in cabinet, but I will do that and get you an answer.

Mr. Mark Muise: Good. Thank you.

Second, could you tell us, Minister, what level and nature of your department's resources you devote to developing policies and programs to assist people with disabilities?

Mr. Allan Rock: It's difficult to say, because there isn't an item in the budget or a section in the building that is devoted to persons with disabilities. Rather, what we ask all departments, all sections, in the department to do is to make sure that persons with disabilities are part of their agendas.

So whether it's policy and research or the Laboratory Centre for Disease Control of the Health Protection Branch, approving pharmaceuticals and medical devices, or whether it's the Health Promotion and Programs Branch, we ask all of them to keep in mind persons with disabilities. I'm not sure I can give you a dollar amount. I can only tell you that the policy of the department is to make sure that whatever work is being done takes into account as a cross-cutting priority the perspective of persons with disabilities. We don't budget for it separately. It's an integral part of the work.

Mr. Mark Muise: Do you think there would be benefit to having a defined amount and allocating certain resources for that specifically, versus the way you're doing it now?

• 1635

Mr. Allan Rock: The reason we're doing it this way instead of that way is that we don't want the persons with disabilities branch to be off in its office developing programs specifically for persons with disabilities; we want to take that effort and spread it through everything we do.

Have you had officials from Health Canada before you? You might want to ask Ian Potter that question. He's the ADM for health promotion and programs.

The Chair: I think the question is this: does Health Canada have a disability policy framework? I think that having a lens through which everything is looked at in terms of these cross-department sorts of issues is a good idea. That would be a good question for—

Mr. Allan Rock: That's what we're trying to do.

The Chair: —Mr. Potter.

Mr. Allan Rock: That's what we're trying to do, as opposed to having a special office of disability, but—

The Chair: Yes.

Mr. Allan Rock: —the question is a fair one. Which is more effective? I think the conclusion to which we've come is that having a cross-cutting priority is better, but Mr. Potter may have a better answer for you.

The Chair: If there is such a disability policy framework document, do you think you could forward that to the committee?

Mr. Allan Rock: Yes.

The Chair: Thank you.

Mr. Scott.

Mr. Andy Scott: Thank you very much.

Welcome, Mr. Minister.

I want to take the occasion to compliment the minister. In his former life as the Minister of Justice, he was also involved in this issue, in a different way. I have to say that support for the amendments to the Canadian Human Rights Act, which included the duty to accommodate—and which the Bloc member on this committee at the time said was the most important recommendation of the task force—was championed by the then Minister of Justice.

I've had the occasion to thank the present Minister of Justice, but I have not had the occasion to thank the new Minister of Health. I will do that now and ask him to show the same passion for a couple of things I'd like to bring up now. It would seem that we're in the deal-making business today.

There are two particular areas, Minister, that I think are particularly important within the framework of the way that the federal government is currently structured around this issue, with the Minister of HRD as lead minister.

One speaks specifically to your particular relationship with aboriginal Canadians. We found in the course of the review we undertook that in fact the state of affairs with regard to aboriginal Canadians with disabilities was so unique and at the same time so tragic that we didn't even really want to pretend to know what to do about it. We wrote this right into the report and said that this was so compelling to us that we wanted to say we didn't know what to do about this, but we do say in the report that the government has to do something very specific.

It would seem that whether it's home care or non-insured benefits or delisting, which we've talked about.... To some extent, as soon as something is delisted, it's a non-insured benefit, and non-insured benefits are reducing and so on. It's a very serious problem, and this is a very precise way in which the ministry can in fact assist in a way that is unique to the opportunity your ministry has. I would appeal to you and say that in fact that would be a very important initiative the Department of Health could take, in conjunction with HRD and in conjunction with DIAND, but very specifically having to do with the power that the Department of Health has around aboriginal Canadians in terms of its relationship on health matters.

In much the same way on the social union file, mobility, which is probably one of the principles that is governing the Government of Canada's relationship with the provinces on the social union negotiations and discussions and so on, is probably more important to people with disabilities than it is to any other Canadians. If you're in need of a particular type of service, for instance, to deal with your disability, and one province provides it and one province doesn't, your mobility is not something up here that other Canadians face, it's real, and it's probably paramount to any other factor in the decisions about where you can live. I would suggest that there is a responsibility on the part of the Government of Canada in regard to the mobility part of the social union discussions.

• 1640

We have to keep Canadians with disabilities first and foremost in our minds, because historically—and I'm speaking now as a minister involved in the social union discussions rather than the Minister of Health per se—at the federal government level, we have viewed these issues as human rights issues, and the provinces have viewed these issues more often as service provision issues, health issues, and so on.

I think it's critically important that the Government of Canada keep that human rights lens way up high, and specifically around mobility, because it's critical and it's not something that any of the provinces can particularly grapple with. Ultimately, they are only responsible for their own jurisdiction.

I would add to that suggestion that the department can show leadership or collegiality, let's say, in terms of helping the minister of HRD with his HALS costs, and we appreciate the consideration. I'm not sure whether we got an answer from the Minister of National Revenue, but I'll use the occasion of having the floor to mention it again.

Also, on questions of consultation, I would broaden this to particularly include aboriginal Canadians with disabilities, because of that unique relationship, but more generally, I think it's critically important that Canadians with disabilities be given particular consideration on questions of consultation, because those consultations are very often more difficult. This committee, when dealing with questions of consultation, has to deal with the question of the additional costs that are associated with various technical things that need to be done. It is a daily barrier to full participation. We talk about it in the context of accessing buildings and accessing other things. What about accessing their rightful place in the discussion of public policy? It's something that we all have to be conscious of all the time.

Your particular department, of course, has such a huge impact on the lives of Canadians with disabilities that I would only make that recommendation as well. So that's it, for the moment.

Mr. Allan Rock: May I respond to those two very good points?

First is the point having to do with aboriginal Canadians. Earlier, we mentioned the rate of disability among the aboriginal population and your own experience with your task force and how tragic their circumstances are. For some time, I've been urging provinces to be more aggressive in the development of home and community care. To me, home and community care means more than just post-acute, more than helping someone who's just been released from hospital after their surgery. Home and community care also means a whole infrastructure of support and services in the community for people who are either ill or disabled or need help by reason of age and frailty, help to maintain independence, dignity, and health.

This issue relates very much to the needs of persons with disabilities, but it was clear to me that if I was going to urge the provinces to broaden their services to include home and community care, I had better be prepared to demonstrate in areas where I'm primarily responsible that I was practising what I preached. In the plans that I developed in relation to the budget that was just tabled in February, I included about $200 million for aboriginal health, the vast majority of which will go to home and community care in aboriginal communities. So I can say to the provinces that in areas where we have primary responsibility we are doing the very thing we're urging them to do—and we're working with the aboriginal leadership. In the months to come, we're going to be developing concrete proposals for home and community care in aboriginal communities.

• 1645

One of the reasons I'm going to northwestern Ontario tomorrow is to look at what's in place at present and to get a sense of where we go from here. I hope that in developing those steps we can address some of the tragic gaps and lapses to which you've referred and which you saw for yourself in your work, Mr. Scott. It won't happen overnight. It's a three-year undertaking—at least that's how we time it—but I hope it's a place where we can make real progress.

On your second point having to do with mobility rights, as the Prime Minister made clear when he put the Social Union Framework Agreement on the table, the Government of Canada considers that mobility rights and a reasonably comparable level of services around the country are pretty basic when it comes to organizing a country, particularly in the area of health. The Canada Health Act has five principles, one of which is portability, namely, you should be able to carry with you, wherever you go in the country, public insurance for the same basic, comparable, medically necessary services.

But we all know that portability is not perfect, that mobility issues arise. Particularly when it comes to home care or pharmacare, it sometimes depends on where you live if you're trying to determine what you get—and sometimes even within the same province. Now that services are determined regionally in many parts of Canada, what you're going to get depends on what part of the province you live in.

Portability and mobility, when it comes to Canadians' access to medical and health services, are very important to me in my job. I'm going to be focusing on that as a priority as I contribute from the health sector to the implementation of the Social Union Framework Agreement. Section 3 of that agreement provides that all governments will be accountable to Canadians by measuring and reporting the performance of social programs, including health. I hope those reports will identify problems in mobility and portability which we can address.

The budget also included some $330 million for information and communication technology, which will help us bring to life those accountability provisions in the social union agreement over the course of the next couple of years.

In sum, I think you've raised two points that are extremely important and are areas in which we can make real progress in the rest of this mandate.

Mr. Andy Scott: It occurs to me that as we hold some accountability measures in that exercise, we, as a committee, would, I'm sure, be anxious that the government in fact be very specific in terms of its accountability on disability issues, if for no other reason than, again, as I said, the fact that, among Canadians, the mobility question is probably most prevalent there. From time to time, this community—I don't think it's malicious—is forgotten, and that's why we are looking for a disability lens.

I would once again take the opportunity to urge you to make sure that there's actual provision on that front and also on the side of health care as it relates to aboriginal Canadians, particularly those with disabilities. What we found that was most troubling was that this was a jurisdictional problem and that ultimately it wasn't necessarily ill will or anybody's desire not to attend to the concerns that we were hearing about, but rather that because of the unique nature of the relationship between aboriginal Canadians and the Department of Health, as compared to other Canadians and their health services in their provinces, many of the services.... These are basic services, not sort of “up here” human rights issues. They are fundamental services that were available to others but were not available here because we couldn't figure out who should provide them.

I would think that as a civilized country we're well beyond the point where that hole should exist. I think it would be a wonderful opportunity for the Government of Canada to demonstrate a very practical place for the Government of Canada to be. Given its obvious responsibility on this file, it's not much in question.

Thanks.

• 1650

The Chair: Just to follow up on the social union, I think one of the frustrations of this committee is this jurisdictional problem, that if 65% of aboriginals live off reserve and have huge health problems and problems with disabilities, that's not the federal government's problem.

What you've articulated so beautifully is that this isn't about whose department it is. It's about all levels of government reporting to Canadians on how we're doing on all of these things. It requires a collaboration. It won't be good enough any longer to say, “that's not our department”, even in the silos of government, and certainly within the layers of government.

An example that I bring to you because I'm not sure what we would do is that there's going to be a federal disability strategy, and I know that the table is working on this and that your department's working on that. Are you sort of confident that what Health Canada takes to that will be more than turf? When Transport Canada came, they said it's not a social union problem, but for the people that I think we're trying to look out for, if they can't actually get from their home in Markham to the doctor's office at Bloor Street and Avenue Road, that is a problem. It's not a federal problem or a provincial problem, but it's a transportation problem. Maybe it's a social services problem or maybe it's a health problem.

How do we develop a federal disability strategy, which obviously we at this committee would hope would be the first thing because of the In Unison document? We already have a sectoral agreement. That's supposed to be a prerequisite to moving through the social union's phase two. How do we make sure that what you take to the federal disability strategy and that what we then move to the social union...?

I think our frustration, and what the Scott task force showed, is that this jurisdictional stuff just doesn't work. In bureaucracies, it seems, if it's too jurisdictionally difficult, people do nothing. It's been studied to death, and we don't want people doing nothing any more because of jurisdiction. Your description of the social union was one of the best, I think, in saying that Canadians just want us to do this, and we'll report to them on how it's happening.

Do you feel optimistic about the federal strategy coming forward?

Mr. Allan Rock: I do, and I'll tell you why. I've seen it now in two or three contexts. I've seen it at the table of the ministerial council on social issues, which, this year, Pierre Pettigrew co-chairs with Bernie Wiens of Saskatchewan, I've seen it in the disabilities initiative of In Unison, and I've seen it among health ministers.

I think there's a preparedness, whether it's in putting together the national children's agenda or looking at strengthening medicare, a preparedness to focus on solutions and not just on jurisdictional lines. I believe that the Social Union Framework Agreement is going to be an important step in advancing that cause. In that agreement, we've promised Canadians that, regardless of constitutional jurisdiction, we're going to report to them. They're going to be involved in the reporting process. We're going to report to them on how we're doing, on how our services to them are performing, and on where the gaps and weaknesses are.

I don't think anybody's going to much care that it's federal or provincial; they'll say, “fix it”. I believe that it will really change in a fundamental way the manner in which Canadians judge their governments and that it will change the expectations they have of their governments.

Can I just give you one example? Here I'll do something that you do far better, Dr. Bennett. You held a seminar in Toronto not long ago on quality care in health care. How do we assure quality? How do we measure quality? You made the point that the Canada Health Act, for all of its advantages and all of its power, doesn't include the word “quality”. Nowhere in the principles is quality care referred to.

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With the Social Union Framework Agreement, we have, for the first time, a commitment by both orders of government that are signatories to that agreement to measure outcomes using common indicators and report to Canadians, and to use average citizens, not just bureaucrats or politicians, in the process of gathering the information, deciding what's to be reported on, vouching for the integrity of the information, and then designing the report.

What does this mean? I believe it's revolutionary, because it means that when the thing is up and running we'll be able to have a coherent and comprehensive report on a wide variety of elements in, for example, the health care system. How many beds per thousand are there here or there? How many MRIs per thousand are there here or there?

But apart from the raw numbers, there are qualitative issues, like the re-admission rate to hospital based on post-discharge infection and what that tells us about whether people are being sent home too soon. What is the success rate of this method of treatment as opposed to that method of treatment? Where is the best research coming from? Where are people getting the most out of their resources in terms of prevention? What's the population health picture in this region as opposed to that region, and why?

We'll be able to have, at our fingertips, information that will lead us to ask questions and get answers and that will allow us to tackle the problems that exist, so that the next time we have a debate about the health care system it won't be just “let's add x billions of dollars”. It will be “let's make sure that when we add the money it goes here or there, where the weaknesses or gaps are”, and it will be “let's change these practices in order to spend more wisely”, or “let's adopt this approach to treatment because it works better”. We'll finally be able to have an informed discussion based on actual information about what standards there ought to be.

That's the other myth about the Canada Health Act. People think that it creates national standards. It doesn't; it creates national principles. There are no national standards. Consensus around national standards can only derive from information. Reliable, broad-based, coherent information isn't available. We don't systematically measure the health care system.

Using the Social Union Framework Agreement, using the information systems that we're going to invest in with the money that was in this past budget, and using the common commitment of all governments to measure and report on health care performance, I believe that for persons with disabilities as well as for those in general who use the health care system, we're on the threshold of changing the way we monitor, measure, and improve health care and services for all Canadians.

The Chair: In the social union agreement, one of my favourite phrases says that we will “consult” Canadians on the social priorities. I guess what the disability community would hope is that they would be included in that process in which we consult Canadians on their social priorities, but also in the things that are—my favourite words from the social union—“best practices” and “outcomes”, all of those good things that I know you've fought hard for. How do we make sure that what we measure and how we measure it actually reflects the priorities of Canadians? What can we do to make sure that the disability community feels included in that?

Mr. Allan Rock: I think the way to do it is to include Canadians in the process of designing the measurement, determining what's reported on, and then vouching for the accuracy and integrity of the report, once made.

The Social Union Framework Agreement, in article 3, talks about citizens being involved.

The Chair: Right.

Mr. Allan Rock: You've talked in the past about having a citizens' council on quality care. Why can't Canadians, regular folk, be involved in the process of measurement and reporting? I think they have to be, and I believe that persons with disabilities have to be an integral part of that representation.

The Chair: Thank you so much.

I had two other little pet things. One is that in the CIHR there's been a great call for an institute of primary prevention. How do we know what we're doing? How do actually make sure about as much prevention from scatter rugs for the elderly to things that we didn't know were toxic in pregnant women or some of the other chemicals...? Obviously there are population health and clinical and evaluative sciences and all of those. Do you feel confident that all of those things will be dealt with in the CIHR?

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Mr. Allan Rock: I do, and I'll tell you why I do. CIHR is being designed by an interim governing council, and that interim governing council, the president of which is Henry Friesen, chair of the Medical Research Council, represents a wide variety of interests, not just biomedical researchers who are interested in laboratory science, but also those involved in clinical research, those involved in the delivery of services, and those preoccupied by the determinants of health. All four points on the spectrum of health research and inquiry are actively represented by leading spokespersons. In addition, at the table we have industry, charitable and voluntary organizations, and governments. Provincial governments are also represented on the governing council.

So I do believe the full spectrum of inquiry, including persons who are interested in prevention as one of the determinants of health, will have a voice in the creation of the institutes, in the allocation of resources, and in the determination of its priorities.

The Chair: One of my other favourite things, as you know, is the women's health strategy. You often talk about how one in five Canadian women are looking after somebody with a disability or an elderly person. Do you feel that we're doing enough on women's health strategy and on looking after the caregivers?

Mr. Allan Rock: No, I don't think we are doing enough, to be very frank. I do speak about it often, because when I first heard that statistic, I challenged it. I said that it couldn't be right, but I was assured that, indeed, it is right. One out of five Canadian women between the ages of 30 and 55 are engaged in looking after someone in the home who is either chronically ill or disabled.

According to the surveys, they spend an average of 28 hours a week engaged in that work. About half of them also work outside the home, and many of them have children to look after as well. The cumulative burden is endangering their health. Whether this person under care is an aging relative or a child with special needs, it is an enormous burden on the shoulders of women—primarily. It's an unmet need to which we have to respond.

Are we doing enough? No. That's why I keep referring to it. I refer to it in the context of the need for more home and community care—

The Chair: And research into it.

Mr. Allan Rock: —and support. I refer to it in the context of research, finding out more about how—

The Chair: Acute and chronic.... This community, I think, worries about an acute and chronic problem, where that woman who is already looking after somebody every day gets pneumonia or whatever...that the one-size-fits-all home care is best for everybody, that maybe that person needs to go to a hospital.... We need much better research so that there are clinical guidelines for those sorts of situations.

Mr. Allan Rock: Yes, and technology can help us too. There are home monitoring devices. Telemedicine in remote locations can help. There's a whole variety of things that we can do.

The Chair: So you're promising us a disability lens in Health Canada and a policy framework and a real sort of strong voice on the new federal disability task force.

Mr. Allan Rock: If you care to summarize it that way, that sounds fine, but I also owe you some answers, which I'm sure we've noted. I'll get back to you about them and give you further information.

May I recommend that you have Ian Potter come by some time and talk to you about how we organize things internally in terms of the disability lens? I think you'd find him very helpful.

The Chair: Thank you so much.

Mr. Allan Rock: Thank you all very much.