HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Wednesday, November 17, 1999

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[English]

The Chair (Mr. Lynn Myers (Waterloo—Wellington, Lib.)): Ladies and gentlemen, I call this meeting of the health committee to order. As you can see, we have a full list of witnesses here from Health Canada today, and certainly under our mandate, Standing Order 108(2), it's our pleasure to hear from Health Canada today.

I'm wondering, Monsieur Lafleur, if you would perhaps lead off. You might have an opening statement, at which point you could introduce the people you've brought with you. I think that would be appropriate. Then of course members present will have questions of either you or the other witnesses here today. So, Monsieur Lafleur, s'il vous plaît.

Mr. Robert S. Lafleur (Senior Assistant Deputy Minister, Corporate Services Branch, Department of Health): Thank you very much. I'll be very brief. I'd just like to make a very short reference to the branch I represent. The corporate services branch provides administrative and support services to the department. We believe that in many respects it has gained a reputation in the public service for providing quality leadership in a number of core administrative areas. It's one of the most efficient branches within government. In the case of Health Canada, it represents 5% of the budget of the department, which is relatively small for the support services that are provided.

I'd just like to highlight for the committee three key areas in which we've done extensive work in the last year. The first is putting into place new year-2000-compliant financial services, with a new system to support it. That was done without major problems. It's now fully functional, and we are planning to expand on its capability.

It is a cornerstone for the work we want to do to improve comptrollership in the department. We plan this year to engage the whole department to implement modern comptrollership in the department. We will rely quite heavily on the capacity of this new system to provide the kind of information that managers need to manage efficiently.

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The second big area of effort, supported by the branch but essentially carried out by the department, is the implementation of the order of the Human Rights Tribunal on the discrimination case that was heard in 1997, which found the department to be responsible for systemic discrimination built up over years in the way in which we administer things in the public service.

We're now tackling that, following orders from the Human Rights Tribunal. We're happy to say that in the first two years of application of the order, we have managed to meet all of the requirements set out by the Human Rights Commission, and we're quite hopeful for the third year as well. The representation of visible minorities has gone up quite significantly in the department, from just above 6% to over 9% now, two years later.

The third one I'd like to note is our department-wide effort on getting the department ready for Y2K. It was quite an involved process, and we managed to meet all of the government's deadlines on that. So the department is ready for Y2K in terms of its equipment and its software.

In addition, on behalf of the National Contingency Planning Group, we have been tracking the state of preparedness of the health care system in Canada—the work done by the provinces under their jurisdictional responsibilities—and providing that information to CPG so they can plan for all contingencies. The work is going well. It's not completed in the provinces, but an awful lot of work has been done.

With that short statement, Mr. Chairman, I'd like to turn it over to the committee for questions. Before I do that, I'd like to introduce the people who have accompanied me to this table.

Scott Broughton is with the policy branch. Seamus Hogan and Michel Léger are with the information analysis branch, and Orvel Marquardt is the director general of finance at Health Canada.

The Chair: Thank you very much, Mr. Lafleur.

Perhaps, Mr. Elley, you'd have a question at this time.

Mr. Reed Elley (Nanaimo—Cowichan, Ref.): Thank you very much, Mr. Chair.

I suspect that everybody in this room would agree with the statement that our health care system in Canada is under a huge amount of stress these days and that the well-being of Canadians collectively is at risk because of some of the immense problems we see in our health care system.

Now, I know you gentlemen don't necessarily have a hands-on in terms of what's happening at the level of hospital care and those kinds of issues, but I wonder if you as a department—Health Canada—and any of you who are representative of that here today, have any information as to how Health Canada is approaching the health care crisis in Canada. Some of you are involved in health policy and consultation.

What's going on across the country mandated by government to bring Canadians together in a consultative process to take a look at what's wrong with our health care system and how we have to fix it? Can you give us any answers on that?

The Chair: Mr. Lafleur, do you want start off?

Mr. Robert Lafleur: Mr. Chairman, going back to the 1998 and 1999 budgets, I think there is evidence that the government has provided support and leadership for the strengthening of the Canadian health system. On a number of occasions the minister has made statements about those efforts and his work with the provinces to achieve that for Canadians.

But perhaps I could turn for some more details to Scott Broughton, who, with the policy branch, is more closely involved with that issue.

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Mr. Reed Elley: Thank you.

The Chairman: Mr. Broughton.

Mr. Scott Broughton (Acting Assistant Deputy Minister, Health Policy and Consultation Branch, Department of Health): Thank you very much.

I'd like to invite Laurette Birch to join me. Laurette is our director general of intergovernmental affairs and in fact handles a lot of the efforts that involve consultation processes with our provincial and territorial colleagues. She can speak directly to the processes we have, which are one of the primary vehicles by which we consult with Canadians in a federal-provincial-territorial context.

The Chair: Ms. Birch, could you give us your title for the record, please?

Ms. Laurette Birch (Director General, Intergovernmental Affairs, Department of Health): Yes. I am director general, intergovernmental affairs.

In response to your question, yes, Health Canada is intimately connected with all provinces. There is a council including the federal, provincial, and territorial ministers of health. They collaborate extensively and are very much engaged in reviewing the circumstances now at play. In 1998, the council established a number of priorities and is now working through a structure of advisory committees to support the development of innovative approaches to engage in information collecting, as you've referred to, which will hopefully assist in developing responses and solutions.

In addition to the funding that was increased in budget 1999—and all of the first ministers signed a letter indicating they would ensure that those additional funds went to health care—there is ongoing work in the area under a number of initiatives, including children, health and human resource issues, and health information, which I think someone is here about. The federal government works in a very collaborative way with its provincial and territorial partners, recognizing that in terms of actual delivery that element is vested in the provinces. The importance in all of this is the collaborative approach.

As well, under the Social Union Framework Agreement, which was signed in February 1999, we have a new framework to guide us and to promote the type of collaborative approach and the cooperation that will assist us as we move into the future in terms of what solutions are at play and what can happen in terms of improving the health care system.

The Chair: Mr. Elley.

Mr. Reed Elley: I appreciate what you're saying. I had a sense that this was going on. However, I think the people I talk to, who are just ordinary Canadians, are taking a look at what they feel is a broken system at the moment. They are really looking for government, and particularly the federal government, as the custodian of the Canada Health Act and one of the huge major players in health care across Canada, to really give us some strong leadership in this area.

There's a sense out there that people just don't think anything much is happening. We're hearing a lot about the problems, but we're not hearing a lot about the solutions.

Is there a communication problem going on, whereby both federal and provincial governments are not indicating to the general public at large that there is something happening, that we are going to see from the federal government and the shared jurisdictions some kind of 5- or 10-year plan to fix the health care system of Canada? Is it a communication problem? What stage is it at? Canadians deserve to know.

Ms. Laurette Birch: I'm at a bit of a loss in commenting in terms of the communication problem. I know there is a regular, ongoing effort to ensure that information about the activities underway is shared with the public, with Canadians who are concerned. Examples of the kind of concrete work underway include the $150 million investment in the health transition fund, which is, I think, a classic example of the kind of federal-provincial collaborative effort that is required to get us the kinds of information we need, to answer the kinds of pressing questions that exist.

I believe that through projects like the health transition fund, which involves setting up projects across the country to evaluate a variety of issues, including service delivery, the kinds of needs that exist in certain areas, the use of technology...that kind of research is the kind of activity that is so critical in terms of ensuring that we're looking at a restructured system that will be able to respond to the needs as we move into the new millennium.

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From my point of view, we communicate. If we haven't communicated enough, we'll have to look at how we do that better. I think there has been strong leadership. As recently as September, the federal and provincial ministers of health met in Charlottetown and issued a strong communiqué from their meeting. It included the release of the second report on the health of Canadians. It included the work on the national children's agenda. It included a commitment to establish principles for organ donation. So the effort to get it out is there. If more needs to be done, I'm sure that can be examined.

The Chair: Thank you very much, Ms. Birch. I appreciate that.

Mr. Lafleur—just before I get to Monsieur Ménard—in your opening statement, you referenced an order from the Human Rights Tribunal. I just wanted you to clarify that. What was the order and what action did Health Canada take vis-à-vis that order?

Mr. Robert Lafleur: Thank you, Mr. Chairman. This was an order made as a result of a case that was taken to the Human Rights Tribunal regarding discrimination in the public service, in this case particularly with Health Canada, arguing essentially that we had been responsible for systemic discrimination, that is, that in the tools we had developed over time to do the selection of people for promotion for advancement in the public service, we had built-in discrimination.

As a result of that case, the tribunal ordered us to take a series of measures, both permanent and temporary measures, to address those deficiencies and to cause a change to start to happen in terms of the opportunities for people of visible minority groups to advance in the department. We have been systematically addressing those directives from the tribunal.

The Chair: Thank you very much for that clarification.

[Translation]

Mr. Ménard, do you have a question?

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): Yes. Mr. Chairman, I would like to join you in welcoming our witnesses.

If I understand correctly, there are six branches within the Department of Health, and the people we have before us today are from two of these branches. Am I right? Our witnesses, then, are from the Information, Analysis and Connectivity Branch and you, Mr. Lafleur, are with the Corporate Services Branch.

Mr. Robert Lafleur: Mr. Chairman, we represent three branches. Mr. Broughton is from the Health Policy and Consultation Branch.

Mr. Réal Ménard: Thank you. I can tell you that it's not always easy to sort out an organization chart. I wanted to be sure I knew where you were coming from.

I have three questions. Since the National Forum on Health, the department has been putting a great deal of emphasis on putting in place what one might refer to as a culture of health evidence. You want to be certain that the policies you recommend to elected officials are based on adequate management of and relevant information on what is happening in the various sectors of the health system.

I would like to know what the transition fund referred to by Ms. Birch is really used for and what is the difference between what one can reasonably expect from the transition fund and the $95 million you obtained for the Canadian Institute for Health Information.

That's my first question. I'll ask a second one on the decision-making process in connection with smoking.

Mr. Robert Lafleur: The transition fund covers much more than the information and data sector alone. It's a program that is basically designed to support provincial initiatives to seek out new solutions aimed at strengthening the health care system.

There are, of course, some components that are related to the information sector, but the greatest part of the efforts and budget last year focussed mainly on the second initiative that you referred to. Perhaps my colleagues....

Mr. Réal Ménard: As far as the transition fund is concerned, do you have a summary that would show a breakdown of the information? In the first place, how much money was there? Who decided how it was allocated? To date, what has it been spent on? What can we reasonably expect to get out of it? For example, will all the progress in the home care field depend on the transition fund?

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Mr. Robert Lafleur: Mr. Chairman, if there is not already such a report, we will prepare a one and forward it to the committee.

Mr. Réal Ménard: How much money does this fund contain?

Ms. Laurette Birch: One hundred and fifty million dollars.

Mr. Réal Ménard: A not inconsiderable sum.

Ms. Laurette Birch: We are in the process of preparing the report that you requested and we will forward it to you.

Mr. Réal Ménard: Good. Therefore, one must conclude that you are attempting to review the system based on information. What does the $95 million of the Canadian Institute for Health Information mean for policy development?

Mr. Michel Léger (Director, Consultation and Collaboration, Information, Analysis and Connectivity Branch, Department of Health): I will attempt to answer your question. The $95 million that was allocated to the Canadian Institute for Health Information was set aside primarily in response to a major survey conducted across Canada involving 500 respondents: researchers, politicians, provincial government officials. The survey was aimed at identifying real information needs with regard to Canada's health system.

Using this survey, we were able to draw up a plan that we call the road map, which describes current priorities with regard to information on the health system. This money will be allocated in part to two main organizations, Statistics Canada and the Institute, which will work closely with the provinces and Health Canada to develop these projects more fully. A total of 32 projects were announced just recently, projects in all health fields, to meet the priority needs identified in the survey.

Mr. Réal Ménard: I find it extremely interesting that we are entering a phase in which we will really have information on the health system in various settings. The Saskatchewan setting is not necessarily the same as that of Quebec. Of course, this fragmentation has to do with interprovincial relations. What do you believe came out of the initiative of the National Forum on Health, which lent great weight to this quest for information? Should I conclude that the Forum led to the creation of the Institute, and that the only information available.... Still, we weren't starting from zero. The department had information on health determinants and on changes in the various environments. I don't want to appear superficial by asking a question that is too vague, but apart from saying that the system is in crisis—which I don't believe—to what particular aspect would you like to draw the attention of decision- makers in order to mobilize them?

Mr. Michel Léger: I'll answer your question by saying that the purpose of setting up the CIHI was to bring together all the different sources of information on health and to draw up a more concrete strategic plan for gathering this information.

The National Forum on Health went further, focussing on the need to create information-gathering systems that would enable us to adopt a more national approach, taking into consideration all the work that the provinces are doing in this field.

Mr. Réal Ménard: Do I have time to ask one last question, a very short one, Mr. Chairman? Do you want me to come back in the second round?

[English]

The Chair: Go ahead.

[Translation]

Mr. Réal Ménard: There's one thing that I find very surprising. I was pleased when I was appointed health critic. I used to be the immigration critic, but health is a fine challenge. When I was appointed, I spent a great deal of time meeting with program managers. It seems to me that there is a paradox in the functioning of the Health Department. First of all, I know that emphasis will be placed, as required by policy, on all policies related to early childhood, from zero to five years. However, if we asked you this afternoon to give an account of your programs, we would have to conclude that there is a gap between your intentions and the programs because, for all practical purposes, there are few concrete programs for early childhood, and when such programs do exist, they have minimum funding.

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Information is available on prenatal health. There is also the CAPC, the Community Action Program for Children, which provides funding to community organizations but, apart from this program, don't you have the impression that you are lacking the financial means to support programs that are aimed at this objective, which is to give new impetus to early childhood efforts and fight poverty?

Mr. Robert Lafleur: Perhaps I should begin by saying that many of the programs carried out by Health Canada have components that affect childhood in one way or another. For example, health protection surveillance programs include a component that impacts on the quality of life of children.

We are gradually coming to focus increasingly on childhood. We are trying to determine what would be effective. There will have to be a transition period during which former programs will be redirected in line with our new efforts. It cannot be done overnight. One of the department's long-term objectives is, of course, to focus more on this sector.

The Chairman: Thank you very much, Mr. Lafleur.

[English]

Mr. Jackson, please.

Mr. Ovid L. Jackson (Bruce—Grey, Lib.): Thank you very much, Mr. Chair.

One of the problems we have is there's a lot of confusion about whether or not the system is in crisis, and what not. I'd like to see if we could clarify some of the questions often asked by Canadians. It gets muddled with us politicians sometimes saying it's in crisis.

The first observation I want to make, for instance, is that the Province of Ontario's budget is about $50 billion. It's spending about $18.5 billion. You might correct me if my stats are wrong. They could spend all $50 billion on health care, but what would happen to all the other departments, whether it's safety, security, policing, or what have you? So governments have measures. Somewhere between 9% and 13% of their GDP is what they use as a number.

We started with a system that worked perfectly well, but a whole bunch of changes have taken place over the years, including the fact that we're living longer and getting our knees replaced. There are lasers for our eyes and new imaging machines and so on that all cost a lot of money. Some departments also grew out of whack, having laundries, restaurants and various other things. So there were refinements to be made in the departments.

Let's get down to it. In the world sphere, nations are evaluated. I'd like to ask a couple of questions. Number one, what indexes are used to evaluate nations and rank them? Where do we rank? I think you've alluded to it, but how the information came from you was kind of muddled.

You say you're gathering information, and I suspect you're gathering information to see exactly what core things we can do, and perhaps how you can get rid of backlogs. For instance, would you bring a bunch of knee experts to a place where a whole bunch of knees need to be done, rather than have a waiting line, or something like that?

There's prevention and there are cures as well. You talked to some degree about prevention. On prevention, for instance, if people don't have accidents they don't need heart transplants or organ transplants. If mothers do not drink alcohol or smoke cigarettes and what not, children have better outcomes, and so on.

I don't know if I've asked you too many questions.

Is the 9% we're using a good figure to use? We could spend the total $163 billion on health care, I'm sure, and people would still be saying it's in chaos. We rank pretty well with the United States, where they spend 13%, and there are reasons why we do that.

First of all, how do they rate countries? Then maybe you could explain a little more about the methods you're using to refine the system to make it better and keep us at number one, if we're not there yet.

Mr. Robert Lafleur: Mr. Chairman, we'll ask Mr. Hogan or Mr. Broughton to answer that question.

The Chair: Thank you.

Mr. Hogan.

Mr. Seamus Hogan (Director of Health Demand and Supply Analysis, Information Analysis and Connectivity Branch, Department of Health): Thank you. In terms of how countries are ranked, traditionally the most common way is to look at obvious indicators, such as life expectancy at birth and infant mortality—those kinds of things. Canada ranks very highly on those numbers, as most wealthy countries do.

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We also look at just total expenditure as a fraction of GDP, but that can be difficult to judge. If you're spending more as a fraction of GDP on health, is that an indication you're putting more into the health system, or you simply have a more inefficient health system?

We often feel—and I think it's probably generally agreed—that Canada has a more efficient health system than the U.S. because of our public orientation, so our lower expenditure as a fraction of GDP compared to the U.S. is just an indicator that we have a better managed system as a whole.

In terms of what we can do to make sure we stay near the top, I'm not sure of the exact numbers on where we rank in particular indicators. We could get that information for you. But in terms of what we can do to make sure we stay at or near the top and improve at the rate we should, we have a number of initiatives underway to look at options, in terms of some of the trends you were talking about in the health system.

There are new technologies, which is good, but they're also very expensive. We have an aging population, and that kind of thing. We're looking at some of those trends and what the needs of the health care system in Canada might be 10 to 15 years down the track. What kinds of policies might all levels of government need to put in place to address those needs?

In particular, we're looking at whether we should just emphasize physicians and hospitals in health care, or if there are other aspects that might become more important, particularly greater use of drugs and the treatment by pharmaceuticals in the health care system.

Perhaps Scott can talk about it.

Mr. Ovid Jackson: Because these refinements and lots of changes are being made, people are confused. They're talking now about private health systems, which I don't think is workable. In my mind's eye, if you have all the money—$78 billion in one chuck—that's where the honey is and that's where all the bees go. As soon as you start to fracture that, the system will get worse. So we need to refine that system and make sure it works for Canadians. We should never have to be judged for treatment by our credit cards or pocketbooks.

How are we doing in terms of making sure the principles of health care remain? Is there a challenge to that? Is anybody thinking of changing them?

Mr. Robert Lafleur: I think the government has taken visible action with respect to some provinces, where it was judged that the principles were not being properly applied. The action in those cases was to hold onto transfers to the provinces.

I believe the government has been quite watchful of that. Nevertheless, there are a lot of different kinds of options being explored in the country as to how we might have the system evolve to better serve Canadians. The health transition fund we talked about earlier is one of the tools being used to support that kind of exploration.

I think we can say there are gaps in the system that we are all working to try to address—the provinces, the federal government and the territorial governments—and that work will go on. We're in a phase of transition in the health care system in Canada, and I think everybody recognizes that. The answers are not all there, but we have to work increasingly together, and ever more so on a basis of hard facts and solid analysis in order to be able to make the efforts necessary to strengthen the Canadian health system.

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The Chairman: Thank you very much.

Thank you, Mr. Jackson.

Ms. Birch, in response to Monsieur Ménard, you had mentioned a document that was a work in progress. As soon as you have it, if you could distribute it to the clerk, we'll make sure all members get it out to everyone who has requested it, if that's appropriate, which it is. Thank you.

Ms. Wasylycia-Leis, please.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you, Mr. Chairperson.

I would like to begin by following up on Ovid's questioning, especially given the news yesterday around Ralph Klein's proposal to really put forward a private, for-profit, parallel hospital system. Today, when asked in the House, the Minister of Health said the document was just received by the department, that an analysis would be done, and that action would then be taken. I guess I'm curious to know where this goes in the department. Who's responsible for it, and who's going to be giving the advice to Mr. Rock?

Mr. Scott Broughton: Thank you, Mr. Chairman.

I believe the initial analytical effort will end in the policy branch. Obviously the nature of the work in terms of the Canada Health Act and the issues around the medicare system will involve everybody in the branch, but I think the policy branch will have to put some sort of an effort forward in terms of that analytical effort. Everybody in the department will have to participate in offering that advice to the minister.

Ms. Judy Wasylycia-Leis: And that's under your direction?

Mr. Scott Broughton: It is. I'm currently acting assistant deputy minister in the policy and consultation branch. I believe Mr. Ian Shugart was here yesterday with the health protection branch. In a couple of weeks, on November 29, he will be the assistant deputy minister of policy, so the majority of the work will be obviously done under his direction as the ADM of policy.

Ms. Judy Wasylycia-Leis: Where do you go then?

Mr. Scott Broughton: I'll be the director general of policy.

Ms. Judy Wasylycia-Leis: Was it the policy branch that developed or worked with the Alberta government several years ago to develop the 12 provincial principles underlying the Alberta health care system?

Mr. Scott Broughton: That I can't answer. I haven't been in the department for a long time.

Ms. Judy Wasylycia-Leis: Is it possible to get some information on why that agreement was struck, what it means, and what led to it?

Mr. Scott Broughton: Sure.

Ms. Judy Wasylycia-Leis: As folks will know, we raised this in the House a fair bit last year and didn't even get an acknowledgement that it existed. We know it exists, because Monique Bégin includes it in her recent report card of the health care system. I think it would be useful for us to get some information about how this happened and how we can work to undo it. That's my own political addition.

The Chairman: You're starting to get into those tricky waters, Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: Okay, I'll get back to some specifics.

The Chairman: Before you do, I just want to be clear. There is some documentation you can get for us, is that what you're saying?

Ms. Laurette Birch: We'll provide what we have. We had been consulted back in 1987, as I understand it, and we can give you what we do know of it.

The Chairman: Okay, thank you again, and you can bring that to the clerk's attention.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: I assume corporate services is really roughly the new name for human resources, if I'm trying to compare branches.

Mr. Robert Lafleur: It's actually wider than that.

Ms. Judy Wasylycia-Leis: It's wider than that. It includes....

Mr. Robert Lafleur: Human resources is one piece of it.

Ms. Judy Wasylycia-Leis: Okay, I would like to ask a few questions on human resources.

Yesterday I asked a question about staff shortages, especially in the food directorate and the health protection branch generally. I referenced the letter that was sent out on September 30, signed by 200 staff persons from the health protection branch. They clearly said there are staff shortages, and they specifically went on to say there was, and remains, an acute shortage of scientists for evaluations and risk assessments.

When I asked that question, I think the response came from Madame Fortier or maybe Ian Shugart, although I can't remember which. the response was that there are no shortages. I didn't get a chance to follow that up. Are these scientists and other staff persons not telling the truth? What is the situation in the food directorate specifically, and in the health branch generally?

Mr. Robert Lafleur: We've had a review of the resource situation of the various branches at Health Canada a number of times this year. With the help of Treasury Board, we've been able to make adjustments. I believe the health protection branch now has all of the resources they need for for the work that remains this year, and indeed all that they plan to use in order to complete the work they have underway and they've been mandated to do.

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There is no doubt that there are possibilities in the future of enlarging the staff capacity of many branches at Health Canada if the government is prepared to undertake new work and support it by new policy decisions. We're always hopeful, and we work toward getting additional resources to do that, but for this year the resources are there.

On another aspect, however, there is an effort to plan for the future by undertaking recruitment programs with universities, particularly in critical areas where there are now some deficiencies in terms of staff availability—nurses, for example, for the medical services provided to first nations and Inuit people, and medical doctors, where we've had some difficulty in competing with the salaries offered to medical doctors at large. So there is an effort underway to do that.

There is also, as part of the health protection transition effort, a general strengthening of the department's scientific capacity, planning for the replenishment of that capacity as people get older and maybe planning to retire. We're going on jointly with other departments to orchestrate that replacement part of La Relève effort of the department, and this winter we're undertaking some initial recruitment work for scientific capacity.

Ms. Judy Wasylycia-Leis: I understand there is a significant budget shortfall for the health protection branch for this budget year. I'm wondering how much the shortfall is and where you get the money then. Do you have to look internally or can you go to cabinet, or how do you deal with shortfalls?

Mr. Robert Lafleur: As I've said in my response to your earlier question, that shortfall has been addressed this year. The health protection branch has never lacked any money during the year, but at this stage we've increased that to ensure they have all of the money necessary to meet their obligations between now and the end of the year.

The Chair: Thank you very much, Mr. Lafleur.

Are there any other questions on this side? Mr. Martin.

Mr. Keith Martin (Esquimalt—Juan de Fuca, Ref.): Thank you, Mr. Chairman.

Thank you all for coming to the committee today.

My view is that the system is broken. While we had a good system in the past when our demographics were different and there were different moneys and more people were working, the system right now is broken and it's only going to get worse, as all of you know. Our population is aging. The number of people over the age of 65 will be double that which it is today. They use 70% of the health care dollar.

Given the fact that the population is aging, given the demographic changes, given the more expensive technologies, given the fact that every aspect, every principle of the Canada Health Act is violated, given that the feds only provide 11% of all of the funding for health care in Canada today, how are you going to ensure that Canadians are going to be able to get their health care in a public system? How are we going to strengthen that public system so they don't have to wait and they can get their health care when they need it?

The last question is this, and I'm glad, Mr. Hogan, that you brought up some very important issues, and others on prevention. The head start program, based on activities that have been done in Moncton, Michigan, Hawaii, and others, has proven to be incredibly successful at preventing a lot of social ills. There have been reductions of 99% in child abuse rates in Hawaii, 60% reduction in youth crime rates, 40% reduction in teen pregnancy rates—a $6 to $7 saving for every dollar invested. Are you looking at working with other ministers, such as the Minister of Justice, the Minister of HRD, and their provincial counterparts in implementing a national head start program?

Thank you.

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The Chair: Ms. Charron, for the record, please identify yourself as well as your title.

Ms. Monique Charron (Director of Policy and Planning, Medical Services Branch, Department of Health): Monique Charron. I'm director of policy and planning at medical services branch. I work on first nations and Inuit issues.

On aboriginal head start, our medical services branch is implementing the aboriginal head start on-reserve program, so I can speak to the context around that. The department also has implemented an aboriginal head start off-reserve program, so what we did is take the off-reserve program and expand it on-reserve, largely based on the very successful results that you are speaking about.

We are just starting to do some of the evaluations on the aboriginal head start program. At this point we haven't been considering a national head start program, but we are very pleased with some of the results that are coming in on the aboriginal head start program.

Mr. Keith Martin: Given that it passed in the House of Commons in May 1998, and given the extraordinary success in that four provinces are on side already, I wondered if you were going to make that available to populations outside of the aboriginal community.

Ms. Monique Charron: We are working with our provincial and territorial partners on the head start programs. There's also interest from the side of the provinces and territories to look at the head start program, and there are some discussions. For example, we were discussing children's issues at the FPT level, and that's one of the issues we are talking about.

Mr. Keith Martin: Thank you. Merci beaucoup, Madame Charron.

Does somebody want to address the first question I had posed?

The Chair: Mr. Martin, in all fairness, it really is a political question you're asking. There would be a lot of debate about whether or not you're accurate in your assessment of this, so I'm not sure that to ask these folks to answer is appropriate. But if they choose to, that's fine.

Mr. Keith Martin: They always have an option, Mr. Chair.

The Chair: I understand that. I'm giving them that right now.

Mr. Robert Lafleur: Could we ask Mr. Martin to rephrase the question, please.

Mr. Keith Martin: Without the preamble, given the fact that we have incredible stressors taking place in our health care system that are going to get worse in the future, how are we going to strengthen the publicly funded health care system?

Mr. Robert Lafleur: Mr. Chairman, I can only answer that by making reference to the efforts already made by the government with budget 1999 and budget 1998 to launch that process after the cost-cutting that happened as a result of program review, and that effort of strengthening is underway.

Part of what we're doing today in discussing the effort on the information side is also an element of that. The system is in transition. There is no doubt that it needs strengthening. I think everyone recognizes that. But Canadians will all have to make choices together as we go through that process, and it has to be done jointly with the provinces.

The Chair: Thank you very much.

Mr. Jackson and then Mr. Ménard.

Mr. Ovid Jackson: When I go into hospital in the province of Ontario, because that's my province, what part of that hospital is the federal obligation? Is there a component in there? I know that service delivery comes from the federal government, and whenever anything happens it's usually us, notwithstanding the fact that the province does the delivery.

I'm trying to get this in my mind's eye. When I go in, is it the building, is it the equipment? What are we paying? Where is the federal component in there?

Mr. Robert Lafleur: I think the answer to that is that health care delivery, including the hospital and all its staff and so on, is the responsibility of the province and not the federal government.

Our efforts are in surveillance activities, in certification of medical products that are used ultimately in hospitals, because it's not very logical to do that in 12 or 13 different jurisdictions. There is also the effort we have in the area of health promotion, health information that everybody across Canada uses, programs that we have joint support for with the provinces. CAPC is an example. But in the hospital itself, the running of the hospital is the responsibility of the province.

• 1620

Mr. Ovid Jackson: Your budget is around $2 billion. Is that your total budget?

Mr. Robert Lafleur: Thereabouts, yes.

Mr. Ovid Jackson: Exactly how much of that is transferred to the provinces?

Mr. Robert Lafleur: We can provide that information, but it does not come out of the department's budget. It is a transfer of the Government of Canada, which comes out through the Department of Finance. The transfer is actually made to the provinces.

Mr. Ovid Jackson: I'd like to know, just for my own edification, exactly what that statistic is for the whole country and, as well, what it is for all the provinces, because I think we come from different provinces.

The Chair: Gentlemen, if we can get that information, again, we'll get it to the clerk and circulate it.

Mr. Robert Lafleur: Yes.

The Chair: Thank you very much, Mr. Jackson.

[Translation]

Mr. Ménard, please.

Mr. Réal Ménard: I have three short questions.

I see that one of you, Mr. Hogan, is the director of Health Demand and Supply Analysis. How would you describe the situation in the provinces? In particular, have you done any correlation analyses involving reductions in transfer payments and the impact of these reductions on national health care delivery, in view of the fact that one of the goals of the national legislation is the system's comprehensiveness? That's my first question.

Here is my second question. Do any of you have any information on what's going on with the establishment of centres of excellence for the well-being of children? The concept of centres of excellence was very important several years ago, and there were a few for the well-being of children. This has some links with the question I asked earlier.

My last question is this: There is a whole debate going on about smoking right now. We all agree that this is a very important issue. We've seen the retail price for a carton of cigarettes go up. Some say—and I shouldn't think it's difficult to prove—that Quebec and Ontario are selling cigarette cartons at prices far lower than those in U.S. border states. What is your role in the pricing process? Do you have a role in the process at all, or is it only the RCMP and Finance Department who are involved in pricing decisions?

[English]

Mr. Seamus Hogan: To your first question, the applied research and analysis directorate in which I am in as the director of health demand and supply analysis is I think one of the newest directorates in Health Canada. We've only been in operation since earlier this year. So in terms of your question, have we looked at that, we haven't had the opportunity to do that yet.

Mr. Réal Ménard: You are a rookie.

Mr. Seamus Hogan: Totally a rookie.

Mr. Réal Ménard: I see.

Mr. Seamus Hogan: As a directorate, we are new, and so we're just building up our research capacity at this time. Our role will be partly to do the kinds of analyses, the research questions similar to what you suggested, on a broad range, and also to read and disseminate the results of research done across Canada or indeed across the world. But at this stage, we're totally new.

Mr. Robert Lafleur: Mr. Chairman, we have Wendy Watson-Wright, who will answer the two other questions. One was on the centre of excellence for children and the other on tobacco.

The Chair: State your title, for the record, please.

Ms. Wendy Watson-Wright (Director General, Policy and Major Projects Directorate, Health Promotion and Programs Branch, Department of Health): Yes. I'm the director general of policy for the health promotion and programs branch. I wondered if you might please repeat your questions, sir.

[Translation]

Mr. Réal Ménard: There are still two questions to be answered. Do you have some sort of report on centres of excellence for children's well-being? If you remember, a few years ago the government was planning to establish such centres of excellence, and all parties in the House were in agreement. I am not certain whether, in his answer to the smoking question and the question on health care in the provinces, Mr. Hogan drew a link with cuts in transfer payments.

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My question is anything but political. Don't you agree, Mr. Charbonneau?

Mr. Yvon Charbonneau (Anjou—Rivière des Prairies, Lib.): I'll think about it.

[English]

Ms. Wendy Watson-Wright: With regard to the centres of excellence for children, we can certainly get you information on that.

With regard to the question on tobacco and who made the actual decision on the prices—

[Translation]

Mr. Réal Ménard: One of my colleagues raised this question yesterday, and I would like to raise it as well.

Regardless of whether we agree with the $1.20 increase on each cigarette carton, there is no getting around the fact that cigarettes sold in Canada are the cheapest on the North American continent, with Ontario and Quebec being the provinces where cigarettes are easiest to obtain.

The department has an anti-smoking policy. Is it involved in pricing, or do only the Finance Department and RCMP have input? How do you see this in the broader context of an anti-smoking campaign?

Mr. Robert Lafleur: I may be able to answer your question, Mr. Ménard.

Ms. Fortier told this committee yesterday that the Department of Finance was largely responsible for both the work and the decision, in negotiations with the provinces. The Department of Health was not involved.

Mr. Réal Ménard: But this is not taken into account in the anti-smoking policy.

Mr. Robert Lafleur: I don't know that. However, the Department of Health was not involved in the decision.

[English]

The Chair: Thank you very much. We've really had a good round of questions here, but we want to get back to the more formal part.

Mr. Hogan, there was something you said that twigged something that Madame Fortier said yesterday, and it's that the IAC, as I understand it anyway, is now one year old.

Mr. Seamus Hogan: That's right, this week.

The Chair: I wonder if you could highlight for us why that was put in place as it is, and secondly, what would you say are your major accomplishments in this past year?

Mr. Seamus Hogan: In terms of why the directorate was created, there was a sense that there's a lot of data and base information in Canada on the health system, but that this data wasn't always being well directed into what we term evidence-based decision-making. By that we mean that policy-makers making decisions on the system as a whole have access to the best information, the best research, but also that medical practitioners have access to the best information, and also that individual patients are fully informed for making personal choices.

We felt that the data being collected wasn't always comparable, it wasn't collected on a regular basis, it wasn't widely available and disseminated. Furthermore, what data there was wasn't always being converted into useful knowledge through a research component, an analysis component, and then not being directed up into decision-making that this informed. We felt that Health Canada itself needed to expand its capacity in that respect, and so the information analysis and connectivity branch was created partly, in the way that Michel Léger can describe, for disseminating information, the information highway, making that data available, but also to bring back to Health Canada something it had in the 1970s and 1980s that had been allowed to atrophy, which is a research and analysis capacity within the department, concentrated in a single place that would be able to digest the information that's available in the research being conducted outside, to think about it and channel it through to decision-makers.

The Chair: Very good. Thank you very much. That's very useful.

Mr. Marquardt, director general, departmental planning and financial administration, perhaps you would now present, please. I think that would be good for the committee.

Mr. Robert Lafleur: Mr. Chair, Mr. Marquardt is part of the branch I represent. Had we gone extensively into the numbers of the financial situation of the department, Mr. Marquardt would have participated. But essentially he participated with me when I made my statement.

The Chair: Right. Thank you very much.

Mr. Broughton, assistant deputy minister, health policy and consultation branch, do you have any comments?

• 1630

Mr. Scott Broughton: I have a few. Thanks very much, Mr. Chair.

Before I start, I could be helpful with one of the questions one of the earlier members asked about the Canada health and social transfer. I was given the information—and we could still get more to you, if you want—that the total for this current fiscal year is $28,782,000,000. I believe the member had asked specifically about the share for Ontario, and that amount is $10,764,000,000. Those numbers are for the Canada health and social transfer, and are for this current fiscal year.

The Chair: Thanks for that information.

Mr. Jackson, it was your question.

Mr. Ovid Jackson: When we talk about health care, it includes both provincial and municipal public spending. There are other moneys. Where do those moneys fit into these numbers? Are they in addition to this?

Mr. Scott Broughton: In terms of the entire health care system, yes, this is the social transfer tax from the federal government to the provincial.

Mr. Ovid Jackson: Is it possible to get the stats on those as well?

Mr. Scott Broughton: I believe it is. I don't have them here, but I believe we could get them for you, yes.

Mr. Ovid Jackson: Thanks.

The Chair: Mr. Broughton, could we get a copy of whatever you just had? Is that possible?

Mr. Scott Broughton: Sure.

The Chair: Again, we'll distribute it through the clerk after the meeting.

Why don't you proceed at this time.

Mr. Scott Broughton: Sure. Thank you very much.

The policy and consultation branch is undergoing a modest reorganization, and it's in this context that I'm going to speak about it. It's as of the end of November, or beginning of December, that these organizational units will exist. It will have eight main organizational components. There will be the policy, planning, and priorities directorate; a health care directorate; communications and consultations; intergovernmental affairs; international affairs; women's health; nursing policy; and we have a management services unit.

The policy, planning, and priorities directorate is being created as a part of the branch's overall priority to strengthen its capacity to provide leadership and strategic planning, policy integration, and the development of policy frameworks in addressing emerging issues, and effectively managing the department's cabinet agenda and support to parliamentary business.

The health care directorate is being established as a new unit—with existing resources but as a new unit. It will provide coordinated strategic leadership for federal initiatives to support the collaborative efforts with provinces, territories, national organizations, and others to strengthen the health care system and its responsiveness to the health needs of Canadians. More specifically, its responsibilities include key files related to home care and pharmaceuticals; quality; health human resources; and broad directions in health care.

The health transition fund will also be part of this directorate, and it was referred to earlier by my colleague Laurette Birch. The health transition fund is a funding program for projects that pilot and evaluate innovative approaches to health services delivery, that operates collaboratively with provinces and territories. It is a $150 million fund, and was announced in the 1997 budget. It is a unique program of applied-policy-relevant research-funded projects. Funded projects all evaluate or test aspects of health care delivery in four priority areas: primary care, home care, pharmaceuticals, and integrated service delivery.

The communication and consultations directorate supports the minister and the department with communications analysis, strategy, and advice. The overall objective is to improve the information the Canadian public has about the programs and initiatives Health Canada is undertaking to achieve its mission, which is to help the people of Canada maintain and improve their health. This directorate, which also has a regional presence, is responsible for such popular tools as the Health Canada website and health on-line.

We have an intergovernmental affairs directorate, which Ms. Birch heads up. This is our focal point for federal-provincial relations. It provides strategic advice, coordination and logistical support on the full range of federal, provincial and territorial issues in order to maintain effective relationships with the provinces and the territories. It supports the branches with respect to the federal, provincial and territorial aspects of their policies, programs and activities. It also administers part VII of the Official Languages Act, related to enhancing the vitality of minority official languages in Canada as it pertains to the health system.

A second major thrust of this directorate is to administer and provide policy advice regarding the Canada Health Act. It does this by monitoring a broad range of sources to ensure provincial-territorial compliance with the criteria and the conditions of the act.

Canada is recognized around the world for its health system and the level of health and human development of its citizens. At the same time, many health issues in Canada have implications for other countries. We have an international affairs directorate, which ensures the development of international strategies while promoting Canada's health interests abroad. Among our key stakeholders internationally are the World Health Organization and its regional office, the Americas. Again, an example might be helpful. In recent years, the international affairs directorate played a key role in ensuring priority for global tobacco control activities.

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The women's health bureau plays a leadership role across our department in promoting a better understanding of the critical roles that gender plays in health and in implementing the department's women's health strategy, which the minister released last March. The bureau is also responsible for managing the Centres of Excellence for Women's Health program. As a part of the reorganization of the policy and consultation branch, this function will now report directly to the assistant deputy minister's office.

In response to the minister's announcement to strengthen the focus of nursing policy in Canada, the office of the executive director of nursing policy was created. Dr. Judith Shamian has joined Health Canada from the Mount Sinai Hospital in Toronto to become the office's first executive director. She brings with her a vast base of knowledge and experience in issues facing nurses and nursing in Canada. Her role is to work closely with the nursing community and stakeholder groups to ensure that a nursing perspective is incorporated into the development of advice to the minister and the department on various policy issues and programs.

I mentioned earlier that we also have a management services directorate, which obviously works with us in support of priority-setting and planning and coordination.

We think the new organizational structure we have for the policy branch is one of the outcomes of an extensive review, conducted through the summer and the fall, regarding the priorities and capacity needs of the department, to strengthen our policy development and coordination and to ensure that the health agenda is closely integrated with the broader social policy agenda of the government.

I mentioned earlier that while I'm pleased to be here today, within a week and a half or so, Ian Shugart, whom you met yesterday, will be taking on the responsibilities as assistant deputy minister of the branch.

On that note, thank you very much, Mr. Chairman.

The Chair: Very good, and thank you very much, Mr. Broughton.

Before we get to questions, I would like to hear from Monsieur Léger as well as Mr. Hogan. Then perhaps we'll go into the rounds of questions, if that's agreeable to everyone.

Monsieur Léger, s'il vous plaît, and Mr. Hogan.

Mr. Seamus Hogan: First, may I start by saying that the assistant deputy minister and the directors general of the information analysis and connectivity branch express their regret that they can't be here today? Unfortunately, they are out of town at a meeting, which had been planned some months ago.

In my answer to your previous question, I've already outlined some of the need that was perceived at Health Canada and that led to the creation one year ago this week of our branch. So let me talk just briefly about the structure and how we'll contribute, we hope, to filling some of those gaps I had identified.

I brought with me today an organizational chart showing the functions of the main groups within the branch. I want to concentrate today on two of those directorates, the applied research and analysis directorate, and the office of health and the information highway, but that's not to say that the third branch, the information management services directorate, is not important; it is crucial for providing modern, productive informatics technology within Health Canada.

I would like to concentrate on the other two, and first, on the applied research and analysis directorate. This directorate has four main roles.

First, it will make widely available within Health Canada access to the available data and information on the health status and health care needs of Canadians, the determinants of their health status, the types of medical interventions employed by health care professionals to address their needs, and the operation of the health system as a whole. We have a broadly based research agenda. It will strongly support efforts by the Canadian Institute for Health Information and Statistics Canada to improve the information base with which we are operating.

Secondly, we want to house an internal policy research capacity that can provide rigorous analytical support to the policy work of other directorates within Health Canada, generating our own research, following and assessing the growing health policy research being conducted elsewhere in Canada and around the world, and ensuring the department is taking account of that research in its policy-making.

• 1640

Third, the directorate will provide a means by which Health Canada can profitably interact with external researchers in supporting their efforts and trying to ensure that our research is policy relevant.

Finally, the directorate, together with the information management services directorate of the branch, is working to improve accountability and performance measurement in Health Canada by raising the standards of performance measurement and reporting in order to reflect both outcomes and their determinants.

Now I'd like to ask Michel Léger to take over and describe the office of the information highway.

The Chair: Thank you, Mr. Hogan.

Monsieur Léger.

Mr. Michel Léger: Merci, monsieur le président.

First, I'd like to open by giving you a bit of background. The office of health and the information highway was created out of two major initiatives of the federal government, the first one being the Information Highway Advisory Council, which had made specific recommendations about Health Canada looking into the adoption of information and communication technologies.

The second biggest piece was the National Forum on Health, obviously, which made some very strong recommendations about the use of information and communication technologies in order to better manage information and to provide the context or the infrastructure necessary to support an evidence-based decision-making approach.

[Translation]

That's why the Office of Health and the Information Highway (OHIH) were established in 1997, in response to increased recognition of the important role played by information and communication technology in the delivery of health services and care.

Within its terms of reference, the Office is responsible for helping the Canadian Health Minister and Health Canada to deal with new and evolving issues, and to formulate long-term strategies to establish Canada's health infostructure. These days, we usually call it the “Canada Health Infoway,” or “Inforoute Santé du Canada.”

Our main achievements include the work of the minister's Advisory Council on Health Infostructure, which submitted its final report to the Minister in February 1999. The report is entitled “Canada Health Infoway: Paths to Better Health,” or “Inforoute Santé du Canada: Voie vers une meilleure santé.” I was involved in the process, and acted as secretary to the Council.

The report, which sets forth a common vision for the Health Infoway and provides 39 recommendations, was very well received by the provinces and territories, as well as the principal stakeholders. It has become a strategic guideline for the new federal-provincial-territorial advisory committee on health infostructure. The Advisory Council's recommendations played a major role in obtaining new funding for our department in the 1999 budget.

The health office is also responsible for establishing the Health Infostructure Support Program in March 1998. To date, 36 projects have been subsidized through the program, by means of pilot projects in such areas as public health, health surveillance, pharmacare, first nations' health, home health care and tele- health.

Our office is also responsible for monitoring three important Health Canada projects. The first is the Canadian Health Network, to be established in the near future. The second is the National Health Surveillance Infostructure, while the third is the First Nations Health Information System. These are three highly significant initiatives, and I would invite you to stay informed.

Another Health Office initiative was a national conference on health infostructure, sponsored in partnership with Alberta. The conference provided a forum for all stakeholders interested in the development of health infostructure to put forward their views.

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A new advisory committee was recently established. This is the fourth departmental advisory committee under the aegis of the Conference of Deputy Ministers of Health. The committee's mandate is to encourage all levels of government to work together in order to establish a national health infostructure, and to provide the Conference of Deputy Ministers of Health with strategic advice. The National Health Infostructure will provide the information services essential to continuous improvement in health care.

That concludes my remarks. Thank you, Mr. Chairman.

The Chairman: Thank you, Mr. Léger.

[English]

Questions. Mr. Elley, did you want to begin?

Mr. Reed Elley: I believe Madam Wasylycia-Leis is in rotation.

Ms. Judy Wasylycia-Leis: Perhaps the order might be.... [Inaudible—Editor]

The Chair: We certainly can do that, Ms. Wasylycia-Leis.

Mr. Reed Elley: I defer.

The Chair: It would be a new round, but we defer to your good question.

Ms. Judy Wasylycia-Leis: Good. Thank you very much. I apologize. I actually have to leave in a couple of minutes to do something on this private hospital stuff.

The Chair: Oh, so you'll be brief, then, is what you're saying.

Ms. Judy Wasylycia-Leis: I'll be very brief.

I'd like to come back to Scott's presentation. He's tabled some statistics around CHST, and I'm just wondering.... Today in the House, for example, the figure used for the shortfall in transfer payments when the CHST came in and the cuts took place was $3.7 billion for health and education. Is that the figure you're working with? What figure are you using for the shortfall, in terms of the transfer payments in 1995 and the cuts that took place, and the situation we have today—with the announcement in the budget last year being accounted for? What's the shortfall, after all of that?

Mr. Scott Broughton: I'm not sure I know what you mean. I'm not sure what was referred to in the House today. The numbers I was quoting are simply the transfer tax for the current fiscal year. I'd have to—

Ms. Judy Wasylycia-Leis: Can you give us the figure for the difference in the transfer payments that remains as a shortfall after you take into account the increase in transfer payments announced in last year's budget? What's the number you're working from in order to describe the shortfall?

The Chair: That's a very complicated question, and in fairness, I doubt they would have that at the top of their heads.

Ms. Judy Wasylycia-Leis: Okay.

The Chair: If you want to provide that in writing, I'm sure we can get an answer.

Ms. Judy Wasylycia-Leis: Okay, sure.

The Chair: I think that's fair.

Ms. Judy Wasylycia-Leis: Fair enough.

The Chair: But it would take some time, I think, to compile exactly. And maybe you'll be very clear as to exactly what you want. I'm a little confused, although I think I know what you're asking for. But if you can provide that in writing, that would be appropriate.

Ms. Judy Wasylycia-Leis: Sure, I'd be glad to.

The Chair: Do you have another question?

Ms. Judy Wasylycia-Leis: Yes, I do. I have one more question.

I'd like come back to Robert and the whole question of human resources. It would seem to me, based on 200 staff persons going public with a letter, and on what the scientists in the Bureau of Veterinary Drugs have been saying, some of their concerns about being under a gag order, that there's a fair amount of unease in the department, a fairly low morale amongst staff. Is that a fair assessment? Is it part of the transition and changes that are happening? What would be your assessment of the morale among staff in the department today?

Mr. Robert Lafleur: In terms of the morale of the staff of the department, I think I'll defer to the survey the public service has undertaken through the efforts of the Treasury Board, which will be made public shortly and in which the department's staff's views will be reflected. I guess all I'd like to say is that through a program of cost-cutting, which the program review was, there's no doubt that a lot of staff felt disturbed. We're now in a period of strengthening the department. I think there's already been significant effort in that direction, and we're planning to do more if we are able to get more funds, ultimately, from the government's budget process.

There's no doubt that there are a lot of changes happening, both in terms of the structure of the department and in terms of the mandate we have to meet. Members have made reference to the changes in people's views about health care, about scientific developments in the field of health care. All of that is creating disturbances. And so it's not surprising that some staff would express that disturbance.

• 1650

But I think generally we have a department that is fully functioning and able to deal with the mandate that is before it. As I've made reference to earlier, in terms of resources for this year, the branches have the resources they need to complete their work, so I don't think there is a concern this year.

The Chair: Very good.

Ms. Judy Wasylycia-Leis: One short question?

The Chair: Well, very short.

Ms. Judy Wasylycia-Leis: It will be very short.

Is TPP adequately resourced to deal with the number of drug applications for the department? We keep hearing concerns about both ends. You know, some folks say drugs are being approved without thorough review, and others are saying it's taking much too long. I'm wondering if there is a resource question at the heart of this, and whether more reviewers and scientists need to be brought on board.

Mr. Robert Lafleur: We have Dann Michols here, who is responsible for the therapeutic products program, and perhaps he could respond to your question.

Mr. Dann Michols (Director General, Therapeutic Products Program, Health Protection Branch, Department of Health): Dann Michols, director general, therapeutic products program.

It's always an interesting question. I think it would be very difficult for anyone to say they ever had sufficient resources to do the job in these areas.

There has been significant progress in a number of areas to calculate the needs, to work with the communities we serve to determine exactly what those needs are, and to put forth proposals of various types to the government for an increase in resources.

A need for the resources really depends on what our stakeholders consider to be adequate processing times. We have never endangered the quality of our decision-making. What varies is the length of time it takes for us to deal with some of these proposals. All of our stakeholders, I think, would like a reduction in the processing times, and that's what the resources would be aimed at.

The Chair: Thank you very much.

[Translation]

Mr. Patry, do you have any questions?

Mr. Bernard Patry (Pierrefonds—Dollard, Lib.): We always have questions. Thank you, Mr. Chairman. I apologize for being late; I was at another committee meeting.

Yesterday, I asked a number of questions about GMOs. I would like to know whether one of your branches is responsible for the study and policy on genetically modified organisms. Canadians are concerned. Though awareness is not very high at the moment, it is increasing constantly. I would like to know whether you are responsible for the study, and if so, how you are going about it.

[English]

The Chair: Do you have someone to speak to that, Mr. Lafleur?

Could you, sir, identify yourself with your title, please?

Mr. Paul Mayers (Acting Director, Bureau of Microbial Hazards, Health Protection Branch, Department of Health): Certainly. Paul Mayers, director of the bureau of microbial hazards in the food program in health protection branch.

The Chair: Thank you very much.

Mr. Paul Mayers: What I would like to ask is, in terms of your question as it relates to policy for genetically modified products and their relation in particular with food, if there are specific issues you are interested in.

Mr. Bernard Patry: The specific issue I'm interested in is the fact that we are starting to get some fear from the population. There are really not specific issues. It's not a problem now. I don't say it will be a problem. I'm not scared about this, but the population is starting to ask us a lot of questions about this, and I have asked many questions of the health department, and nobody seems to be able to answer us. I don't know what is being done about this.

It's mainly that. It's not urgent now, but before we face a problem, I'd like to know. I asked a question yesterday regarding the fact that it seems to be more of a problem right now...not a problem in Agriculture. Agriculture might do a study about this, and they say it's about health, but it's not health, it's agriculture.

For me, I think the safety of the foods of our population is very important. Agriculture is also important, the fact that we export billions of dollars of exports in agriculture to the States. But I really feel that safety of food is an issue right now. Just look at David Suzuki in Sierra Leone, at what they're doing right now. We don't have any proper answers to give to our constituents. This is what I want to know a little more about.

• 1655

Mr. Paul Mayers: Thank you very much for the clarification.

I would fully agree with you that the safety of the foods developed using these techniques is in fact the paramount issue. For that reason, under the Food and Drugs Act we have put in place a regulation that requires each and every product, prior to its entering the marketplace, to be notified to Health Canada and be subjected to a complete safety assessment.

That is the approach we take in terms of these products, that for each product they are not permitted in the marketplace until the safety assessment has been completed, similar to the way we deal with other new products entering the market. They are subjected to a comprehensive safety assessment in each case. That safety assessment follows international agreed-upon principles for safety of products developed using biotechnology.

In addition to that, and one of the very important issues that you raise, is the issue of information. To that end, what we have done in terms of the website is to provide on the website information on each and every decision that we have taken related to novel foods, and in particular the products of genetic modification, to provide information in a more general sense about what genetic modification involves, what the issues and responses are, and how risks are addressed.

In addition, our entire safety assessment strategy is provided on the website to allow critics the opportunity to review how we deal with it and to provide criticisms to us so we can ensure that the very best science is being applied to assessing the safety of these products before they're permitted to be marketed to Canadians.

The Chair: Supplementary, Mr. Patry.

Mr. Bernard Patry: Yes. I just want to comment.

I'm very pleased about your answer. My comment is just about the fact that you say safety assessment is done for every product. That's great. You say it's on websites, but I don't have the time to go to websites, nor do my colleagues. You understand this. Is it possible for you to provide us with exactly what was done and the way it is done right now, that is, what you have just mentioned to us? I'd like to read about this and I'd like to know a little more about this so I will be much more able to inform my constituents about these problems.

Mr. Paul Mayers: Absolutely. We can ensure that the information kits that are available are provided to the clerk for distribution.

The Chair: That would be very useful. If you'd do that, it would be appropriate.

Mr. Paul Mayers: Certainly.

The Chair: Thank you very much.

[Translation]

Mr. Ménard.

Mr. Réal Ménard: I do have a question, but then I will have to leave. I apologize for not remaining until the end of the meeting.

The Information, Analysis and Connectivity Branch is new. I would like you to explain the evaluation and analysis process you use to determine how each of the provinces complies with the five program criteria stipulated in Canada Health Act: public administration, comprehensiveness, universality, portability, and accessibility. How do you carry out that evaluation, and what information can you provide to parliamentarians so that they can arrive at an informed opinion?

People said that the system was in crisis, but once this was said, nobody said anything. It seems to me that we need a more detailed picture of the situation. For instance, how does the newly established Analysis Branch enable the department to fulfil this obligation? Don't be shy. Give us all the information we need in order to have a good understanding of this issue, because it is important.

[English]

Mr. Seamus Hogan: I think an analysis of how different provinces comply with the Canada Health Act would be outside our branch. I don't know—

A voice: Maybe Laurette....

Ms. Laurette Birch: I would like to invite Mr. Serge Lafond to speak to this matter.

The Chair: Thank you.

[Translation]

Mr. Serge Lafond (Acting Director, Health Insurance Division, Policy and Consultation Branch, Department of Health): As far as the enforcement of the Canada Health Act is concerned, we are responsible for monitoring how the provinces apply the principles.

Our division publishes an annual report, entitled “Annual Report on the Canada Health Act,” which explains just how the provinces are complying with the criteria set forth in the legislation. We can send you a copy, if you'd like.

• 1700

Mr. Réal Ménard: You look like a man who is very educated. University statistics courses teach you how to do correlation analyses. I would imagine that your branch has done some analyses to find out how the cutbacks in transfer payments have affected the provinces' ability to fulfil their constitutional obligation to implement the law. Do you have any data on that? Is that part of the assessment that you do in your report?

[English]

The Chair: Monsieur Ménard, we're now getting into political questions.

Mr. Réal Ménard: No.

The Chair: Yes, we are. I think what we can do is to get the statistics, which we'll do, and then we'll leave it to you to analyse in terms of what you think is happening or not happening. To get into the question of whether or not we're meeting our constitutional obligation is, I think, beyond the realm of what these folks are here to talk about. We'll get the information for you and we'll take it from there.

Do you have another question?

[Translation]

Mr. Réal Ménard: Mr. Chairman, first of all, I want to assure you that my questions will never be of a political nature for the remainder of the work to be done. However, I bow to your desire to ensure that we obtain the report and that we then provide a personal assessment of the figures contained in this report. That answers my question. Thank you.

[English]

The Chair: Thank you very much.

Mr. Elley, you will close with your question.

Mr. Reed Elley: Thank you.

I'm not sure just who this question should be addressed to—maybe Mr. Michols, but I'm not sure. Last year we spent a lot of time in this committee talking about natural health products. I'm wondering if you could give us sort of a progress report as to the setting up of the natural health products division, under THP, I think, the number of personnel involved in it, and what's happening there. I get constant questions from my constituents about what are they actually doing.

Mr. Dann Michols: Certainly. In response to the report that the Standing Committee on Health made on the regulation of natural health products, the government agreed with all of the recommendations and the Minister of Health instructed that an office of natural health products, responsible for the regulation of these products, should be set up within the health protection branch.

Activities are underway at this time to find an executive director for this office. There is a staffing process underway. I would suspect that it probably should have an executive in this position by the end of this calendar year.

There was also a transition team established, made up of representatives from a wide range of stakeholders in this particular area. They are working through a number of policy issues, like the attempt to define what a natural health product is. The standing committee did not venture into that area. Also, they are taking a look at how the office should be structured and what elements there should be within a regulatory framework.

The office of natural health products will work closely with my organization, therapeutic products, and with the food program, because with natural health products there is a continuum, if you like, between food and drugs. There is also a process underway to establish an expert advisory committee made up of representatives of the various disciplines that would be required for the regulation of these products.

I think there has been considerable progress since the government announced its intentions. We're well on our way to addressing the challenges for the regulation of these products.

Mr. Reed Elley: Thank you.

I have just a couple of small questions for clarification. Your timeframe, then, is what in terms of the actual setting up of this office and actually having it do the work? When do you expect that to take place?

Mr. Dann Michols: My expectation is that there would be an executive director in there before the end of the calendar year. There are one or two staff people in there now who are supporting the transition team, but obviously the staffing should be left to the new executive coming in. He or she determines the requirements.

There then has to be an analysis of the extent to which the appropriate regulatory framework can be introduced under the existing regulations within the Food and Drugs Act or whether it might require changes in regulations, which requires a six- to twelve-month process. While that is being planned and is underway, there is no reason why there can't be interim steps taken to develop the standards that are required for these products and to move forward on their regulation.

• 1705

Mr. Reed Elley: You still haven't answered my question, though. When are we going to see this actually happen?

Mr. Dann Michols: It is happening now. It will unfold, and I would suspect the—

Mr. Reed Elley: Next year?

Mr. Dann Michols: Absolutely in place during the next calendar year, yes.

Mr. Reed Elley: Thank you.

The Chair: Thank you very much, Mr. Elley.

I want to thank all the presenters from Health Canada. This was a very useful exercise. It has certainly been very enlightening for all the members of the committee. We appreciate your taking the time to be here.

Just before you go, colleagues, and before I adjourn the meeting, we have a housekeeping matter. Mr. Martin has requested, by way of a 48-hour notice of motion, that the minister appear—

Mr. Reed Elley: Excuse me, Mr. Chair. He's asked that it be deferred until our next meeting.

The Chair: Oh, has he?

Mr. Reed Elley: Yes.

The Chair: Great. Then we'll proceed accordingly.

Again, thank you to all of you. This meeting is adjourned.