SPER 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 DISABILITES

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

EVIDENCE

[Recorded by Electronic Apparatus]

Wednesday, May 16, 2001

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[English]

The Chair (Ms. Carolyn Bennett (St. Paul's, Lib.)): Bienvenue. Welcome to our round table on disability income support. Our tiny, perfect committee is always eager to learn all there is to know about the income security of persons with disabilities. We feel pretty strongly that if we're going to run income security programs, people should feel that their incomes are secure. So we are keen to hear what you have to teach us.

We're going to begin with Cam Crawford from the Roeher Institute.

Mr. Cam Crawford (Acting Executive Director, Roeher Institute): Thank you, Dr. Bennett.

I thought I would give a general overview of the current arrangements that are in place, and I would begin with the general context that in any given year there are more than a million people who have disabilities who are either not actively in the labour force or they may be looking for work but don't currently have jobs, which is a huge amount of people. In any given year, approximately half of that group would be attached to the so-called system of income support in Canada.

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Our system is a complex maze of programs consisting of contributory social insurance programs, contributory private insurance programs, non-contributory programs, and the tort system. This tort system is the one where you go and sue people and get the stuff you want.

The contributory social insurance program would include workers' compensation—workplace safety and insurance in some provinces—the EI sickness benefit, public auto insurance in some provinces, and the Canada-Quebec Pension Plan.

Under the contributory private insurance, you have both individual private insurance and the group insurance that you get through your employer.

Then we have non-contributory programs such as the welfare programs, and in some provinces such as Alberta you have the assured income for the severely handicapped, and there is the Ontario disability support program. These are very similar to welfare programs but are slightly different in terms of focus.

Access to income through this system depends on a whole range of factors. Many of these you're familiar with. But the cause of disability has a major bearing on where you are going to access service.

So if you have a congenital disability, your route is a very different one than if you become disabled as a result of a car accident or a work-related accident. The level of benefits you would access, depending on the cause of disability, would be radically different because of the route you take.

The nature of the disability you have, whether you have an intellectual disability, diagnosed mental health issues such as schizophrenia, a soft-tissue injury—all these kinds of diagnoses as well have a bearing on the kinds of programs to which you might have access and your benefit level.

The length of attachment to paid employment will also have a bearing. For example, if you've been paying into the CPP for a long time at a reasonably decent level, chances are you will have a much more adequate return from that investment at the end of, say, ten years of labour force attachment than if you were paying into the program at a minimum wage level.

The severity of disability is a requirement in some programs, as some programs put much more emphasis on severity than do other programs.

The discretion of case workers, whether they got up on the right side or the wrong side of the bed this morning and also how they interpret the rules and the guidelines, has a tremendous bearing, as does the individual skill and assertiveness of the person who is applying for benefits.

As well as these factors, the system is a jurisdictional tangle. You have the federal and provincial governments involved in regulating the insurance industry, provinces with responsibility for workers' compensation, provinces responsible for social programs like welfare and age, but the feds kicking in major cash infusions and other transfers through the Canada health and social transfer, and you have interfaces between all these programs—between workers' compensation, private insurance, welfare programs, and the Canada and Quebec pension plans.

So at the gates between these programs, I think it's fair to say that no one wants to be the full payer, and there's maybe a bit of a scramble for everyone to be the last payer. There are also major dollars invested in the gatekeeping process, and those are dollars that are not flowing into the pockets of people who are in financial need.

My time is fast elapsing here, but there are a couple of other broad points to be made. One is that, except perhaps for workers' compensation, the level of benefit that one would achieve, generally speaking, on these programs is very low. Overall in Canada, for people who received anything through social assistance in 1994, based on the survey of labour and income dynamics, the average take-home was a little over $7,000 in provincial welfare programs, and that amount varies very considerably from province to province since in some provinces you have people taking home at about 40% of the poverty rate, the low-income cutoff level; in other provinces, people will be taking home somewhere around 70%.

So we have real discrepancies in the system that vary by region and by the kinds of programs to which people are attached.

The other point to be made here is that, depending on the program in which you're involved, there are not only major disincentives, because I think that blames the person who has the disability, but major impediments, barriers to actually seeking and finding labour market reintegration or labour market integration for the first time.

We needn't go into all of that, but it's the fear of losing benefits such as drug plans, dental for certain individuals, and other benefits for which there isn't a cash transfer to the individual but that really have an economic impact on their lives. I would argue that people looking at the loss of perhaps thousands of dollars worth of drug benefits a year would not be inclined to go into the labour market and take a low-wage job if that's what they stand to lose. It could put their life in jeopardy.

There are other issues as well, but I was given five minutes. I've tried to wrap up some of the main things.

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I think the final point is that of all the people who are attached to the income system right now, about 30% who have ever worked in their lives are attached to provincial welfare programs. They're not on the CPP. So there's some movement there of people who were probably at one time attached to the CPP. They had an attachment to the labour market system, and, for whatever reason, they're on the provincial welfare rolls at this time. There's a big problem there.

The Chair: Thank you very much. What an excellent example of actually taking the time limit seriously. We are so impressed.

With the round tables, it's great if everybody can keep it down to five minutes. Then we actually get to chat with one another, and the more we get a consensus by the end of this afternoon, the better work the committee can do. So thank you.

[Translation]

We will now hear from the Confédération des organismes de personnes handicapées du Québec.

Ms. Chloé Serradori (Executive director, Confédération des organismes de personnes handicapées du Québec): Good afternoon, everyone.

We would like to talk primarily about some research that was done by the Confédération on systemic discrimination and, in particular, the impact that such discrimination has had on the income of individuals with functional limitations.

First of all, the attainment of the zero deficit at both the provincial and federal level has resulted in a drop in income and in greater poverty amongst people with functional limitations. One has to consider the catch-up factor. It is good when all citizens participate, but for people with functional limitations, the catch- up factor has decreased.

As regards income, we were asked what worked and what didn't. As far as things that don't work are concerned, right now it is the costs associated with the disabilities of people with functional limitations that are not yet recognized, despite all the advocacy work that we have done until now. We would like to see a citizens' income that would reflect the basic needs of all individuals. When we talk about basic needs, we mean housing, clothing, heating, food and free access to public services.

The other thing—and often these two aspects are lumped together—is the recognition of the costs associated with disabilities. As Mr. Cam Crawford said, there are two systems for personal income, in addition to work. There is an insurance-type system. When we talk about insurance-type systems, we're talking about systems such as the CSST, which covers work-related accidents, and the Société de l'assurance automobile du Québec, which covers people who have been involved in car accidents, the IVAC, which compensates victims of crimes, and the Régie des rentes du Québec, which deals with disability pensions. These are all insurance-type systems.

The other component is more like an assistance system. These programs include the Canada Income Security Program, and the conditions are not the same for all sectors that may provide income to individuals with functional limitations.

For many years we have been trying to find a way to get all of these structures to come together in order to stop the discrimination against individuals with functional limitations according to the cause or reason for their limitations.

The other way to increase income, is obviously to accelerate and, more especially, implement all aspects of equal access to employment. We still have a very long way to go.

We also touched on the issue of taxation. We could still do something with taxation, particularly with respect to refundable tax credits.

This is the general overview of the situation. We are really insisting on the fact that, once all the costs associated with disabilities are recognized and compensated, perhaps more people will be able to join the job market.

Thank you.

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[English]

The Chair: Merci.

Harry Beatty from ARC, welcome.

Mr. Harry Beatty (Advocacy Resource Centre for the Handicapped): Thank you, Dr. Bennett. I think we're all going to be saying much the same thing in maybe a little different way.

I know as members of Parliament you will be dealing with constituents who are regularly receiving or not receiving Canada and Quebec pensions. I'm going to focus my remarks on those programs, particularly CPP since I come from Ontario. I think the same principles apply quite generally to other programs.

One of the most difficult things, as an advocate to people with disabilities, is to advise a person who is considering, having received disability income, whether to attempt a return to work, or perhaps go to work for the first time, or education, or a training course—some form of what could broadly be considered rehabilitation. The individual has in most cases a real, and I think fully justified, fear that things may work out so that the person loses everything. Perhaps the person will not be able to succeed eventually in employment, not because of any limitations of their own, but because of the inaccessibility of the workplace—all the kinds of barriers that are there. Even if the workplace is accessible, there may not be transportation to get the person there. Or, as happens to a number of our clients, having taken a job, they find that all of a sudden they lose a benefit they had previously—subsidized housing, for example, or some type of health benefit.

The result is that many people who, given the choice, would prefer not to be dependent on disability income and who would have a great deal to contribute in employment and society—not to say that people can't contribute and don't contribute in other ways, but that's the way that most adults contribute—yet because of their concern about needing some kind of income security for themselves and for their dependents are really forced to stay away.

With advances in technology, computers, diversification of work, and all the other new opportunities, there are a tremendous number of people with disabilities who could make a huge contribution to society. But I think ultimately, with a program like CPP, the fundamental flaw is that it defines disability and eligibility in terms of inability to work. That necessarily means that although there are some attempts within the program to address that in the short term, a person may find themselves, after having done a job for a couple of years, to then be assessed as no longer disabled.

I think that issue has to be faced head on. We have to look at some kind of new model of the assessment of disability, which will treat people fairly in these circumstances, which will acknowledge that in some cases people have worked, even though they're in a tremendous amount of pain, even though they're in a lot of emotional distress, even though it was physically very hard for them to do so. That should be taken into account fairly in definitions and the assessment process.

I also believe, although this would be controversial as well, there may be a need to look at a separate program or separate provisions for people who are employed as opposed to those who are dependent on income.

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In doing the study that I've handed out for Council of Canadians with Disabilities a couple of years.... And I'll mention that there are two other documents as well available on their website, which I have not distributed to you. One is a comparison of the Ontario, Alberta, and B.C. disability social assistance models. The other is an attempt to do case studies comparing what people in particular circumstances would get in four different provinces—or I think we finally got it up to six. That was instructive just because it was so difficult to find anyone who could actually tell you what the person was entitled to. We got completely contradictory answers about entitlement, because the system is so complex.

I think that in some ways within programs like CPP, “unemployability” is the meaning of “disability”, the sole definition. I think that really needs to be addressed in a fundamental way. We need to look at the basis for the program and our understanding of people with disabilities and their role in society. I don't think shorter-term or more limited changes to the program are going to have much effect.

It'll be very interesting to see after the health and activity limitation survey is done in 2001 how much progress really was made in respect of independence, mainstream participation of people with disabilities. My gut feeling is that it may not be very much. Until we're willing to look at more fundamental changes to the system, I don't think there's going to be a lot of progress.

Thank you.

The Chair: Thanks very much.

We'll now hear from the MS Society. Nickie.

Ms. Nickie Cassidy (National Social Action Volunteer, Multiple Sclerosis Society of Canada): Thank you, Madam Chair and members of the subcommittee, for the opportunity to present the views of the MS Society of Canada.

Today, we'll be focusing on our main priority, which is income security. Our primary reason for focusing on income security is that adequate income defines the ability to be a full member of society. Without secure income that is sufficient to support a decent quality of life, the results are devastating. The consequences affect us all.

Canada has one of the highest rates of incidence of MS in the world. An estimated 50,000 Canadians have this all too frequently disabling disease. The possible results include vision problems, numbness, loss of balance, extreme fatigue, and even paralysis. Spontaneous recovery from symptoms can occur and last for months or years. However, unpredictable attacks occur and can cause additional symptoms. Although MS is unpredictable, most people with MS eventually are unable to work full time. Many experience total disability.

In 1991 44% of adults with disabilities aged 15 to 44 were not part of the labour force. With MS this is significantly higher. Fully 70% of people with MS are not working five to ten years after they are diagnosed. In a recent MS study, one-third of the participants had mild MS, one-third moderate, and one-third severe MS. Despite the relatively low age of the participants, who were in their late thirties and forties, the effect of their disease on their ability to work was dramatic.

In the mild MS group, 37% experienced a change in their employment status because of MS. Only 28% of those with moderate MS and 4% of those in the severe category remained fully employed. The key problem is that they experience recurrent, but not necessarily continuous, impairment of their abilities. Fluctuations make it very difficult for people with MS to work. It is this recurrent, variable, and unpredictable nature of MS attacks that is fundamental to the income security challenges faced by people with the disease, because it prevents them from qualifying for disability benefits.

As the following figures indicate, MS can be very costly in lost wages and health care. Converted to current Canadian dollar values, the average annual cost of MS in the U.S. exceeds $62,000 per person. For individuals with the progressive forms of MS the costs average $90,020 per year—that's a lot of money. The burden of illness study of MS estimated the total annual cost of MS in Canada at $1 billion, higher than the cost of asthma and all infectious diseases in Canada, despite those diseases having a much higher incidence than MS.

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CPP disability benefits are a key support for people with MS. As of December 1999, 10,027 of the approximately 50,000 people with MS, one-fifth, were receiving CPP disability benefits. The current qualification criteria for CPP disability benefits require that the illness be severe and prolonged. The obvious problem with these criteria is that they require the applicant's symptoms to fit into a narrowly defined box that excludes from coverage people who have substantial, recurrent impairments. MS is permanent and often severe, although the impairment it causes may not be. The often fluctuating nature of the illness precludes many individuals with MS not only from participating regularly in the workforce, but also from qualifying for disability benefits.

The Province of Ontario has rectified this problem. It examined examples of eligibility criteria for people with disabilities in other jurisdictions, and as a result recognized exclusively cyclical or episodic disabilities, such as those caused by MS, in the definition of disability through the word “recurrent”. Under the ODSP, a person is disabled if he or she has a substantial physical or mental impairment, the impairment is continuous or recurrent and expected to last one year or more, and the impairment results in substantial restrictions in one or more activities of daily living, personal care, functioning in the community, or functioning in the workplace. The Ontario Human Rights Commission also adopted this approach, including people with fluctuating or recurrent disabilities under their definition.

The MS Society of Canada urges the subcommittee to recommend that the Government of Canada introduce a fairer definition of disability to cover individuals with a continuous or recurrent disability that is expected to last one year or more.

CPP disability benefits are calculated based on the amount of earnings and contributions credited to an individual's CPP account, as well as how long the individual contributed. Currently, under the CPP 15% dropout rule, individuals who have contributed to CPP for at least ten years are able to drop from the benefit calculations 15% of the months in which they had the lowest earnings. This rule affects individuals with MS who are diagnosed in their late twenties and early thirties and are therefore unable to contribute for the required ten years to take advantage of the dropout rule. As a result, their benefits are often extremely low.

The MS Society of Canada urges the subcommittee to recommend to the Government of Canada that the 15% dropout rule be extended to those who have contributed to the plan for at least five years. For young adults disabled by MS, this would provide them and their young families with a more adequate level of disability income.

CPP disability benefits provide near-universal coverage for employees and self-employed individuals. Despite this plus, the all-or-nothing character, which we've heard before, of the eligibility criteria creates a version of the familiar welfare trap. Given the recurrent or episodic nature of MS, some people are able to do some work to supplement their incomes, but CPP discourages part-time work, and people risk their continued eligibility for CPP benefits.

The MS Society of Canada urges the subcommittee to recommend to the Government of Canada the introduction of more flexible rules that would allow beneficiaries to do part-time or occasional work without risking their eligibility for benefits, in keeping with this year's Speech from the Throne.

In the past the MS Society has criticized the backlogs in initial CPP applications and the often lengthy delays. Recently there have been some improvements, and still there is more to do. HRDC now includes a key result commitment of 62 working days—that's more than twelve weeks.

The MS Society urges the subcommittee to recommend to the Government of Canada that applications be processed within 60 calendar days of receipt, that internal reviews be completed within 60 calendar days of receipt of a request for reconsideration, and that decisions of the tribunal be rendered within 60 calendar days of an appeal hearing.

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The MS Society is also concerned about the lack of understanding some CPP officials appear to have about MS. In one case, for example, CPP staff wrote that an applicant with MS had been cured—if only that were so—now that she was receiving medical treatment, and she was therefore found to be ineligible for benefits. Unfortunately, there is no known cure for MS. This error was not addressed until the third level of appeal. Like many people with MS, this client eventually won her appeal, needless to say.

Our client files reveal other such instances and lead us to conclude that CPP staff are not as knowledgeable about MS as they could be. We have found that the majority of people with MS who appeal with our assistance are eventually granted benefits. This suggests there is a flaw in the system from the beginning, making the process inefficient and wasteful of taxpayers' money.

The MS Society urges the subcommittee to recommend to the Government of Canada that CPP officials be provided with information and learning materials to increase their understanding of MS and the circumstances of people with the disease. The MS Society would be pleased to work with the Government of Canada to produce such materials and to ensure they are accurate and current. We would be pleased to assist further in any way we can.

The income security issues we have raised with you today do not represent all of the concerns or needs of people with MS. We have focused on these issues for two reasons: secure and adequate income is the foundation for the ability of people with MS to fully exercise their rights as Canadians and to be part of mainstream economic and social life, and the recent successes of the federal government's fiscal policies have created new and important opportunities for the fairer treatment of people with disabilities.

We thank the subcommittee for its time and consideration. We'd be pleased to answer any questions you may have.

The Chair: Thank you very much.

Next is Mr. Phil Upshall from the—

[Translation]

Ms. Mercedes Benegbi (Vice-President, External Affairs, Confédération des organismes de personnes handicapées): Madam Chair, could we ask people to talk a bit more slowly?

A voice: We have a copy of everything we said in French.

Ms. Mercedes Benegbi: Even the interpreter will not survive if people don't speak a little bit more slowly.

[English]

The Chair: Next is Mr. Phil Upshall from the Canadian Alliance on Mental Illness and Mental Health.

Mr. Phil Upshall (Chair, Canadian Alliance on Mental Illness and Mental Health): Thank you, Dr. Bennett, and thank you for the opportunity to come before you today and participate in this really important round table.

Everyone who has spoken before has said what I wanted to say, so I can't add too much.

Let me tell you a bit about the Canadian Alliance on Mental Illness and Mental Health, however. We are a coalition at the national level made up of the Canadian Psychiatric Association, the Canadian Mental Health Association, the Mood Disorders Association of Canada, the Schizophrenia Society of Canada, and the National Network for Mental Health.

Our mission is to facilitate and promote the establishment and implementation of a Canadian action plan on mental illness and mental health that reflects a shared national vision for meeting the needs of persons with mental illnesses and enhancing the potential for the positive mental health of Canadians. We came together primarily because as individual organizations we were having very little success at getting the attention of the Canadian governments with regard to issues of major national importance.

I don't think it's any surprise to our elected MPs that mental illnesses are a major issue because, as I understand it, you have a large number of phone calls coming into your offices every month with regard to them.

Mental illnesses, primarily depression, are now the largest disabling illnesses in the world, and they certainly will be in Canada by the year 2015. Schizophrenia is a hugely disabling illness, and it impacts about 1% of the Canadian population. Bipolar effective disorder affects another 1% of the Canadian population, but it is less disabling in many ways.

Our groups, as a general rule, report to us that they have a very difficult time applying for the CPP and QPP benefits. The turndown rate is substantial, notwithstanding the fact that the requirements are appropriately completed along with the necessary psychiatric reports. When it comes to a person suffering from mental illness, particularly depression, the turndown has a huge impact on them. It frequently sets their illness back dramatically and puts them in a position where they are unable to appeal. It also has a huge additional impact on the family and the caregivers.

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The appeal process is difficult, as I've mentioned, and I'd be glad to discuss that during the round table discussion.

Of course, mental illnesses in Canada, as they are throughout the world, are impacted by systemic discrimination or a stigma, which I think we're all quite aware of.

We'd like to see CPP in particular established as a true entitlement program. You fill out the application, as you would for your normal CPP at age 65, and if you meet the criteria, you get it.

In terms of solutions to the problems, I know we'll be discussing these in the round table, but we'd like to suggest that maybe HRD can structure it so that they can err on the side of the applicants. If there is an issue as to whether or not someone is entitled, pick on the someone instead of the whole community.

We'd like to suggest that you set up a consumer panel to assist HRD in understanding some of the issues that surround mental illnesses in particular. I'm sure that is something you would welcome, given the large number of applications that come from our sector.

We'd like to see, as others around the table would, an alteration of the regulations so that there is support by HRD for the people who are attempting to go back to work on a part-time or sporadic basis. These are the kinds of concepts we involve ourselves in when we talk about the need for a civil society.

I'm sure all our politicians received comments about the CPP from the Canadian Mental Health Association during the last election. I know everyone read them and committed them to memory, but I'd like to read them in case you have forgotten them. They have a list of five key messages. The most important ones are, firstly:

The concept of permanent unemployability implied in the CPP Disability criteria is outdated and unacceptable; disabled does not equal unemployable.

Disability-related costs should be separated from income support programs.

A couple of the facts they rely on are:

Although it is becoming more accepted that people with mental illness can participate in the labour force, not all Canadian disability income programs have kept up with this changing perspective. CPP Disability criteria currently penalize initiative more than they encourage employment.

And, as I mentioned earlier:

The CPP definition of disability reflects the outdated notion of “permanent unemployability”.

Thanks very much. I look forward to participating.

The Chair: Thanks very much.

Next is Tina Head, the senior counsel of the legal services unit of the Office of the Commissioner of Review Tribunals Canada Pension Plan/Old Age Security. That's a mouthful, isn't it?

Ms. Tina Head (Senior Counsel, Legal Services Unit, Office of the Commissioner of Review Tribunals Canada Pension Plan/Old Age Security): Yes.

The Office of the Commissioner of Review Tribunals is the first of two external levels of appeal in the Canada Pension Plan system. We hear appeals in groups of three members chosen from the panel appointed by the Governor in Council. Our members are part-time and they're located across Canada. Every hearing is chaired by a lawyer. In disability appeals, which is about 95% of our work, one of the three members is a health professional and satisfies criteria prescribed by regulation as to their qualifications. The third member can come from any occupation. What we've found through experience is that all three categories of our members tend to have good roots in the community. They tend to be activists in the community.

I don't want to talk so much about the hearing process as about our observations as a tribunal with regard to the income support system for people with disabilities.

I want to preface that by saying we're not a policy-making body. Certainly, from the point of view of the Canada Pension Plan, I'm sure the experts are just about to follow me.

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We have a continuing commitment to improving at least our level of the appeal process. That's our mandate. We want to make sure we provide an appeal experience that's fair, effective, and quick.

And yes, Nickie, we too would support a 60-day standard for decisions, because in fact our own internal standard is four weeks to six weeks. We think that's fairly generous, and we're working to make it even tighter than that.

One of the priorities of our commissioner, apart from improving the quality of the appeal experience, is to reduce the number of appeals in the first place. We acknowledge that in any kind of program there will always be the need for an appeal mechanism. It's one of the essential elements of our democratic structure. But the success of the system is judged I think in the end by how many unnecessary appeals there are, how often the right decision can be made at the very first opportunity. And we're all committed to having that happen.

In terms of some of the things we're doing at our tribunal to help achieve that goal, I think we've had some very effective partnerships over the last while with the income security programs branch in improving the communication to appellants about the criteria for the program and about what the appeals system can and cannot deliver. We've had some good success in some mutual pilots.

We've just started some major consultations with frequent representatives at our tribunals. We've sent a package to all representatives who've appeared three times or more before our tribunals and have asked for their input on how we can improve both our products and our process.

We haven't yet put the final details on it, but I do believe this will be followed, in the coming year, by an in-person consultation, again with frequent representatives.

One of our concerns that we've not yet been able to resolve in a very effective way—we're really just turning our attention to it—is the overlap between some programs and the Canada Pension Plan. One of our most current concerns is the overlap between people who've been in the private disability process and the Canada Pension Plan. In our experience, there are certainly examples of people who've been aggressively forced through not only the CPP application process but all the way through the appeal process by their private insurers.

That's the tip of what we think is a fairly complex problem, and certainly we would encourage some discussion of that.

The appeal process is not an easy process. No matter how hard we think...it will always be challenging for people. By the time they're in an appeal process, they've been through a long personal road. I think it behooves all of us to make sure you don't go there unless you necessarily have to.

So those are some of the concerns that most preoccupy us at the moment, and I'd be happy to participate later.

The Chair: Thanks very much.

We now have the officials from HRDC. With us is Paul Migus, the assistant deputy minister, income security programs.

Do you want to introduce your colleagues?

Mr. Paul Migus (Assistant Deputy Minister, Income Security Programs, Department of Human Resources Development): I will.

[Translation]

Thank you, Madam Chair. Ladies and gentlemen, good afternoon. I would like to introduce you to the two people in charge of income security programs who are accompanying me here today. This is Mr. David Cogliati, Executive Director, and Nancy Lawand, Director, Canada Pension Plan policy.

I am pleased to appear before this subcommittee for the first time and to hear directly the concerns expressed by the members of Parliament and by the disabled persons community with respect to the type of income support provided to disabled Canadians.

The CPP disability benefit program is a primary source of income support. Indeed, it represents the biggest long-term disability insurance program in the country.

[English]

Madam Chair, disability touches all of us in one form or another. We at HRDC try to be fair and compassionate in our dealings with the applicants and with the beneficiaries.

At the same time, as has been pointed out, we are only one part of a network of income support programs. We operate under very specific defined legislation, which we as public servants must respect at all times. As many of you know, and as has been repeated here, the Canada Pension Plan disability definition of disabled is fairly strict; there is severe and prolonged, which has been mentioned a couple of times, and that which prevents an individual from undertaking regularly any employment or any job.

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HRDC strives to ensure that Canadians with disabilities and their families have access to the programs and the services they need to participate in society. Access to income supports when employment is not possible is one of the key requirements for full participation in society, as has been stated by the participants around the table.

I want you to know that we're working, and we're trying to work more, in partnerships with the voluntary sector and with the medical community, and we're trying to ensure that the approach to helping people with disabilities is as comprehensive and compassionate as possible.

The process of obtaining income support from CPP regularly comes under scrutiny, and we're very aware of the significant impact we have on the lives of applicants and their families. We have looked closely at our policies and procedures and we have tried a number of new approaches. Some of these were in their infancy or had not yet been identified when my predecessor first appeared here before the subcommittee back in May 1999.

Our progress I think responds to the most commonly expressed frustrations by clients and members of Parliament who write to us on behalf of their constituents. Let me offer a couple of examples.

A number of members of Parliament have communicated, and I quote, that: “My constituent does not understand why he/she has been denied. The decision-making system is confusing and unfair.”

We have tested, and we will continue to test, a number of new approaches that allow us to provide early client contact. By that I mean trying to personalize the contact with the applicants we have. This means calling a client once the application is received. It means maintaining contact with the client to obtain more information, or to ask for clarification, or to seek more medical information as required. It also requires us to explain the steps in the process and explain the reasons why an application may not have been approved. If we deny an applicant, we are going to contact them with a full explanation and direct them to other supports. In the process, we're also looking at redesigning a number of our communication products to make them far more clear and responsive—in other words, to put them in plain language.

We've also heard from members of Parliament, and I quote: “The appeal process is onerous and stacked against the applicant.” We have recently provided, in a number of cases, additional information to the appellants at this point in time as to why a decision had been taken. This is part of natural justice, we believe, and we believe much more of that should be taking place, and probably far earlier than at the stage of the appeal process.

But I would like to comment at the same time that 90% of all CPP disability cases are resolved by the department either at the initial application stage or at the first level of reconsideration, the first level of appeal. That is, 10% move on to the Office of the Commissioner of Review Tribunals or the Pension Appeals Board. I recognize that there can be lengthy waits at the last level of appeal and that this is very difficult for people, but at the same time, I want to underline that we have provided, as a government, additional resources to the appeal process. For example, in the case of the Pension Appeals Board, the number of judges has increased from 21 to 76 over the last two years to try to handle the workload they have.

I've given you but a few examples of some of the things we've been trying to work on, and I'd be happy to provide more detailed information and to answer any questions you might have.

[Translation]

I would like to conclude by saying that the work, in my sector, is constantly evolving. We would like to move forward by drawing on this experience and the ideas of all stakeholders.

Thank you for this opportunity to participate in this round table and I would be pleased to answer your questions.

Thank you.

[English]

The Chair: I'd like to get some figures down. In terms of the first level, what percentage of applicants are turned down the first time? I remember my first HRDC meeting with the then Deputy Minister, Mel Cappe. As a family doctor, I thought it was 100%. How close are we to being turned down the first time?

• 1635

Mr. Paul Migus: Last year there were approximately 55,000 applications received, and 17,000 were approved on the first instance. So we're saying about 35% are approved initially.

But at the end of the day, to the whole process, approximately 50% are approved.

The Chair: But when you say that 90% are resolved by the department, that includes those who were turned down and didn't appeal.

Mr. Paul Migus: It includes the fact that the department has responsibility, Madam Chair, for the first level of appeal, which is the reconsideration. Of that number that are turned down, a number do request reconsideration. The departmental officials handle the first level of appeal, and approximately 25% of those who apply are reviewed and are granted.

The Chair: Is there yet—I think I've asked this question before—some sort of exit interview with the people who don't appeal? Is it that they've gone into a tailspin, as Mr. Upshall has said, and are now so depressed they can't even be bothered? Or do we know these people are satisfied that they don't qualify?

Mr. Paul Migus: I don't think anybody can ever say that one is satisfied when they haven't been successful in obtaining—

The Chair: But somehow we take our success to be whether they appealed or not—whether or not they feel up to appealing, they don't want to get a lawyer, or they can't face it any more. I've seen a lot of those people. Do we know how many of those people there are—the ones who just don't have the wherewithal to appeal?

Mr. Paul Migus: There are a number of reasons that applications are not approved. One of the first ones is that the individual has not had sufficient contributions in the first instance. They have not been in the labour force; they have not made contributions to the Canada Pension Plan. Without the contributions, they're not eligible.

That's number one, and we can't really judge. I'm sure they're unsatisfied with the outcome, but that's one indicator. There are others as well, obviously.

The Chair: Okay.

There are other ones that I'm concerned about. Before we look at the numbers, there are a lot of people being pushed to apply when it was known to begin with they didn't qualify. Is there some capacity, other than when it gets to the appeals process, where there are all the copies to the insurance companies, for you to know right at the beginning whether this person was asked by a third party to apply? Because that's a lot of the taxpayers' dollars, filling out forms in your office for people who didn't qualify, when some insurance company is making them apply because they won't pay them unless they do. Do you know how many there are?

Is there a question on the form yet that says, “Did somebody else ask you to apply?”

Mr. Paul Migus: No. We do not have that particular question on our application form.

But, Madam Chair, it's not just the private sector insurance companies that are asking individuals to apply. One can also say from our experience that we do have provincial governments, provincial agencies, also indicating that before they put people into their programs, they must have gone not only to the Canada Pension Plan, but also through the entire appeal process.

We have recently written to some of the provinces asking them to reconsider that approach in that it causes undue stress on the applicants to have their expectations raised and to be held up from the ability to be dealt with in the first instance.

The Chair: Maybe later the round table can help us, because I think, certainly in the working meeting that I was at for the MS Society, they said there could be tools to fast-track this stuff. If all the MS people eventually get it, they could maybe help develop a tool. That's certainly what I've been hearing from a lot of the disease groups, that they could help so that they wouldn't get turned down the first time.

Mr. Paul Migus: That would be very welcome as well. We would like that very much, to be able to have those conversations.

The Chair: Monsieur Crête.

[Translation]

M. Paul Crête (Kamouraska—Rivière-du-Loup—Témiscouata—Les Basques, BQ): Thank you, Madam Chair.

I found your comments most interesting. Before I ask my question, I would like to point out that if we managed to establish a citizen's income, the competition that exists between the various organizations to protect their benefits, which is understandable since each organization must ensure that its legislation is being enforced, would decrease tremendously. A system that is tied more to citizenship, such as the one referred to by Ms. Serradori, would eliminate this particular aspect.

• 1640

I have a question for Mr. Migus and perhaps some of the other witnesses. In addition to the work done by this committee, is there an automatic, mandatory and annual mechanism that would enable the various witnesses who testify to submit their comments to the department, which would have to provide a mandatory response? As is the case with the Auditor General, who issues an annual report, such a mechanism would enable us to rectify problems within one, two or three years. What type of mechanisms exist in this respect?

Mr. Paul Migus: Currently, there is no consultation process for our program but we would like to see this happen. At the departmental level, the Office for Disability Issues uses a consultative process with volunteer organizations. In addition, our department recently awarded a grant to an organization,

[English]

the Council of Canadians with Disabilities, from the perspective of providing additional support to the voluntary sector to create a forum for the consultations that are required, not only with respect to the Canada Pension Plan but also with respect to the other disability supports and employment issues that the department and the minister are committed to providing support for.

[Translation]

Mr. Paul Crête: I would like to know if the other groups would be interested in having some type of mandatory informal consultation on these things. Would you recommend that the committee promote such an idea? Do you feel that this would be useful? Somebody made a comment along those lines. Do we not have to break a vicious cycle in order to eliminate such reoccurrences? I would like to know their opinion.

Ms. Chloé Serradori: We have, of course, always asked to participate and we have asked that individuals with functional limitations be assessed. COPHAN is a member of the Council of Canadians with Disabilities. A great deal of work has been accomplished. Earlier, criteria were mentioned. We have something to say on this issue. You asked why people found it so difficult to appeal their case. I am not very familiar with the Canadian system, but in Quebec, the last income level is called income security. Since this is a last resource, steps have to be taken with the Régie des rentes du Québec. This excessively cumbersome procedure delays the time when the person will receive a benefit.

You also referred to another difficulty pertaining to access to legal services at the third level. People with functional limitations only have access to lawyers, generally speaking, if they qualify for legal aid. I have accompanied many people and I can attest to the fact, generally speaking, the lawyers agreed to take their case to the first level, but not to the third, because they do not make enough money on these cases, it is not profitable. We have heard several lawyers say so. Consequently, it does not make sense for them to spend several thousand dollars in order to get access to such a small income. This is a reality that we do not talk about very often, but it does exist.

• 1645

[English]

Mr. Cam Crawford: The other members around the table might correct me if my perception is completely off base, but in response to your question, it's my view that over the last, I think, five years there has been an increasing demoralization within the disability sector in Canada. There is a sense, certainly among people involved in national organizations, that issues relating to disability are really not on a political radar in any substantive sense; that there's been a withdrawal of commitment on the part of various levels of government to serious, sustained, frank, and constructive consultative processes; that the kinds of reporting and accountability frameworks that at one time were in place, I think, with the parliamentary Standing Committee on Human Rights and the Status of Persons with Disabilities are no longer there. You get infrequent consultations, for which the disability sector is ill-prepared, because they simply don't have the person-power to divert from the other projects they're having to do just to raise money to stay afloat. They don't have the capacity to be involved.

My sense is that they would welcome the opportunity, with some financial support, to be involved in serious, frank, constructive, practical consultations with a view to really changing things. My sense is that they would also welcome a framework such as you've put forward, a process whereby issues relating to disabilities, not just the Canada Pension Plan, but more generally in the country, get some regular attention, where issues are systematically flagged, where there is some public profile to those issues, and where there's some obligation on the federal government, and maybe even, by moral implication, some sense of need to respond on the part of other levels of government as well. I think it would be really helpful and could infuse a new energy and commitment in this sector, and I think it would begin to rally people again. I think they would take that as a very constructive and helpful sign.

The Chair: Mr. Upshall.

Mr. Phil Upshall: Dr. Bennett, one of the things I'd like to suggest is that you might like to recommend a formalization of an advisory board or some sort of an expert panel on disabilities that could work with the assistant deputy minister and his staff. Perhaps they could meet once or twice a year, review an annual report of HRDC, and make comments as to accessibility, funding, and other issues as they arise, and develop a sense of trust, which I agree is, quite frankly, lacking, sadly so, because it's such an important institution for our Canadian society.

I can tell you as a member of the expert panel for the Canadian community health survey, working with Statistics Canada is a joy—if you can believe that. You can have input, they listen, they make notes, and they change attitudes and aspects, particularly as regards the upcoming mental health survey.

I suspect that if we could work together with HRDC people over a period of time, a level of trust could be established, so that we could communicate that trust to the people we represent and you represent. There would be a sense that at first instance they were treated fairly, because quite frankly, right now there's a sense that they're not treated fairly at first instance. If they're not going to be treated fairly at first instance, the people in our community suggest they'll never be treated fairly. Then from our community you get a large increase in the homeless population, both visible and invisible, and that's a reality I think we have to respect.

Ms. Helen Wagle (Manager, Social Action, Multiple Sclerosis Society of Canada): I would echo some of the comments being made by other groups. I think the consultation is an excellent idea. We've been having meetings with HRDC, and those have been extremely helpful, as well as with other departments. So rather than doing the one-off, where one society makes their presentation and then another organization, it would be very helpful to have members of other groups who have an interest in Canada Pension Plan and other disability issues working together, so that what we present is actually making sense for other groups. We do that work on our own, so it would be nice to have this kind of opportunity to talk to other groups about issues of concern.

Speaking to the point about the CPP and private insurers, I'm not sure, Madam Chair, if you're aware that CPP is actually the first payer. So insurance companies actually have a fairly strong incentive to try to get people with multiple sclerosis or other illnesses, once they are applying for long-term disability benefits, to apply for the Canada Pension Plan.

• 1650

I certainly do get calls fairly regularly from people with MS who say, “Okay, I have my LTD, I finally got my CPP, and they've just docked my CPP payments right off LTD, so what was the point of the whole exercise?” It's a good question. I certainly don't have an answer to that question, but it's something that has been raised.

I also want to mention, in terms of a model for consultations, that we have been involved with and have been monitoring the voluntary sector initiative. I don't know if it's a model that could be used in this kind of context, but it is a fairly successful model where government and voluntary groups are sitting at the table together. In fact, the process is a joint chair process. Rather than having voluntary sector groups making presentations to government, and government then under the obligation to respond back to those groups, there's an opportunity—and this comes only when there is a certain level of trust—to do a joint process so that we're working together at the same time to create policy options that make sense for everyone rather than this sort of one-off consultation and other processes.

So there are examples of models that are working well for the relationship between government and the voluntary sector.

The Chair: Harry.

Mr. Harry Beatty: I think it would be good to have consultation between disability organizations and HRDC, but at the same time, we have to keep in mind that in the last round of changes to the CPP in 1998, the federal government and a sufficient majority of the provincial governments in Canada put in place a plan essentially to reduce eligibility. The contribution rules were made tighter, and in fact, in discussing the future of the plan, there were actuarial projections that showed that the amount of money that would go into disability benefits would be reduced. At the same time, of course, the CPP Advisory Board, which was in place, was abolished.

Sure, consultation is a good thing, but if governments don't acknowledge their responsibility for setting the framework, if there are legislative and financial restraints on what can be done, there's a limit.

Right now, the absolute numbers of people approved for CPP across Canada are at the level of the early 1980s, roughly half what it was three or four years ago. Everyone doing this kind of advocacy who is perhaps not associated with a specific disability group—I come from the legal clinic system in Ontario—is basically reporting that they're winning about a third as many cases as they did a few years ago.

If you look at the overall statistical picture, there is no doubt whatsoever that the system has been made much tougher, and this is a matter of deliberate policy on the part of the federal government and the provincial governments that supported it.

The Chair: That's hopefully what this committee can work on.

We'll let Wendy ask her questions and have you respond, but if you're actually saying we need policy changes, and even definition changes, that's not something for meeting endlessly with the officials at HRD. They actually just get to enforce the rules; we're here to see if the rules need to be changed.

Ms. Wendy Lill (Dartmouth, NDP): What Harry just said in his last interjection really says it all. When we started, Carolyn, you said with income security programs, the incomes have to be secure. That's the bottom line.

I hear from Nickie Cassidy that people are basically living in poverty. When they finally manage to get on CPP, they are living at a poverty level, so the rates aren't high enough.

Harry Beatty is saying there are many fewer people eligible for benefits. I do remember back in 1998 fighting in the House of Commons over that issue, about the cuts to CPP and what that was going to mean two or three years down the line to people who are disabled, and lo and behold, here we are. There is less money. The eligibility criteria have been tightened up, and a lot fewer people who are disabled are able to receive decent income security.

• 1655

You always dream that when you get together the people who are speaking out on behalf of the clients, the persons with disabilities, with the people who are able to....

Well, actually Carolyn just made the point. I think we have a political problem here. We have a government that has decided to cut back on the amount of money that's going to be available for persons with disabilities, and we're hearing it every time we have somebody come before us. It's a central problem to this committee, and we want to address it in any way we can.

On a very specific level, though, I'm interested in the definition the Ontario government has accepted. I certainly do not find that a progressive government, but I must say that the fact that the Ontario Disability Support Program Act now has a definition of a person with disability that includes recurrent, the sense that impairment that is continuous or recurrent.... I can read it into the record:

4.(1) A person is a person with a disability for the purposes of this Part if,

(a) the person has a substantial physical or mental impairment that is continuous or recurrent and expected to last one year or more;

(b) the direct and cumulative effect of the impairment on the person's ability to attend to his or her personal care, function in the community and function in a workplace,

If the CPP adopted that particular definition, life would become very different for millions of Canadians. Correct?

I'm just talking now. I'm putting forward some observations out of this meeting. I feel that we can put together a panel of experts to advise you, and that would be wonderful, but quite frankly, we need political will and we need money back into our income support programs.

The Chair: Maybe, Wendy, what you've raised is that.... The numbers we've heard, that maybe 40% or 50% of the people are actually on social assistance.... In terms of the context of what the supports and services for persons with disabilities might be, people go onto a pension and they lose their drug card. They don't qualify for supports and services.

In terms of looking at a comprehensive approach to this, is CPP working at all for people with disabilities if it's not coordinated with decent supports and services and drugs and everything else that people need? How can you help us not only with the definitions, but if we were going to build this whole thing again, what would it look like?

Ms. Wendy Lill: Well, we would obviously have more money.

Mr. Cam Crawford: And there may have to be agreements with the provinces and territories whereby if a person is in receipt of a Canada Pension Plan—and I won't speak to the Quebec Pension Plan because I think that's quite a different situation—there wouldn't be a clawing back of the provincial benefit, or if there were a clawing back of the provincial benefit, that money goes somewhere else, maybe into the support system or something, so that the net impact would be a higher level of basic income for people, regardless of how you get from point A to point B.

Point B is a higher level of income, and any money that comes out of that person's pocket provincially would then be reinvested in the attendant services, maybe broadening eligibility for the drug program, the assisted devices, all the other supports that people need, which I think right now are pretty severely starved for funding in a lot of jurisdictions.

On the definitional issue, there was a report done a few years ago, financed by HRDC. Subsequently, we found the same thing in some other work we did with HRDC, using the Survey of Labour and Income Dynamics. In any given year when we do surveys like HALS, the finding is we take a snapshot of the population wherein by some decision these folks have a disability.

• 1700

If you asked the same questions next year, you would find about 30% of the people who last year said they had a disability, this year no longer feel that way. A lot of the people who didn't feel that way last year will feel that way this year.

There's an entrance and exit phenomenon of about 30%. In any given year, 30% will be coming out of the experience of disability and will no longer feel or report disability; about 30% or 40% will be moving into an experience of disability.

We don't have long-term data that allow us to establish, from 1993 continuously right through to 1998, 1999, or 2000, what group is continuously disabled all of those years.

What's the fluctuation in and out? On the basis of the information we have, it sounds like a significant percentage of the population are moving in and out of the experience of disability. It confirms your sense of a tremendous cyclical phenomenon, or an episodic phenomenon, to which the current definitions really don't pay any heed.

I think we do have the information at Stats Canada on the basis of the national population health survey, where those longitudinal results are released for 1994 right through to 1998, and more currently. Also on the basis of the SLID file, it should be possible to estimate the consistent group who is permanently disabled, for want of a better term, the group moving in and out of disability status, or perhaps the group moving out after a long time of being in.

There's a very complex phenomenon there, I think, that needs to be better understood. There has been no research effort invested there at this point.

The Chair: What percentage of the 30% are the same people with cyclical illness who come in and out all the time?

Mr. Cam Crawford: We don't know.

The Chair: What of the people who come in or out once—

Mr. Cam Crawford: Exactly.

The Chair: —but need to be counted in those two snapshots?

Mr. Cam Crawford: Because a person is coming in or moving out, it doesn't mean there aren't real income issues. There really are income issues. For all practical intents and purposes, they have a functional limitation that year that takes them out of the labour force. They need money because they can't work for whatever reason.

It shouldn't be a system of creating a definition, so we triage the penalties that are put against people, favouring only those with the permanent, long-term, severely disabling condition. There has to be recognition of the economic disadvantages people face as they move through this episodic reality, or “once in, once out”.

The Chair: Going back to the definition and MS, people have the Kurtzke expanded disability scale. There are obviously many conditions with things in common, fatigue being the number one probably, whether it's hepatitis C, MS, or chronic fatigue syndrome.

How far along are we at quantification of those sorts of scales? I know we talked to the commissioner and we talked to these people. When you do the face-to-face interview, or you look at somebody's daily journal, as I would, a day in the life of this person would tell a huge story.

Yet we aren't really doing that with the forms until it gets to the face-to-face interview. I think there must be scales and things that could be shared. It's quite clear this person is disabled. Yet, as you said, we have tied it all to employability and such, at a huge cost to their personal life and all kinds of other things.

Is there another way we could be doing this?

Ms. Nickie Cassidy: I would like to add something. As a person with MS myself, I find very discouraging, as you were saying, the recurrent and cyclical nature of an illness like MS. I could add lupus and arthritis. Let's not go into the litany of diseases affected by that kind of cyclical nature.

Suffice it to say, there are a number of people who are affected in that way. We talked earlier about the all-or-nothing trap in which we find ourselves. If we suddenly have to declare ourselves completely, severely disabled, what options are then open to us if, a year from now, we suddenly go into a remission?

We feel we could contribute. We could earn some money; not very much, probably. It may be a day or two a week, or even a few hours.

• 1705

If we can do that, we can ask for permission. But we're putting ourselves on the line and risking someone saying: “Hey, if you can work a few hours or a few days, then maybe you're not severely impaired. We'll look at you again.” And then you're gone.

There has to be some kind of mechanism in place for people with cyclical and recurrent illnesses. We shouldn't be categorized; we're not a bunch of statistics. We are people with recurrent and disabling illnesses. I could understand someone who is disabled for life crying, “Those people don't have problems, do they?” But for the vast majority of people, I think there is a bit of this recurrent and cyclical aspect in almost any of the people who do eventually qualify for CPP.

I think we're asking for two things. One is an acknowledgement that there's something wrong with the way we're looking at the situation now. If people are going through all these appeal processes, then we need to get together—perhaps regularly—to look at what is going wrong and to fix it. If there's a mechanism in place to fix a situation by the time it reaches Tina's level, then why do we have to go through this process? Surely, to save taxpayers' money, and our sanity, it could be done at a much earlier stage.

Having said that, there should also be a mechanism to allow for moving in and out of the system. I know there is one on the books, technically, but the system should be more flexible in allowing that kind of thing. What we're saying is that we don't want to have to reach Tina's level; we want to get caught and fixed at your level.

The Chair: Nancy Lawand.

Ms. Nancy Lawand (Director, Canada Pension Plan Program Policy, Department of Human Resources Development): On the second item, you may remember that in the mid-nineties we introduced a number of work incentives. Perhaps we didn't do enough publicity about them, but they are now operational. They offer a three-month work trial for someone returning to regular work; they remove restrictions on volunteering and going to school; and they also allow for a fast-track reapplication process.

We are now introducing some additional measures to do exactly what you were talking about: communicate to clients the fact that they can have intermittent earnings at a certain level that will not risk the loss of their benefit in any way. We've established the level at $3,800 for this year. The objective is to get word out to our clients that they can try employment, intermittent work, etc. We also want to start talking with clients and perhaps being more proactive about supporting people than we have been in the past.

On average, over the last few years, about 2,500 CPP disability clients have told us they're trying to get back to work and earn money. But for the very reasons you mentioned, many of them—up to about 40%—don't actually leave the benefit, or only leave it for a very short time. Then they come back right away, because they really aren't capable of working on a regular basis. That's perfectly acceptable, and is part of the way we assess their capacity to work.

In addition, as some of you may know, we have established a vocational rehabilitation component. This year, we have about 500 clients actively in the program, and we're hoping to increase that number over the next few years. So I think we're taking the next steps to being more supportive for clients who want to try employment.

The Chair: The rapid reinstatement programs: are those just pilot projects now, or are they actually happening? Where did the three-month period come from?

• 1710

Ms. Nancy Lawand: That was introduced in 1996. It's a three-month paid work trial, when clients report to us that they feel ready to go back to work, or have started to have earnings. We will monitor them to a point when they might be starting to work regularly, as opposed to intermittently. Then we provide them with an additional three months of CPP disability benefits before stopping the benefits. So they could be earning from their employment and continuing to receive their CPP benefits.

The Chair: My concern is, what happens to people if they find they can't do it?

Ms. Nancy Lawand: Well, there's a process. We try to do it in a timely way, rather than have them go to the back of the queue and fill out a whole new application. The reapplication is just a short form that allows us to go back and check their current medical condition, etc. Almost all the people who return to us on the fast-track reapplication are put back into the pay system within a couple of months of coming back.

That's an area we're working to improve, because of what we've been told by organizations such as yours. Perhaps the three-month work trial is premature, and maybe people need to be kept on the books a bit longer, until they're sure, and we're sure, that they are actually able to stay employed. So we're going to be bringing in some additional flexibilities to try to manage that process a bit better.

Mr. Paul Migus: Perhaps that could include the option that once people have been eligible and have received CPP benefits already, there should be some sort of immediate reinstatement—without having to reapply and go through a long waiting period. A number of improvements are being looked at.

The Chair: Maybe Harry can comment, and then Wendy.

Mr. Harry Beatty: I think I take issue with that to some extent, because these policies are quite discretionary. Nancy, you said you would communicate a different message to people. But if I'm advising a client, even if they do get rapid reinstatement, you still have the legislative authority to reassess them in a couple of years. How does the person know their doctor won't say, “Well, you're able to go to this first job for a couple of months, so I don't think you're disabled any more”?

As long as the system is this discretionary, it's a problem. With the policy at this time, didn't you say that almost all are reinstated? What if I tell my client, “Go ahead and try it”—and then he or she turns out to be one of the unfortunate few who aren't reinstated?

Ms. Nancy Lawand: That's well said, but I think it's part of our responsibilities to develop policies that work for people, and to make sure they get communicated. I think back to the other issue of having a regular opportunity to share views with those who are most affected. I think perhaps that will help to rebuild some of that trust.

Mr. Harry Beatty: But my point is that if it's a policy rather than in the legislation, you can change it tomorrow. A person could rely on it and get hurt. That happens all the time. People in other programs, not just this one, can have a nice long discussion with their case worker or some caring official, who might say to go ahead and give re-employment a try. But then if the person is cut off from working a year or two later, that helpful official might have moved on and been replaced by someone who doesn't know anything about this situation.

The Chair: So would you look at changing the legislation, Harry, drafting a policy into legislation, in terms of specific reference to certain kinds of recurrent illnesses—or for everything?

• 1715

Mr. Harry Beatty: I don't know the details, but what I'm pointing out is that the legislation still says “permanently unemployable”. I still think this is a legitimate concern for people and their advocates, that any attempt at rehabilitation may cost them their only chance of staying off welfare down the road.

This program is modest, but it's still very important to a lot of people—especially older people, who can't get LTD because they haven't been employed in a profession that has it, but who basically can't get anything else.

A lot of older people in their fifties and sixties—a group I'm advancing towards myself—develop health problems and encounter a lot more barriers and discrimination in the workforce. A lot of these people have worked for 30 years or more, and they want to work—their whole lives have been built around working. They really cannot afford to risk being told that this is a policy. A policy today may be a different policy tomorrow, or interpreted in a different way.

The Chair: What happens when it gets to your level, Tina? If it's in the legislation this way, what would you do if some kind worker somewhere had told a client to have a go?

Ms. Tina Head: We would be at the receiving end of Harry's argument and desperately wishing there had been some legislative or regulatory direction to resolve the problem.

The Chair: Cam.

Mr. Cam Crawford: Right now, it seems the federal government is of at least two minds in its approach to disability. Looking at the disability tax credit, it shows quite a different way of thinking about disability than the Canada Pension Plan.

Why is that? Is there any really compelling reason why the federal government should have a double standard when it comes to disability? Merely in the interest of bureaucratic coherence and efficiency, doesn't it make more sense to have one definition that works right across all the departments?

Couldn't one tinker with something like the disability tax credit, which really doesn't do much for people who have intellectual disabilities or psychiatric disabilities? Such people really don't fit within the framework of the disability tax credit. Couldn't you deal with those issues and then apply that to the Canada Pension Plan? If you're disabled, you're disabled.

I think there's another problem with the definitional regime, which is that it puts doctors in a dilemma. On the one hand, they do a functional assessment of the person's physiological health—figuring out whether this person is up to the demands of a typical job in the community. But that physician typically knows nothing about the labour market conditions with respect to people with disabilities, or what disability supports there are in that community. Physicians don't receive a whole lot of training on this stuff at any point in their careers. Medical schools don't usually do that kind of thing.

So the physician might look at a person and say, yes, she can lift, do all kinds of stuff, she's perfectly able to work. But the reality in this community is that levels of employment are chronically low, there's no accessible transportation, and there's an attitude of sweeping ageism among employers. They all want to push these people off the private insurance programs, because it's really costing those little companies too much for them to be competitive.

There are all kinds of economic factors going on in that community, about which the doctor may know very little, but which have a very direct and immediate impact on the employability of a person with a disability. There's a very complex reality around “employability”, and I would argue that it's not something that can easily be figured out from a doctor's office. Maybe an entirely different approach, which prescinds entirely from employability, ought to be looked at.

The Chair: I think sometimes there's also game-playing, depending on which specialist you were sent to. My experience was that if you had a disease that had to do with fatigue, they would send you to a shrink, who would say you were psychologically okay. Then it comes back saying there's nothing psychologically the matter with them, and as the family doctor I would say yes, I knew that. They're tired. There's nothing psychologically the matter with them, but because they got the tick-off from the psychiatrist, it's as if they're not tired. You get this lineup of specialists giving these reports, and it was not about the question that should have been asked. I think your coherence question in terms of the patients on CPP disability not qualifying for the disability tax credit has always been of some concern to us sitting in the office and trying to explain that to somebody.

• 1720

I understand they do something different in Quebec. Do you know? Maybe Chloé does.

A witness: I would defer to my colleagues on that.

[Translation]

Ms. Chloé Serradori: The situation is not all that different in Quebec, in that it is very difficult to secure disability benefits from the Régie des rentes du Québec.

One thing that is different is that one may be entitled to work for a certain period of time. However, the risk is still the same; you could be reassessed and lose your disability benefits from the Régie des rentes du Québec.

So there is some opportunity. When we talk to people with functional limitations, they are somewhat better off with the Régie des rentes du Québec than they would be with welfare because the amount is a bit higher.

I would like to come back to what was said earlier about people with cyclical functional limitations. The question was what should be done. I think it is very dangerous to categorize people. People who have a functional limitation that might be called severe and prolonged—and I do not like those terms—those who have cyclical functional limitations and those who suffer from mental health problems, multiple sclerosis, muscular dystrophy or HIV, they all have needs while they are coping with those problems.

Could we not, for once, try to meet their needs instead of trying to fit everyone into little boxes? If those needs last six months, we should help for six months. If they last eight months, we should help them for eight months. If they can subsequently go back to work, so much the better. But there too, support is needed.

Another point is that each policy runs counter to the rest. There is an employability policy with a definition of people with functional limitations. For tax purposes, there is another definition. For the Régie des rentes, there is yet another definition. Eventually, any encouragement to go back to work penalizes the individual, who runs the risk of losing benefits for going back to minimum wage work. There too, an effort must be made to harmonize policies.

Thank you.

[English]

The Chair: Tony, did you have a question? Wendy has one.

Ms. Wendy Lill: We don't have too much longer.

We've heard you in this group as well as those in the other round tables we've had say the same thing over and over again, probably for the last four or five years. You've probably said all of the same things to the Andy Scott task force. I'm looking at you, Harry, because you keep going back to legislation and the whole political realm.

I'd like to ask you all to do a bit of blue-skying. I'm sure you do it all the time. If we could just do one thing right now, what is that one thing that needs to happen? What is the first thing that will put the focus on everything else, the thing that will make it clear and that will in fact set things right? I don't mean to be simplistic here. If you want to just say we need more money, we need to cut the crap, and we don't want to come here again until you have more money.... Just say whatever you'd like to say. It would be helpful to me just to hear it. I feel that you're the ones who know.

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[Translation]

Ms. Mercedes Benegbi: I am no expert. This is just a comment based on my personal experience and contacts with many other people who have functional limitations.

I think a big first step would be to create a common definition of “ person with a disability ” for all programs. After that, the genuine needs of these people should simply be recognised, including the need to remain active and involved in their community on the same basis as other people, despite the fact that they may have so-called severe and prolonged disabilities. These people have the same desire to be active in their community and are able to get involved socially on the same basis as other people.

Some people with disabilities refrain from joining the work force because their medication, special equipment and all their health needs are paid for while they remain on welfare. It is no longer paid for if they get a job. They end up worse off, even financially, when they are working because their wages do not fully cover all their needs.

So this is a whole category of people who keep living off society or welfare or some other plan because we fail to see that we could assist them with their health needs other than through a guaranteed income. Do you see what I mean?

[English]

Mr. Cam Crawford: I have a couple of comments. With regard to definitions, I was thinking about the provincial definitions under human rights codes.

There's a different approach in some jurisdictions. In Ontario and, I think, Nova Scotia—I'd have to check it out just to make sure—there's a three-part definition. It's a matter of either/or. If the person has some functional limitation that affects their mental or physical activities—this means people who would have any of the following but not limited to them, and they list a bunch of indicators of what's meant by the first—or they're people who need any of the following kinds of things because of their condition, such as assistive devices, wheelchairs, or hearing aids.... There are a whole bunch of other proxy indicators of what's meant by disability.

So there are really three things. There's some reference to a functional limitation and perhaps some listing of categories of conditions that maybe are connected with functional limitation as examples but not as the definitive list and and other proxy indicators, including the need for support, as you've pointed out. The presence of any of those things would become a prohibited ground of discrimination in some provinces. That's the way it works right now.

In terms of what's needed in order to advance the disability agenda in a meaningful way and to make a real difference in people's lives, I think three things are needed. It's not all about money, but it's a lot about money. For some research we're doing, we've been talking to people at the provincial level, and I think they certainly would welcome an infusion of federal money into provincial treasuries for the purpose of making available a broader and more robust range of disability supports for adults, kids in school, and so on. If there were greater fiscal capacity in the provinces without a whole lot of federal strings attached but with some agreement on outcomes and how to measure and monitor, that would be welcome, I believe.

The other thing that is needed is an infusion of money, whether you do it through the CHST or directly through the CPP or some other mechanism. By and large, disabled people in Canada are poor, and they need more money in their pockets to spend on basic things, such as food, shelter, getting around, clothes, and stuff for their kids. If we could somehow make the personal income a little better than what it is now, which is way below the poverty line, that would be welcomed, I believe.

The third thing is that the disability sector needs better capacity than it has right now to engage in meaningful, constructive discussions with federal and provincial governments. They're just starved. It would help if we could somehow bring up the ability of those organizations to participate in real consultations, ones that aren't pro forma, such as around the CPP where the decision had already been made before the consultations took place. Everybody knew that but we all went. People don't want to be part of that. They want to be part of something else.

The Chair: Thanks very much.

Harry.

Mr. Harry Beatty: It's not really something that lends itself to identifying one thing, because we really have to move on everything.

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There are many things of course working in disability areas that trouble me, but one of the things that troubles me the most is the cutbacks that are happening in Ontario, at least to special education and the supports. That's provincial jurisdiction and it's a complex issue. But we get calls all the time from parents of kids who are having essential supports taken away in the schools, and they ask how is that youngster going to be a functioning adult in society without having been given a proper education. It's like we're going backwards.

I think, though, that both my colleagues have touched on essential supports. There are still places, I found when I did these case studies, where a person's right to get funding for a wheelchair, even such essential needs as that, basic disability equipment.... For many people, the issue is not having even these basic entitlements. Start working on some of those things. I don't think it should be discretionary whether people get oxygen, or a wheelchair, or ostomy supplies.

Just by way of an historical comment, when Justice Emmett Hall chaired the royal commission that led to medicare in that part of our society, the recommendation of the commission was that all these things be included, be funded 100%, but that got dropped.

As our colleague from Quebec has pointed out, a policy that says we're going to reduce your funding for this stuff when you get a job—that just makes no sense whatsoever. So at least extend the eligibility for those benefits to people who are working or have some other source of income.

Again, I don't like to identify clients or pick on one, because I wouldn't want to embarrass someone, but right now we have a client and basically that's what happened to her. She got a job. Everything was going great; she was doing well on the job. The incontinence grant is taken away. The rules were so complex, she didn't even know what happened. This is a determined person, so our client is now working two jobs to pay for the supplies. But not everybody can do that.

The Chair: We hope Mr. Romanow will help you with this. We have to make sure we're all organized when it comes to phase two. We hope he reads Emmett Hall in phase one of his fact finding and that in phase two we'll all be there to tell him what we want in his report.

We're going to have to jump to Nickie and Phil because the double bell means we are actually voting in less than 15 minutes.

Ms. Nickie Cassidy: We've discussed what we need, so I'll give it to Helen to make it quicker.

Ms. Helen Wagle: I don't think we have much more to add. We've had a fairly good discussion this afternoon, and we certainly do appreciate the time of the committee and subcommittee in hearing what we have to say.

I like the idea of exploring more opportunities to have a consultation, whether that's on CPP or other issues. I'm hearing that echoed around the table, and I think we need to explore how best to do that rather than present now what option would work best. I think we need to think about that as organizations, and as well what government's capacity should be around that.

I agree with the increased level of money, certainly for benefits. One of the concerns we've always had is why are disability benefits within a retirement scheme? Was that the best place to situate that type of a program? Does it make sense? Was it an add-on? How well has it been doing for people? I think that would be a good question to ask Canadians with disabilities. Do CPP disability benefits work for you? Why or why not? Let's get down to what the problems are and start resolving them.

Ultimately, we came here today trying to explain the nature of MS and how the current definitions of disability don't work for our population. I hope we've made that message loud and clear. But I think there is value to having a definition of disability across all jurisdictions that works for people with disabilities.

So I think these would be our three out of today that we'd love to see happen.

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Ms. Nickie Cassidy: Can I add that the definition you mentioned for the income tax should be the same for CPP and for all these things. It's extraordinarily confusing to people with disabilities if you're faced with a bunch of definitions of what you think is all the same thing. As a potential user of these things, it would be nice to have a definition that makes sense, that is very clear. And as much as it surprised me, as you mentioned, to have a Reform or PC Party come out with a definition that is inclusive, I would hope you would have a chance to look at that one fairly carefully and perhaps adapt it to the programs at the federal level that currently exist.

The Chair: Mr. Upshall, very quickly.

Mr. Phil Upshall: We agree with everything that's been said today. We think there needs to be a greater attempt to make this whole process user friendly. We think there's a need to make it with greater transparency, and that transparency is frequently obtained by a greater interface with the people who work with the system. Simultaneously, we hope you'll take back to the standing committee, and the standing committee back to caucus, that it's really essential that funding considerations be looked at, at the political level. It's absolutely essential that you do this.

As a matter of practical workings, I work closely with the Federal/Provincial/Territorial Advisory Network on Mental Health, which works through Health Canada, and I think you're aware of that. It's a great body that works towards commonality throughout the provinces and works to bring recommendations up to the provincial governments and to the federal government. It works tremendously well, and it may well be a mechanism that's useful here as well.

Thanks very much for the opportunity to be involved.

The Chair: Thank you all for coming. We'll get opportunities to talk to the officials and Tina again, I'm sure. We are serious about trying to move this file forward and to be thinking a little differently around this. First the facts. Obviously the disaggregated data on MS versus mental illness, versus cystic fibrosis, versus all of these things that don't seem to fit in would be really helpful, and maybe we can ask for that.

Hopefully we will see you all again soon with our little action. We hope it is an ongoing relationship, and if there any ideas that come à l'esprit, please be in touch. And let us know what you think our next step should be as we try to put this all together into a report to the main committee and a report to Parliament before we rise. Maybe a study.

We're going to run and vote now. The meeting is adjourned.