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Standing Committee on Health



Wednesday, February 9, 2022

[Recorded by Electronic Apparatus]



     I call this meeting to order.
    Welcome to meeting number six of the House of Commons Standing Committee on Health. Today we are meeting in public to continue our discussions and reach decisions on the committee's future business.
    Today's meeting is taking place in a hybrid format pursuant to the House order of November 25, 2021. Members are attending in person in the room and remotely using the Zoom application.
    Regarding the speaking list, we'll do the best we can to maintain a consolidated order of speaking for all members, whether participating virtually or in person.
    Please be reminded that screenshots are not allowed. We would discourage you from doing that. The proceedings will be made available via the House of Commons website.
    Given the ongoing pandemic situation and in light of the recommendations from public health authorities, as well as the directive of the Board of Internal Economy of October 19, 2021, we will be following all appropriate protocols to remain healthy and safe.
    I do not intend to offer anything more by way of preliminaries.
     This is committee business and the floor is open.
    I recognize Mr. Lake.
     I'll start by thanking the clerk for arranging to have name tags here so that we know who we are. That's great.
    Colleagues from all parties, I appreciate that many of us have had many conversations since the last meeting so that we can move forward productively on the committee. It doesn't necessarily matter what order we go in. Maybe we'll start with the human resources study. In the spirit of co-operation, we'll move to finish that particular motion with the understanding that we will then move to the children's health study motion.
     Is that fair?
    This is a bit tough for me, because I really don't believe in the principle of apportioning witnesses. I think I made that clear enough last time around, but we have had some conversations. I don't want this to be a precedent. Within that motion, we're prepared to amend it to say—wherever we put it in the motion; I can't remember exactly where it was—that witnesses be allocated one-third to the Liberal Party, one-third to the Conservative Party, one-sixth to the NDP and one-sixth to the Bloc Québécois.
    Thank you, Mr. Lake.
    I appreciate the intervention. I want to make sure that procedurally we are sound here. What I take from your intervention is, first, that you are proposing we continue the discussion at this meeting where we left off at the last one and that, further, you are proposing an amendment.
    I guess I'll start with this. Is it the consensus of the committee to proceed in this fashion and that we pick up from where we left off at the last meeting?
    Do we have consensus in the room?
    Just before I give you the floor, Mr. Davies, if we are to proceed from the point where we left off in the last meeting, we would actually have to deal with your amendment, but I'll recognize you because I'm guessing that if we have agreement, then you'll withdraw your amendment.
    It's over to you, Mr. Davies.
     Thank you, Mr. Chair.
    I find it unwieldy when we begin a meeting by saying we'll pick up where we left off, because I'm not sure that we [Technical difficulty—Editor] helpful. I'm not really sure that we were all on the same page where we left off. I think we should just start afresh at this meeting, but I think we all understand what Mike has suggested.
    It might be wise, procedurally, for the clerk to read the two motions.
    If I'm understanding it correctly, I think we're going to go with Mr. Hanley's motion to study the health care human resources crisis first. I thought I understood that there might be a change to the number of meetings proposed in there for witnesses. I'm not sure. I'll leave that to Mike to clarify. Then we're also going to move after that study to the study on children's health that was moved by Mr. Berthold, I think.
    I think we'll need to have both of those motions formally read for your benefit, Mr. Chair and Clerk. One thing I wanted to clarify is that the witnesses in both cases will be as per the formula that Mr. Lake described.


     All right. Thank you, Mr. Davies. I think you're bang on.
    We can deal with one motion at a time. I see that Dr. Hanley is next on the speakers list.
    Dr. Hanley, it's your motion. If you would please read the health study motion that is before us, then we can have Mr. Lake—
    I have a point of order, Mr. Chair.
    In order to do it in the correct way, I think we should continue what you just said, continue the discussion on the amendment from Mr. Davies. He should withdraw it, and after that, we can go back to the motion.
    Another motion would be proposed by Mr. Lake about the number of witnesses, and another motion will be moved to change the number of meetings. I think that is the correct way to address it.
    After that, we will do the same for children's health, because there is already a debate on the children's health study, so we need to do that procedurally correctly to be sure that we deal with everything.
     I think it will be easy today, Mr. Chair, because what I'm feeling in the room is that everyone wants to achieve something, so if we do it in order, we will be able to do it correctly.
    Thank you, Mr. Berthold.
    Mr. Clerk, could you please read the motion that is before the committee from Dr. Hanley.
    Absolutely. Mr. Hanley moved:
That, pursuant to Standing Order 108(2), the committee, in recognition of exhaustion and burnout amongst health care professionals, undertake a study on how the federal government can facilitate the recruitment and retention of physicians, nurses, nurse practitioners and other health care providers to the public health care system; including a focus on rural and northern communities. That this study be prioritized by the House of Commons Standing Committee on Health in the 44th Parliament. That the Committee invite experts and representatives to appear; that the Committee hold a minimum of eight (8) meetings with witnesses on this study; that the committee present its findings and recommendations to the House; and that pursuant to Standing Order 109, the committee request a comprehensive response to the report by the government.
    There's a pending amendment to that motion by Mr. Davies.
    Thank you, Mr. Clerk.
    Mr. Davies has his hand up.
    It would be in order if we proceeded as Mr. Berthold has suggested, and I think it makes sense to withdraw your amendment for the sake of clarity. Then we can go forward with Mr. Lake's suggestion.
    Mr. Davies, you have the floor.
    Yes, I am happy to withdraw it. Again, for purposes of the next two, three or four years of the committee operating, as it may be—or one more year—I think it's important that we get straight whether or not we pick up a new meeting with the business that was pending at the end of the previous meeting.
    It's my experience that it's not. It's my experience that the last meeting is done. The order of business died, and we start a meeting afresh.
    I'm happy to withdraw it, but I think it would be helpful for us all to be on the same page so that we know procedurally how we're going to operate.
    I would suggest that you start every meeting fresh. Dr. Hanley has moved his motion. My amendment last time ended in indeterminate debate.
    Otherwise, if we do it the way Mr. Berthold suggests—
    I have a point of order, Mr. Chair.
    In order to move ahead, no one in the room.... Don, I know you're not here, but no one in the room is disagreeing with you. Can we just move on?
    That's the way it's always been. We agree that that's the way it's always been. That's the way it was at the last meeting. No one's disagreeing with that.
    If I may, Mr. Lake, Mr. Berthold said I had to withdraw my motion to amend. That's exactly what I'm responding to. My motion to amend was in the last meeting, and the meeting was talked out and concluded with that motion never being voted on.
    What I'm trying to clarify is that when we come to this meeting, there's nothing for me to withdraw. That's what I'm trying to clarify. It was Mr. Berthold who raised that.
    Procedurally, if we're going to proceed on the basis that the thing we were last discussing at the previous meeting is what we open a new meeting with, I can deal with that. That has not been my experience. I don't think we should go that way. That's the only reason I wanted to clarify, Mike, just to make sure that there's nothing for me to withdraw.


     Mr. Davies, you are exactly right. If this helps clarify things, what you have said is entirely consistent with the rules of procedure. I've come across this question before. We considered it at the start of the last meeting. You are right that technically there is nothing for you to withdraw. I simply asked you to do it for the sake of clarity and because it was suggested by Mr. Berthold. Technically, it isn't necessary.
    We now have a motion on the floor.
    I will go to Mr. Lake, because I believe he wishes to propose an amendment.
    For simplicity, I'm going to move both of these at the same time, because they're right at the same spot in the motion.
    Where it says “eight meetings”, we're going to replace it with “six meetings”.
    After “on this study;” we're going to add “that witnesses for this study be allocated in the following fashion: one-third for the Liberal Party members of the committee, one-third for the Conservative Party members of the committee, one-sixth for the Bloc Québécois member of the committee and one-sixth for the New Democratic member of the committee”.
    Then, of course, it would just continue on with regard to the committee presenting its findings and recommendations.
    Thank you, Mr. Lake.
    The amendment is in order.
    Colleagues, it has been pointed out to me that to the extent that there was a withdrawal of Mr. Davies' amendment, and I would say that there was, we actually require the consent of the committee in order for it to be withdrawn.
    Do we have it?
    Some hon. members: Agreed.
    (Amendment withdrawn)
    The Chair: Thank you. We have that cleaned up.
    The debate is now on the amendment proposed by Mr. Lake.
    Dr. Hanley, you put your hand up some time ago. Is it still your wish to intervene?
    No. I'm good. Thank you. I appreciate the initial intervention by Mr. Lake.
    I recognize Mr. Thériault.


    Thank you, Mr. Chair.
    I just want to clarify matters to make sure I understand.
    Are we talking about the number of witnesses who would be heard or the number of witnesses proposed? For the past while, members have been referring to the last meeting, where we were preparing lists. Some of the witnesses we propose may be the same in some cases, but I'm wondering about the constitution of witness groups.
    To take a specific case, let's say there are two groups of three witnesses at a meeting. That would mean six witnesses. From what I understand, in that case, two witnesses would be proposed by the Liberals, two by the Conservatives, one by the Bloc and one by the NDP. Is that correct? I'd like someone to confirm that for me if that's what we are aiming for.
    Then what would happen if we adopted this amendment as drafted but it were to apply to the number of witnesses who must be heard, not to the number of witnesses we can propose? There's a difference there.
    Furthermore, would that be a binding or not? For example, what would happen if a witness wasn't available? In other words, would the meeting absolutely have to be held based on those proportions or not?
    I'd just like some clarification.



     Mr. Lake, please.
    This is precisely why I hate this process. We are moving ahead with this process because it was pretty clear in the last meeting that this was the will of Liberal and NDP members. However, I would indicate that if we go ahead with this process.... Obviously we don't want to stop having meetings. I would hope that we see how it works in this study and maybe the second study, that common sense will prevail as we move forward with those studies, and that if a circumstance like that arises, we can find a way together, by consensus, to figure it out. We will make every effort to have the actual number of witnesses who appear before the committee meet this allocation.
    In reference to your mathematical understanding, Mr. Thériault, yes, that is clear. The example you gave of two, two, one and one is what we're shooting for with this proposal.
    Thank you, Mr. Lake.
     Mr. Davies.
    First of all, I would just like to say thank you to all my colleagues, particularly to Mr. Lake and my Conservative colleagues. I appreciate the compromise they've made and that everybody has made.
    At this point, with that clarification, I'm prepared to just trust in the process and to trust in Mr. Chair and Mr. Clerk. Nobody is going to be—at least speaking for myself I'm not going to be—looking for mathematical certainty to the second decimal point. This is a rough approximation and as long as everybody is working in good faith toward that number, I'm not going to sweat a witness here and there.
    We're talking about a first study. I think maybe the first two are probably going to have six meetings; this is what I'm anticipating. If you're looking at 24 witnesses—four witnesses per meeting, that's 24—it's going to work out very well. One-third is eight so it will be eight witnesses for the Conservatives and eight for the Liberals, and the remainder will be split four and four for the Bloc and the NDP.
    It will work for three meetings when there are 12. It will be four, four, two and two. There's a problem if we only have two meetings, but I think you've clarified that very generously, Mike. I appreciate that.
    If there's one meeting that we have on something and it turns out that it's two Liberal witnesses and two Conservatives, if that's how it is, I'm okay with that. As long as we do our best to roughly approximate this number, for my part, again, I'm not going to be sweating supreme accuracy for this.
    Thank you, Mr. Davies.
    Are there any further interventions?
    Seeing none, are we ready for the questions?


    Go ahead, Mr. Thériault.
    We could vote on the amendment, but I'd like to get more clarification. I wonder if I can get it right now to speed up the process.
    When we agreed to consider all the testimony gathered in the course of the studies conducted during the previous parliament, that was so we could continue discussing pandemic follow‑up. Even though we didn't expressly address that aspect during the committee's last two meetings, we had a kind of tacit agreement that, out of a total 28 meetings until June, 14 would focus on pandemic follow‑up, pursuant to the motion that we adopted to consider previous testimony, and the other 14 would be used to conduct other studies.
    However, two of those 28 meetings have already gone by. I see we're now going to adopt a first motion proposing a study that will take up 8 meetings, in addition to an upcoming study that will take up 6. From what I understand, 14 meetings will be reserved for those 2 studies, which means that, if we continue at this pace, there'll be no room to conduct other studies suggested by other parties.
    Consequently, I am announcing that I'll be introducing amendments to change the number of meetings that has been proposed for those studies.


    Thank you, Mr. Thériault.
    Does anyone wish to respond?


     I have a solution.


    I have a proposal for Mr. Thériault to resolve the human resources issue.
    At least two meetings for the study on children will concern COVID‑19. They could therefore be grouped with meetings on the COVID‑19 study. That way, we could use those meetings to start examining all aspects of the study on children that are relative to COVID‑19. Then the following four meetings for the study on children would concern children in general.
    That would mean only 10 meetings devoted to studies. So there would be room left for other studies.
    Thank you, Mr. Berthold.


    Are there any further interventions in respect of the amendment of Mr. Lake?
    Go ahead, Mr. Davies.
    It is just that I appreciate my colleague's concern, but I think in some ways we're a bit hostage to fortune, the agenda and things we can't foresee, for instance, legislation coming before this committee.
    I think getting one or two studies done before June is good. Of course, we're going to be coming back. I don't think anybody foresees any election in the summer, so we're going to be coming back in the fall, and there will be time to pick up other studies, including some of the excellent suggestions that Mr. Thériault has made.
    For my part, I'm not bothered if we don't get four studies done by June. I think we'll be doing well if we can get two studies and reports done by then.
    I don't view the COVID portion of this as being unimportant. I still think it is a very important role of this committee to keep, as I call it, a watch and brief on COVID every week as we call witnesses and stay up to speed on the new developments. As we chip away at the studies, I'm comfortable with having one or two studies done by June, and I know we'll get to Mr. Thériault's issues in due course, as I hope we'll get to at least one of mine.
     Seeing no one else on the speakers list, I believe we are now ready for the question.
    The vote is on the amendment proposed by Mr. Lake.
    (Amendment agreed to [See Minutes of Proceedings])
    The Chair: The debate now is on the motion as amended.
    (Motion as amended agreed to [See Minutes of Proceedings])
    The Chair: Thank you, colleagues. The floor is open.
    Go ahead, Mr. Lake.


    We have some momentum.
    I'm going to start discussing Mr. Berthold's motion on child health. In the spirit of what Mr. Davies said, I will go back to the original motion.
     Just to remind everybody, a change has been made to Luc's original motion to make sure we have addressing children's nutritional needs in it, so it's already in the motion and we don't need to make that amendment, just in case it comes up. It had already been changed in your original motion, I think.
    There are six meetings, and we're good with that.
    We said that we would try this formula out in two studies, so we're going to add the exact same wording into this motion after point number three, “the study consist of a minimum of 6 witness meetings”. We would add the same language, which is “that witnesses for this study be allocated in the following fashion: one-third for the Liberal Party members of the committee; one-third for the Conservative Party members of the committee; one-sixth for the Bloc Québécois member of the committee; and one-sixth for the New Democratic member of the committee.
    I'll move that amendment, and then I think there was an amendment that the Bloc wanted to move last time. I think we had agreed to it, but it didn't ever get officially wired in, so that is just a reminder to Mr. Thériault that he may want to do that afterwards.
    I'll just leave my amendment as it is right now.
     Thank you, Mr. Lake.
    I'm going to go back to the excellent advice that Mr. Berthold gave us as we launched into the debate on the last motion.
    Mr. Berthold, would you please formally move your motion? We will then actually have a motion on the table and have the specific wording around the debate, for clarity.
    I move it, Mr. Chair.


    That way we can discuss it, since it's a very important topic.
    I'll stop there, Mr. Chair, and let my colleague present an amendment.


    All right.
    So that everyone is clear on where we are, Mr. Clerk, would you be able to read the motion that was presented by Monsieur Berthold at the last meeting, I believe, or the one before that? That's the motion we're on, I presume.
    Yes. There's agreement from the committee to resume debate on the following motion that was moved by Monsieur Berthold. This is the amended version, as it was amended by Ms. Vignola two meetings ago. It reads:
That, pursuant to Standing Order 108(2), the committee undertake a study on children’s health and the recent impact the pandemic has had on children and that:
1. the study include, but not be limited to: addressing health care service backlogs affecting children, addressing interprovincial barriers for research, data collection and sharing on children’s health, addressing children’s nutritional needs and addressing shortages of qualified health care workers capable of dealing with children’s health issues in order to find potential solutions;
2. the study include a focus on disparities in access to services for rural, indigenous, racialized and lower-income communities;
3. the study consist of a minimum of six witness meetings;
4. the Minister of Health be invited to appear for one of these meetings; and
5. the committee present its findings and recommendation to the House.
    Thank you, Mr. Clerk.
    That is the motion that is currently under consideration by the committee.
    Mr. Lake, you had some specific wording for an amendment. Could you please now formally propose the amendment, and then we'll have the debate—
    I have another item, if I may.
    Excuse me, Mr. Lake.
    Go ahead, Mr. Clerk.
    I apologize, but I must flag that there is a similar issue with this motion in that there is a pending amendment by Mr. Davies that was never disposed of. That meeting adjourned before a decision was made.
    That amendment is similar to the one we dealt with at this meeting about an equal number of witnesses. It would also need to be withdrawn or voted on before a new amendment could be considered.


    Thank you, Mr. Clerk, but I think we agreed, because it wasn't dealt with and it hasn't been reintroduced, that what is properly before the committee is the motion and the motion only. We're going to proceed on that basis.
    Mr. Lake, please proceed with your amendment.
    My amendment would come after point 3, “the study consist of a minimum of six witness meetings”. At that point, we would insert “and that witnesses for this study be allocated in the following fashion: one-third for the Liberal party members of the committee, one-third for the Conservative party members of the committee, one-sixth for the Bloc Québecois member of the committee, and one-sixth for the New Democratic member of the committee.”
    The amendment is in order. The debate is on the amendment.


    Do you want to speak, Mr. Berthold?
    Pardon me; I made a mistake: it was Mr. Thériault who raised his hand.
    Go ahead, Mr. Thériault.
    Thank you, Mr. Chair.
    In fact, I wanted to ensure that Ms. Vignola's amendment had been added to the wording. Now that the clerk has read the text of the amendment, I see it's no longer a problem.
    Thank you.


     Are there any further interventions on the amendment of Mr. Lake?
    Seeing none, is it the will of the committee to adopt the amendment as proposed by Mr. Lake?
    (Amendment agreed to)
    The Chair: The debate is on the motion as amended. There is no one on the speakers list.
    (Motion as amended agreed to)


    Go ahead, Mr. Thériault.
    I'd like to discuss a proposal with you:
That, pursuant to Standing Order 108 (2), the Committee undertake a study to follow up on the improvements that have been put in place to tighten Health Canada's rules and improve oversight of medical devices (breast implants) in 2018 and assess the feasibility of establishing a central breast implant traceability registry that would make it mandatory for practitioners who implant, remove, or replace breast implants to enter certain data into the registry and that:
a) the Committee hold a minimum of two (2) meetings with witnesses;
b) the Committee report its findings and recommendations to the House;
c) pursuant to Standing Order 109, the Committee request the government to submit a detailed response to the report.
    I drafted this motion based on the discussions we had, during which we planned to conduct a number of short studies before June. However, I think this topic merits further attention. The motion for which I gave notice proposed that two meetings be held, but I'd like to increase that number to four.
    We've been discussing this topic in this Parliament for many years. Many members, particularly former NDP members, have tabled legislation in an attempt to establish a breast implant registry. Now in 2022, that still hasn't been done despite all those attempts.
    As the motion states, the rules have been tightened. In 2006, certain types of silicone breast implants had been approved, and that caused some problems. That explains why the rules were subsequently tightened. It's important that we be able to conduct follow‑up to determine where we stand in 2022. Is what was put in place back in 2018 actually working? We need to hear from witnesses who can discuss their experience with us.
    This is crazy. The trouble we've had in this file stems from the fact that the problems, in many instances, emerge 10, 15 or 20 years later. The practitioners in question are often retired or no longer in the picture. Since there's no registry, the women who are dealing with the problems or who are unaware of any potential problems can't verify what was implanted in them. When you know that most problematic implants were introduced during reconstructions, in women who have had cancer, for example, it's important that we be able to resolve this issue once and for all.
    We can't presume to know the conclusions and recommendations that will emerge, but we want this study to remain very specific. Otherwise, when studies are too broad, you rarely manage to determine the main recommendation and ensure that it results in a bill or action. Consequently, in this instance, we need to move as quickly and precisely as possible to come finally to the recognition that everything done over the years should have culminated long ago in a single measure, the creation of a registry.


    That's more or less what I had to say. I have a 26‑page file that I won't read to you today, but I can answer any questions you have on the relevance of this motion and debate it with all my colleagues.
    Thank you, Mr. Thériault.
    I'd like to raise a technical matter.
    You have introduced a motion that is absolutely admissible. However, my impression is that you then moved an amendment to your motion. Your motion is in order, and we will debate it. However, a problem arises when an amendment is moved by the member who introduced the motion. You have to obtain unanimous consent to move an amendment to your motion.
    Do we have unanimous consent for Mr. Thériault to move an amendment to his motion to increase the number of meetings devoted to this study to four?
    Go ahead, Mr. Berthold.
    I'd like to make a proposal to Mr. Thériault.
    Instead of requesting four mandatory meetings, we could say “at least two.” Then we can add more if we need to hear more witnesses and gather more information.
    I think it would be more efficient and easier to obtain everyone's consent if we proceeded this way.


     Mr. van Koeverden.
    It's nice to see everybody virtually. I'm sorry I'm not there with you in Ottawa.
    I appreciate that we are still focusing on committee business until, likely, the end of today's meeting. I believe that with about six meetings for human health resources and with the child health care study, in addition to our 12 or so meetings on COVID, it probably brings us until June.
    I'm wondering aloud here if it wouldn't be prudent to discuss a third study at a later time and move on to focus on bringing witnesses and ensuring that our meetings next week on Monday and Wednesday are productive ones.


    Thank you, Mr. van Koeverden.
    Before I go to Mr. Thériault in response to Mr. Berthold, I'm advised that the motion as presented already indicates a minimum of two meetings, but I took it that Mr. Thériault was proposing that that number be changed to four.
    I recognize Mr. Thériault at this time.


    That's right, Mr. Chair. In presenting the motion, I could have immediately said “four”. But I was reading the motion for which I had given notice and said that I wanted it to read “four”. This may of course have looked like an amendment, but I didn't move an amendment. I simply told my colleagues which motion it was, because people often don't recognize the motions that were introduced.
    I think the subject deserves four meetings. Other problems might also come up…


    On a point of order, Mr. Chair, I'm not entirely sure that you can amend your own motion, so it's a bit of a moot point, if I'm not mistaken.
    No, you're not mistaken, which is why I asked for the unanimous consent of the committee for it to happen. That hasn't happened yet.
    Mr. Thériault.


    Do I have unanimous consent or not?
    I won't spend any more time on that. But I would prefer to begin with four meetings. Earlier, Mr. Davies spoke about a program that could continue until fall. Given that the first two motions will take us into June, I don't believe that adopting this motion to have four meetings is problematic.


     Before we go any further, Dr. Ellis is quite right. We should bring this to a head. Is there or is there not unanimous consent for Mr. Thériault to amend his motion to a minimum of four meetings? If there is not unanimous consent, then someone else will have to move such an amendment and we can vote on it.
    Is there unanimous consent to allow him to so amend his motion?
    Some hon. members: No.
    The Chair: There isn't consent. The debate is on the main motion. It would be in order if anyone else wishes to move the amendment for us to do so, but the motion that Mr. Thériault made is receivable; it's before us, and the debate is on the main motion, which prescribes a minimum of two meetings.
    I recognize Mr. Lake.
    I just want to somewhat support Adam in moving on. The easiest way to do that, if we're all in agreement with pursuing this study, is to keep debate to a minimum. It doesn't put this study third in the order. It just says that we're eventually going to study it and we agree at some point that we'll study it. Let's pass it and move on to other business. We've had a productive meeting so far; let's keep it going.
    Dr. Ellis.
    Thank you, Mr. Chair.
     I would like to support my colleague's comments and agree with Monsieur Thériault. This is a very important study, and it should be included in our list, absolutely.
    Mr. Thériault.


    Mr. Chair, I'd like to return to Mr. Berthold's comments.
    The motion does mention a minimum of two meetings. As our meetings continue, I would imagine that our colleagues would understand the importance of this issue, as Mr. Ellis pointed out, and that they would agree to hold however many additional meetings are required to produce a report containing the appropriate recommendations.


    Thank you, Mr. Thériault.


    Are there any further interventions in respect of the motion?
    Mr. van Koeverden.
    I appreciate the support from Mr. Lake. I think it's something worth considering later on. I would just offer that my honest assessment of the situation is it's really outside the realm of an emergency pandemic time.
    I think there would be a rationale to study breast health in a broader context. I recognize the relevance and the timeliness of the motion, but at present I hope we can move on to the business of our next 24 meetings or so and commit to coming back to this at a later date.
    Mr. Davies.
    I think we need to come to an understanding on what exactly we're deciding if we vote in favour of this motion. We need to clarify if it's just to say, yes, we agree to study it at some point, but it's not necessarily the next study after we conclude the study on child health. I'm like Mr. van Koeverden. I'm not saying this isn't something that I would want to study at some point, but I'm not sure it would be something that should be studied third, given the priorities that we have.
    I also think it's important to be very clear-headed on the number of meetings we have. When we say six meetings and six meetings, we're talking about six meetings of witnesses, if I'm not mistaken. I wanted to clarify that. It's always hard when I don't have the actual text in front of me, but I think we agreed—maybe I could have a nod, Mr. Chair, from you or from the clerk—that it's six meetings of witnesses for each of the two studies we just passed.
    Yes, that would certainly be my interpretation, Mr. Davies.
     In practice, then, it really means we're talking about eight, nine or 10 meetings for that study, because after you hear the witnesses, there is usually a meeting to discuss instructions to the analysts for the report. Then there is usually at least one meeting—in my experience, it's usually two and sometimes three—to finalize the report.
    Really, you're looking at somewhere between seven and 10 meetings for each of those studies. Add the fact that we already know a bill has been introduced in the House by the Minister of Health on the rapid tests. That's coming to this committee as well. We will not get to any other study besides the two we've talked about. In fact, we may not finish the children's health study by June, but hopefully we will.
    The other thing is this. I don't know, but speaking for myself, the discussion we had, when we were blue-skying committee business, about having a series of short studies or longer ones.... That was never voted on or decided. It was a good idea, perhaps, but I don't think we ever came to a firm conclusion on that. That was an idea that was suggested by Mr. Berthold and then by Mr. Thériault.
    In fairness, I don't think we came to a conclusion that this committee was going to have a series of short studies. The question really becomes, then, of all of the notices of motion, of all the potential studies that are on here, is this particular study of such pressing nature and of such widespread interest that it would warrant this committee's time?
    I must say that I find it very granular. I've had the opportunity to have one discussion with Mr. Thériault about this, and similarly.... Our minds are in the generally same area, because I have a motion on breast health generally. That includes breast screening guidelines, wait times for diagnostic services, access to treatment, and options to improve health outcomes.
    I think that could be broadened, like Mr. van Koeverden said, to include the very important issue of breast implant registry. However, with a breast implant registry itself, it would be very appropriate if we had decided to have targeted short studies. If we're not doing that, then it's very, very granular. In my opinion, it affects profoundly but a very small number of Canadians, whereas something like breast health generally affects, I'm going to say, 51% of the population. In fact, someone pointed out to me that breast health can affect men as well, but primarily it's women. We're talking about millions and millions of women who have an interest in access to timely breast screening and services and breast health.
    Those are my general thoughts on this. We also have motions that have been moved on oral health, which I have moved, and substance use and addiction. In my respectful view, with great respect to the importance of this issue that Mr. Thériault was championing, I think they affect far more people and are of more urgency in terms of the impacts they have on a broad number of people. That's not to take away, of course, the significance of this issue to those who are interested in it.
    I've been an MP for 14 years, and I don't think I've ever been contacted by anybody who has an issue over a registry of breast implants, but I have many, many people contacting me about a lack of access to dental care, or the opioid crisis, or breast health generally.
    I'm happy to support this motion on the understanding that this vote not specify that we will be studying this issue as our third study. If that's okay with Mr. Thériault, then I'm happy to support it. I'd like him to clarify whether it's his intention, by passing this motion, for it to be the third study. If that were the case, I would move an amendment to broaden it to include breast health generally so that it includes not only the issues he wants to look at, which are important, but also the broader issues.


    Thank you, Mr. Davies.
    I am advised that there is a technical problem in the room with respect to an inability to turn MPs' microphones off. It doesn't affect those who are here through Zoom, but I will suspend the meeting for five to 10 minutes.
    I would encourage you to talk among yourselves to see if we can get through this during the suspension.
    The meeting is now suspended.



     I call the meeting back to order. I'm pleased to advise that it appears the technical issues are resolved and we can now continue.
    Next on the speakers list is Dr. Powlowski.
    I wonder if Luc could clarify. A number of people have questioned whether his motion is to have this proceed as the third set of meetings or if it's just a motion that at some point we will do the study that he wants.
    I'm happy to have Mr. Thériault intervene. It is not specified in the motion, but he can clarify his intent.


    Mr. Thériault, you have the floor.
    Thank you, Mr. Chair.
    It's true that it's not specified in the motion. I'm nonetheless surprised by the question because it seems that we won't be able to discuss the motion until the fall.
    In the interest of fairness, each party usually presents one of its priorities. I fully understand that Mr. Davies would like to discuss breast health generally. The wording of his motion is also very good. But how can we discuss breast health without factoring in the pandemic? How can we talk about access to treatment, wait times and late diagnoses while ignoring the pandemic? There were circumstances prior to the pandemic, and circumstances during the pandemic. We could combine all these factors under the general topic of pandemic follow‑up.
    But my motion wasn't part of that, because it's too precise. Now this motion has some virtues, including the fact that it's precise. Because it is specific and short term it would enable the committee to come up with a strong recommendation.
    The purpose of the study is, among other things, to determine whether it would be appropriate to introduce a breast implant and reconstruction registry. How come Health Canada handles certification, without any way of tracking cases in the event of problems. Wouldn't it be important to have a registry like this?
    Because it is so specific, this study would be a short one. I have been a member of this committee for only two years, but in my view, a committee like this one always needs short studies on specific matters of this kind because it gives us the time to do longer-term studies and reports on other subjects.
    Everything about this struck me as positive. I find Mr. Davies' motion very interesting, but believe that it could very well be dealt with during the meetings devoted to pandemic monitoring. When we studied the collateral impact of the pandemic, a topic I put forward during the third wave, we could see that the pandemic had had an impact on screening and access to services for breast cancer, one of the foremost and most serious forms of cancer.
    I would therefore not want the study I have put forward to be appended to a study that may be very interesting, but that might continue throughout the 14 meetings about the pandemic. Mine should not be a part of that.
    Committee work often varies and I am receptive to the idea that it could be the fourth or fifth study. But I would not want to see it disqualified on grounds that it is too specific. I think that being precise has merits, as I have already explained.
    I would like my colleagues to consider this to be an important motion. If they are interested, I could send them a package of literature on the subject. This would enable them to see that it's an important issue.


    The key is not the total number of women who have experienced this type of situation. Indeed, even if there were only one case where certified implants had caused a woman stress and led to the recurrence of a cancer, it would be one case too many.
    We need to establish today the measures that would be most appropriate to ensure that not even one woman who has had to have breast reconstruction surgery following cancer should have to experience anxiety 20 years later if a problem were to occur.
    I don't think the motion should be downgraded simply because there are more important issues. What's important is clearly the pandemic. Is there access to care during the pandemic? Mr. Davies could certainly suggest that his motion be dealt with as part of the pandemic follow‑up process. I personally would like to have my motion adopted. If that works for us, then indeed,…



    Mr. Lake has a point of order.
    Go ahead, Mike.
    It's not really a point of order, but I'm going to say super quickly that I think this motion will pass if we just let it come to a vote. I suspect it will pass, given that he's not moving that it's number three on the priority list, or anything like that. Then we can get on to planning next week's meetings, which is really important for us.
    You're right. It's not a point of order.
    Go ahead, Mr. Thériault.


    Mr. Chair, Mr. Lake is not the only one entitled to talk for a long time when it suits him. It's now my turn to speak.
    My colleague did not properly understand what I said. I'm not at all opposed to have this motion come up third on the list of priorities. I said that it would probably not be studied until the fall. I would like it to be studied this fall, as early as possible. The health of women depends on it. They are waiting for us to address this very specific and important issue of concern to them.
    When it was a matter of the Conservative or the Liberal motion earlier, did the question of whether it would be studied first, second or third come up? No. It was just assumed that the Liberal and Conservative motions would be adopted, and it seemed to me that it was my turn to introduce one, because no one else had anything to propose at that time.
    Given that the number of meetings had been accepted and I had not put an amendment about it, I did not necessarily expect the study to be carried out between now and June. Given the specific nature of the motion, it would not be a problem for this study to be the third on the priority list and considered in the fall. If that presents a problem, I'd like to be convinced of it. Personally, I don't see a problem.
    In any event, I'm not sure that we're going to complete the second study by the month of June. There are always imponderables. For example, we sometimes have to devote meetings to the appearance of a minister who comes to speak to us about urgent problems. Sometimes urgent meetings are called in compliance with Standing Order 106(4).
    I'm not saying that the study I'm proposing ought not to be considered third. I repeat that its narrow focus and the fact that it would be a short study means that it could be handled without difficulty in a timely manner.
    Thank you, Mr. Thériault.


    Next on the list is Mr. Lake.
    Before I go to Mr. Lake, as we're rapidly approaching the appointed hour, I'm going to throw open the suggestion that we perhaps talk about a deadline for briefs for the two or three studies that we've committed to and witness deadlines for those studies in terms of getting witnesses in.
     We are on Mr. Thériault's motion, and Mr. Lake is next up.
    Go ahead, Mr. Lake.


     You can take my name off the list, but I'll just say that if we all stopped talking, we could come to a vote and move on to that other idea about planning the next meeting.
    Thank you.
    Go ahead, Mr. van Koeverden.
    I'll remove my hand so we can vote.
    Go ahead, Dr. Powlowski.
    I remove my hand, too.
    Are there any further interventions on the motion?
    Seeing none, it sounds like we're ready for the question.
    Is it the will of the committee to adopt the motion of Mr. Thériault by consent, or is it necessary to have a standing vote?
    We need a vote.
    All right.
    Mr. Clerk, could you please do a standing vote? Thank you.
    Absolutely, Mr. Chair.
    The vote is on the motion of Mr. Thériault to initiate a study on the registry of medical devices.
    (Motion agreed to: yeas 11; nays 0)
     We are very close to our allotted time, but if we're going to move to getting these studies set up, there are three things we need to do. We need to adopt a word limit for briefs, because we would normally call for briefs to be submitted for anyone who is appearing or anyone we're not able to accommodate as a witness. We need to set a deadline for witness lists. We need to do at least those two things.
    Right now, we have adopted studies in respect of COVID, in respect of workforce, in respect of child health and in respect of medical devices. My understanding is that we're going to proceed immediately with COVID and workforce. Could we take the advice of the committee as to a deadline, a word limit for briefs and a deadline for witness lists, please?
    Mr. Lake, you have the floor.
     Yes, we're trying to be as quick as we can.
    We had the opportunity to have some conversation in the room while technical difficulties were happening. A suggestion would be that we do that COVID update on Monday, and then on Wednesday we have our first meeting with witnesses on the human resources study. The deadline for us to submit witness lists would be five o'clock tomorrow, eastern time, in order to start the committee study next Wednesday.


    It sounds like you had productive discussions. Has Mr. Lake captured the consensus of the committee?
    Go ahead, Mr. Davies.
     While I appreciate the efficiency, it's very fast. We have six meetings. That's 24 witnesses. In order to consider who might want to testify, to give us less than a day is too short.
    I also must confess that I've been wondering, with the volume of material that has been prepared by the analysts, whether one day is sufficient to summarize the COVID evidence. I would suggest we take Monday and Wednesday next week to review the COVID evidence and get briefed. We have a break week after that, and we can pick up the study after that. We also have to have witnesses for the COVID study. It makes sense to get ready to start the week after the break week, with one of the days on COVID and one of the days as the first day of the human resources study.
    I wouldn't suggest we take much more time, because the other thing is that we have to give the clerk time to get in contact with the witnesses and arrange them. It's probably more reasonable to say we have witnesses in by, say, early next week, on Monday or Tuesday. That gives the clerk all of next week and the break week to arrange the witnesses to start the study for the week after.
    At the same time that we're asking for witnesses for the human resources study, we could also submit some witnesses on COVID. Maybe we should determine how many we'll do. If we're devoting half the time to COVID and maybe firing in four or five witnesses that we each want to hear from on COVID, we can give the clerk time to schedule that as well.
    However, it's far too fast to try to get this done for tomorrow.
    Go ahead, Ms. Kramp-Neuman.
    I have a point of clarity with regard to the length of briefings.
    You suggested that we try to sort out how long they should be. I don't know whether there's a standard length. We don't need to reinvent the wheel. Is there a standard length for a briefing? This is new to me.
    I'm advised by the clerk that the standard limit is normally 2,000 words. If we're not reinventing the wheel, that's probably a good measuring stick. He indicates that sometimes it's framed as 10 pages, but otherwise, it's 2,000 words.
    Okay. Thank you. If that's the will of the group....
    Go ahead, Mr. Lake.
    I take Mr. Davies' advice. The one suggestion I would have is that we go with COVID for even-numbered meetings and non-COVID studies for odd-numbered meetings. If we're going to use the first two meetings next week on COVID, we can also discuss our plan forward on COVID as part of that conversation. We don't need to decide that now, in terms of witnesses.
    I would suggest, so that we get a good start after the break, that the first two meetings be on the human resources study; following that week, we'll start alternating again, with Mondays being about COVID and Wednesdays being about human resources.
    Does that make sense? Next week, as Mr. Davies suggested, we'll have two meetings, both on COVID. At that time, we'll also discuss our plan moving forward on the COVID side of things. Coming out of the break, we'll have the first two meetings on human resources.
    I didn't catch when the deadline for witnesses would be then, Mr. Davies.
    What he proposed was Monday and Tuesday of next week.
    It would be Monday and Tuesday of next week. That's an extension from what we were talking about.
    While I have the floor, can I throw out that we could put forward a primary list of witnesses? There's nothing to stop us from adding more names as this study goes on. We might have some ideas as the study goes on.
    Go ahead, Dr. Hanley.
    Recognizing the time, there's definitely merit in what Mr. Lake is saying. At the same time, it would be easy to get certain witnesses lined up for next week to set the stage for what might help us to be able to plan the next few meetings more methodically. It serves to meet the priority aspect of this—we are really concerned about the state of our workforce—and it would give us the time to make the future meetings successful.
    I would respectfully submit that we do it that way. I'm pretty confident we can set the stage well for witnesses for next week.


     Mr. Jowhari.
    I definitely support my colleague, Mr. Hanley, but if I may, I'll suggest a compromise.
    We start on Monday on COVID, as agreed, and do our best to make sure we get witnesses for Wednesday on the study on HHR. If we cannot get any witnesses, then we move into doing the second meeting on COVID. That way we have a backup plan. We have a plan that we move forward and a contingency plan if we can't get the witnesses.
    However, I believe we will be able to get witnesses for the Wednesday meeting on the study.
    Mr. Davies.
    We have a couple of different suggestions. I'm not going to repeat what I said.
    I like Mr. Lake's suggestion. I think that's eminently reasonable.
    We could start by next week, but we have a very busy day tomorrow in the House. I can speak for some of us. We have an opposition day motion on health care. We're tied up on that.
    It's not fair to the committee to say that we have tomorrow to fire in our witnesses. I want to think about the witnesses I want to put forward. I want to consult some of the witnesses. It takes some time.
    There's no pressing reason that we have to rush to do this for next Wednesday. Again, it's also the practical reality that it's difficult for the clerk to contact and line up witnesses on four business days' notice. I don't see any real reason to rush this process that fast when we've taken a week and a half to get started. Also, there's going to be some overlap of witnesses and it might take some time to work that out.
     I stand by what I said. We should have until the end of Monday to get in our witnesses on the health study. I like Mike's suggestion about taking the second meeting next week to not only to finish off the briefing but maybe have a chat about how we might want to structure the COVID study and what kinds of issues we might want to look at. That might be helpful.
    We also have to get in our witnesses on COVID. I'm okay with both meetings during the week after the break week being on the health care human resources study. That means there will be eight witnesses called that we have to prepare for. The week after that, we're going to have to have a meeting or two on COVID.
    Those of us who have served on committees have some sense of the cadence of these things and how long things take. It seems like a really easy thing to go out and get our witnesses and tomorrow we'll schedule them. It usually takes a bit longer than that.
     I stand by my suggestion on the end of business day Monday and with Mr. Lake's schedule.
    Mr. Lake.
    We need to make a decision before the end of this meeting. I listened to my Liberal colleagues here. The compromise they're suggesting makes some sense, too.
    I could go either way, quite honestly. Given that there are five members of the Liberal party and colleagues here....
    As a reminder to Mr. Davies, what we discussed here is that we don't need to put our full witness list here. We just need to get some preliminary witnesses out so that we have a good first meeting, as Dr. Hanley brought up in his comments.
    Maybe that's just the way we go to get something moving. We can decide on our preliminary witnesses—enough to have one meeting and get started. We can let our steering committee decide when we need to get our main list of witnesses together.
    In the interest of compromise and of moving on, I think we've had a great meeting. I'm willing to agree with Dr. Hanley and Mr. Jowhari.


    Mr. van Koeverden.
    Unfortunately, we've spent quite a lot of time. I think it's really important that we get to work. I respectfully submit that we should start our human health resources study on Wednesday. I appreciate that from my colleagues from the Conservatives.
    We owe it to Canadians to get right to work as quickly as possible with preliminary witnesses and have our first HHR study on Wednesday.
    That's my position. Thank you.
    Dr. Hanley.
     My suggestion would be to Don, if—
    Dr. Hanley has the floor.
    No, I give way to long as it's agreed.
    Some hon. members: Oh, oh!
    I'm going to give it to Sonia.
    Some hon. members: Oh, oh!
    Mr. Marcus Powlowski: I would suggest to Don, if you go with what Brendan has suggested, then next week we would have the first one on COVID, then the second one with the Canadian Medical Association and the Canadian Nurses Association for a general overview of the problem with shortages. We think that getting, for example, the Canadian Medical Association, the Canadian Nurses Association and a few academics who want to talk about the situation in general in terms of the health workforce shortage, would be easy enough to do. Then we could get going and have a plan for next week.
    Mr. Davies.
    What's the proposal? If we are going to get our briefing on Monday and then Wednesday we'll start the human resources study, what is the deadline for getting a few witnesses in? I didn't hear what Dr. Hanley's suggestion was.
    By the way, I think we should also pick a date to get witnesses in for COVID to start when we come back.
    Dr. Hanley, do you want to respond to that? Then I'll go to Monsieur Berthold.
    Sure. I didn't necessarily submit it, but I think the advice that we received on the floor was end of day tomorrow to have that preliminary list for next Wednesday.
    There's no hard deadline for our final witness list, then.
    That's correct.


    Go ahead, Mr. Berthold.
    That's what I wanted to say. To abide by the motion, it is absolutely essential to establish a list. We can't just decide to receive representatives from the Canadian Medical Association and the other association you mentioned because there is no consensus yet. The witnesses now need to be divided up by political party, in compliance with the proposal that was accepted.
    We need to have the time required to submit a list of witnesses. I think we might have until tomorrow evening to put our list of witnesses forward. We could then look into the matter of next Wednesday's meeting.
    Unfortunately, this motion prevents us from proceeding by consensus and mutually agreeing to have briefings from national organizations. This means that the choice of witnesses now needs to be based on political party representation.


    We have two more people on the speakers list, but we're now at two hours. Please allow me to summarize what we have agreed upon and maybe get a nod of the head.
    We've agreed that we're going to have a briefing from the analyst on COVID on Monday. It appears that there is emerging consensus that the workforce study will commence on Wednesday, that members will get their preliminary priority witness lists in as soon as possible, and that the maximum length of briefs will be 2,000 words.
    I think that's where we are, but I'll recognize the last couple of speakers on the list.
    Mr. Lake and then Mr. Davies.


    I'm good with that.
    Mr. Davies.
    I'm good with that too, although Monsieur Berthold makes a good point. I would just say that getting some witnesses in so we can have a meeting next Wednesday, to fire in the first four witnesses.... I'm fine with figuring out the math later on, because of course we have a break week after that. We should all put some witnesses in, and then I'll leave it to the clerk and chair, at their discretion, to choose the four witnesses next week. We'll have plenty of time to make it square with the motion passed in terms of the proportion of witnesses.
     I agree, and I appreciate that confidence.
    I would now like to entertain a motion to adjourn.
    Is it the will of the meeting to adjourn? Is there consensus in the room?
    Thanks, everyone. We got some stuff done today. Have a good evening.
    We're adjourned.
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