HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, May 28, 1998

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[English]

The Chair (Ms. Beth Phinney (Hamilton Mountain, Lib.)): Ladies and gentlemen, I call the meeting to order. This is meeting 43 of the Standing Committee on Health, Thursday, May 28, 1998. Pursuant to the order of reference dated February 26, 1998, Health votes 1, 5, 10, 15, 20, and 25 have been referred to the Standing Committee on Health. That's what we'll be looking at this morning.

We welcome this morning our Minister of Health, Mr. Rock, and his deputy minister. Mr. Rock will be available to us for one hour this morning, so I'll be fairly strict about keeping to the five minutes for questions and answers so that everybody gets their fair share of time.

Mr. Rock, would you like to begin?

[Translation]

The Hon. Allan Rock (Minister of Health): I'd like to begin with a very brief speech to present the important subjects.

[English]

I want to say at the beginning how much I appreciate this opportunity to appear before my colleagues on the committee and discuss plans and priorities for health in the coming year.

The period covered by these estimates is one that will be characterized by change and evolution in the health sector. I know every member of the committee is aware that one of the greatest challenges we face as parliamentarians is to maintain the proud tradition of the Canadian health care system. I also want to tell colleagues that in my view, despite some of the issues we've had to deal with recently that are extremely difficult, this is a tremendous time to be Minister of Health, to be involved in this effort of renewing and restoring confidence in the health care system. We face very exciting challenges as we move into home care, pharmacare, and other issues, and I look forward to working with my colleagues in this committee on that process.

[Translation]

As I worked with my officials on finalizing our plans and priorities for 1998 through 2001, these fundamental objectives and the serious public concerns over the problems of our health system have guided our efforts. We worked on developing solutions for the long term where the federal role in health could have the most positive impact. Our watchwords have been openness, collaboration, pragmatism and innovation.

The Government of Canada's support for the health system includes federal transfers, strategic investments and constructive partnerships with provinces, territories and health stakeholders.

[English]

One of the most promising of these strategic investments is the health transition fund, designed to support and evaluate innovative projects that will generate evidence on concrete, practical ways to improve the health system.

This $ 150 million initiative, as you know, Madam Chair, is funding a series of pilot and evaluation projects in four priority areas. It's important to note that these priorities were not selected only by the Government of Canada; they were identified in collaboration with our provincial partners. They reflect our shared priorities: home care, pharmacare, a better integration of primary health care services, and primary care reform.

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The fund has also provided the resources for Health Canada to co-host three national conferences. It co-hosted with Saskatchewan on the subject of pharmacare last January, with Alberta on health information systems, and with Nova Scotia on home care.

Our plans and priorities are drawing lessons from and acting upon the findings of these important meetings. In particular, delegates to the national conference on home care clearly stated the real need to move ahead to advance the modernization of medicare through home and community care. So throughout this fiscal year we'll be exploring how we should proceed with provincial and territorial partners and with others in the health sector on home and community care.

If I had to say there is a single priority above and beyond the others for the current period, I would say it is home and community care. To my mind, it's the next great challenge in the unfinished business of modernizing medicare for the 21st century. It makes sense as a priority for so many reasons. We've seen over the last 15 years a shift from hospitals to community. We've seen with the Canada Health Act, the insurance of health services provided in hospitals and by doctors, but now more and more, with the closing of hospitals and the emphasis on community care, that focus has shifted.

The result has been too often a burden on families. We all know someone who's looking after someone in the home, whether it's an aging parent or a relative who's ill or disabled. In fact, one in five Canadian women between the ages of 20 and 55 is looking after someone in the home who's either chronically ill or disabled. That's one in five. According to research, they spend an average of 28 hours a week on that home care.

About half of these women also work outside the home. Many of them have children of their own, and that burden is placing a strain on their own health. We must address it in a way that will fill gaps that have been left by changes in the system that have not been reflected by changes in the coverage of health insurance.

There's also a connection between home and community care and problems in the acute care sector—the fact that there are waiting lists or line-ups in emergency rooms, awaiting beds in hospitals. Too often people cannot get beds in hospitals because those who are there cannot be transferred to community facilities because they do not exist.

So we have to provide that community infrastructure and take the pressure off the acute care facilities. I believe strongly it's the important overriding priority for the current period for the Government of Canada, and it's one to which we will return with enthusiasm in the coming months.

Let me say a few words about the regulation of the blood system. Through federal-provincial collaboration, which was initiated by Minister Dingwall when he was Minister of Health, there's been agreement on the form of governance and the shape of the new Canadian blood services. That agency will be operational later this year.

The Government of Canada will continue to improve its role as regulator, bearing in mind the recommendations of the Krever commission report. As I've said on other occasions, we are accepting the recommendations of Krever in relation to regulation. We'll be putting them in place, and we'll have more to say publicly as they're developed and implemented, so the public knows those recommendations are being followed.

Health Canada will also continue to monitor developments at all levels in the blood system of any changes that are made. We're determined to see that we learn the tragic lessons of the past.

Let me spend just a moment on the health protection branch, which is an important part of the Health Canada operation. In light of emerging challenges to public health, the health protection branch has undertaken a three-year process of renewal. The task is to adapt to a new environment by employing leading-edge science and new technologies for information management and surveillance and creating a contemporary and streamlined legislative foundation.

This comprehensive review of our health protection programs covers our main areas of responsibility, from food and drug safety to environmental health risks, and regulatory and scientific capacities. It will ensure we have a first-class science base and an improved capacity to anticipate, prevent, and respond to public health risks.

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The members of the committee will also be aware that in order for Canadians to see that there was some independent arm's length assessment of these efforts, we appointed last December a science advisory board made up of independent and distinguished scientists, who will look at the science capacity of Health Canada and ensure, through reporting publicly, that we have the science resources in the department to meet the challenges and our responsibilities. That board is chaired, of course, by Dr. Roberta Bondar, an outstanding Canadian scientist.

I'll touch briefly on natural health products, only to say that I look forward to the report of this committee. I know you've spent many hours looking at the way natural health products are governed at present, listening to alternatives in the way we might regulate them in the future, and helping us find the right balance between regulation for the sake of safety and purity on the one hand, and on the other, providing Canadians with the choice they need in getting access to natural health products.

Health Canada also has a responsibility to provide health-related services to first nations and Inuit Canadians. Health Canada is committed to supporting aboriginal peoples in the transition that is seeing them take responsibility for their own health services.

The health conditions for aboriginal persons are markedly worse than for the general population, and that fact is unacceptable. Our determination over the planning period is to contribute to the process of changing that reality, so we have among first nations the same health situation we have for the rest of Canada.

[Translation]

My department is also acting upon the National Health Forum recommendation that children be the focus of investment in health. We are proceeding with the reinvestment of $ 100 million in Health Canada's community programs aimed at children at risk, the Community Action Program for Children and Canada's Prenatal Nutrition Program.

These plans and priorities also reflect our strong belief that well-informed, systematic and integrated use of information technology is a fundamental requirement if we're going to succeed in solving the problems that are at the top of people's minds—whether it is better management to overcome the problem of waiting lists, overcoming service gaps in rural and remote areas or implementing new innovations.

To this end, our government has committed $ 50 million to support the development of a comprehensive national health information system and established a Ministerial Advisory Committee on health info-structure.

[English]

Let me close by saying that the report you have before you takes into account the additional fiscal resources allocated to Health Canada in last February's budget. This reconciliation of the estimates with planned spending for 1998-99 resulted in positive adjustments totalling more than $ 155 million. Among the most important budgetary adjustments are an additional $ 40.7 million for HIV-AIDS strategy, and $ 30 million to set up the new blood agency itself.

There are certain specific initiatives that I won't develop here, because I'm anxious to get to your questions, but I hope I'll have a chance to touch upon them in the course of our discussion. We've announced the opening of an office for—

[Translation]

Have you got an interpretation problem?

Ms. Pauline Picard (Drummond, BQ): Yes.

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): It wasn't you. The problem was the interpretation.

Mr. Allan Rock: I should just speak in French.

[English]

The Chair: No, it's okay now.

[Translation]

Mr. Allan Rock: Fine.

[English]

I'll just mention briefly that we're opening an office of rural health in Health Canada because the health issues in rural and remote areas are quite different from and sometimes more urgent than those in the urban and more developed areas. When we talk about two tiers of health care in Canada, what I really worry about is the difference between urban and rural locations.

[Translation]

We have to deal with this difference quickly and efficiently.

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[English]

The second thing is the renewal of the AIDS strategy, which I'll be announcing later this morning and of which we're very proud, mostly because of the collaboration that was involved, the discussions with the affected communities, the people who helped us develop priorities for spending.

The last thing is tobacco. We're soon going to fulfil the commitment we made as a government a year ago in relation to sponsorship, and we will also table regulations

[Translation]

and clarify our position concerning our anti-smoking efforts to encourage people to stop smoking or encourage young people not to start smoking.

Thank you once again for the opportunity you have given me to appear before you today. I will be very happy to answer your questions.

[English]

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

The first question is for Mr. Martin.

[Translation]

Mr. Keith Martin (Esquimalt—Juan de Fuca, Ref.): Thank you very much, Madam Chair.

[English]

The Chair: Mr. Martin, you're not a regular member of the committee. I'm not sure if you understand, but it's five minutes, five minutes, and then we go over here for five minutes.

Mr. Keith Martin: Thank you for letting me know.

Thank you, Minister Rock and Madame Jean.

Where to begin...? There is so much.

First, you mentioned the renewal of the AIDS strategy. Bearing in mind that the numbers of people dying of AIDS is going down, why hasn't there been an increased amount of money set aside for people who are suffering from hepatitis C, given that there's going to be an increasing number of morbidity and mortality associated with those individuals? Will you commit to setting aside an affordable pool of money that can be put to people who acquired hep C through tainted blood prior to 1986? The public wouldn't disagree with having an affordable pool of money. They know we can't have an open cheque book. Challenge the provinces to come up with an equal amount of money. Set up this pool. People would be compensated based on their morbidity and mortality, because everybody with hep C doesn't get sick, as we know.

The second point is that with the funding of acute care, speaking personally, what we've done is we have cut out the muscle and bone of acute care for the sake of trying to shift money into other directions.

You're absolutely correct in moving things to the community. However, there is no replacement for somebody who gets into a motor vehicle accident, falls off a house, breaks their leg, overdoses. I've got people in emergency departments waiting two to three days to get into the intensive care unit. That's not appropriate care.

Furthermore, there are huge differences between the provinces, demonstrating that the Canada Health Act has been violated on many levels across this country.

The third point is that the health parameters of aboriginal communities are actually getting increasingly worse, as we know, from tuberculosis to type-1 and type-2 diabetes. There's a suggestion that there is a great deal of money being misappropriated in some reserves; there is no accountability. I can just tell you again that the people on the ground, Minister, the rank and file aboriginal people, are being hammered, and the money that is supposed to go to them simply is not. They're caught between a rock and a hard place. They can't go to their band councils because some of them are misappropriating the funds. If they go to the ministry, they tell them to go back to their band councils. What happens is they suffer. Some of the conditions on some of these reserves, as you know, are beyond appalling. They rival something in a third world country.

The Chair: Mr. Martin, if you want him to answer any of these questions....

Mr. Keith Martin: Okay.

Lastly, on the tobacco strategy, you can up the taxes to what they were prior to January 1994. That drop in taxes was the single worst implementation of a health care policy, which is going to damage our youth in this country, that we've seen in the last 30 years.

Thank you.

The Chair: You have two minutes, Mr. Minister.

Mr. Allan Rock: Where to begin...?

First of all, on tobacco, if I can start in reverse order, the tax reduction, as you may remember, was made necessary because people didn't have any less access to cigarettes with the taxes where they were. In fact, they had easier access to cigarettes. They had a more competitive market with lower prices, and kids were smoking more because they were able to buy their tobacco, not at the local store, where we had some chance to enforce the laws against selling them to kids, but they were buying them on the streets, where the black market was making them readily available.

So reducing the taxes was necessary as a matter of common sense. I agree with you that putting them back up as much as we can, without triggering that situation again, is a valuable policy goal, and it's our goal.

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Last December I announced with the Minister of Finance, for example, an increase of $ 1.20 a carton, and we're going to keep going up as much as we can as quickly as can because kids are price-sensitive. But those decisions are made in concert with provinces, which also have to agree, the RCMP, which along with other police forces monitors smuggling especially at border points here in Ontario and in Quebec, and Health. There are other factors as well, but I certainly agree that if we increase the taxes, that's a good thing.

I'm heartened to note that the Americans are talking about increases. In the McCain legislation now before Congress, they talk about significant increases over the next four years. It's not fast enough for my taste, but at least they're talking about a dollar a package, or something like that eventually, and that will help a great deal.

On aboriginal communities, I acknowledged it when I began this morning. The health situation in aboriginal communities is unacceptable. Jane Stewart, the minister of DIAND, is just as determined as I am to use our time here to do something about that, whatever can be done.

I have to tell you that I'm a little surprised at your reference to the misappropriation of moneys. If you have knowledge of any such circumstances, Mr. Martin, please let us know. That's a matter for the police, and we'll take it very seriously.

I believe there is accountability. As you know, we're in the process of transferring the administration of health services to first nations where first nations have agreed to take that responsibility. Those transfer agreements have accountability mechanisms. Now the Auditor General has made recommendations that allow us to improve them, but they're there and they're enforced, I assure you.

In terms of aboriginal health conditions particularly, we'll shortly be announcing that we're proceeding with the aboriginal health institute, which was a commitment we made during the election campaign. This institute will permit us to focus resources on research, which is of particular relevance to aboriginal communities, and also on ways of delivering services more effectively in aboriginal communities.

I look forward to having a discussion with you on this. I'm sure you'll have constructive suggestions to make in the process of designing that institute, and I think it will help.

The Chair: Do I have the approval of the rest of the committee for him to continue to answer the questions?

Mr. Allan Rock: Can I just touch upon hepatitis C? I don't want to miss that before I leave it.

The Chair: Yes, go ahead.

Mr. Allan Rock: Those afflicted with hep C, however they may have contracted the infection, will in the future require treatment that'll cost money. The provinces estimate $ 1.6 billion in medicare costs over the next 20 years. I believe that's their number.

So you wonder why there's money for AIDS but no more money for hep C. I knew I'd face that today, but I think it's insidious to compare diseases, such as why isn't there more for breast cancer, and what about tuberculosis? I don't think we ought to take a calculator out and decide which is the most important disease.

The fact is that AIDS is a preventable epidemic. Yes, we've made some progress in recent years, but there are real signs of trouble. I think you've seen the numbers. The average age of infection with AIDS is now 23. There's no cure. It's particularly preying on aboriginal communities—this is to come back to your point—and the young. So I say that we should not ignore one problem because we have another. Let's deal with them both.

On hep C, you and I had the opportunity to meet yesterday and we talked about this. One of the things I pointed out to you is that your proposals, which are very constructive, for dealing with the future health costs for those with hep C are before the working group. That's indeed one of the options that the working group is examining at the moment. They're shortly going to report back to the ministers of health, and we'll be in a position to advise our governments on what steps we can take to address that issue.

There are other things, but I think I should leave it there because other members may have questions.

The Chair: All right. We may come back to him so he can answer the rest of the questions. Thank you very much, Minister.

Madame Picard.

[Translation]

Ms. Pauline Picard: Mr. Minister, I'd like to return to the question of my Reform Party colleague about hepatitis C. I was very surprised, and I think many others were, that at the meeting of the provincial ministers, you didn't put any new money on the table to compensate hepatitis C victims. You said that you were following all the recommendations made by Justice Krever regarding the blood system. I think that one of the recommendations by Justice Krever was to compensate all victims, regardless of fault. Justice Krever also said that one of those chiefly responsible was the federal government.

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The provinces, in a last-ditch effort, imposed in turn the cuts they'd suffered from the federal government under the Canada Social Transfer. They are nonetheless prepared to reach an agreement, but they expect you to support them because you're the ones with the money. Why create a committee that isn't looking for a way to compensate victims, that's just trying to establish who should pay the compensation? Let's talk now about the amendments to the anti-smoking law, which you're supposed to have tabled for a year now, amendments respecting support for sports and cultural events. This was an electoral promise from the Prime Minister. Frankly, it's contemptuous not to keep the Members better informed, while we find out from journalists about the measures you want to take. It also shows contempt for the spokespersons for sports and cultural events, because these events, which are going to take place soon, still have a sword of Damocles hanging over their heads. These people are very anxious. I'd like to know when you're going to table these famous amendments.

The Chair: Mr. Minister.

Mr. Allan Rock: Fine.

Mr. Réal Ménard: Good question.

Mr. Allan Rock: Good question, good answer.

First of all, we've often discussed the tobacco issue in the House of Commons. It's true that more than a year has lapsed since the famous letter from my predecessor, which clarified the position of the government, which wanted to amend the law so that people could sponsor sports events. This is a pretty complex issue, though, Ms. Picard.

As Mr. Dingwall said in his letter, we have to take into consideration the health objectives of our Bill C-71. We have to take into consideration international standards and practices. We also have to take into consideration the legal situation with regard to the Charter and the Canadian Constitution. Finally, we have to find a solution for reconciling all these considerations. It's not easy. It's not easy at all.

Recently, we were apprised of Quebec's position, and Mr. Rochon has finally, finally tabled his bill.

Mr. Réal Ménard: Tut, tut, tut, tut. Come on!

Mr. Allan Rock: Finally! We have examined it carefully. We have learned about the approach adopted by Mr. Rochon and we're still developing the Government of Canada's position.

I assure you that we are bearing in mind the interests of the events, the cultural festivals and so on. We are also bearing in mind health priorities: discouraging people from smoking and so on. We also bear in mind international practices, because in other countries, in Europe and the U.S., a certain trend against smoking and against sponsorship by the big tobacco companies can be observed.

We have to consider all that and, as I said in the House of Commons, we intend to table our amendment when the government is ready. Personally, I hope to be able to do so before we leave for the summer, that is, in the next two or three weeks. I assure you that the amendment will be consistent with all the objectives I've just mentioned.

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As for hepatitis C, it's true that we didn't settle the issue at the ministers' meeting, two weeks ago. Frankly, as far as I'm concerned, it was pretty clear from the start that such an outcome would be impossible because almost all the ministers from all the governments came to the table without the authority to make a decision or take any action whatsoever.

We nevertheless accomplished something important that day: we began an efficient and careful process for examining all the options, as I said to Mr. Martin, including the option he himself suggested for handling this issue and respecting the interests of the people who were infected with hepatitis C, regardless of when they became infected.

We're now looking at these issues with our partners and I hope we'll soon be able to provide an integrated response. I feel the response will be better for those who are infected if the governments act together. It's no solution for one or another government to act unilaterally. That's not in the best interest of those who have contracted this disease. A coordinated response by all Canada's governments is the best approach. That's been my position since the beginning. I'm the one who initiated the process of intergovernmental discussion. I'm the one who created the agreement three months ago, and I'm the one who's at the table to try and conclude another intergovernmental agreement.

[English]

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

Mr. Myers.

Mr. Lynn Myers (Waterloo—Wellington, Lib.): Thank you, Madam Chair.

I wanted, Minister, to go back to your comments on home and community care. As you know, I attended the Halifax conference, and certainly people in my area—you've witnessed that first-hand—are very interested in that.

It seems to that we have to take a look at, first of all, how to define home and community care, and second of all, how best to deliver it. I wondered if you could elaborate on either of those two ideas and then maybe give us some ideas as to how you see this proceeding in the next, say, 12 to 20 months.

Mr. Allan Rock: I mentioned when I began, Mr. Myers, that among all the things we're doing, I think this is the principle priority, and I'd like to see us, in this mandate of government, make a very significant contribution toward the creation of an infrastructure of home and community care across Canada, and weave it into our system of health care so that it's there as a dependable, consistent element of care for Canadians.

But you touched upon, I think, the two principle challenges we face. The first is definition. As you saw in Halifax—and I was delighted to see you, Aileen Carroll, and so many of our other colleagues in Halifax for the conference—the first challenge is definition: What is home and community care? If it's defined sufficiently broadly, then you're suggesting that government do everything for the individual, and it becomes unworkable and, more to the point, unaffordable.

I think you have to define home and community care in a way that's practical. It's for that reason that much of the work in Halifax and since has been looking at what we mean by the term.

We've been assisted in that effort by many of our provincial partners who have already accumulated significant experience with home and community care. One thinks of Saskatchewan, Manitoba and British Columbia, in particular, and New Brunswick as well, where in various ways, sometimes at different paces, sometimes taking varied approaches, our provincial partners have created home and community care plans of different kinds.

We're learning from that. We're learning what works and what doesn't. We're learning about costs, and about savings.

We received, with gratitude, the report prepared by a Saskatchewan commission—I forget the name—on costing in the health system. Stephen Lewis of that commission examined the cost-effectiveness of home and community care and identified places where we could make huge savings by shifting care from the acute to the community care setting with a better outcome for the patient, less cost for the system and fewer line-ups, as Keith Martin was talking about, for the acute care facility.

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I hope I'm not straying from the point of your question. Defining what it is and examining how it's best delivered—these are the two central questions.

We've established a task force in Health Canada. We've appointed a particular assistant deputy minister to lead the home and community care effort. She has been chairing that task force, which includes some people from outside the department.

We hope to create a formal federal-provincial mechanism soon, in mid-June, I think. And in the coming months, I hope to be able to report very substantial progress with home and community care as a government priority, in order to complete the system of health care, to take pressure off other parts, and to relieve the burden that's too often fallen on families and disproportionately on women because of the absence of community care.

Mr. Lynn Myers: Thank you very much.

Second, Minister, I'm putting on my public accounts hat for a minute. I was very interested in the aboriginal information that we received, not only here but also at public accounts, with respect to some of the changes the Auditor General was recommending in that area. I noted that in the estimates there is very little in terms of following through on what the Auditor General and the public accounts committee recommended. I wondered why that was the case, specifically, I think, as it relates to the medical services branch. Could you comment on that and whether or not action in that area will be taken and will be forthcoming?

Mr. Allan Rock: It will, and I should say that the absence of detailed reference in the material before you does not in any way reflect a lack of interest or commitment on the part of the department in addressing some very real problems that exist. Because of the shortness of time, let me touch upon one: the comments of the Auditor General with respect to access to prescription drugs in aboriginal communities.

You'll recall that in the report, in chapter 13, the Auditor General made the observation that too often there was not sufficient monitoring of prescription drug use; that is, sometimes there were repeated presentations of prescriptions by an individual. And there were other alleged abuses in the system.

Since that time, across the country, we've put in place—and I think it's now completely in place—a point-of-sale technology that permits pharmacists to tell when the prescription is presented whether the person has presented the same prescription to a different pharmacist within a recent period. That kind of point-of-sale technology which allows us to monitor the prescription drug use by individuals has been extremely helpful in reducing the incidence of abuse or misuse of the system. And I think it represents, in very large part, a response to the concern raised by the Auditor General.

Paul Cochrane, the ADM in charge of the medical services branches, is here this morning. If time permits, I'd be happy to have him respond to other elements of your question. Otherwise, we can make Mr. Cochrane available to you on some other occasion to give you a more detailed response.

Mr. Lynn Myers: Thank you very much.

The Chair: Thank you very much. Time's up.

Gordon.

Mr. Gordon Earle (Halifax West, NDP): I have two questions.

Mr. Minister, you mentioned first nations and Inuit nations and how severe their health conditions are. You said it's unacceptable.

There is a very serious situation involving the Dene people in the Northwest Territories at Great Bear Lake. I've raised this issue in the House. The community there is suffering from years of radiation poisoning as a result of mining.

As a result of many people dying of lung cancer, bone cancer and so forth—this very serious health problem—they've specifically requested a meeting with the Ministers of Indian Affairs and Natural Resources and yourself in particular, as health minister. Can you tell us if you are going to meet with that community, and if so, when?

Mr. Allan Rock: The response is being coordinated through the office of the minister at DIAND, but I also want to say that Mr. Cochrane, who I referred to earlier, is here and may want to speak directly to that community because of his personal knowledge of the delivery of services there. I invite him to respond to the reference to the circumstances in the community.

Mr. Gordon Earle: Just before his response, Mr. Minister, let me say that they want you specifically, as health minister, to meet with them, along with Jane Stewart and Ralph Goodale. Are you going to do that?

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Mr. Allan Rock: I'm not sure yet what response we're going to be delivering together through Jane Stewart's office. Let me find out from her through an update where the discussions are and I'll let you know.

Mr. Gordon Earle: Thank you.

Mr. Allan Rock: It's not that I'm resisting a meeting. I meet with people all the time and I really enjoy it. I don't want to speak for her. I don't know the state of her discussions.

Mr. Gordon Earle: No, not for her, for yourself.... I'm wondering about you specifically.

Mr. Allan Rock: I understand that. We've agreed that her office will coordinate the communications. I'll let you know as soon as I've spoken with her and have an update.

Mr. Gordon Earle: Thank you.

My second question—

Mr. Allan Rock: Could I just ask Mr. Cochrane to comment on the—

Mr. Gordon Earle: I don't want to run out of my five minutes.

The Chair: You only have five minutes to ask questions.

Mr. Allan Rock: Do you mean you only want to ask questions and not get answers?

Some hon. members: Oh, oh.

Mr. Gordon Earle: Perhaps we can come back to him, but I'll ask my second question first, okay?

Mr. Allan Rock: Okay.

Mr. Gordon Earle: You mentioned the importance of following Justice Krever's recommendations in terms of regulation of the blood system. One of Justice Krever's recommendations was that the bureau of biologics and radiopharmaceuticals be given sufficient resources to carry out its functions properly.

We are now faced with a situation in which albumin is being brought into this country by a U.S. firm, Alpha Therapeutic, which does not have a licensed Canadian distributor and is under a court order from the U.S. FDA for extensive safety violations, including such problems as the manufacturing process, record-keeping, staff training, cleanliness and product failure.

So if the bureau does have sufficient resources, what steps has it taken as the federal regulator to perform quality control measures on this albumin? Has it done a lot-by-lot investigation of the product? Has it sent inspectors down to the plants?

Mr. Allan Rock: Mr. Cochrane, did you want to speak to the Great Bear Lake situation?

Mr. Paul F. Cochrane (Assistant Deputy Minister, Medical Services Branch, Department of Health): I'll just add to what you said, Mr. Minister.

In terms of direct health services delivery in the Northwest Territories, the responsibility for direct delivery for the provision of services such as those you are referring to was transferred to the Government of the Northwest Territories from Health Canada.

In this particular case, though, both the medical services branch and my colleagues in the health protection branch, who have continued surveillance responsibilities, would certainly be pleased to work with the officials in the Government of the Northwest Territories to provide whatever expertise and advice we could on the particular situation in Great Bear Lake—but the lead responsibility has been transferred to the GNWT.

Mr. Allan Rock: Thank you, Mr. Cochrane.

On the subject of albumin, it's true to say that the Krever report recommended that the bureau of biologics have sufficient resources to do its job, and I'm going to ensure that it does.

But I don't think you should confuse resources at the bureau of biologics with the shortage of albumin. There is no connection between the two. Albumin is in short supply for reasons that have more to do with market forces and the availability of materials than anything else. It's not the bureau of biologics that's responsible for the supply.

When the usual licensed importers, principally Bayer, reported early this year that they were short of a supply, Red Cross and others, like physicians, then asked Health Canada to permit, through the special measures programme, an American manufacturer without a license to import—but with an approved product—and bring albumin into Canada.

My understanding from officials is that Alpha had approval for albumin some years ago. That approval continued. At some point in the past the plant was inspected. When it was requested that Alpha bring albumin into the country because of the shortage, that was permitted under the special emergencies policy.

As I said in the House yesterday, I'm not a scientist, but I have asked these questions of officials. Indeed, I arranged for a meeting between your colleague, Judy Wasylycia-Leis, and officials of the bureau of biologics so that with her they could go through the history of this matter, through the steps taken to assure safety and approvals and to ensure that all the appropriate steps were taken to make sure the safety was there.

I'm also told—and again, I'm not a scientist—that albumin as a product has the lowest risk level in that it's pasteurized and heat-treated in order to destroy any viruses it may contain, and among all the blood products, because of the way it's manufactured and the kind of product it is, it poses the least risk and has not in the past been known to communicate any viruses or contain other contaminants.

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Lastly, with respect to your reference to the FDA and measures it has taken in relation to Alpha in the United States, I think one has to be careful. What happened in the States, I'm told, is that in recent years, as here, they've introduced good management or good manufacturing practices and so on, and there are record-keeping and other elements in the way Alpha does business that don't relate to the purity or safety of its product. This caused the FDA to enter into a “consent decree”, as they call it in the States, which imposed a discipline on the company for a period of time. But it doesn't go to the safety or the approval of its products. They remain approved by the FDA, which uses a pretty good standard. Rather, it's the other aspects of manufacturing practices that are being changed and improved in Alpha.

The Chair: Thank you, Mr. Rock.

Mr. Thompson.

Mr. Greg Thompson (Charlotte, PC): Thank you, Madam Chair.

Mr. Minister, it's nice to have you with us.

I have some questions on hepatitis C, Mr. Minister, if you don't mind. I'll try to keep my questions short and hopefully we'll have some dialogue here and get in a few.

With regard to the original hepatitis C package that was announced earlier in the spring, is it fair to say that you were disappointed in that package because it only compensated those victims between 1986 and 1990?

Mr. Allan Rock: When you say.... I'm not sure I understand.

Mr. Greg Thompson: Is it fair to say that you were disappointed in that package that only compensated those victims between 1986 and 1990? In other words, were you looking for a bigger package to compensate those innocent victims?

Mr. Allan Rock: I think there are so many overlays now on this subject, because of all the politics, but if we go back to the reality of it, Mr. Thompson, it was clear from the time I became Minister of Health that something had to be done about the people who got hep C through the blood system. I had hoped it was something governments could do together. I had hoped it was something we could do for all people who got hep C through the blood system, and that's still my hope.

Mr. Thompson, at one point, for example, in discussions with the provinces—I needn't go into detail, but I've always said it—it wasn't easy. It wasn't easy to develop an agreement among all governments to take steps for those who contracted hepatitis C through the blood system. Most governments, all governments, said no at the outset. They said “Absolutely no, we won't even talk to you about it”. We had to talk them into it.

Mr. Greg Thompson: Okay.

Mr. Allan Rock: Hang on a second. You've asked me the question and you're going to get an answer.

Mr. Greg Thompson: Okay.

Mr. Allan Rock: Okay, so—

Mr. Greg Thompson: I'm anxious to get on. I know you are as well.

Mr. Allan Rock: I'd like to just answer your question.

Mr. Greg Thompson: Go ahead.

Mr. Allan Rock: You can't just ask a question and....

Through the process of discussions we eventually got to the point where provinces were prepared to talk about it. I think the tabling of the Krever report helped in that regard. Once we began to talk about it, we began in the end to talk about what it is we're doing and for whom we're doing it.

There are different ways you can approach this. Are we settling a lawsuit, because we're being sued? You know, in many ways the 1986-90 initiative was to try to settle a lawsuit. We were being sued by people and were being told by the lawyers there was a good chance we may lose. As to the others, what can we do for people who got hep C through the blood system?

At one point I said to the provincial governments: “If you won't put money on the table for them, will you at least provide an extended package of health services to all those who got hep C through the blood system?” I was talking about drug coverage so they wouldn't have to pay cash for their interferons and other drugs, home and community care, residential care that's not covered now in certain provinces, physician counselling, so doctors know.... I mean, care is the way we show compassion, not cash. Cash is the way to settle lawsuits. So I asked them if they'd at least provide a broader range of care. I said “If you do that, then maybe I'll take an even further disproportionate share of the cash responsibility.”

Mr. Réal Ménard: You are the cash.

Mr. Allan Rock: You see, the overlay of politics goes on and on.

Mr. Greg Thompson: Right, okay.

Mr. Allan Rock: Greg, let me just finish by saying this: I spoke earlier this morning about home care and pharmacare. I believe there are ways, through medical services, by which the Government of Canada can design and develop programs with provinces where we can indeed serve the interests of all those who need medical help in this country, including those who got hep C through the blood system. I also point out to you that right now, right at this very moment, all governments are working together on a bunch of options in relation to those who got hep C through the blood system that may indeed produce other results before this process is over.

When you speak about disappointment, I'm disappointed that the whole issue has not been resolved. I'm confident that we're going to get there, and I look forward to the outcome of the process now under way with the provinces in order to achieve that result.

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Mr. Greg Thompson: One of the points you've made continually in the House—and I think all of us appreciate this, despite what side of the House we're on—is the financial means capacity or the wherewithal of governments to address something that could indeed cost a lot of money. We all recognize that, politics aside.

One of the questions that disturbs me is that the department has never told us, and apparently does not know, what the real numbers would be. In fact, of the victims between 1986 and 1990, I guess we have a pretty good idea of how many are in the package. Outside of that package, there appears to be a lot of confusion and even no sense from the department or your officials of what that number might be. There's obviously a disagreement between some of the numbers you've been using and some of the numbers hepatitis C groups have been using.

Until that number is determined, or there is a little more accuracy regarding that number, how do you intelligently talk about a compensation package for those people? In other words, don't we have to get at that number, and very quickly, so we know what we're talking about?

Mr. Allan Rock: Well, I think we have to get at the number, and for that very reason we've put a process in place that I hope will allow that to happen.

First of all, prior to 1986 I'm told it's extremely difficult to get a hard number because hospital records don't exist and Red Cross records are partial. It's very difficult before 1986. There is a lot of guesswork, although it's guesswork by epidemiologists, so you call it opinions. But the effort must be undertaken. We have written to a wide variety of people. Madame Jean sent a letter last week as part of this effort now under way. We have written to the Hepatitis C Society, the Hemophilia Society, the provinces, and to others, saying let's bring our experts to the same place, have them put their numbers on the table, describe how they got to them, try to sort this out, and come to a number we can all agree on.

Mr. Greg Thompson: Mr. Minister, given the changes in what we perceived or what the department perceieved that number might be, given the fact that Ontario and other provinces have money on the table for those victims outside of that original package, is it possible that those victims could very well be compensated at the end of the day? I believe the number is going to be much lower than what we originally anticipated. I shouldn't say “we”, but the department.

Mr. Allan Rock: We don't know what the numbers are yet. Of course, the position the Government of Canada and the governments of the provinces have taken is it's not an issue of numbers; it's an issue of how to proceed. But I'd rather wait for the outcome of the working group process. That's under way now. People of good faith are sitting at the table looking at all the options.

Mr. Greg Thompson: Are you a little more positive this week than you were three or four weeks ago?

The Chair: Mr. Rock, could you just finish answering that question and then we'll go on to the next person. You're way over.

Mr. Rock, do you want to answer that?

Mr. Allan Rock: I'm a very positive person, notwithstanding everything, and I look forward to the outcome of this process. I think it's a good process. People are trying to find solutions. They're looking at all the options. They've heard everything that's been said.

Mr. Greg Thompson: Well, Minister, you're on the record—

The Chair: I thank you very much.

Ms. Carroll, you have the next question.

Mr. Greg Thompson: Your expectations...

[Editor's Note: Inaudible]

The Chair: Mr. Thompson, let's be courteous to the other members, please.

Ms. Carroll, next question.

Ms. Aileen Carroll (Barrie—Simcoe—Bradford, Lib.): Thank you, Madam Chair.

Mr. Minister, I too welcome you to our committee this morning. I am disappointed, however, that members of the opposition parties who wanted very much to have you attend this morning for some reason were not able to join us. While indeed we welcome their substitutes, it's disappointing that Dr. Hill and his compatriot, Reed Elley, is not able to be here in duty as well. I'm sure they would have enjoyed our discussions.

I wanted to ask you about hepatitis C, and although I've been listening carefully to Mr. Thompson, I read with interest about the Pritchard study, which recognized that our public health had to be fault based. He recognized as well that to have no fault would be unsustainably expensive. A lot of concern has been raised that the provinces are leading us into that kind of a response. There's been much talk about Mr. Justice Kreever, and while he talked about the Pritchard report, he never squared his recommendations with that recognition.

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As one person who very much understands the difference between cash compensation and care, I do think that it would be interesting to have you address that question. Where was Mr. Justice Krever when he didn't take into account the Pritchard? My law is by osmosis, and I'm probably very insolent to query Mr. Justice Krever, but I would be interested in your comments.

Mr. Allan Rock: It's true to say that the Krever report made reference to Pritchard's analysis. Pritchard was in 1990, and Pritchard talked about a no-fault system where you'd have payments being made or compensation if people suffered harm through the medical system that was avoidable. If it was unavoidable then they didn't get anything, but if it was avoidable then they would be compensated, whatever that might mean.

We have Krever's recommendation for compensation, but again he didn't define that term. We don't know whether he meant cost-free access to treatments and drugs or whether he meant cash as in the sense of a lawsuit compensation.

Anyway, as I mentioned, it's thickly overlain now with layers of politics. I can say that there were very different views expressed around the table when ministers met a couple of weeks ago on this subject and what it might mean for the health care system in the future, but there was also a willingness to look at all the options, which is what's going on right now. And I for one would prefer to await the outcome of that process before coming to any conclusions.

Ms. Aileen Carroll: Thank you.

The Chair: Ms. Caplan, did you want to take some of her time?

Ms. Elinor Caplan (Thornhill, Lib.): Yes, if I could.

One of the unique roles of the federal government is the newly defined role in the area of population health. I think it's an area that people don't understand. The provinces, when we originally established medicare.... It's been described as an illness treatment system. I have said that if we could change anything it would be to change our understanding of health and all of what that means, not just illness. I'm interested in the efforts of Health Canada in raising the consciousness of the provinces and the work you're doing in the area of population health. I wondered if you could take a few minutes here to just bring us up to date. I notice that it is part of your estimates and that it is a new priority for the ministry.

Mr. Allan Rock: I often have to remind people that I'm Minister of Health, not minister of illness, and you're right in saying that it's often overlooked. The focus tends to be on medicare, on illness, on treatments and cures and hospitals, because that of course is where our concerns are most prominent. We think about one of our children becoming ill or we ourselves needing treatment. We want to feel secure that the best possible treatment's available to us and our families if we become ill or are injured.

But you're quite right to emphasize that another part of my responsibility is to keep people well by encouraging physical activity, by monitoring trends and by discouraging unhealthy practices like smoking—and that is population health.

One of the people sitting here today is Ian Potter, who's the ADM in charge of health promotion and disease prevention. He administers a budget and runs a section of Health Canada that deals with people of all ages, from children, through our children's programs, to the middle years of life through to the senior citizens. It focuses on areas where there are risks to health and tries to anticipate them, and encourages practices that limit the risk and raise the population's health overall. I can say that there is a population health institute under discussion now, which is intended to pull all this together and, among other things, provide an annual report card to Canadians on what the state of our health is.

Ms. Michèle S. Jean (Deputy Minister of Health): It's in the estimates.

Mr. Allan Rock: Yes, you're quite right, it's right there in the estimates.

The point is that you'd be able to pick up one report and say we're down in prostate cancer but we're up in breast cancer, and ask why is that and are there regional variations. In other words, look at the big picture and see how we can influence Canadians' behaviour to minimize the incidence of disease and lengthen their lives. And that's everything from preventing accidents right through to preventive measures in terms of taking medication. So it's a large part of the job, an interesting part of the job. It doesn't get a lot of attention, but it's really worth while.

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The Chair: We have the meeting down as closed at 11 o'clock, because somebody else is coming into the room.

I'd like to thank the minister, the deputy, and all the assistants from the department.

Mr. Gordon Earle: On a point of order, I feel the remarks made by the member opposite with respect to—

[Translation]

Mr. Allan Rock: Thank you, Madam Chair.

[English]

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

Mr. Gordon Earle: —our disappointment concerning our health critic not being here are a bit out of order. The meeting was originally scheduled for Monday, and our health critic had it marked in. Then the meeting was changed. She is now in Winnipeg, working on a health issue.

The Chair: Okay, thank you very much.

Mr. Gordon Earle: I think that remark should be clarified.

The Chair: It's duly noted. Thank you.

Mr. Gordon Earle: Thank you.

The Chair: The meeting is adjourned to the call of the chair.