Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 10 - Evidence
OTTAWA, Wednesday, March 9, 2005
The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill C-39, to amend the Federal-Provincial Fiscal Arrangements Act and to enact an act respecting the provision of funding for diagnostic and medical equipment, met this day at 4 p.m. to give consideration to the bill.
Senator Wilbert Keon (Deputy Chair) in the chair.
[English]
The Deputy Chairman: Honourable senators, I call the meeting to order.
I wish to thank the witnesses for appearing before us.We believe that this is good legislation. I have already spoken to it in the Senate and recommended its passage here. We are hoping to do clause-by-clause consideration tonight and report Bill C-39 back to the Senate.
The Honourable John McKay, P.C., M.P., Parliamentary Secretary to the Minister of Finance: I hope that senators find that Bill C-39 reflects some of the work the Senate committee that was chaired by Senator Kirby did on the state of the health care system in Canada. That report concluded that timely access is a very significant consideration for Canadians and also that no Canadian should suffer undue financial hardship, two principles which are reflected in the proposed legislation.
As you well know, the Prime Minister and the premiers signed a memorandum on a 10-year plan to strengthen health care, with funding of $41 billion over ten years divided into three important focuses. The first is the Canada health transfer, with a new $19 billion base. The second is additional funding for wait times of $4.25 billion over the next five years and $250 millionfor the following five years for a total of $5.5 billion over the 10-year period. The third is additional funding of $500 million for diagnostic and medical equipment.
As I mentioned, the new base will be established at $19 billion and the government will invest $1 billion in 2004-05 and $2 billion in 2005-06 to bring the base up to $19 billion.
Included in the new base is a $500-million provision for home care and catastrophic drug coverage that supports the first minister's commitment to improve access to home care and community care services. That funding also addresses concerns expressed by Canadians for necessary new drug therapies. Senators will note that it has an escalator of 6 per centannually going forward, which is higher than nominal GDP and probably reflects the demographic reality of our country for the next 10 years.
The wait reduction strategy is a commitment to achieve meaningful reductions in priority areas such as cancer, heart, diagnostic imaging, joint replacements and site restoration.As I mentioned, it is $4.25 billion in the first five years that can be drawn down as the provinces see fit within that five-year time frame to suit their own priorities. The final $250 million annually for five years, for a total of $1.25 billion, is to be drawn on an annual basis over that time. That reflects the agreement of flexibility and priorities.
In the 2000 and 2003 health accords there was in the order of $2.5 billion put into diagnostic and medical services. This new accord adds a further $500 million for a total of $3 billion of investments in medical equipment. In dollar terms alone, the story of increased federal support for health care is compelling. Total federal cash transfers in support of health will rise to $30.5 billion by 2013-14, an increase from $16.3 billion in this fiscal year. That is quite an increase, and that is in cash; it does not reference tax points.
The premiers and the Prime Minister have agreed to an action plan to achieve measurable results. Bill C-39 includes a Parliamentary review, which I know honourable senators will be interested in going over with us. It reflects a partnership of the two orders of government and provides Canadians in every region with a publicly funded health care system on which they can rely.
There are officials here from the Department of Finance and the Department of Health who will assist us in responding to your questions.
The Honourable Robert Thibault, P.C., M.P., Parliamentary Secretary to the Minister of Health: Honourable senators,Bill C-39 respects the jurisdiction of all provinces and territories, assists financially, expresses the priorities of Canadians and puts in place measures to ensure we work toward them with certain checks and balances.
It is important that it be understood that delivery is the responsibility of the provinces and territories. There is good faith that they will do what is right for their people and that the priorities that they hear expressed by their people are the same priorities that we hear. This process was negotiated over three different federal-provincial-territorial sessions.
The Deputy Chairman: I would like to make a comment on behalf of our committee. We are very pleased. As you know, we recommended that some money had to come forth to introduce change in the system. We were anxious that money not be spent propagating some of the mistakes we made in the system, but that it would introduce change. A real effort has been made to introduce some change as it relates to home care, catastrophic drugs and palliative care, which is of great interest to Senator Carstairs.
When I spoke in the Senate yesterday, however, I did express a very deep concern about what has gone wrong with our system in Canada. Our problem is that there has been doctor and hospital care insurance and not much insurance for anything else. These two segments of the health care sector are enormously well organized and powerful.
This is a tremendous shot of money to come into the system, an unprecedented amount of money, and I am deeply concerned that the big barrier to access is not going to be addressed, and that is primary care.
Notwithstanding everything that has been done about primary care: the special funding for it, the special committee, and Dr. Bowmer's work, which is outstanding, I am deeply concerned that as this money flows, the organized people will be standing in line waiting for it. Again, it will propagate something that is a problem now, and that is that the very well-oiled machines, one of which I was CEO of for my whole life, are in a great position to receive this funding because they are well organized.
If we are going to control costs in health care, we have to look at organizing primary care in concert with community services, home care, palliative care and public health. Indeed, I find it quite frightening, as we look ahead to our mental health report, to try to dream up a way of implementing our recommendations when we do not have a primary care system in the country that can do the job.
I would like you both to think about that issue. Having said that, I will move on to the questions.
Senator Callbeck: Thank you for coming today and for your presentations.
I have a couple of questions on accountability. As I understand it, as soon as this proposed legislation becomes law, the $500 million for diagnostic and medical equipment will flow to the provinces.
Does the federal government ask the provinces to show that they have put this money into equipment?
Mr. Thibault: All the jurisdictions have reporting procedures to their public and to their legislatures. They are, as is the federal government, accountable for the monies they receive, whether they receive it from a direct access or from the federal point of view.
We know of a lot of problems. I will ask Ms. Ballantyne or Mr. Campbell to tell you the specifics on that particular problem. We know there have been problems in the past and that there has been some questionable use of some of these funds.
However, what we also know is that if we are to achieve our goals we have to change the structure of the system. We also have to make sure that our system is the most efficient system possible. In today's world, that means very good machinery, very good equipment and trained professionals to do the job.
On the equipment side, it is good to have an MRI but you also need the radiologists and the technicians to operate them and all of the support people that are required in order to provide a full service.
We have some guidelines as to what can be done and there is a bit of good faith that the provinces will do what they have promised to do, and they do have their reporting procedures.
Ms. Meena Ballantyne, Director General, Health Care Strategies and Policy Directorate, Health Policy Branch, Health Canada: In fact, we have had the medical equipment fund from 2000-03 and now the subsequent investment.
In 2003, we implemented a set of operating principles that guide the use of this fund. Essentially, it was an agreement between the provinces and territories to say, for example, on the medical equipment that it was supposed to go to high-tech equipment as well as low-tech equipment, and it was also to support training of the technologists to run these machines.
There is a degree of accountability built in apart from the reporting that each of the jurisdictions does to their own residents, as well as the reporting the Canadian Institute for Health Information does on a regular basis. CIHI reports how much equipment is in the system and, for example, how many more MRIs and CT scanners we have at the present time.
As Minister Thibault was saying, there is accountabilitybuilt into the system. We learned about communication challenges from the 2000 medical equipment fund, andin 2003, we instituted these operating principles, which also will guide the 2004 investment.
Senator Callbeck: Is it correct that since those regulations were put in place in 2003, we have not had any problems that have come to light?
Ms. Ballantyne: There has been nothing, if it is not used for the type of equipment that they laid out.
Senator Callbeck: I am pleased to see that $500 million is being put into catastrophic drug prices and home care, as funds are badly needed in those areas.
How will we know whether the provinces are actually spending that money? Will that be left to the end of the year when they explain to the public where they have spent the money, or does the federal government get any follow-up on the spending?
Mr. Thibault: Throughout the entire year we have the both the institute of health indicators and the Health Council of Canada that keep an eye on the spending. We have each jurisdiction reporting to their people. We have the federal government, the provincial government and territories working together on a pharmaceutical strategy that will look at all this.
We also know of the concerns of home care. We know that the provinces are very concerned about this issue. They understand, as we do, that you cannot just keep doing what you are doing, putting more money in and hoping that somehow the structure will change itself.
I was a municipal administrator for 10 years and on municipal council for three years prior to that. I have seen too many instances where the only way you could get assistance to people who required special care was admission to a hospital. It was a misuse of the hospital system for a social purpose, and the only way you could go to get care.
We recognize, and everybody does, that you have to have a proper home care program. We also have to have, as the budget this year reflects, recognition of the need for public health, for preventive health care, and for all the other elements that are very important to our system to achieve the structural changes and achieve the clinical mentality we have about what a proper health care system is.
Again, there is a good-faith, confidence system built in. We understand that the provinces recognize the problem and they will work to achieve success. There are also two levels of Parliamentary review.
In 2008 and 2011, whoever is in our chairs at those times will see if we are achieving what we started out to do, and if the taxpayers' money is going toward the stated goals, and take whatever action is necessary, should there be any.
Senator Callbeck: Will that committee look at things like that to see whether the $500 million is actually being spent on home care and the drug plan?
Mr. Thibault: I would presume so. This $500 million is in addition to everything that is already being done on home care, and this money for pharmaceutical strategies in addition to everything that is being done in that area. We will be getting some indicators and some benchmarks, moving towards those and making sure that the whole machinery is working towards achieving those results.
The specifics of where the dollars are spent are a different issue. What is important is that the current home care system is improved and that the current pharmaceutical system is improved, and all of that goes to meet the goals we state.
When we state that we will give 50 per cent of Canadians access to 24-hours a day, seven days a week, primary health care by a multi-disciplinary team, it is a huge goal. That is a huge structural change. It is not laid out exactly how it will be done and how we will measure all those things. As abilities change and experiences are gathered, you have to change your perspective depending, therefore, we leave room for flexibility for those actions in the future.
Senator Cook: I would like to go back to primary care.
I want to begin by congratulating the government on this much needed infusion of funds into our health care system.
Help me to understand. I see this as the disbursement of funds, primarily based on trust, to provinces with no accountability written into the system.
In my province, the health care system, as we say in the vernacular is "skinned out.'' When you say that we will not have to worry about the health care system for 10 years I believe that it will take that amount of time to train people to take care of the waiting lists that exist today. It will take 10 years to complete the recruiting programs that will train the people that we need.
While Bill C-39 looks wonderful and it will alleviate some of the stresses on our present system, we have to look at what we have to work with in this 10-year period and look at the benchmarks and the accountability. I do not see any transparency. I hear that the accountability will be achieved through existing programs, which is kind of a patchwork system.
I would like to see something from the provinces otherthan trusting each other with this and seeing how we will move step-by-step, given the state of not only primary care, but the ability to deliver it and eventually to bring the waiting lists to where they should be. We do not have the human resources trained, at least in my province, to achieve that goal.
I know this must be flexible. It is for the federation called Canada, but I need to look at it through the lens of the province where I live and the province I represent. The one uncomfortable thing I see, and my colleague Senator Cochrane will agree, is that Bill C-39 is tied to population.
If you are able to assure me on some of my concerns I would thank you very much.
Mr. Thibault: You bring out all the points so I think I would have to write a book to cover them all, but I will try to touch on a few.
You raised the situation as it exists now very eloquently and the example of your home province is a good one. Just as Senator Keon was saying, if you keep doing what you are doing you are going to lose greatly in your province.
In my province we have a hard time getting doctors to rural areas, but sometimes we have a little more financial ability or are able to give incentives that some of the rural areas in your province are unable to do.
You have a very good medical school and our municipal representatives have been scouring your province, hiring people out of your province, and that is not a good thing for you, but it is good for us. We get very good people, but it is not good for your province because you lose those people. We have to realize that we cannot just keep doing what we are doing.
As for the provincial reporting, and the transparency, the areas of education and health fall within provincial jurisdiction. They are priorities for all Canadians. We have always made the transfer to the provinces.
One of the essential roles of the federal government is the distribution of wealth across the country, or capacity to provide service. This is what we do here, but we go further than that because we state goals. When we say that we have to change the thing, it is not an uphill battle because we have had every professional organization across the country agreeing that the existing systems could not be exactly as they are and we have to look at structural change.
We have to look at multi-disciplinary health care. We have to look at new people and new professions. Nurse practitioners are being used in an isolated area of my riding on an island that is too small to have a GP practicing, but a nurse practitioner supported by physicians is doing an excellent job. In some of those rural areas we have done additional training for the ambulance people, where they are more like physicians' assistants would be in the military. We have those physician assistants that we will start training on the civilian side in Manitoba.
There are all these possibilities that we can integrate into our systems that change them. Also, we have to look at the question of foreign credentials. There are people willing to work, ready to work with capability. Some might need upgrading. There may have to be some structural change in the professional associations and organizations that exist so they would be welcomed. The same thing is true for provincial regulations in certain instances. We have to continue creating more spaces for training human health professionals. That is not just doctors and nurses but they are probably the barometer. If we look back and reverse what we did some 20 years ago when we reduced the seats and now we have started adding, but it will be a few years yet before we start feeling the impact. That will be against the trend of a lot of people, the baby boomers in the profession now who are leaving that have to be replaced. Some have some huge practices and the expectation of practice of the new professionals is perhaps not what it was 30 years ago. You have to work with all those things and understand the reality of the problems that creates and that we live with.
The other thing we have to understand and we have to grapple with is that this does not solve it but it gives the opening for discussions. There are requirements out there for care other than the types of care that we have given before for holistic approach and all the other things that exist and cannot be neglected. Canadians want access to that, but it must be there in a safe and reasonable manner.
I hope I touched on a few of your concerns.
Senator Cook: I hear you saying "we''. When you say "we,'' do you remember, as reflected here, the province and the federation?
Mr. Thibault: When I say "we'' I mean Canadians. That is the partnership of all Canadians.
Senator Cook: Benchmarks and best practices will onlycome as the participants, as outlined in Bill C-39, give a commitment to this. It is not enough to tell me today about trust. As this evolves, we have to develop a standard and accountability, because 10 years at my age is only a blink and we will only have turned the elephant around a little bit.
Even though the system is doing magnificent work in the areas of nurse practitioners, in the areas of tele-medicine, we are managing within it, but this is designed to put on a new face, to turn it around, to look at the health of Canadians.
I want to be reassured that there are good partnerships with the provinces that are getting this money through the federal system and along the way can be held accountable on a regular basis, not in 10 years time.
Mr. Thibault: I hear you well, senator, and I think that would be typified as maybe "trust with verification.''
We heard that term somewhere a while back.
The institute of health indicators or the question and the health council have agreed to participate in different ways and all of their information will be part of the reports. These are third-party organizations so there is a little bit of distance, so we are confident they will each have an objective view.
The province of Quebec signed a sub-agreement that agreed to meet those standards and to do share that information. I believe that both the provinces and the federal government share a genuine desire to meet the challenge to provide a better system for health care in the future.
We cannot continue to simply put in more money. In Nova Scotia, for example, which is a very small province with the same financial difficulties as yours, the health care budget not so long ago was 25 per cent of gross revenues. I believe it is now upwards of 70 per cent.
Everything else suffers and the ability to tax extra is not there. There are more requirements and more expensive requirements, knee and joint replacements, all these things are relatively new and very expensive, as well as drug and other therapies.
To meet the challenge of the future with an aging population and increased expectations cannot be done by maintaining the status quo; you have to do it by redesign.
Mr. McKay: If I may offer a few observations, you will recollect that only a few years ago, all we did was transfer money and we had no accountability whatsoever. In some respects, we have come a long way. It may not be seen to those of us who consider themselves federalists as happy a resolution as we might like, but it is a significant improvement over absolutely no accountability, which was basically the CHST transfer for quite a number of years.
The second point has to do with the communiqué that Quebec signed. Quebec is the most resistant of any of the provinces in terms of standardizing, but the communiqué says that:
Quebec will apply its own wait time reduction strategy in accordance with objective standards and criteria established by the Quebec authorities, including health human resources management, community care reform, home care, drug access strategies, et cetera.
Then it goes on to say that "The Government of Quebec will report to Quebecers.'' That is fine. The communiqué goes on to say that Quebec will continue to work with other governments to develop comparable indicators, and that Quebec's health commissioner is responsible to report to the Government of Quebec on Quebec's health system. The health commissioner will cooperate with the Canadian Institute of Health Information, and in the field of health Quebec will continue to work closely with all levels of government in the sharing of information and best practices.
There we have the most resistant of all the provinces signing on to a communiqué which is embodied in the legislation and is referenced throughout the legislation, and which will be subject to the Parliamentary review in three years.
I think you can look at it as being either half-empty or half-full. It may not in some measure satisfy those of us who think that there should be more rigid accountability, but we have come a long way.
Senator Cochrane: Mr. Thibault, you have opened up a can of worms for me. You mentioned the regional medical school in St. John's, which is a fabulous medical school but we really cannot afford it. It is a very expensive operation to run.
How do we go about looking into the idea of creating one regional medical school in the Atlantic Provinces? That would be wonderful to have. I do not think that we can afford the medical school we have.
Mr. Thibault: If I may give my personal opinion on that, and I do not think this Bill C-39 addresses that issue.
Senator Cochrane: No, but you mentioned the medical school.
Mr. Thibault: That is contrary to what the thinking is now. There are examples of that if you look at the Cuban training delivery system, not that I would say that we necessarily want to emulate that in Canada, but it is good to look at what others are doing. The thinking now is about training people as near to the area you want them to work in as possible if you want to be able to give service to all of the population.
If we did that in Atlantic Canada, it would be good for Newfoundland if it all goes to Memorial, but if it goes to Dalhousie it is no longer good for Newfoundland. If you look at what we are doing in Ontario where we are training in northern communities and in the nursing professions where we are going even further training in the Inuit communities and outlying areas, there is a better chance that the people will stay and work in those communities if they being trained nearer to home. Taking them out of their environment at 18 years of age until 27 years of age and expecting them to return to the outlying areas is a bit of a risk.
How you finance that is interesting. It is a problem we face in the Atlantic area and in Nova Scotia. There are a lot of university seats per capita in Atlantic Canada and we are very proud of that and would never want to lose that. We are proud of the students who come to us from all over the country and other parts of the world but it is expensive. We would like the see the money come with those students.
Perhaps in the future, we can see a system where the federal government assists students more to go to the schools so that the students pay and not so much the province. On the other hand, the federal government does assist in the transfers for education and for specialty institutions. There have been huge investments in the last few years with the Canadian Foundation for Innovation and research chairs and other bodies to upgrade the capacities of those institutes in other parts of the country.
Senator Cochrane: There must be a give and take within the provinces, because everything is so expensive today. We have to look at what is best for everyone.
The Dalhousie law school in Nova Scotia services all of Atlantic Canada and is doing wonderfully well.
Mr. Thibault: Yes, but you have UNB and the University of Moncton.
Senator Cochrane: Most of my people go to Dalhousie from Newfoundland, and there are no complaints about it and it is wonderful. I was wondering if we could do something like that with a medical facility.
Mr. Thibault: That is an interesting point and maybe it is one for discussion between the premiers of Atlantic Canada.
We have done some of that in Atlantic Canada. Prince Edward Island is now the primary trainer in the veterinary field.
Senator Cochrane: Yes, and that is doing well.
Mr. Thibault: From a medical point of view, it is a little different. I would like one more medical school. I would like there to be a francophone medical school in Atlantic Canada, perhaps in Moncton.
Senator Cochrane: I think that nurses should be given more input into our whole health care system.
Mr. Thibault: I do not disagree with you.
Senator Cochrane: Is that for the federal government or the provinces to take care of?
Mr. Thibault: Part of the initiatives that we are undertaking will look at questions like. We will consider the multi- disciplinary approach. We will see whether our health care professionals are being used to their optimum level and see if there is a better way to provide primary health care. We have to be open with this is part of the process.
Senator Cochrane: Nurses could substitute in many cases for doctors in rural areas where they have communication with a central hospital. We have to look at new ideas because in my view, this is not working. I do not know if putting more money into something like this will work again. We should be looking at new formulas, methods and strategies.
Mr. Thibault: I agree wholeheartedly.
The Deputy Chairman: We have built magnificent health science centres but now we need family physicians, and they are being trained in quaternary centres. That does not make sense. They should be trained in community health units, as they are in other countries. Unfortunately, none of us have addressed that issue. We did not address it in our committee study and neither does this accord or Bill C-39. We have to think about that, because we have such tremendous opportunities with this huge infusion of funds. We have to think about strings we can tie to this to change things.
Mr. Thibault: You are right. I do not think anyone sees this as a panacea. With regard to training of general practitioners, I met two weeks ago with the federation of doctors in training. They explained to me that their debt load and the low salaries they make in their residency years encourages them to go into the highest paying specialty rather than the practice which is nearest to their hearts. We have to look at questions like that in the future.
Senator Trenholme Counsell: I find this all very exciting. Of course, it is never enough.
I have been reading about accountability, reporting and collaboration, and there is a lot here on that. I hope that there will be more collaboration across the land than we have ever seen before. Much of this reporting is to the provinces and the first reporting back to the federal government will be in three years.
Mr. Thibault: The reporting is continuous. The provinces report to their people. It is brought together in a single report annually by the Canadian Institute for Health Information and the Canadian Health Council. The first Parliamentary review is in 2008 and the second review is in 2011.
Senator Trenholme Counsell: That is very good. I understand that the goal is to establish comparable indicators andevidence-based benchmarks, but we must encourage, through the first ministers, the maximum amount of sharing, because with indicators, benchmarks, targets, et cetera, it is only by putting the best minds together that you get the best answer.
I am disappointed that the objective is for only 50 per cent of Canadians to have 24/7 access to multi-disciplinary teams by 2011. Perhaps that means newly-developed, best practicesmulti-disciplinary teams, or does it mean primary health care?
What percentage of Canadians has a family doctor now?
Mr. Thibault: I could not tell you.
Senator Trenholme Counsell: Could you elaborate on that? It seems to me to be a weak objective.
Mr. Thibault: I am as disappointed as you are; I want it to be 100 per cent. If it is only going to be 50 per cent, that 50 per cent has to be in rural areas. I am afraid that the powers that be might decide to pick the low-hanging fruit by providing that service in urban areas. It is much easier to do in the urban areas, and that would give the 50 per cent result. I hope that the provinces, which are responsible to their people, will balance this through the provinces.
This is talking about structural change. When we as a nation set a target like this, it does not encompass everything that we want to accomplish. It does not give 100 per cent perfection, but imagine all the steps that have to be taken to reach that. Imagine all the areas that will be at 70 per cent or 80 per cent. If you reach that goal, imagine how much you will have improved the system throughout all communities of the nation. Even if there is not a full multi-disciplinary team available everywhere 24 hours a day, seven days a week, everything should improve. A rising tide floats all ships.
Senator Trenholme Counsell: I do understand that the goal is not just family doctors but the availability of the health care team, which would be far better than what we have now. In reference to a health care team, 50 per cent is good.
You speak of e-prescribing under electronic records and telehealth. This is something that must be monitored and scrutinized very carefully because it is very close to the situation with Internet pharmacies, although that is a cross- border issue.
I hope that is being studied carefully to ensure that if this is allowed under provincial jurisdiction, a doctor or nurse who signs an e-prescription has actually examined the patient.
Mr. Thibault: That is the concern with cross-border Internet pharmacies. The concern is whether a doctor-patient relationship has been established.
This would ensure the maintenance of such a relationship while taking advantage of modern technology and assisting in isolated areas where it is difficult to have face-to-face contact at all times.
Ms. Ballantyne: This is meant to be within the context of an established patient-physician relationship. E-prescribing is a method of reducing adverse events that are the result of poor handwriting resulting in pharmacists not being able to read the script. You are absolutely right that many checks and balances must be included in the system to ensure that privacy is maintained and that all concerns of the patient, the physician and the pharmacist are taken into consideration. This is along-term, structural issue that is currently being worked on with Canada Health Infoway.
Senator Trenholme Counsell: This has brought our health care system to a new level of accountability, planning, vision and financing that will be reflected in the results at each stage. That some of this is meant to be reported as early as December 2005 is commendable.
Senator Carstairs: I am a little concerned with our debate and discussion today in that it looks as if there is no federal presence in health care.
We talk about the money all going to the provinces and the provinces delivering it. That is simply not the case. There are still considerable amounts of money left with the federal government for the federal government to buy the very change that we are talking about the provinces also having to buy into.
For example, Ms. Ballantyne and I have worked closely on an initiative. The federal government put in $1.25 million, and with that money, all undergraduate physicians will be trained in palliative medicine.
That is the kind of initiative that the federal government can still engage itself in and buy significant change in this country.
Are there other things that the federal government will still be able to do in order to buy the very change and to set the direction to make it easy for the provinces to buy in?
Mr. Thibault: The other day I sat with Dr. Bernstein of the Canadian Institute for Health Research, and he showed me some of the projects they have done with 100 per cent federal money. We do not create new institutions or new institutes. We work with the researchers out there and the peer reviewed process to decide which projects get financed.
They showed me some very simple things, and I wish I had the list with me. We have discovered the one type of treatment is as efficient as another, and the total Canadian system ends up saving a few hundred million dollars a year from these procedures or different treatments. That continues to go on. That is an example of the federal initiative supporting everyone.
Another example is Canada Health Infoway. The provinces are all involved with us, but the big federal money will give us the data and a way of having the electronic information system that we all need to make the system more efficient. That is another great initiative.
We do a great deal of federal spending and we are the fifth largest deliverer of health services. We stand behind the police, the veterans, the Aboriginal communities and the military. There is always room for efficiencies and we continue to learn. Look at the reactions we took after we heard from the Auditor General.
In this budget we have added another $805 million forthe next five years for direct health funding, $75 millionover five years to accelerate and expand the assessmentand integration of internationally educated health care professionals, $15 million to complement federal wait time for federal-provincial-territorial initiatives, $110 million to improve data collection reporting, $300 million to encourage healthy living and control and diagnosis of diseases, and a number of others. These are other initiatives that can be done by the federal government, and that will be done, in addition to this transfer to the provinces. That is in this year's budget and outside of this agreement.
Senator Fairbairn: Thank you very much. It is nice to be sitting at this table again. I am sorry I was late. I may have missed a few things that would have answered my questions.
I wanted to come today because of the nature of the issue that we are addressing. I do agree with what others have said about there having been a tremendous boost to this truly indispensable area through the budget and through other actions that have been taken over the last year.
In your remarks, Mr. McKay, you talk about how the provinces and territories, through new funding, will have the flexibility to access the third party trust funding, according to their priorities. This will allow them to address priorities such as clearing backlogs and hiring more health professionals.
One of the biggest problems that seemed to come before this committee over and over again is that we are still far behind in acquiring the health professionals that we need. We understand that we are faced with this situation because of cut-backs that occurred 10-or-so years ago. At that time we cut-back on the admission and teaching of doctors and nurses.
When you talk about hiring more health professionals, just where will they come from? Is there not still a huge deficit in our both nurses and doctors?
Are we thinking of using some of the resources in this large amount of money to encourage people to enter these professions?
It takes a long time to become a doctor or a nurse, and longer to become a specialist.
Are we thinking of importing people from elsewhere?
In your vision, how will we get the number of people that we need to care for our Canadian citizens who are in need of care, in need of operations, in need of all sorts of things?
We do not have that pot of people here in Canada.
Mr. Thibault: You raise an interesting social dilemma. We, as a nation, want to assist developing countries to maximize their social and economic welfare. If we go into those countries and bring all their doctors out because we need them here, it is contrary to what we are trying to do. Often we are forced into that position, or they seek to come here because of the advantages of the Canadian practice. That is part of it, and their foreign credentials are part of the solution.
Having new places in the medical schools is part of the solution. We have done some expansions and there are expansions yet to be done. We have done the same with nursing schools, as well as technicians in the medical trades, and there are still things to happen there. There is additional training that can be given to some of those professionals that will help them enjoy their career for a longer period of time. In some of the professions, we have seen people leave the job early because the work is difficult to do for a long time. There might be solutions to be found in that problem. There is the use of other professionals that we are not using now, such as the question of nurse practitioners and physician's assistants. There is a lot of potential to maximize the people we have now by giving them the proper tools to do their work.
I will give the example of the Yarmouth hospital, a small regional health centre that services a few of my communities. We, through the medical equipment fund, were able to help them. They are putting in an MRI, but we were able to help them with a brand new CAT scan machine and a brand new digital X-ray machine, all connected by high-speed Internet access. The doctors and radiologists and technicians working there now can accomplish a lot more in the amount of time that they have because of the speed of the machinery and the new technology. They also have access to second opinions from people anywhere in the world who are equipped with wide-band Internet access and have the same equipment. It makes it more attractive for professionals to work in those settings.
There is not one easy solution, but there are a whole lot of them. I am not sure it applies as much to the nursing profession as it does to physicians, but we will compound the problem if we have a lot of people leaving the profession in the coming decade, because there is a gap.
The other thing I wanted to point out is that we are, together with the provinces, creating residency positions. That has been a problem. We need those positions, and we need those capabilities.
Mr. McKay: Mr. Thibault has given you a specific answer. Maybe I can give a general answer.
When I travel with the minister and we visit with the provincial treasurers one thing they repeatedly say is that the transfers from the federal government are so unpredictable that they never know just how much money they will get in any given year.
This is a 10-year agreement and the sums are fixed. There isa 6 per cent escalator and the provinces know exactly how much funding they will get for the next 10 years, within some minor area of adjustment.
In the event that a province chooses to open a medical school or to close a medical school or open a nursing school, they now have a stable level of funding. Effectively, the Government of Canada has bought the risk. There is no possibility that whenever things turn bad, the provinces will suffer. We bought down the risk and have appropriated what is essentially an economic risk to the federal treasury.
The Deputy Chairman: I will make a point that is a little bit irrelevant, but since you are in great positions to listen, I will make it.
You should do the same for the Canadian Institutes of Health Research. There is a terrible problem there that they are on annual funding. They really do not know how much money is coming in until the budget is announced. The granting system is enormously complex. Good scientists go out of business because they cannot have that transitional funding.
I know you have to change the system, it is not simple, but between the two of you, if you put a pot of money someplace that would allow those 13 institutes to have enough flexibility to carry a good scientist when he gets caught on the cut-off, you would be making an enormous contribution. I am sorry for taking time out from the other issues to raise this issue.
Mr. Thibault: I agree with you 100 per cent. That is one of the things we will have to look at. Dr. Bernstein explained the conundrum to me. We have two systems under which we are operating. If you look at a system like Canada Health Infoway, where we create a foundation and we put in a pot of money and they use it as needed, they have that stability and they can make long-term contracts.
It is not that the Canadian Institutes for Health Research does not know how much money they will receive, but the way that the Financial Administration Act works, they cannot commit to a multi-year research program. It ends up that there must begood-faith negotiations with the researcher. I am thinking ofDr. Mendez at Dalhousie University who will have to take a little bit of a leap of faith, rather than accept a position in Bolivia or Chile where they can give him a 10-year contract.
There is the problem with the foundations — I do not consider it a problem, but some people do — that there is such a long leash out there, and then there is the Canadian Institute for Health Research that has a very short leash.
It would be good to find something between the two so that these researchers would know where they would likely be in five years or 10 years. Perhaps this would speed along our advances in eliminating some of the terrible diseases.
Mr. McKay: If you placed the call to the Auditor General, we would appreciate it.
[Translation]
Senator Pépin: So, with the Infoway program, the federal government provides funding to the provinces who then administer the funds and decide who can participate in projects and who is accountable?
Mr. Thibault: Infoway works on the same principle as a foundation with precise objectives to be reached. The federal government, the provinces and territories are equal Infoway partners. Deputy ministers from all those levels of government are on the Board of Directors. The President holds a permanent appointment. Board members grant funds for research or development projects according to the objectives set.
Senator Pépin: This will be done on the federal, provincial and territorial levels?
Mr. Thibault: Yes, but differently because the funds come from the federal government. People say they are frustrated with the slow pace of the program but around $170 million have been advanced for projects that require time to plan because we want to find the appropriate solutions. It is a complex issue to bring all the management and computer systems of the provinces and territories to a common base. The challenge is great, but so are the benefits.
Senator Pépin: Quebec's drastic cuts in physician and nursing jobs have created a shortage of medical personnel that will take a dozen years to fill. Yet, in Montreal, there are many immigrant doctors who are driving taxis. Though they are qualified physicians, they must train for an additional one or two years before they can be certified by the Collège des médecins du Québec. Making them eligible for the same loans and bursaries as our own students would ease their integration in the medical environment. As it is now, most of them don't have the financial means to put off earning a living to get that training.
Mr. Thibault: That is an excellent suggestion. We have funds for such projects. We recognize that those people have the necessary abilities. In the little hospital in my home region, in Yarmouth, we took vacant space in the building and set up five offices for immigrant physicians to work under the mentorship of our regional doctors. That is the process they must follow to be recognized by the province as certified practitioners. And our region reaps the benefits of having five more doctors. We must find that kind of solution for situations that frequently crop up.
[English]
The Deputy Chairman: Another area is the repatriation of Canadian doctors who end up abroad for one reason or another. For example, my own daughter is a doctor who went to Oxford to do her preliminary Ph.D. before she did her MD. She got married over there to a young man two years ahead of her, and followed him through Oxford in the Ph.D. program and the MD program. Now she is not qualified to practice in Canada.
Mr. McKay: How could you not be qualified?
The Deputy Chairman: It is unbelievable. In my generation, I would have killed to get to Oxford. I got to Harvard. You could go there without any worry and then you could come back. This is absurd. Anybody who goes to one of the great universities in Europe cannot come back home, which is crazy.
Mr. McKay: That is your union.
The Deputy Chairman: You are right. It is our fault.
Mr. Thibault: On the other side, there is recognition by all professional organizations in Canada that it is a problem and we have to find solutions. Everybody is at the table in those discussions. I do not want to point a finger of guilt at anybody. I welcome them as people who are coming forward with parts of the solution.
The Deputy Chairman: On behalf of the committee, I want to thank you for coming here and giving us your valuable time. I do want to congratulate the government on what they have done, although I must say whoever the next government will be will not have much to talk about when it comes to health.
Are you ready to do clause by clause?
Hon. Senators: Yes.
The Deputy Chairman: We will deal with the title. Shall the title stand postponed or carried or defeated?
Hon. Senators: Carried.
The Deputy Chairman: Shall clause 1 carry?
Hon. Senators: Carried.
The Deputy Chairman: Shall clause 2 carry?
Hon. Senators: Carried.
The Deputy Chairman: Shall clause 3 carry?
Hon. Senators: Carried.
The Deputy Chairman: Shall clause 4 carry?
Hon. Senators: Carried.
The Deputy Chairman: Shall clause 5 carry?
Hon. Senators: Carried.
The Deputy Chairman: Shall clause 6 carry?
Hon. Senators: Carried.
The Deputy Chairman: Shall clause 7 carry?
Hon. Senators: Carried.
The Deputy Chairman: Shall the title carry?
Hon. Senators: Carried.
The Deputy Chairman: Is it agreed that this be adopted without amendment?
Hon. Senators: Agreed.
The Deputy Chairman: Is it agreed that I report Bill C-39 at the next sitting of the Senate?
Hon. Senators: Agreed.
The committee adjourned.