Proceedings of the Standing Senate Committee on
Social Affairs,
Science and Technology
Issue 2 -- Evidence
Ottawa, Tuesday, May 7, 1996
The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill C-18, to establish the Department of Health and to amend and repeal certain acts, met this day, at 10:00 a.m., to give consideration to the bill.
Senator Mabel M. DeWare (Chair) in the Chair.
[English]
The Chair: Honourable senators, for our consideration of Bill C-18 this morning, we have representatives of the Department of Health. Mr. André Juneau, Assistant Deputy Minister of Health, is here, and he has with him Mr. Mark Wheeler and Mr. Mario Simard.
Gentlemen, I welcome you on behalf of the committee and I would ask you to go ahead and guide us through this briefing book.
Mr. André Juneau, Assistant Deputy Minister, Policy and Consultation Branch, Department of Health: It is a pleasure to be here. I do not have a prepared statement, but if it is okay with you I would like to make a few opening remarks.
[Translation]
To remind the members of the committee of what they may have had an opportunity to learn from reading the documents, the bill before you results from the reorganization of the government ordered by the Prime Minister in the summer of 1993, under which the Welfare component of National Health and Welfare was detached from the Department. Other components and departments were added to the Department of Health.
Senator Gigantès: Under the then Conservative government?
Mr. Juneau: The proposed legislation would confirm the existence and mandate of the Department of Health. The bill is not fundamentally different from the legislation it would replace. Naturally, it reflects the Department's new components.
Under the bill, the responsibilities of the Minister of Health are extended to all matters at the federal level relating to the promotion and preservation of the health of the people of Canada.
[English]
The act reflects a holistic approach to health, which takes into account the physical, mental and social being of the population. In this statement I will not go through all of the sections of the act, but I would draw your attention to subsection 4(2), which lists the specific functions of the Minister of Health.
I would also like to make a few comments about the department as it now stands. It is made up of three program branches and two corporate branches. Forty per cent of our employees work in the Health Protection Branch, which is the home to our regulatory and disease monitoring functions. This is the place that administers the Food and Drugs Act. This is the place that approves or does not approve medical devices. This is the place that cooperates with public health authorities in Canada and around the world in disease surveillance activities, and it is where the laboratory centre for disease control is located, for instance.
Our other large branch is the Medical Services Branch; that branch is largely responsible for health services on Indian reserves and in the Yukon Territory and it is made up of about 2,500 people.
Our smallest program branch is the Health Promotion and Programs Branch, which is the home of our various population health strategies and is also the home of the National Health Research and Development Program.
Then there are two corporate branches. There is the Corporate Services Branch, which does administration, finance, facilities management, infomatics -- the usual things; and then the smallest branch, which is my branch, is the Policy and Consultation Branch, which has responsibilities for planning, communications, federal-provincial relations, and international relations, and also looks after substantive policy areas such as the Canada Health Act, women's health, and other major policy issues such as new reproductive technologies.
That is just a cursory overview, Madam Chair, but perhaps I can leave it at that and I will be very happy to answer questions that the members might have.
[Translation]
Senator Lavoie-Roux: I must confess something to you. I saw this very recently. It is a very brief overview of the situation. You are transferring the Welfare component to the Department of Human Resources Development. What bothers me in this, all at once, is that Welfare is separated from health, although you were saying somewhere:
[English]
It is an holistic approach: mental, social and everything. It does not bother me whether it was done under a Conservative or a Liberal government. If it was done under the Conservatives, I suppose the Liberals were elected to do better, but, more seriously, this is counter to the actual, stronger trend to make close links.
[Translation]
You are putting it in two different departments. This is perhaps a somewhat political question. I won't hold your reply against you. Doesn't this surprise you? It runs counter to the current trends of making very close links between the social conditions and welfare of people and health.
After all, the studies all prove that the poorer you are, the sicker you are and the younger you are when you die. You know the statistics. Suddenly, you are dividing the two. Who is going to ensure the links between them? How are you going to make the links between the two?
Mr. Juneau: I prefer to answer the question as you formulate it, at the end of your question. For years, in the Department of Health, we have promoted a broader concept of what affects the health of individuals. We are working with other federal departments and other agencies, including the provincial governments of course, to advance this more comprehensive conception. This requires that we work with the Department of Finance, the Department of Environment, the Department of Immigration.
To illustrate this, we worked within the framework of a federal-provincial committee at developing a document entitled "Une stratégie pour la santé de la population", in which we encourage the federal government and the provincial authorities to work in a more comprehensive fashion.
It is not within my responsibilities to comment on how prime ministers organize their governments.
Senator Lavoie-Roux: From the professional standpoint?
Mr. Juneau: We have to have links with a whole series of other departments, not only the Department of Human Resources Development. Having said that, insofar as the Department of Human Resources Development is concerned, we do have some close links with them. They enable us to advance this more comprehensive concept you are talking about. The Welfare component in the Department of National Health and Welfare included all sorts of programs, for example, the pension plan, family allowances at one time, the transfer programs to individuals and the provinces. This does not alter the nature of the collaboration we have to have.
Senator Lavoie-Roux: I am not opposed to your pruning back on programs that need not pertain to Welfare and Health. They can impede functioning and prevent you from focusing your energy on the real health problems.
You say there will be links with the Department of Human Resources Development; their worries or their concerns are, on the one hand, very strongly financial in nature; on the other hand, they affect social assistance, unemployment, the pension plan.
There cannot be the same real comprehensive thinking about the implications of social factors on health, and vice versa. What will the nature of these links be? You are speaking from one deputy minister to another. I have been acquainted with this, education and health.
Mr. Juneau: If you have been acquainted with this system, you know that within the same department it is not always obvious.
Senator Lavoie-Roux: I agree. It worries me. Can you tell me whether there will be a new conception of interdepartmental work that will guarantee that this concern is not lost and that at some point unemployment will get the upper hand over health, or vice versa. How is the genuine cohesiveness between the two to be established? If it isn't, we are going backwards.
Mr. Juneau: It is hard to be convincing. You are right. It has to do with bureaucratic systems. For example, we have established some mechanisms for joint action with them on all matters affecting children and young people. We have some very elaborate committee systems, documents drafted jointly, priorities identified together. We are asking the people in the regions to work together.
The problem does not seem to be much different from that of the horizontal collaboration we ought normally to have with a whole series of government departments. You know this is difficult. It has to be done.
Senator Lavoie-Roux: It is not your choice.
[English]
Senator Cohen: My question concerns how this bill deals with, or is affected by, the integration of the Department of Labour with the Human Resources Department under Bill C-11.
On April 30, during the debate on Bill C-11, Senator Kinsella questioned Senator Romkey on whether the Secretary of State on the Status of Women was included in the new department, and Senator Romkey said that the point was well taken and that we should pursue it, because at the moment the status of women is in with, I think, Heritage Canada and that whole division. Senator Kinsella's point was the following:
...the mission of the new machinery of government is to give focus to human resources development in Canada in a manner that is sensitive and includes the participation of all Canadians. As we know, unfair pay practices continues to be one example of inequality. If responsibility for the status of women has been moved to that ministry, that would be very congruent.
Senator Gigantès: Very what?
Senator Cohen: It would be a proper home is what he means, rather than being within Heritage Canada, or, as he put it, being bounced around. He thought we should look into that, and Senator Romkey agreed that that was an important point.
I would like to have some clarification on that and maybe the committee would consider looking at it a little further, because I think it is important.
Mr. Juneau: Senator, I am not sure I follow your question so far as I am concerned. You are commenting on whether the Secretary of State for the Status of Women should be attached to the minister responsible for the Human Resources Development Department.
Senator Cohen: It should have as one of its units the status of women.
Mr. Juneau: Given what this bill is about, I understand why that might come up, because we are talking about a Department of Health that is no longer responsible for units that are now within the Human Resources Department, but I would prefer not to comment on the specific units other than to say, since you have given me the occasion, that the Women's Health Bureau of Health Canada is part of my branch and I am quite happy with that arrangement.
Senator Cohen: I probably put it in the wrong slot, but I think it is something that this committee should consider.
The Chair: I would like to make one comment to the witnesses about the aspect of palliative care. We had, as you know, an extensive study on euthanasia and assisted suicide. In that study we made some very demanding recommendations, or recommendations that we thought were very important to the Department of Health in the way of more palliative care in the country and also on the pain-management side, where we felt that there should be more drug research done to assist with pain management in the country.
I hope that in your health information, in your research and so on, you will take into consideration the recommendations of the committee, which worked on that for 18 months, when you are dealing with that, because we as a committee felt that that was a very important aspect of it.
Senator Lavoie-Roux: When Minister Marleau came before us, I believe she said there probably was no more money for that purpose, but money would be reallocated so they could take into consideration the need for more palliative care. Am I right in saying that?
Mr. Juneau: I accompanied the minister when she spoke to the Senate committee that was working on those issues so I am reasonably familiar with that work. I can tell you, although he would probably want to do most of the talking about this, that Mr. Dingwall is personally very interested in matters related specifically to palliative care.
Senator Gigantès: I have some personal experience on this issue. For the last two months of my wife's life she had nurses around the clock. Eighty per cent of the cost of that care was paid by the insurance company; but it costs $30 an hour, so that left $6 an hour for 24 hours. I could afford it, but what happens to a poorer family who cannot afford it?
Senator Lavoie-Roux: Palliative care can be delivered with no charge also.
Senator Gigantès: Not in the Province of Quebec. I went to the CLSC, but they could not provide palliative care at home; they told me to take her to the hospital. It is more expensive in the hospital than it is at home, as we all know.
Senator Lavoie-Roux: Is the CLSC in all areas?
Senator Gigantès: The CLSC Grande-Rivière in Hull has won prizes for its excellence in palliative care, and I have no complaints about them, but I had to hire the nurses; they did not have enough.
The Chair: Senator Gigantès, we do not want to get into a discussion about palliative care. It means a lot of things; one is a support team in a community to look after people in need, not only the patient but supporting the family of the patient, and it really encompasses a great deal more, and we hope that if the research people start there will be support for people like you in Quebec and elsewhere.
Senator Bosa: How many people does the Department of Health and Welfare employ as it stands now?
Mr. Juneau: The exact number published in the Main Estimates is 6,362.
Senator Bosa: For the department as it stands now?
Mr. Juneau: Yes.
Senator Bosa: After this bill becomes law, how many will be transferring to Human Resources -- how many in that section?
Mr. Juneau: They are gone already.
Senator Bosa: They are gone already? We have not passed the law and you have already made the changes?
Mr. Juneau: Yes.
Senator Bosa: It is nice to know that you depend on our decisions; I mean you have the clairvoyance to know what we will do.
Senator Lavoie-Roux: How many were there before they left?
Mr. Juneau: About 10,000. Senator, I believe the way this works is that there is legislation on the books that allows the government, by order in council, to move units of the government around; but it is not final until legislation is passed.
Senator Bosa: Of the 6,362, how many will be transferred to the Department of Human Resources?
Mr. Juneau: None.
Senator Bosa: None? No, no, there is something missing here. The Department of Health and Welfare, before this becomes effective -- or maybe it is already in effect, although the legislation has not been passed, but how many people did the department employ?
Mr. Juneau: Oh, I am sorry, senator; there were about 10,000 people in National Health and Welfare and about 40 per cent were transferred out.
Senator Bosa: To Human Resources, which was the part of the welfare aspect of the department?
Mr. Juneau: Right.
Senator Bosa: I see. Maybe this is out of the purview of your responsibilities, but how many people does the Human Resources Department employ now?
Mr. Juneau: It is not exactly my responsibility, but it would be somewhere between 25,000 and 30,000, I would say. I used to be in the old Department of Employment and Immigration so I have a sense of this.
[Translation]
Senator Losier-Cool: My question may not be directly related to the bill. I refer to the perspective of health in Canada. What are the centres of excellence in health? Ms Marleau spoke of some. Mr. Dingwall said he was leaving them in abeyance.
Mr. Juneau: It's all going ahead. The minister should be able to announce soon which centres will have been selected.
Senator Losier-Cool: I should find it within the strategies for improvement. I am referring to page nine of the document. It is part of research.
Mr. Juneau: Essentially, yes.
Senator Lavoie-Roux: I understand that it is a political decision. I don't understand the separation between Health and Welfare. Unemployment insurance was in Immigration, not in Health. Training was in Immigration. Basically, there is nothing new. I referred to this tendency in all the provinces to move toward unification. Ten years ago, Quebec and New Brunswick put health and social services together. Some people want to divide it. There are all kinds of reasons. The doctors find that social services take too much and vice versa. Other provinces have come into it. It is a movement that is increasing for some very specific reasons that you are acquainted with. The federal government is going in the opposite direction.
Mr. Juneau: I may make another comment. Two logics are involved. One, the one you refer to, consists of putting health and social services together. The other is to say that, in order to assist those who are most disadvantaged in the labour market, we must combine social assistance, unemployment insurance and labour force training. This is a logic that Quebec has long upheld. The government of that day elected to go that route with the logic that says that all the instruments designed to facilitate income support or labour force participation should be put together.
I will not take a position on how I would have proceeded if I had been the prime minister.
Senator Lavoie-Roux: I will make my comments on this in the Senate.
[English]
I think it is going back. You are familiar with the way it works in New Brunswick; there were a lot of advantages in having both. Even so, social welfare, including unemployment, if we may talk about social welfare for a moment, was not within the ambit of health and social services; it was out in Le Securité de Revenue in Quebec and maybe in the Department of Labour in some other provinces I am not familiar with. However, I agree that this, because otherwise it gets to be so big that it does not make sense; but, on the other two ministries, I really would like to see the discussion paper you have prepared in order to assure myself that the junction, or the amalgamation, is well made and that we do not lose anything in terms of policies or the division of the two ministries.
[Translation]
Mr. Juneau: In the branch responsible for health promotion programs we have retained a number of responsibilities pertaining to social development. The intervention programs for children, seniors, some categories of women, for example, victims of family violence, all this has been kept in the Department of Health. I don't want to give the impression that all the social programs are now in the Department of Human Resources Development. There is a fair share, I round it off at 200 million, that has remained with us.
Senator Lavoie-Roux: I would appreciate getting the organization chart showing what will remain in the Department of Health.
[English]
The Chair: I believe that is all we have for you this morning, gentlemen. We appreciate your time. Thank you for coming before the committee. You will hear our results this afternoon.
Senators, I believe that we now have the bill to deal with in its entirety.
Senator Bosa: I move that the committee adopt the bill without amendment and that we report it to the Senate.
Senator Lavoie-Roux: I am not quite ready for that. I received the briefing book only at 9:30 this morning. Now you say go ahead and approve it without amendment. I cannot do that. I do not want to delay the bill; I think it has to go through, but --
The Chair: Did you have the bill, though, to look at before you got your briefing book?
Senator Lavoie-Roux: Yes, but I must also confess that I did not spend my weekend reading the bill; maybe I should have, but I have other public affairs to take care of as well. I dislike the idea of our not giving ourselves any time for discussion after we have heard witnesses on a piece of legislation.
Senator Gigantès: May I ask when Senator Lavoie-Roux thinks she would be ready?
Senator Lavoie-Roux: I would be ready on Thursday.
The Chair: We have not been able to find a time slot for this committee to meet again this week. We have tried, because we wanted to have the Department of Human Resources come before the committee, but there just does not seem to be any other time this week for this committee to meet. Every one of you is busy doing something else.
Senator Lavoie-Roux: If you want to send it like this, go ahead; but I think at least we should express our concerns. But perhaps I am the only one who has a problem, because I was Minister of Health and Social Services. Since health and social welfare are so closely knit -- and all the social studies are to that effect, I think we should at least make a recommendation that both ministries, health and human resources, work out the proper interaction so that neither one loses.
In view of the trend in the provinces over the last ten years, I think it is important to get the two concerns more closely knit.
The Chair: The deputy minister did agree to give you the flow chart, did he not, of how he thought it would happen? Would that suffice?
Senator Lavoie-Roux: He might not be able to send it to us within 48 hours, though.
Senator Gigantès: I propose that the committee attach a commentary to the bill, when we approve it, which would say what Senator Lavoie-Roux has said, that we consider it terribly important that there be proper and tight interaction between the welfare side and the health side.
Senator Lavoie-Roux: And a proper link so that the exchange between the two assures us that neither one side nor the other gets lost in the process.
The Chair: If it is agreed, then, we will attach a note to the bill with a recommendation from the committee expressing that concern.
Senator Lavoie-Roux: Yes, because it is important.
The Chair: With that, Senator Bosa has a motion on the floor to accept the bill without amendment.
Some Hon. Senators: Agreed.
Senator Lavoie-Roux: With the condition that we add the recommendation.
The Chair: Yes, we add the recommendation.
Senator Bosa: Madam Chair, just for the benefit of Senator Lavoie-Roux, I should like to say that I have taken into consideration the fact that there are no other witnesses that have requested to appear before the committee, that this is not a controversial bill, that this is merely a detachment of one section from the Department of Health to Human Resources. In making my motion I did not mean to prevent anybody else from making any observations, and I am glad that Senator Lavoie-Roux made that observation.
Senator Lavoie-Roux: It is also a matter of policy and it is no obstruction whatsoever.
Senator Bosa: I realize that.
Senator Lavoie-Roux: We have the responsibility to ensure that policies do not go down the river, especially if they are important ones. That is all; it is a matter of principle.
Senator Bosa: That is fine. I think your views are very useful to us. I am certainly in favour of incorporating that in the bill and then we will report it without amendment.
The Chair: Shall we report the bill without amendment, but with a recommendation?
Hon. Senators: Agreed.
The Chair: Carried. Shall the title of the bill carry?
Some Hon. Senators: Agreed.
The Chair: Carried.
Honourable senators, we will meet at the call of the Chair. Senator Haidasz does not want to be the first witness on his bill, so that holds us up a little on that. In the meanwhile, we will try to get the Department of Human Resources in, but if we do not have witnesses to hear next week, then we will make it a work week on the budget.
Just before we adjourn, senators, there is one other matter I would like you to think about for next week. This committee used to have a subcommittee dealing with veterans affairs; I think we must decide whether we intend to continue with that practice, and I would ask you to come prepared to discuss that next week. Do we intend to go ahead with the Veterans Affairs Subcommittee with a couple of our committee members on it? Please think about that.
The committee adjourned.