Carolyn Bennett

[Supply, February 4th, 1999]

Mr. Speaker, it is interesting again that some of my colleague's suggestions are things that would be a national standard. We need to be on the international stage showing that we are sticking up for these kinds of things, whether it is child poverty or accessibility to university. One of my constituents has seen McGill University documents courting Americans who will pay more but she cannot get her son into McGill.

There are national standards we want to see throughout this country. It is a matter of our sticking together and saying that it should not matter where we live in this country, that we are entitled to have good health care, good access to post-secondary education and good social programs. We are going to figure out how we measure that so that every Canadian, regardless of their postal code gets the same kind of care.

[Supply, February 4th, 1999]

Mr. Speaker, it is a pleasure to talk today about health care but I am saddened that yet again we seem to be talking about turf.

The motion is filled with words about turf and not about the welfare of Canadians. Words like jurisdiction, unconditionally, encroach and health care field actually mean that we refuse to discuss what is most important to Canadians individually but also to Canadians' role in the international field.

I would like to talk to this motion from two perspectives.

Canada on the international stage when sitting at a meeting with other countries with the Canadian flag in front, needs the ability to be responsible for the kind of health care delivered across the country.

Mr. Speaker, I forgot to mention that I will be sharing my time.

Canadians across the land need to know that when they are represented internationally they will not be embarrassed. Canadians hold their health care system with huge pride. They have expressed that medicare is their badge of honour.

Canadians feel that fairness in the delivery of health care across the country is the most important thing to them. They do not think the size of somebody's wallet should determine where one stands in line for a required procedure. It is extremely important to remember that the provincial responsibility has been for the management and the delivery of health care, but the federal government has always had a role in health care promotion and prevention.

Prevention is the most important thing we can do for our health care system. It must not and can never be separated from actually what is the vision and values of health care for the country. It is integral to doing a good job in health care.

The federal government has always had an important fiscal component in health care. The central vehicle of this has been the CHST. The CHST has been an important lever in terms of a cash transfer. Up until now it has been our only way of insisting on the provisions of the Canada Health Act which are actually essential to the security and confidence that Canadians have in the system.

Public administration, comprehensiveness, universality, portability and accessibility are important aspects to Canadians but as I have said before, unfortunately the Canada Health Act says nothing about quality.

Canadians risk losing confidence in their health care system. It is imperative that the federal government has a way of ensuring high quality care. That begins with an understanding and co-operation in terms of measurement.

It is thrilling that today with the social union talks we have begun discussing things like accountability. I remember last summer when the Minister for Intergovernmental Affairs first mentioned in terms of the social union talks the word accountability. A lot of us were thrilled that there was the beginning of a discussion on how we ensure to Canadians that it is not the federal government checking up on the provinces but it is a matter of both levels of government being able to report to Canadians on how these outcomes are being done.

Today we see in the document things like achieving and measuring results, monitoring and measuring outcomes of social programs, sharing information and best practices, something we know we need to do in order to find the savings. Just giving money is never going to be enough, unless we can ensure that health care is delivered in a collaborative way where all the provinces get to share their good ideas with one another and professionals get to determine what are best practices and a cost effective way of spending the money.

Today we have publicly recognized the respective roles and contributions of all levels of government. But we also know that when funds are transferred from one government to another for the purposes agreed upon it is extraordinarily important that this not be passed on to the residents in some other way. We need to make sure that the dollars for health care are spent on health care and that they are spent wisely on health care.

Involving Canadians in some sort of vision exercise is going to be the most important thing we do. We have to ensure that there are effective measures for Canadians to participate in what it is they want and the ability of the federal government to make sure that it happens.

There are certain places within the provinces that do extraordinarily good things. The kind of standard that is now in Quebec in terms of home care is a model for the country. We should share that information across the country and talk about how we get that for all Canadians. Recently when we saw the B.C. outcomes in cancer, we were all a bit jealous and wanted to know what was being done. It is up to the federal government to be the clearing house to make sure those good ideas happen.

Whether it is waiting lists or outcomes or how people are doing in early discharge, we have to measure the readmission rates, if we are going to boast about early discharge in terms of maternity for example. We need to know about hysterectomy rates and Caesarean section rates and birth weight. We are judged internationally as to how we are doing on things such as birth weight. It is not good enough that we leave the accountability for the provision of health care without holding our own valued responsibility to Canadians in terms of how the dollars are spent.

Traditionally the federal government has had some small direct spending ability. Today in the talks it was again articulated. Federal spending power should be used in making transfers to individuals and organizations in order to promote equality of opportunity, mobility and other Canada-wide objectives. When the federal government introduces new Canada-wide initiatives funded through direct transfers to individuals and organizations, it is going to give notice and co-operate with the provinces.

Look at our CAPC program. There are a lot of areas in Quebec where that is hugely welcomed and gratefully received. It is that kind of initiative Canadians have benefited from again irrespective of turf.

I implore my colleagues across the way to help us decide. There were social union discussions today. The next step must be to move to a proper vision exercise to decide together what kind of country this is and what are the values and the vision for this country. Then we must continue to co-operate in a way that is good for Canadians and accountable to Canadians.

[Science, Research And Development, February 4th, 1999]

Mr. Speaker, much of our future depends on the insights and the capacity for innovation of our country's young scientists and engineers. Since 1964, NSERC has singled out more than 100 researchers for the prestigious title of E.W.R. Steacie Memorial Fellow. These are 100 of our brightest and most productive research stars, individuals who have made a profound contribution to their fields and to Canada.

Today my colleague, the Secretary of State for Science, Research and Development, announced the names of the four newest fellows. Like their predecessors they have distinguished themselves by rapidly acquiring at a relatively early stage in their careers an outstanding reputation in advanced research.

I ask members to join me in congratulating professors Norman Beaulieu of Kingston, Douglas Bonn of Vancouver, Mark Freeman of Edmonton and Barbara Sherwood Loolar of Toronto who are this year's recipients of NSERC E.W.R. Steacie Memorial Fellowship. Their achievements provide convincing evidence of our ability to develop and keep young research talent in the country.

As part of this award NSERC will contribute $180,000 to the recipients' universities in their names.

[Finance, February 2nd, 1999]

Mr. Speaker, people have always gone to the Mayo Clinic when there has been a conundrum up here and I think we will never stop that. It is important in terms of the choice of Canadians.

The hon. member must remind himself that sometimes we see specialized care from watching ER or other American television. Specialist driven care is not the best health care, as the member mentioned. We actually know in terms of research that we have good care in Canada where 50% of medical practitioners are family doctors and are good case managers. People do not end up with unnecessary tests. People end up being counselled in terms of prevention and stress.

We actually have a great system. We need to begin to look at accountability. We need to take time with Canadians to explain the options. We need affluent Canadians to stick up for our system. If we lose the confidence of the affluent people to speak up for our publicly funded system, we actually lose our best allies.

I would counsel anyone to have a look at the outcomes of some of the specialist driven things that have come from Harley Street. Going from specialist to specialist to specialist is not good care. We have a great system. Our family doctors are platinum trained. They are being recruited to the United States which ends up with a cost effective care that is actually managed care, not the kind of managed costs that is a concern in the HMO and managed care system in the United States.

I am hugely optimistic that we know how to do it here and that it is actually better care.

[Finance, February 2nd, 1999]

Mr. Speaker, it is a pleasure to speak in three ways this evening, first as the member of parliament for St. Paul's, second as a member of the finance committee and third as someone who has fought hard for the protection of the Canadian health care system and who feels deeply that the confidence that Canadians have in that system is the most serious protection we have against the slippery slope to a two tiered system.

In St. Paul's we had a prebudget consultation of some of the opinion leaders and it was clear that they too felt there were three main things that we should be focusing on. They felt that debt reduction was imperative. It was clearly the priority of those people who were in attendance. The talk of debt reduction focused on how much should be spent on that and many mentioned how debt reduction would have a positive impact in a number of ways.

Almost everyone in attendance at the meeting spoke about social spending. While most discussed their priorities for the 1999 budget in terms of health care, medical research or employment spending, many cautioned that the instability of our economy in a volatile global environment necessitated prudence in any spending measures. They also felt that we should be cautious about raising spending expectations.

With respect to health spending, many of those in attendance expressed concerns about the growing gap between the rich and the poor, which we have heard a lot about. They expressed a desire to see the 1999 budget address the connection between poverty and health and preventive care. National standards were also mentioned as being health priorities. Health spending topped the social spending agenda for the people in attendance.

The other area was in research spending. While discussing social spending many mentioned the need to increase spending on scientific research and that this would be a very concrete investment that would have high returns. In fact some of them were specific in that 1% of public health dollars should be the target perhaps over a three or five year period.

Tax reduction was also a priority for some of the people in St. Paul's and some felt that it should be a major priority. Like debt reduction, many saw that the benefit of tax reduction would translate into improvements in other areas. The number one priority was to decrease personal taxes, especially for those who live in poverty. Some felt quite strongly that paying slightly higher taxes than some other nations, notably the one to the south, was part of living in a just and civil society. They placed tax relief after the spending initiatives.

In the finance committee we found that there were many, many thoughtful presentations. People talked about the brain drain, about the need for health care and research. There was a rather interesting presentation on the progress indicators as they change from the GDP. In fact in St. Paul's we had a town hall meeting on that subject in the past month, looking at some of the work of Marilyn Waring. We are very proud that as Canadians it is the first time StatsCan has been able to actually put the unpaid work of women into our census.

There were many external factors which those of us on the finance committee felt. Obviously there was the change in terms of the OECD warning us about debt reduction, as well as its admonition with respect to the necessary tax cuts.

Members felt that the rising tax burden of Canadians and the lack of disposable income was a problem, as we have seen disposable income, personal after tax income, fall steadily since 1990.

People were concerned about the UN, although we still are number one in human development. We felt the fact that we are 10th in human poverty was something we should look at. Obviously, we considered the conference board's concern regarding our standard of living and, again, the fact that our best and brightest are leaving to go to other countries.

We felt clearly that an increase in the personal tax exemption would be a good thing for almost all Canadians. This would take a certain percentage of Canadians right off the tax rolls. It would be of specific help for the working poor in terms of their disposable income.

There was one night in St. Paul's when we had a town hall meeting on bank mergers where there was one very vocal person who said “Don't give the provinces any more money for health care”. This was unlike the hon. member for Markham, in that they felt that they could not be trusted in terms of what they would do with it.

That has been the major debate in this country regarding what we actually do about the CHST. I would like to remind the hon. member for Markham that in the Progressive Conservative election platform they were actually going to reduce the cash transfer to zero. I do not think that then they would feel that the federal government was giving zero to health care. We have to continue to remember that there is only one taxpayer. We have to figure out what it is that Canadians need in order to feel confident about the quality of health care in their country.

There are four things that are most important when dealing with health care and how important it is to Canadians. We must remind ourselves that unfortunately when the Canada Health Act was written the word quality was nowhere to be seen.

Although the five tenets of the Canada Health Act presumed high quality care, I do not think it could have presumed the sort of bargain basement care that has come about since people have not actually been accountable for how the money is spent.

The trends from hospitals to community care, doctor to multidisciplinary and a kind of evidence-based, best practices kind of care have not been dealt with appropriately in the follow-up to the Canada Health Act.

First, we have to recommit to the Canada Health Act. Second, we must begin to measure what the outcomes actually are in terms of the waiting lists and in terms of a real commitment to the information technology that is required to do that.

Michael Decter, who is head of Canadian Health Information, said in Maclean's in June that Canada had badly underinvested in health information and that we spend only 2% of our total health care budget on health information. He said that we would get much better value for our total health dollar if we increased this vital investment to 4%.

We have to know what we are doing. One of my concerns has been that when the Canadian Medical Association or anybody else continues their chant about underfunding we do not actually know where that money is going. People are continually concerned about unnecessary surgery, antibiotics for virile infections and many other things.

In 1995 there was a paper called “Sustainable Health Care for Canada” done by Angus, Auer, Cloutier and Albert. It was very clear about what we have to be doing. We have to be dealing with the fiscal pressures on government, the lack of knowledge about the links between health care and help, the ethical dilemmas involved in rationing health care services and contradictory incentives built into the rules and regulations governing health care. They felt that those tensions were not new, but that we could not keep throwing money at the problem.

They felt that if we actually moved to best practices there would be $7 billion worth of savings every year. In those days 15% of the public health care costs could be saved.

We should actually move to a more accountable system. Money will not be the problem. We need to have some sort of accountability, as we said, in terms of the Ontario Hospital Association saying this was really about mismanagement and not necessarily just about money.

We have informal standards in this country. When the B.C. cancer outcome rates are much better than the rest of the country we sort of see that as an informal standard. When Quebec's home care system is better than the rest of the country, viewed by experts, we see that as an informal standard that all Canadians expect.

We now have to find a way to have all three levels of government report to Canadians on a regular basis. It is not big brother checking up on the provinces. It must be, as the Minister of Health has said, a way for all levels of government to be accountable to Canadians about how their health care dollars are being spent, their tax dollars.

The fourth area has to be in research. As some of the people in St. Paul's have said, the idea of moving to a target of 1% of public health dollars for health care is a target that we should be shooting for.

The proposal for the Canadian institutes of health research is a good one and I am thrilled that we are starting to see things like population health, clinical and evaluative sciences, and primary prevention, as well as our amazing track record in the medical model of research.

I am hugely optimistic as we move into this next budget. It is a thrilling problem to have a surplus. I think that all Canadians thank the government for what it has done in a prudent fashion and I look forward to the budget.

[Finance, February 2nd, 1999]

Mr. Speaker, as a physician in the province of Ontario I feel quite sensitive to the hon. member's comments in terms of the CHST having been the problem. We know the reduction in the CHST has had one-fifth of the impact on health care spending as the tax cut in Ontario.

At the finance committee we heard from the Ontario Hospital Association: “The underlying problem is thoughtless mechanic tinkering with the system in nearly every province. The crisis is rooted more in faulty planning than demographics, finance or technology. The good news is that this management crisis can be fixed”.

I suggest this upcoming election may be what we need in order to fix health care in Ontario. If you actually look at these so-called increases in the health care dollars that you are touting in the province of Ontario, a lot of that is actually the severance for fired nurses. You have to actually have a look at what you are saying. We know that we need accountability on this stuff. We actually need a real plan.

[Taxation, December 8th, 1998]

Mr. Speaker, my question is for the Minister of Industry. The opposition wants us to believe that the minister is in favour of higher taxes as a way of boosting productivity. Can the minister tell this House where he really stands on this issue?

[Violence Against Women, December 7th, 1998]

Mr. Speaker, on Friday, December 4, I was honoured to participate in a special candlelight and roses commemoration for the victims of the Montreal massacre. The hour of remembrance was held at the Women's College site of the Sunnybrook and Women's College Health Sciences Centre.

Our two guest speakers were Professor Wendy Cukier, President of the Coalition for Gun Control, and former mayor of Toronto, Barbara Hall. Professor Cukier spoke emphatically about the need to recognize the significant role that rifles and shotguns play in the high number of women assaulted and killed by their intimate partners and the importance therefore of our new, strong gun control legislation.

The need for prevention was echoed by Barbara Hall, chair of the national strategy on community safety and crime prevention. Ms. Hall stressed the need to use all available resources in order to make our communities safe for women. We must create an environment in which women feel safe. By doing so, we will in turn have created safer communities for all of us to live in.

Friday's event was a reminder of the terrible consequences of violence against women. Clearly we must focus on preventive measures. We cannot allow such an event as the 1989 Montreal massacre to be repeated. We cannot allow violence against women to continue. We must never forget.

[Health Care, November 27th, 1998]

Mr. Speaker, today in Halifax the Minister of Health, together with Nova Scotia Health Minister Jim Smith, announced some important initiatives for the future of health care in Nova Scotia and all of Canada.

Funded under the health transition fund, these four projects will be testing ways to improve primary health care to enhance the health of children and youth in Nova Scotia, to pilot palliative home care in rural areas and to develop a new model for primary care in the Eskasoni First Nations community. Total funding for these projects will be $4.8 million.

The common thread through all of these projects is that they put the patient first by organizing health services around the needs of people instead of the needs of the system.

In the spirit of co-operation that is guiding our efforts, these projects will be managed in partnership with the Nova Scotia ministries of health, education, community services and justice, the Prince Edward Island department of health and social services, Health Canada, Dalhousie University and the Eskasoni First Nation reserve.

These projects will generate evidence based information to help provide the right care, at the right time, in the right place.

[Points Of Order, November 18th, 1998]

Mr. Speaker, if you come across information that would be interesting to the House or possibly new information that was not raised here this afternoon, would it be possible for you to bring that to us so that we could comment?