Health Committee on Nov. 25th, 2009

[Michael Brennan]

If I may just add one more thing, it's critical.... I hope I'm not conveying the message that the federal government is responsible in some way for this, because the federal government is a participant in this, but the professions themselves must inform health consumers about what works and they must do it collaboratively. We have a very good relationship with physicians, nurses, and other health care professionals, and if we fail to make a cultural change where patients expect this collaborative care, then the fault is ours.

We are undertaking a national advertising campaign starting in February, at our expense, with our communications--by the way, as a primary health care profession--to tell patients about what collaborative care and access to physiotherapy means for them. We're not looking for any government handouts. We're simply asking the government to seize the opportunity.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Would there be agreement among all of you for how we would describe that conditional transfer of money? Would it be collaborative practice or multidisciplinary group practice? I mean, is there enough in all of your papers that we could put this in as a recommendation in a report that we're supposed to do very soon?

[Dr. Jeff Poston]

I think there probably is. I would suggest.... I think the word that's emerging is inter-professional; it's either collaborative practice or inter-professional practice. I think that's where the literature and the serious thinking around this are heading.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Didn't Roy Romanow's royal commission put the emphasis on group practice?

[Dr. Jeff Poston]

I think the important thing is the inter-professional piece, which is the bit that that we want to try to get at.

[Dr. Paul Saunders]

It might be in groups, but it's a group of professionals working together cooperatively.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

That's very helpful. Thank you.

[The Chair, Conservative, Joy Smith]

Thank you so very much.

Now we'll go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I'm really interested in what you have to say because of my background. I'm a chiropractor. I.I've worked in multidisciplinary clinics with physicians, physiotherapists, psychologists, nutritionists, and naturopathic doctors, so I've seen first-hand how it works, but I was wondering if you could help us out.

My colleague asked what the federal government can do. We've heard that the federal government doesn't have a brain, but with jurisdictional issues, I believe that--

[Voices]

Oh, oh!

[Colin Carrie, Conservative, Oshawa, ON]

I think health care is a provincial jurisdiction anyway.

But what can your professions do to help decrease wait time? We've heard of this collaborative model, and I know that in my own practice, about 30% to 50% of the practice of the average physician that we worked with was musculoskeletal. They didn't like doing it. They referred it to the physiotherapist or the chiropractor and that freed them up to do a lot of other things.

We're talking about better use of professions on the ground. We've heard that naturopathic physicians have said that sometimes there's bias in the system. What do you mean by that? Is it the government? Is it the insurance companies?

I've heard stories about notes for work. People go to the physiotherapist or chiropractor or somebody, but they have to go to the physician for notes for work.

You mentioned therapy requirements. Can you give us solid things as recommendations? Should we work with insurance companies and tell them that they will start taking notes for work for these things from naturopathic doctors, chiropractors, and pharmacists as well. That won't cause this bottleneck to occur. Could you comment on that?

I may be sharing my time with Mrs. McLeod if we can get that answer.

[The Chair, Conservative, Joy Smith]

Maybe you will.

Who would like to tackle that first?

We'll start with Dr. Busing, and then we'll hear from Mr. Brennan.

[Dr. Nick Busing]

I speak from a physician's perspective, but we see a number of examples in the country that we need to build off. I think there are a few things in common, so I'll just mention two very quickly.

You all know about the hip-and-knee study out of Alberta. How did they move from many weeks to a matter of a number of weeks to move people through the system?

I think you all know about the breast cancer study out of Mount Sinai in Toronto. Again, it's the same thing.

We should look at a couple of those studies and at what made the difference. We see a number of themes. I don't have them in front of me, but one theme is that both of those models had, for want of a better word, a “facilitator” to make the whole system work. There is some literature around the use of facilitators, triage officers, or managers, whatever you want to call them, who are the people who just take the individual patient through the system.

I'm giving you just one example because we have very limited time. I think this is the kind of strategy we should look at because the evidence is pretty powerful.

On the primary care side, which is an area I practice in when I have a moment to practice, we are developing advanced access systems. We are trying to encourage family physicians to change their whole model of booking so that the bookings are not based on coming back in four months for high blood pressure. The bookings are based on same day and 24- and 48-hour calls to the physician.

We have a number of things going on and we need to pull them together. We've done a lot of pilots and we're doing a lot of things, but we're not putting it together. I must say that we're probably duplicating it across the country, and we wouldn't need to if we could roll it out.

[The Chair, Conservative, Joy Smith]

Mr. Brennan.

[Michael Brennan]

Thank you.

Dr. Busing stole my Calgary example, which is perhaps the most famous one where physiotherapy is concerned. The reduction of wait times for musculoskeletal surgery--hip and knee especially--is very dramatic and the example is so clearly understood by a layperson such as myself that it begs the question of why we can't do this across the country.

The answer is that we can and in fact we are. The question is, are we doing it fast enough to meet the needs of this ever-increasing health care cost? Bill 179 in Ontario is a good example of a provincial government getting ahead of the pilot project type of approach and opening up or removing, if you will, barriers to the implementation of exactly those kinds of projects and systems. I think there's a lot of potential there.

Again I would come back to what the federal government can do, which is simply to make sure, if you are funding any kind of health care expenditure, that the folks you're giving the money to are using those types of inter-collaborative models. The health care expenditures in first nations, in the military, and, again, with the public health care plan: those are billions of dollars. Obviously we're talking hundreds of billions when you do health care systems provincially, but it's still a significant amount of money, and you can take action on that today.

[The Chair, Conservative, Joy Smith]

Mr. Poston.

[Dr. Jeff Poston]

Yes, if I could just add to that, I think we've seen some good examples recently, one, for example, from the United Kingdom, where the government is actually funding--and Scotland has been the key piece--minor ailment schemes for community pharmacies. Patients register with a pharmacy and the pharmacy is reimbursed on a capitation-based system.

The idea there is that the pharmacy actually takes care of a lot of the routine stuff in terms of minor ailments and common symptoms and helps to reduce some of the pressure on family medicine and on emergency teams. I'm hoping that's something that we may see come out of Bill 179 in Ontario.

[The Chair, Conservative, Joy Smith]

Are there any other comments?

Dr. Lescheid.

[Dr. David Lescheid]

I just had one point that I think we could be helpful with. I think one of the messages that I'd like to see strengthened is the importance of health promotion and disease prevention. We could actually keep people from the hospitals, from the wait times, by really promoting a stronger stance on health promotion. I was fortunate enough to speak at an international swine flu conference yesterday, and one of the messages, loud and clear, was that we have a reactive rather than a proactive health care system.

I think there's been a lot of evidence in regard to looking at the chronic diseases, the complex chronic diseases, and at how we can prevent a lot of that through diet, lifestyle, nutrition, and natural health products. I'd like to see that emphasized more and I'd like to see people who really have an expertise in that area having a stronger place at the table. I think that would be really helpful.

[The Chair, Conservative, Joy Smith]

Very quickly, Mrs. McLeod. We only have one minute left. Go ahead.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

It's okay. That's not enough time for anything.

[The Chair, Conservative, Joy Smith]

I'm so sorry. We watch the time very carefully and that's why we're so strict with it. My apologies.

We certainly have appreciated the input and the expertise you've brought to the panel today. We're about to go into another topic now so we will suspend for one minute, but I thank you for joining us today.

[The Chair, Conservative, Joy Smith]

I ask our guests to please take their seats.

Welcome back. We're so happy to see you once again. Pursuant to Standing Order 108(2) and a motion adopted by the committee on Wednesday, August 12, 2009, we're going through a study of H1N1 preparedness and response.

Truthfully, Dr. Butler-Jones, Dr. Gully, and Sue Ronald, we are so happy that you take the time to come here to update us and allow the committee to ask questions on this very important topic.

Can we start, please? You know the regular course of events.

We'll begin with the Public Health Agency of Canada and Dr. Butler-Jones.

[Dr. David Butler-Jones, Chief Public Health Officer, Public Health Agency of Canada]

Merci.

I'd like to begin by introducing Sue Ronald, director of marketing, creative services and e-communications at the agency. She will be pleased to answer questions on communications activities and explain Twitter if you like.

As usual, I'm here to provide an update on the H1 flu virus. FluWatch, the national surveillance system, tells us that current activities are still well above the expected range, so it's really not time for complacency. The number of hospitalizations of severe cases and deaths is still increasing, although the rate of increase in hospitalizations is smaller than in recent weeks.

However, there is some promising news. There is now evidence that the rate of influenza illness in many Canadian communities has begun to level off. The number of positive flu tests has fallen and there have been fewer results of flu outbreaks in schools.

Even though we have not yet had any spikes nationally, the level of flu activity in the community shows that we could be starting to reach the height of the season.

Influenza remains unpredictable, though, and reaching the peak of the second wave does not mean the pandemic is over. There remain millions of infections to be prevented. Current flu activity levels are still well above the expected range for this time of year. The numbers of hospitalizations, severe cases, and deaths are still increasing.

Oh. I have that twice.

[An hon. member]

It must be important.