Health Committee on May 13th, 2010

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

One of the things we heard over and over again was that we needed more interdisciplinary collaboration or communication or working together or agreements, and so on. Do you agree with that?

[Dr. Joshua Tepper]

Yes, I agree very strongly.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

How is that going to be accomplished?

[Dr. Joshua Tepper]

Each jurisdiction is doing it in slightly different ways. The federal government has put millions into this as well. There are basically two focuses: one is on changing the educational system, and one is on changing the practice environment.

There are reams and reams of information. There are websites, materials, pilot projects, established projects, and thousands of providers now working in new interprofessional models across Canada. There are thousands of them. I would say there is almost no large academic health science centre in Canada that is not engaged in interprofessional education to some capacity. We have competency criteria and we have curriculum criteria.

I'm conscious of time and I don't want to just sound as if.... If you give me a focused set of questions, I can probably get the data.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

At our last meeting we had testimony from occupational therapists, and they said they were underutilized. When we heard from the different disciplines, I'm not sure that they felt there was much of a collaboration.

[Dr. Joshua Tepper]

Again I'd go back to the comment that I think there is always more work to do. I don't think we're there by any means, but I think where we are now versus five years ago is fundamentally different. There is always more work, and there are always providers in different types of settings who are underutilized. I would support that. I absolutely agree with it.

It is culture change and it is model change. It's huge culture change and economic change. It's a lot of change to build these new models. In different places it is happening in different ways, but it is not 100% there.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Tepper.

Now we'll go to Ms. Hughes.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you, and thanks for your input.

I want to focus a little bit more on aboriginal health and human resources, and especially on the initiative. We heard through a lot of the witnesses that multi-year funding is what is required. You see an extension of two and a half years added, or just mentioned; how difficult is it to plan with regard to getting only a two-and-a-half-year funding plan?

[Shelagh Jane Woods]

As far as I know, we have two years of funding and we are accustomed to working under these constraints. We might like a lot of our initiatives to be longer term, but the work goes on.

As I said earlier, we did have a small initiative, the Indian and Inuit health careers program, that had existed for a long time before the AHHRI. We were able to roll that forward in with this. Communities and institutions just go ahead and do the planning, but I think it's also important to say that we rely on some of the other existing planning mechanisms within our department, so we've integrated and are integrating health human resources planning into some of the larger planning processes, such as the community-based reporting and the planning tools.

If you'll allow me to use a somewhat simple analogy, we're not putting all of our eggs into the one basket of the AHHRI. We're using it as a mechanism to spread the planning beyond just its narrow confines, so I don't think it's as big a problem as all that.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

We heard over and over again that this certainly plays into the opportunities for students to be able to enrol or to stay enrolled, and not knowing if they can.

As well, with respect to the first nations students, as well as the educational pursuits, full-time study is three years in the university, and the post-secondary through INAC or through the government is considered four credits, so it's three credits versus four credits. We heard that this was problematic for people to be able to get funded. Are you familiar with that at all?

[Shelagh Jane Woods]

No, that's not an issue I understand at all. I'm sorry.

[Debra Gillis]

In terms of funding for post-secondary education, we have an agreement with the National Aboriginal Achievement Foundation whereby we provide them with funding and they receive applications from first nations, Inuit, and Métis students, which tends to top up, for example, first nations students who may be receiving money through the Indian Affairs post-secondary program. It tops up the money that they have.

So we ourselves don't directly fund. It's a well respected aboriginal organization that has a long history of funding post-secondary education.

I've never heard about the three and four. Students who can demonstrate a need for additional funding to pursue their health careers, based on the amount of money that the NAAF has, will receive money.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

I want to turn to the community health representatives.

We also heard that this organization actually was providing much-needed support to the physicians and nurses in the first nations and Inuit communities. A lot of the witnesses indicated that front-line paraprofessional health care providers who undertake this education and the health promotion activities were no longer being supported by Health Canada.

Why did the government actually choose to no longer provide funding for the paraprofessionals, such as the community health representatives, and does Health Canada provide funding for other types of paraprofessionals who undertake similar tasks?

[Shelagh Jane Woods]

To answer directly, we have not stopped funding CHRs. We provide funding to the bands. The CHRs are not employed by us, but by the first nations directly. There are over 600 of them. There's tremendous variation in the roles they play and the things they do. They are associated usually with a number of community-based program activities, but it's the first nation that determines what they will do.

We do support a lot of other community-based paraprofessionals and allied health professionals working in such areas as addictions, mental health, diabetes, maternal and child health, and home and community care. We have no intention of stopping support, because that's a very important cadre of people, and in fact what you'll see in our renewed aboriginal health human resources initiative is that we put more focus on the paraprofessionals and on getting down to the community level to help communities provide opportunities to bring those people up to a level of competency certification so that they will eventually be comparable to people who practise off-reserve.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

We also heard from Dr. Strasser from NOSM about some of the challenges with regard to rural health. I am wondering, Dr. Tepper, whether some similarities have come up in the meetings and discussions you're having. Are there some similarities? What are the differences, and what should we as a group be considering with regard to the deficiencies within rural care? Even the Canadian--

[The Chair, Conservative, Joy Smith]

Ms. Hughes, I am sorry. I have been trying to get your attention. I have to interrupt you. Your time is up. I apologize, but we have to carry on.

Go ahead, Ms. McLeod.

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

Thank you, Madam Chair.

I'll draw on some of the earlier comments in terms of the general agreement on professional collaboration. I would think it is predominantly related to primary care, but there are also many other areas.

You say we're making some good progress, but have we hit the tipping point? Are we there? How do we get there?

[Dr. Joshua Tepper]

It's interesting. I am sorry we did not have time to talk about the rural issue, because it is one very close to my heart.

We are not there yet. I would say four or five years ago people were not even talking IPC--

[The Chair, Conservative, Joy Smith]

Dr. Tepper, if you have some documented information that you could supply to the clerk on the rural issue, I would be very happy to distribute it to the committee.

[Dr. Joshua Tepper]

I would argue that chapter 7 of Roy Romanow's report, the opening quotation in particular, is very powerful.

[The Chair, Conservative, Joy Smith]

Thank you. Now we will go on.

[Dr. Joshua Tepper]

We are not at a tipping point yet by any means. I think we've gone from this being heresy to being something that is now on the table and discussed. We have gone from probably no pilots to some very extensive pilots, for example, with primary care models in several jurisdictions involving millions of patients now. There are entire other models of care around hip and knee replacements, and hundreds of cataract surgeries, etc., are being done in this model, but unfortunately we're not quite at the tipping point yet.

This is a huge culture change for the health system. It is very profound and it requires a realignment of a lot of other parts of the health system: compensation, regulation, in some cases legislation, and in some cases insurance issues, depending on who you talk to.

I believe at least now a discussion is being held, but I think it is incredibly powerful, and the results we're seeing from those who have gone there are incredibly positive.

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

I will pick up on my previous colleague's comments. Rural health care is, of course, important. I represent many rural residents who are struggling. I think Health Canada over time has managed to look at very isolated communities, and through the use of paraprofessionals and other tools and people has managed to meet a need, but perhaps not to a complete extent, and I look at the dental therapist model that was part of Health Canada's approach to supporting aboriginal communities.

I'll give it back to you in terms of rural health care. I think it is important to many of us in this room.

[Dr. Joshua Tepper]

I think rural health care is something that makes Canada unique except for perhaps only one other country, which is Australia. I am very glad you had a chance to hear from Roger Strasser, who is a tremendous leader in this field.

I would say every jurisdiction has tackled this challenge in different ways, starting with the educational system. British Columbia has put a branch of their school up in Prince George, Ontario has built a whole new school in the north, and New Brunswick and P.E.I. have bought residency positions to put in rural areas. Everybody's worked on education and thought about who's coming, where they're training, and how they're being trained, because it's fundamentally different.

Also, the practice patterns and the practice models and how you think about people working need to be very different as well. You have a completely different scope of practice in rural areas.

I've worked in Iqaluit. I've worked in northern B.C., in Hazelton, and in a lot of these places. I've worked right across northern Ontario, literally probably in a dozen communities, some as small as a thousand people, or probably 650 people in the winter.

As I said, we need very different models and very different education systems to support people there. It really needs to be a focus of your report.

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

Thank you.

If I have time, I have one quick question for Statistics Canada. Apart from the information that's routinely available, how many health-related requests do you get in a year for which you have to charge and do special searches?