Thank you very much.
I'd like to thank the committee for inviting the Canadian Health Services Research Foundation to appear on this very important subject.
The Canadian Health Services Research Foundation is a non-profit agency funded by the federal government. It's mission is to accelerate healthcare improvement and transformation for Canadians.
My presentation will focus on how health systems should be adapted to better meet the needs of patients with chronic conditions. Although provincial and territorial governments have primary responsibility for health care delivery, federal investments through health transfers, research, and spreading innovations are absolutely essential to reform.
To start with some good news, we know a great deal about how to realign health care services to meet the needs of patients. Unfortunately, the reality, the bad news, is that actually making the changes is extraordinarily difficult politically, particularly for provincial governments. However, it is quite possible that the needs of aging boomers and the reality that as we age we experience more chronic illnesses will create sufficient momentum to change the way in which we organize and pay for health services.
On Monday, the U of T's Mowat Centre released a report by Will Falk that explained that we actually don't need new revenues, nor do we need to privatize services to meet our needs. Change can actually happen within the public system.
The fact that chronic disease management has become the main duty of our healthcare systems shows the effectiveness of modern medicine. Illnesses such as heart disease, some forms of cancer and AIDS, which at one time was fatal, are now chronic diseases.
A recent assessment conducted by the Canadian Academy of Health Sciences indicates that there is a considerable gap between how the healthcare system currently functions and the needs of patients with chronic diseases. It isn't just the people with chronic diseases who would benefit from a new organization of healthcare services, it would be good for all of us.
In a report prepared at the request of the CHSRF, Jean-Louis Denis, a full professor and a Canada research chair in governance and transformation of health organizations and systems, is proposing a strategic harmonization of front-line services, the management of chronic diseases and the health of Canadians.
In preparation for a national meeting of health care CEOs next February, we commissioned a health policy expert from Saskatchewan, Steven Lewis, to answer the question, what actually needs to be done to achieve integrated high-quality care for people with complex chronic conditions? He said much the same thing as Professor Denis. He defined integrated care as needs-based, comprehensive and holistic, convenient, seamless, easy to navigate, team-based, oriented toward patient participation and self-management, and, most important, evidence-based and data-driven. He has identified seven barriers to improving performance and seven solutions.
One thing he said was that it's actually rare in Canada to find true team-based shared care models. Non-physician practitioners are generally not practising to their full scope. For example, in the U.K., in England, most chronic care is delivered in the community by nurses.
He also drew our attention to the difficulties that the current payment systems create for modern use of communications. Many high-performing systems in the States allow patients to communicate by e-mail with their physicians. In some places in Canada, physicians cannot be paid for e-mail or telephone communication.
He also points out the exponential danger for patients taking five or more drugs, and some patients with chronic conditions are taking up to 10. If there isn't a comprehensive electronic health record and more integration of pharmacists, that really combines to make the problem more difficult.
To help answer questions about changes to how the healthcare system functions in order to meet the needs of Canada's aging population, we organized round tables in six cities. Over 200 policy-makers, health system leaders, researchers and so on took part. Members of the Senate Special Committee on Aging also participated in these round tables.
Several solutions proposed by Mr. Lewis and Professor Denis were explained during these round tables. They also pointed out that we need to think about the issues particular to the very specific population groups. For example, a good number of aboriginals have only limited access to transportation and housing. They also have a higher than average rate of chronic diseases. They have also asked to strengthen partnerships. They have asked organizations like ours to disseminate these innovations because, otherwise, we won't move forward.
Last year we helped in the spreading of innovations in primary health care through a conference called “Picking up the Pace”, where we featured 47 innovations in primary health care delivery, many of which highlighted better ways to care for patients with chronic conditions. For example, the Centre de santé et de services sociaux-institut de gériatrie de Sherbrooke and a research team from the Research Centre on Aging in Sherbrooke, first developed, in 1999, an integrated service model for seniors that was unique in Quebec. They had real success in reducing the number of elderly people who were going into residences, and they also, and this was very important, put the brakes on the deterioration in the health of elderly people during hospitalization because fewer of them were in the hospital.
This was shared in the Province of Quebec, but as in many instances, people cherry-pick, and they pick some things but not others, so it would be interesting to see whether or not the results were quite as sterling as they were in Sherbrooke.
I'd like now to turn to a concrete example of how the Northwest Territories is working with us to develop an integrated chronic disease management strategy.
The NWT estimates that 70% of all deaths, half of all hospital admission days, and costs of over $136 million annually are related to chronic disease.
Working with the territory at the nexus of policy and delivery, our focus has been on mental health, diabetes, and kidney disease. We're bringing together researchers who've spent years studying these topics, together with the territorial policy-makers, health system managers, nurses, and doctors. Drawing on their mutual strengths, they are identifying improvement opportunities and building solutions across their extraordinarily large territory. Closely associated with this work is evaluation to ensure that the ideas and practices spread.
Governments across Canada are working to meet the challenges posed by chronic diseases. We know in recent scans that we've done across the provinces that there are activities everywhere. This is a big concern of all systems.
At the pan-Canadian level, the federal government has supported a number of disease-based frameworks, strategies, and bodies that also are attempting to mobilize support across the country and reduce the burden of specific chronic conditions, whether it's the Mental Health Commission of Canada, the Canadian Partnership Against Cancer, or through the Canadian Institutes of Health Research, the strategy for patient-oriented research.
These federal investments are essential in the reform of health care, so we at CHSRF continue to search for ways to improve health care for Canadians and to share these innovations across the country.
Thank you very much for your invitation to appear.
I'll be happy to answer questions later.