Health Committee on Nov. 28th, 2011

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Okay.

[The Chair, Conservative, Joy Smith]

I'm sorry....

Dr. Rosenberg, go ahead, please.

[Dr. Mark Rosenberg]

I would just make one quick comment, and that is that the supply of health care professionals is really a function of decisions that are made by provincial governments with respect to the resources they wish to spend on their university and college systems. The other issue is indeed that the universities and colleges, in essence, respond to those decisions that are made by provincial governments, and until the provincial governments, in a sense, incentivize the universities to shift resources more into health care professional training, the shortages will not be solved.

I think we fool ourselves in this country, when we talk about shortages of physicians, nurses, chiropractors, and all other health care professionals, if we think there's any other solution than shifting resources into training, and all these other discussions—with all due respect—are really in a sense smoke and mirrors. It's purely a function of policies being made by provincial governments to the universities, and the universities and colleges responding.

[The Chair, Conservative, Joy Smith]

Thank you so very much.

Now we'll go to Mrs. Block, please.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I, too, would like to thank all of you for being here today. It has been a very good discussion so far. I know we've talked about expectations, those that exist and those that will exist for future generations. We've also talked a lot about innovation and even incentives.

I've had the privilege of living in both urban and rural Canada, about half my life in either place, and also in serving on rural district health boards and the largest health board in the province of Saskatchewan. It seems to me that these issues are not necessarily new, that they've been around for a very long time.

I want to pick up on something that you've shared, Mr. Nolan. When I was chairing a health district board, we had EMTs. You referred to other levels of paramedics that are probably new since that time. I know that in rural Saskatchewan we needed paramedics and we didn't have paramedics, so I understand the kind of care that needed to be provided in small towns in rural Canada and couldn't quite get there sometimes.

Also, I do have to put a plug in for the health bus in Saskatoon. That's where I'm from. I had the privilege of being at the grand opening of that health bus, I think it was about four years ago. I know they are opening up a new one this coming Friday. You referred to the other one being a refitted RV. This is actually a bus that's been built to provide the service to the community, and it's very exciting.

My question for you is, how has new technology assisted EMS professionals in being able to respond to the demands of the population?

[Michael Nolan]

Certainly, we appreciate your acknowledgement of the innovation in Saskatchewan as it relates to the health bus. To use that as an example, from a transportation perspective, we are quite literally pulling the bus into underserviced areas of the population. In Saskatoon, we pull into neighbourhoods that are predominantly first nations and reach directly into pockets of society that have traditionally underutilized resources in an appropriate time, otherwise waiting too late. Or we've been able to open the doors to populations of immigrants, for example, and been able to reach out to them without having walls around us from a hospital's perspective. It becomes more inviting because we're doing it on their doorstep.

Innovation has also assisted us in being able to provide technologies in the community. For example, you once would have to go to the hospital to have an ECG. Paramedics are now able to do not only a 3-lead but a 12-lead, a full endocardiogram, in the home, and that ECG can be interpreted in the RV, or the health bus in that example, in the back of the ambulance, or in your living room. So we can now do early detection of disease with the advancements of technology. And we're able to do other tests in the home and in the community for which at one time you'd have to wait for a laboratory to get the results. Basics like blood glucose monitoring, for example, and other diagnostics in the home can be done with the prick of your finger. Paramedics can now do that diagnosis and work with other health care professionals to ensure that you get timely access to service.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

I want to follow up with what sorts of changes have been made in the last 15 to 20 years in terms of providing an equal level of service in small towns and rural Canada. I know we used to lament about an eight-minute response time in the city when we were looking at half an hour in rural Canada, and also that golden hour that we've talked about before in terms of the timeliness of getting out to some place in rural Saskatchewan or other provinces.

You have new designations here. What is happening in rural Canada to address those issues in those communities?

[Michael Nolan]

Certainly Human Resources and Skills Development Canada, over 10 years ago, assisted the Paramedic Association to identify the national competency profile, so educational institutions now have a standard language of what a paramedic is or isn't. A primary care paramedic is what would be known as an EMT, and an advanced care paramedic is like an EMTP, for EMT paramedic, as you may have noted in your jurisdiction. However, the provinces are not required to have a baseline of any sort as it relates to ambulance or emergency medical service or paramedic care. It's the educational institutions that provide those varying levels of graduates, and then it's up to the province to determine how many of what type of provider are available.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Nolan.

I'm sorry about that. I have the rare privilege of asking a question now, because they've put me on the roster, which is very nice. Thank you, colleagues. I'm keeping time, right?

This has been a very interesting dialogue today. You know, what we're hearing is really about thinking outside the boxes. We talk about end-of-life issues and seniors issues being centred in the home. We talk about paramedics who can do things so that seniors don't have to go to a doctor's office and wait in line. They take blood pressures and administer IVs and do all those important things.

Dr. Rosenberg brought up an extremely important point, which was that a lot of our older citizens come from different ethnic communities—the Polish, the Ukrainian, the Chinese, etc. In five years, we are going to have more senior citizens than younger people in our country. We have to think differently.

Now, I wonder if one or two of you can make a comment or two, having looked at this myriad of paradigms that have shifted across our nation. We used to think of hospitals, doctors, and nurses. Now we're thinking of chiropractors, paramedics. We're thinking about a whole global community that can contribute in a major way.

I wanted to ask you if you think it would be useful to look at the innovations across this country and to use them to compile a list of best practices. We hear a lot of different things. We go through a lot of different things, everything from H1N1 to MS. You name it, we have it on this committee. I can hear all the committee members saying in unison that we need to think outside the box, in a more innovative way, to look at the best practices and include all these important health care components.

Then there's the education factor. Dr. Rosenberg, you were very astute when you made the observation that there are thousands of teachers graduating but not enough jobs even for hundreds. Is that right? I know my own daughter is going through health care now, and there are jobs all over the place. It's just where you fit in.

Could some of you comment on what my thoughts are on this question?

Mr. Nolan.

[Michael Nolan]

Thank you, Madam Chair.

We would welcome this committee and this government looking at best practices in Canada. We believe strongly that interdisciplinary solutions are the way of the future. We believe that paramedics have a strong role to play. We also believe that, through the health accords, the dollar value changes as well as the population health metrics. Looking at significant requirements as it relates to funding spurs innovation through the outcomes. We would welcome participation in this effort.

[The Chair, Conservative, Joy Smith]

Thank you.

What are your thoughts, Dr. Reichman?

[Dr. William Reichman]

I would just caution not to take a quick look at best practices and feel as if we've done our job. The field is dynamic; innovations are being introduced every day. I would ask that there would be an institutionalized federal effort to keep track of innovations in aging, both within the nation and outside our borders, and to find the means to work in partnership with the provinces to incentivize Canadian health care providers and others in academic settings to test new models and demonstrate why they are advances over the past.

[The Chair, Conservative, Joy Smith]

I'll go to Dr. Rosenberg.

[Dr. Mark Rosenberg]

I think the value-added that needs to be worked on is getting the provinces to accept these best-practice models and diffusing them through their systems. I think there is a tremendous effort going on in organizations like CIHR to disseminate research findings, but I think the provincial governments are slow to push these models through their systems.

[The Chair, Conservative, Joy Smith]

Thank you so much.

I've run out of time. Very briefly, Mr. Béland.

[Prof. François Béland]

In fact, one of my proposals was that the federal government reinstate the health innovation funds. Indeed, work has already been done regarding best practices. Amongst other things, reports were tabled with the health department, namely Hollander's work, Chappell's work, ours and those of our Quebec colleagues, like Réjean Hébert. Already, best practices are—

[The Chair, Conservative, Joy Smith]

Thank you. I'm so sorry, I have to stop you there, but I'd be very happy to talk to you at a later time.

Now we have Mr. LeBlanc. Welcome to our committee.

[Dominic LeBlanc, Liberal, Beauséjour, NB]

Thank you.

[The Chair, Conservative, Joy Smith]

We have time for one more. Ms. Davies, did you want to ask a question? You have time.

[Dominic LeBlanc, Liberal, Beauséjour, NB]

I'm happy if Ms. Davies has questions.

If there are other colleagues—

[The Chair, Conservative, Joy Smith]

It's an opposition question.

[Libby Davies, NDP, Vancouver East, BC]

Actually, I would give some of the other panellists an opportunity to respond to my questions because I really think it is about shifting the system.

I'd really appreciate knowing whether or not.... It seems to me that we need to do something that's really big and broad and has a big impact; it has to be a shift to community care. It could be scattered in a thousand directions and we don't know what the impact would be.

If we linked the human resource issue Mr. Rosenberg referred to with the need to have integrated primary care centres that are more community focused and closer to home, would that, in your mind, be the kind of dramatic shift we need to see that would provide better care and be a much more efficient use of our system?

I feel we need to get a handle on something that is both big enough and broad enough to produce this kind of—some people say the word “transforming”—systemic change in our health care system. We keep missing the boat.

So I'll give you an opportunity to respond to that.

[Prof. François Béland]

Very briefly, I would say that there are—

[Libby Davies, NDP, Vancouver East, BC]

Actually, if you don't mind, it was Mr. Béland who replied to my question last time, and I'm not sure the others got a chance—so my apologies to you.

[The Chair, Conservative, Joy Smith]

Who would you like to hear from?