Evidence of meeting #17 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was paramedics.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

William Reichman  President and Chief Executive Officer, Baycrest
Michael Nolan  President, Emergency Medical Services Chiefs of Canada
François Béland  Professor, Department of Health Administration, University of Montreal, As an Individual
Mark Rosenberg  Professor, Department of Geography and Department of Community Health and Epidemiology, Queen's University, As an Individual

4:40 p.m.

President and Chief Executive Officer, Baycrest

Dr. William Reichman

Yes.

Of all the things we could potentially do to lessen our risk for cognitive failure in later life, whether it's frank dementia—Alzheimer's being the primary cause—or whether it's a milder version, called mild cognitive impairment, the data are most compelling that physical exercise in mid and later life is the most important protective thing we can do. And that's something we have control over.

Whether, ultimately, it reduces the risk of our ever getting Alzheimer's disease is still an open question. But in order to maintain cognitive health, just like maintaining cardiovascular health, good nutritional practice and physical exercise is where the most compelling data reside right now.

I think the critical message there is that if you ask boomers what they are most afraid of when they get older, as much as we will accept physical frailty and the dependence that may come with physical frailty, what we most fear is giving up autonomy. When do we have to give up autonomy? We give up autonomy when we can no longer make decisions for ourselves, and that's because of cognitive frailty, not physical.

At Baycrest, as well as other places across Canada, there are research programs growing now, looking at how to maintain good brain fitness, good cognitive fitness. Let's not wait until somebody has dementia to first think about how to restore cognitive health. We don't wait until advanced congestive heart failure to think about how to improve or maintain the cardiovascular fitness of a population, so why would we do that with brain fitness, which is exactly what we've been doing for the last 30 years? But it's shifting, and a lot of the research we do now is focused on how middle-aged people can keep their brains as vital as the rest of their bodies.

4:40 p.m.

Conservative

Patrick Brown Conservative Barrie, ON

I know the new horizons program funds things like computer labs in seniors' homes, and art programs—

4:40 p.m.

President and Chief Executive Officer, Baycrest

4:40 p.m.

Conservative

Patrick Brown Conservative Barrie, ON

—but it would probably be worth investigating whether we could fund physical activity programs as well, whether it be a gym in a seniors' home.... I guess the challenge is that if it's long-term care it's already too late, and it's difficult to change habits. What would your advice be as to how the government could stimulate physical activity in an aging population?

4:40 p.m.

President and Chief Executive Officer, Baycrest

Dr. William Reichman

I think the first thing the federal government can do in association with advocacy organizations like CARP is to confront some stereotypical myths about what seniors want to do or what they don't want to do.

For each of us in this room—those of us who are middle-aged, as well as several who are younger—the things in our lives that give us a sense of purpose, that give us gratification, that give us a reason to get up in the morning, those things that are meaningful to us are also meaningful to seniors: staying engaged recreationally and socially; keeping your brain challenged; and keeping your body in good shape. It's a myth that people outgrow that need as they get older. It's a myth.

4:40 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you.

On that note, I will say thank you. My goodness, this is even getting better than when it started. Brain fitness, good—I hope I'm better at that than I am at the physical fitness end of it.

Now we'll go into the five-minute round.

We'll begin with Ms. Davies, please.

November 28th, 2011 / 4:40 p.m.

NDP

Libby Davies NDP Vancouver East, BC

Thank you very much, and thank you to the witnesses for coming today.

I feel as if you've all given us these universal truths that we hear over and over again, so it's very perplexing that we can't get it right. One of those truths is that there are too many people in acute care, and that people are being forced into acute care because they don't have other options. Of course, it's the most expensive and the least efficient. We all get that, and that we need to divert people into community care.

I think you also brought out a very interesting observation today, and that is that I think there is a myth that older people are burning up the system. I think each of you in a different way has refuted that. Most seniors are healthy, and the ones who have chronic diseases...if we just managed them differently, we'd be doing a heck of a lot better job. We hear this over and over again, that baby boomers and seniors will eat it all up and we won't be able to sustain medicare and health care. So I think you've helped respond to some of that.

Why don't we seem to be able to change the system? I don't know myself why we can't do that. Where do we begin? Supposedly, the health accords we have are meant to deal with that.

Is one of the questions that we need to look at who is in the ER? Do we even know? Who's going there and possibly is overrepresented in terms of what they are presenting when they go to the ER? If any of you have any research or know of research on that, I think it would be useful for the committee.

In terms of diverting people into a much more responsive community care setting and all those varieties, it seems to me that integrated primary care centres.... You've talked about the paramedics, you've talked about your day programs, for example, but why do we have so few integrated primary care centres, or what we commonly call community health care centres? Isn't that where we should be going, where you can go to something that's community based, maybe community controlled, integrated? You've got a variety of services. To me, it's just so obvious, yet we don't seem to be able to get there.

Any of you who would like to address that can respond to those two questions.

4:45 p.m.

President and Chief Executive Officer, Baycrest

Dr. William Reichman

The good news is that we don't have to invent something that hasn't already been demonstrated to work. There are programs in different parts of Canada, and I would be happy to get you this information, where it's been demonstrated that if you bulk up a primary care practice by adding other kinds of disciplines to that practice, whether it's a pharmacist, an OT, a PT, or perhaps even a paramedic...by bulking up these primary care practices so they're more interdisciplinary, there are better outcomes and patients get better access because they can be seen by another professional in the practice. It doesn't have to be that physician to get many of what their health needs are that caused them to go into the office.

4:45 p.m.

NDP

Libby Davies NDP Vancouver East, BC

What if we just added nurse practitioners?

4:45 p.m.

Conservative

The Chair Conservative Joy Smith

Can I just interrupt for a minute, because Professor Béland and Mr. Nolan would like to comment on your question.

4:45 p.m.

NDP

Libby Davies NDP Vancouver East, BC

Okay.

4:45 p.m.

Conservative

The Chair Conservative Joy Smith

Please, Professor Béland.

4:45 p.m.

Professor, Department of Health Administration, University of Montreal, As an Individual

Prof. François Béland

Health care systems and the provinces, but especially Quebec, have basically tried two things up till now.

First, they tried to change the structures. Hospitals were merged, demerged and remerged. Regions were created, regions were eliminated, new ones were put in place, they were made bigger, and then the department was changed. I think you get the picture.

The second thing is that the funding was changed. However, when you change the funding, virtually all provinces come to see this as being a way to control health care institutions and doctors, rather than as a way to mobilize resources.

As Dr. Reichman so eloquently said, the areas where we need courage, and which we really need to change, are clinical practices and professional practices. We have now reached that point, but it will be the most difficult thing to achieve. We need to change clinical practices and professional practices. We must bring about change in both clinical and professional practices so that they align with the needs of individuals.

To make these changes, organizations will also have to align with the requirements of the clinical approach to treat elderly people who have several chronic illnesses. We also need the proper amount of funding.

For example, the member talked about snow removal earlier. In our SIPA project....

4:45 p.m.

Conservative

The Chair Conservative Joy Smith

I'm so sorry, our time has run out. We're in five-minute rounds.

I'll have to go now to Mr. Williamson.

4:45 p.m.

Conservative

John Williamson Conservative New Brunswick Southwest, NB

Thank you, Chair. I'm going to try to pepper some questions, actually.

Michael Nolan, you talked about things in Nova Scotia and how resources were allocated more efficiently. How did that happen?

4:45 p.m.

President, Emergency Medical Services Chiefs of Canada

Michael Nolan

The Nova Scotia government is quite integrated within its paramedic service. First and foremost, they have their hands on the wheel, if you will. Of course, within their system as a whole, they've been able to maximize the role of paramedics. Not unlike the situation in many other provinces in Canada, there has been a shortage of nurses and physicians for quite some time. They recognized early that paramedics could play a much more significant role in primary health care, and they gave them the tools, skills, and policy support to be able to do that. We're seeing, as in the Parrsboro example I gave you, seven other emergency departments this year that are slated to be staffed by paramedics at night to depressurize their physician shortage.

Long Island and Brier Island are rural and quite remote in fact. You have to take two ferries to get there. They said they have a resource. The only resource left standing in the community is paramedics. What do they need to be able to serve this population better? They did it over 10 years ago, and it has proven to be a big success.

4:50 p.m.

Conservative

John Williamson Conservative New Brunswick Southwest, NB

Very quickly, do you have any idea what the savings were from freeing up resources to be used elsewhere in the health care system?

4:50 p.m.

President, Emergency Medical Services Chiefs of Canada

Michael Nolan

What types of resources, do you mean?

4:50 p.m.

Conservative

John Williamson Conservative New Brunswick Southwest, NB

What dollar amount did this change? You might have addressed that before, and if so, please excuse me.

4:50 p.m.

President, Emergency Medical Services Chiefs of Canada

Michael Nolan

No, that's okay. Dr. Carrie asked me earlier about overall health savings. We can certainly speak to that from the perspective of what a reduction of one 911 call means for the system. We're looking at this more globally in terms of overall health economics. It's absolutely significant, both on the response side and on the resourcing side. A paramedic making $25 per hour, plus or minus $5, puts you into that $50,000 to $70,000 range I spoke to earlier. On the front end there are savings. In many parts of Canada there are underemployed paramedics. We're not in the same situation as many of our peers. We have an availability that is significant and available to all Canadians.

4:50 p.m.

Conservative

John Williamson Conservative New Brunswick Southwest, NB

Thank you.

My next question is for Mr. Béland.

On page 3 of your presentation, you talk about

expenditures on MDs, hospitals, and other health services.

The upper curve of the chart presents... I will read it in English.

It's total HCE.

Does this represent the federal transfer, the cash transfer only?

4:50 p.m.

Professor, Department of Health Administration, University of Montreal, As an Individual

Prof. François Béland

No. It represents total health spending in Canada.

This spending includes medicare and all amounts spent by the provinces. This line only represents public health care spending. This line includes everything which CIHI, the Canadian Institute for Health Information, deems as being public health care spending. For example, it would include medication, lodging services, services at home, and so on.

In short, the line includes all public health care spending, whether it is provincial or federal spending. The federal government, among other things, also provides health care services to the military, to veterans and to first nations.

4:50 p.m.

Conservative

John Williamson Conservative New Brunswick Southwest, NB

Unless I'm mistaken, these are public expenditures.

4:50 p.m.

Professor, Department of Health Administration, University of Montreal, As an Individual

Prof. François Béland

Yes. That represents overall public health spending.

4:50 p.m.

Conservative

John Williamson Conservative New Brunswick Southwest, NB

As it now stands, it is 22%.