Evidence of meeting #8 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was dementia.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Eleanor White  President, Canadian Chiropractic Association
  • John Haggie  President, Canadian Medical Association
  • Barb Mildon  President-elect, Canadian Nurses Association
  • Frank Molnar  Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society
  • Maura Ricketts  Director, Office of Public Health, Canadian Medical Association
  • Don Wildfong  Nurse Advisor, Policy and Leadership, Canadian Nurses Association

4:35 p.m.

President, Canadian Medical Association

Dr. John Haggie

It is. In one sentence, I think the system has to be responsible and accountable to the person who funds it, which is the Canadian patient, the Canadian taxpayer, and there are various ways you could do that. But yes, I agree.

4:35 p.m.

Conservative

The Chair Joy Smith

Mrs. Block.

October 17th, 2011 / 4:35 p.m.

Conservative

Kelly Block Saskatoon—Rosetown—Biggar, SK

Thank you very much, Madam Chair.

Thank you, to all of you, for being here today.

My questions are going to be for Dr. Molnar.

I used to sit on a health board—the largest health region in Saskatchewan. I haven't been there for about three years, but I know that the lion's share of a provincial budget typically is going to health and that the lion's share of the health budget is typically going to acute care.

Back in the day, I recall we had something called a “one-way valve”. We moved into the health district model and then the region. We could take acute care dollars and put them into community services, but we couldn't take from community and put into acute care, and that's probably for obvious reasons.

I want to ask you about the slide in your presentation under “Community Care: The real cause of Hospital ALC crisis and Bed Gridlock”. We've talked about primary care models, encouraging collaborative effort on the part of health care providers. In the last point, it says that hospitals are the most expensive site of care and they've become the default care system. You say that this needs to change. What would you do to change that reality? What has to happen?

4:35 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

Number one, we have to strengthen community care.

My area of expertise is in the realm of dementia. Many people with dementia get sick with minor illnesses—a bladder infection—that just brew and stew until they explode into a septic episode where they end up in hospital for a long stay, for months and months.

What you really need is a community care system that allows people—CCAC nurses, home care workers—to identify symptoms early, allows the patient to get to the family doctor quickly, or that has home visits.

Toronto has been experimenting with home visits. There are many seniors who cannot get to the out-patient clinics; they can get to the emergency department by an ambulance, and that's it. We need a system that gets them to family doctors, or that gets family doctors or nurse practitioners to them very quickly, that deals with the acute problems quickly, and that has immediate access to specialists in areas where they don't feel they can manage. Those specialists should have some ties to the hospital, and they should have the ability to have some elective admissions—this is language we don't like to use in acute care—maybe a one-week admission, to pre-empt or prevent a three-month admission.

We really need to look at systems in other countries, to see how we can get to patients quicker, how we can get help to them quicker, how we get to the specialists, and how we can do controlled, short admissions rather than long ones. That's what I see is missing in the system right now.

4:35 p.m.

Conservative

Kelly Block Saskatoon—Rosetown—Biggar, SK

Again, we've talked about primary care models, health care providers working together at the local level. What are the different associations you represent doing at a provincial or national level to address the need to change that focus and address community care?

4:35 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

Is that a question for me, or for someone else?

4:35 p.m.

Conservative

Kelly Block Saskatoon—Rosetown—Biggar, SK

Anybody could answer it.

4:35 p.m.

Conservative

The Chair Joy Smith

Who would like to answer it?

Dr. Haggie.

4:35 p.m.

President, Canadian Medical Association

Dr. John Haggie

I'll have a crack at that.

My own jurisdiction is Newfoundland. Telehealth, which Bob mentioned, is being pioneered by a unit in Labrador, where they've had challenges delivering health care to rural communities. It has made a big difference. Again, it's a question of multiple strands to answer the problem.

On the concept of looking at funding models, in Alberta, for example, there is a system whereby funding can be attracted for the primary care networks. It goes to non-medical services for groups that agree to provide comprehensive care. That money allows them to provide walk-in clinics, on-site foot care clinics, diabetic counselling, nutritional counselling, and those kinds of things. Groups of doctors amalgamate under this umbrella of a primary care network.

To step back and ask what could be done at the federal level, I would take you back to the two issues of best practice and innovation. There is no comprehensive system for identifying loci of best practices. There are good things in Labrador, there are great things in Saskatchewan, and there's the urology practice in Saskatoon. There are wonderful things in Alberta and perhaps in Ontario, but that information doesn't get shared. There's no centre for best practice. The health council may have thought at one time that would be part of its mandate, and it kind of never went that way.

The other thing is innovation. How do you plant the seed and fund models that are trying something out? If you don't allow new ideas to bubble up and succeed or fail without prejudice, you'll never get any further than you are at the moment. The Canadian Medical Association would like to see the feds look at a centre for innovation. There has been some talk of that and some money suggested in that direction. We say that's a good start, and let's have some more.

So if you want to try to build a firmer foundation you need to have mechanisms to identify and promulgate best practices--areas where there's funding for innovative approaches along team lines, and that kind of thing. In actual fact, that was one of the things that fell out of the 2004 accord right back at the beginning. There was some money set aside for primary care reform, and that kick-started some team approaches in our province for the money that was produced there. So I'd offer that as a possible way ahead.

4:40 p.m.

Conservative

The Chair Joy Smith

Do you have a brief comment, Ms. White? Go ahead.

4:40 p.m.

President, Canadian Chiropractic Association

Dr. Eleanor White

From a slightly different perspective, where fee for service is an issue with your question, in Ontario there is no provision for lower-income people to access chiropractic care and have it funded, since funding was withdrawn in 1994. That makes it difficult when you're looking after a population stuck at home, perhaps in poverty.

There are experimental clinics in many loci, as Dr. Haggie mentioned, where we're doing a salary-based approach that is covered by local associations, and you have a multi-disciplinary approach. That has had terrific reviews from the seniors and chronic-care patients. We're in the midst of work on a project in Nunavut as well--a multi-disciplinary project for that community. But again, the projects are not interconnected, they have not yet become the norm, and fees are a problem.

4:40 p.m.

Conservative

The Chair Joy Smith

Thank you very much.

Ms. Mildon.

4:40 p.m.

President-elect, Canadian Nurses Association

Barb Mildon

Thank you very much. I will be brief.

There are just three things I want to mention. First of all, we are certainly partnering with our other associations, and are very pleased with our recent collaboration with the CMA on transforming the health care system. There are documents out on that. Of course, everywhere CNA goes we advocate for an integrated home care and community-based system.

Another example that has recently been given is the PATH program. It stands for “partners advancing transitions in health care”, under the auspices of the Change Foundation. It is focusing on engaging and supporting a community coalition of providers, patients, and caregivers to redesign problematic care transitions--in other words, those where complexity is causing the ALC length of stay.

4:40 p.m.

Conservative

The Chair Joy Smith

Thank you very much. I'm glad you caught that and gave us that insightful information.

We'll now go to the second round, with five minutes for questions and answers, and we'll begin with Dr. Morin.

4:45 p.m.

NDP

Dany Morin Chicoutimi—Le Fjord, QC

Thank you very much.

I would also like to talk to you as a health professional. We all agree that bad lifestyle choices contribute to a rise in chronic problems for seniors and adults alike. As health professionals, we tell our patients to eat healthier. Yet they continue to eat food that is bad for their health. We tell them to exercise and they do little or none. The same goes for smoking, for cigarettes; they continue to smoke for pleasure or for other reasons. At the end of the day, even though we have the best of intentions as health professionals, our recommendations and advice are not followed. In short, prevention is no easy task.

I would like to open this discussion and ask the representatives from all the associations, including the Canadian Geriatrics Society, what we can do. In addition to our good intentions, what can we do to really change the habits of our patients?