Framework on Palliative Care in Canada Act

An Act providing for the development of a framework on palliative care in Canada


Marilyn Gladu  Conservative

Introduced as a private member’s bill.


This bill has received Royal Assent and is, or will soon become, law.


This is from the published bill. The Library of Parliament often publishes better independent summaries.

This enactment provides for the development of a framework designed to support improved access for Canadians to palliative care.


All sorts of information on this bill is available at LEGISinfo, provided by the Library of Parliament. You can also read the full text of the bill.

November 7th, 2017 / 3:40 p.m.
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Student, School of Nursing, Trinity Western University, As an Individual

Melissa De Boer

Social inclusion and quality of life for Canadian seniors also extends to dying well. Nurses advocate for dying well as an extension of living well. It is estimated that 90% of Canadians will require care and support at the end of life, yet currently less than a third of Canadians are estimated to have access to high-quality palliative care services. Palliative care must extend beyond care for those who are dying from cancer to also support those who are dying from chronic conditions.

Professor Sheryl Reimer-Kirkham is involved with a University of Victoria research team led by Dr. Kelli Stajduhar on end of life care for persons who are under-housed. This research is showing how dying happens in the cracks between our health and social services, and that end of life care is often provided by volunteers and shelter staff who know little about how to care for the dying. Other times, vulnerable seniors are dying alone on the streets.

Bill C-277, a framework on palliative care in Canada, is a chance to address this. We need a coordinated approach to palliative care, coordinated across sectors, jurisdictions, and levels of government. Linking a national seniors strategy with a national home care plan and a pan-Canadian palliative care strategy will ensure that a shared-care model is coordinated, comprehensive, and effectively administered across governmental sectors.

June 5th, 2017 / 9:35 p.m.
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Karen Vecchio Conservative Elgin—Middlesex—London, ON

I apologize, Madam Speaker. That was my error.

The article states that:

The man advising [the Prime Minister] on building a new infrastructure financing agency was told the body could take on a “significant” amount of risk to help projects come to fruition.

The agency would “help bear a significant portion of the risk” in a project if the government took on an equity stake to make a project more attractive to private investors, says a confidential briefing package prepared for special adviser Jim Leech.

The Feb. 20 briefing document says the bank could take on debt that allows other debtors to be paid first in order to provide a “loss buffer” to the private sector, or invest on an equal footing “at concessionary terms.”

That latter reference could mean giving a private partner exclusive rights to use and receive revenue from a piece of infrastructure, like a rail line—such as the arrangement between the U.K., France and the private companies involved in the Channel Tunnel.

With reference to the infrastructure bank, we have asked time and time again in the House of Commons if there will be risk to the government and to the private sector. All the opposition side, whether the official opposition or members of the NDP, has heard is that the only person on the hook for this will be the taxpayer. The only way we were going to get this type of information was through an access to information request, and it was requested by the Canadian Press. The government has backgrounders on information and it is not willing to share because it is against its mandate and agenda. We see that with the carbon tax and the infrastructure bank. We are asking for some transparency on behalf of taxpayers. Somebody needs to be the voice of the taxpayers.

By no means am I an economist. I like to look at things as simply as possible. I am looking at information from the Fraser Institute, which noted that in 2016-17 the combined debt of the federal and provincial governments will be $1.4 trillion. I know we have talked a lot about this. People have said that deficits do not matter. We have heard that over and over again. However, when the government continues to spend greater than the revenues received, it will matter. It will have an impact on those things that are vital and important to Canadians, our top priorities.

If we know we are spending billions of dollars, a lot of which is money that we have borrowed, imagine when we have to start paying interest on that, money that could benefit Canadian society. I believe the cost would be over $37,000 per person if we were to divide the debt among everybody. That is more than the cost of my new car. That means everybody would be able to buy a brand new car as of today. I want to put that into perspective, because most families are buying a used car or cannot afford a car at all.

The government is spending all of this money. If we are looking at $62.8 billion just in interest in 2015-16, let us put that into what really matters. The member who sits beside me could buy the Toronto Maple Leafs 62 times over. Everybody knows how wealthy the Toronto Maple Leafs team is. Our debt is 62 times the worth of the Toronto Maple Leafs. We could buy 315 F-35 fighter jets. Would that not be wonderful for our troops? Instead, we have to worry about a debt that will continue on.

I look at the effects this will have on our generations. We talk about the debt, but we really do not understand the effects of that debt. What will that mean to the future of our health care system or our our educational system? How will that affect the environment, something so important to the government? How will that affect the government if we spend all of the money today? Later on we will be unable to afford anything. It concerns me because as we move forward with the great plans of the government, all we see is debt. We have already discussed that the debt we are accumulating is all on borrowed money. Who is going to pay this debt back? Debt and deficit do not seem to be key words for the government, but for most families it is.

As the critic for family, children, and social development, what would happen if we budgeted that way in our own homes? We would lose our cars, houses, and everything we ever owned. We cannot max it out time and time again. This is what the government is doing.

A lot of times when we have this conversation, the government of the day will reflect back to the spending of the previous government when we went through a global economic downturn. There was one in 2008, 2009, and 2010. We were the first country to recover, and we did so very well. I would like to thank the late Minister Flaherty for doing such a phenomenal job in the work that was done in Canada. Out of that spending, there were new arenas, new roads, new facilities for our communities, and a lot of growth in the economy as we went forward.

Now we are spending for the sake of spending and it does not make sense. We are not in a global recession when we need to go up against huge debt. I do not know why the government is putting our future in debt time and time again. The next generation will pay for this. When we look at medical care, such as palliative care, as Bill C-277 put through, why are we not investing in things that are really important to Canadians? Why are we not investing in long-term plans? We are spending so much money. I could talk about the $130,000 spent by the Prime Minister to travel abroad. Something as simple as that reflects respect for Canadian taxpayer dollars, and we do not see that.

I will bring this back in layman's terms. A lot of times when we talk to Canadians, we often talk about such big numbers, and they cannot grasp it. We are talking about miles and miles of money. If we laid it down, how much would it look like? A lot of times Canadians cannot put it into perspective because it is so grandiose. We want to do a lot of things in Canada and I am really fearful of where this ongoing debt and bad plans, such as the infrastructure bank and all of the other things that are planned, are going to put our country. It is going to put our grandchildren far behind the eight ball. What is going to happen to their education and health care? These are so important that we have to step back and ask ourselves how we can do it better. We are spending and spending and there is no plan to get back to a balanced budget.

Again and again, the opposition side has asked the government for its plan to get back to a balanced budget. Unfortunately, I do not think any member on the government side has actually said there is a plan. All we are hearing is 2035, 2055, or whenever it may be, but it will not be in two or three years, as it should be. When the government was elected, you said there would be a $10 billion deficit and I am not sure why you, time and time again—

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 6:20 p.m.
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Marilyn Gladu Conservative Sarnia—Lambton, ON

Madam Speaker, it has been heartwarming to see the way members of Parliament have worked together, from the beginning when the all parliamentary committee first studied palliative care, to the work of the Special Committee on Assisted Dying, to the discussions and the many heartfelt testimonies in the House from all parties as we studied this, to the amendments at committee and the collaborative way people worked together to bring improvements to the bill, to the Minister of Health who pledged $11 billion for home care, palliative care, and mental health care in the 2017 budget. This is how Parliament ought to be, addressing needs of Canadians and doing it in a way whereby we work together and come up with a better solution.

A growing number of individuals of all ages in Canada suffer from chronic pain or deadly diseases. Palliative care services can replace a wide ranges of services, such as short-term care, home care, crisis care, and psychological or spiritual assistance services.

Canadians need palliative care. It is hard to know how much palliative care is really available because the data is not that good. We have heard discussion tonight about the need to do more in collecting data on this situation. At least 70% of Canadians have no access to palliative care. We do not have enough palliative care physicians. Certainly from a cost perspective, palliative care done in different ways, by home care, by paramedics, can reduce the cost from $1,100 a day in a hospital down to $200 for hospice or $100 a day or less a day by paramedics. There is an opportunity to get more with our health dollars.

When the bill went to committee, the members were very happy about the language around the defining of service. We modified some language to clarify the federal and provincial jurisdictions. We had discussion around the collection of the research data and made a slight adjustment there. We had some great additions to restore the secretariat for palliative care to ensure that action was driven as we move forward into the future. I was very happy with the amendments that were brought because they made the bill stronger. I think this measure will be supported in the Senate.

Everyone has shared a personal story and throughout all the times I have been here, I have never shared any stories.

First, I thank the member for Langley—Aldergrove for being my seatmate when he was on the Special Committee of Assisted Dying and for giving me a book called It's Not That Simple, which talks about palliative care. It was made me interested in bringing this bill forward.

Within my riding of Sarnia—Lambton, we have a hospice called St. Joseph's. My father-in-law died of cancer, and he was in hospice. As I watched him wilt away like a sparrow, at least he was surrounded by a caring environment. He was pain free. He was surrounded by his family. I began to appreciate the services. We have 20 palliative care beds, a great hospice, and an integrated home care system. To find out that most Canadians did not have that was just a shock to me.

I am happy to see the bill move forward. This is the right direction.

I want to thank the many organizations that supported the bill throughout its journey. I want to read them because there are so many. It is just amazing. These organization include the Canadian Medical Association; the Canadian Cancer Society; the Canadian Nurses Association; the Canadian Society of Palliative Care Physicians; Pallium Canada; ARPA; the Canadian Hospice Palliative Care Association; many member hospices like Bruyère Continuing Care, St. Joseph's Hospice, West Island Palliative Care Residence; the Heart and Stroke Association; the Kidney Foundation; the ALS Society of Canada; the Canadian Association of Occupational Therapists; more than 50 organization members of the Coalition for Quality Care and the Interfaith Groups, including the Centre for Israel and Jewish Affairs, the Canadian Conference of Catholic Bishops, the Canadian Council of Imams, the Evangelical Fellowship of Canada, the Armenian Prelacy of Canada, the Canadian Conference of Orthodox Bishops, and the Ottawa Muslim Association Ottawa Mosque. I thank them all for their ongoing promotion and support of the bill.

It is these kinds of organizations across our country that will help us to integrate palliative care and leverage our best practices.

I want to also thank all my colleagues for their support and encouragement. I want to encourage everyone to vote yes to Bill C-277.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 6:20 p.m.
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Mark Warawa Conservative Langley—Aldergrove, BC

Madam Speaker, it is a honour to speak to Bill C-277. I want to congratulate the member for Sarnia—Lambton on her good work.

I was honoured to sit on the special legislative committee that dealt with assisted suicide and euthanasia in response to the Carter decision. From that came a number of witnesses who highlighted two prominent needs.

First, there has to be a national palliative care strategy in Canada to prepare for our aging population. People who need palliative care are primarily elderly, at end of life. People do not have to be old to die, though. Palliative care provides those basic, dignified needs of people at the end of their lives, whether they are young or old.

The second issue was that we needed to provide conscience protection for physicians and health care institutions.

I am thrilled the member for Sarnia—Lambton received a low number in the private members' business draw and was able to have this bill presented. I am also thrilled this basically has been unanimously supported in the House and will very soon go to the Senate, with some very constructive changes.

This is needed in Canada. Right now there are more seniors in Canada than there are youth. One in six Canadians is a senior. In 12 short years, and I have been here 13 years, one in four Canadians will be a senior. Right now, 70% of people who need palliative care do not have access to it; 30% do.

As a civilized democracy, a western democracy, we need to provide for the basic needs of dignity. In testimony we heard different terms. We heard “medical aid in dying”, which is not assisted suicide. It is helping somebody die by reducing the pain and making them comfortable. That can be through visitation, drugs, palliative sedation, or medical apparatus. There is a number of ways.

I was shocked that our medical professionals received very little training in palliative care or end-of-life care. There is a very large interest in taking care of babies, in pediatrics, but for geriatrics, not so much. Babies are very cute. We desperately need to train Canadians in geriatrics.

With the massive change in our demographics in Canada, the aging population, where one in four will be a senior, it is not possible to build enough care facilities. Therefore, we need to train people so we can provide that home care.

Palliative care includes all of that, medical care and required infrastructure. We need to create this national seniors strategy. Again, I thank every member in the House who supports Bill C-277.

Then we need the investments in the infrastructure and the training to see this happen. The aging population is coming. It will be here in 12 years. We are not ready for it. I encourage the government and I thank it for supporting the member for Sarnia—Lambton and for its commitment to this bill. We all look forward to the investments in the next budget. Next spring when the government introduces the budget, there have to be those investments.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 6 p.m.
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Shannon Stubbs Conservative Lakeland, AB

Madam Speaker, I am honoured to speak in favour of Bill C-277, an act providing for the development of a national framework for palliative care in Canada. This bill is important. It would benefit Canadians right across the country and also at home in Lakeland. I would like to congratulate the member for Sarnia-Lambton for her steadfast advocacy and for highlighting this priority need across the country. I know that this bill is the result of months and months of hard work and dedication by the member, and I congratulate her.

Canadians work hard, live busy lives, and expect one day to have the option of end-of-life care. The goal of this bill is to support improved access for Canadians to palliative care by creating a national framework, with the intent of expanding the availability and quality of front-line services in communities across Canada. That result would increase options and reduce the burden on family members by providing vital end-of-life care for their loved ones. This aim supports the dignity and comfort all Canadians deserve in the final stages of their lives.

This bill is also the distillation of the work of my colleagues on the Parliamentary Committee on Palliative and Compassionate Care. The committee published an excellent report, which outlined the current Canadian landscape with respect to palliative care. Through studies and assessments, the committee conducted a full review of current palliative care options in Canada while identifying specific areas that require improvement. All Canadians and all political parties can and should support this bill.

Right now there are only 200 hospices across Canada, so there is clearly a need for universal palliative care options. The framework provided in this bill would provide a definition of palliative care and identify the training needed for palliative care in Canada. It would also consider amending the Canada Health Act to include palliative care as a guaranteed health care option. Additionally, the act would outline periodic report releases from the Minister of Health highlighting gaps and recommendations for the framework of palliative care.

I am concerned about the Liberals' approach to palliative care in Canada so far. Although the Liberals are supportive of this initiative to date, they started their mandate by making a significant promise to Canadians: an immediate $3-billion investment for home care, including palliative care. However, the Liberals have changed course a bit. They are using the urgency of palliative care in communities as a bargaining tool, a stick, in negotiations with provinces. Those provinces that have agreed to the Liberals' terms when renegotiating the health accord were given funding for both mental health and home care, while others that had not yet agreed to those terms received nothing.

This priority is too important to use as political leverage like that, because the need for palliative care will never go away. In fact, 80% of Canadians receiving palliative care are cancer patients. Right now, two out of five Canadians will develop cancer in their lifetimes, and that statistic is expected to increase by 2030. These patients deserve a comfortable end-of-life option. The problem is that 30% of Canadians do not have access to palliative care services.

The Canadian Society of Palliative Care Physicians says that palliative care should be available in homes, hospices, hospitals, and long-term care centres throughout Canada, but it is not. Availability depends on where one lives, how old one is, and what one is dying from. This needs to change. The CSPCP goes on to say that strategic investments in palliative care have been shown to reduce the cost of delivering care by about 30%. Presently it costs about $1,200 a day to remain in the hospital, $400 a day to remain in hospice care, and $200 a day to receive home care. To reduce these costs by at least 30% would offer more opportunities for Canadians, free up scarce resources in health care facilities, and ultimately improve the quality of life and care for patients suffering from serious and terminal illnesses.

This is important, because Canadians are suffering from chronic and terminal conditions in growing numbers. Good palliative care covers a wide range of services, such as acute care, hospice care, home care, crisis care, and spiritual and psychological counselling.

Support from Canadians is evident across the country. There have been 83 petitions on palliative care presented in the House by members of Parliament in this session alone. Thousands of letters have been received by members of Parliament on all sides of the House. I personally have received dozens of letters from constituents across Lakeland outlining the need for palliative care options, particularly for seniors, who have limited options for end-of-life care. Right now, Statistics Canada confirms that there are more seniors in Canada than children. With an increased demand for health care, hospitals, and clinics, the option for hospice care has clearly never been more important.

Communities in Lakeland are fortunate to have access to health care and consultants in all regions of the riding, but more can be done and needs to be done to ensure greater access for everyone. Remote and rural regions of the country like Lakeland do not always offer the same robust services as urban centres and highly populated areas. Regional accessibility is an important consideration for a national strategy, and one we cannot ignore.

The current palliative care options in Canada are inadequate and do not meet the needs of Canadians. That is what this framework seeks to address.

In 2011, it is estimated that only 16% to 30% of those in need were receiving proper palliative and end-of-life care. The current health care system favours short-term acute care, which it does extremely well, but experts report that the system lacks the capacity and the funding to properly and consistently provide quality long-term palliative care. The cost of acute care is four times that of hospice palliative care, so clearly there is an opportunity to provide long-term, consistent care responsibly. It is a challenge that provincial governments and elected representatives at all levels face and must take on.

The proper training of medical practitioners and nurse practitioners is an important step in creating a comprehensive and well-equipped palliative care structure. On average, medical and nursing students spend as little as 20 hours of their four years of study learning about palliative and end-of-life care. In 2011, there were fewer than 200 geriatricians in Canada. Today, the estimated need is upwards of 600.

Bill C-277 would also have a positive impact on the lives of caregivers. In 2011, there were an estimated four million to five million family caregivers in Canada. They contribute $25 billion to the health care system. These same selfless caregivers often bear a heavier financial burden and have to miss one or more months of work because of their duties. Family caregivers provide 80% of all home care in Canada, and 77% of these caregivers are women.

These numbers are not to be taken lightly. Caregivers experience financial, social, and physical burdens that can have lasting effects on their lives. The Canadian Cancer Society says that Canadian caregivers are the invisible backbone of the health care system, providing $25 billion in unpaid care.

This added support would encourage palliative care in the home, which has been demonstrated to be beneficial for everyone involved. Allowing patients to stay in their homes for as long as possible is a compassionate choice that should be available to every Canadian. We have a duty to those Canadians.

Many Canadians who require palliative care are seniors or veterans. Seniors built our communities, founded our businesses, created opportunities for future generations, and supported our economy. Seniors built this great country, fought in wars, raised their kids, and laid the foundation for the free and prosperous Canada in which we are so fortunate to live.

It is our fundamental responsibility to ensure that the most vulnerable are taken care of, and when these individuals, who have done so much for us, need the most support, it is Canada's turn to give back to them. That is a core reason that I support this important bill. I encourage all members of the House to do the same.

I thank my colleague again for all of the good work she has done in bringing forward this pressing need.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 5:50 p.m.
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Sonia Sidhu Liberal Brampton South, ON

Madam Speaker, it is an honour to rise today to speak about Bill C-277, an act providing for the development of a framework on palliative care in Canada.

I first want to congratulate my colleague, the member for Sarnia—Lambton, for bringing this forward. I also want to congratulate my fellow members on the health committee for working so collaboratively on this bill at committee stage. I think our work and amendments improved this legislation to become something positive for all Canadians.

It is essential for us to be talking about palliative care. It is something I heard about a lot during my election campaign and continue to hear about from community members. Palliative care and access to end-of-life care are important issues for all Canadians.

Brampton South is a riding with a significant population of seniors, who brought this forward as an issue of dignity and quality of life. A strategy to address this need is an important step. I want to thank them for raising their voices and for championing this in my community.

As members know, palliative care is for all, regardless of age, who are approaching the end if life. It is for all people who desire a compassionate and comfortable place to receive care. In our conversation about medical assistance in dying, I raised the need for palliative care and home care to be involved in that discussion. That is why I am extremely proud that our government responded to all aspects of this issue in our relatively short time, so far, in government.

As members know, we will be investing $6 billion in home care through the provinces and territories; $2.3 billion will be going to fill needs in Ontario, which I hope will serve to fill the gaps that exist in our rapidly growing Peel region. Home care is about responding to Canadians' overwhelming desire to be at home, to receive care at home, and, sadly, if needed, to live out their end-of-life stage at home when possible. Palliative care is the other option that serves to make life more dignified for our most in-need people.

I would like to mention that palliative care workers and PSWs deserve our utmost respect for the difficult but important job they do for people in our communities.

I strongly support Bill C-277's goals to make a strategy and to incorporate work governments have been doing on this already. A strong evidence-based approach will deliver real results. That is the approach our government ran on and the one Canadians endorsed when they elected us.

Please know as I give my comments today that we recognize and respect that the provinces play the principal role in the delivery of health services, including palliative care. This bill, with the proposed amendments, understands that the federal role in health lies in coordinating and ensuring that there are the same services available for all. I am very pleased that the government will support this bill, with amendments.

The proposed amendments respect the intent of the bill but seek to align it with the scope of federal roles and responsibilities in relation to palliative care. They also seek to build on existing palliative care frameworks, strategies, and best practices being undertaken by provinces, territories, and stakeholder groups.

To ensure that Canadians have access to the best quality of palliative care, it is important that we do not reinvent the wheel. In many provinces, there are existing frameworks and policies. As such, it was important to me and my colleagues on the health committee to ensure that any new work on this would build on what exists already.

We also know that when it comes to caring for Canada's seniors in need of palliative care, the job falls not only to health care professionals but to other caregivers, including family members. As such, our committee made changes to the bill to ensure that all who provide care at this stage are supported and have their needs considered in the establishment of a framework for palliative care.

With our government's focus on evidence-based policy, it was also very important to ensure that any new work on this issue include the promotion of research and data collection so that we can ensure that the care provided to Canadians is based on the most relevant research, best practices, and up-to-date evidence in this area.

This is a very important part of the picture, as we all know very well that the incredible ongoing research in the Canadian health care field is innovative, leading to new opportunities for greater care. It is essential that this new knowledge be considered as we develop and maintain a framework for palliative care across Canada.

Our proposed amendments would facilitate federal support for improved palliative care in relation to three pillars, which are aligned with the objectives of the bill: training for health care providers; consistent data collection, research, and innovation in palliative care; and support for caregivers.

We continue to support pan-Canadian initiatives that enhance Canada's capacity to provide quality palliative and end-of-life care as well as a range of programs and services, such as family caregiver benefits and resources, that address the actions proposed in the bill.

Our government's investments in the provinces to in turn deliver health services are outpacing inflation, ensuring that they can deliver better health outcomes. I want to commend the Minister of Health on the recent health accord agreements.

I am also very proud to say that we are also working with first nations and Inuit stakeholders to identify options for building on current resources and services to provide increased access to palliative care.

It is crucial that any work we do regarding the health of Canadians reflects the different realities of the many communities across the country. Specifically, we know that the health care needs of first nations and Inuit communities deserve special attention to respect the traditions and existing frameworks that have been developed from community to community.

Overall, I cannot say enough how pleased I am that this important discussion is happening in this place. I do not doubt that this conversation will and must continue. The health committee, on day one, agreed that this was something we should look at, because it is an important issue for seniors and for us, too.

We have many important pieces of business before us at committee, but I imagine that a review of this strategy and of strategies stakeholders or provinces currently are using could be a full study in the future.

Palliative care and end-of-life options are the kind of hard but real topics that are our responsibility as leaders to address. These are the things that make us think of our loved ones and our own futures in personal ways. Regardless of our own views or choices, we are setting up a system that is fair, compassionate, and just. By taking a public health approach to issues like this, we are doing the responsible thing that serves as a framework for all Canadians.

I want to thank the parliamentarians in this House for supporting the bill and for all the contributions so far. It is something I have followed closely in the House. Today we continue to move this forward towards action.

Again, I congratulate the member for Sarnia—Lambton on Bill C-277 and her work to promote its aims. It is a noble quest that aligns with the priorities of this government to bring positive change to our health care system and with my own priorities to ensure that Canadians have access to the best possible health care services. I hope all members will join me in supporting the bill again at the next opportunity to vote for it.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 5:40 p.m.
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Kelly McCauley Conservative Edmonton West, AB

Madam Speaker, I am proud to rise today in support of Bill C-277, which calls for the development of a framework to increase access to palliative care. I would like to personally thank the member for Sarnia—Lambton for introducing this private member's bill.

Years ago, while I was living in Victoria, I had the honour of serving as the president of the Greater Victoria Eldercare Foundation, Vancouver Island's largest seniors foundation, supporting six extended care hospitals. The Greater Victoria Eldercare Foundation, under my good friend executive director Lori McLeod, has developed leading community programs to assist seniors, including the annual Embrace Aging month, with initiative raising awareness about the wealth of resources and opportunities available year-round to help seniors and their families navigate the journey of aging.

I was pleased to hear recently that it has added additional palliative care facilities at its Glengarry facility. It was through my involvement with the Eldercare Foundation that I encountered first-hand the many issues that seniors and their families face now: the difficulty of obtaining proper care for seniors, proper facilities, and proper understanding of the unique situations and issues they face. I owe a lot to the many volunteers and staff whom I worked with at the Greater Victoria Eldercare Foundation, and I know they too would be supporting this excellent bill.

Alleviating the suffering of Canadians is a collective duty of the House, regardless of political agenda or party affiliation. Whether in hospitals or at home, Canadians should not have to go without the care they need simply because there is not sufficient support. Our society is capable of providing the best care for our citizens, and Bill C-277 provides a framework to utilize and implement these resources. This bill helps to promote good health while preserving the independence of Canadians in need of health support. As a Conservative, I am a proud supporter of this bill, which will invest in long-term and palliative care, which the Liberals have failed to do despite their many promises.

In 2015, the Supreme Court of Canada's decision in Carter v. Canada established that Canadians have a right to physician-assisted dying. We debated Bill C-14, and while I opposed the legislation, the House and Senate passed it and it received royal assent almost a year ago. One of the key aspects of the Carter decision, however, was its call for an advancement of palliative care as a means of increasing Canadians' access to compassionate health care. The Carter decision is intended to ensure that Canadians can make a legitimate choice regarding their own health care, and one of those options is to receive adequate palliative care, care that is focused on providing individuals who have a terminal illness with relief from pain, physical and mental stress, and the symptoms of their illness. It is intended to ensure that those who are at the end of their life can pass peacefully, with dignity and without pain.

The Carter decision enabled Canadians to pursue assisted dying, but it also established an obligation on the government to ensure all Canadians can access proper, adequate, and compassionate end-of-life care. Right now, we are not getting the job done. We are not in any imagination fulfilling our obligations as a society in caring for those in need of care. For example, a survey of pre-licensure pain curricula in the health science faculties of 10 Canadian universities shows many would-be doctors receive less training in pain management than their counterparts in veterinary medicine. I am sure my dog Hailey, who is no doubt at home on my couch right now as I speak, finds this reassuring, but as someone formerly involved in senior care, I find it quite distressing.

A survey of more than 1,100 doctors and nurses shows that those who treat fewer terminally ill patients, therefore knowing the least about symptom management, are most likely to be in favour of assisted suicide, while those with more experience in symptom management and end-of-life care tend to oppose it. Dr. Max Chochinov, a noted specialist on palliative care, explains that the will to live is directly inverse to the amount of pain, and that loss of dignity drives wanting to die and treatment of pain can improve sense of dignity.

We also have to remember the impact of terminal illness on a family: the emotional, physical, and financial struggle of caring for a loved one at the end of their life. Under the current regime, it is up to families to carry the overwhelming bulk of this burden. This system is not fair. People should not have to choose between paying bills and caring for their spouse, their parents, or their siblings.

We have heard horror stories time and time again from families who were completely ambushed by palliative and in-home care costs after their loved one got sick, and these instances are becoming more and more common. The health minister herself has acknowledged many times that Canada has a deficit in access to quality palliative care, yet despite her pledges to do more and provide more, she has neglected to take meaningful action to date. Canada's population as a whole is growing older, and seniors now outnumber children.

I said before in my speech to the RRIF financial security act—another bill that would have helped seniors, which the Liberals voted against—that we need to be ready to have the proper programs and mechanisms in place to adapt to our shifting demographics.

A recent Globe and Mail article states that, according to the 2016 census, we have seen “the largest increase in the share of seniors since the first census after Confederation”. Across Canada, the increase in the share of seniors since the 2011 census “was the largest observed since 1871—a clear sign that Canada’s population is aging at a faster pace”. That figure is projected to rise even more in the coming years. The proportion of those aged 65 and older climbed to 17% of Canada's population. This is not a new phenomenon obviously.

A September 2015 Statistics Canada report noted that, by 2024, 20% of our population will be over the age of 65, so we need action plans in place to address this shift, this massive wave that is going to be overtaking our health care systems. The provinces are going to be faced with an epidemic soon enough of people trying to access systems that are not capable of supporting the demand. Less than 30% of Canadians have access to this vital service, which allows them to choose to live as well as they can for as long as they can.

It is time for the government to fulfill its obligations to provide quality palliative care to all Canadians. This framework answers some of those calls, and it represents the needs of the aging population across Canada, including those in Edmonton West. The percentage of individuals in Edmonton aged 65 or older has risen to 14%, a significant figure representing thousands of individuals who will benefit from universal palliative care.

I know this bill will serve the aging population in my own riding, particularly those who find comfort in knowing that their family members and loved ones will receive the best care. No one should have to suffer through ailments alone, without the support of well-trained and compassionate health care practitioners.

Bill C-277 is required to define the services covered, to bring standard training requirements for the various levels of care providers, to come up with a plan and a mechanism to ensure consistent access for all Canadians, and to collect the data to ensure success. Good palliative care can cover a wide range of services, such as acute care, hospice care, home care, crisis care, and spiritual and psychological counselling. The creation and implementation of a palliative care framework will give Canadians access to high-quality palliative care through hospitals, home care, long-term care facilities, and residential hospices.

We need to ensure that our communities support the aging population with respect and dignity. As parliamentarians elected by our respective communities, reacting to this shift should be a priority and cannot be ignored. When I introduced my private member's bill last fall, which sought to help seniors who were being disproportionately targeted by an outdated tax measure, I heard from countless seniors across Canada who felt they were being left behind. While it is important to ensure the provinces are not pigeonholed by federal legislation, we need to acknowledge a legislative gap when we see one. Seniors need help, and no amount of discussion papers, working groups, or committee meetings will make this issue go away. We know what the issue is and we need action.

Bill C-277 is a step toward providing the much-needed support for seniors today and seniors to be. Palliative care is good, compassionate, and meaningful. Providing access to quality and affordable palliative care can help make painful decisions a little more manageable for those suffering from a terminal illness. It can also significantly help the families of those suffering, who carry the disproportionate financial and emotional burden of end-of-life care. The government needs to pass this legislation to begin the development of a framework on increasing access to palliative care.

When the Supreme Court's decision in Carter v. Canada was delivered, it included a significant and serious obligation on the government to ensure that Canadians could make a real decision on their end-of-life care. The ability to make that decision requires that the options are actually available, and today's unfortunate reality is that our palliative care system is inadequate.

As I mentioned, I would like to thank the member for Sarnia—Lambton for bringing this fantastic private member's bill forward. I am very pleased to hear my colleagues in the NDP speak so favourably toward this, and to hear that they will be supporting it. I am extremely proud that I and other members of the Conservative caucus will be supporting this very important bill.

The House resumed consideration of the motion that Bill C-277, An Act providing for the development of a framework on palliative care in Canada, be read the third time and passed.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 30th, 2017 / 5:30 p.m.
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Don Davies NDP Vancouver Kingsway, BC

Mr. Speaker, I rise today to speak to Bill C-277, an act providing for the development of a framework on palliative care in Canada.

The legislation would require the Minister of Health to develop and implement a framework designed to give all Canadians access to palliative care provided through hospitals, home care, long-term care facilities, and residential hospices. The bill would also require the health minister to convene a conference within six months of the act coming into force, with provincial and territorial governments and palliative care providers, in order to develop a framework on palliative care in Canada. Finally, the bill would require the Minister of Health to table the framework in Parliament within a year and post the framework online within 10 days of tabling it.

New Democrats will be supporting the legislation because we believe that palliative care is a vital part of comprehensive health care provision, and we believe that every Canadian has a right to high-quality end-of-life care. New Democrats have a long history of strong advocacy for better palliative care services for Canadians. We are proud of the New Democrat motion adopted in the last Parliament with all-party support, which laid out a pan-Canadian strategy for palliative and end-of-life care. Launched October 31, 2013, my colleague the member for Timmins—James Bay's Motion No. 456 called for the establishment of a pan-Canadian palliative and end-of-life care strategy in conjunction with provinces and territories on a flexible and integrated model of palliative care. It passed with almost unanimous support on May 28, 2014.

At present, only 16% to 30% of Canadians have access to formalized palliative or end-of-life care services. Even fewer receive grief or bereavement services. With the subsequent legalization of physician-assisted dying, the provision of high-quality palliative care services has now become more important than ever, since it provides meaningful options for end-of-life decisions. It is well past time for the federal government to act.

Palliative care is the health discipline focused on improving the quality of life for people living with life-threatening illness. The World Health Organization defines it as follows:

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

provides relief from pain and other distressing symptoms;

affirms life and regards dying as a normal process;

intends neither to hasten or postpone death;

integrates the psychological and spiritual aspects of patient care;

offers a support system to help patients live as actively as possible until death;

offers a support system to help the family cope during the patients illness and in their own bereavement;

uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;

will enhance quality of life, and may also positively influence the course of illness;

is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

There is consensus among academics, health professionals, and the public that improvements in the palliative care system in Canada are desperately needed. Without clear national standards, individual jurisdictions are left to develop their own policies, programs, and approaches, resulting in inconsistent and inadequate access across the country. In Ontario, for instance, 40% of cancer patients do not receive a palliative assessment in their last year of life. In some regions of Atlantic and western Canada, data shows that less than half of people who die in a hospital receive palliative care.

The number of individuals actively caring for a friend or family member is expected to increase as Canada's population ages. On average, Canadians estimate that they would have to spend 54 hours per week to care for a dying loved one at home, and two-thirds say they could not devote the time needed for this care. Currently, family caregivers provide more than 80% of care needed by individuals with long-term conditions at home, in long-term care facilities, and in hospital. Replacing family caregivers with a paid workforce at current market rates and usual employee benefits has been estimated to cost about $25 billion.

Furthermore, according to a synthesis of the empirical literature, palliative family caregiving for older adults is gendered. When acting as caregivers, women experience a greater degree of mental and physical strain than their male counterparts. This is linked to the societal expectation that women should provide a greater degree of care at the end of life for family members.

Remarkably, there are many jurisdictions across the country where we do not even know how many Canadians receive quality palliative care. We lack consistent and ongoing data collection at a systemic level, which leaves us unable to effectively hold our health care systems accountable.

Indicators such as location of death, use of acute care before death, and referrals to formal palliative care show that there is significant room for improvement. Many Canadians who require palliative care receive it in acute and emergency care, if they receive it at all. Not only are acute care settings more costly than dedicated palliative care, but they are also not as well equipped to provide the most appropriate treatment and care for patients and their families.

It is vital that any national palliative care strategy take into account the geographic, regional, and cultural diversity of urban and rural Canada. It must also respect the cultural, spiritual, and familial needs of Canada's first nations, Inuit, and Métis people. According to Dr. Mary Lou Kelley, research chair in palliative care at Lakehead University, the federal health care dollars that would help indigenous people receive end-of-life care at home have not kept up with the increasing demand. Health care for first nations is the responsibility of the federal government, of course, and it does provide some home care services, but the system was never designed to provide complex health care to people with chronic or advanced terminal diseases.

Finally, I would be remiss if I failed to note that, although the bill is sponsored by a Conservative member, the previous government eliminated the federally funded national secretariat on palliative and end-of-life care when it first took office in 2006. If it had not been for this cut, we would have developed a palliative care framework a decade ago.

From 2001-06 the federal government funded the secretariat through Health Canada with an annual budget ranging from $1 million to $1.5 million, virtually nothing in terms of the federal budget. However, when the Conservative government disbanded the end-of-life care secretariat, it stopped working on a national palliative and end-of-life care strategy.

In 2011, the Conservative government made a one-time commitment of $3 million to fund the study and framework creation of community integrative models of hospice palliative care. This initiative was led by the Canadian Hospice Palliative Care Association, but according to Dr. Greg Marchildon, Ontario research chair in health policy and system design at the University of Toronto:

There is no national policy on palliative care in Canada. Instead, there are national guidelines developed by community-based palliative care organizations operating at arm's length from government.

Although Conservative support for palliative care had previously been absent, it is certainly better late than never. That is why New Democrats reached across the aisle at the health committee to successfully move an amendment to the bill requiring the federal government to evaluate the advisability of re-establishing Health Canada's secretariat on palliative and end-of-life care.

I will give credit where credit is due. The member for Sarnia—Lambton responded to our proposal thoughtfully, saying: “I'm a fan of doing that. As I said, I was not here during the Harper regime, so I can't fix the past. I can only improve the future.”

New Democrats, in keeping with that sentiment, will work together to improve the future. I will conclude my remarks by reiterating the NDP's support for this vital initiative and affirming that all Canadians deserve to live their final days in dignity and comfort. We look forward to contributing to the framework development process and sincerely hope that it will provide the strongest possible palliative care strategy for every Canadian from coast to coast to coast.

The House resumed from May 9 consideration of the motion that Bill C-277, An Act providing for the development of a framework on palliative care in Canada, be read the third time and passed.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 7:25 p.m.
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Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

Mr. Speaker, I am pleased to be here today to address Bill C-277, an act providing for the development of a framework on palliative care in Canada and to discuss our government's commitment to improving palliative and end of life care for all Canadians.

This bill comes at the right time in our national dialogue on palliative care, and I would like to recognize the efforts of the member for Sarnia—Lambton in moving this discussion forward.

I had the opportunity to review this legislation with my seniors council in Coquitlam—Port Coquitlam at our last meeting. I want to thank the members for their input and for helping me better understand just how important it is for this bill to proceed.

Our government knows that the quality and availability of palliative care is an issue of great importance to Canadians. A Harris/Decima survey found that more than 90% of Canadians believe that palliative care improves the quality of life for both patients and their family members. Studies have shown that patients who receive palliative care services are happier, more mobile, and, in some cases, live longer than patients who do not.

The recent legislation on medical assistance in dying has amplified the public conversation on options for care at the end of life. While medical assistance in dying is only one potential option at the end of life, experiences in other countries suggest that only a fraction will seek it.

It seems that many Canadians who could benefit from palliative care do not receive it. For example, Health Quality Ontario found that two in five Ontarians had not received palliative care services at the end of life in 2015.

Palliative care is a priority for our government, and I support the creation of a framework to guide our work. I was pleased to see the amendments made by the Standing Committee on Health so that the framework takes a more targeted and integrated approach and builds upon the important work already under way to improve palliative and end of life care in Canada.

There is a wide range of promising initiatives established in provinces and territories as well as in stakeholder organizations in the health care sector. These initiatives touch upon many of the elements put forth in this bill, including identifying training and education needs for health care providers and other caregivers, providing supports for care providers, facilitating access to care, and promoting research and data collection.

The federal government recognizes the advantages of and the growing need for palliative care and has funded a series of strategic initiatives in order to establish key fundamental approaches and to address key issues.

For example, the Canadian Partnership Against Cancer, an independent national cancer organization funded by the government, has convened a group of palliative care experts from across the country to create the palliative and end of life care initiative. The network includes representatives from every province and territory, officials from provincial ministries of health, representatives from both professional medical organizations and patient advocacy groups, and patient and family representatives.

Through this venue for national conversations, the palliative and end of life care initiative is working to improve coordinated support for patients and families through the education of health professionals, patients, and caregivers. The network is also increasing access to evidence-based, integrated, high-quality palliative care services that align with patient preferences.

Apart from the network, the Canadian Partnership Against Cancer has also funded a series of studies focused on the experience of palliative care from the patient and family perspective. This patient-centred approach focuses on the importance of early and ongoing assessments of the expressed wishes of the patient and family for symptom management and quality of life. The Canadian Partnership Against Cancer has been expanding the visibility of its work by distributing its findings widely so as to bring this evidence to the broader health care community. By emphasizing the centrality of the patient and family, the Canadian health care system can provide end-of-life care that is responsive to patient needs and provide an improved experience for patients and families going through the most trying moments of their lives.

The Canadian Foundation for Healthcare Improvement is another national organization funded by our government to help identify proven health system innovations and accelerate their spread across Canada. In recent years, one of its priorities has been to evaluate and disseminate data on best practices with respect to palliative care services. The Canadian Foundation for Healthcare Improvement's programming in palliative and end-of-life care is well under way and focuses on identifying and validating high-impact innovations and practices ready to be spread and scaled up across the country. For example, in February it launched a pan-Canadian call for innovations to identify and validate high-impact palliative care models, practices, and tools. Projects identified as having the greatest potential impact will be featured at a forum of experts, decision-makers, and health administrators in June to discuss how these innovations can be scaled up and spread to other organizations and jurisdictions.

I would also like to highlight the important work being undertaken by Canadian researchers to understand the current status and potential of palliative care in Canada. Since 2011, the government has invested over $546 million with the Canadian Institutes of Health Research to support research on aging, including palliative care or related late-life issues. One area where the Canadian Institutes of Health Research is supporting a wide variety of research is through its team grants in late-life issues. In the past, these research projects have examined some of the most pressing issues on palliative care in Canada, including improving knowledge uptake across providers and institutions, appropriate protocols for transferring patients between different levels of care, and developing ways to measure the quality of patient experience.

Another example of CIHR research is the improving end-of-life care in first nations communities project. Led by Dr. Mary Lou Kelley from Lakehead University, this project was designed to improve the end-of-life care in four first nation communities through developing a culturally appropriate approach to palliative care. Providers in each of the communities chose a series of clinical, educational, or administrative interventions to build local capacity, with each activity being evaluated for its contribution to developing palliative care. The four communities created locally designed and controlled palliative care programs. This demonstrated the feasibility of providing local palliative care at home in first nation communities, the effectiveness of first nations community capacity, and the associated benefits of enabling among first nations people the choice to receive palliative care at home. Furthermore, the project produced a series of reports and resources for first nation communities and the government, with recommendations that will be critical for the improvement of palliative care in first nation communities and nationwide.

To build on this work, our government has now provided funding to work with Lakehead University to provide coaching and mentoring support to 24 first nation communities in Ontario who want to implement palliative care services within their community. The message is clear: Canadians want access to high-quality palliative care.

Based on these existing foundations and accomplishments, our government is poised to play an important role in helping Canadians receive the most appropriate, timely, and compassionate care at the end of their lives.

I am proud of the work our government has already supported in this area and the significant strides we have seen in the provinces and territories, as well as among stakeholders in the health care sector. I look forward to continuing to work toward improving access to quality palliative care services for all Canadians.

The member for Sarnia—Lambton should be commended for her work on this and for bringing this legislation forward. I also appreciate the work my seniors' council did to prepare me for this debate.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 7:05 p.m.
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Brigitte Sansoucy NDP Saint-Hyacinthe—Bagot, QC

Mr. Speaker, I am pleased to rise in the House today to speak to Bill C-277, an act providing for the development of a framework on palliative care in Canada. I would like to thank the sponsor of the bill for her work and the members of the Standing Committee on Health for this new version.

The New Democrats have long supported and advocated for the idea of a Canadian palliative care strategy to provide end-of-life care to Canadians. With Canada's aging population taxing our health care system, the need for a coherent, coordinated, nationwide palliative and end-of-life care strategy is becoming more acute. This issue affects and will continue to affect us all directly or indirectly.

I was pleased to see these words in the new version of the bill:

2(1)(g) evaluates the advisability of re-establishing the Department of Health’s Secretariat on Palliative and End-of-Life Care.

I would remind members that we are in this situation because, when the Conservatives were in power, they decided to abolish the secretariat on palliative and end-of-life care and stop work on the palliative and end-of-life care strategy. We therefore missed an opportunity to make incredible advances for the well-being of patients, their families, and our society. Those decisions, combined with 10 years of inaction on this issue, have had a negative impact.

I hope that, with this bill, the Liberals will take this opportunity to restore the secretariat on palliative and end-of-life care and that it will be given adequate funding. I also hope that health care professionals will have the resources needed so that they can provide services across the country, because as we all know, there is a great and ever-increasing need.

I was able to gauge the extent of these needs when I had the opportunity to sit with my colleagues from the House and the other chamber on the Special Joint Committee on Physician-Assisted Dying. At the hearings, the vast majority of witnesses and experts told us how vitally important accessible and good quality palliative care is to Canadians. I was made aware of the fact that across the country only 16% of Canadians have access to quality palliative care. Thus, one in ten Canadians have access to quality palliative care. One in ten is too little, far too little.

The NDP respects the fact that a good part of health services are provided by the provinces. However, the federal government has a fundamental role to play when working with them. For that reason, we have been asking for a long time for a national palliative care strategy that respects provincial and territorial jurisdiction, but that seeks to find way to provide adequate palliative care services for everyone.

At the Special Joint Committee on Physician-Assisted Dying, we made informed and necessary recommendations on palliative care that called for reestablishing the secretariat on palliative care and funding, creating a properly funded national palliative and end-of-life care strategy, and support for family caregivers and better compassionate care benefits.

These recommendations have to be considered. They respond to the concerns of Canadians. As everyone probably knows, National Palliative Care Week is from May 7 to 13. It is happening right now.

I want to take this opportunity to thank all those who work with our constituents day after day. I am talking about health professionals and volunteers who devote their time to this. Their commitment is essential and I thank them from the bottom of my heart. I want to take this opportunity to specifically thank the health professionals, agencies, and organizations, and the many volunteers in the riding of Saint-Hyacinthe—Bagot who work directly or indirectly with the patients. The role these people play in providing high quality palliative care cannot be measured. They provide patients and their families the support they so desperately need during one of the most difficult times in their lives. The palliative care that they provide whether at home, a palliative care centre, or a hospital, is indispensable.

In my riding, Saint-Hyacinthe—Bagot, countless organizations do exceptional work.

These organizations offer palliative and respite care. Others raise funds to ensure that those who need quality palliative care can get it. One of these is the Hôtel-Dieu-de-Saint-Hyacinthe. The centre's palliative care team has been providing palliative care for 30 years. Hundreds of people go to the nursing home to live out their last days. It is around 500. The hospital has hundreds of beds, but only 12 palliative care beds.

In Acton Vale, the Centre d'hébergement de la MRC-d'Acton has just one palliative care bed. All of the people who work with patients and their families, on user committees and elsewhere, are doing exceptional work, and I am deeply grateful to them.

In support of Hôtel-Dieu residents, the Fondation Aline-Letendre will be holding a spaghetti supper and “Rock à la Sylvain Lussier” party on Saturday, May 13, at 7 p.m. in the Centre communautaire Douville in memory of Lucie-Anna Gaucher and Jeanne Palardy, who both received palliative care at the Hôtel-Dieu-de-Saint-Hyacinthe.

This Saint-Hyacinthe organization does crucial work in our community. I want to recognize the incredible work of its executive director, Christine Poirier, its volunteers, and its board members. Since it was created over 20 years ago, Fondation Aline-Letendre has given over $7 million to the Hôtel-Dieu-de-Saint-Hyacinthe. I am also thinking of the staff and volunteers at Les Amis du crépuscule, a community organization that provides assistance to people receiving palliative care and later to their grieving families. We also have the Maison Marie-Luce-Labossière, which provides support and assistance, as well as accommodations, in a safe, peaceful environment to people suffering from “preterminal” cancer, among others. The Maison Marie-Luce-Labossière also has spaces for short-term stays in order to allow caregivers a period of respite during the summer months.

Like me, the members of these organizations believe that a national palliative care strategy would have a positive impact on patients and their families, and that it is high time Canada developed such a framework for palliative care.

The growing demand for palliative and end-of-life care poses a major challenge for our society. The bill before us today encourages us to think about existing frameworks, strategies, and best practices in palliative care. In that regard, I would like to acknowledge the exceptional work that Quebec has been doing for the past several years to deal with this reality and provide appropriate services to Quebeckers. Quebec created a palliative and end-of-life care development plan in 2015, which builds on other existing measures, such as the end-of-life palliative care policy. Quebec is a leader in this area and we should learn from its example. There is also another inspiring initiative in this regard, and that is Motion No. 456, which was moved by my NDP colleague on October 31, 2013. The motion sought to create a pan-Canadian strategy on palliative and end-of-life care in co-operation with the provinces and territories.

New Democrats have been working with many stakeholders and organizations for a long time in order to develop and implement a palliative care strategy. We are proud that the member revisited the NPD's motion on palliative care, which was adopted in 2014. The motion was adopted in the House three years ago, but no real progress has been made on this vitally important issue since then.

That is why it is high time that we move forward without delay. The federal government must demonstrate leadership and take immediate action to establish a palliative care framework that will give all Canadians better access to quality palliative care.

I would like to once again thank the sponsor of this bill, which I urge all of my colleagues to support. We should be in unanimous agreement in the House on this subject.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 7 p.m.
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Louis-Hébert Québec


Joël Lightbound LiberalParliamentary Secretary to the Minister of Health

Mr. Speaker, I am pleased to be here today to express support for Bill C-277, an act providing for the development of a framework on palliative care in Canada.

Our government believes that Bill C-277 provides us with a timely opportunity to take a leadership role on this issue. I would also like to recognize the efforts of the member for Sarnia—Lambton, who had the class and the elegance to send flowers to the minister with whom I feel fortunate to work. I would like to return the favour. I think she did an excellent job on this issue and has put forward a very thoughtful proposal. I sincerely congratulate her.

I also want to congratulate the members who served on the Standing Committee on Health and who studied this bill with a great deal of attention and care.

Our government understands that palliative care is a critically important part of our health care system, providing much needed support to patients and their families at one of the most difficult times of their lives. We also know that Canadians overwhelmingly support a palliative approach to care at the end of life.

Still, studies have reported that as few as 16% to 30% of Canadians have access to palliative care, depending on where they live in Canada.

There is no question that we must improve palliative and end of life care so that Canadians, irrespective of where they live, have access to timely, high-quality care at the end of their lives. If we are going to be successful in achieving this goal, however, it is paramount that the federal government collaborate with the provinces and territories and draw on the considerable expertise that key stakeholders, health care providers, and caregivers have to offer.

I would now like to take this opportunity to speak to some of the amendments made by the Standing Committee on Health, which I believe strengthen the bill.

The Standing Committee on Health received a number of briefs from key stakeholders on Bill C-277, including the Canadian Society of Palliative Care Physicians of Canada, the Canadian Cancer Society, the Canadian Nurses Association, and Pallium Canada. All of these organizations expressed strong support for the implementation of a federal framework on palliative care. However, they also indicated that a significant amount of work had already been done and should be leveraged in the development of any federal framework on palliative care.

For example, most provincial and territorial governments already have a palliative care strategy, plan or framework in place to support palliative care. Several of the briefs submitted to the committee also identified the Canadian Hospice Palliative Care Association’s “The Way Forward: Towards Community-Integrated Hospice Palliative Care in Canada” as a key resource that could be built upon.

Funded by Health Canada, “The Way Forward” Framework was developed through an extensive consultation process with health care providers, experts, key stakeholders and all levels of government. It provides guidance, best practices, and other resources to help communities and organizations adopt a palliative approach across all settings of care.

Organizations across Canada, including the Government of Alberta, the Canadian Home Care Association, the Canadian Nurses Association, the Canadian Medical Association, have used the framework to guide their efforts to implement an integrated palliative care approach.

I was pleased that the members of the Standing Committee on Health acknowledged this significant body of work and that it will be studied when developing any future framework.

A number of stakeholders also expressed their support for the priority areas identified in the framework, including palliative care education and training, support for care providers, and data collection and research. Each of these elements is widely understood to be essential in improving access to high-quality palliative care services by patients and their families.

Our government has been very clear in expressing its support on these issues. For example, the government has provided $3 million in funding to Pallium Canada to support training in palliative care to front-line health care providers. This initiative has developed a range of educational materials, trained trainers, and facilitated sessions to increase the palliative care capacity of health care providers.

We also recognize the critical role that unpaid caregivers play in the care of so many Canadians.

As announced in budget 2017, the introduction of the new Canada caregiver credit and a new EI caregiving benefit will provide additional support to Canadians caring for critically ill or injured family members.

Supporting the development of a solid evidence base has also been a clear priority for our government. Through the government's research funding arm, the Canadian Frailty Network centre of excellence is receiving $23.9 million in support over the next five years to facilitate evidence-based research, knowledge sharing, and clinical practices that improve health care outcomes for frail older Canadians, their families, and caregivers. It is my sincere hope that these foundational investments can be leveraged to guide future work in this area.

Our government is also committed to working co-operatively with provincial and territorial governments to improve the quality and availability of palliative care for Canadians.

While the federal government can provide leadership through the implementation of a framework to help support and unify efforts to make positive change, it is the provinces and territories that have primary responsibility for the delivery of health care services, including palliative care.

When first introduced in the House, Bill C-277 called on the Minister of Health to develop and implement a framework designed to give Canadians access to palliative care provided through hospitals, home care, long-term care facilities, and residential hospices. The bill is significantly strengthened by the changes made at committee to indicate that the federal framework on palliative care developed through Bill C-277 would support improved access to these services by Canadians. While the federal government is well positioned to complement and bolster the important work under way across the country by provincial and territorial governments, this wording better reflects the constitutional realities of the Canadian health care system, as it is the provinces that deliver the services on a daily basis.

The amended bill being considered by the House today no longer requires an evaluation of “the advisability of amending the Canada Health Act to include palliative care services provided through home care, long-term care facilitates and residential hospices”.

While this would no doubt highlight the importance of palliative care within the health care system, I would agree with the briefs sent to the Standing Committee on Health by the Canadian Nursing Association and the Canadian Society of Palliative Care Physicians, expressing concern over potential amendments to the Canada Health Act as part of this bill.

Given the complexity of the Canada Health Act, there is a real risk that this measure would lead to lengthy delays in the implementation of the framework, when more immediate action is needed. That is definitely not our objective, nor that of the member for Sarnia—Lambton, I am sure.

These organizations also expressed concern that the review on the state of palliative care, as prescribed by section 4 of this bill, may not necessarily result in increased access to community and home-based palliative care services, services for which Canadians have expressed the greatest support.

With these considerations in mind, the removal of this point will focus attention to where it is most needed, the development of a framework which would support provinces, territories, and stakeholders in their front-line efforts to improve palliative care.

I would like to thank the House for the opportunity to reflect on some of the important changes that were made to Bill C-277, which I believe significantly strengthen the proposed framework.

I will conclude as I started by thanking the member for Sarnia—Lambton for putting forward such a well-considered proposal, and offer my support and the government's support for the amended bill currently before the House.

Framework on Palliative Care in Canada ActPrivate Members' Business

May 9th, 2017 / 6:40 p.m.
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Marilyn Gladu Conservative Sarnia—Lambton, ON

moved that the bill be read the third time and passed.

Mr. Speaker, I am so pleased to be standing in the House today at third reading of my private member's bill, Bill C-277, an act providing for the development of a framework on palliative care in Canada.

The need for palliative care is increasing in our country. What began as a seed with the all-party parliamentary committee on palliative and compassionate care that studied this issue in the 2011 session and brought forward a report, recommendations, and motion to the House, grew into this bill, which has been supported both here and at committee, and is now ready for final consideration in the House.

Canadians need palliative care services now more than ever. Less than 30% of Canadians have access to this vital service, which allows them to choose to live as well as they can for as long as they can.

Bill C-277 is the next action required to define the services to be covered, to bring standard training requirements for the various levels of care providers, to come with a plan and mechanism to ensure consistent access for all Canadians, and to collect the data to ensure success. Through the amendments at committee, it will also consider re-establishing the palliative care secretariat.

A growing number of individuals of all ages in Canada suffer from chronic pain or deadly diseases. Palliative care services can replace a wide ranges of services, such as short-term care, home care, crisis care, and psychological or spiritual assistance services.

A palliative care philosophy is needed to meet all sorts of needs through a process that is adapted and patient-centric. Increased demand for home and palliative care will split the cost of health care in four, compared to the cost of short-term care or palliative care in hospitals.

The creation and implementation of a palliative care framework would provide consistent access to high quality palliative care in hospitals, at home, in long-term care facilities, and in nursing homes.

The bill is timely, since the special committee that studied the Carter decision on medical assisted dying legislation said that without good quality palliative care there would be no true choice. We want Canadians to have a choice.

During discussion in committee, we heard testimony from some of the outstanding Canadians who pioneer in palliative care, people like Dr. David Henderson, a lead physician in palliative care, and Dr. Pereira, another pioneer in palliative care. We heard from national organizations of nurses, hospices, and other palliative care experts. As a result of their testimony, several amendments were brought.

The first amendment tasks the federal government with developing a palliative care framework though the provinces are responsible for implementing it. Of course the federal government will support the provinces in this, and I was pleased to see the $11-billion investment in palliative and mental health care in budget 2017.

The second amendment clarifies the wording of the provision dealing with the training of palliative care providers. Many individuals are active in this field, including health care providers, volunteers in a variety of settings, and family caregivers. The committee felt it was important to better define training for health care providers and other people involved, so it amended the wording of the provision accordingly.

The committee also requested that the provision amending the Canada Health Act to include palliative care as a protected service be removed.

From what the witnesses told us, there were clearly other mechanisms that the federal government was already considering, such as health accords, infrastructure spending reviews, and programs for palliative care and home care.

The focus of the bill was on developing a plan, and there are many ways to do that.

One of the amendments brought forward at committee was that the proposed framework designed to support improved access for Canadians to palliative care evaluate the advisability of re-establishing the Department of Health secretariat on palliative and end-of-life care. In June 2001, the secretariat on palliative and end-of-life care was established as the first step in Health Canada's work to co-ordinate a national strategy on palliative and end-of-life care.

Nearly a year later, the secretariat brought together over 150 national, provincial, and territorial specialists in the field. This included practitioners, researchers, and those making decisions in palliative and end-of-life care. This summit, the national action planning workshop on end-of-life care, resulted in the establishment of the main priorities or working groups deemed as essential for quality palliative and end-of-life care in Canada.

These five working groups led to the beginnings of the Canadian strategy on palliative and end-of-life care and focused on best practices and quality care, education for formal caregivers, public information and awareness, research, and surveillance. I am very interested to see what an entity similar to the Department of Health secretariat on palliative and end-of-life care could look like today.

The bill now outlines the advisability of re-establishing this secretariat, which could be discussed at length. However, I would like to elaborate on what such a secretariat or regulatory body might look like.

It would be known as the central entity for palliative care information, education, and accessibility in Canada. Setting a national standard, or a national framework, would create consistent care across the country through a variety of mechanisms. Virtual care, home care, palliative care, and hospice care are only a few of the current possibilities.

Working all of these types of different care into community networks would be beneficial to all Canadians and would facilitate the process of finding and transitioning into palliative care. At the heart of these operations would be our health care workers, our nurses, doctors, palliative care physicians, and all the many other caregivers that exist.

An amendment to improve the wording of the need to provide research and collect data on palliative care was approved, as well as an amendment to remove ongoing responsibility for measuring the performance of the framework, since the provinces would have metrics in this regard.

The committee felt that the wording of the bill was adequately clear to cover all Canadians and, as such, no further amendments were required. I want to thank the committee members for their diligent consideration of the bill.

I was able to tell the committee what I would like to see happen when the framework was implemented. In terms of covered services, I would like to see the covered services include pain control, crisis intervention, spiritual and emotional counselling, as well as all services provided in home care and hospice. In an overall patient-oriented palliative care approach, these things are brought forward when needed and do not necessarily apply to the circumstances of every patient.

I would like to see the government leveraging training on palliative care that is already available through organizations like Pallium Canada and many universities. I would like to see us encourage more palliative care specialists to work in Canada, since we only have 200 versus the current need of 600.

I have heard a lot of innovative ideas that have been implemented to accelerate getting palliative care in more remote parts of Canada. For example, there are places where they have trained paramedics and home care workers, and then they are connected to a virtual call centre with palliative care specialists who can guide the care providers. Training at this level really accelerates the actual care that can be provided in remote communities, which is currently a real challenge.

An excellent example of palliative care done right can be found right at home in my riding of Sarnia—Lambton. With an increasingly aging population, Sarnia—Lambton has done incredible work by creating and continuing to expand its senior care network in our communities. With 20 palliative care beds, five palliative care physicians, and our integrated network of home care and hospice care, I believe Sarnia—Lambton is ahead of the pack.

I am proud to say that St. Joseph's Hospice in my riding survives on fundraising currently of $1 million a year, so hopefully we can have the government provide support for these hospices, which provide such a great service. I would like to thank Dr. Glen Maddison who, along with his many colleagues at St. Joseph's Hospice, provided input on this bill.

I believe all Canadians should have access to consistent and quality care, such as is available in my riding. I would like to thank Sarnia—Lambton's many institutions and groups that support and deliver palliative care, such as the St. Joseph's Health Care Society, Bluewater Health Palliative Care Unit, the Erie St. Clair Community Care Access Centre, and of course, St. Joseph's Hospice. Unfortunately, these resources are not abundant everywhere, so I am doing everything in my power to create them in the rest of Canada.

I would also like to have the data we need to take improved action on palliative care over time. We know, for example, that palliative care in home care settings costs about $200 a day versus $1,200 a day for an acute care hospital bed, but we do not know how much the true cost of palliative care averages. Because of the numerous ways people receive palliative care, and the many who have no access, there is a clear lack of information about what the true demand is. Knowledge about which treatments are more effective or are more cost-efficient are also needed. Knowing how many hospices we would need to adequately address the demand is equally important. There are only 30 hospices in Canada versus 1,300 in the U.S., so there is definitely a need.

Using some of the infrastructure money that the government has announced, I would like to see it spent to create Canadian jobs and to build palliative care infrastructure. That would certainly be money well spent. The palliative care framework in Bill C-277 will contain the plan, and the government will then determine the pace of spending and where it will be focused.

There has been so much interest in this subject, and such great support from the many arenas, I hope that when I thank people I will not forget anyone.

I want to thank the many organizations that have supported this bill through its journey, such as the Canadian Medical Association, the Canadian Cancer Society, the Canadian Nurses Association, the Canadian Society of Palliative Care Physicians, Pallium Canada, ARPA, The Canadian Hospice Palliative Care Association, with many of their member hospices, like Bruyère continuing care, St. Joseph's Hospice in my own riding, and West Island Palliative Care Residence. I want to also thank the Heart and Stroke Foundation, the Kidney Foundation, the ALS Society, the Canadian Association of Occupational Therapists, the more than 50 organization members of the Quality End-of-Life Care Coalition, and the interfaith groups, including the Centre for Israel and Jewish Affairs, the Canadian Conference of Catholic Bishops, the Canadian Council of Imams, the Evangelical Fellowship of Canada, the Armenian Prelacy of Canada, the Canadian Conference of Orthodox Bishops, the Ottawa Main Mosque and the Ottawa Muslim Association for their ongoing promotion and support of this bill. It is through organizations and groups like these that we can integrate palliative care into the current health care system and make a true difference in the lives of Canadians.

I also want to thank my colleagues on all sides of the House who have spoken passionately, and in support of this bill.

I want to thank the thousands of Canadians who have written letters to MPs and the Prime Minister, and who sent more than 84 petitions to this House asking for palliative care.

I want to thank the Minister of Health for her advocacy on this issue with the provinces, and for putting dollars into the budget to begin the journey to ensure that all Canadians have access to palliative care so they can choose to live as well as they can for as long as they can.

The time is right. This bill has been another fine example of how political parties can come together and work for the common good of Canadians, and it has been an amazing experience being part of it.

With that, I encourage each member of this House to support this bill. People in their ridings and people all across our nation desperately need access to good quality palliative care. This bill is another step in the right direction.