Finance Committee on Sept. 27th, 2017

[Pierre-Luc Dusseault, NDP, Sherbrooke, QC]

Thank you.

Dr. Votta-Bleeker, you spoke about the indirect costs of research. I remember learning about related, or indirect, costs that aren't necessarily covered or reimbursed. I know there is a major problem with that.

Has this situation been resolved? If not, what do you recommend in order to resolve the situation of the indirect research costs?

[Dr. Lisa Votta-Bleeker]

The indirect costs of research are something that we have been long advocating as needing some overhaul. One of the key players in that has been the Canada Foundation for Innovation, the CFI.

The report recommends more matching ratio funding and more reimbursements for universities that are based on smaller sizes to larger sizes so that they are able to maintain the investments the government has made in the past. Right now, what we're hearing from the universities is that these wonderful investments were made and that they don't have the funds, either as universities or from further funding, to maintain these facilities, so these facilities are going for naught. It's essentially becoming wasted money.

There are recommendations in the report that do recommend these. One, for example, was the $143 million, which would bring it to a certain percentage. There were also other cost estimates in the report. Our recommendation is to at least start with the lowest amount the report recommended, the $143 million, to start assisting with some of those indirect costs.

[Pierre-Luc Dusseault, NDP, Sherbrooke, QC]

I have one last question, and it is for Dr. Kells.

It has to do with the health system performance data collected by province. I really wonder why data should be collected at the national level rather than at the provincial level. If each province collects its data and publishes it, then you ultimately have a national registry. Why do we have to have a national registry? I have a hard time understanding it.

[Dr. Catherine Kells]

The issue is that we have a complex health care system with provincial and federal partners in everything that we do. Historically, the provinces received health care dollars, most of which they use for providing health care. The information collection that is done is done very variably. Some institutions do it themselves. Some provinces have registries, and many don't. Smaller provinces don't have registries at all. Larger provinces, for instance Ontario, have core health, so they have a registry.

But what they're measuring in Ontario is not the same as what they're registering in British Columbia with Cardiac Services BC versus what they're measuring in Nova Scotia, which is only three different, small quality indicators. Many provinces don't have a registry. We have CIHI. They measure administrative data, but up until we started working with them with medical expert stakeholders, they were providing administrative data like number of bed days, which is meaningless to doctors.

What we want to know is our death rate, our complication rate. I need to be able to compare what I'm doing in Nova Scotia to what's happening in Saskatchewan or Ontario, because I may think I'm doing a fabulous job. Maybe my length of stay is four days for treating a heart attack patient. I think that's good, but I might find out that in Ontario they can have people home in two days, and when I see that, I wonder what Ontario is doing differently. Right now we don't have a pan-Canadian process.

We did it with our demonstration report in one small area on transcatheter aortic valve replacement, which is a very expensive new innovation. We had 100% participation from all institutions across the entire country, including Quebec. We did a demonstration report with that in 2016. Just getting the data back to the operators led to immediate changes in practice when they saw their own data compared to others, and it helped inform how they built their new programs in Saskatchewan and other places.

The difference is providing stakeholders, medical experts who are engaged into collecting what's really important to us, pulling together what's already been done, adding what's missing, and then giving the toolkits back to the operators—the doctors, the practitioners—not just publishing in some Excel spreadsheet someplace. We have our annual congress where all the cardiovascular specialists come together. We have workshops where we show the data for the whole country and show them how they're doing it differently. From that we can start to build best practices and share them.

[The Chair, Liberal, Wayne Easter]

We'll have to end it there. We're substantially over on that one.

Mr. McLeod, you have a final question.

[Michael McLeod, Liberal, Northwest Territories, NT]

Thank you, Mr. Chair.

My comments are for the Canadian Alliance on Mental Illness and Mental Health.

Prior to sitting on this committee, I sat on the indigenous affairs committee and travelled around the country talking about the issue of indigenous youth suicide. Many issues contributed to the level of despair in our communities: poverty, sexual abuse, housing, addiction, isolation, and cultural disconnect. These are all issues that are out there.

I really want to say thank you to your organization for raising this issue. I know our government has invested quite a bit in mental health, so I applaud them also. There are also other populations in Canada, for example, middle-aged males, who are also experiencing high levels of suicide.

How do you see additional investments in providing mental health services addressing these issues specifically? Is this one of the gaps that you mentioned in your submission, trying to target the vulnerable groups in a certain way?

[Dr. Karen R. Cohen]

Thank you for that question.

One of the strong messages of CAMIMH is that we need more accessibility to mental health services and supports. We know that of people who take their lives, over 90% have mental health issues and disorders, so providing care is the first thing we need to do better so that when they reach out, they're actually getting the help they need.

[Fred Phelps]

If I may add, that's why the investment is in access. Mental health, 10 years ago, wasn't discussed as it is now. People are able to come out of the shadows because there is some government leadership. There is some leadership from national organizations such as our own, but Bell and others across the country have led the way to promote the destigmatization of mental illness. As you know, in your communities, when people come forward and they cannot access...that's when the suicide issues arise in greater numbers. That's why we're looking for the federal government to support the provinces and territories to move from 7% to 9% of overall funding for mental health.

[Michael McLeod, Liberal, Northwest Territories, NT]

We know in the north we probably have 10 times the rate of suicide as the rest of Canada.

[Fred Phelps]

Yes.

[Michael McLeod, Liberal, Northwest Territories, NT]

While we were doing the study, which took a little over a year, we estimate in the north we had over 100 youth commit suicide. It's a crisis situation and there is not one magic solution to dealing with it. It's going to take many levels of government. It's going to take a focus on healthy people and healthy communities, and responsibilities are intertwined and it's complicated.

I'm really curious. In your submission you talked about the United Kingdom and Australia taking a different approach. Can you talk a bit about that?

[Dr. Karen R. Cohen]

One of the main differences when it comes to the United Kingdom and Australia is that delivery care is under federal authority, so making change happen is a little more nimble than in Canada, where care is delivered by jurisdiction.

What the U.K. did was it developed programs to enhance access to psychological therapies. They trained many health care providers. The programs are static. They collect data on over 90% of every visit. The programs are evaluated. Often the psychologists take the role in terms of evaluation, but the delivery is by a range of health providers who work within these facilities, and they have been able to make a huge difference. Tens of thousands of people have gone off disability payments. Recovery rates are about 60% for those living without symptoms in recovery.

What Australia has done, conversely, is more of a fee-for-service model. They have a program called enhancing access to family doctors, psychiatrists, and psychologists, and some other specially trained providers as well. They will fund up to six sessions of services, renewable three times, of services on the referral of a family physician for mental health care, but that may have changed.

[The Chair, Liberal, Wayne Easter]

Okay, with that we have to go to a vote.

Just to remind members, there are some changes in location. From 8:30 to 11:30 tomorrow morning, it will be at room 415, Wellington, on tax planning. It won't be in this room. The minister will be there from 11:30 to 12:30 on the same issue, and from 3:30 to 6:30, on pre-budget consultations, it will be here in this room.

With that, I want to thank each and every one of the witnesses for their presentations. I'm sorry we're a little short on time, but that is due to votes down the way.

Thank you to those who came to Ottawa. Thank you for your earlier submissions that came in prior to August, and thank you for your response today.

The meeting is adjourned.