Finance Committee on Sept. 20th, 2018

[Phil McColeman, Conservative, Brantford—Brant, ON]

Thank you, Chair.

[The Chair, Liberal, Wayne Easter]

Mr. Villeneuve, you wanted in as well.

[Michael Villeneuve]

I want to share that it's a little hard to get our hands on 428,000 RNs and nurses in all categories and where they work, because they're all through the system. Therefore, how you do something? Simply, it is tough.

When we talk about innovation, let me give you one example. At Toronto Western Hospital, they discovered that they had an awful lot of admissions of older folks transferred in from nursing homes, and we know that every time we transfer an older person, they're never quite the same after. They never recover the same way we would, and the older you get, the more of a problem it is.

They undertook an initiative to see if they could reduce the number of transfers by sending nurses out from the emergency room to those places rather than bringing the people in. A one-year trial showed an 80% reduction in the number of people being transferred. There were huge implications for those people and for the costs. How could governments help? Someone needs to send the nurse out. Someone needs to pay for the cab to send the person out there.

When I got sick in London, England, last year, I did what one always does. I googled, “What do you do when you're dying in London?” It said to go to a certain place, a clinic. First of all, they didn't ask for any information, other than my name. They didn't want any money. They didn't want to charge me for the drugs. That was the whole thing, and it was run entirely by nurses. There were seven nurses and 200 patients a day. They triage you within three minutes and you're out the door in two hours. They weren't affiliated with a doctor or a hospital. They were nurse-run clinics.

In answer to your question about how we could work with governments, we're ready to set those things up. We have a nurse practitioner workforce across the country and a registered nurse workforce. We just need some help to make it happen, to move it. There has to be a place for them to go. They have to be regulated to be able to do that. I think we're ready to jump on some of those for a fairly reasonable cost.

[The Chair, Liberal, Wayne Easter]

Mr. Sorbara.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Thank you, Mr. Chair.

Welcome, everyone.

There's a bit of a theme here, obviously, with the CMA, CNA, CPA and CCS in terms of health care. One of the things we're dealing with in our country is that there are now more people over age 65 than there are people under the age of 15. The majority of the health care costs that we incur are incurred at points of time in our lives, and that usually happens near end of life, unless we're getting treatment for cancer or some other illness. It's really important that we come up with strategies to make sure our system is efficient and make sure that people are covered.

To the pharmacists, you've used a term that I actually quite like, called a “close the gap” approach to pharmacare. Whereas approximately 80%, or thereabouts, of Canadians have coverage when they need a prescription drug, and my family does, fortunately, as we have two young children so it's very important, some Canadians don't and that “some” number is actually quite large.

I wonder if you could just elaborate on this catastrophic drug coverage plan, knowing in the basis that, because we are a federation of provinces, each province is different. Quebec has a great model, a great formulary model in place, but I do want to hear more on the “close the gap” approach to pharmacare.

[Joelle Walker]

Thank you very much for the question.

We support universal pharmacare in Canada. There are too many Canadians who either don't have coverage or are under-covered.

Universal pharmacare can be achieved in different ways. Quebec is probably the best model to suggest. They actually have universal pharmacare. It's just built on both the private and the public plans. There are advantages to that, just as there are of course probably some disadvantages, but on the front lines we see some of the advantages that building on that coverage we have brings to Canadians.

The reality is that private plans are more comprehensive than public plans, generally. As we move forward, our hope is that the public plans would actually raise up and the access for Canadians would not be brought down. I think that building on the strengths of those, of the mix, is probably a good place to start.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

If I can interject, some people like to bring up New Zealand as an example, but if you look at the public plan they have, the coverage is well below the coverage you would receive here in Canada under a private plan that's offered, i.e., for the better drugs. Especially on personalized medicine that you get coverage for here in Canada per se, it's my understanding that those would not be available for the folks down in New Zealand under their public plan. Is that correct?

[Joelle Walker]

That is correct. They have fewer choices in New Zealand. They have a smaller formulary.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

If I may, then, I'll move on to the Canadian Cardiovascular Society.

You've been here before. I've supported your request, quite frankly, for $2.5 million. If I look at just the input and then the output, the input is small and the output is quite large in measuring health outcomes. How important is it for us to know how well people are doing after they go in for surgery or some sort of treatment for heart disease and so forth?

[Dr. Catherine Kells]

For the amount of money that we cost the Canadian taxpayers and the government and for the importance of heart disease, as one in 12 Canadians have it, I would say that it's almost irresponsible to not know that we are offering treatments that are cost-effective. It is crazy for people to be staying in hospital for 12 days after their aortic valve replacement in one centre while other hospitals are sending them home in two days.

Those who were keeping people 12 days, which was costing I don't know how much money per day, didn't know that there was a better way of doing it until we produced reports, in English and in French, that real practitioners could read and then say, “Oh, my gosh, look at that. B.C. is sending them home in one day, so let's find out how they do that.”

Whenever we give information they care about to the providers, as soon as they see that their centre is not as good as another centre, it immediately triggers an audit. They look at the charts. They look at the cases. They call a meeting and they figure out how to do it better. The few things that we've done with the start-up money we had from the Public Health Agency of Canada are publicly available and you can look at the website and see whether your centre is doing well or not.

We take in this information that we get and we have workshops to teach the providers how to do things better.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

This question is for the firefighters.

[The Chair, Liberal, Wayne Easter]

Make it very short.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

I'm really proud to say that in the city of Vaughan we recently appointed our new fire chief, Deryn Rizzi, who is awesome. She is, I believe, one of the first female fire chiefs in Ontario, and she is doing a great job.

Can you expand upon your request on that lapsing program, please?

[Scott Marks]

I'm happy to. It's one of the things people need to understand about the fire service and how we tie into the economic infrastructure of society. One of the mistakes the fire service made a number of years ago was that we were always talking about fires as losses. When we have a major fire, we talk about the loss to the community in dollars. We realized that we should be talking about what proper fire protection actually saves a community, and this relates just as much to hazardous material training.

When you think about it, that proper first response for a hazardous material accident will allow the entire incident to be mitigated. If the first responding crews are making appropriate decisions on whether people need to be evacuated or the area needs to be cordoned off and diked, we are enabling the commercial and industrial community around there to function. It is not disrupted for a number of days because improper decisions were made.

Therefore, it's actually a commercial saving to the community if all these things are run properly, just as when you have the proper response to a fire in a community. A proper response, which can then put the fire out or mitigate the loss, actually results in a savings down the road, as there's less disruption. In a retail operation, for instance, you have people going back to work the next day because the fire was stopped and the adjacent stores are able to continue to operate.

We need to talk more about the value the fire service brings to the community, as opposed to just what the costs of these incidents are.

[The Chair, Liberal, Wayne Easter]

Go ahead, Mr. Richards.

[Blake Richards]

This question is for the Canadian Medical Association with regard to the disability tax credit. An academic review was done earlier this year. It found that about 1.8 million people are living with severe disability in Canada, but only about 40% of them actually receive the disability tax credit. The report suggests that what it calls the mind-numbing rules of the Canada Revenue Agency to assess eligibility for the credit are one of the reasons for the poor uptake. It also indicates that even those who go and try to get this done find that many doctors who try to fill these forms will have different interpretations of the guidelines because they are so difficult to interpret.

That report indicated that basically a lot of patients are being wrongly denied the credit for that reason. Do you have any thoughts, suggestions or recommendations in that area?

[Dr. Gigi Osler]

I'm an ENT surgeon. In my speciality in particular, there aren't a lot of patients coming with the disability tax credit forms, but I have filled it out again and again over the last 20 years.

Personally speaking, I think there has been a simplification of the form in recent years, and where I see my patients struggling is probably due to my field. They don't realize that they may qualify for a disability tax credit. In the ear, nose and throat world, hearing loss is probably one of the biggest disabilities I see. Education and awareness among patients about what would qualify for the disability tax credit would be helpful. We certainly have those discussions among ourselves, as doctors, to make sure we understand which patients qualify so that we can ensure that they fill out the forms appropriately and apply for the tax credit.

I don't think anybody—doctor or patient—wants more complicated forms.

[The Chair, Liberal, Wayne Easter]

Mr. McLeod.

[Michael McLeod, Liberal, Northwest Territories, NT]

Thank you, Mr. Chair. I want to put a question to the Canadian Medical Association and the Canadian Nurses Association.

First of all, thank you for raising the issue of long-term care and indigenous health in your submission. I certainly believe the federal government has a role to play in supporting long-term care, especially when it comes to small jurisdictions such as the one I represent, the Northwest Territories. I've watched all my life as a lot of people in my communities have to go to centres that are located either in the south or in regional centres. Our challenge is that we have to eat different foods, not everybody speaks the same language and patients are away from their friends and family. It's heartbreaking.

We have to start looking at doing things differently. I've talked to the Government of the Northwest Territories, which has been working with indigenous governments, the Métis, the first nations and the Inuit, and it's apparent that the federal government has a role to play if we're going to do any justice to this issue and start providing better support.

How do you envision indigenous governments getting involved in supporting and addressing the issue of long-term care?

[Dr. Gigi Osler]

Thank you for the question.

Coming from Manitoba, where most of the care is delivered in Winnipeg, we see the problem with delivering care effectively to remote northern and indigenous communities. I have patients who come down from Nunavut. You're right; it is difficult. I think there has to be ongoing discussion and consultation about how to better deliver health care in our indigenous communities, especially in the communities that now have the ability to run their own health care system.

With the demographic top-up to the Canada health transfer, I see the potential for improving care to all Canadians—not just our seniors—particularly in some of the remote, northern, or rural communities. For example, you could use innovation and technology so that you could monitor patients in their home communities and not have them come down to Winnipeg for a very quick follow-up visit. If we had some of those strategies in place, I think we could deliver better care to our under-serviced people across the country.

[Michael McLeod, Liberal, Northwest Territories, NT]

I just want to ask a second question to Sally Guy. I think I asked this question before, but you could speak to it. I had talked about student loan forgiveness for social workers the last time. It made it into the recommendation, but it didn't get into the budget. Maybe you could expand on that.

You talked about some of the challenges with burnout and caseloads, but you didn't mention PTSD. I have a region, an area where we have a high number of suicides. I talked to a social worker fairly recently who had to deal with four suicides in one year. These are front-line workers, and I'm not sure the supports are there for them. It's a huge issue. How do we deal with that?

I live in a community where I see a social worker come in about every 10 months. They can't stay. They can't deal with it. It's just too much for them. The burnout rate is so high, and there are so many other challenges. Could you just quickly talk about those two things?

[Sally Guy]

To go back to the report we just released this summer, we found that 44% of social workers experience threats or violence on the job. That's almost 50%. You are absolutely correct that those types of traumas, as well as vicarious trauma by seeing people go through these situations and witnessing suicides and things like that, are absolutely taking a toll on the care that is being provided to those communities. The first thing I would say is to go back to the idea of a caseload study. Even if the supports are there in place to help people get through these kinds of situations, they're not going to be able to take advantage of them if they're just drowning in administrative burden and caseload size. We really need to figure out an appropriate caseload before we even start thinking about the next steps.

[Fred Phelps]

In terms of PTSD, we have and will continue to push the federal government, while it is looking at first responders, to include social workers in that. Oftentimes, as a past front-line child protection worker, I have seen things that keep me awake at night. If you're on the front line for 20 or 30 years, that compounds. The vicarious trauma compounds, as does the PTSD. First responders, firefighters, and the police are there, but oftentimes, it's the social worker who makes the call for them to come.

I very much appreciate your question.

[The Chair, Liberal, Wayne Easter]

Does anyone have one quick last question?

Go ahead, Peter.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you very much, Mr. Chair.

I have a question for Ms. Walker about the possibility of a universal pharmacare program.

The parliamentary budget officer has evaluated our current system and concluded that a universal system would save companies and individuals a great deal of money.

If I understand correctly, your association is not opposed to establishing a universal system instead of the current system to plug any holes. Is that correct?