Good morning, Mr. Chair and honourable members of the committee, and many thanks for this opportunity to present on behalf of Pallium Canada.
Pallium Canada is a non-profit organization that reaches across the country, and our goal is to improve capacity with respect to palliative care.
In June 2016, medical assistance in dying—or MAID, as it is referred to—was legalized in Canada. There's been a concerted effort by many entities to ensure that all Canadians have access to MAID.
During the debates that preceded the introduction of that legislation, the point was repeatedly emphasized that there should also be universal access to palliative care. We have, however, lagged far behind in making this happen. Access to palliative care is patchy across the country. The Canadian Hospice Palliative Care Association, for example, has estimated that only 15%-30% of Canadians who need palliative care have access to it.
The request that we, Pallium Canada, have submitted to the finance committee will increase access to palliative care across the country.
It is often erroneously assumed that palliative care is delivered only by specialist palliative care physicians and nurses and that palliative care is activated only in the last days or weeks of life. These assumptions reduce capacity by relying on a small number of health care professionals to deliver all the palliative care that is needed for cancer diagnoses and for non-cancer diagnoses such as advanced lung, heart, liver, and kidney diseases, among others. Patients are subjected to needless suffering during their illnesses, and opportunities are missed for more timely discussions and planning for end-of-life care. Poor treatment choices are made, including unrealistic, burdensome, and costly treatments, and sometimes inappropriate use of precious health care resources.
I can sit here and share with you many studies that highlight the benefits for patients' families and the reduced cost to the health care system, but I'd like to share with you my own personal story, the story that brought me to palliative care. It is a story that for me illustrates the power of what we are doing.
In the early 1990s, I was working as a family physician in a small rural community in Manitoba, and one day a patient by the name of George and his wife came into my office. I'd never seen George before. He sat down and he said to me, “Dr. Pereira, I need help. I know I have advanced cancer, and I know I'll be dying in the next few months, but I'm with terrible, terrible pain, and I need help.”
Now, I had not received any palliative care education and, unfortunately to this day, there are many health care professionals from many different disciplines—family medicine, oncology, internal medicine, renal specialities, etc.—who have not received training.
I gave George the wrong advice, and the advice I gave him regarding his pain medication was woefully inadequate. I vividly remember the moment George stood up and took his wife by the hand. As he left the room, he turned to me and he said, “I hope one day doctors like you can help people like me.” That was the inspiration for Pallium Canada.
As a result, I went and got some training. It was difficult in those days to find some short training. I got it in Hamilton, flew back, and asked him for a second chance, which he graciously gave me, and so I cared for him for the last months of his life in that small community in Manitoba. What it taught me was that with a little bit of training, a family physician such as myself in a rural community or any other community, or a nurse or a pharmacist, can make a very big difference to these patients.
In 2001, after specializing in palliative care, we founded Pallium, and since then we've been reaching out to train more and more health care professionals to reduce inappropriate emergency room visits, to reduce inappropriate hospitalizations, to reduce costly treatments that are inappropriate, and, importantly, to improve the quality of life of patients. The main vehicle of our work has been a course we've called learning essential approaches to palliative care, or LEAP.
We bring experts from across the country together. We bring nurses, doctors, and pharmacists, doctors from different specialty areas, nurses from different specialty areas, and social workers to learn together and to work together. We bring experts from across the country to develop the material, to disseminate it, and to teach in their local regions.
With the foundational funding we have received from Health Canada in previous years, we have developed the LEAP courses and other complementary products, such as online learning management systems—one called Pallium Portal—and an app for point-of-care learning.
We have trained and certified over 500 facilitators across the country, and that's what gives us our scalability. We are proud of the return on investment and the value added we've achieved. From 2001 to 2003, for example, we delivered 27 courses. In the fiscal year 2014-15, we delivered 43 courses, and in this past fiscal year, we were able to deliver 205 courses across the country. That's almost one course every one and a half days. We have trained 8,000 health care professionals with these basic skill sets that make all the difference to people like George.
We have learned the power of collaboration. We have set up key partnerships in this very province. In P.E.I., we partnered with emergency services to train all their paramedics. We did that last year within four months. Early observations indicate reduced emergency department visits and costs when EMS services care for these patients and are called to see these patients in their homes.
In Ontario, we have partnered with the Ontario Renal Network to develop the LEAP kidney program and have started educating teams across the province to reduce the burden of advanced disease and unnecessary treatments.
In the Quebec City region and in Ontario, we have partnered with family medicine clinics to do training. We've partnered with home care agencies. In British Columbia, our LEAP long-term care course is being used by local teams to improve end-of-life care in those homes.
With additional funding, which is our request, we will be able to scale up our work, particularly to build the capacity to provide palliative care in the home and in the community. We will be able to further leverage the LEAP courses to catalyze systems-level change, innovation, and improvement through quality improvement interventions. We will be able to ensure that all our materials are in the two official languages. We will be able to continue reaching out to the indigenous peoples of Canada and strengthen cultural competencies in our programs. We will be able to invest in new technologies to develop the next generation of our online management system and apps and collect more data to further guide us in targeting our strategies.
We need to reach out—and this is important—beyond the health care sector. Imagine, for example, if young Canadians in high schools were equipped with some basic life skills related to palliative care and were able to volunteer in the area and engage themselves in end-of-life discussions. This represents a tremendous opportunity for a much-needed culture shift to occur. Imagine a compassionate neighbourhood watch program, where neighbours and communities help each other.
We can improve palliative care access in this country. We already have tried and tested methods and tools at hand. We now need to be bold and invest in the opportunities that present themselves at this moment in our history.
Thank you very much.