Finance Committee on Sept. 21st, 2022

[Steven Staples]

That's a great question, and we certainly do need measurements of performance outcomes. I think those are very important. In fact, some studies by the OECD and so on that I've seen say that there is a discrepancy between the amount of money we spend and the kind of performance we get from our health care system versus the case in other countries, so that's certainly an area of concern.

One of the points I want to make is that, increasingly, as provinces move to for-profit providers to try to stem the very real issue of getting these wait times down, there's a great concern among health care advocates like me and my colleagues that there is no indefinite pool of doctors out there. You're going to have doctors, nurses and health care professionals move from the public system over to the private system, and for good reason. We understand that working conditions may be better and more manageable; however, it's going to make the problem worse. It's one of these perfect storm situations in which we try to solve things over here and we make the problem worse over there, in our public systems.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

I want to get in one quick question, because I agree with you. We're in violent agreement.

How would the situation for Canada with private versus public be affected by CUSMA? While we have a health care crisis, the U.S. private health care industry looks at us as a market. How is our position different from that of, say, the U.K. or other countries in Europe?

[Steven Staples]

That's a great question.

I haven't looked at that as closely, so I wouldn't want to venture a determination, other than the fact that we all know our health care program makes us really unique. Without our public health care, our medicare program, we're not that different from our colleagues and our cousins down south of the border. The influence of big pharma, which is largely from the United States and other European countries, has been a barrier to our moving forward on pharmacare.

[The Chair, Liberal, Peter Fonseca]

That's time, MP May.

Thank you, Mr. Staples.

We will now move on to our final questioner, MP Blaikie from the NDP.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Thank you very much.

To start, I'll direct my question to Ms. MacEwen, who I think hasn't had an opportunity to answer many questions. If there's time remaining and folks from the Canadian Health Coalition want to jump in, I would invite them to do that.

I want to return directly to the question of privatization, first of all. I think Mr. Staples just touched on this. We're seeing right now a huge spike in the extent to which nursing agencies are used to fill vacancies in the public system. These are people who are available to work. They work in that industry. Canadians are actually paying outrageous premiums in order to hire these nurses right now from private nursing agencies that are making a profit on that expenditure to have them come and work in public institutions.

Clearly, there is a question about appropriate spending. One of the places we might hope to see some remedy for that, in the case of provincial governments that are bound and determined to carry on this expensive and broken course, is at a table that the federal government has the power to convene with its spending power for provinces to talk about best practices, including when it comes to privatization and the inordinate amount of spending that's going on through private nursing agencies right now.

Perhaps you can speak, first of all, to how Canadians benefit when governments pay for private nurses over public nurses, if they do at all—it seems to me perhaps not. How can the convening power of the federal government be used in order to establish some fairer criteria that are co-determined with the provinces that would govern the way new health spending is done in Canada?

[Angella MacEwen]

This is a fantastic example. CUPE has members right now—I was speaking to some in northern Ontario last week—who are working at facilities where full-time, 16-hour, get-lots-of-overtime agency nurses are working beside them. The agency workers don't necessarily have the history in the department either, so they actually ask the public workers to do more work, to take care of the agency nurses and to provide some of that continuity of care that is so important. The agency nurses can work between institutions and travel around to fill gaps, which might help the scheduling manager but doesn't improve the quality of care. It actually is very disrespectful to the workers who are at their home station. You're actually increasing their workload. You're not offering them the overtime opportunities, and you're paying them less than this person who's coming in.

It's also really expensive. Some of the nurses I was talking to are paid $25 an hour. The agency nurses who are coming in to work alongside them are paid $60 an hour. The temp agency that manages them gets an extra $40 on top of that. We're paying four times the cost of a regular nurse to have this agency nurse there working alongside them, and that agency nurse doesn't have the same capacity to do the job because they're switching between organizations.

That is exactly the type of thing we would want to sit down to talk about at a table. We would gather data through CIHI in order to be able to make these types of decisions and have evidence-based discussions about where we're wasting money. I can tell you that nine times out of 10, we're wasting it by privatizing. It's a shortcut that we're trying to take to fix an immediate problem, to stopgap, which is actually creating cascading problems. Those nurses who aren't getting paid $60 an hour are ready to leave the profession now, because they're just not getting the respect they deserve.

[The Chair, Liberal, Peter Fonseca]

Thank you, Ms. MacEwen, and thank you, MP Blaikie.

On behalf of this entire committee—the clerk, the analysts, the staff, the interpreters, and all of the members—I'd like to say thank you. I don't know if you know, but this is the hardest-working committee on the Hill, in our humble opinion, although we may be a little biased. Thank you for helping us kick-start our fall session as we study the current state of fiscal federalism here in Canada. We wish you a great evening.

On that, members, we'll adjourn the meeting. Thank you.