Health Committee on April 17th, 2008

[David Tilson, Conservative, Dufferin—Caledon, ON]

I'd like to add to the exchange between Ms. Wasylycia-Leis and Mr. Fletcher on this report. Obviously the report does indicate there is an improvement. Moneys come from the federal government. In Ontario, moneys also come from a health premium. I'm from Ontario. It got people all excited when they put forward that health premium.

My question is whether the provinces are pulling their weight. I mean, we're giving the money. We, the federal government, don't deliver health care. Whether it's wait times or whatever, are the provinces doing what they said they would do under this accord?

[Krista Campbell]

The provinces and territories have primary responsibility for the design and delivery of their health care systems. They are responsible for the choices with respect to the priorities they make and how they deliver services to their population.

Canada is a considerably decentralized federation, where provinces are able to levy taxes and, for the most part, decide the activities to tax within their jurisdiction. Determining whether or not provinces are pulling their weight and providing services the way people want to see them is a question for each of the populations in those provinces to challenge their governments on.

The federal government does have a role in terms of the Canada Health Act, a certain amount of national standards, encouraging mobility across the provinces, and ensuring that programs like equalization help provinces provide comparable services at reasonably comparable levels of taxation, but beyond that it really is up to the individual provinces to determine and to answer to their electorates as to whether they are doing enough.

They have made commitments. We are seeing progress. The funding is flowing the way it was intended to flow. Beyond that, as I stated, I think it is up to the provinces to determine.

[David Tilson, Conservative, Dufferin—Caledon, ON]

You gave a good answer. That's normally an answer we give.

I have a question from this book you gave us. Tab 3 talks about wait times. Can you help me read these charts? It's full of dots, and I don't know what it means. Can you read them? I can't.

[Dr. Karen Dodds]

That would have been provided by the committee, not by us.

[David Tilson, Conservative, Dufferin—Caledon, ON]

By the committee.

[The Chair, Conservative, Joy Smith]

Okay. Thank you very much.

We will now go to Monsieur Ménard.

[Serge Ménard, Bloc, Marc-Aurèle-Fortin, QC]

Thank you, Madam Chair.

Thank you for coming here.

I am probably going to continue talking about something we talked about a lot this morning, but about which there is really very little I could tell a constituent who asked me about wait times. The work that has been done is unquestionably considerable and respectable. It shows that we are living in a wealthy country, we have to acknowledge that, and that health care is a matter of concern. As well, like other wealthy countries, particularly the European countries, and not entirely like our neighbours to the south, we are concerned that all Canadians be equal when it comes to illness and that they be able to benefit from scientific developments. So this can be a very positive thing. Generally speaking, the public recognizes that we have a good health care system, that when we enter the health care system we are well cared for, with empathy and with all the technical and scientific quality that can be provided today.

The objective of everyone being equal when it comes to illness means that many people have to deal with lengthy delays. This is the main subject about which we hear criticism from the public. The government was aware of this. All the politicians were aware of it, when they wrote the 10-year plan. If I remember correctly, they allocated $5 billion dollars to this in the plan. My constituents would like to know whether this is producing results.

I have been listening to you since this morning and I don't really know what to tell them to persuade them. I can tell them that we have gone from C to B, to C- or D, and so on. People don't understand things that way. What people do understand, and I realize it can be difficult to find, is what the newspapers often give us. For this surgery, there are so many weeks of wait time. For that disease, there are so many weeks or months of wait time. This morning we learned that it took five years to get a sleep apnea diagnosis.

Could you tell me, framing it in that kind of way, where there has been progress? What progress? What was the wait time when the program started? What is it now? What is the wait time objective? I think it would be a good idea to have an average, if you can give one, but I imagine it depends on the topic. Could you help me here? Could you explain, as you did to the person who spoke before me, what I can look at on the table? How can I simplify it so I can respond to my constituents' main concern?

[Dr. Karen Dodds]

I can give you a few specific or concrete examples, and I will start with Quebec.

Long waits for cataract surgery and hip and knee surgeries have declined very sharply. In Ontario, between November 2004 and April 2007, wait times for hip replacements dropped by 27%, or 94 days, while waits for knee replacements fell 30%, or 133 days. Wait times for cataract surgery decreased 41%, or 128 days.

In Nova Scotia, women aged 50 to 69 are getting mammograms at nearly double the rate they did at the start of the decade.

In Alberta, 90% of patients were receiving cardiac bypass surgery within 11 weeks in November 2007, down from 17 weeks a year earlier.

So those are a few specific examples that I think citizens would relate to.

[Serge Ménard, Bloc, Marc-Aurèle-Fortin, QC]

If I tell them what you have just told me, they will probably ask me whether those are not the best results. How do we judge it overall? What is the answer? The people who spoke before me told you that the tables you give us in the reports incomprehensible. Could you tell us what to read in the report and perhaps give us an explanation ...

[The Chair, Conservative, Joy Smith]

Your time is up.

Dr. Dodds, perhaps you could just answer that question for Monsieur Ménard.

[Dr. Karen Dodds]

If you want specific information across Canada, the Health Council of Canada has an annual report and the Canadian Institute for Health Information has a 2007 report on wait times.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Dodds.

Mrs. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Madam Chair.

Thanks very much to our presenters and panel here this morning and this afternoon for helping us try to understand and evaluate this accord. It's certainly an important issue.

Although we're only into the fourth year of this accord, there are a lot of questions that not only this committee but the public, the people, are asking.

I have three or four questions. Maybe I'll just put them out and give you an opportunity to respond.

One of the things I want to ask about is in regard to wait times in the targeted areas. We've seen that there are improvements in the targeted areas, but is that having any negative impact on untargeted areas? I think that's been rather inferred here this morning. I'm not sure anybody has addressed it, so I'd like to hear that.

Also, another issue that Dr. Bennett brought up was in regard to the data collection. She rightly referred to the fact that she could be considered in that physician count, when in fact there may be physicians included who are not practising physicians. Is this different from the way the data was collected before, or are we comparing apples to apples or apples to oranges when we talk about the increase, the growth in the numbers? I need that clarified.

One other thing was the provincial obligations. I understand that, in many respects, health care delivery is the responsibility of the province. The federal government transfers the funds and the provinces spend them. Are some provinces doing things differently? Have some provinces met their obligations more closely in human resource areas as opposed to wait time guarantees, or is it standard across the country?

My final comment is that since this is a ten-year plan and we are in our fourth year of it.... When I look at the indicators in this report card—and I'm seeing it for the first time, just fifteen minutes ago—I see that access indicators have gone from inconclusive to C plus; establishing the wait time benchmarks has not moved, but establishing the timetable to achieve those benchmarks has gone from a D to a C plus; and collecting and disseminating wait time information has gone from a C to a C plus.

I think there has been a considerable amount of movement in four years of a ten-year plan, but maybe my expectations aren't as high as those of some others. How do you feel about it? Did you have higher expectations than this? Do you think there's movement there too? Those are my questions.

[Dr. Karen Dodds]

I'll start. I'll take them in the order in which you put them.

Dr. Bennett suggested that the attention on wait times in specific areas could be having a negative impact on other areas. Indeed, information from the Canadian Institute for Health Information indicates that is not happening, that the attention on wait times in certain areas is not then extending wait times in other areas. So the information is that this is not happening.

With respect to data collection, what we did have and what we do have, I think this is one of the big advantages of starting to focus attention on a certain area. It's clear, for example, that before you had a commitment to address wait times, probably most provinces couldn't even tell you what the wait time was. There are still discussions about what the definition of a wait time in a certain area is.

So in all of the areas of health, the data are improving. The discussion and the work on just starting to measure things is improving our data and our understanding. I think that's an enormous benefit, and that is certainly going to benefit areas beyond the targets. Again, you see some of that reflected in the Wait Time Alliance report card, and if you talk to organizations such as the Canadian Institute for Health Information, they'll tell you the same thing, that the quality of data and the reproducibility of data province to province is improving with time.

In terms of provincial obligations, a number of members have noted that the provinces themselves are responsible for how they organize and deliver services. So we do see different undertakings in different provinces. A lot of that can even simply reflect demographics. The Atlantic provinces, with the more senior population, an older population, will do things differently from Alberta and British Columbia, which might have a younger population. Again, I would refer you to the Health Council for their reports by province on what's going on.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Dodds.

Ms. Wasylycia-Leis, please.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thanks, Madam Chairperson.

Let's go back to health human resource strategies for a moment. I know you've said that there is money that will continue, but I didn't get any answer about a plan. I think we really need to know where the focal point in the federal government is with respect to this dire situation--a serious shortage on many, many fronts. Just today the Canadian Society for Medical Laboratory Science held a press conference and talked about the critical shortage there and the fact that half of our technologists are eligible to retire in eight years, yet there's no plan to recruit and augment and ensure an adequate supply of technologists, who are vital for the whole system.

For my first question, one of the concerns of this organization is that a focus on clinical education was part of this 10-year accord and part of the health human resource strategy. According to this organization, there's a significant shortage of clinical instructors. Once someone in this field has completed the initial training and goes into the clinical world, we just don't have the capacity to provide them with on-the-job training and education. That's something that's been raised for many years as part of the health human resource strategy.

Where is that issue of clinical instruction in the health human resource strategy specifically, and where is the plan for dealing with shortages in all health care professional fields for the next five years?

[Dr. Karen Dodds]

The action plan builds on the pan-Canadian health human resource strategy, which was established in 2003. One of the most successful aspects of that strategy has been ongoing collaboration that occurs through an FPT process and includes stakeholder engagement. Collaborative efforts are being used to share and centralize data, identify barriers, and share best practices among participants. Obviously, the planning is to work to help ensure an adequate supply and an appropriate mix of health care professionals. It builds on work, on health labour relations and information on health sector labour relations collected in the health cross-jurisdictional labour relations database, and on work on interdisciplinary or interprofessional education and investments in post-secondary education. This includes federal funding through the interprofessional education for collaborative patient-centred practice initiative. This is to ensure that nurses can work with doctors, physiotherapists can work with nurses, that all of the different health care professionals can work well together.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

The problem, in the case of technologists, is having adequate instruction capacity to equip them to take on this profession on a certified basis.

What has been done on what has already been identified as a problem? Is the federal government putting some resources into provincial systems to augment clinical education instruction? Is the government putting in place a fund to help ensure that there are more training places for nurses? Is there a fund in place to augment the number of spaces available for doctors?

This is not a foreign idea. This is something the Canadian government has done in the past. It has played an active role in terms of actually augmenting training capacity and education opportunities to ensure that we won't have a serious shortfall, which we are facing. It's imminent.

We need a sense of urgency from the federal government. There has to be some focal point, a locus of activity, a strategy, money, an idea--anything--that you could convey to us today.

[Krista Campbell]

There is, and the funding that's provided to provinces and territories though the Canada health transfer is available for health human resources to address the various pressures they're facing.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Is there money beyond that for this particular issue?

[The Chair, Conservative, Joy Smith]

I'm sorry, Ms. Wasylycia-Leis, your time is up.

Can you just quickly finish in the next few seconds?

[Krista Campbell]

In addition to the Canada health transfer, there was the $5.5 billion provided to provinces and territories for wait times reductions in the 2004 plan. The initial upfront payment of $4.25 billion, made through a trust fund, was to jump-start some of the wait times issues. The $250 million transfer that will be ongoing as of 2009-10 specifically targets health human resources strategies. It is to help ensure that the progress made on wait times, and continuing and ongoing progress on wait times, has dedicated funding for health human resources.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Campbell, for your very insightful and concise comments.

We'll go to Mr. Khan.

[Wajid Khan, Conservative, Mississauga—Streetsville, ON]

Thank you, Madam Chair, and thank you for being here today. This is my first day on this committee and I've learned a lot.

Given the comments Ms. Wasylycia-Leis made about health care workers, I hope we can count on their support for Bill C-50, an immigration bill. That is one way of bringing in technicians and nurses.

[An hon. member]

[Inaudible--Editor]