Health Committee on May 6th, 2008

[Dr. Jeanne Besner]

I'll ask one of my team members.

It was not an established accord, it was a communiqué.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

So what does that mean? Could you elaborate on that? Explain that to me a bit.

[Dr. Donald Juzwishin]

If I were to think about the context in which that had been communicated, it would be an opportunity in which individuals came together to try to deal with a common problem. The result of that communication would simply have been put with the label of “communiqué”, just as one can have a letter of understanding, for example, or a memorandum of intention, or a social or health accord. I think these labels are a way of simply identifying them. I don't know that there was any specific definitional reason.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

So there was no legal ground, and no money attached or any ultimate commitment. I just wanted to be clear on that.

And on the other....

[Dr. Jeanne Besner]

To go back to your first comment, I think there are a lot of initiatives going on across the country that do reflect a pan-Canadian focus. We were charged with the responsibility of monitoring and reporting on the elements of the accord where there was agreement to develop, collaboratively, particular types of indicators, establish benchmarks to do whatever. We were only speaking in relation to those specific elements of the accord. We do not have a mandate, nor was I trying to reflect all that is going on across the country. We're just focusing on the work we were asked to report on.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Donald--I hope you don't mind my using your first name, because there are challenges with the last name for me--you did raise the issue of disseminating information across the country. You used Ontario as an example. Based on what you know of the Canadian Partnership Against Cancer, would you agree that it is a good initiative? It is unique, and a lot of organizations are looking at that as a model. It's really important that we understand your views on initiatives like that.

[Dr. Donald Juzwishin]

Yes, it is, and we've been very fortunate to have been invited to participate in the conversation on Dr. Eldon Smith's initiative on cardiovascular disease across Canada. We've engaged in conversations with Dr. David Butler-Jones with respect to the Public Health Agency of Canada's initiative to address and advance efforts across the country.

The Health Council of Canada is extremely committed to facilitating the kinds of conversations that will help advance Canadians' understanding of the health care services they are receiving. And we are committed to identifying best practices in other parts of the country that might be adopted in areas that would be interested in doing so. Any of those kinds of initiatives that generate synergy to improve delivery of care to Canadians we, of course, are very supportive of.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much, Mr. Juzwishin and Mr. Fletcher.

We will now continue with Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much.

This is a very interesting report. I want to ask Ms. Yeates, from CIHI, a question.

You stated that the variation in measurement approaches still prevents interprovincial comparisons. You are speaking to a federal body here. These are all MPs. The whole idea that there was a commitment to this in the first place from the federal government and from the provincial governments was to ensure that Canadians would not have disparities, depending on the province they lived in. So you are saying that you don't even know whether that's happening and whether Canadians are in fact suffering disparities in terms of wait times based on where they live, because you don't have the ability to do that tracking. Is that what you said?

[Glenda Yeates]

I think it's clear that even within provinces there are disparities. We know from all the wait-time information, even if you measure median waits, that there are people who get in very quickly. The first 10% of people make it in quite quickly, and the last 10% of people may wait a long time. So it's clear that regardless of procedure, even if you live in the same city, there will be disparities.

The question is whether can we compare the extent of those disparities between one province and another. Often the definitions that are used are quite different, so at this stage we are not saying that we can compare across the country.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I understand that. Basically what is needed in order to pull together some sort of database that is pan-Canadian, to pull together some kind of clearing house with that data, and to look at what we're comparing--and whether we're comparing apples to apples and oranges to oranges--is some leadership from the federal part of the team .

So what I think I'm hearing is that this leadership hasn't surfaced.

I also wanted to talk to Dr. Besner and ask her a question. You stated very clearly on page 1, and I quote, that “The Health Council of Canada is particularly concerned about nine areas of health care renewal where action has been slower, less comprehensive, and less collaborative than First Ministers originally envisioned in the accords of 2003 and 2004”.

You also stated that in June 2006 the interprovincial group was disbanded. Then you went on to list the nine areas that concern you. Again, what I'm hearing is that there doesn't seem to be a commitment to the collaborative approach to the vision for moving this agenda forward that was put forward in 2003 and 2004 by provinces and the federal government .

Your Infoway goal of 50% of Canadians having a secure electronic health record, you tell me, is not on track. How far is it off track?

[Dr. Donald Juzwishin]

Canada Health Infoway is going to be releasing their annual report in June of this year, so we will have that data available at that time.

The numbers reflected in Jeanne's data to this point are for 2007. The others will be forthcoming.

[Hedy Fry, Liberal, Vancouver Centre, BC]

But you said here, clearly, that they're not on track. You said that we are not on track to meet Infoway's goal of 50% of Canadians.

[Dr. Donald Juzwishin]

Right.

[Dr. Jeanne Besner]

The data we have shows that as of March 2007, approximately 5% of Canadians have an interoperable electronic health record.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Yes, good.

Here is one final question. You talked about wait times, and I wanted to congratulate you for bringing up the idea of clinical guidelines, because obviously something that most people don't talk about is that in order to bring your wait times down you've got to use your resources appropriately.

Can you tell me if there are any other groups working on clinical guidelines for appropriate use of care and appropriate use of diagnostics?

[Dr. Donald Juzwishin]

I would be prepared to answer that. In my experience, there are some real jewels of success across the country. If we go to the Calgary Health Region, we probably see one of the pre-eminent programs for the delivery of hip and knee surgery in the country. The program that was developed there was done on the basis of very, very specific kinds of indications and included developing care plans with pre-admission activities that took place and made sure that when people were discharged from that program, they would be cared for appropriately in the home. That particular initiative, I think, is a model of clinical guideline development that would be a marvellous one to be looked at.

Those are then checkered with other initiatives that are undertaken in other parts of the country. Saskatoon has developed an initiative facilitating care in urology associated with specific maps so that when patients come in for their treatments, they know exactly what to expect, when they're going to get out, and what's going to be required in post-treatments.

So there are some real positive things to be looking at.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much, Mr. Juzwishin.

Now we will move on to Mr. Clarke.

[Rob Clarke, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you, Mr. Chair.

I'm just trying to grasp a couple of things here. First of all, I'm first nations. I have lived on a reserve. I've worked on the reserve. I've seen health issues on reserve, from my day-to-day job activities as a law enforcement officer with the RCMP.

The Kelowna communiqué.... This is the difference here. I'm just trying to grasp this. Was there any funding or anything like that with regard to first nations, or is this just...? I just want some clarification here, if you don't mind, on the difference between the Kelowna communiqué and the accord.

[Dr. Jeanne Besner]

I'm trying to remember the specific elements of aboriginal health in the accord. I think there was a particular focus on trying to look at healthy populations or the health of populations with a particular focus in the accord on aboriginals. I don't remember that there were specific allocations of funding targeting that.

There were?

I just don't know the answer to that.

[Dr. Donald Juzwishin]

I can give you one example that has been undertaken. That is where the health care delivery mechanisms and social delivery mechanisms, which were taking place in isolated kinds of ways from different departments within health, have now been developed into an integrated structure, facilitating easier movement of individuals between the different types and levels of service that are available. So that's one specific thing that I do recall having been introduced just within the last several years.

[Rob Clarke, Conservative, Desnethé—Missinippi—Churchill River, SK]

Living on the reserve and working there, I was always under the impression that there was funding for this coming forward. So you're just saying there's a communiqué. There's no funding.

[Dr. Jeanne Besner]

According to our staff member, yes, there was money, but it was not substantial. It was about $5 million.

[The Vice-Chair, Liberal, Lui Temelkovski]

Anyone else? Mr. Tilson, do you want to pitch in? You've got a couple of minutes.

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

A couple of minutes, yes.

Ms. Yeates, I find the chart with respect to physicians and nurses interesting. The percentage increase is actually encouraging, because certainly in my community that's one of the favourite subjects for questions: the shortage of doctors, the shortage of nurses. So that's an encouraging response.

Has your organization gone into this issue further, looking at doctors returning to Canada from the United States, doctors anticipating retiring, whether or not there has been an increase in foreign doctors, and qualification of foreign doctors? In other words, have you gone into a complete analysis of this issue?

Finally, is there a time when we as a government or governments need to be concerned that there might really be a shortage of doctors because of the issue of retirement, the issue of the age of medical practitioners?