Health Committee on May 6th, 2008

[Christiane Gagnon, Bloc, Québec, QC]

Thank you for being here today to discuss the 10-year plan to strengthen health care.

My question is for Ms. Besner. In your presentation, you talk about aboriginal health. You say that contributions under the promising intergovernmental accords for 2005 remained relatively modest. We know how much aboriginal people need health care, and we need to be able to meet their needs.

How is it that in a report like this one, the federal government does not have to be accountable and the provinces have to produce status reports on the plan's objectives, for example, on wait times? These people come under the federal government's responsibility, after all.

Aboriginal people are under federal jurisdiction, but there seems to be no willingness to provide them with better health and work with them.

[Dr. Jeanne Besner]

In my opinion, the Kelowna Accord and the blueprint on aboriginal health are federal-provincial-territorial accords. There have been no progress reports. Our role is to provide oversight and report our findings. We have nothing to report because there has not been much progress, as far as we can see. We do not know who is responsible.

[Christiane Gagnon, Bloc, Québec, QC]

These people come under the federal government. We are not talking about the general public here. There are aboriginal people and the military. At National Defence, there is very little information to assess the quality of health care. In her 2007 report, the Auditor General pointed that out.

What difficulties have you had in monitoring this issue?

[Dr. Jeanne Besner]

As part of our mandate, we have to report on progress. To be able to do that, we need indicators. That is what we are missing.

[Christiane Gagnon, Bloc, Québec, QC]

What would you need in order to be able to report these statistics?

What concerns me is that the federal government is responsible for clienteles such as the military, veterans, and federal detainees, but there doesn't seem to be any action. There are often attempts to interfere in provincial areas of jurisdiction in addition to reporting requirements, which Quebec refused to comply with. On the other hand, there are very good results when it comes to follow-up.

So perhaps the federal government is responsible for that and that's working. But according to the Auditor General, there's not much that is working when it comes to the clienteles that report to the federal government.

[Dr. Donald Juzwishin]

Yes, this is an area of significant challenge. You think of the accord just starting in 2003, but it isn't a great length of time that's been associated with attempting to get these indicators in place.

Despite the challenges, I think there have been some promising results. For example, there was an article in The Globe and Mail this morning that identified the initiatives that are taken on the pan-Canadian effort to try to better understand the issues around neonatal mortality within the aboriginal communities. That conversation requires, of course, the clear definition of what is meant by health within the aboriginal communities, as well as taking those definitions, turning them into indicators, and then standardizing them across the country.

That conversation has not yet taken place, and that is something I think this committee may want to encourage facilitation of. Dr. Besner and Ms. Yeates have indicated that we are at the beginning of being able to understand where we are with cataract, hip, and cardiac surgery, so in these other areas we have to make some significant advances and introduce these conversations so that we can provide the information you're seeking.

[Christiane Gagnon, Bloc, Québec, QC]

Is there a need to be very proactive, to provide more money or better support? If there are delays... The federal government is responsible for meeting objectives in every area where we're supposed to see results, such as in the medical field. It's a bit disappointing to see that you haven't got your ducks in a row. You produce a report, but perhaps it would be better to adopt a different approach based on the different communities that are the federal government's responsibility.

[Dr. Jeanne Besner]

I've just been told that our staff met federal government representatives to ask basically the same questions. Based on what our staff have said, they've developed their vision and started to define their objectives. But for the time being, we don't have anything to report, although the action plan has been developed. We should have more results in the upcoming years.

[Christiane Gagnon, Bloc, Québec, QC]

I was wondering what would be needed for you to submit a more in-depth report, which takes into account all these factors. It's the whole support component that gets me a bit angry. It's not the first time that there have been reports of alarming situations in the aboriginal population.

[Dr. Jeanne Besner]

We need indicators and measures. We've already met with federal government representatives and we're going to continue our dialogue with them with a view to developing indicators and measures in the future.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much, Madame Gagnon.

Ms. Priddy.

[Penny Priddy, NDP, Surrey North, BC]

Thank you, Mr. Chair.

Thank you to the presenters. Your presentations in some way have made me want to yell “Help!” I'm sitting in for someone today, so I've not sat at this committee table for some time now, but the issues seem to be very similar to ones that were discussed when I was here.

My worry is that we have CIHI collecting the information that they're supposed to collect--fair enough--but indicating that there certainly are some differences in terms of availability of data, how people measure, and all of that across the country. From the Health Council of Canada we have some indicators of really the same sort of thing, either movement that is slower than it ought to be or indicators that we cannot find because they're not there.

None of this is anybody's fault. This isn't a finger-pointing exercise. But if we have two, probably three organizations, if not more, measuring or looking at similar things without the data to support how we do that, how do we fix this? I don't want to be here in six months' time and have the same kind of report: yes, we're moving forward slowly; yes, it's been a catalyst.

I would agree with one of the comments in here that the focus on the accord, at least in any kind of public way, is much, much decreased from what it was when it began, and so is the excitement around it--other than if you speak of wait times for hips, because then you can get people excited.

How do we go about integrating the information that people are gathering, for one thing? There's a lot of hunting and gathering going on out there. How do we integrate all of that information so that when we sit here, we hear something that has some match between the people who have gathered the information? And then, how do we more quickly ensure that there are compatible measurements so that when this information comes forward we know that it is at least empirically similar to what each organization is hearing?

I'm just worried about the lack of integration of the information, the inconsistency of the data that are being collected, the standards under which the data are being collected, and I guess the disappointment of people with the fact that this has not moved forward with more excitement.

Both people, please.

[Glenda Yeates]

Perhaps I'll begin.

With regard to improving data, I appreciate the frustration, which I think all of us in the sector share. But if we take a longer view at CIHI.... We began 14 years ago with a few databases in acute care, and we're now up to 27 databases and building more. My sense is that there has been progress in terms of improving the data. It is slow work, as you point out.

In terms of branching out beyond acute care into new areas of home care, pharmaceuticals, and health professionals beyond doctors and nurses, and deepening our understanding of those health professions, we are continuing to build the data. It is never enough data to answer all the questions people have, but I think there is progress.

In terms of how to integrate it, we've concluded that there is a challenge in making sure we turn the data--because it is expensive to collect--into indicators and measures that people can actually use. We certainly work with our stakeholders to understand how to simplify and how to produce health indicators that can be used, whether it's in a small regional health authority, in a rural area, or elsewhere.

In terms of making the data comparable, that is, in a sense, a role that we take very seriously, and we do work to enhance the comparability of data. There has been convergence in wait-times data, but it is not yet at the point where we have comparable data, as we mentioned. As we point out the differences, that will help convergence to occur over time.

[Penny Priddy, NDP, Surrey North, BC]

Thank you.

I'll have a comment in a minute, if I might, but I'd like you to answer this.

[Dr. Jeanne Besner]

In terms of interpreting data, one of the strategic directions the Health Council has determined it's going to take over the next five years is to actually look at multiple sources of data and try to create more of a story that speaks to Canadians about where there is value for money in the system, about the things that we're doing right, about the areas where we should be doing things differently and so on, and perhaps place less emphasis on trying to collect comparable data when there are none.

I think we can add value to the health system and help inform the public of Canada about choices to be made by working collaboratively with our colleagues from CIHI, Statistics Canada, and many other sources, in terms of gathering data from a variety of places, interpreting it, and beginning to be clear about how we can make decisions about where we need to go. We have to make a lot of choices in the health system, but we also need to get a bit clearer about where it is we're trying to go, because it's pretty hard to develop indicators and measures about everything and anything.

[Penny Priddy, NDP, Surrey North, BC]

I agree.

[Dr. Jeanne Besner]

We need to be a bit more focused than we have been.

[Penny Priddy, NDP, Surrey North, BC]

Thank you, Mr. Chair.

My concluding statement would be that we have.... Yes, it's a long-term project, and I understand that. But there's also money being spent and there are people in crisis. Aboriginal people are in crisis. Our pharmacare program is in crisis, or at least people in certain parts of our country are dying, and they would not be dying if they lived in a different province. Hopefully, where we focus our energy and our resources is on those people who can't wait five years for us to figure out the indicators and figure out all of those things. They are in crisis now, and indeed have been very hopeful about this, that it would bring about changes faster for them.

I will close with that. Thank you.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much, Ms. Priddy.

Now we'll move on to Mrs. Davidson.

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

Thank you very much, Mr. Chair.

Thanks very much to our presenters for being here this morning.

Certainly it's been interesting to hear the opinions and the progress--or lack thereof in some cases--that you presented to us this morning.

Dr. Besner, I want to ask you a question first. You had outlined nine areas where there were concerns. Then you went on to say there were several reasons why you may have seen some disappointment in meeting some of these commitments, and you talked about key elements not being well defined as the first reason. Then you went on to state two or three more.

What's the mechanism for correcting this? Is there a mechanism to open the accord, or add to it, to add definitions or...? How can this be addressed?

[Dr. Jeanne Besner]

I think with anything, if you have a vision of where you want to go, that helps. The accord provided an overarching vision of where we wanted to go in terms of health reform, but outcomes don't get achieved very easily. Going from visions to outcomes you have to develop some very clear strategic plans, some strategic activities that need to be followed. In some ways we need to go back to that step, because I don't think it was done well enough to give a really clear sense of movement forward. You can't develop comparable measures if you have different ways of approaching issues and so on. We just need to work more collaboratively in future, and governments do as well, to redefine where they want to go and what the priorities are and translate that into more concrete actions that we can then clearly evaluate.

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

This is something the provincial, territorial, and federal governments can work on underneath the existing framework. It is not something that needs to be opened up, added to, or--

[Dr. Jeanne Besner]

No, that's right, and I think that's what--

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

How does this get encouraged if some of these groups aren't meeting now? Were they some of the groups that should be looking at this?

[Dr. Jeanne Besner]

Yes, I would think so.