Health Committee on May 6th, 2008

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

So this has not constrained you, or has it constrained you to some degree?

[Dr. Jeanne Besner]

It has not constrained us a whole lot. We've had difficulty in doing comparable reporting across the country in any case, because we don't have comparable indicators in other areas.

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

With respect to wait times, the starting point for each of the provinces has been different and they've pursued their own priorities and strategies. Can you provide examples of where there have been significant wait-time reductions in some of the five priority areas?

[Dr. Jeanne Besner]

I think I should defer. Ms. Yeates has more information.

[Glenda Yeates]

The starting points are different because different provinces chose different priorities.

As I understand it, the choice of priorities in the most recent round of negotiations and money that was furnished for wait times is not something we've commented on specifically in our reports. What we have attempted to do in each case is to look at what the overall situation is in the provinces, as we understand it from the reported data. Where there are trends, we've been able to report those, and we will be continuing to monitor that as it goes forward. But it is true that we see the starting points being very different, if you look at rates of surgery going into the 2004 accord. Regarding the emphasis that different provinces have placed, some have focused very much on hip replacements and knee replacements; others have found the need in their jurisdiction to be cataract surgery, for example, and have put their focus there.

So we do see in the data, certainly, evidence of different provincial priorities being pursued.

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

Ms. Yeates, could you elaborate somewhat on slide 8 of your presentation, which has to do with diagnostic imaging? I look at the change in the number of scanners and the change in the number of exams. I assume doctors are ordering more exams and in fact are probably performing more operations. I assume that; I don't know whether it's a right assumption.

[Glenda Yeates]

Yes.

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

I assume that's what this chart tells us. Therefore, I ask this question. If that assumption is correct, is there a change in the waiting lists?

[Glenda Yeates]

I think one of the lessons we've learned, as a country, in the last number of years is about the complexity of the relationship between doing additional volumes and the impact on waiting times and waiting lists. It is absolutely the case that we are doing additional volumes of scans, as well as surgeries, in the priority areas. I think that's very clear.

The impact that would have on times is less clear. It may be the case that the ability to do surgeries in a more timely way draws out more demand, as some have speculated. There may have been suppressed demand, where people felt the list was too long. I've heard some physicians express the view that perhaps they weren't suggesting surgery because it was simply too long a wait or they were waiting until they felt there was greater access. So there may be increased demand coming forward because of the increased volumes.

What individual jurisdictions are looking at is the complexity. We are doing more, but that doesn't necessarily mean in all cases that there's a corresponding immediate decrease in the waiting times. We are seeing those emerge in some places, but in other places we see increased volumes and yet the time remains relatively stable, and that may be because of increased demand.

So I think it's important to look at the volumes. It will also be important for us to track the information on waiting times over time.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much, Mr. Tilson. Your ten minutes is up.

Ms. Priddy.

[Penny Priddy, NDP, Surrey North, BC]

Thank you, Mr. Chair.

First, let me ask this. One of the items you've looked at, in terms of progress, is around the health care workforce. Can you tell me who in the health care workforce you've looked at?

[Glenda Yeates]

We have data on physicians and nurses. And when I say “nurses”, I mean we have information on RNs, licensed practical nurses, as well as registered psychiatric nurses. We are expanding now. We've just begun databases in five new areas where we're collecting data: pharmacists, occupational therapists, physiotherapists, and we are developing databases for medical radiation technologists and lab technologists. So those are the five that are under development currently.

[Penny Priddy, NDP, Surrey North, BC]

I see. Okay. I was concerned about the fact that it's fairly narrow, and I would think about adding things like dieticians and physician assistants, which is a smaller but growing population.

When you looked at nurses, did you look at nurse practitioners?

[Glenda Yeates]

Yes. Now a component of the nurse database is nurse practitioners.

[Penny Priddy, NDP, Surrey North, BC]

That is a much broader base than the doctors and nurses.

I want to go back to something that was said earlier, which is about whether they will will get to the stage, and whether we should get to the stage that it simply is not possible to do comparable data; that, no matter how hard we try, we can't get it.

I don't want to find us waiting to do things, as I said earlier, for people who are literally, as aboriginal people are, dying while waiting for movement in the area, for instance, of aboriginal health or pharmacare. Is that a consideration or a discussion that the committee has had: that we might get to the stage where you say—I don't care who answers it—we tried; we looked, and it's not possible; let's move on and find a different way to get some of these improvements out to people, without forever chasing something that we've now decided is impossible to be caught, or will be simply a work of process for the sake of the process?

I would hope we would all agree that process is really about outcome, because those people who are dying for not having drugs or potable drinking water or health care in their communities at some stage will stop being very interested in our comparable data.

Somebody—anybody—have you had this discussion?

[Dr. Donald Juzwishin]

I'd like to point out that I became associated with the field of health informatics at the University of Victoria in the mid-eighties. It is an emerging area, and it is an absolutely essential area. Since the Hospital Insurance and Diagnostic Services Act was passed in 1958, and then the Medical Care Act in 1968, followed with the continuing care work during the 1970s, we've been very much institutionally focused, so we've been counting a lot of widgets, a lot of activity in that way.

There is a paradigm that is emerging now, which is turning our attention to exactly the words you have used: what are the outcomes? Because we're in the very early days at the moment, it seems hopeless, but I can assure you it is not. There are material ways of being able to have conversations around what it is we want to measure, coming up with those indicators, and agreeing on what they ought to be across the country.

From my perspective, the conversation you've facilitated here is the beginning of advancing that agenda. I think it's an important one.

[Penny Priddy, NDP, Surrey North, BC]

Thank you.

[Glenda Yeates]

The only thing I would add is that we see the advantage of comparable data for looking at things such as outcomes, and for understanding what we are producing, and whether, if you measure one set of activities in the same way as others, you can then compare it with others. Some of those comparisons are what can lead us to understand outcomes.

This is the reason we've reported wait times as we have them now, even though they're not perfectly comparable. We believe that when we put the information there, noting the differences, it's still very valuable and useful information. I think comparability is the gold standard, and we should certainly strive towards it, but I think we can gather information and use it and make decisions on it even when it's not perfectly comparable.

[Penny Priddy, NDP, Surrey North, BC]

That would be my hope, in spite of the fact that the first question I asked you was about comparability of data.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much.

[Penny Priddy, NDP, Surrey North, BC]

Are we done?

[The Vice-Chair, Liberal, Lui Temelkovski]

Yes. Thank you.

We'll move on to Mr. Fletcher.

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

Thank you, Mr. Chair.

I'd like to thank the witnesses for being here today.

There has been talk about pan-Canadian initiatives, and I'd like to seek your views on the fact that the government has invested over $1 billion in public health across the country. We also had some mention about disseminating information on cancer--for example, the Canadian Partnership Against Cancer, which is a unique structure that has the buy-in and participation of all the cancer agencies in Canada, and the Canadian Cancer Society, the cancer care community in each province. They are tasked with doing exactly that. Part of their mandate is ensuring best practice and disseminating information. I wonder if you could comment on that.

We also have the cardiovascular steering committee, which is coming up with a plan that will likely be similar to the Canadian Partnership Against Cancer. They're meeting right now. So there is activity taking place in that realm.

Moreover, there is also the Mental Health Commission-- $100 million going into mental health. And though it's a taboo subject, it's something that affects one in four Canadians at least once in their life. It's very important. I'd be interested in your comments on that and perhaps the unintended positive consequences of these types of programs.

I also have a question for Ms. Besner. On page 2 of your report, you talk about the Kelowna communiqué. Could you explain the difference between a communiqué and an accord?

[Dr. Jeanne Besner]

I can't answer the last question, the difference between the communiqué and the accord. I'm sorry.

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

You obviously had deliberate wording. Why is the wording different?