Health Committee on May 13th, 2008

[Barbara Byers]

The temporary foreign worker program is not working, for those workers who are being brought in. It is not immigration; it's exploitation. It's not working for the system either.

As well, we have a number of workers who have immigrated to Canada who cannot get access to the kinds of training they need. The temporary foreign worker program is not a good program in any occupation that workers have been brought in for.

[Kurt Davis]

There's a key issue in the clinical education for foreign workers as well in our profession, because many of them have taken advantage of bridging programs that are provided to integrate them into the Canadian workplace. You're robbing Peter to pay Paul for a bridging program that's taking seats away, usually, from a local clinical program of an academic training program in a local college. Bridging programs and integrating international students into the system in Canada are a lose-lose situation in our profession.

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

I guess one of the best examples today—

[The Chair, Conservative, Joy Smith]

I think Ms. Silas wanted to answer.

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

Let me just reference the question for Linda Silas in terms of the fact that as we're sitting here today, Saskatchewan nurses are at the bargaining table. The pilot project for aboriginal health care workers seems to be on the shelf or dead, yet Saskatchewan has just recruited 297 nurses from the Philippines. It seems to me this is typical of what's happening across the country, and there's no Canadian strategy to deal with it.

[Linda Silas]

Immigration, all the panels have said, is not the solution. We should be an open country. We're a great country, but we have to be responsible. We're a very rich country, and we should be sustainable in our health human resources and our education programs. What message we are giving to our children is one of my issues, as a mother.

In regard to Saskatchewan and Manitoba, we have to realize that we still have under Indian Affairs a department called Aboriginal Workforce Participation Initiatives, and that's what Paul was talking about. It's again at a standstill, but it's looking at collective agreements and how you bring aboriginal people into your collective agreements, because the word “union” doesn't even exist in aboriginal language, for example. The grievance procedure is very different.

Those were very positive initiatives that are on the same hold. We're hoping they will all come back. Again, we're a rich country, and we should educate our own and welcome others.

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

Thank you.

Maybe I have time to ask Paul a couple of questions on the Canada Health Act and the whole move towards privatization and the use of PPPs and so on.

Didn't you take the government to court over dereliction of duty concerning the Canada Health Act? Where do we stand now, in terms of enforcement, and how can we make a difference?

[Paul Moist]

Through the chair, we did take the previous government to court over the annual report, which has pages and pages left blank from many provinces. Some provinces, such as Manitoba and Saskatchewan, comply. The Federal Court ruled that we certainly had a point and that it was up to parliamentarians to enforce this, as the givers of the cheques, if you will.

So there's no accountability there.

As I said, there are two provinces not participating in the Health Council of Canada. I don't know how they can be accountable. I hear often that we shouldn't intrude on the provinces. Well, I think the citizens in those provinces expect your cheque to have accountability attached to it.

The ultimate intrusion, on the other hand—PPP Canada Inc.—for any project over $50 million.... You couldn't build an acute care hospital in a large Canadian city for under $150 million. Any project with more than $50 million, this government is saying, you must consider a private hospital, a P3 hospital.

So we intrude in provincial jurisdiction there, but we don't enforce millions of dollars going out in medicare transfers, and we accept many blank pages. CUPE doesn't accept that.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Moist.

Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you.

It would be appropriate today to direct my questions to the Canadian Federation of Nurses Unions. I know this is National Nursing Week. I spent Monday morning in my riding going to work with a few nurses and seeing what a splendid job they do in the health care facilities there.

When we look at the 10-year health accord, we see that there are certainly some success stories we can be proud of. I asked my local hospital what the patient wait times partnership has meant to them, and they mentioned to me 606 additional cancer, cataract, and joint replacement surgeries and 1,880 more MRI hours.

There have been some positive steps forward. When you delve deeper, there are some things we can learn from this, and I want to get your comments on them. When I look for things we can improve in the future, I notice the human resources issue is a huge one. In my riding, there are 30,000 individuals who don't have a family doctor, and the shortage of nurses is related to the shortage of doctors. I see this at the Royal Victoria Hospital.

There is a geographical disparity in health care services in this country. The level of service is not as high in rural Canada, in small towns. There are not as many medical professionals practising there. I'm not sure this health accord recognizes the challenges we have in this geographical disparity.

One thing we can look to improve upon is how we match our national expectations on a provincial level. I wonder whether we have all the levers required to ensure that our health care dollars are being spent on the priorities that you all have spoken about. I was intrigued, Ms. Silas, when you spoke of an audit of provincial funds coming from the federal government.

Could you expand upon that? Why do you believe it is needed, and what expectations would you have if there were to be more tools for an audit of these federal funds? What are your expectations for those federal funds, within the provincial administration?

[Linda Silas]

With respect to the audit request, the last audit was done in 2002, if my memory serves me right, and a lot of federal dollars are going to the provinces and territories on health care. You have to realize that Health Canada is the sixth-largest health care employer in the country, so we need to know where our dollars are going.

You're right that there has been progress made in wait time management, but a lot of it has been in managing the wait list itself. We still have physicians and specialists who keep their wait time lists on post-it notes. We need a lot more computerization, etc. We have in Canada, through Health Canada, an advisory committee on health development and health human resources. It is a pan-Canadian committee. They need to go further than the bureaucrats. They need to involve the stakeholders. They need to involve the people around this table so that they know what's going on. I have to give credit to HRSDC. They've gone into rural communities. We have a project in Regina, which is not rural. We have another project in Cape Breton, though, for the skills upgrading of nurses, and we have a big one in front of Health Canada to do more of that.

You and Monsieur Malo are saying that there's good news, but it's not transferring to the regions. It's stuck at the bureaucratic level, and we need to implement the stakeholders throughout. We have to make sure that what the minister hears is what the CEO of a hospital and the nurse on the floor hears. Everything has to connect, and to do it we have to work together.

[Patrick Brown, Conservative, Barrie, ON]

I heard from my local nurses union that with all these goals being set for health care, people have to reallocate dollars. CEOs of hospitals are doing this. You talk about the shortage of nurses. All these nurses who are eager to work are being given part-time positions rather than full-time ones. With respect to human resources, how would it alleviate the situation if we put more funds into full-time than part-time? In some cases, when you add up the overtime, we're paying more for part-time.

[Linda Silas]

It's the supply and demand magical question. Everyone has their role. Hospitals are now paying $3,000, $5,000 to nursing students to guarantee them there. Why wouldn't the federal government have a program? You've just established a federal program for police officers. We need to establish one for health care workers. CMA proposed a $1 billion education plan for health care professionals about five years ago. It's still not being acted upon.

That $3,000 that your hospital gives could go into health human resources.

[The Chair, Conservative, Joy Smith]

Thank you so much, Ms. Silas.

Ms. Kadis.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you, Madam Chair, and thank you to our guests today.

We've heard through today's hearings, as well as previously in other sessions, regarding the need for more financial resources. Are there other impediments to achieving improvements in the 10-year health care plan to improve the health and safety of Canadians? Is it financial? Is there enough commitment from the federal government currently to achieve these goals? We have continuously heard of the need for a pan-Canadian strategy. We have also heard the concern that it's not there to the extent that it was originally, and that it has been weakened. There was $42 billion. There was great promise.

I would be very interested to know what you feel will get us there and what your recommendations would be to this committee.

[Barbara Byers]

If I can begin, one of the things we would recommend to the committee is that if you want to look at the question of controlling costs and providing needed services to people, you really have to get into the national pharmaceutical strategy. That has to be there.

Earlier I believe Mr. Brown raised the question about the levers to control costs and dealing with that. Well, the federal government has those levers. They can deal with the question of patent protection and the long, long years of patent protection. They can deal with the question Ms. Silas raised about New Zealand's bulk buying and bringing down costs. That's one of the issues.

If the strategy is to continue to throw money into the private sector, they will bleed the system dry and no one will be able to afford it.

[Dr. Jeff Poston]

I think we have to continue to focus on ways of reforming the system and better ways of using the money that's currently invested.

We have to look very critically at scopes of practice of health care professionals. We have been very interested in the experiment in Alberta to look at better utilization of pharmacists, where pharmacists have been given prescriptive authority under some well-defined conditions.

I think we heard from earlier presenters today looking at the need to actually invest in home care and long-term care. If we can keep people out of hospitals for longer, and if we can treat people with minor ailments using pharmacists or nurse practitioners, we don't have to always rely on the physicians.

The whole issue of health care reform is something I think we need to continue to work on.

I have one caution. I've heard twice this morning about New Zealand and bulk purchasing of drugs. That has been fairly disastrous in New Zealand. It has led to significant drug shortages, because with bulk purchasing you create a monopoly supplier. If the monopoly supplier has problems with raw materials or manufacturing, you lose that supplier in the market and suddenly you have no drugs. So I think there needs to be some caution about some of the solutions.

Thank you.

[Linda Silas]

As I said in our last recommendation, we have to consult a lot more than we're doing. This is the first report on the 10-year plan. We need one every year. And it has to start at the level of the bureaucrats, to the advisory committees, and come back to you with all the stakeholders.

I know you have a lot on your plate, but if it's not done on a yearly basis for the next six years, until we're done, we will analyze the 10-year plan as a failure, and we will all be responsible for it.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you.

[The Chair, Conservative, Joy Smith]

You have another minute.

[Carolyn Bennett, Liberal, St. Paul's, ON]

We would love it if you would give an overview of what would make your heart go pitter-patter if it was in our report.

[Barbara Byers]

You can start with implementing 99% of what was in the Romanow commission. You could bring in a lot of those things: MRIs, the other--

[Carolyn Bennett, Liberal, St. Paul's, ON]

Just a second. This is a review of the 10-year plan.

[Barbara Byers]

Yes.

[Carolyn Bennett, Liberal, St. Paul's, ON]

So in terms of how we think we're doing on the 10-year plan, what do you think our report should focus on in the areas you think are weak or the areas we should be focused on?