Health Committee on May 27th, 2008

[William Tholl]

I have a number of comments to make.

In my opinion, as I look at the provinces that have performed well and those that haven't, it has to do with leadership and it has to do with assignment of responsibility. In Ontario you have Dr. Alan Hudson as the wait time czar. In Manitoba it's Dr. Brian Postl, the wait time czar. You have specifically tasked people to bring down and keep down wait times. I think that's the major distinction between those provinces that have been more successful or less successful in terms of the WTA scorecard.

[Christiane Gagnon, Bloc, Québec, QC]

The Health Council of Canada's data with respect to reports on Aboriginal health were not available. It is not clear what progress has been made; we don't even know whether funding has yet been allocated. In answer to questions with respect to monitoring, have you made the same observations, or is it because they are not providing better support with a view to meeting Aboriginal needs? In fact, we wanted to invite representatives of various organizations so they could tell us what their needs are.

[The Chair, Conservative, Joy Smith]

Madame Gagnon, we're just over time.

[Christiane Gagnon, Bloc, Québec, QC]

My colleague will pursue that in another round.

[The Chair, Conservative, Joy Smith]

Madame Tremblay, would you like to address that question quickly?

[Paulette Tremblay]

To the question in relation to data not available, we are missing data. There are gaps. We are not able to track because we have no mechanism yet to look at the real numbers of aboriginal health human resources. Using the statistics from Stats Canada isn't good enough; they're not fully accurate at times. It's some sort of measure, but we need more. We need to go to the community level to see what is actually happening, what is needed, and we're beginning that with the needs assessment and situational analysis for first nations health managers. We have a contract with Health Canada under which we've begun project work. We're doing a needs assessment. But we're just beginning; we're only starting.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Tremblay.

Madam Wasylycia-Leis.

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

Thank you, Madam Chairperson.

And thanks to all of you.

You should know that this is the last chance we get to hear from the public about the 10-year accord. Time is limited.

Mike, you made a good point. It has not necessarily been by the wishes of the committee, but I think, really, by design of the government, because we got a letter right from the very start from the Minister of Health suggesting that a focused, time-limited review by the committee would be in order. The suggestion was that very little progress has been made; therefore, there wouldn't be much point, even though we're almost halfway through the 10-year period.

I simply need to know from all of you—and I'll ask this in three different areas—what recommendations you would have for us as we prepare our report. It is a critical juncture. We're talking about the overall state of our health care system. I want to break it into three areas.

One, with respect, Mike, to the Canada Health Act, you were the only one who mentioned the lack of accountability and the failure of this government to live up to the standards in the Canada Health Act, which is part of the accord. People seem to forget. Written right in the accord is an agreement on the part of all governments to the existing system, and they pledge to renew the system, not dismantle the system.

We couldn't get the minister for this committee to deal with the CHA, we couldn't get the motion passed here at committee, so what do we do now to get some accountability from this government with respect to the Canada Health Act?

That's the first question. Then I want to go on to health human resources and then aboriginal health.

[Michael McBane]

Maybe to respond quickly from the perspective of the Canadian Health Coalition, there is an essential statutory duty on the part of the federal government, and if the current government doesn't believe in that, then maybe they're in the wrong job.

We have an election coming, and if they think health care is exclusively provincial and that Canadians don't want national standards, that Quebeckers don't want health care when they move to British Columbia, and vice versa, then that should part of the election debate.

I think we are at an impasse. We don't have real accountability. This committee has been shot down, in terms of examining the accountability standard in the Canada Health Act annual report, which is totally inadequate, according to the Auditor General.

I think most Canadians want to know where their money is going, so I think we have to keep at it and demand higher standards of accountability.

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

Thank you.

The minister was before committee, and it was interesting that he didn't mention the words “Canada Health Act”, “medicare”, “universal health care”, or “national health care” once. So I do question where he's coming from, what the government agenda is. But you're right, maybe all we can do is hold them to account in an election.

I know there are other hands, but let me raise another question and then have you jump in. That is the question of health human resources, which I think, by everyone who has appeared before the committee, is probably the number one issue facing the health care system.

When the deputy ADM appeared before the committee at the start of these sessions, there was not a word from her, Karen Dodds on the health human resource strategy. When the minister was asked, he basically tried to suggest, “Oh, we're doing a bit in terms of foreign graduates, and really it's a provincial responsibility.”

I guess I would like to hear from Elisabeth, from Marlene and from Antonia, and of course Dr. Day, on what we put in this paper, this response to the 10-year accord, that will drive this agenda and move it forward. This spring we're at the end of the five-year health human resource strategy. The government has no commitment to put a new strategy in place. What are we going to do?

Let's start with Elisabeth, and then Marlene.

[Elisabeth Ballermann]

Thank you very much.

It's a difficult problem. The constitutional squabbling between the federal and provincial governments has been going on for generations. It seems to me we need to ensure that we have a plan and data to determine how many health professionals we will need and where we will need them. We need to have some level of encouragement to prevent the situation where Newfoundland educates a school of respiratory therapists and they all move to Alberta because that's where the money is. We need to do something to equalize the level of health human resources in this province, so it's not just a matter of wherever the money is best and that's where they're going to go.

I acknowledge that this is an incredibly difficult problem in a free country where people are free to move from point A to point B, but we have to figure out how to create incentives to ensure that all regions of this province have enough, and also that we create enough health professionals for our own uses. It is unconscionable that we would be going to other countries to take their highly qualified professionals when they desperately need them themselves.

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

Antonia, Marlene, and Dr. Day, I agree there are problems in terms of jurisdiction, but wouldn't it help to at least have the federal government enunciate the problem and say we have a serious crisis that we have to get on top of?

Marlene, and then Antonia.

[Dr. Marlene Smadu]

Thank you for the opportunity.

Before I address the health human resources, I do want to let you know that we did talk about accountability for the Canada Health Act in our brief as well.

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

Sorry, yes, you did.

[Dr. Marlene Smadu]

That's a very important issue for us as the Canadian Nurses Association.

[The Chair, Conservative, Joy Smith]

I want you to keep in mind that there are two questions directed to two people and we only have a minute left.

[Dr. Marlene Smadu]

Okay. I'll be very pointed.

The federal government is a huge employer of health human resources. There's a role they have to play in that regard. We have a pan-Canadian health human resources plan and it needs to be implemented. It deals with many of the things that Elisabeth talked about. On self-sufficiency, we need to ensure we are creating enough health providers for ourselves. We live in a global environment where the health human resources are a big challenge.

[Dr. Antonia Maioni]

It's not just about health; it's about education, it's about labour, and it's about other social services. We can't just think about health in a silo any more. This has to be an interdisciplinary effort, on the one hand.

Secondly, I don't see a lot of movement on that collaboration between disciplines and this particular issue of health human resources. We don't want health human resources to become the crisis du jour, as wait times were back then. We figured out it wasn't really about wait times; it was about doctors actually performing the services. We have to worry about having the crisis du jour attitude.

The next thing is about dispute resolution. There's a part about dispute resolution. I don't know if Michael alludes to this in his context, but I don't know what's going on there. Do we have any better way of resolving disputes than before? That too is at the heart of the problem between federal and provincial governments.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Maioni.

We'll now go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chairman.

My questions are for Mr. Day. I have three areas I want to delve into with you.

As we look at the health accord, obviously the rationale behind having hearings like this is to be able to improve whatever the next step is. I have three areas of concern I want to get your perspective on.

One is the different levels of service we have in Canada in terms of rural and urban delivery of health services. If you look at areas like physician shortages, obviously they're much more acute in a rural area than they are in an urban setting. The tendency is that hospitals face greater crunches in small towns on a range of levels.

Capacity is another issue I have a concern with. I'm not convinced the health accord gives enough attention to the capacity issues hospitals are facing. I look at my own hospital, the Royal Victoria Hospital. They tell me that consistently they're at 96% or 98% capacity, and there isn't a lack of beds. What leadership can we provide to have a vision and a plan to make sure there is an adequate infrastructure in the country so that our hospitals aren't always running at capacity?

A third area, an area that I think everyone is concerned about and has touched upon, is the recruitment and retention of health professionals. I sit on my own physician recruitment task force in Barrie, and I know many communities have these task forces, which are sort of competing with each other to recruit health professionals. It's certainly an effective solution to tread water right now, but it is in no manner a long-term solution.

I know you talked about the fact that we've gone from 1,500 to 2,700 graduates a year from medical schools. What is the long-term level we need? I understand that we'll be approaching 3,000, but what is the number that actually would serve Canada well? Is it 4,000? Is it 5,000? It would be interesting to know exactly where Canada needs to be.

I heard mention of the 1,500 doctors trained overseas and the need to bring them back. That's an area of concern too. Are there things we can do to expedite that process? You never want to have someone delivering pizzas or driving a taxi when he can be helping Canadians. But at the same time, are there any concerns that people who have not been accepted at Canadian medical schools but who might have got in abroad are up to our standards?

I realize we have equivalency exams. Are there things we can do to make sure those equivalency exams are as seamless as possible? I understand the cost for equivalency exams is $1,000 or $2,000, and many new Canadians don't have the funds to pay for those exams.

We set up a scholarship fund in my riding of Barrie to pay for those exams for foreign-trained doctors because they don't have the capacity to pay for books. What could we do nationally to help foreign-trained doctors integrate into the system faster?

[Dr. Brian Day]

With respect to rural and urban, we have a strategy on that. In British Columbia, for example, and elsewhere, it's been shown that if you have students from rural areas going to medical school, they're more likely to practise in a rural setting. In fact, the data on that in British Columbia is very positive. Those from the rural centres tend to want to go back. Of course, the crisis in medical manpower is at its greatest in rural Canada.

In terms of capacity, the theme I talked about in my remarks was about empowering the patient, not focusing on the system, which is what some people here want to do. Put the patient at the centre and not the system at the centre, and have everyone revolve around the patient. One of those means is to attach the funding to patients so that when patients go to an institution they are a value, not a cost.

We are the last OECD country that block-funds our hospitals. When you say there's no capacity.... There is no incentive in our system for a hospital to be efficient, to be effective in admitting and discharging a patient. We've seen a situation in Britain, which had a national health service and has universal health care, where in three and a half years wait lists have gone down and capacity has increased, because there's more.... For example, if I have an operation that takes one and a half hours and it's 3:30 in the afternoon, they won't let me do that operation because I might go overtime. That's because the patient is using up the hospital's money. So it's inefficient, and it's not putting the patient at the centre of the system.

On recruitment, 1,500 medical students are going to foreign medical schools, and many of them are very, very bright. In fact, there are over 200 Canadians in Australia and over 300 in Ireland. At one of the Australian universities, four of the top five students in the graduating class were Canadians. So they're not B students.

I think, again, we have a problem with recruitment and retention. Yet we have a situation in which 50% of newly trained orthopedic surgeons--some of the biggest wait lists in the country are for orthopedic surgery--leave within five years of graduation because we can't give them operating room time.

So the word that defines our approach to our health system is rationing. We're rationing access. The way we can break that is by attaching the funding to the patient, and then the vicious circle will be broken.

[Patrick Brown, Conservative, Barrie, ON]

Is there any comment?

[Anne Wilkie]

Just very briefly, yes.

I wanted to comment that I'd like to see everybody kind of step back. We're all dealing with this issue of a shortage of resources and wait list times. We're coming from a different perspective. We'd like to see the resources focused more on health promotion and disease prevention.

There are excellent stats out there, health economic data, that show the health care cost savings that arise from the use of supplements. If you feed pregnant women multivitamins with folic acid, you reduce significantly the risk of neural tube defects. If you have supplements routinely used by elderly populations--calcium and vitamin D, for example--there are huge reductions in hip fractures. If you give lycopene to increase eyesight, there are benefits. There are decreased visits to doctors. There's decreased interdependency. There are huge savings that can be realized from the use of supplements and from giving the power back to consumers before they become patients.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Wilkie.

Now we'll go to the second round, and that will be five minutes for the questions and the answers.

We'll start with Ms. Kadis.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you, Madam Chair, and welcome to all our witnesses.

I know we have very little time. There seems to have been a theme that's cropped up at all our meetings, and that is that there seems to be a lack of federal leadership by our current government on a variety of these important goals and objectives in the 10-year plan. One, in particular, is the national pharmaceutical strategy.

Ms. Smadu, we can't seem to get information on this. What's happening? We don't know if there's a co-chair of the intergovernmental body. What do you think is hindering this process? This appears to be typical of why we're not achieving a lot of these goals quickly enough.

So I'd like to ask you that and give everyone an opportunity, briefly, to put forth recommendations for our committee's report on the plan to strengthen health care.