Good afternoon. I am very pleased to be here to represent the Health Council of Canada.
I believe that members of the committee have received our briefing note, so I am just going to speak to a few of the points that were made in there.
In my day job I am a researcher in Calgary and have been for the last eight years, looking at the whole area of health human resources, workforce optimization, service delivery models, and so on. So I will pepper some of the health council comments with some of my own observations and experiences drawn from that research.
We noted in our report that in June 2008 we had commented that ensuring that we had the right number of health care providers in the right place was a central component of both of the health accords. One of the elements of the 2004 accords was the development of a pan-Canadian framework for health human resources planning that all of the members and jurisdictions had agreed on.
I think it is important to note that it was a needs-based health human resources planning framework that was to take us away from a supply-based model of planning for health human resources.
Certainly in my own experience and observation, we have not moved very far in the whole approach to needs-based planning, but in our research, my team and I have certainly tried to develop that. One of the things that has become very clear is that when you begin to look at the needs of the population, and much of our research has been done in acute care, a very high proportion of the bed-days in adult hospitals--about 42% in Calgary--is for individuals over the age of 65, many of whom have multiple chronic diseases. Yet our research has indicated a huge gap of knowledge in the health professionals who are providing service to that population relative to the gerontological risk factor assessment and so on. There is evidence that this lack of understanding of risk factors in particular types of populations, regardless of their specific diseases, in fact leads to avoidable complications of care and less than optimal quality of care. So I think the whole focus on needs-based planning, certainly in my opinion, is very important.
It is also clear to us that while we talk a lot about shortages of nurses, physicians, and so on, the shortages that exist may be worse than we think or not as bad as we think, but there is a lot of evidence, at least in nursing, which has been one of the areas where we've done a lot of work, that the under-utilization of health professionals is really part of the whole supply problem. We have registered nurses in many cases doing work that could be done by licensed practical nurses, health care aides, janitors, housekeepers, and others if the service delivery model were different from what it is.
So we do have to think a lot about how we structure delivery of care as well as look at whether or not the people who are delivering care are actually working to the full extent of their knowledge and skills. While most of our research has been done in acute care, some of it is also currently occurring in primary care networks, family practice networks, and so on. There is evidence there as well of under-utilization of health professionals and the potential to move to a very different place if we think differently about many of the issues we are looking at.
Also, in our “Value for Money” reports, we have talked about whether or not we are using our health human resources to provide cost-effective services. Again I could provide a lot of evidence of the fact that I think we are not. By really focusing on the needs of populations, the risk factors, the management of people versus the management of diseases, we could perhaps prevent a lot of the readmissions, for example, that we see occurring over and over again. So based on my own experience I think there's lots of room there for doing things quite differently.
In our reports we have quoted one of the respondents to our “Value for Money” website who said that “it seems governments and institutions are in a race to cut funding and positions based on today's circumstances”. That is something that we saw in the 1990s. We cut a lot of positions--and nursing was one example--and those were the result of very short-sighted decisions, because those cuts are what has caused the shortage that we have today.
I think as we move into another economic crisis we are going to have to be very careful to think about what we are doing if we consider any cuts.
We also need to match the resources we have to the policy agendas we are talking about. We talk about improving population health, moving to more disease prevention, and so on, yet we're utilizing most of our health care providers in the disease management basket, rather than looking at which of our health care providers really could add and advance the health promotion agenda, the population focus, and so on.
I think it is important that we have a national plan that begins to look at what our real shortages are, where they exist, and so on, but we should do that in light of the policy directives. Where do we want to be ten years from now? Are we educating the right number and types of providers to take us to that place at that time?
We've noted on page three the lack of data on outcomes. It is important to link the health human resource agenda to the kinds of outcomes we're trying to achieve. If we really begin to talk about improving health, well-being, self-care capacity, and so on, that speaks to the need for a different kind of provider mix from what we have when we focus primarily on morbidity or mortality outcomes.
There's no question in my mind that we really need to talk about what collaborative practice models mean for Canada. We've talked a lot about team-based care for a number of years, but the collaborative practice model, using Health Canada's definition, places particular focus on patients and families being part of the decision-making process, being engaged in their care, and ensuring that the services provided to them are very well matched to their needs, goals, and so on. We have a lot of evidence that the system is far more provider-centric than client-family-centred. That's another area where by moving forward with a clear vision of where we want to go, we could make a lot of improvements in the delivery of health care.
I'll stop there. There will be an opportunity for questions later if you have any.
Thank you for giving us the opportunity of presenting.