Evidence of meeting #16 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.
A recording is available from Parliament.
4:45 p.m.
Conservative
Tim Uppal Conservative Edmonton—Sherwood Park, AB
Thank you very much.
Thank you for coming here and adding to our study.
I just want to get back a little bit to what I guess would be federal and provincial differences there. A couple of times we had mentioned nurses that were laid off in difficult times at the provincial level. Those are obviously provincial decisions. I know that in Alberta, when we went through it, it was a big deal. Now you're saying that there is a shortage, and some of that has to do with those shortages. Those are provincial decisions.
As a federal association, how are you guys dealing with the provinces, and how successful are you with the information you're exchanging with them? Are they listening to what you're saying? Do you find that you're being successful?
4:45 p.m.
Conservative
4:45 p.m.
John Abbott Chief Executive Officer, Health Council of Canada
In terms of the work we do at the Health Council of Canada, we're very dependent on the provinces, territories, and the federal government for a lot of the information and the insights that they can bring to bear, because they're in the field and are responsible for delivering most of the services.
In terms of then responding to our findings and our recommendations from time to time, there's less take-up, to be fair to us and to be kind to them. Part of that is they're constantly moving and the agendas are moving, and they're moving very quickly.
Some of the work we do is a bit of a retrospective: this is what you've committed to in the accords, here is where we are today, and we're trying to project. There's a bit of a disconnect.
If I can use one example where the jurisdictions did come together a number of years ago, it was around medical school enrolments. They agreed. They made a decision. In retrospect, we could argue it might have been the wrong decision.
Governments can act and do act when they feel it is in their interest to do so, collectively. So the accords are an example of that. We think, when they look at wait times and other issues, when it's viewed as critical to the public interest, the national public interest, they come together.
What we need, and are trying to implement through our process here and the work others are doing, is to say human resources planning in the health care field is another call to develop and define as a national interest. We need that, or else in five years' time or ten years' time your committee will be asking the same questions.
We have an aging population, and we know the parameters of care that are going to be required. So if we set some objectives and then design the services around that, we can then also design the human resource requirements around that.
The health ministers of Canada are not there today. I think what this committee can do is point them in that direction.
4:50 p.m.
President and Chief Executive Officer, Canadian Health Services Research Foundation
I have three examples. In a sense, we're not an organization that's negotiating federally and provincially. We're outside of that. To give an indication, the western health ministers have asked us to work with them on health human resources questions to produce a research synthesis on health human resources, particularly in under-serviced areas. So they've come to us and asked if we would work with them on that. Similarly, Nunavut has asked us if we could put together a team that can help them with the health services organization questions in Nunavut. In a sense we're responding to those requests.
Similarly, in the much more micro-level programs that we're involved in, which I mentioned, that bring together researchers and executives in the health system, we have excellent representation from across the country. People apply to be part of it, and it turns out that there's very good representation from across the country. Actually, we've worked very closely with the Alberta Heritage Foundation for Medical Research and the search program there.
Our relationships aren't part of any kind of negotiating. We're not following up on federal-provincial commitments. Rather, organizations that are provincial get together with us when they want to do something together with us and they either want to combine on their money or they want to combine in terms of expertise.
4:50 p.m.
Conservative
4:50 p.m.
Vice-President, Programs, and Executive Director, Quebec Office, Canadian Institute for Health Information
I just have a small comment. CIHI has a different mandate. We don't do research, and we don't make recommendations. We provide the state of health and the use of health care services. It's really statistics.
I have to say we have excellent collaboration with the provinces. We even have bilateral agreements with each of the provinces. Each of the provinces contributes to our funding. We see that the information we produce is being used by policy-makers effectively to either change legislation or change the way they practise to improve the efficiency of the health care system. But we don't make recommendations. We just provide the facts, and we see that they use them.
4:50 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Thank you, Madam Chair.
I will ask you three questions and you can have the time remaining to answer them. I'm going to base my question on the comments made by Ms. O'Neil.
You said earlier, Ms. O'Neil, that improvements are made at the local level, that this is where the best practices are developed, but that we have to come up with a way to share the successes. I was under the impression that there were publications, not only here but also international publications that enabled us to do that, that there were forums, that there were conferences. I would simply like to know whether these tools for disseminating information are useful and whether or not they do the job well.
You also made a comment on the scope of our study, which may be a bit too broad. I would like each of you to tell us whether or not we should limit our study. If so, what should be the focus of this study?
The third question is for Mr. Beaudet in particular. Ms. O'Neil said that research was a poor cousin, and that it was under-funded. Do you share this opinion?
All of these questions are for the whole panel.
4:50 p.m.
President and Chief Executive Officer, Canadian Health Services Research Foundation
With respect to your question about how to more efficiently share research, not only research but also innovations that take place in our various institutions, I believe that we must hold more forums at both the provincial and even the federal-provincial level so that front-line workers have an opportunity to share their experiences. There are many forums for academics because researchers are much more likely to believe in their importance.
I must say that nursing heads in various hospitals don't have many opportunities to exchange information amongst themselves about what is going on with patients in a hospital. I think that it is here, at the operational level, that we need to organize many more forums between the provinces, in order to discuss change.
I am not talking about researchers exchanging information amongst themselves. Researchers all have many opportunities to talk to one another, but the people working within the system have fewer opportunities. We know this, we organized a forum for teams; we work better in teams, etc. The people who attended the forum came from the workplace. They exchanged ideas amongst themselves. They came from all corners of the country, and it was appreciated because there are very few forums of this type.
4:55 p.m.
President, Canadian Institutes of Health Research
Now then, the first part of your question refers more or less to what you just asked regarding the breadth of vision. With regard to research, we are talking about competitiveness at the national level, about combining our resources and establishing uniform standards of practice across Canada. The availability of mechanisms for recruiting patients for Canada-wide studies will clearly make us much more competitive internationally. I think that everyone wants this, and all the provinces certainly want it.
Your second question is about funding. In 1999, I told you that research was woefully under-funded in Canada. We must recognize that the efforts made in a wide range of fields over the past eight years have been truly remarkable: research chair programs have been created in order to support and to attract researchers of renowned in Canada and abroad. There are Canadian scholarship programs that encourage students to go on to graduate studies; and the recently announced Vanier scholarships have enabled us and will in the future enable us to attract very highly qualified foreign students. Finally, significant investments have been made in infrastructure.
Ten years ago, our infrastructure was sadly lagging behind other industrialized countries. We have erased that gap, and we are once again competitive. The CIHR budgets, since it was created, since the MRC went over to CIHR, have tripled in value. This all adds up to a very significant investment.
Clearly, research—and let me repeat this—involves international competition. It is very clear that Canada will have to carry on with its efforts if it wants to remain competitive at the international level. I must tell you that its competitive position is very good.
April 23rd, 2009 / 4:55 p.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
Thank you, Madam Chair, and thanks very much to all of our presenters. Every time we hear from somebody, it just becomes more evident what a huge task they've taken on.
It's interesting to hear the different aspects and how the different groups see the issues, the problems, and the solutions. I am interested in a couple of things that were said during your presentations.
Dr. Besner, I think you said we needed to get into needs-based planning, and you talked a bit about underutilization of health professionals. Are you talking about all health professionals? To fix this problem or to make things better, do all health professionals have to be involved?
As well, when we talk about that, are there common issues among some of the different groups, such as technologists, technicians, alternative medicines, and so on, as well as the doctors and nurses we're familiar with? Maybe you could comment on that a bit, please.
4:55 p.m.
Chair, Health Council of Canada
I can't speak to all of the groups, but certainly when we ask a number of different health professionals if they believe they have knowledge and skill that they can bring to the improvement of health outcomes but that are not being tapped into, a majority of them will say yes.
I think it's probably worse in some areas than in others. We've primarily studied nursing up to this point in time. We have done interviews with a number of different professionals; what we've identified across the board is a focus on tasks, and there's a lot of overlap in tasks across many of the health professionals. Giving medications, for example, is not the domain only of pharmacists or physicians or nurses. Patients also give them, and so on, so this focus on tasks blurs a lot of the distinctiveness in terms of the knowledge of various professionals, and role ambiguity is something that has come out in all the work we've done.
When we begin to look at under-utilization, I can only speak to nursing, because I've only studied extensively in nursing. We have baccalaureate-prepared registered nurses now in Canada. When we moved to that, it was different in different provinces, so we can't refer to a particular time, but the expectation when we moved to baccalaureate preparation was that registered nurses would contribute more to the population-focused approaches, disease prevention, and so on. However, when we actually study their practice, they are very biomedicalized, as we call it. They're very much involved in medical management--not that they shouldn't be, but that's primarily what they're doing.
In some of the work we've done, we've found it very difficult to differentiate the practice of registered nurses from that of licensed practical nurses, because of this focus on tasks. In some of the work we've done, we've begun to identify that part of the reason registered nurses are not doing what they can do is that we don't have enough licensed practical nurses and health care aides in the staff mix.
Then you begin to wonder what difference it would make if we changed the model of service delivery and had collaborative practice models that incorporated all three. We're only beginning to explore that area of research, but I can give you one tiny example of one medical unit in which we've moved to a collaborative practice model. On a day shift, for example, we went from having 9.5 equivalents of registered nurses and two health care aides to six health care aides, five registered nurses, and four licensed practical nurses. You begin to change, and we're having improved outcomes, more job satisfaction, and a whole lot of stuff. Just that one unit begins to give you a sense of the potential that exists for beginning to work differently, but it also highlights a problem in the mix of people available to us: we can't implement that model in as many places as we'd like because we don't have enough licensed practical nurses in Alberta, and so on and so forth.
That is just an early example of experimenting with new models of service delivery through collaborative practice. What does that mean? We have occupational therapists telling us they are asked to come and be part of the care team when one provider has a particular idea about what that OT can do. As one occupational therapist said, “I'm treated as if I am a technician. I'm called in when somebody wants me to perform a particular test, but if I had been brought in a little earlier, I might have prevented the decision to send that patient to long-term care rather than back home”.
Those are just examples.
5 p.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Thank you.
I'm going to go back to Dr. Bennett's question about the high-level recommendations you'd give if this were your study and you wanted to point the direction, and I'll also be touching on the comments around under-utilization of resources and pan-Canadian visions.
My context is obviously British Columbia. There we're using midwives because there aren't enough obstetricians, but there is actually research that supports the outcomes midwives get. We're also moving to primary care teams that would include naturopathic physicians, and so on. In B.C., a Chinese doctor is part of a regulated profession, with a college, and in how many other provinces is that the case? Probably fewer than half are in that situation. When we want a pan-Canadian vision and if we want to tap into all our health care professionals, including complementary professions, we've got a big problem.
Do you think it would be beneficial to have a pan-Canadian direction around regulatory and scope-of-practice equivalency across the country, so that Nova Scotia would know what a naturopathic physician is and midwives could do their work and have hospital privileges right across the country? Do you think that's possible? Do you think it would be beneficial? How key is that equivalency in the scope-of-practice and regulatory approach for a pan-Canadian vision, or can we work around that problem?
5:05 p.m.
Conservative
The Chair Conservative Joy Smith
Who would like to take that on?
Ms. O'Neil, thank you. Please go ahead.
5:05 p.m.
President and Chief Executive Officer, Canadian Health Services Research Foundation
Certainly that is a vision. I wouldn't, in practical terms, see it happening soon. On the other hand, I think it would be useful to have regular discussions around the key question of how different provinces are regulating, just for the benefit of having those discussions. The federal government would never say, “Now we are going to do this”, but if there were a means of starting those discussions and if they were seen to be taking place, I would think it would be extraordinarily useful. Otherwise, everybody's redoing everybody else's work. However, I know people have spent entire careers working on interprovincial trade and the removal of trade barriers, so I wouldn't see it happening any time soon.
There's another thing. I don't know what the research budget is for this committee, but it would be really interesting to make the point that you can't really talk about health human resources without understanding what the actual organization of the services is going to look like and having a go at pointing out that if services were organized in a certain way, we'd need this many of this kind of profession and that many of that kind. In a sense it is similar to Jeanne's point that at a very micro level, in calculating the cost of running a surgical floor and the nurses to be allocated, you can't say you'll need this many nurses with that training, because it depends who else is there. It would be very important to make the point that it's the way in which services are actually organized and financed that determines how many of which profession you're going to need.
As an illustration, I know the Conference Board of Canada, together with the Ontario Medical Association, was trying out a model in Ontario that just looked at doctors. What's wrong with that model is that it assumes we're only looking at doctors and only looking at the current organization of services, so it gives you just one answer. If you were able to hypothesize a number of different ways of organizing services and then do the modelling, it would make the point very clearly that it's how the services are organized and financed that determines what the spread of different service providers needs to be. It would be a big contribution just to make that point.
5:05 p.m.
Conservative
5:05 p.m.
Chair, Health Council of Canada
I agree. I think there are two issues in health human resources. One of them is the scope of practice and the optimized utilization of professionals; the other is the service delivery model and the way in which care is organized. One can't really be fully looked at without the other. We haven't done that at all in most places in Canada.