Evidence of meeting #17 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was physicians.
A recording is available from Parliament.
3:30 p.m.
Conservative
The Chair Conservative Joy Smith
Good afternoon, ladies and gentlemen.
Thank you so much to our witnesses for joining our committee. We certainly very much value your input.
Prior to starting with our witnesses, I am going to just take one moment. A motion has been submitted by Judy Wasylycia-Leis. I know she needs the will and consent of the committee; otherwise, she is going to need to have this on the docket for 48 hours.
Ms. Wasylycia-Leis, would you like to speak to your motion for a moment?
3:30 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Thank you, Madam Chairperson.
I'd like to request unanimous consent from the committee to deal with the motion before you today. It has, of course, to do with the swine influenza, and it provides a mechanism whereby the health committee could be involved when the situation demands that kind of committee collaboration. I say when it demands; I mean, in fact, that right now we are having regular briefings from the government, from the Public Health Agency of Canada, and the communication has been good. We've been in the loop--and that's on an all-party basis--with daily meetings. We also know that the Public Health Agency of Canada has been effectively dealing with the issues and is certainly following its mandate of providing ongoing surveillance around the swine influenza and coordination of the necessary public health response.
My suggestion is that we empower the chair to convene meetings as necessary on an emergency basis as this issue progresses and as we receive more information or requests from the Public Health Agency of Canada.
3:30 p.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Thank you, Madam Chair.
I think all members of the committee share the deep concern that was just expressed; however, we will be opposing this motion for the reason that there is a motion under discussion by the House leaders currently to deal with this, which we think is a more comprehensive approach than one meeting by the health committee.
I would like to read this proposed motion, which is being discussed and negotiated as we speak. It proceeds as follows:
That in order to reinforce the confidence that all Canadians should have in Canada's public health system at this time, when concern is growing in many countries about the risk of a new international influenza outbreak, a special surveillance committee of parliamentarians is hereby established, with all the powers given to standing committees by the Standing Orders, consisting of 11 members of the House of Commons, including five from the Conservative Party, three from the Liberal party, two from the Bloc Québécois, and one from the New Democratic Party, with a chair to be elected from among the government members, for the purpose of monitoring all developments in respect of the influenza situation and ensuring that the public receives the timely, accurate, and useful information needed to react appropriately to evolving events. To that end, the parties should select their representatives on this committee at least in part based on their expertise in public health matters. The committee should receive daily briefings from senior government officials, in camera when necessary, on all matters that it deems to be relevant to protecting and promoting the public interest.
That's being debated.
Madam Chair, I propose that this motion before us be withdrawn until such time as the proposed Liberal motion that the House leaders are debating has come to its conclusion.
3:30 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Thank you, Madam Chairperson.
This motion stands on its own for the work of the health committee. Given the reaction, I think, to the Liberal motion presented yesterday and the idea of another whole structure, another semi-permanent subcommittee--sub or not--it was felt that it's the last thing we need, and that in fact what we need is a mechanism by which, if necessary, the health committee is consulted.
The committee is now made up of all parties and has good expertise from all parties. It was felt that there's no need to reinvent the wheel and set up another whole structure just to do this. In fact, between the regular briefings we're getting, the work of the Public Health Agency of Canada, and the work of our own committee, we have provisions to deal with the unfolding situation with respect to the swine influenza.
3:35 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you.
Just for clarification, Ms. Murray, my understanding is that that particular motion was taken to the House yesterday and was denied. Is that correct or incorrect?
3:35 p.m.
A voice
Yes, it was.
3:35 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Just a point of information. The motion that's just been read by my colleague from the Liberal Party was presented to the House for unanimous consent and it was denied. It is still going to the House leaders' meeting as we speak, and as I understand it, they will have a full discussion, but they will also take into account the fact that our committee has this motion before it, which might provide an alternative to the suggestion being made.
3:35 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Madam Chair.
I think the government can support this motion and would be happy to move it forward.
3:35 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Thank you, Madam Chair.
Ultimately, there's nothing compelling about this motion, since it gives you the power to convene a meeting of the committee.
However—and I often repeat this to colleagues around the table—there is nothing, at any time, preventing members, together at a meeting, from determining what will be on the agenda. Whether we adopt this motion or not, it will still be time later for committee members to convene an emergency meeting on this situation, if the need is felt.
Of course, Madam Chair, we can give you the power to do so, but the power will ultimately belong to the members of this committee. That's it.
3:35 p.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
Time and time again, I think we have learned that trying to develop work plans by motion is not a good way to go, and we need to be able to have a constructive discussion about how we would go forward.
I think this motion is totally inadequate to allow the supervision of this outbreak in a comprehensive way. We need to find a way that should the level rise to level 5, level 6 on a weekend, we can have updates. We need a way of going forward.
I hope the House leaders will make a decision about that, but the idea that this motion moves us any further forward to an active supervision of this outbreak is not good enough, I think, in terms of the Liberal position. We don't need a motion to call public health officials, but we also have been, I think up until now, heartened by the fact that when I spoke to the minister on Sunday and asked for a briefing on Monday, we got it.
We then spent two hours this morning trying to get an update, a briefing for today, and finally got it. I don't want to spend two hours of every day trying to negotiate with the minister's office about whether we get a briefing or not. We want an ongoing way that we can do this so that we can know on the weekend if there's a way that members....
Madam Chair, today in the briefing what we heard from Dr. Grondin was so important, in terms of just how we as parliamentarians can accidentally use the words “travel advisory” instead of a “travel warning”. These kinds of things make it hugely important that we all be on the same page at all times. An extra meeting here or there is not going to do the job of having parliamentarians seriously in the loop at every decision taken.
I was told this morning by the minister's office that nothing had changed since the briefing yesterday and we didn't need one. In fact, the WHO had raised the level up to level 4. In fact, Canada had issued a travel warning, and therefore we had to fight back.
I do not want to spend my time as a parliamentarian fighting with the minister's office to get briefings. I want something formal and I want it ongoing, and this motion goes nowhere near what we need.
3:40 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you, Dr. Bennett.
You did not get consent of the committee, so you'll have to withdraw it, Ms. Wasylycia-Leis.
3:40 p.m.
NDP
3:40 p.m.
Conservative
The Chair Conservative Joy Smith
Bring it back in 48 hours. We were just trying to get it done today, and that is not going to happen. So bring it back and you'll have the 48 hours' notice. Thank you for the motion; it was very good.
Now I would like to go to the witnesses. We have some very dynamic witnesses today. We have representation from the Canadian Federation of Nurses Unions, the Canadian Medical Association, the Canadian Nurses Association, the Royal College of Physicians and Surgeons of Canada, and the Canadian Chiropractic Association.
We will begin with the Canadian Federation of Nurses Unions and Linda Silas, president.
You may give a 10-minute presentation, and after all the presentations are made we'll go to questions.
3:40 p.m.
Linda Silas President, Canadian Federation of Nurses Unions
My name is Linda Silas. I'm the president of the Canadian Federation of Nurses Unions and a proud nurse from New Brunswick. We represent nine nurses' unions across the country, and we have excellent working relationships with the Fédération interprofessionnelle de la santé du Québec. As you know, over 80% of nurses in Canada are unionized. We thank the Standing Committee on Health for the opportunity to share our views.
I realized this morning when preparing my notes that I've been in this job for six years and have presented more or less the same recommendations and more or less the same data on a yearly basis to more or less the same committee or committee members. The federal government itself has spent millions on HHR sector studies. The evidence is clear: there is a nursing shortage and it's not getting any better. Nurses across the continuum of care, in hospitals, long-term care, home care, and in our communities, are living the symptoms of the shortage every day, and we need action on a long-term basis.
CFNU's first recommendation is the creation of a national observatory on HHR. Provinces are spending health care dollars competing with each other to attract nurses and other health care workers from one jurisdiction to the other. There's not one jurisdiction in Canada that's currently producing a nursing surplus. The existing federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources would need to have its mandate expanded and membership expanded to include active participation from stakeholders in order to have realistic and attainable goals. Or maybe a better idea is to start afresh with the national observatory on HHR that stakeholders have been requesting for a number of years.
We stress again the engagement of stakeholders, the only way to ensure appropriate and accountable actions, targets, and timeframes. We have to remind ourselves once again that health care is not only a government issue, it's everyone's issue.
Our second recommendation is to continue and increase the data collection and reporting on HHR. This role must be filled by the federal government. Repeating the national survey of work and health of nurses conducted by CIHI and Statistics Canada and expanding it to other health care professionals is a must. It will also measure the impact of change in policy and practice from the perspective of the workforce.
Third, fund innovative projects related to retention and recruitment in HHR in Canada and across the continuum of care. Forty-nine per cent of nurses retire before the age of 65. That's compared to 43% of any other field. We cannot afford to lose this experience in patient care. For example, CFNU receives support from HRSDC for a project in Cape Breton to provide an opportunity for nurses to upgrade their skill set and meet a serious nursing shortage in critical care while remaining in the rural region. We also had a project in Saskatchewan where valued, experienced, and seasoned nurses were allowed to work on a mentorship program. This year we received funding from Health Canada for nine pilot projects to apply evidence-based retention recruitment strategies. This is a start.
This kind of innovation in the workplace, supported by macro-level resources, will ensure retention of a skilled workforce. How often do you hear and see federal funding applied and evaluated directly in the workplace? This is the only way to make real and sustainable change.
Of course we have to talk about child care. Most of our population are women and child-bearing, so we have a fourth recommendation on supporting the creation of a child care program that addresses the need for shift work.
Our fifth and last recommendation is the creation of a federal HHR fund to support education and lifelong learning. As CFNU mentioned before, the federal government can use the EI program to provide educational support to health care workers entering nursing and for nurses to expand their scope of practice through job laddering and specialty training. This would complement support given to the building trades apprenticeship program that already exists under EI. These strategies would help attract more aboriginal Canadians to the health care workforce and would help underserved communities, supporting local residents to enter and progress in the health care profession, and would bring best investments to build sustainable services in those regions.
As a conclusion, what is the price of inaction? A high workload leads to a high turnover rate, and turnover is really expensive in our profession. It can be up to $64,000 per nurse. A shortage means the present workforce is doing a large amount of overtime, a costly solution for an inadequate supply of nurses. In 2005 it was 18 million hours of overtime, 144% more overtime than was worked in 1987.
Currently, CFNU is updating this study, but the preliminary reports are suggesting that the numbers are even worse. Let's remember that 66% of young nurses are showing signs of burn-out.
The extensive and growing body of research showing the relationship between nurse staffing levels and patient outcomes should be the most compelling reason for government and policy-makers to address the nursing shortage. But using the shortage as an excuse to bring in less skilled, less knowledgeable workers—similar to what the Canadian Blood Services is trying to do today—is plainly dangerous and should not be supported by any policy-maker concerned about public policy.
We thank the committee for undertaking this important study. Hopefully, we will meet again next year to provide you with a progress report and not a whole bunch of further recommendations. This problem is ongoing, and we all need to stay very focused on this issue.
Merci beaucoup.
3:45 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you so very much for that insightful presentation.
Now we'll go to Dr. Ouellet from the Canadian Medical Association.
3:45 p.m.
Dr. Robert Ouellet President, Canadian Medical Association
Thank you very much.
Good afternoon, everyone.
I am Dr. Robert Ouellet. I'm a radiologist from Laval, Quebec, at least when my duties as president of the Canadian Medical Association allow me.
It is essential to address the labour shortage in the health sector in Canada if we want to transform the Canadian health system into a truly patient-centred system. The research conducted as part of the Canadian Medical Association's health care transformation initiative shows that the European countries that have universal access and do not have significant wait times all have a higher physician-to-population ratio than ours.
During the 2008 federal election campaign, four of the five parties represented in the House of Commons heard the CMA's warning about serious shortages in the health care workforce. They all promised to act. We haven't seen action on that front yet.
The CMA is here today to present a plan of action in three specific areas: capacity, the retention of Canadian physicians, and innovation. In our brief, you'll find 12 practical recommendations within the jurisdiction of the federal government.
Canada lags behind other countries in our capacity to educate and train physicians.
Currently, between four and five million Canadians do not have a family doctor. The problem doesn't just affect the rural areas. We're talking about places like Barrie, Ontario, as the honourable member from that riding very well knows. The same problem exists in Quebec.
More than one-half of Canadian physicians are over 55 years of age, and I am one of them. Many of them will be retiring soon or will be reducing their workload. Most are no longer accepting new patients.
At the same time, medical progress and better living habits are enabling Canadians to live better and longer, which further increases demand for health professionals. As you know, chronic diseases are increasingly a burden.
But with better coordination among jurisdictions to allow HHR planning on a national scale, we can respond to these challenges. Canada's doctors and other health professionals are ready to assist policy-makers in their planning and coordination to better meet the health care needs of Canadians.
International medical graduates, or IMGs, also play a huge role in Canada's supply of doctors. Close to one-quarter of all physicians in Canada are IMGs, and the CMA fully supports bringing into practice the qualified IMGs already in Canada. However, poaching doctors from countries that cannot afford to lose them is not an acceptable solution to our physician shortage. Canada must strive for greater self-sufficiency in the education and training of physicians.
The Canadian Medical Association also believes that the same evaluation standards must be applied to foreign graduates as to the graduates of Canadian medical faculties. The CMA further recommends that greater funding be made available to the provinces so that they can offer mentoring programs to foreign graduates to enable them to obtain their licences.
It is also important to note that up to 1,500 Canadians are studying medicine abroad. Two-thirds of these homegrown IMGs want to come home to complete their post-graduate training. We must increase training opportunities so that we don't lose Canadians who have studied medicine to other countries. We must understand that Canada's teaching centres are bursting at the seams as they try to meet demand. This must be addressed.
Competition to attract physicians is raising a few challenges for us here in Canada and internationally. The new Agreement on Internal Trade within Canada and other agreements will ease the movement of health professionals from region to region, but could make it even more difficult to retain physicians in under-serviced areas. The international demand for medical staff has never been as great. Canada must continue to strive to retain the health professionals it has trained and to facilitate a return to Canada by physicians wishing to return and practise here.
While Canada must do more to increase both our supply and retention of HHR, we must also support innovation in order to better use existing health resources. Collaborative models of care and advances in information technology can help create a more efficient health care system that provides higher-quality care. In fact, new collaborative care initiatives are popping up across the country to the great benefit of patients.
Information technologies can help create a more efficient health system, but Canada lags far behind the other OECD countries in the adoption of electronic medical records. Recent investments in Canada Health Infoway will help, but an estimated $500 million should be invested to equip all points of care in the communities.
Canada's doctors believe we can build a health care system where all Canadians can get timely access to quality care services regardless of their ability to pay. To do this, we must shift our attitude and implement new strategies, new ideas, and new thinking. This is what the CMA's ongoing health care transformation project is all about.
A national health human resources strategy is the turning point for our efforts to build a patient-centred system. All we're lacking is action.
Thank you.
3:55 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you so much, Dr. Ouellet.
We will now go to the Canadian Nurses Association, to Kaaren Neufeld, the president of that association.
Welcome.
3:55 p.m.
Kaaren Neufeld President, Canadian Nurses Association
Thank you. Good afternoon. My name is Kaaren Neufeld and I am the president of the Canadian Nurses Association, which represents some 136,000 registered nurses and nurse practitioners across Canada. Thank you for the opportunity to present to you as you are studying health human resources.
The brief I'm presenting to you today is organized into three main areas. I want to talk about the RN shortage, health and safety in the workplace, and national-level HHR planning. However, first I want to acknowledge the federal government's commendable leadership so far in health human resources, particularly with regard to a number of issues: the health accord in 2000, the allocation of $85 million to the renewal of health human resources, the annual $20 million it committed to the national health human resource strategy in 2003, the creation of a 10-year plan in 2004, and the creation of the framework for collaborative pan-Canadian HHR planning.
However, challenges remain, as we all know. I will discuss the nursing shortage first.
In 2002, CNA used past workforce patterns to project a shortage of 78,000 registered nurses by 2011 and 113,000 RNs by 2016. Next month, CNA will release its new report on Canada's RN workforce, entitled Tested Solutions for Eliminating Canada's Registered Nurse Shortage. This report will estimate the number of nurses we'll need in clinical care in Canada from 2007 to 2022. We will use those numbers to estimate how far we'll fall short of those estimates.
More importantly, this time the report will highlight what we can do about the shortage by quantifying the impact of six specific policy scenarios that can reduce or even eliminate the shortage. One of the key solutions to the nursing crisis outlined in this report lies in more effective and efficient use of existing resources, including better use of technology, changing work processes, and addressing workplace issues that lead to absenteeism and turnover.
For example, one employer in Ottawa found that 30% of the work RNs were doing could be done by staff who did not have a registered nurse's skills or knowledge. The facility added support staff to complement its workforce of registered nurses and thereby reduced the time nurses were spending on non-nursing duties.
In light of the successes of this initiative and many others like it, the Canadian Nurses Association recommends that the government establish a formal mechanism or tool to promote the sharing and adoption of innovative yet practical solutions to the health workforce crisis.
Now I'd like to turn to the second point in this brief: the issue of workplace health and safety and its impact on health professionals. Four years ago, the national survey of the work and health of nurses ranked nursing as one of the sickest professions in Canada. Nurses' absenteeism due to illness and injury was 58% higher than the average found in the labour force overall. A similar study for physicians found that almost one-quarter of physicians had been depressed in the past year.
Those surveys were just a snapshot in time. We don't know if these trends have continued since then, and we don't know if the investments in workplaces have made a difference, so the Canadian Nurses Association recommends that the federal government fund an ongoing national survey of the work and health of nurses, and that the survey be expanded to include other health professionals as well. We also recommend that the government implement a national occupational health and safety strategy for the health workforce.
I come now to my third point, which is national-level planning in health human resources. Although provinces and territories are primarily responsible for health care deliveries, CNA and the Health Action Lobby believe that the health workforce is a national resource. Health professionals and students of health programs are mobile. The federal, provincial, and territorial governments themselves recognized this when they recently revised chapter 7 of the Agreement on Internal Trade. In addition, research shows that factors affecting the recruitment and retention of nurses do not differ greatly from one province or territory to another.
The federal government invested $12 million in six sector studies, including nurses, physicians, and pharmacists. They produced concrete strategies addressing the health workforce crisis. Unfortunately, very little action has been taken on these reports.
Similarly, federal, provincial, and territorial governments developed the framework for collaborative pan-Canadian HHR planning. Progress is slow, and CNA is concerned that implementation of the action plan is not receiving the attention and support it needs from governments.
The Canadian Nurses Association recommends that annual funding for the pan-Canadian HHR strategy continue for at least another decade and be increased to $40 million per year to support the activities identified in the action plan of the framework for collaborative pan-Canadian HHR planning.
We recommend that the federal government create a pan-Canadian HHR institute or observatory. The concept of an HHR institute was put forth by several of the sector studies that I mentioned a few moments ago, as well as by CMA and others.
Health human resources institutes and observatories have been implemented in Europe, Africa, Latin America, and the Caribbean. In Canada, the observatory would bring together researchers, governments, employers, health professionals, unions, and international organizations to monitor and analyze trends in health outcomes, health policy, and HHR to provide evidence-based advice to policy makers. It would also spread information about promising advances in HHR activities across the country and would coordinate HHR research.
In conclusion, we understand that these are difficult economic times, but having a healthy, stable, and sufficient supply of health professionals is necessary to keep Canadians healthy and productive.
CNA's upcoming report on the shortage of registered nurses in Canada will show that the shortage can be resolved, but it requires both political will and resources on the part of the federal government. CNA has invited all MPs to the release of this report on May 11, and we urge the committee to attend.
Thank you for your time today and for this opportunity for CNA to continue to work with the federal government on this important issue.
4 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you so much for your presentation.
We'll now go to the Royal College of Physicians and Surgeons of Canada, to Dr. Andrew Padmos.