Health Committee on Nov. 18th, 2009

[Gary Switzer]

It's long-term care, the community care access centre, the Meals on Wheels, the Alzheimer Society, and all the small community agencies.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

What do you see as the biggest challenge with our health human resources? Do you think it's any one thing or do you think it's a whole combination of things? Is it the aging workforce? Perhaps some of us see it as a misuse or an abuse of the existing system. Is there any one thing that is an issue?

[Gary Switzer]

In my view, it's the absence of a national plan to address this on a national basis. We're spending close to 50% of our tax dollar in Ontario on the delivery of health care. I consider our health care professionals a national resource. It's 50% percent of our tax dollar. So we should invest in that with a strategy on how to attract them, how to retain them, how to make it easy for professionals to maximize their potential.

In my view, nurse practitioners are just the best new item that came to primary care. We need to do more of that. And let's do it across the country. As I said, this is part of our brand. We should be proud of this.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

How many patients would a doctor typically see in a community health centre as compared to a private office setting? Is it comparable?

[Gary Switzer]

No. I can defer that to Jack, seeing that he runs a CHC.

[Jack McCarthy]

It varies. There's a high degree of variability. We just completed a study with the University of Ottawa looking at panel sizes of physicians and a benchmark—I don't know if I can be saying this yet, but I'll go ahead—in terms of looking at 1,200 patients per physician at a CHC.

Again, there is a high degree of variability. This is a benchmark that we're in discussions with in terms of all the different CHCs. It could be higher in a rural setting. This is more an urban figure. Based on this more recent assessment of panel sizes of physicians in CHCs, this is the figure that is being talked about as--

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

How does that compare to a private office setting?

[Jack McCarthy]

It would be less. John may know the panel sizes for doctors. I'm not exactly sure of the comparable models.

[Dr. John Maxted]

The average family doctor across the country has about 1,200 to 1,500 patients per practice.

Coming back to the models, there's a very nice model very close to your own city here in Ottawa where they set up a primary care team. They have six to eight family doctors, but they also have a number of other professionals. They have the electronic means of sharing information and managing the patients there, and right now, over the last year or so, they've been putting ads in their local papers to take on an extra 250 patients every six to eight weeks. This is the result of newer technology, more inter-professional care, and more effectiveness and efficiencies within the practice setting itself as a result of model development.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

We've talked about the CHCs for health care as family physicians and so on, but what does this do for the acute care system? Does it free up emergencies?

Gary.

[Gary Switzer]

Of our business in our emergency departments, 90% is for non-urgent care. They are visits that could be deferred. It could be a prescription renewal. It could be having access to a nurse to have stitches removed.

By having our CHCs in the community and working closely with the hospitals, we can divert a number of non-urgent cases. Specifically in Essex, in our three CHCs there, we keep open appointments in the morning and the afternoon so that when patients present in the emergency room, if they are CTAS V, which is the least urgent, they are rerouted immediately. They are connected and go over to the CHC for a real-time appointment.

The other benefit of our CHCs is that they have a direct connection to orphaned patients who are discharged from hospitals, those patients who do not have a family physician. There's a strong tie to our CHCs, where they'll accept orphaned patients. They bring them in and assign them to a family physician and a nurse practitioner. That is a very strong element in reducing the impact on emergency departments, which allows for increased flow and better access to acute care.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Right. Thank you.

[Jack McCarthy]

Might I add a quick point to that? With the recent H1N1 outbreak in the city of Ottawa, when there was a huge surge at all the emergencies, the CHEO, Children's Hospital of Eastern Ontario, with usually 150 emergency visits a day, went to 350, resulting in having to cancel out-patient clinics, having to cancel surgeries and so forth. We activated flu assessment centres, which were the CHCs and a couple of other sites, and within five to six working days we saw those levels in emergency departments start to drop. This is to show there's good collaboration between primary care settings, like CHCs, and the hospital settings in terms of managing some emergency volumes.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

You are certainly speaking of something near and dear to my heart. I believe that every Canadian should have access to a family physician who is supported by a comprehensive team or a nurse practitioner.

I have two comments. One is that I have real concern that what we have right now is a sort of scattering of models, and I think in some ways where we have effective teams--I'll use integrated health networks in British Columbia--you have people who are attached to a physician in those settings where you could, perhaps, see a respiratory therapist within a few days for a spirometry versus having to wait six months for the regular system. So until we fully flip into a model that works in each province, we have really created some real inequities. I guess that is a concern.

I don't know if anyone has any comments on that.

[Dr. John Maxted]

I have a comment I could make, and that is to point to some of the research that's coming out right now on the medical home. The college recently released a paper on the Canadian medical home and tried to define what its pillars are and what its foundation is, etc. The concept has really caught on in the United States, where, if I may, the primary care system tends to be in more disarray than it is here in Canada, and therefore, of course, it tends to be appealing.

But what is appealing about the medical home is to actually refer to those basic requirements that each primary care model should have. I really don't care what they want to call it in each of the jurisdictions. If we put some emphasis on what the basic elements are that each of those models need to have, then we will be creating models, regardless of what they are called, that will actually supply the needs of the population, as defined by the population they are serving.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. McLeod. I really appreciate your questions.

I want to thank the witnesses very much for coming here today. All of your insightful comments are very useful to our committee.

I have a couple of questions to ask the committee quickly before we go into our next segment, so I will thank you, and we'll now go into our other part of the meeting for a couple of minutes. I'll give you a minute to depart.

Thank you.

Committee members, we're going into the H1N1 issue very shortly and we also have Dr. Bennett's motion. Because bells are ringing at 5:30, I want to ask the committee, when do you want to deal with this motion? What time should we adjourn to deal with that motion?

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

I understand that it's much easier for Dr. Butler-Jones to come here at 4:30. As long as we have an agreement in the committee that with votes or whatever we'll make sure there is adequate time for us to do our work as a committee....

I have sent to the clerk a number of names of witnesses who I think would be prepared to make some commentary or enlighten us in terms of how things are going on the ground.

In the province of Québec, in particular, there are Drs Massé, Lessard and Poirier.

There's also Dr. Isaac Sobol in Nunavut, who has his already done.

Also, there are some of the local medical officers of health.

In B.C., there's Dr. Perry Kendall, who gave excellent testimony in the summer. We'd like to see how things are going there.

Obviously there's Dr. Daly from Vancouver, who is worrying desperately about the effect on the upcoming Olympics. We don't know whether--

[The Chair, Conservative, Joy Smith]

Of course. Do you want to do that today or Monday? What should we do, then? We have a lot to discuss.

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

It would be a matter of the clerk and the researchers sorting out whether we use the full meeting next week for H1N1 or the week after that. I'm sure they're not all available on the same day, but I think we should hear from a number of these people, as well as the officials, between now and Christmas to see how things are going. I think it was the agreement of the committee that we would hear from people as we needed in order to do our job.

[The Chair, Conservative, Joy Smith]

Dr. Bennett, I'm assuming that you're withdrawing your motion, because you've agreed that if the briefings are held from 4:30 to 5:30, it's fine. So is the motion withdrawn, then? Okay. That's great.

Now, I want to make you aware that we have some new things. I would like the clerk to quickly speak to this. We have some of the other issues that you brought up and we do have a time squeeze between now and the break. I'll let the clerk explain that to you.

[The Clerk of the Committee, Ms. Christine Holke David]

The minister is available on December 7 from 3:30 to 4:30 on supplementary estimates (B). Her officials will be staying for the full two hours. That means the December 7 meeting will no longer be the drafting of the two draft reports: HHR and sodium. We need to discuss this with the researchers to see when we are going to slate that in. It's important.

I also want to advise the committee that Bernard Michel Prigent is available to appear before the committee on Monday, November 30, from 4:30 to 5:30. During the first hour of November 30, we will have the Auditor General as agreed.

I will be distributing an updated calendar to the members throughout this next portion, but I would like the researcher to also address the issue of the draft reports.

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

First, could you explain about the estimates and December 7? Is it by the end of the day? If we wanted to make a change to the estimates, what would happen? Are they not deemed reported by December 7?

[The Clerk]

At this point in time, yes, but the last supply date hasn't been determined yet; that's my understanding. So it's still an iffy date, to tell you the truth. December 7, at this point, is the last date to report the supplementary estimates (B), but that might change. We are going to find that out, I was told today, sometime next week.

[The Chair, Conservative, Joy Smith]

Could I have the analyst talk about the reports quickly while we're doing this?

[Karin Phillips, Committee Researcher]

What I was going to suggest, since we can no longer consider the reports on December 7—and I still have to confirm this with my colleague—is that we discuss the sodium report on December 2 instead of having an HHR panel on labour mobility, and then we look at the HHR report on the 9th.