Health Committee on Nov. 25th, 2009

[Dr. Paul Saunders]

Yes. We have looked at the B.C. scope of practice. It's just being put into place so we don't have all the details, but that would definitely be very helpful, because it will allow them to have access to the botanicals, the nutritional substances, the amino acids, and the vitamins and minerals that we are trained to use and are able to use in practice. That would definitely help.

[The Chair, Conservative, Joy Smith]

Thank you so very much.

Now we'll go to Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you very much, Madam Chair.

In the documents that our witnesses have provided us with, I find one aspect to be virtually the same: the use of human resources. With your permission, I would like to highlight it for the committee.

Here is what the Canadian Physiotherapy Association writes in a paragraph entitled: “The importance of efficiency in health care and health human resources”: “The only way to afford current health care standards in the face of this increased demand is by increasing efficiency”. This, then, is about the efficiency of health care and health human resources, as the title indicates.

Here is what the Canadian Pharmacists Association writes: “The health system is not optimizing the use of its pharmacy human resources”.

In the brief from the Canadian Association of Naturopathic Doctors, the first point in the conclusion says that it is necessary to: “ensure the utilization of all health care professionals to their full capacity”.

So all three seem to be telling us that health human resources are not well used or are not used to their full potential.

I just wonder—and this is my question for the witnesses—since health care is in the jurisdiction of Quebec and the provinces, have the witnesses also, first and foremost, made these observations to stakeholders in Quebec and the provinces?

I have a follow-up question. Since our witnesses feel that their observations are clear, that the present level of human resources is adequate but they are perhaps poorly used, why do we still have problems?

[The Chair, Conservative, Joy Smith]

Who would like to begin with that?

Mr. Brennan.

[Michael Brennan]

Thank you for the question.

Yes, indeed, we feel that improved efficiency can resolve, if not all the problems, at least a majority of them. Given the age of the population, we will certainly need more doctors, nurses and physiotherapists. On the other hand, we know that studies done in Canada and around the world show that health care efficiency is suffering, here in Canada, and around the world. The teams that are often mentioned have been tested, and pilot projects have been conducted. We are known as a country of pilot projects.

The time has passed for asking questions or studying examples. We know that all members of those teams work to their potential, meaning that they use their knowledge, skills and experience to the best of their ability and that it is not a question of supervision, but of cooperation. The potential exists.

The first question is to find out whether present legislation allows that knowledge to be used. The second question is whether, given our culture, Canadians are ready to go to see a physiotherapist before going to see a doctor.

The answer to the first question is that, in some provinces, the problem has not been solved and we are requesting that this be done in each one of them.

The answer to the second question, about the culture of Canadians, is why I gave my speech. Employers must demand change. It is up to us to tell Canadians that they can benefit from more a efficient health care workforce. But it is up to Canadians to understand their rights by asking for specific services in a given area.

[The Chair, Conservative, Joy Smith]

Would anybody else like to comment on that?

Dr. Saunders.

[Dr. Paul Saunders]

Yes. To answer your first question, it is. We have brought this up to the provinces numerous times across Canada. Secondly, Canada's primary health care transition fund funded a study from 2004 to 2006 to establish interdisciplinary cooperative care. They established models. They put together a tool kit. They put together ways in which to do this and were ready to set up demonstration projects.

Unfortunately, there was no funding for the EICP findings, so they have sat on the shelf since 2006, until now, and there really has not been an opportunity to demonstrate that these cooperative things will work, and that when you remove these barriers, various practitioners, primary care providers, and secondary providers can work together as well.

[The Chair, Conservative, Joy Smith]

You have a little bit more time.

Go ahead.

[Dr. Jeff Poston]

The issue of health care reform, and particularly reform relating to primary care, is high on the agenda for many provinces, and particularly the development of inter-professional practice as well. We appended to our submission the results of a large national study we had done in terms of the changes that needed to be made with respect to pharmacy human resource policy, and we're beginning to see some of those changes.

Our large “Blueprint for Pharmacy” project is really going to be aimed at bringing the profession together in one place and communicating to provincial governments some of the changes, but change management in health care is a complicated process. One of the things we've identified is that you actually need integrated changes in five areas: education and training; information technology; pharmacy human resources; legal, regulatory and liability; and financial viability and sustainability.

I think the work is going on. I think it needs some further funding for research. Funding for the EICP project is a good example. But the professions are engaged in communicating this and taking our own initiatives to begin to move this sort of thing forward.

[The Chair, Conservative, Joy Smith]

Dr. Busing, I think you wanted to make a couple of comments.

[Dr. Nick Busing]

Yes, please, I would just like to add a few words.

First, I have listened to the other presentations and I would like to refer you to the fourth recommendation of ours. We are trying to deal with that situation, in fact. That is, the federal government must play a leadership role by creating an environment that allows all the information to be gathered in our country. I do not want a situation in which we would make ad hoc decisions; I want an environment in which we will be able to gather all the resources so that we can develop a strategy for health human resources. I feel that that is the best way to move forward.

Second, in regard to interprofessional care, Mr. Brennan said that we are a country of pilot projects and I really agree with that. There are a number of examples: here in Ontario, we have the Family Health Teams, and in Quebec, they have the CMSs. Interprofessional models are starting to be developed.

Third, we have done a study on doctors' education. We are going to present the recommendations, one of which is clearly

to have more inter-professional education and practice.

Everyone has their own perspective, but there must be an environment in which everything can come together.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Busing.

We'll now go to Ms. Wasylycia-Leis.

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

Thank you all very much.

We've been talking for years and years about changing the scope of practice, about moving towards multi-disciplinary teams, about opening up the gates so that some of the other professions, such as naturopathic doctors, could be included. We've been talking about being less territorial. We've been talking about holistic approaches to health care.

You're all saying that today. How do we move this ship? What do we do?

[The Chair, Conservative, Joy Smith]

Mr. Brennan.

[Michael Brennan]

If I may be so bold—and I've had an opportunity to talk to some of you about this before—I think this is an opportunity for the federal government to take a dramatic leadership position and say that it will only pay for health systems that truly incorporate inter-professional collaboration.

I keep coming back to the public service health care plan, but it's a very big and very expensive example. All it takes is the stroke of a pen from the Treasury Board Secretariat to say that we are going to allow these teams to work collaboratively so that you don't all filter through a bottleneck to access these services. That's one example, and it may be the best example in terms of what you could do this week.

Beyond that, in our proposal, we talk about how it may be time to talk about funding for implementation when it comes around to the 2014 health care transfer discussions and so on. It's not too early to start talking about that. There are some dramatic successes that came out of the 2004 funding model, whereby innovation was rewarded. I think we can do the same thing, but we would surely encourage that bold first step to lead by example.

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

While you are answering that, Steve, if this came forward, phased in with collaboration from the provinces, do you think there would be any objection from provincial governments, which have been struggling with the same thing for an equally long period of time?

[Steve Slade]

I think it can be frustrating to see HHR conferences held across the country and disconnected from one another. We have agencies such as CIHI, Statistics Canada, and Health Canada's pan-Canadian HHR strategies division all doing excellent work, but if you ask where home is, where you would direct your question to, and where there is an agency that brings together these myriad stakeholders of government, health care providers, managers, researchers, and then across clinical scopes, the nurse practitioners, nurses, physicians, pharmacists, and physiotherapists, there is no such place right now.

There is, I think, among those organizations, a willingness that has not been there in the past. The turf wars that are part of our history have really become a thing of the past. The HHR observatory, our proposal 4, really is the spirit of this. We have a body with many appendages and now we need a brain, but that brain doesn't exist right now. Through that human analogy, that's what we are proposing.

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

That's a good analogy.

Paul—and then I'll get to Jeff—never mind 2006: we've been doing this since, what was it, 1990?

[Dr. Paul Saunders]

I know. I was only giving the example.

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

Ten years ago, this committee came up with a report on natural health products and alternative medicines.

[Dr. Paul Saunders]

It was 10 years ago, back in 1999.

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

Has anything happened since that report?

[Dr. Paul Saunders]

No, not really. In fact, natural health products are still not fully regulated. That's the problem, and yet some of the things are disappearing. But as my colleagues have said here at the table, I think we need a push from the federal government to tell the provinces that we all want cooperation so let's do it. Let's get together, get the best minds from each of these groups together, and figure out a way to make this happen cooperatively. We would be very happy to come to the table to do that.

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

Jeff.

[Dr. Jeff Poston]

I actually think that provinces are beginning to take some action. We've seen dramatic change around scopes of practice for pharmacists, with legislation to give pharmacists prescribing authority in a number of province. There have been quite dramatic things, but the issue is that we really need an integrated approach.

A good example is that in some of the provinces we've seen legislation that has given pharmacists prescriptive authority, but there haven't necessarily been any systems developed to support education and training. The processes haven't been in place to support collaborative practice in terms of communication with family physicians.

What we're learning from our experience and the international experience in pharmacy is that changing one thing on its own doesn't work. In terms of changing legislation, changing payment models, and changing education and training, you need an integrated approach. That's where I think the idea of an HHR observatory or an institute is going to be very valuable to tie the pieces of string together and to begin to develop an integrated approach.