Health Committee on May 11th, 2010

[Leslie MacLean]

The department, some years ago, had succeeded in obtaining funding to buy an electronic health record. Last year our work was not successful, so yes, we have some funds set aside to help us purchase a health record.

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

And you talked about looking at the scopes of practice and of course aligning in the different jurisdictions, and without mentioning any particular province, have you found that there are some provinces that have a scope of practice that allows a much more flexible and appropriate response, or is it pretty well consistent across Canada?

[Leslie MacLean]

In the nursing area, we certainly see much more alignment among scopes of practice, with the exception of nurse practitioner, which is not a regulated scope in all jurisdictions. The other area where we would have noticed more difference was actually in the psychology area, where the qualification level seems more variable among the colleges.

Our commitment is to ensure that we have people with licences, or who are eligible for licences, providing our health services.

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

I hope I can get in at least two more questions. Have you been looking at integrating nurse practitioners into the care that's delivered?

[Leslie MacLean]

We actually did a very large workload measurement study of all nurses in the service last year, and we will be using that to analyze both opportunities to improve how our staff are working and to make sure we've got good resource indicators, and yes, nurse practitioners would be an area of practice of interest to us in the service.

Our current obstacles in that regard are, one, that it's not recognized, is my understanding, by the classification standards under which we work, managed by the Treasury Board, and secondly, it's not yet a regulated scope of practice in all eight provinces where we have institutions.

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

My last quick question is to Ms. Scott. We've made some adjustments to try to limit bogus refugees from certainly two of our significant countries where we thought they were--

[The Chair, Conservative, Joy Smith]

I'm sorry, time is running out and I'm just going to have to cut it off here, because we do have other witnesses waiting.

I want to thank you so much for being witnesses at our committee. Your comments were extremely helpful and very insightful. Thank you.

I am going to suspend for two minutes, and if you would do me a huge favour, please do not have conversations with committee members inside this room. If committee members need conversations, please do it outside.

We'll take two minutes to get our other witnesses settled, please.

[The Chair, Conservative, Joy Smith]

I am going to begin now. We do have a lot of witnesses today. We welcome the witnesses. I thank you for being here. Your input is extremely important.

We're going to be very tight on time so we get a chance to listen to all the presenters today. We do have a very long list of people.

We have, from the Association of Canadian Community Colleges, Terry Boyles. You will be presenting from your association, Ms. Boyles?

[Terry Anne Boyles, Vice-President, Public Affairs, Association of Canadian Community Colleges]

Yes, with a short presentation from Rae Gropper.

[The Chair, Conservative, Joy Smith]

You will have five minutes, so if she doesn't have time to do it, I'll have to cut that off. You'll be sharing your time.

From the Canadian Association of Occupational Therapists, Ms. Elizabeth Steggles. You'll be presenting from your association.

From the Canadian Public Health Association, Dr. Neudorf, and from the Canadian Society for Medical Laboratory Science, Ms. Nielsen.

From the Association of Canadian Academic Healthcare Organizations, Glenn Brimacombe. You'll be the person presenting, Mr. Brimacombe? Great.

Pursuant to Standing Order 108(2), let's begin, starting with Terry Boyles, please.

[Terry Anne Boyles]

Thank you.

The Association of Canadian Community Colleges represents Canada's colleges, specialized institutes such as the Michener Institute, polytechnics, CEGEPs, university colleges, and colleges with university mandates. Our membership is very broad. We have 150 member institutions and we have campuses in over 1,000 Canadian communities.

There is a crisis in advanced skills in the country. Even with the recession and the downturn in the economy, industry sectors across the board have been coming to the association saying they're very concerned about this.

Twenty national industry associations, including the Canadian Healthcare Association, led by Pamela Fralick, are meeting. They're concerned that they're raiding each other's staff, particularly when you're looking at people with backgrounds in maths and sciences. Moving forward, they're really concerned about the capacity of Canada's colleges and institutes. Pamela Fralick is actually one of the leaders when we appear before the finance committee speaking about that concern and crisis.

On the aboriginal front, first nations institutions are members, but certainly our colleges serve aboriginal peoples. We share with the Assembly of First Nations the real concern about the cap on the post-secondary education program for status Indians and Inuit. There were over 10,500 students on the wait lists in 2006. Our estimate with the AFN is that they're growing at 3,000 per year.

In the math and science areas in particular, we're really concerned. I was a college president. We're seeing the people de-skill, and we're seeing them becoming almost discouraged and not going on to post-secondary, or it's discouraging to other people from their communities about going into post-secondary education.

On the immigration front, I just want to draw the committee's attention to materials in our kit. Our association ran the pilots for the Government of Canada for immigrants between when they're accepted and when they come to Canada, to introduce them to the regulatory frameworks, to the region of the country they're moving into, to the bridges and ladders in terms of accreditation processes. We've just been awarded the contract to expand that to 25 countries overall, so we'll be opening up a new office in London and one in the Middle East shortly.

In our recommendations—and those are on the last page of the document—they really talk about the capacity issue and that the system programs are full; the aging infrastructure; the cost of technology; and recruitment of our faculty out into the health sector and into other countries—a major concern. There's a dearth of data on health human resources.

I'd like to have Rae Gropper just speak to one of our big national projects.

[Rae Gropper, Consultant, Association of Canadian Community Colleges]

It's a challenge to speak so quickly on an issue of such importance, but I'll do my best.

I'm involved in a project called “Sustaining an Allied Health Workforce”. It's a constituency that gets very little attention because the attention focuses more on physician and nursing education. But the diagnostic and therapeutic activity within the system is critical in this workforce.

What we're looking at is demand and supply and trying to get a handle on the issues that are involved here. This is an area in the country that we don't have a good handle on in terms of numbers. We're hoping to promote a pan-Canadian approach to sustain supply, to identify and promote innovative practices. We're going to do this by developing a blueprint and policy statement in consultation with all stakeholders: provincial, professional, and educational.

Our working group consists of 14 to 16 members, uniquely representing educators, professions, regulators, employers, and creditors. Our blueprint activity will be beginning shortly. The innovative activity will focus on six regions in the country and will try to address and evaluate innovations that can be of use to the colleges that are doing about 70%-plus of the training.

The colleges I represent participate both in the collaborative forum, which involves educators, professions, and regulators, as well as the allied health programs and the deans of allied health.

[The Chair, Conservative, Joy Smith]

Thank you very much.

I know the constraints are restrictive for all of us. We have to live within the rules, but when the questions and answers come, if there's a point you really want to make, sneak it in there. That's what some people do, and it's helpful to you.

[Rae Gropper]

Thank you.

[The Chair, Conservative, Joy Smith]

Oh, you're very welcome.

Now we'll go to Ms. Steggles from the Canadian Association of Occupational Therapists.

[Elizabeth Steggles, Assistant Professor, Project Coordinator, School of Rehabilitation Science, McMaster University, Insititute for Applied Health Sciences, Canadian Association of Occupational Therapists]

Good morning, and thank you for this opportunity to contribute to your committee's study on human health resources.

My name is Elizabeth Steggles, and I'm an assistant professor at McMaster University. Today I'm here to represent my profession and my association, which is the Canadian Association of Occupational Therapists. I'd like to share my thoughts--our thoughts--with you about the challenges and opportunities being dealt with by occupational therapists.

Occupational therapy is an essential health service that enables Canadians to maximize their productivity, reduce lifestyle restrictions, and avoid unnecessary dependency. A sense of well-being and meaning in one's daily occupations is an important determinant of health and is an effective means of reducing health care costs for the public purse.

Occupational therapists are faced with human resource challenges similar to those faced by other health care professionals. We must deal with workforce shortages, a lack of seats in universities, exclusion from service delivery, and the inclusion of internationally educated professionals.

Labour market information and workforce studies indicate that there is a strong and persistent demand for occupational therapy services across Canada to address the challenges of aging; mental health issues, such as post-traumatic stress disorder; workforce management; and chronic disease management.

Yet to us as a health profession, whose use is limited when compared with countries with similar health systems, underutilization is primarily due to a shortage of therapists and to limited use or the exclusion of occupational therapy in appropriate health care settings.

The Canadian Association of Occupational Therapists believes that the answer to human resource concerns for their profession lies in effective health human resource planning, including enhancing the integration of foreign-trained occupational therapists into the Canadian workforce.

Workforce shortages are resulting in negative impacts on occupational therapy service delivery. Occupational therapists are concerned about the impact of organizational and workplace demands on the quality of services they deliver to their clients. They report that workplaces demand higher productivity, while they provide fewer resources to support service delivery and limited opportunities for professional development. On a personal note, I'd like to note that I hear that from my colleagues on a daily basis. Professional requirements for an evidence-based service are frequently placed in conflict with employer demands to assume high caseloads while reducing the costs associated with service delivery.

Ensuring an adequate supply of occupational therapists will require a greater current commitment to increasing seats in occupational therapy programs in Canadian universities as part of any health human resource modelling plan. Increasing the number in our profession is also being addressed through our program that assists international graduates who immigrate to Canada fully qualified to work as occupational therapists. Internationally educated occupational therapists play an important and growing role in meeting service demands for occupational therapy in Canada. Many employers are actively recruiting occupational therapists educated outside the country to meet staffing needs and the needs of our clients, who themselves come from diverse and multicultural backgrounds.

International occupational therapy graduates often find it difficult to practise in Canada and face barriers to entering the occupational therapy workforce.

The Canadian Association of Occupational Therapists has undertaken a number of initiatives to work with occupational therapy partners to address barriers experienced by international graduates. For example, the occupational therapy examination and practice preparation program assists internationally educated occupational therapists as they prepare to write the Canadian exam and transition into practice.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Steggles.

Now we'll go to Dr. Neudorf, please.

[Dr. Cordell Neudorf, Chair, Board of Directors, Canadian Public Health Association]

Thank you for this opportunity to appear before you, both as chair of CPHA and as informed by my practice as a public health leader in Saskatchewan.

This committee has heard CPHA say on prior occasions that the vast majority of our health dollars within the country go to fund the treatment side of the system at ever-expanding cost, without a commensurate increase in people's health status. Public health, that part of the system that focuses on keeping people healthy and preventing disease, is relatively underresourced—less than 2% of the health budget in many jurisdictions.

In times of crisis, the public rightly expects a robust public health system, but between crises it seems less top of mind than waiting lists for surgery or other treatment or diagnostic services and often becomes vulnerable to budget cuts. As a result, we have in the country a patchwork of approaches to and variable investments in public health. We need strong federal leadership to bring forward the implementation of a coherent, coordinated, and consistent approach across the country to deal with issues such as immunization coverage, inspection rates, chronic disease prevention, injury prevention, etc.

The people on the front lines, my staff, the public health workforce, are the key element to building and maintaining public trust and confidence in the public health system. But this workforce isn't expanding at a rate that matches increased demand for service from the public, and it doesn't have sufficient surge capacity to respond in an effective and timely fashion to simultaneous public health emergencies and outbreaks. We need a pan-Canadian public health infrastructure action plan that includes as a key element the expansion and enhancement of the country's public health workforce.

CPHA has advocated for many years for increased investment in public health in the implementation of a population health-based approach to health sector human resource planning and allocation, and certainly some progress has been made of late; for example, the 2005 “Pan-Canadian Framework for Public Health Human Resources Planning”, the Pringle and Emerson report, and the Public Health Agency of Canada's April 2008 online resource Core Competencies for Public Health in Canada , and also the recent emergence of several schools of public health in Canada. But there hasn't been sufficient response to achieve the necessary improvements to public health capacity at the front line.

Although health care is a provincial responsibility, ensuring that a strong and unified public health system is in place across the country certainly should be a federal concern. We feel that the best way to guarantee public health capacity in times of crisis is to ensure that the public health system has a strengthened baseline capacity, working on enhanced disease and injury prevention, health promotion, and protection activities between crises.

CPHA's brief to the Standing Committee on Health, “Enhancing the Public Health Human Resource Infrastructure in Canada”, presents several recommendations that we encourage the committee to consider in its deliberations and final report to Parliament.

The pan-Canadian framework for the planning of public health resources exists. The challenge before us is to implement it now, with well-defined timelines and the achievement of key milestones and the definition of roles and responsibilities of key players.

We also need some minimum level of public health workforce investment across the country. CPHA also suggests a targeted investment approach through transfer payments that require a percentage of matching dollars from the provinces in order to ensure a stable level of funding for a public health system across the country. This mechanism has been used successfully before. The national immunization strategy is one example in which federal funds were targeted to certain immunizations deemed core for all Canadians, which in turn helped leverage provincial funding in support of this public health priority area.

We don't expect the federal government to do everything; it's a joint effort. But it does need leadership, championing, and stewardship, and it needs political commitment to get the job done. I can assure you that CPHA will do its part to support the enhancement, expansion, and further development of our country's public health workforce.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Neudorf.

We'll now go to the Canadian Society for Medical Laboratory Science.

Ms. Nielsen, please.

[Christine Nielsen, Executive Director, Canadian Society for Medical Laboratory Science]

Thank you, Ms. Chair.

Good morning, and thank you for giving me the opportunity to comment on the committee's study on HHR.

The Canadian Society for Medical Laboratory Science, or CSMLS, is the national certifying body for medical laboratory technologists and medical laboratory assistants. It is also a voluntary, not-for-profit society that represents 14,000 medical laboratory professionals who work in Canada and around the globe. You may be surprised to hear that our profession is the third-largest health care profession in Canada, and approximately 85% of physician decisions are based on medical laboratory test results.

Canada is presently facing a nationwide shortage of medical laboratory technologists. Our organization predicts that by 2016, half of our MLTs will be eligible to retire. Since 1998, we have been alerting decision-makers that the number of seats in medical laboratory technology education programs is not sufficient to produce enough new graduates to replace those who are leaving the workforce. The domestic supply is simply too low.

Since 2000, governments have taken great steps to address the shortages by opening new MLT education programs and increasing capacity in others. This is a positive development; however, we are still more than 120 seats short annually.

But there is a bigger problem. Funding for programs has been provided for the classroom portion, but not for the clinical training piece. As with most health professions, clinical training is a vital component of medical laboratory science education. Completion of a clinical placement is mandated by the accreditation body, and students cannot graduate from their programs without completing a clinical placement.

In 2004, in partnership with Health Canada, we completed a research study, Clinical Placements for Canadian Medical Laboratory Technologists: Costs, Benefits, and Alternatives. The report revealed several issues that if not addressed will compromise the ability of education institutions to deliver the clinical component of their programs in the future. Most importantly, there is inadequate funding for the clinical education, staffing shortages at the clinical sites negatively impact their ability to allocate resources to student training, and there is very little research on best practices in clinical education.

But we're not alone. Other health care professions are facing exactly the same problem. The pan-Canadian HHR plan explicitly recognizes the importance of clinical education and sets a specific goal of increasing access to clinical training and clinical education.

So where are we today? We're in a situation now where clinical sites, primarily hospital labs, are refusing to accept students because of staffing shortages. It's becoming a very vicious cycle: they can't take students because they're too busy due to staffing shortages, and they're short of staff because there are not enough students supplying the labour market. We have to break this cycle soon.

This brings me to the issue of the internationally educated medical laboratory technologists. We recognize and applaud the federal government for its continued work to accelerate and expand the assessment of internationally trained health professionals, but more needs to be done. As the shortage continues to grow, we are consistently receiving about 600 self-identified technologists through immigration annually. But practice varies significantly across the globe, and it is a requirement that all practitioners in Canada meet the rigorous entry-to-practice standards to provide excellent patient safety. A system that allows for additional training and practice in the Canadian context that is accessible, affordable, and reliable is imperative.

“Bridging programs for internationally educated medical laboratory technologists: a business case” is a project that we recently completed study on. It concludes that bridging programs significantly shorten the time in which internationally trained technologists become certified and start working in the Canadian workplace. They also decrease their financial hardships.

We conduct prior learning assessment and credential evaluation every year for about 300 medical technologists, and about 90% of them do not meet the standards required in Canada. Furthermore, the failure rate on the national exam is well below the Canadian average. So it is absolutely imperative that the government invest in bridging programs for the internationally trained and make some provisions to fund clinical training spots.

In conclusion, we strongly recommend long-term, sustainable investments be made to support on-site clinical education. We need dedicated full-time preceptors in our labs who can devote the necessary time and attention to students and the internationally trained. We further recommend long-term and sustainable funding for bridging programs to facilitate quicker entry into the workplace. Strong investments today will help ease the future impact of the shortages.

Thank you for your time and attention.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Nielsen.

We'll now go on to the Association of Canadian Academic Healthcare Organizations, with Mr. Glenn Brimacombe.

[Glenn Brimacombe, President and Chief Executive Officer, Association of Canadian Academic Healthcare Organizations]

Thank you, Madam Chair.

I'm Glenn Brimacombe. I'm president and CEO of the Association of Canadian Academic Healthcare Organizations. I'm joined today by Dr. Jack Kitts, who is the ACAHO board chair, and he's also president and CEO of the Ottawa Hospital.

ACAHO represents Canada's teaching and research hospitals, academic, provincial, and regional health authorities, and their research institutes. Our members are uniquely defined in terms of their publicly stated, integrated, tripartite missions of patient care, education and training, and research and innovation. This morning our remarks are focused on the issue of the supply mix and distribution of health providers and the role of the federal government in the context of the standing committee's study on health human resources.

Of the estimated 18,000 new graduates each year from medicine, nursing, and other professions and disciplines, most will have had at least one practicum in an ACAHO member organization. For students across all years of a multi-year clinical training program, ACAHO members provide 55,000 clinical placement and residency opportunities per year. These placements enable the transition from textbooks to the reality of human life and the provision of care. In many cases, these experiences shape the foundational practices and career decisions that will influence these individuals for a lifetime and the care their patients will receive.

In addition to sheer volume, however, these placements are also occurring in environments in which the research and innovation mandate allows world-class training experiences. With the co-location of research, ACAHO member organizations are more likely to be early adopters of innovation, resulting in the ability to take on complex health issues. For example, some ACAHO members have mandates to improve aboriginal health, the health of the vulnerable, complex, and aging populations, and to lead in the use of innovative health and information technologies to achieve efficiencies and improve system sustainability, while improving the quality of care, enhanced patient safety, and better health outcomes.

By virtue of the capacity resulting from the integration of patient care education and training and research innovation, ACAHO members provide a national resource by consolidating rare, expensive, and complex procedures to optimize outcomes and efficiencies, but also to minimize competition for scarce human resources and sub-specialty resources; by providing clinical mentorship to trainees who may become employees of other organizations, often in other provinces or parts of the country; and generate research and innovations that have no geographic boundary, which can be applied across the system and have a global impact.

While the policy issues related to health human resources and their supply mix and distribution are largely addressed at the provincial and territorial levels, ACAHO is of the view that there is a strong complementary and catalytic role for the federal government to play, given their constitutional responsibilities. To address the sustainability of the clinical training experience, the pre-budget submission of the 38 national associations that form the Health Action Lobby, which is known as HEAL, recommended that the federal government establish a five-year, time-limited, issue-specific, and strategically targeted national health human resource infrastructure fund. Such a fund would allow organizations to sustain and engage experienced clinicians in the training and mentorship of new trainees by providing funding for special initiatives to offset the direct cost of training providers and developing leaders, such as the cost of recruiting and supporting more community-based teachers and mentors, funding for the indirect or infrastructure costs associated with the educational enterprise, support for departments' education offices, and the materials and equipment necessary for clinical practice and practical training. The fund would also focus on the need for an overall data management system for specifying, tracking, forecasting, and costing of health human resource requirements in the face of evolving population health needs.

We would also recommend that it be complemented by the creation of a body, which some have termed an observatory, that would enable providers and policy makers to exchange, learn, and pilot widely implementable leading practices.

In closing, ACAHO believes that the federal government has a role in contributing in a complementary pan-Canadian fashion. It can do so by leveraging national resources to optimize the integration of patient care, education and training, and research and innovation, and by providing the infrastructure needed for evidence-informed management of the many health systems across our country.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Now we'll go into our first round of questions, which is a seven-minute Q and A. We'll begin with Dr. Bennett.

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

Thanks very much.

First I want to congratulate Ms. Nielsen on what you've been able to do with the bridging program. It shows what can happen, and your success could happen in lots of other areas. And I hope we can make sure that some examination of bridging programs and preceptors can help in terms of incorporating our foreign-trained health grads.

We have such great people here that I want to take a slightly different approach. Separate from what you've told us, if we're going to focus on quality and cost-effectiveness over the future of health and health care and evidence-based policy and practice and practice-based evidence...I want to just think about Cuba, where now every polyclinic has a statistician and an epidemiologist measuring what they're doing all the time and feeding back. The fact that they've now beat us on infant mortality speaks to actually measuring and adapting, and measuring again.

Dr. Neudorf, you have led the country, pretty well, in using health informatics and GIS mapping on the social determinants of health. And obviously the academic health facilities are worried about patient safety and measuring and adapting, whether it's hospital-acquired infections or.... It seems appropriate, in this week of National Nursing Week and World Health Week, that we are celebrating Florence Nightingale, who was a statistician more than she was the compassionate lady with the lamp.

How do we make sure that our health human resources include the people who can measure, make assessments, and manage not only in health promotion and disease prevention but also in the care we give?

[The Chair, Conservative, Joy Smith]

Dr. Neudorf, do you want to start with that?