Health Committee on May 11th, 2010

[Dr. Cordell Neudorf]

Sure.

Certainly what we've found in public health, with the new regionalization of health services occurring in much of the country...we see these skill sets not only as a service provision within the service of public health but as a support for the rest of the health system and health system planning. And you've heard ACAHO talk about observatories. And similarly, within the population health initiative, the perspectives that we feel can be brought to the table in an observatory manner for population health data to inform health system planning, as well as quality improvement, are something we're experimenting with at the local level in various areas across Canada where those types of skill sets—measurement, epidemiology, surveillance, quality assurance—are being merged together.

What we're not seeing are the kinds of support to hire these types of people to help us manage the system better.

[The Chair, Conservative, Joy Smith]

Dr. Kitts.

[Dr. Jack Kitts, Chair of the Board, President and Chief Executive Officer of the Ottawa Hospital, Association of Canadian Academic Healthcare Organizations]

I think you've hit the nail right on the head.

In health, change is very difficult. We're completely risk averse, and if that's the way we've been doing it for 20 years, it must be good. I think the only way to achieve effective change is that this health human resources plan for the next 10 to 20 years has to be based on a different service delivery model. We cannot continue to provide the same service delivery and add more of the same to the status quo.

So change is essential. It should be collaborative, with a full scope of practice and health care professionals working in a team. The biggest factor to effect that is to be able to measure quality outcomes and base those decisions on evidence, which we don't have today.

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

So if you were going to write recommendations for pushing “reset” on all of this and how we would do things differently, does it mean that community colleges have to be training people who can do these things? What extra set of statisticians, epidemiologists, applied research do we need?

[Dr. Jack Kitts]

I would suggest that the health service delivery model begin with taking every one of the professionals—some of whom are represented here today—beyond doctors and nurses and use them to the full scope of practice based on the needs of the patient, working in a team. I suggest we'd find we have lots of health human resources in that respect.

I do believe that if we do it right...the future has yet to be defined; health care providers will require close work between hospitals and colleges to create the course that will develop those health care providers based on the patient need, working in a team.

[Rae Gropper]

From our perspective, you're absolutely right, and I think the first primordial step is for us to get a handle on what's going on in allied health. We can't seem to get a really good analysis around the country, and that's part of what I would recommend to you, that you move onto in recommendations. The other, of course, is to integrate very strongly the whole idea of interprofessional education as a core component of every curriculum regardless of the profession. I think Dr. Kitts, Christine, and I agree on that wholeheartedly.

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

At the health infostructure we can't really be measuring unless we can get into this century on not only measuring patients but with health human resources at the same time, in terms of instantaneous....

The occupational therapists...you obviously feel you are being underutilized in terms of teams as well.

[Elizabeth Steggles]

Certainly, yes. There are beginning to be small breakthroughs. In Ontario now we've just been included on family health teams, which is a big breakthrough. We know from experience and research that by introducing occupational therapy into interdisciplinary teams, as has been pointed out by other members here, you can produce a more satisfactory service in a more cost-effective manner.

[Terry Anne Boyles]

I have a point on the data. I sit on the chief statistician's advisory committee on post-secondary education and statistics, and one of the biggest concerns--obviously there is lack of data on the colleges altogether--is that there is a wealth of information in the census reports that would be extremely useful to the work of all of us as we look at health human resources. But you actually have to buy that data, and most of the partners can't buy the data.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Boyles.

We will now go to Mr. Malo.

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

Thank you, Madam Chair.

I would also like to thank our witnesses for being with us today.

My question is for Ms. Boyles.

You said that your organization is responsible for the Canadian Immigration Integration Project. Could you tell me how that project works and how you implement it around the world?

[Terry Anne Boyles]

Certainly. Excuse me if I speak in English. It's my Saskatchewanian background.

Once an immigrant in the three pilot countries--we have an office in Manila, in Guangzhou, and in Delhi--is accepted for immigration to Canada, they are referred to the staff in those offices. The staff work with them, and they do workshops on the area of the country they might be moving to, their particular field or discipline, linking to the regulatory groups, the accreditation groups--medical lab technologists, for example--trying to fast-forward the ability of the immigrant to enter the employment field once they get to Canada. We've identified the bridge areas that need to be moved into, and depending on where they are being located to in Canada, we then link primarily to Canada's colleges that do the bridging programs, in partnership, in this case, with the various health professions. That's now being expanded to the other 20-plus countries.

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

Does it work? Are there a lot of people who use it? Are there employers interested in it?

[Terry Anne Boyles]

Yes, the pilot was about three years in length. We now have 8,000 people who have gone through the program. In your packages--it's only in English, I'm sorry--there are four examples of health care workers who've moved into employment in hospitals, in home care settings, in technology lab settings in Canada. That's the reason why the Government of Canada has moved from the pilot to expanding it to the other 20-plus countries.

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

Do you have something to add, Ms. Nielsen?

[Christine Nielsen]

Just to add to that, being a national professional association that receives immigrants globally, ever since the program started we have been receiving incremental increases of applications offshore. In terms of the success for someone who has applied and figures out where they will fit into the Canadian context, it's much better for them to do that while they are in their source country. So the three source countries they are working in, with the expansion into the U.K., will definitely help our profession. As I said, 90% of our people are not equivalent, and they can fill those gaps while they are still in their home country. We are not limited to just using domestic resources. Our PLA program allows for the philosophy that education can be obtained anywhere as long as it meets the competency requirements. So for our association it has been a very successful program by allowing people to have better answers on a much timelier basis while they are still at home.

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

Ms. Boyles, do the usual consular staff manage this project or has a new team been set up to do that? If so, how many additional people have to be deployed to carry out the project?

[Terry Anne Boyles]

The managers of each of the centres are employees of our association, working in partnership with the consular staff, so the consular staff refer to the team. It's a combination of Canadians who are posted into those communities and locally hired people working on the program. We posted, actually this week, the management positions for the new centres as well. We are hiring now for the office in London and then the office in the Middle East.

[Elizabeth Steggles]

I want to add that we have realized, through the services we've been offering to internationally educated occupational therapists, that to try to talk to people offshore before they come here is in fact a great advantage.

A lot of people are coming here. It's taking them far longer than they ever anticipated to transition into practice. We've developed some online resources to assist people in countries before they come here. We are in the early stages of this, but we're beginning to realize that this is going to be a big advantage, because people often don't have a good idea of the health care system here. To get some of that knowledge before they come is really going to help in the transition. Also, they don't end up in low-paying jobs as soon as they get here and get trapped into that position.

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

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Now we'll go to Ms. Leslie, please.

[Megan Leslie, NDP, Halifax, NS]

Thank you, Madam Chair.

Hi, there. My name is Megan Leslie. I am the member of Parliament for Halifax. Welcome.

Mr. Neudorf, you said “strong federal leadership is needed in some areas”, and I really very much agree. Maybe we can figure out a way to increase the number of seats at universities and colleges; maybe we can figure out a way to help internationally trained grads get certified here. But I look at your pan-Canadian framework for public health human resources planning project and I think it's tremendous.

I am wondering if the two of you can talk to us about some of the lessons learned from that. When we're thinking about doing a national health strategy that includes, as one of its key components, health human resources, what are some of the lessons learned that we can transfer to the health strategy?

[Dr. Cordell Neudorf]

I can certainly start on that.

The challenge we have with many of the allied health professionals, I think, is that we don't have sufficient capacity in many of the provinces to be self-sufficient in training some of these professionals, so we require more of a pan-Canadian approach to generate the number of professionals we need. Health inspection is a very good example; within Canada, there are only two or three places where they're trained. To take my own specialty as a public health physician, not all colleges of medicine have training programs in that area as well. So an approach that looks at what the need is overall has been necessary, and I guess that's what has driven the project.

But also what we have seen is a large change in the way the health system is delivered and organized, whereby there's a lot more emphasis on integration. We have heard about interdisciplinary teams, but also trying to use professionals for a better scope of practice, not just within their area of service but for the rest of the system. That has changed the way in which people need to be trained and the kinds of experiences they get in their training as they start to transition into the workforce.

Similarly, are the right positions in place for them, once they graduate, to continue practising in that environment? We've seen a bit of a disconnect between the field and the training program in that area, such that in some cases the field is a little ahead of the training program, and in other cases the training program is setting up an ideal interdisciplinary environment, but the students graduate and find it difficult to discover the same type of practice out there.

What we've been trying to do is get those two groups together in the health human resource planning—the training institutions and the field working a little more closely together, as one plans to provide the needs for the other.

[Megan Leslie, NDP, Halifax, NS]

That's a piece of the progress. What is the progress on implementation right now?

[Dr. Cordell Neudorf]

With the schools of public health being invested in by multiple universities, for example, you're starting to see some investment from the universities coming in. The core competencies models that have come out to list both common and unique core competencies in various disciplines in public health have been a huge benefit. They have translated into accreditation standards in our area as well.

The area in which we're starting to fall short, though, is the ability of people who are already in the field to take advantage of some of the retraining and continuing education to meet these core competencies. In some cases, there is not the requisite investment in the new types of positions that are required at the field level, so the students come out and the jobs aren't available for them, because those investments haven't been created yet.