Health Committee on Nov. 2nd, 2011

[Dr. Elizabeth Badley]

I think there are a number of things. A dialogue at the federal-provincial level is essential. We need research because we need to understand a lot more about co-morbidity, the issues of people who have more than one health condition. One health condition can interfere with another and may lead to yet another. We tend to think of diseases one at a time, and we need to take a more holistic view. There is not a lot of research out there in that area. I'm a researcher, and that's the way people can help. I think the public health agency can help with information on that.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Badley.

I will now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you, Madam Chair, and my thanks to the witnesses for being here today. I found your presentations excellent and really forward-looking.

Before I got into this business, I was a chiropractor and I ran wellness clinics. It was trying to put together something like you were talking about, a multidisciplinary team. We have an acute care health system and everybody is in silos in this country. But the model doesn't quite fit with the management of chronic conditions. We should be looking at cost savings, outcomes, patient satisfaction, and having a system that's more patient-oriented and flexible.

It's something that is coming together, thanks to the testimony we're getting at this committee. You mentioned a study the Mowat Centre did. We've been told that a different model would over time save a lot of money for governments. I was wondering whether you were aware of research that supports or refutes this claim. Are there other models around the world that are starting to do this?

[Maureen O'Neil]

The reality is that practically since the ink began to dry on medicare, there have been studies and reports done in Canada on different ways of organizing health services. In fact, when I was a young analyst, I worked on the Manitoba white paper on health policy, which talked about exactly the kinds of questions we're talking about today. It recommended multidisciplinary regional health authorities and all of this, with money allocated in a block and population health being the main decider of how you would allocate your money. We're not short of this.

Various aspects of this do pop up in different parts of the country. It's just that unlike some other countries, we have not embraced it as the main way of doing business.

I'm sure you know better than I that to make changes in the way different professions are funded, organized, and work together requires, first of all, a vision that people are going to stick to over a period of time. This has been talked about so many times, and it's been written about so many times. As I said in my presentation, maybe now--unless Dr. Badley finds that in fact the boomers are not going to suffer from lots of chronic diseases--the pressure is rising. It'll become inescapable, if we want to continue to have a public, financially sustainable health care system, that we can't put off any longer those sorts of changes, which have been written about for 40 years.

[Colin Carrie, Conservative, Oshawa, ON]

Are you aware of any models or any systems out there? There seems to be a little bit of a disconnect in training professionals, too. We see certain specialties in medicine that aren't that busy. Other ones could be a lot busier.

I think my colleague brought up that there are only 200 gerontologists in Canada, or something along those lines. I remember from friends of mine that each of these patients would take half an hour or 45 minutes for a visit, and if you're trying to run your office, it is very difficult if you're getting paid per service.

Is there any advice you could give us on training and connecting that with what the population needs?

[Maureen O'Neil]

There are in fact other models in other countries, but there are also models of doing it in Canada. It's just that they don't get expanded.

The study from the Mowat Centre that Will Falk did focused on some of that. But also, even within the acute care setting, different professions are not used up to their full scope of practice, and technology is not necessarily managed. Even just within that there is a lot of scope for change. It's like changing personal habits. Somebody has to be really inspired to stick with it to make these changes. There are models around the world of approaching things in a multidisciplinary way. There are different training programs. But lots of this we've known.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. O'Neil.

We'll now go to Madam Hughes. Welcome back to the health committee.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you very much. I didn't think I'd get a chance here, so my mind was going in a different direction.

What we're hearing today is no different from what we heard at the HHR study we did: multidisciplinary teams are the way to go.

This past weekend I was up in Hearst and heard about a woman,

une femme sage.

[A voice]

Une sage-femme.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

She is a wise woman, in any case.

[Voices]

Ha, ha!

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

She works with the doctor. They have a good relationship, that is truly unique, just like the fact that they agreed to work together. We don't see this in the rest of Ontario. They are shown as an example at some conferences.

I think it is very important to say that a number of studies have been done and that the results are always the same. We really need a government that is taking action now in this direction. I'd like to know if you agree.

[Maureen O'Neil]

Instead of talking about the government, we should be talking about governments. As I just said, the provinces have the power to act, but the policy surrounding this makes the task very difficult for them.

For example, when the Government of Ontario decided to use nurse practitioners, who have advanced training, a good number of members of the Ontario Medical Association were a little frustrated by the decision.

In healthcare, every time a decision needs to be made, for example to close a small hospital—actually, it's a little dangerous to have small hospitals where the employees are not up to par—there are geographic and political considerations. Each time something needs to be done, there is a sometimes almost violent reaction.

If we were the ministry of health of a province, we should have the trust of people to act, including that of the Prime Minister. But, as we have already pointed out, the reactions to the changes are always there.

We may wonder whether the federal government can or cannot help us in this difficult political process. Is it the responsibility of the provinces to make changes? It's not a money issue, but a policy issue. It is important to act with great wisdom to organize the changes, to say that changes are necessary.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you for your intervention. It's really the question we are asking ourselves, and the answer is always the same. We hope that someone is going to move forward.

I have another question, but we may not have enough time. Since I want to make sure my colleague will have an opportunity to ask a question, I'll share my time right now with Jinny.

[Jinny Sims, NDP, Newton—North Delta, BC]

Thank you very much for your presentation. We all are the baby boomers or the end of baby boomers. We're experiencing that time in our lives when we're looking after our parents who are aging.

You're absolutely right, they don't have only one ailment. It's a multiplicity. One of the things that I found with my father—he developed Alzheimer's and then had three strokes and multiple other things—was that what really assisted us as a family was when he ended up in a facility where there was the kind of integrated care that you're talking about.

It not only helped him. It actually helped us and reduced the stress level of the six siblings facing this.

As I look to the future, am I hearing from you that an integrated approach to care of the elderly could be done within our public system if there was the will? If so, what role could be played by the federal government—because that's the only thing we have any control over—to facilitate, nurture, and encourage this kind of a move?

[Dr. Elizabeth Badley]

When we're talking about integrated care, I also think we need to refocus and think about integrated care in the community. There are some people who need to go into institutions, but we need to keep a lot of seniors at home. That was a re-referencing. And then the funding--

[The Chair, Conservative, Joy Smith]

I'm sorry, time is running out, so if you would wrap up quickly, please....

[Maureen O'Neil]

Very quickly, I think the federal government's capacity to facilitate the sharing of knowledge of what works across the country, the reports of committees like yours but also reports on what's working, and also facilitating discussions among the provincial officials at the working level who are focused on these changes, that is the way to go. It's like consciousness-raising.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. O'Neil.

We'll now go to Mr. Williamson.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Thank you.

Ms. O'Neil, I'm curious because during your discussion you said that privatization was not necessary, which is fair enough, but sometimes people hear what they want to hear as opposed to what you actually meant. In the first round of questions you then said that, working within the system, delivery was open to negotiation, open to change. I'm curious if you can tease out those ideas a little more because they seem to run counter to one another.

[Maureen O'Neil]

The important question to pose is this: is the payment for services private? That's one big thing, and certainly the study I was citing said no. It didn't get to that; it just said there's enough money in the public system now to do what we need to do, if we're able to work up the courage to do the required reorganization.

We also have to remember that as Canadians, unlike citizens of other countries, we already pay privately for about 30% of health services: drugs, many physiotherapists, psychologists, etc. We do not have a completely paid for public system.

In answer to your question about the best delivery model, I think there's lots of room for experimentation with that, if you think of—one always picks up one—the Shouldice Hospital in Ontario, which is private but publicly accessible, and that's interesting, but I think there are many problems that can go along with that. We have a hard enough time in Canada keeping the standard of care high and safe. I'm sure everybody followed in the newspapers in Ottawa the story about private clinics, where it turns out there are fewer regulations than for restaurants, in terms of levels of cleanliness, etc.

There are a host of other problems. It's very easy to glibly say, yes, we can split up our system and have it run differently, but we have to then have a regulatory framework that makes sure it's safe. We have a hard enough time keeping it safe in the system we've got. If we start looking at other ways of delivering it, it's not necessarily bad, but we then have to ask ourselves how we manage it so that it's safe.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Often when people talk about it not being a question of money, that it's a question of politics, that's a polite way of saying it's a question of doing what the public doesn't want politicians to do. When you talk about federal oversight in Quebec, for example, where some rather innovative reforms are being made to tap into private health care, but all within the barrel of the medicare system, is that an area where you think the federal government should be applauding them or putting up roadblocks as they experiment to meet their health care needs in a way that fits within the budget of Quebec?

[Maureen O'Neil]

I think what Quebec--and I'm sure they're doing this--and the federal government should be doing is evaluating very carefully whether these forays into private medicine are delivering the outcomes that were hoped for. How are the costs being spread around? Are people getting good care? Are they not? What was expected of them? Are they delivering it? I think it's extremely important to evaluate all of this, because you're quite right.

Since the Chaoulli decision, a lot of shifts have been happening, and I think there are probably more shifts happening around the country than people are aware of. But I think the key thing is that these are closely evaluated. Are these really delivering what we hoped for? Who's bearing the cost burden? Who is accessing them? Are they getting the right kind of treatment? Are they getting too much treatment? There can be too much of a good thing. How many MRIs do people need?

The important thing is to follow very closely what is going on, which reinforces the federal role in supporting that kind of evaluation.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Sure, but in that it sounds as if your organization opposes....

You trust but verify; keep an eye on it, but allow it to happen.

[Maureen O'Neil]

I don't think our organization believes or disbelieves. We think that change in health care should be based on evidence, so if you do something, track it and look at it in five years, and ask both the equity questions, the optimal outcome questions—