Health Committee on Nov. 16th, 2011

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Could I have the answer to my question first?

[The Chair, Conservative, Joy Smith]

I did answer it: I said it will be exactly the same as usual.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

So it will be seven minutes, and then each of us will have five minutes.

[The Chair, Conservative, Joy Smith]

Yes.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you.

[The Chair, Conservative, Joy Smith]

You are very welcome.

Dr. Sellah.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Madam Chair, I could not agree more with my colleague Mr. Morin. If my math is right, based on the normal procedure, it takes two hours for everyone to be able to ask the minister one question. Yet the minister is only going to be here for an hour. So I'm guessing that not everyone will have the opportunity and the privilege to ask her a question.

[The Chair, Conservative, Joy Smith]

Just to give you some background, as I know you are new to the health committee, after we deal with the motion we'll let you know that the department and officials can stay for the second hour. So you will have ample time to ask any questions you may have. We will have the minister for the first hour and the officials for the second hour. The timing is as per usual, as the rules lay out, which is what you've done since you first came here as a committee member. She gives a 10- to 15-minute presentation, then you have seven minutes for the first round and five minutes for the next round.

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Quite often, if you get together before the minister comes, there is a first seven-minute round, and it's often split so that everybody gets a chance. How you use your time is certainly up to you.

[The Chair, Conservative, Joy Smith]

Absolutely. You are free to split your time at any time. I'll be very pleased to make sure you all get on the docket.

(Motion agreed to)

For the second hour we'll bring in the officials so you will have additional time to ask questions.

Is there another question, Dr. Sellah?

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

You mentioned one hour for the estimates. Shouldn't it be two hours?

[The Chair, Conservative, Joy Smith]

That's the day for the estimates. It's one hour for the minister and one hour for the officials. The minister can only come for one hour.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Can't we have the minister and the officials for one hour each?

[The Chair, Conservative, Joy Smith]

It's the same way we usually do it in the health committee. There are no changes.

Those are good questions.

Are we all set to go now? Are there any other questions? All right, I think we can go now.

We'll have our presentation from the Fédération interprofessionnelle de la santé du Québec. We have Madame Régine Laurent, the president. I've asked the clerk to help correct my French pronunciation. What a beautiful name. You will be presenting.

With her is Madame Lucie Mercier, the labour advisor.

You can proceed with a 10-minute presentation.

[Régine Laurent, President, Fédération interprofessionnelle de la santé du Québec]

Thank you, Madam Chair.

Good afternoon, honourable members.

The Fédération interprofessionnelle de la santé du Québec represents over 60,000 members, including nurses, nursing assistants and respiratory therapists working across Quebec. By virtue of our professions, we are concerned about health and diseases, chronic diseases in this case.

For us, the aging of the population, although real, is not the destiny that the advocates of the apocalypse would want us to believe it is. Only an increase of 1% in the costs of healthcare services is associated with the aging of the population. The effect of age and the effect of death should not be confused in the costs of healthcare services. Furthermore, we have to remember that the financial situation of the elderly is not necessarily an enviable one. And that is especially true when it comes to the poverty of elderly women.

In terms of chronic diseases, we have mainly relied on the definition of the Health and Welfare Commissioner, who says that chronic diseases include a great number of conditions: cancer, diabetes, disorders of the musculoskeletal system, and so on. It is therefore not surprising that they drain a lot of resources from the healthcare system. In fact, 5% of the population uses nearly 50% of the short-term care.

Moreover, we are well aware that you want to hear us talk about chronic diseases in the elderly. But with a broader view of health, we also look at data for people age 12 and over who suffer from chronic diseases. We are talking about 52.6% of people in Quebec. So chronic diseases are not just exclusive to the elderly. Unfortunately, they can affect all ages.

Different types of services are required by people with chronic diseases. Some are important to us: screening, diagnostic, treatment, support, rehabilitation, and also palliative care. Our organization appeared before a parliamentary committee in Quebec a few weeks ago. We believe palliative care is highly lacking.

Healthcare institutions are not always the best choice when the time comes to treat a person with a chronic disease. The literature is full of integrated models for the management of people with chronic diseases. Among others, there is the Chronic Care Model, a clinical model retained by the Health and Welfare Commissioner and the expanded model for the management of chronic diseases, which integrates aspects of prevention, community and population in order to have a greater impact on the determinants of health.

In terms of community development and clinical models, there is the SIPA model. This clinical model, which we also use, is built on case management, meaning that all services have clinical responsibility.

When we talk about chronic diseases, we also have to think about home care. Home care should be considered as medically required in the Canada Health Act and consequently, it should be covered by the public healthcare systems. The income level of people with chronic diseases, whatever their age, must be avoided at all cost in determining the care to which they will have access. This principle, which is the basis for the Canadian healthcare system, is still a consensus across Canada. Unfortunately, home care currently represents a small proportion of the healthcare expenses in Quebec and in Canada. We would very much want to see it go up.

We are also concerned about access to medications. In many cases, pharmacological treatments with the proper follow-up can replace hospitalizations. That is why it is of utmost importance that drugs be available at reasonable costs. We are concerned about the negotiations in progress to conclude the Comprehensive Economic and Trade Agreement between Canada and the European Union, more specifically the clauses on protection of intellectual property. That is very likely to result in an increase in the costs of medications, which are already very high. Let me take you back to the beginning of my presentation where I mentioned the poverty of elderly people. So they are being further penalized.

We think that palliative care, meaning end-of-life care, must also be included in the basket of insured services and not be the subject of disengagement of the state as is the case currently, where beds that were reserved are now closed and where the community must raise funds to finance palliative care hospices.

The last point I would like to make has to do with informal caregivers. It is undeniable that informal caregivers, generally women, greatly contribute to the well-being of people with chronic diseases. Furthermore, according to the Health and Welfare Commissioner, 25% of informal caregivers have been diagnosed with depression. But we have ways to support informal caregivers so that, if they want, they can continue taking care of their loved ones. They should benefit from conditions facilitating their care of those with a loss of autonomy. That is why we are putting forward the concept of compassion benefits.

We know full well that, in Quebec, health falls under provincial jurisdiction. We wanted to join you today because we are concerned about what is going to happen after 2014, given that the health agreement is surely being discussed again with the provinces. This is an important part for us. As I was telling you, all federation members work with people on prevention—and they would like to do more of it—but they also work with the elderly affected by chronic diseases.

Thank you.

Have I gone over my time limit, Madam Chair?

[The Chair, Conservative, Joy Smith]

No, you certainly didn't, and I want to thank you for your very insightful comments.

We will begin our first round of seven minutes for the questions and answers, beginning with Ms. Quach.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Thank you very much, Madam Chair.

Ms. Laurent, thank you for your presentation. You touched on some interesting things, especially in terms of access to medications, which is becoming increasingly difficult. The elderly actually have rather limited resources and they have trouble buying medications. The situation is only getting worse for them.

You talked about your concern over the Comprehensive Economic and Trade Agreement in terms of the cost of medication. Could you further explain the negative impact this could have on the increase in the cost of medication, as well as on patients?

[Régine Laurent]

I am going to answer your question about medications, and then, my colleague, who has really gone through the entire agreement, can give you an answer.

Here is our concern about medications. As soon as people are no longer in hospitals, as soon as they are at home in the community, they have to pay for medication. Unfortunately, given the poverty rate, especially among women, we see on a regular basis in our profession elderly people who are choosing between eating properly and buying medications.

As health professionals, we feel this is all linked. People should be able to eat well and should not have to choose between healthy food and medication. We are very concerned about this because we think that someone who does not eat properly will have other health problems at some stage. It is really about the big picture.

I was talking about clinical models. I think they might be useful for us because we deal with prevention. This includes all services, not just nutrition. We have to make sure that those people exercise, that their mental health is satisfactory and that they have the means to buy medications.

[Lucie Mercier, Labour Advisor, Sociopolitical Affairs, Fédération interprofessionnelle de la santé du Québec]

In terms of the economic agreement currently being negotiated, the information we were able to get indicates that the chapter on the co-ownership of intellectual property is supposed to increase the protection period for patents. The duration of patents per se does not actually go up, but as a result of three factors, including data protection for clinical studies, the effect will be the same.

This was part of a study done by people in pharmacology at the University of Toronto, I believe. For Quebec only, the potential increase in the patent protection period would cost roughly $278 million. That worries us because medications are already very expensive and patent protection in Canada is one of the longest in the world, as we know.

[The Chair, Conservative, Joy Smith]

You have some more time.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Okay. Thank you.

I have another question about chronic diseases. You have said that healthcare institutions are not necessarily the best places to cater to the needs of people with chronic diseases. You have also said that there are a number of integrated models.

In addition, you talked about case management and clinical responsibility in relation to the SIPA model. Could you talk about it some more? Does Quebec have a model that the rest of Canada does not, or vice versa, and that we could use to make a difference in people's lives?

[Régine Laurent]

Actually, when we ask the elderly people with chronic diseases this question, they all hope to be at home, just like all of us. So we think there is a way to put in place a model in communities, regardless of which model we choose. The idea is to make sure that we are going to be able to address people's needs in terms of home care and all the other services that can be provided in the community.

As for models, I started to slowly implement this new model in Quebec. Let me give you an example. Why can't there be nursing clinics in the various parts of a city? I am thinking of Hochelaga-Maisonneuve, the district I live in and I am very familiar with. There are a lot of elderly people there. When you have a chronic disease, medication monitoring is often more important than a purely medical follow-up. So if there were nursing clinics in the community, we could follow up on the medication. The elderly person establishes a relationship of trust with the people who are close in the community. That might make it possible for the elderly to stay in their own homes in the community, at a very reasonable cost. To my knowledge, there is nothing like this anywhere else.

There is a similar model in Ontario. That is why we are in close contact with our colleagues in Ontario. We would like to see how we could adapt that model to Quebec. But I haven't had a large audience in Quebec yet.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Okay.

You have also talked about the new agreement of 2014, and about your concerns in terms of provincial jurisdictions. While respecting provincial jurisdictions, can the federal government speak up in order to help the federation improve care? Would you be able to suggest some ideas?

[Régine Laurent]

I think that what is generally important is leaving Quebec and its population the flexibility to decide how to deliver health care.

I will be more clear when it comes to my concerns. We have seen dedicated budgets in some places. We do not want that to happen in health care, because, when it comes to health care, we have to keep in mind each province's population. We are worried about being forced to have dedicated budgets, in the Government of Quebec. As a result, we might not be able to carry out certain projects that would be useful and would meet Quebeckers' needs. We would not be able to carry out those projects, as some budgets would be dedicated.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Laurent.

We will now go on to Mr. Strahl.