Evidence of meeting #17 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was paramedics.
A recording is available from Parliament.
Professor, Department of Health Administration, University of Montreal, As an Individual
That's right. Let's consider all public administrations, as they are defined by Statistics Canada. I can give you the definition.
Conservative
John Williamson Conservative New Brunswick Southwest, NB
Does this curve include...?
If we take these two lines and add them together....
the one at the top?
Professor, Department of Health Administration, University of Montreal, As an Individual
Yes, it should be the one on top.
Conservative
John Williamson Conservative New Brunswick Southwest, NB
That makes sense now. Thank you very much.
Dr. Reichman, you seem to be an advocate of 10 laboratories of innovation in Canada. You're suggesting provinces go out there and just do things, and we'll find the ones that work best, and other jurisdictions should copy them. Things that don't work as well won't be copied, obviously. How is that working? What can the Government of Canada do to encourage that, as opposed to doing something else?
Conservative
The Chair Conservative Joy Smith
Dr. Reichman, please respond quickly, if you could. I know our time is up, but we would really like to hear your answer.
President and Chief Executive Officer, Baycrest
I believe there's great creativity in each of the provinces here, and there are provinces as well that are looking outside of the four walls of Canada and looking at models abroad. Many of these models may work in Canada, several of them won't, but we won't know unless we try it.
What we've been advocating at Baycrest is to leverage all of this talent across the nation, create a Canadian centre for innovation in aging, bringing together the very best practices that have been demonstrably effective in different jurisdictions of the nation, and then distribute those results where they are most needed. What can be distributed is not only best practices of demonstrable effectiveness from Canada, but as well best practices that have been demonstrated to be helpful from other jurisdictions. Right now we have a very fragmented approach to that in the nation.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
My question is for Mr. Béland. You briefly talked about aboriginal populations. You also said that the Government of Canada should innovate in areas where it has full jurisdiction over the health care for certain populations, such as veterans.
Can you tell us a little more about what you mean when you talked about a test-tube experience with regard to the aboriginal population?
Professor, Department of Health Administration, University of Montreal, As an Individual
Aboriginal people are not really my area of expertise. I know that the federal government often claims that health does not fall under its jurisdiction, but it is nevertheless responsible for certain populations. I mentioned aboriginal people, since the federal government indeed is responsible for their health care needs.
Regarding aboriginal people in particular, some approaches should be taken. In my opinion, they are different from those which should be taken for other groups. In that regard, I agree with Dr. Rosenberg. However, since we are talking about elderly people and chronic illnesses, all of these approaches must include a vision which promotes good health, as Dr. Rosenberg said.
However, within native communities, and among veterans and other groups within Canada, there are elderly people who have serious disabilities, in addition to chronic illnesses, depression and cognitive deficiencies. It costs an awful lot of money to look after this group.
What approach should we take for aboriginal people? Obviously, we will have to take an approach which is very different from the one we would take for veterans, for example. We have to call upon all communities. This is the responsibility of the federal government. The government has an opportunity to show the provinces what it is doing and to tell them that it has an opportunity to innovate.
Dr. Reichman and Dr. Rosenberg are absolutely right. All kinds of solutions are available. There is, for instance, SIPA, the research program on integrated services for the elderly, as well as PRISMA, and other projects in Canada, which have demonstrated that it is possible to develop both health care and social services which meet the needs of the elderly. We know what is needed. The issue now is to figure out how to bring everyone together to get things done.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
Do you feel that there is a lack of leadership on the part of the federal government?
Professor, Department of Health Administration, University of Montreal, As an Individual
I do not want to point the finger at any government in particular, but as I said earlier, I believe that we are at a crucial junction for the entire health care system. I do not believe that we are going to find solutions by just tinkering with our structures and with funding. We need to figure out how to organize care around the individual.
Until now, there has been talk about integrating structures. But we have to begin by talking about integrating services around people who need care. If we do that, we will be able to say that people need a whole range of services. For example, elderly people who are very disabled need to have snow removal services at home. The funding would have to cover that type of cost. The funding would have to align with the needs of individuals. The organization has to align with the needs of individuals, and not the opposite, namely patients should not have to align with the needs of organizations and with the funding requirements of the health care system. We therefore have to flip our approach around.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
In that case, is the government's current solution, a 6% increase in its transfer to provinces, the right solution to bring our Canadian health system up to date? Should we go further?
Professor, Department of Health Administration, University of Montreal, As an Individual
The whole issue of the accord renewal funding would require separate consideration. One thing is certain: the funding is not sufficient, but it is critical.
In addition, we have to innovate, and we know how to do that.
Conservative
The Chair Conservative Joy Smith
Thank you so much. Thank you, Dr. Morin.
We'll now go to Mr. Strahl.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
Thank you very much.
I would like to start by saying I think a 30% increase in funding is better than the alternative. Three of you spoke about innovation and about how, basically, we won't tolerate the status quo for our parents. We certainly expect better for ourselves and hope for better for our children.
We've heard time and again, as Ms. Davies said, about innovation, about too many people in acute care. Is it legislation? Is it politicians? What is standing in the way of that innovation taking hold and getting to that next level where we're actually seeing demonstrated results across the provinces?
Mr. Reichman, would you like to start?
President and Chief Executive Officer, Baycrest
First, I think it's critical to articulate a concrete goal of what we're trying to achieve through innovation, and that will then rally people around that goal. That's what I think is the proper role of the federal government, to articulate goals that Canadians are entitled to achieve. And the means of achieving the goals, most of that responsibility, with the right federal support, can exist at the provincial level.
For example, at the very beginning of my talk I threw out a very specific goal. I said that rather than having the nursing home be the last two years of your life, it will now become the last two months of your life. That's a very specific goal. And it's going to require a whole series of efforts to get us there that include much better support in the community to keep people who would otherwise go into nursing homes out of nursing homes.
So I think it's important to articulate very specific goals. Every Canadian who wants to die at home instead of in an acute care hospital is going to die at home.
Now, let's talk about what it's going to take to get us there. Every Canadian who needs a primary care doctor is going to have a primary care doctor. Let's talk about why we're not there. What are the obstacles? Let's do it. If we can send a man to the moon and safely return him back to earth, we can certainly do these things.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
Mr. Nolan, do you have any comments? You mentioned innovation as well, as a key part of your organization's goal.
President, Emergency Medical Services Chiefs of Canada
I think we need to take some chances within the system. We need to take chances amongst the professionals who are providing the services and to look at opportunities to work together like we never have before.
There was a question earlier about reaching out to senior populations and providing exercise opportunities. Here in Ottawa, the University of Ottawa Heart Institute has a heart-wise exercise program that's across all of eastern Ontario, and into the greater Toronto area now. We provide, through community paramedic programs, volunteer instruction so that people in long-term care facilities can get out and self-manage by walking in the halls of those nursing homes, and doing it in a way that's predictable in terms of improving their health.
I think overall, from province to province, we've seen variations in care. One of the things we're asking for in Canada is to define the standard of care in paramedic practice. We believe community paramedicine is an essential part of that. We believe that by looking at best practices, by having the federal government take a leadership role in saying, break down the professional silos, provide the services in the communities, stop putting money into bricks and mortar, and start putting money into people's homes so that they can manage their own care, that has been demonstrated to save significant dollars and empower people who truly want to continue to care for themselves.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
Okay. The final question would be this. Are the provinces sharing the innovations that are taking place in their jurisdictions with one another? Or is there resistance to doing that? And if so, why would that be?
Does anyone have an answer?
Professor, Department of Health Administration, University of Montreal, As an Individual
In my own experience, I've noticed that the Quebec government encouraged such sharing, especially between Quebec and Ontario, regarding performance, performance measurement and the way to use performance indicators.
In addition, information now circulates. For example, the Canadian Health Services Research Foundation now plays a much greater role in information sharing. Canada is one of the countries where the sharing, the transfer of knowledge, is encouraged to quite a remarkable extent.
There are also initiatives supported by the provinces. For example, in Quebec and in the whole of Canada, there is a movement to adapt hospitals who serve elderly people and those with chronic diseases. That's ongoing and there are concrete programs in that regard. There are a great many such examples.
Conservative
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
We have been talking about the increasing number of seniors.
The committee has learned that this population will increase from 14% to 25% by 2036. This demographic trend will also affect health professionals. I am truly astonished to learn that there are currently only 200 geriatricians in Canada.
Has your organization studied what the impact of this demographic increase will be on the labour force, whether in 2036 or right now?
We are told that there is a shortage, both of paramedics and medical personnel. I was happy to hear Dr. Reichman say that we've reached a point where we can send people into space, but we aren't able to provide a family physician to all Canadian families. I find that very troubling.
Conservative
The Chair Conservative Joy Smith
Who would like to answer that?
We'll start with Mr. Nolan and then go to Dr. Rosenberg.
Go ahead.
President, Emergency Medical Services Chiefs of Canada
Thank you, Madam Chair.
Certainly in the case of paramedics, while being the third largest health care provider in Canada in terms of our demographic, we're not on the health human resource planning horizon. We're not currently being studied by the federal government in terms of the army of resource that's available to you. However, our demographic is significantly younger than that of the physician group and the nursing group by virtue of the advent, if you will, of paramedics over the past 40 years across Canada, and we're now quite a bit younger and have greater capacity in terms of our ability to shift both culturally and geographically given our prevalence in rural and remote communities across Canada.
In terms of the patient demographic, if you will, we are certainly experiencing significant challenges. To recap one of my points earlier, 60% of our responses are to patients who are over the age of 60, and when you look at those over the age of 80, that's 27%—almost a third of our response is for people over the age of 80. We recognized earlier, from Mr. Béland, that may not be the largest group of people in the population, but they do use our services at an exponential rate from earlier age groups, and as a result, we're able to respond to that with a younger workforce.