Health Committee on Oct. 18th, 2012

[Dr. Alain Beaudet]

We don't have them in Canada, but I recommend that you refer to a report of the Institute of Medicine in the U.S., which was published three weeks ago. It produced a very important and interesting analysis of the waste in the U.S. health care system. Although we have to be careful in not equating things, as our systems are very different, I think there are a number of things that you will find are akin to what's happening here.

[Matthew Kellway, NDP, Beaches—East York, ON]

With respect to your two organizations, what's required to maximize or at least to enable more research into these issues?

[Dr. Alain Beaudet]

There are two things.

First is more money, as always. Let's face it. We're talking about having to support that research. I think it's great to see that the provinces are willing to invest with us in this area, that they recognize the importance of a better evaluation, and a constant evaluation, of not only new treatments but also current treatments and practices.

Second is the people to do that type of research. We don't have enough clinical investigators. Their time is not protected. Their salary is not supported. We don't have enough implementation researchers. We don't have enough health economists. We don't have enough biostatisticians in this country. We have to train these people. This is a type of researcher that we haven't trained enough of.

That's what we're pushing for with our partners in the universities, in the academic health centres.

[Matthew Kellway, NDP, Beaches—East York, ON]

Dr. O'Rourke.

[Dr. Brian O'Rourke]

Those in fact are the types of people who work in our agency and who do the work in our business. I would agree 100% that there is a limited capacity of people with that expertise.

I would say as well that what is needed is better collaboration. These are tough decisions. When you're going to take something away from either the patients or the clinicians using it, it's pretty hard to do. You have to engage very carefully with the clinical community, with the patient groups.

An interesting campaign that started in the United States is called “Choosing Wisely”. They went to a number of clinical associations and asked them to come up with a list of five things they should stop doing.

Something like that would be very beneficial from a Canadian perspective, to Canadianize that sort of an approach.

[Matthew Kellway, NDP, Beaches—East York, ON]

Can you name those things? Do you know them off by heart?

[Dr. Brian O'Rourke]

No, I don't have all of those, but I certainly could provide you with a link to the website.

[Matthew Kellway, NDP, Beaches—East York, ON]

That would be great.

[Dr. Brian O'Rourke]

They work very closely as well with patient groups and consumer groups to ensure that the information is spread widely as well.

[Matthew Kellway, NDP, Beaches—East York, ON]

Dr. Beaudet, is it the case that the provinces have money on the table and they're waiting for federal matching funds? Is that the circumstance you've described?

[Dr. Alain Beaudet]

This is correct. The patient-oriented research strategy is really a joint initiative. It brings together all the stakeholders. We're all facing the same issues. It brings together the provinces, the territories, the federal government, but also stakeholders from the private sector and from the charities sector, to chip in jointly to invest in the type of research that I've been talking about, the patient-oriented research.

[The Chair, Conservative, Joy Smith]

Yes.

I'm just going to pick up on what Mr. Kellway said. Some very good questions came from him today, in my opinion, for what it's worth. My side has allowed me the time to ask questions, so they've given me this question.

Picking up on the funds, I heard you say that there's a need for more funds for researchers and all those things. We hear that over and over again. There's never enough funds. Innovation is intended to increase the productivity and efficiency of health care delivery and research, and in 2007 mobilizing science and technology to Canada's advantage was a strategy that was put forth by our government.

When we're looking at the aging demographic, when we're picking up on some of Mr. Kellway's questions, when we're looking at what actually is needed out there, could either one of you comment on what roles the private sector, the academic institutions and health care professionals play in the science and technology strategy in a collaborative manner?

You were saying that collaborative interaction is integral to this whole process.

Would anybody like to comment on that?

[Dr. Alain Beaudet]

First of all, I would comment on funding. We're spending $170 billion a year on health care in this country. CIHR's budget is $1 billion.

Now, just think of what successful company invests that percentage of their budget in R and D. That's just a question. We want the system to work. We have to invest in innovation. That's how we're going to increase the efficiency, the quality, and the accessibility.

That being said, I think it's not only for the public sector to do so. More and more we realize, particularly through participation with the provinces, because it is their constitutional responsibility to provide care, that by collaborating with the provinces we gain not only financial investments—I'd even say that it's not the most important thing—but we also get, by partnering with them, an involvement. We get a true involvement, early on into the research agenda, into why integrating research and care is absolutely critical to the future of the quality of care in this country.

The partnership is more than just money. The partnership is getting involved.

[The Chair, Conservative, Joy Smith]

Yes, I know that very specifically, though I asked about the private sector and the professionals, because later on in our innovative study we're going to have doctors come in who have done amazing things in terms of collaborating with other doctors in making a one-stop shop and servicing the community.They have patient buy-in as well for healthy living. That's what I was getting at, because we have an aging demographic and there is not enough money in the world to address the health care issues.

I wondered if you had any new ideas.

Mr. O'Rourke.

[Dr. Brian O'Rourke]

There's one program that has started in Ontario, through MaRS actually, and it's referred to as EXCITE. I can't recall what each of the individual letters mean in that acronym, but it's a different way of looking at technology. It's getting the users of the technology, the clinicians, the patients, to work with industry upstream. Rather than an industry coming forward and saying they have a technology that's very helpful and we should buy it, it's the clinicians saying what things would be very helpful to them, and what the gaps are in the system.

If you developed a technology like that, we'd be very interested in it.

[The Chair, Conservative, Joy Smith]

It's somewhat like what we heard earlier from another panel on a different day. They were engaging health care professionals and asking how to make our hospitals more efficient, where they should put the supplies, what is needed or not needed to cut down on the waste. That was basically what they were saying.

[Dr. Alain Beaudet]

It's true of the research agenda. Let's face it. The research agenda to a large extent is one that has been a researcher agenda. I think we have to bring in the decision-makers, the policy-makers, the patients, and involve them in defining the research agenda.

[The Chair, Conservative, Joy Smith]

Thank you so much for allowing me to ask a question, and thank you for your very insightful comments.

Ms. Davies, you're next.

[Libby Davies, NDP, Vancouver East, BC]

I'd like to follow up again on the health human resources that my colleague, Matt, and I both raised today. Again, my question is, what kind of overview is there in terms of the gaps in the system?

Everybody talks about innovation, cost savings, efficiencies, but a massive transition takes place as these new innovations come into the system. It has an impact on equity across the country, but also on human health resources. In terms of the research that's done, are there any studies that track what happens with health human resources? What happens when we get a sudden surge? You talked about some of the positions that are needed simply in the patient-oriented strategy research. Who's keeping track of that overall so that we have a system that can actually be responsive, one in which we're not always trying madly to catch up two years later, or something like that?

[Dr. Alain Beaudet]

It's an excellent and also a difficult question because we haven't done enough. One of the reasons we haven't done enough is that it's expensive to do what you're talking about.

There's an excellent report from the Canadian Academy of Health Sciences on measuring impacts of health research at every level, starting with the basic outcomes, the papers that are published, to the more complex impact on longevity, on morbidity, on improvements and outcomes in various diseases.

What we're finding at the CIHR is that we have to do better to track these impacts. We realize there's a limit to the money we can invest in producing metrics, so we have to choose the metrics very carefully. I think that as we are developing our new programs, we're being very careful to ensure that each specific objective of the program is matched with the very specific metric. The researcher knows what he or she will be evaluated on because they are aware of what the metric is. They are then aware that the metric is absolutely linked to the objective of the program. Therefore, if they don't meet the objective, they won't meet the metric.

It is expensive and time-consuming, and is a change in culture. It means that for every metric you need a baseline. When we're talking about health outcomes, the baselines often become a problem, and measuring outcomes across the country is a challenge. Don't forget that we're not talking about one health care system; we're talking about 13 health care systems.

[Libby Davies, NDP, Vancouver East, BC]

In fact, within that, we're talking about many other jurisdictions in terms of local health authorities. There isn't any kind of national baseline, then. It does not exist.

[Dr. Alain Beaudet]

Not to my knowledge.

[Libby Davies, NDP, Vancouver East, BC]

It seems to me that in the 2004 health accord, this was an area that was identified with respect to improvement in strategies around human health resources.

Do you think that any progress has been made since that agreement was put forward in 2004?

[Dr. Alain Beaudet]

I think there's definitely been a lot of progress made. Organizations such as CIHI, for instance, have really pushed that to an extent that didn't exist at the time of the accord. Can we do better? Can we go further? I think we could, we can, and we ought to.

[Libby Davies, NDP, Vancouver East, BC]

Do I have more time?