Health Committee on Nov. 1st, 2012

[The Vice-Chair, NDP, Libby Davies]

Thank you very much, Dr. Seely. We can come back to you later if you have other quotes you want to read in.

Thank you very much to all of the presenters. I think it was great information that you gave us about what innovations are taking place or could take place in terms of service delivery and providing support to patients.

For our remaining time now we'll go into questions and comments. The first round is for seven minutes, for both the question and the response.

We will begin with Dr. Sellah.

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

Thank you, Madam Chair.

I would first like to thank all of the witnesses for coming to talk to us about their innovation initiatives today.

My first question is for Ms. Thomassin and Ms. Lemire.

As you know, Quebec is always in the vanguard when it comes to certain projects, particularly in the socio-medical field. If I understand correctly, the UQTR multidisciplinary clinic offers health care to the public in the region and to employees, retired employees and their families, in a training environment designed for students in a number of health care disciplines. It offers on-going care, particularly in speech therapy and occupational therapy. I applaud that initiative. I was one of the physicians when I did my residency in Quebec. At that time, I said that the best thing was for physicians to be multidisciplinary in a closely related field. I see here that you are ahead of the physicians. I therefore applaud the work you are doing. This might be a case of best practices that could be reproduced elsewhere in Canada.

Do you know whether there are models like yours elsewhere in Quebec or Canada? What is the main obstacle to setting up a clinic like yours?

I would also like to focus a little on access to health care and ask you whether a clinic like yours means that waiting time for seeing a general practitioner or specialist physician can be reduced.

[Lyne Thomassin]

I will answer part of your question, if I may, and let Ms. Lemire handle the rest.

I am going to talk to you about the challenges. It really is not a simple matter. As a university clinic, we also work with the departments. Their prerogatives are very specific when it comes to training. The fact that the needs of each department or program, and the training objectives, have to be coordinated within the clinic is an on-going difficulty.

Even though we are going to acquire more experience over the years to come, that will still be significant. As well, the multidisciplinary and interdisciplinary concern is not necessarily something that comes spontaneously to people in the departments, given that we are dealing with students who do not have the minimum skills for working in their profession. We start with professional skills, and so that means that the multidisciplinary vision is upstream from there.

[Carole Lemire]

In terms of the innovative project, and more specifically the nursing clinic for primary health care nurse practitioners, PHCNPs, we are at present the only clinic in Quebec that offers a partnership with physicians and NPs, to supervise ours students. This means that the students see real patients, in real time, from the university community. At present, we are considered to be the only NP school/clinic in Quebec.

Perhaps the biggest problem, as you noted, is the partnership with physicians. In general, our students do their training placements in medical clinics or GMFs, family medicine groups. Perhaps the biggest difficulty I have had to overcome is getting physicians, on contract, to come to the PHCNP clinic to work in partnership with our nurses. So that was something novel. As well, we had to initiate talks with the MSSS, Quebec's health and social services department, and the FMOQ, Quebec's federation of family practitioners, so that this "first" could happen. Essentially, there are not a lot of physicians who teach nurses directly.

I address the last point in my presentation. At present, we serve the university's employees and students. Of the UQTR students, at the hospital, about 20% of the patients we see are foreign. They come from outside Canada. Many in that 20% represent an orphan clientele: they have no family physician because they are from outside Canada. And there is an excellent partnership with insurance companies to provide payment for their health care.

At present, we are really serving a significant orphan clientele. The plan is for the clinic to be open two days a week within a fairly short time. We plan to open it later to the orphan clientele in the Trois-Rivières region, region 04, where there are, for example, a lot of patients with chronic illnesses who are not under the care of a family physician. This is really with the goal of providing a service to a population that is not receiving it at present.

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

Thank you.

[The Vice-Chair, NDP, Libby Davies]

You have about one minute left, if you'd like a quick follow-up.

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

Yes, a quick question, please.

My question is for José Côté.

I congratulate you on the work you are doing on innovative practices. I know your goal is to support and equip patients using virtual interventions.

What are the factors that distinguish a patient who is capable of managing their own care from another patient who has trouble doing it? Are there social factors that come into the equation?

I recall the case of a transplant patient who decided not to take her anti-rejection medication, who had to make a choice between her medication, being on the street, and paying her rent. She is now on dialysis, unfortunately.

[José Côté]

Thank you for your question.

[The Vice-Chair, NDP, Libby Davies]

You only have 15 seconds to reply. We'll have to come back and try to pick it up again. Perhaps you want to say a couple of sentences.

[José Côté]

The condition that has the most effect on an individual's capacity to act is depression. We see this co-morbidity among our patients: they have a chronic illness and also suffer from depression. It has an enormous effect on their capacity to act. I work with a diabetic clientele, and 30% of that clientele, representing about 300 patients, suffer from depression. That is where we see that these people's capacities are very limited.

It seems I will have to come back to the subject.

[The Vice-Chair, NDP, Libby Davies]

Thank you very much. I realize how tight time is and that it's difficult to get the questions and responses in.

We'll now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I'd like to start by thanking all the witnesses for being here.

I want to start my questions with Dr. Seely.

I was really pleased to be able to attend your opening last month to see it first-hand. One of my colleagues, Ms. Block, told me that integration is innovation in health care. I was really impressed how patient-oriented your clinic was and how you're focusing on education. I was impressed to see you had a kitchen in your facility, because nutrition is such an important part of things, and to see the cooperation among the oncologists, the naturopaths, and all the different professionals who work with you.

Your centre really does strive to assess and reduce the possible causes of cancer in people who've undergone these treatments, to get them back on track. I was wondering if you could expand on the kind of innovative treatment and management programs you use in the clinic.

[Dugald Seely]

Thank you for the question, and thank you for participating in the grand opening event. We had a lot of people who were very affected by that.

In terms of innovation through the kinds of treatment modalities we use, we do really try to touch on different types of therapies that work from the physical standpoint, the psychological standpoint, and even the spiritual standpoint, to some degree.

For example, you mentioned the kitchen. We're running nutritional workshops. That provides a way in which patients can come and get hands-on experience with how to cook foods that are more healthy, from a cancer perspective. That's one thing.

In terms of the naturopathic care options that we provide, we look at a lot of lifestyle approaches—helping people to do exercise and to build that into their lives in a way that is safe. We know for sure that exercise is incredibly effective, an additional thing that people can do to help prevent recurrence and as a treatment modality.

We also use targeted supplements in ways that are used in other countries as almost conventional therapy. One example would be the use of a mushroom extract from coriolus versicolor. PSK is the extract they use in Japan. That's considered conventional medicine there, and there is a lot of very good data to back that up. We use that to help support the immune system. That's a particular therapy that really is nice because there is very little risk of any interaction with some of the chemotherapies and other things. We can look at supporting the body's internal environment to help fight off the cancer itself by using a very different approach from what's conventionally used. It does work well in combination and it's something that's helpful.

Those are some examples.

Also, there is massage therapy and lymphedema therapy. For example, someone who has had a partial mastectomy may have some lymph nodes being removed and they have a higher predisposition to lymphedema. With someone who's trained in lymphatic drainage therapy, you can include that, and you can help to reduce the likelihood for development of that.

I think having these different services available in one place and integrated within that clinic is very innovative in and of itself. The approach and the reaching out to conventional doctors to enable patients to feel comfortable doing both of these things is one of the most innovative components of it.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

I was impressed too that some of the guests you had there were survivors. You mentioned in your comments now the importance of an exercise lifestyle to help prevent recurrence. We're finding with the research now that so many cancers are related to lifestyle issues, and the cost of recurrence is not only emotional to the family but to society as well.

I was wondering if you were working with any international researchers. You talked about having some funding from CIHR, especially on these issues of recurrence and the cost benefit of taking an approach like this. Do you have any comments you could give the committee on that?

[Dugald Seely]

We haven't done any research on the cost-effectiveness component of that in terms of cancer. We've looked at cardiovascular disease and we've looked at the cost effectiveness of including a naturopathic approach to care for people who are at higher risk for cardiovascular disease. This was actually a study in three centres across Canada involving Canada Post workers. We showed dramatic societal benefits in terms of cost effectiveness there. I think it was just over a thousand dollars per individual.

That's representative of a kind of chronic disease that responds to a whole-person approach to care. Cancer is definitely a chronic disease now. It's more of a disease that is managed rather than attempted to be cured, so it fits very well within that.

We do need to do the cost-effectiveness research to see what benefits there are there, especially if we're able to prevent recurrence. There is no question there would be a massive benefit from that.

In a lot of the cases, people will come to us after conventional therapy. They've just finished their chemotherapy, their radiation, and they wonder what they do now. They feel let go and they don't know what else to do.

Complementary practitioners are often a place that people will go for that. That's definitely an area where we see patients. My bias is very strong that we're able to improve recurrence rates, and there is data for that as well.

[The Vice-Chair, NDP, Libby Davies]

Thank you very much, Dr. Seely.

That's the seven minutes. Time is short today because we're going to go on to committee business at 12:30. I'm going to try to keep to the time so that we can get in as many people as possible.

Go ahead, Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Madam Chair.

I want to thank everyone for coming.

Some of the innovations I heard you speak about are ones we've all known, through evidence, would work. I'm glad to see you're moving forward with them.

My questions are for Mr. McBane.

Mr. McBane, I was delighted to hear your presentation. I want to read something for you from the 2004 health accord, which had indeed stipulated that one of the five things meant to be a result of the accord was a national pharmaceutical strategy. All 13 premiers and the prime minister of the day, Paul Martin, agreed on this. I just want to read what it says:

First Ministers agree that no Canadians should suffer undue financial hardship in accessing needed drug therapies. Affordable access to drugs is fundamental to equitable health outcomes for all our citizens.

Then, of course, they decided to establish a ministerial task force that would achieve a minimum of about eight things that would constitute a strategy.

You are absolutely right that the kind of bulk buying, etc., that the premiers are now trying to undertake through the Council of the Federation is something they shouldn't have to do alone. It is absolutely essential, as the accord said—and the accord talked about jurisdictional flexibility—that the federal government has to be a player in this.

This is now how many years later? We just have two more years left in the accord, and the federal government walked away from this particular thing in 2006.

My question is this. I would love to know what happened to that money that was put into the accord specifically to develop a national pharmaceutical strategy. I don't suppose you could tell me what happened to it. The point here is simply this. The Conference Board, as you say, had a good meeting. One of the things they talked about is bulk buying, but they also talked about access to generic drugs.

There's a real question here that I want to put to you. There is a shortage of drugs in Canada currently, as you well know. That shortage comes mostly from generic drugs. Once the patent expires, generic drugs are made and sold, but because generic drugs are so much cheaper, a lot of companies that are no longer making the kind of profit they used to make from selling generic drugs have stopped making them. This is a really important question because I think we all need to struggle with this as we talk about health care. What do you think one should do to ensure that generic drugs are available and that they don't just go off the market and are no longer made by companies because they're no longer profitable? Is there an innovative suggestion that you have for this?

I want to go back to look at the fact that earlier on, in Trudeau's day and in Mulroney's day...obviously Connaught Laboratories was a government laboratory that provided medications that weren't being made anymore. Putting that on the table, if we go to generic drugs, which obviously are going to be cheaper, could you tell me of some innovative ways that you see us ensuring that they're there for us—seeing that they're not?

[Michael McBane]

Thank you, Dr. Fry, for your questions.

I have a very quick comment on the national pharmaceutical strategy. I was delighted to see that as part of the 2004 accord. I considered that the most important piece of the accord, aside from the secure financing. Therefore, I don't think you can exaggerate how much damage the abandonment of it by this government does to the health care system.

I believe you cannot have health reform without getting pharmaceutical management under control. Right now pharmaceutical management is out of control. Spending is out of control in pharmaceuticals. The federal government is directly responsible for the escalation in the costs. In fact, the government is currently negotiating a trade agreement that would add another $2 billion, but it's not paying the bill. It's going to give the bill to the provinces and to Canadians to pay out of their pockets.

So there's an uncontrolled cost escalation and sabotage in terms of Canadians' health, because there are a lot of other pieces in the national pharmaceutical strategy, in terms of appropriate prescribing and other essential elements. Also, not everything should be a prescription drug. Alternative therapies should be considered as well—appropriate therapies.

I really think we have to get the federal government back to the table. It's the one area where there's unanimous consent in all the jurisdictions. Unilaterally walking away—

[Hedy Fry, Liberal, Vancouver Centre, BC]

My question is about these generic drugs. How do we get them, and how are they made?

[Michael McBane]

I'm glad you referred to Connaught Labs, because that was a public company, a crown corporation. It's interesting. They were left certain patents by Banting and Best, given to the people of Canada, which were later privatized. So there is a precedent that the public sector can play a role in ensuring the manufacture and the access to essential medicines. I think that's one thing we can look at.

The Government of Canada has contracted for certain vaccines that they considered essential to public health. There's no reason that there can't be public contracting for generic medication to ensure access, to ensure supply. I think we should be looking at that. Certainly other countries can provide some examples for that.

[The Vice-Chair, NDP, Libby Davies]

You have less than a minute left.

[Hedy Fry, Liberal, Vancouver Centre, BC]

That's fine, Madam Chair. I'll let you move on.

[The Vice-Chair, NDP, Libby Davies]

Thank you very much.

Mr. Lizon.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Madam Chair.

Thank you to all the witnesses for coming here today.

The first question I have is to Mr. Lacombe.

In your presentation you stated many times that you want to involve, or you are involving, patients as partners. Can you maybe elaborate in more detail on how you want to do it without concrete plans to get these people involved? I suppose you want to involve potential patients, to prevent illness.

[Dale Lacombe]

Certainly, and thank you for the question.

We talked quite a bit about the patients as partners or the customer service element as we were setting up the committee and the three subcommittees. We chose patients as partners as opposed to patients as service, because we believe that inherently, in the word “partner”, they need to work collaboratively with their providers—and not just work with their providers, but they also need to be educated about the system.

As an example, at the annual general meeting we presented to 90 executive teams from chambers across the province. I would hazard a guess that 60% of them—I don't want to say had no idea—did not have an understanding of the costs of the health care system. We believe that partnership means you want to be involved, not only in your health, but you want to be involved in long-term solutions. You want to have all the information at your disposal. We think when you have that information—it's always going to be emotional, sensitive, political—you can act much more as an informed participant and add a whole lot more value.

From a health perspective overall, there's been a lot of discussion over a long period of time now around bending that cost curve. We support that, but we also think that through better education, involving the public and the patients more aggressively and more and more interactively, we can bring the demand curve down.

The need for health services is not going to go away. If you're sick or if you hurt yourself, you need to see a doctor.

We think that through more engagement of the public, whether it's through a patient contract...as an example, an individual having a patient contract with their doctor: “These are your achievements. These are your meds; we need to make sure you're taking them. We understand you're smoking or you're not exercising now. We'd like to see a plan because we're interested in your health, so we're working together.”

So it's really about education and ownership of their health.

The other piece I'll mention is that we were glad, frankly, we didn't mention patient service. We respect the Patient First program in Saskatchewan, but what really came through in our dialogue is that providers and everyone in the health care system really do put their patients first. We thought, you know what? That passion is there. We see it in the providers. We now need the patients to be more engaged. They need to be partners in the discussion.