Health Committee on March 7th, 2013

[Prof. Adam Holbrook]

Thank you. I have two quick answers to that. I've already been asked that question by the Government of British Columbia. My answer was that I'm not certain you can teach people to be innovators. I have this feeling that there is some kind of innate ability to innovate and that the real question for educational institutions is to identify those who have that innate ability; hence my disparaging comment that you can't teach a health sciences graduate to be an entrepreneur.

On the other hand, you can also provide an environment for innovators and that's the other part about the social innovators and intrapreneurs. That's the big thing that's missing. We're assuming that innovators are automatically entrepreneurs in the commercial sense and that perhaps, particularly in the health care sector here in Canada, which for the most part is in the public sector, we should be asking ourselves how we reward the nurse, the technician, as well as the doctor, who comes up with an idea. These ideas need not necessarily be R and D related. There are all sorts of operational changes and procedural changes. I'm not talking about operations as in surgical operations, but just simple day-to-day changes within the operating fabric of the hospital.

How do you reward somebody for that? How do you get people interested in thinking about it?

[Dr. David Jaffray]

We wrestle with this issue from the point of view of modelling. How do we model entrepreneur activity in these alternate environments? Within health care, there has been a lot of discussion, specifically on the intrapreneur, someone who's doing entrepreneur activities within an organization. It often happens in large companies, and hospitals and health care facilities are large companies.

What we found is that individuals will migrate to an environment where we're doing commercial activity, where we're doing things that translate more readily, and I think it's really important to create these environments where we are actually driving these innovations. That will pull in summer students and undergrads. We've seen them now, as a stream, start to flow because they see the opportunity to have impact based on their experience and then the potential to go further and turn that into product.

[Ben Lobb, Conservative, Huron—Bruce, ON]

You alluded to the Fraunhofer institutes, and there's one at the University of Western Ontario. I would say that model has really pushed the auto industry in Germany for a long time and kept their automobiles ahead of the curve of almost everybody else's. There's a professor at the University of Windsor, a co-founder of Auto 21, who is looking at the Canadian Automotive Research Institute, at what would be very similar to a Fraunhofer that would help to push innovation and research in Canada, mainly Ontario and Quebec.

The next thing I'm thinking about is the report we're looking to do from our study here. Is there a piece in there that should say that we should look at this, where you have this created to help take a small or mid-sized company, which maybe doesn't have the biggest and most robust R and D department, and to help them work with academia, to help them work—

[The Chair, Conservative, Joy Smith]

You only have 30 seconds, Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I was just about done my question so it should work out pretty good. Is that something we should come out of this study with as a recommendation, or is there already something out there like this?

[Prof. Adam Holbrook]

The quick answer would be hospitals themselves are probably these intermediary institutions anyway. So the question then comes, how do you get that sort of research pool, how do you get hospitals going back to the university saying, come on, we need this piece of research to do something, and then turning around on the other side to a commercial entity and saying, okay, now we need the black box, now we need the home device for kidney dialysis?

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Holbrook.

We'll now go to Dr. Morin.

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

Thank you, Madam Chair.

My first question is for Ms. Lehoux.

On the third slide of your PowerPoint presentation, you recommend setting up an intersectoral body. Do you know how much this initiative might cost? If we are talking about setting up new programs or new bodies, the federal government will obviously want to know what the costs are.

[Dr. Pascale Lehoux]

I don't want to take a chance and hazard a guess, but somewhere else in the presentation it says that there are large budget envelopes dedicated to health research and development. I also mentioned the envelopes discussed in the Jenkins report. Those envelopes are dedicated to industrial research. So it’s the equivalent. We are talking about $6.4 billion.

I think there are major levers at the federal level. However, I cannot say how much that would be. We would need to do a bit of research to determine which model to follow. But I can tell you that the United Kingdom is the country we should turn to. The way its health and wealth policy is developing is very interesting.

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

Thank you. I will take note of that.

On the sixth slide, you indicate that we have to preserve the future of care systems by focusing on design. But health care systems vary from one province to another. The provinces are basically the ones that can innovate on the ground, in their own health care system.

How can the federal government innovate? Is it by setting up an intersectoral body or by creating something else that you have not mentioned yet? Furthermore, what do you mean by “focus on design”?

[Dr. Pascale Lehoux]

In terms of health care systems, it is important to understand that, even though each system falls under provincial jurisdiction, the challenges and needs are similar. Actually, Canada is not the only one to deal with those challenges and needs; every developed country is dealing with the same ones. Technology and staffing costs are high everywhere. It is difficult to reach patients outside urban centres everywhere. The challenges are the same. Innovation must address the challenges of health care systems.

In terms of design, we need to be able to look at technology from the perspective of how it is actually used. I think, in a number of cases, we look at doctors—in many cases, specialists—as the main users of the technology. But for many health problems, including chronic illnesses, the patients should be the main users. So we are talking about promoting the patient's autonomy, their ability to have access to user-friendly equipment. Patients are a very important niche.

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

Thank you.

In your presentation, you said that it was unfortunate that foreign companies are buying our start-ups that have a lot of potential. You are not the only one to point that out. At other committee meetings that dealt with those issues, a number of people also mentioned that Canada has a commercialization problem.

In Canada, we have an investment act, but it does not really apply to investment. First, the companies have to be worth at least $312 million, which is probably not the case for most start-up companies.

Do you think we should use the act as a deterrent, by making specific amendments, or would it be better to focus on the positive side of things and should the federal government take these companies under its wing to some extent and help them in various ways?

[Dr. Pascale Lehoux]

I am not an expert on that issue. Perhaps the colleagues around you are in a better position to give you an answer than I am.

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

In that case, I have one final question for you.

Do I still have one minute?

[The Chair, Conservative, Joy Smith]

You have one minute.

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

That's fine, I will be quick.

In your third message, you are saying to “design and market much more ingenious innovations than those that are currently on the market”.

Are you really weighing your every word when you talk about innovations in Canada? Many witnesses we hear from are telling us that we are a country of pilot projects, but that we are unable to share our best things. Do you really feel that we are not ingenious enough?

[Dr. Pascale Lehoux]

I come from public health. I have spent a lot of time researching health care services, policies and organization. Unfortunately, what we are seeing is that many innovations are not adapted to either the context or the needs.

That is why I am more critical. I think more ingenious innovations will enable us to minimize our dependence on specialized services that keep going up in price. That is what we must avoid.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go to Ms. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I join my colleagues in welcoming you here today. I also join them in their observations in terms of how difficult it is to get our heads around some of the things we're hearing today.

Certainly, what we've heard today really has taken us down the path of examining a number of reasons why innovation is important, not only in the health care system, but in other industries as well, and ultimately for our country. As you stated in one of your slides, Dr. Lehoux, from the economic perspective, innovating businesses should contribute to job creation and the vitality of Canada's industrial fabric. So we know that innovation is important in a number of areas.

We've heard many challenges today. Mr. Hoch, you talked about the suitcase. I'm thinking that the way to get a bigger suitcase is to encourage private investment. Yet Dr. Jaffray, you talked about your experience in the United States and said you wouldn't necessarily support the notion that the economy of innovation would be a return on investment.

After all of our discussion today I'm wondering what the economy of innovation should be.

Anyone can answer that.

[Dr. David Jaffray]

We have to look at taking the existing investment in health care, realizing that it's not just a service, it's actually the way we figure out what will work for our population, and fund that activity to be a dynamic learning system that pulls technological or pharmaceutical innovations in, and we bolt health technology assessment onto that to confirm we have those delivered.

At this point in time that requires investment. Nobody can invest in a vehicle that's not built to give a return. We have to put together some kind of economy. It's going to have to be a financial return—maybe that's a U.S. model. It could be a quality metric. It could be letting hospitals roll their budgets over. It could be intellectually stimulating, with benefits to inventors. But we need to figure out how to turn our health care system from something that's service oriented to something that continuously improves the health care we deliver.

It shouldn't take money from basic science to do that, because that's pushing technology. It should be new funding in health care innovation that draws and capitalizes on the throughput and the innovations we have within Canada.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Is there anyone else?

[Dr. Jeffrey Hoch]

I apologize if what we've said has been complicated. From my perspective it seems very simple. We have people who are making things, we have people who are getting what's made, and we have a third group of people who have to pay for what's getting made. You can focus on how we get more things that we don't have money to buy. We could focus on making people appreciate the value of what they're not getting. Or we could think about, once we do have this, how we're going to get the money.

The costs are going to translate into someone's revenue. If you're a business person you're not going to invest in something you're going to lose money on. If you're thinking of something that you're going to be making money on, there's someone on the other side who's thinking he or she has to pay for it. It seems to me it can be as simple as that from a payer's perspective.

[The Chair, Conservative, Joy Smith]

You have one more minute.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

There is another answer.

[The Chair, Conservative, Joy Smith]

Go ahead, please.