Good morning, Mr. Chair and members of the committee. My name is Michele Brenning, Assistant Commissioner, Health Services, Correctional Service of Canada. With me is Henry de Souza, Director General of Clinical Services and Public Health.
I would like to thank the committee for the opportunity to comment and provide input on the federal role in the scopes of practice of Canadian healthcare professionals.
The Correctional Service of Canada, or CSC, is mandated under the Corrections and Conditional Release Act to provide every inmate with essential health care and reasonable access to non-essential mental health care. Moreover, the act stipulates that the provision of health care shall conform to professionally accepted standards.
To accomplish our mandate, CSC relies on approximately 1,250 health staff, as well as contractors, who work in interdisciplinary teams and include nurses, psychologists, social workers, occupational therapists, general practice physicians, psychiatrists, and pharmacists. In addition CSC is looking to diversify our staff mix to include nurse practitioners and physician assistants, as well as non-regulated health professionals such as personal support workers.
On a typical day there are 15,000 offenders in federal institutions across Canada. CSC's institutions are divided into five regions: Atlantic, Quebec, Ontario, prairie, and Pacific.
To support professional competencies, CSC provides ongoing training in a variety of areas within the streams of mental health, public health, and primary health care.
Along with adherence to professional standards of practice as articulated by the relevant professional colleges, CSC's national essential health services framework, the national drug formulary, and active quality improvement processes are key tools used to promote consistent, safe, and effective delivery of health services to our clientele.
Health care is costly, and human resources are a significant cost driver. As a provider of health care to a challenging clientele, understanding the scope of practice of various disciplines and finding the right staff mix are critical in our efforts to maximize effective and efficient service delivery.
Although there is no consensus definition, the key element of scope of practice can be identified in the Canadian Nurses Association definition:
A profession’s scope of practice encompasses the activities its practitioners are educated and authorized to perform. The overall scope of practice for the profession sets the outer limits of practice for all practitioners. The actual scope of practice of individual practitioners is influenced by the settings in which they practice, the requirements of the employer and the needs of their patients or clients.
Achieving the optimal staff mix requires leveraging the flexibility within overlapping scopes of practice, while at the same time valuing and strategically utilizing the specialized expertise. For example, in the field of mental health there is overlap within the professions such that the mental health counselling can be carried out by the disciplines of social work, nursing, psychology, general medicine, psychiatry, or occupational therapy.
On the other hand, there are activities where the expertise resides exclusively or primarily within the discipline. For example, a multidisciplinary team will rely on a psychologist to conduct a psychological assessment. Similarly, general practitioners providing primary mental health care may rely on a psychiatrist for more complex or tertiary level psychiatric interventions.
As a federal government department operating within several provincial jurisdictions, and therefore several provincial colleges, there are barriers to optimizing efficient delivery of health care. For example, there is no automatic interprovincial transfer of licensure for professionals. This significantly limits the mobility of registered professional staff across Canada, thereby limiting matching staff availability to the geographic area of need.
Telemedicine and telehealth are recognized as being both effective by providing access to specialists who might not otherwise be possible, and efficient by reducing travel costs and enhancing the ability to see more patients. However, there is still no consensus on liability with respect to providing treatment across provincial jurisdictions.
Although the scope of practice may allow certain activities by a professional, training may be required to ensure competency in unfamiliar areas of practice.
As a result of these observations, we would offer a few recommendations to improve the ability of health care professionals working with CSC to better respond to our evolving needs. These include a national standardization that allows interprovincial mobility, and flexible scopes of practice that allow, in collaboration with the relevant college, the option to train to an accredited standard beyond the scope of practice in order to address needs in rural and remote areas where recruitment is difficult.
I believe that CSC is well placed to offer an opinion on the practice and training of healthcare professionals on the federal level in direct relevance to this committee study.
Although considerations for time prevent me from providing more specific details. In my opening remarks, I would be pleased to answer any questions this committee may have.
Thank you once again for the opportunity to appear before you today.