Thank you, Mr. Chairman, and good afternoon, everybody.
My name is Bill Tholl. I am the President and Chief Executive Officer of HealthCareCAN, which is the national voice of hospitals and other health care organizations in Canada.
We foster informed, continuous, results-based discovery and innovation across the continuum of health care. We act with others to enhance the health of the people of Canada, build capability for high-quality care, and help to ensure value for money in publicly financed health care programs.
You would better know us historically as the Canadian Hospital Association and the Association of Canadian Academic Healthcare Organizations. About a year ago, the two organizations merged.
This afternoon I'm joined by Dr. Raj Bhatla, chief of staff and chief of psychiatry at the Royal Ottawa Health Care Group here in Ottawa, one of our 40 member organizations. I've asked Raj to illustrate for you in some practical ways some of the issues around scope of practice and the area you're studying here today.
Before doing that, though, we're pleased to be here to contribute to your study of best practices and federal barriers related to scope of practice and skills training of health care professionals.
As one of the last groups to present to your study, we're certain you have heard a number of critical issues from individual professions. We would like to think that we bring a collage of those perspectives to this table. Many of the professions you've heard from work in our hospitals, in our academic health care institutions, and the perspective you get from that multi-professional perspective is somewhat different again. We'll try to explain just how that looks from our perspective.
The issue of scopes of practice is one of legislation and involves more innovative approaches to teaching. It is an issue requiring legislators not to look just at eliminating barriers but also at creating bridges, so my remarks today will be split into the two categories of looking at some of the barriers, but also looking at one of the things that the federal government can do. Given this is an area that's principally the responsibility of the provinces and territories—they are the ones that determine scopes of practice, that develop disciplinary legislation, that regulate—there are things the federal government can do to aid and abet, help, or hinder, so I'm going to break my remarks into two categories.
Generally speaking in this context, looking at scopes of practice is a function of time and place. This isn't the first time I've been before this committee talking about scopes of practice, wearing at least four different hats, but it's a different time. The fiscal environment is much different from that of the last 10 or 15 years, so it's not a simple task in the current policy environment of getting it right in terms of scope of practice.
I chair the finance and audit committee at the Royal Ottawa Hospital. We're now into the fourth year of zero means zero in terms of annual budget increases, and it has now become absolutely necessary to look at how we get it right in terms of scope of practice. Dr. Bhatla will share with you some of the things we have been doing at the Royal Ottawa Hospital.
As numerous professional groups have stated already, and I would echo, we need leadership and better leadership at all levels within institutions, within governments or across governments, and in fact, right down to patients. We need leadership such as that being demonstrated, we believe, by Minister Ambrose with the establishment of the Naylor advisory panel on health care innovation.
Health care organizations and personnel seeking innovative solutions find ways to work around things. I don't know whether folks have recommended to you the “From Innovation to Action” report that was prepared for the premiers and released in July 2012, but it identified nine very specific examples of integrated, full scope of practice exemplars across Canada.
One that I remember is the Brier Island, west of Halifax, where they had trouble keeping emergency physicians. They would go in and they would leave. They would shut down the ER department and they would have to open it up again. They came up with a marvellous innovation, which was to have souped-up paramedics to work in the actual community with direct on-call access to emergency physicians as and when necessary. That's the kind of innovation we think we need to have in Canada.
What's missing? What's missing is an ongoing source of support for that innovation. There is no ongoing innovation secretariat. The health care innovation working group doesn't support that. That's an area where we think the federal government has a role to play in establishing an innovation fund that would help promote the Brier Island kinds of innovations in Canada's health care system.
Another potential barrier is the new legislation on temporary foreign workers. You have heard, I think, from others that it has the potential for unintended consequences in terms of impeding our academic health care institutions from going out and recruiting post-residency training professionals or health researchers who are in their fellowship or post-fellowship training programs to spend a couple of years here in Canada. The current law potentially—potentially—creates barriers to our doing that.
I'd be glad to elaborate on any of these.
The last one I'll mention in terms of barriers is kind of a cultural barrier. The recently published report of the Canadian Academy of Health Sciences entitled “Optimizing Scopes of Practice: New Models of Care for a New Health Care System” notes, “Determining the optimal scopes of practice of these health care providers will be an essential element in leading health care transformation for the future.” I remind you that 80% of our health care costs in our hospitals are about people—health human resources—so we have to get that right in terms of striking the right balance. The report goes on to say, “Unfortunately, the systems in place for determining and regulating scopes of practice have done more to preserve the status quo than promote change.” We have to get past that. That's looking to the past to try to create a better future, and that won't work.
Let's get to the more positive stuff. What are the examples of building better bridges that would involve, or could involve, the federal government in a leadership capacity? This is all in support, by the way, of what I've already heard here today, which is the recurrent theme that we need better approaches to needs-based health human resources planning, the emphasis being on needs-based. When all is said and done, we've been more saying things than doing things when it comes to needs-based planning in this country.
I'll give four or five examples. One, the Government of Canada, working with the provinces, could convene a national symposium to bring all stakeholders together to talk about what you're talking about. Health Canada could fill the void left by the health care innovation working group, and in particular the health human resources working group which, to be frank, floundered as the third of the three working groups, and pick up where they left off.
For a very long time we've talked about creating an observatory where we'd look at health human resource needs through the lens of the patient and evaluate those on an ongoing basis, and yet we have not done anything. The closest thing we have come to it, by the way, is to fund a health human resources network on the basis of a CIHR funding grant. Dr. Ivy Bourgeault here at the University of Ottawa is heading that up. Their funding ends at the end of this month. I think that's a tragedy.
Health Canada could continue to work with HealthCareCAN and others to harmonize legislation and regulations across the country. I would put this under the general rubric of aiding, abetting, and supporting the overall intent of the Agreement on Internal Trade. We still have a lot of work to do in terms of harmonizing accreditation and licensing programs across the country.