I think there are many barriers, but let's not forget as well the examples of excellence across the country where they are able to overcome those barriers. We are known across the world as innovators. The problem is that we innovate a lot of pilot projects, and we need to scale them up.
In terms of barriers, there are numerous barriers. One of them, though, and an important one, and almost the elephant in the room, is a culture that refuses to talk about end-of-life care issues, a culture that unfortunately equates palliative care only with death and dying and does not see it as about living and improving quality of life, and a culture as well that is overreliant on the health care sector to come up with solutions. I firmly believe that it's time we started looking at other sectors, such as education, the financial sector, and social services. Can you imagine, for example, if our children, finishing K-to-12 school, ready to go into the world, are equipped with those life skills that allow them to have frank discussions about this, to talk about advance care planning, and importantly, to be able to care for their grandparents—even perhaps their parents, perhaps even friends, as my children have experienced—and able to have those skills to sit at the bedside of someone who's frail and elderly and listen to their stories and hear from them? We'd start getting this cultural shift occurring.
Imagine if companies were able to have programs in place so that they were aware that a staff member or family member had an advanced progressive disease and were able to put measures in place to help them out. I think there's a lot we can do as well from a non-health care sector.
If we look at the health care sector, there are a lot of resources we already have. It's a matter of reformulating and readjusting them. I gave the example earlier of the fee for service. If the ministries in those provinces, including Ontario, were to say, “Okay, we're already paying these doctors; let's pay them in a different way that helps them build capacity”, I think we might start seeing more capacity being built.