Health Committee on March 7th, 2017

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

As the next question, we come up with a national palliative care strategy, but that has to be built into legislation. You commented on that briefly, but I'm wondering if you could expand on that aspect a bit more. In your estimation, should we have this as part of our health act going forward? Should we renegotiate that?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Well, it's a balance of what else people will want to put into the Canada Health Act. I'm an engineer, so I'm very pragmatic, and I'd just open it up. Originally when we first did the draft of the bill, we said we'll just amend the Canada Health Act and stick in palliative care, including end-of-life care, as a covered service, and we'll be away, but there are a huge number of people who want to add many other things to the Canada Health Act, so I think there is an inherent fear of opening that can of worms.

Right now we're negotiating a health accord with the provinces, so there's an opportunity. Provinces want to be offering the service and they're already starting to move in that way, and the federal government is in discussion with them, so there's an opportunity naturally at this time there.

That may take a long time to put in place, so in the interest of trying to get things happening in a hurry, that's where government programs can come into play. We've seen infrastructure announced of $186 billion over the next 10 years. Why couldn't some of that be for establishing a palliative care infrastructure in co-operation with municipalities? Why couldn't that be used to provide some training resources to upgrade doctors, nurses, and home-care providers and paramedics?

The third mechanism I described is my idea of how to get there fast while you figure out what the other long-term mechanism is to make sure it's clear what is federal jurisdiction and what is provincial.

[Rachael Thomas, Conservative, Lethbridge, AB]

Awesome. Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Mr. Oliver is next.

[John Oliver, Liberal, Oakville, ON]

Thank you very much.

Thanks for bringing this forward. I think it's a really important piece of legislation to be considering, particularly, in my view, against the medical assistance in death. To have that coming forward and not to have appropriate palliative care choices or to have anybody opting for some of the provisions under MAID because they don't feel there are adequate palliative care services for them makes me think it's morally imperative that we have appropriate palliative care programs.

I totally support what you're doing and also your comments about whether people are getting care in the right place. I think the Canadian Hospice Palliative Care Association said the majority of Canadians wish to die at home, but 75% of deaths are occurring in hospitals and long-term care facilities, so we really do need to change our understanding of where and how a well-managed death can occur.

My questions are a bit more detailed, then, within the bill itself. There's been some discussion here about federal versus provincial jurisdictions. In subclause 2(1), where you talk about the Minister of Health, in consultation with the provinces and territories and private care providers, developing and implementing a framework, I'm just wondering about your choice of the word “implement”. Clearly the delivery of these services and the implementation of palliative care programs will, under our model, belong with the provinces and territories, not the federal government, so what was your view of the word “implement” there?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

My view is let's do something. The comment I heard during the debate was that this was one area where they would like to modify the words. Although it says that it's the Minister of Health in consultation with the provinces, it's clear that the provinces have the responsibility to implement whatever it is that's determined, so I'm happy to see an amendment there to reflect that point.

[John Oliver, Liberal, Oakville, ON]

Okay.

Under “Review and report”, you have to report back, within five years of the tabling of the report, on the effectiveness of the framework and implementation of it, but then you're proposing every five years after that. I have a concern with legislation that never ends, and I'm not quite sure what you gain in year 10, year 15, from these reports. I was wondering about your thoughts there.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Well, I would say that being new at this private member's bill business, I took what was typically recommended in other similar bills.

That said, the idea is that you're going to start down a path of implementing palliative care and you need to check back every so often. Does the mechanism have to be legislative? No, it doesn't, but if it's not, sometimes governments come and go and they slash Statistics Canada or whoever is collecting the information, and then you lose information and you lose your benchmark. It was an attempt to see that this is in place.

As with everything, I think it's important to move forward, so I'm flexible to change if there's a different suggestion.

[John Oliver, Liberal, Oakville, ON]

On that one, after five years, assuming we have a successful take-up by the provinces and territories, the federal leadership is done at that point, and it's really going to be the provinces and territories that will have to be executing and delivering the palliative care models. That's why I thought that at a federal level to have a report 10 years after it starts.... I just wasn't quite sure. Thank you, Ms. Gladu, for that.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Sure. I'm open to wording to say that it would be succeeded by provincial reporting or whatever. Somebody needs to be tracking it and looking at it.

[John Oliver, Liberal, Oakville, ON]

On education, then, I think the Department of Justice talked about palliative care when they had their consultation on physician-assisted dying in January 2016. They said that out of 77,000 physicians, 51 are palliative care specialists and 123 family practitioners have that focus. Out of 77,000, fewer than 200 are equipped to medically provide supervision. Out of 360,000 RNs, 1,348 have a certificate in palliative care.

There's clearly going to be a need to focus on education to make sure there's appropriate training. You were kind of silent on that, I guess. You identified palliative care training and the educational needs of palliative health care providers, but we're really looking at generic positions and having them with some degree of specialty versus.... Or were you picturing a whole new type of provider who is focusing on palliative care?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

No. There are providers today who are offering palliative care training, and I think we need to take advantage of it at the different levels to start expanding the amount of service that can be provided.

For example, think about RNs. There's a course they can take with Pallium Canada. It's available today. It's available in multiple provinces. There are also other courses. I don't want to pick only one, because we have to be non-commercial here. In universities and in a number of places, levels of training are available for doctors, nurses, home care providers, and paramedics. It's available for different levels of service providers.

With regard to the numbers you're talking about, certainly those programs would grow over time, but even with the existing programs, I think moving down that road and getting people trained is what's required.

[John Oliver, Liberal, Oakville, ON]

You talked about the educational needs of palliative health care providers. I want to be very clear about it. My view is that we provide some additional training in palliation to doctors and nurses who already have broad skills. You're not looking at a new type of health care provider, then?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

No, but I'm looking at using some of the less traditionally used health care individuals, such as paramedics and home care providers, especially when you start to think about what the plan is for rural and remote areas. They don't always have a palliative care specialist, that's for sure, and sometimes not even a doctor. They might have a nurse, but they might just have people providing home care or people coming by occasionally, so what can you do? There are examples of people who have trained the paramedics to understand palliative care and to be able to administer it. I think that's a great innovation.

[John Oliver, Liberal, Oakville, ON]

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much. Your time is up.

Mr. Davies is next.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Carrie asked some questions about the current health accord. Do you feel that there is enough money in the current new offer by the federal government to the provinces to adequately allow the provinces to deliver the palliative care services that you believe are necessary?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Well, I don't think there's enough that has been put forward, but that said, I think there's enough to start. I haven't seen what's been done with the $3 billion that was already proposed, but in terms of some of the things that could begin, between that and the $186 billion over 10 years in infrastructure that's been announced, I think there's an opportunity to double, triple, or quadruple the amount of palliative care that's available. That's the direction we need to move in.

[Don Davies, NDP, Vancouver Kingsway, BC]

You believe that in terms of whatever infrastructure funds for capital projects may be allocated over the next 10 years, at least some of that should be allocated to publicly built palliative care facilities. Is that right?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

I believe the federal government should be putting in that money, to be matched by individual providers, municipalities, or charitable organizations, to build the hospices we need, for example, or to build the kind of virtual palliative care centre that's available in Winnipeg. I think these are things that the government should do.

[Don Davies, NDP, Vancouver Kingsway, BC]

Certainly, you wouldn't, I take it, support those public funds going to private sector for-profit facilities. Are you calling for that kind of public subsidy to private providers, or are you talking just about—

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

No. This is part of the standard health care provision under provincial health care.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. Of course, you come before us as a Conservative in opposition. Ms. Gladu, you know that under the previous Harper government there was an imposed health accord in 2014 for 10 years that had no money for palliative care. There was no $3 billion allocated for any kind of home care palliative care.

Would you agree with me that this was an accord concept that would not be able to fund the kind of palliative care you think is necessary?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

I would say that I can do zero about fixing the past. I can only fix the path forward. I think it's clear from the unanimous support the bill got that people are ready to implement palliative care. It is going to take some money, and the government has to determine the rate at which to pace that. It's not something that you can bankrupt yourself today on, but it's something you need to invest in and you need to figure out how to get the best bang for the buck.

[Don Davies, NDP, Vancouver Kingsway, BC]

For sure. Ms. Gladu, as my late father used to say, wisdom comes so seldom that we shouldn't reject it because it comes late. I agree.

The health accord is live before us, so I'm trying to find out what your policy would be, what recommendations you would make to this government about how much they should spend on palliative care and home care, given that we had 10 years of government that really didn't allocate anything.

As a matter of fact, from 2001 to 2006 the federal government funded the Secretariat on Palliative and End-of-Life Care, giving them $1 million to $1.5 million a year. One of the first acts of the Harper government in 2006 was to cut that. That basically took about $10 million to $12 million out of a federal government entity that was charged with creating an end-of-life strategy. Would you like to see that money restored?