Health Committee on March 7th, 2017

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

It's not a lot.

[The Chair, Liberal, Bill Casey]

Thank you.

Go ahead, Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

Thank you, Ms. Gladu, for the work that you do here and for your constituents. They must be proud of the work you're doing on this palliative care issue.

I have two hospices in my riding of Calgary Confederation: the Rosedale Hospice and the Agapé Hospice. They are wonderful facilities that do great work. The Rosedale Hospice opened about 20 years ago. My family and I were quite involved in starting up that hospice. There was a lot of volunteer work done there. Also, my constituency assistant right now was the executive director of the Rosedale Hospice for many years, and then she came to work with me in my office. We're quite proud of the work we have done in Calgary with the hospices.

One struggle that Rosedale Hospice has always had was funding, and they continually had fundraisers and such. It seemed the director was more involved in trying to raise money than in providing care to the patients there. It was quite a struggle, and I'd love to see more funding come from the government for these private hospices.

The other hospice we have is the Agapé Hospice. I know that hospice very intimately. My wife, at 37 years of age, was diagnosed with stage 4 breast cancer and went through a long struggle with the disease, and there was wonderful home care provided to us. Donna Dryer, a lovely, wonderful registered nurse came to our home daily to care for my wife, and she was a godsend. I would love to see more focus on home care in the country here. My wife Heather spent three days in the hospice. We kept her at home as long as we could, and that's where she wanted to be. Where most people want to be is at home. Again, I can't say enough about how important it is to have a good home care system throughout the country.

Ms. Gladu, I find that Rosedale and Agapé are incredible care facilities. They would be wonderful for best practices around the country. Have you looked into federal best practices, whether here in Canada or internationally? Do you know of other countries that are doing a better job at this? If so, who are they, and what can we learn from them?

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

Yes, certainly. There certainly are very many.

First I want to thank you for sharing the story of your wife. My father-in-law died in a hospice, and that was my first exposure to seeing the excellence of their multi-faceted care. My daughter is now a home care nurse providing palliative care, so I'm seeing this from all angles.

In terms of people who do it well in the world, if they have implemented assistance in dying, they have typically put palliative care in place to provide a choice, so many of the countries, like Belgium and the Netherlands, are very far down the way in terms of palliative care. I think you're going to have testimony from Dr. David Henderson. He keeps an eye on who's doing it well in the world, and what to leverage. The quality coalition organization, which brought forward “The Way Forward” palliative care framework, has had a lot of hospice members as part of its organization, and so they share best practices. I think in the future that's exactly what should happen, because many provinces are starting to implement things that are working very well, so having conversations with the provinces and providing some standardization across the country would be a great direction for the government to go.

[Len Webber, Conservative, Calgary Confederation, AB]

With regard to jurisdiction within the provinces and territories, then, do you see an issue there? I know we had that issue with pharmacare in the past, and also with organ donation registries and programs. Do you see some issues with regard to palliative care?

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

There's always a fine balance between what's provincial and what's federal, but the provinces are clearly the ones to execute the care. I don't think we're in a situation of the provinces not wanting to implement palliative care. I think the provinces do want to implement palliative care, and they're struggling with resources and an overall plan of how to get there. I believe that's what they would look to the federal government to provide, a plan, and then to determine how long that is going to take. As I said, this is a hugely expensive thing that you cannot do instantaneously, and the $3 billion that's been announced is a great place to start.

[The Chair, Liberal, Bill Casey]

Thanks very much. Your time is up.

Go ahead, Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Ms. Gladu. We worked in the past on the pay equity committee. This is a very important issue. Thank you for raising this issue.

If we see that in the background—the issue of pay and gender equality when we were working together—what's your thought about gender equality? It also raises the question from the perspective of the varying types of work, varying hours, varying lifestyles. How might a national strategy on palliative care reflect on the needs of the people who are providing the care to the loved ones?

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

This is a very interesting question, because if you think about the resources that are needed to get more palliative care, you're talking about a lot of nurses, a lot of personal care workers, and an increase in physicians, and these are areas where women are predominant in the workforce. This measure would create well-paying jobs for women. I think that would be a step forward, certainly.

In terms of whether women are more affected than men in the need for palliative care, I have not seen any statistics on that. I would be interested to take a look at some of the things, such as ovarian cancer and breast cancer, that seem to be very prevalent with women and typically can lead to the need for palliative care.

[Sonia Sidhu, Liberal, Brampton South, ON]

You talked about $1,200 in expenses in the hospital and $200 in home care. Is this new research? Is there any data like that?

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

An economic report that just came out has studied this aspect. I could provide it to the clerk, if you like. A previous study that was done by the Canadian Medical Association looked at the average figures for a palliative care bill in hospital versus hospice versus home care.

[Sonia Sidhu, Liberal, Brampton South, ON]

When you talked about standardization of training for the PSW, I wanted to raise the question of the language barrier. Canada is a diverse country. People are from different areas. Do you have any strategy for the language barrier for people in palliative care?

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

Well, I think there is an opportunity. Palliative care training is offered in English and French in the programs that exist today, but as you move into some of the remote communities where first nations languages may be the language of choice, or into other communities, then there would have to be an effort, I guess, to move into other languages. One way of addressing that is to hire people who are from that area and who speak that language; then that is an immediate overcoming of that barrier.

[Sonia Sidhu, Liberal, Brampton South, ON]

Do you foresee any other challenges or any other barriers to the implementation of a national strategy of this kind?

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

No, I think the time is right. I sense that across all parties and across both provincial and federal governments, people are ready to start doing palliative care. I think there is a question of how fast we could implement it and what should come first.

There are things that are easier to do. Putting money into home care is easier than building infrastructure, for example. Addressing the rural and remote communities is the most complicated, because in many cases they are without Internet and without any transportation or fly-in crisis response service.

I would say there is an order of operations, and that should be part of the plan that is recommended in this framework.

[Sonia Sidhu, Liberal, Brampton South, ON]

You also mentioned the palliative home care and virtual home care in Winnipeg. Can you elaborate a little bit more?

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

Yes, this is amazing. I had them come and show me what they were doing there. They have a 24-7 staff of palliative care specialists. You can call in there—nurses and home care workers from anywhere—and receive a walk-through of what to do to the patient in terms of administering pain control, crisis intervention, and all of these different things. This makes the service, first of all, economically great to deliver, but also just think about having access to that service. If you're nowhere with your resources and all of a sudden you have access to seasoned palliative care specialists who really know what they're doing and can give specific instructions and are experienced in doing that, I think that is an innovation we should definitely leverage across the country.

[Sonia Sidhu, Liberal, Brampton South, ON]

Okay. Thank you.

[The Chair, Liberal, Bill Casey]

Go ahead, Ms. Harder.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

Thank you so much for taking time to be with us today and to answer questions with regard to your bill. I think this is a cause that is certainly worth fighting for, so thank you for taking the initiative.

As we're all aware, Bill C-24 came to fruition in June, and with that, of course, we have now given Canadians the opportunity to choose physician assistance in dying.

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

It was Bill C-14.

[Rachael Thomas, Conservative, Lethbridge, AB]

I'm sorry; I meant Bill C-14.

With that, we have given people the option to choose physician assistance in dying. At the same time, however, we have not given them the option to choose access to palliative care should they choose to die without medical assistance and simply want to be pain-free in an environment of comfort when they do die.

In my estimation, then, I would say that our present legislation and of course our lack of palliative care are creating a problem in Canada, and that problem is a lack of choice. I wonder if you can comment on that further.

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

Certainly the special committee that studied the Carter decision said that without good palliative care, you don't really have a choice. You can appreciate how somebody who would be suffering agonizing pain day after day after day, with no hope of any intervention, would choose assisted dying. That certainly was the pattern in countries that began to implement assisted dying without any palliative care to come alongside. However, countries that have put good quality palliative care in place find that 95% of people choose to live as well as they can for as long as they can, so I think we do have a responsibility to Canadians to give them a choice, and the 70% of Canadians who have no access to palliative care today really don't have a choice. That's why we need to move quickly to address the need.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

In your overview, you briefly mentioned research and data collection. Can you comment further on how we currently do that, and whether there are changes needed so that we can have better delivery when it comes to palliative care?

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

I had great conversations with the Minister of Health on this one, because apparently there is a vacuum of data. There is really no information about how many people need palliative care or how many people are being given palliative care because it's being administered in so many different places and in so many different ways, and some of them are tracked and some of them are not.

This is the data we really need to understand: what is the need, what is the cost, and how are we making progress over time? I'm certain that the information could be collected in any number of ways. It could be through Health Canada; it could be through Statistics Canada; and there is the Canadian Health Information Management Association, which collects a lot of health information. I think it's for the government to determine what is best, but definitely you measure, and then you do. I think that would be good.