Health Committee on May 6th, 2020

[Andrea Seale]

I could speak briefly to it. Among the top concerns we hear from cancer patients, I think they relate to financial strain overall. When you have chronic health conditions, such as cancer and others, there are burdens placed on patients depending on where they live and what kind of access to health care they have, and there's the financial strain it places on people in having to get to treatments or losing employment. Any of these changes that add to financial stress are the kinds of things we hear about and that patients feel very deeply.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[Anne Simard]

If I may add to that, the other piece in terms of virtual care is that what has actually been a success story is how not only many health care provider clinics but also patients have responded to virtual appointments, renewing prescriptions by email and getting consent by video conference. There is a lesson in here that is a success story. It's about how there has been a fair bit of resistance and many challenges for so long, and there's been a bit of a breakthrough in this period around accessing different modes of care, and an acceptance that wasn't there.

I'm not diminishing the challenges presented, but there is a piece about the virtual appointments, telemedicine and the adaptiveness that patients and caregivers and the health care providers have shown that I think is an important go-forward strategically for the health system.

[Dr. Mohit Bhutani]

I'm going to add to that for just two seconds, Mr. Chair.

I would echo those comments. In Alberta we've been using telemedicine for a long time for rural and remote communities, and it's worked very effectively. To see it gravitate into the more urban centres has been a real positive. I think the investment in the virtual care is good for now, but is also going to be helpful for the future.

[Dr. Durhane Wong-Rieger]

I don't mean to take up all of your question time, but I have to put in a very strong word about rare diseases. For our patients, because they don't normally have a good plan of care and their specialists are oftentimes isolated far away, we have patients who say, “I can get a meeting with my family physician, but they know nothing about my disease.”

We come back to needing to have comprehensive plans of care for patients with rare diseases, plans that they can own, that they can hold. This is what many other countries do. We need to have the ability for patients to manage their care, and then they can actually have access to what we hear is happening in cardiovascular disease, in cancers and in other conditions. For us, this is something that has actually turned into a nightmare for most patients, because they can't get access to others who would actually know anything about their disease.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Sidhu.

Mr. Cloutier, I would point out that when you're answering a question, you can leave your headset on so we can talk to you if there are translation issues or sound issues and so forth. Thank you.

Also, Dr. Wong-Rieger, try to remember your microphone, okay?

We go now to you, Mr. Thériault. You have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I'd like to thank the witnesses for their very informative testimony.

Ms. Seale, experts have come to tell us that this will not be the only pandemic, that there will be others in the coming years. I have read your brief carefully, and it's quite comprehensive. Other witnesses have also come to tell us that the underfunding of the health care system has weakened it. As a result, when we are faced with a pandemic as virulent as the one caused by COVID-19, the system is unable to take care of its patients. The system was already overburdened and, in terms of diagnosis, we know how important it is to diagnose in a timely manner, especially with cancer, which is the leading cause of death. It's clear from your brief that right now patients and caregivers feel left out, and they are.

It seems that we have learned nothing from SARS. In your brief, you make it clear that, this time, perhaps we need to be aware of the long-term effects of this pandemic and its impact on the treatment of our patients. We didn't collect that information during SARS. I was looking at everything you do, and I thought your organization would certainly be interesting, important, and relevant enough to do that kind of research. What would you think if we did put the money forward so that your organization could take the lead on this kind of research? Do you think it would be in a good position to do this follow-up, which wasn't done during SARS?

[Andrea Seale]

Yes.

I'm sorry. I missed the very beginning of your comments, but I think the rest was directed to me. Is that correct?

[Luc Thériault, Bloc, Montcalm, QC]

Yes, absolutely.

[Andrea Seale]

Thank you.

Absolutely, I think there are going to be many lessons to be learned. From the patient perspective, I think there has been a great deal of understanding that the health care system is in an impossible situation and that we've had to prepare for the worst. At the beginning of the pandemic, when you looked around the world, it really looked like of course Canada needed to avoid the worst that we saw in other countries. Perhaps our preparation has meant that we won't see that in Canada, which I think cancer patients, like all of us, would be very grateful for.

Absolutely, there are lessons to be learned here about the impact. One of the things that's a great challenge for our Canadian health care and that applies to cancer very specifically is the lack of access to data about patient experience, which is held in different pockets across the whole country and makes it quite difficult to understand in real time what people are going through and adjust. I think there are great lessons to be learned.

There's absolutely research that should be done to understand not just how we would deal with another pandemic, but also how we could create a health system that can be more responsive to people's needs on a very timely basis. We would think that would be another good outcome from what's been such a challenging situation, just as Ms. Simard mentioned virtual care as being something that's been a real, positive leap forward that the pandemic has caused. I think we could apply the same...to understanding the impact of strain on the system on different types of diseases and patient groups.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

Would you like to add anything, Mr. Cloutier?

[Paul-Émile Cloutier]

Mr. Thériault, I find your question very relevant. I would just like to add a new dimension to it, without, however, contradicting what you said.

Today in Canada, most of our hospitals are operating at a capacity beyond what should be the norm. Often hospitals are operating at 110% or 120% capacity, and there are no beds or space left for patients. The COVID-19 crisis has put additional stress on the system, forcing hospitals that were already operating at overcapacity to let some patients return home and to convert some rooms, such as operating rooms, to intensive care units. This problem is caused by the lack of adequate infrastructure to meet Canadian needs.

[Luc Thériault, Bloc, Montcalm, QC]

How should—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

I'll continue in the next round.

[The Chair, Liberal, Ron McKinnon]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair. Thank you to all the witnesses for being here.

My first question is to Ms. Seale.

Ms. Seale, you've talked about the profound impact on the finances of the Canadian Cancer Society. I know that you requested emergency funding of $16.4 million from the federal government for a few things: to protect vital services, reduce isolation, support mental health, expand navigation resources and provide practical supports for cancer patients. Has the federal government responded to that funding request yet?

[Andrea Seale]

We've had numerous positive conversations about the request and, I think, a great deal of understanding of the needs of cancer patients and the role that we could play in supporting them. But those conversations are still ongoing and we haven't had any confirmation of funding.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Cloutier, you gave some pretty sobering statistics about the age of hospital infrastructure in Canada, and apparently the majority of it is well over 50 years old. You've also written that Canadian hospitals are forced to defer much-needed maintenance due to budget constraints in order to maintain front-line care for patients, and you've noted that we have not adequately funded the upkeep of our health institutions. In your view, what does the effect of this deferral of needed maintenance have on infection control in our hospitals?

[Paul-Émile Cloutier]

It certainly has an impact, and especially an impact on patients who are either vulnerable or older. It also has an impact on our ability to introduce new technologies within our hospital sector. I'm always reminded that one of the hospitals which I visited was receiving a gamma knife, but the infrastructure for receiving the gamma knife did not allow that to be placed within that hospital. So it has an all-around impact on the organization.

We had estimated a few years back the number of projects and we had gone to many of our institutions, which are members of HealthCareCAN, and asked them what projects they would put in place to allow them to really upgrade their institution. I believe that number is in the billions of dollars. I don't have the exact number.

This leads me to my last point on this. At this moment, hospitals are not allowed to access any infrastructure funds, and again it's a simple regulation that does not allow hospitals and schools or universities to apply for the competition within the government's infrastructure fund envelope. I believe that's unfair, and I believe that hospitals—

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Cloutier. I'll move on to another question.

You've also written that once COVID-19 is behind us, it is imperative that we complete the unfinished business of medicare by closing the gaps in long-term care and traditional institutional health care systems. There's been some talk lately about establishing national standards for long-term care, perhaps bringing them under the Canada Health Act or establishing a federal transfer to the provinces and territories, but tying that money to observing higher standards of care for long-term care for seniors. Is that something your organization would endorse?

[Paul-Émile Cloutier]

Yes, it would be something our organization would endorse. I find that the long-term care organizations have been left behind. They should be enshrined in the Canada Health Act. I think that would be a first step. They need to be a partner in the delivery of health care. They can't just be put on the side, thinking they will organize by themselves. We saw the complexity with COVID-19; what was happening among hospitals, long-term care and the delivery of the care.

To me it would be an appropriate move, and I think a political move that would be welcomed by all Canadians.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Wouters, I want to make sure I understand this. You're saying that non-COVID-19 research in Canada is not being funded right now purely because the CERB criteria that has been set by the federal government excludes hospital or clinical-based research.

Do I understand that correctly?

[Dr. Bradly Wouters]

Yes, the main issue around the reduction of revenue is because when research is suspended it means that much of our revenue also gets suspended. We do a large amount of clinical research, clinical trials, funded by external industry, pharmaceutical companies and biotech companies. Because of what the hospitals have done to prepare for COVID-19, as you heard from the other witnesses, a large number of those clinical trials have been stopped. That revenue has also been stopped.

For us alone, our single institution, that represents a drop of over $6 million per month in revenue.

[Don Davies, NDP, Vancouver Kingsway, BC]

The remedy for that is what?

What advice would you give us to recommend to the government to fix that?