Evidence of meeting #19 for Health in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was data.
A recording is available from Parliament.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
That means collectively, through our company plans, through drug plans or through the government plans that already exist, if we add those all together, we would pay $5 billion less if we had a national universal pharmacare program.
National Director, Policy and Advocacy, Canadian Health Coalition
That's right. We didn't just come up with those numbers ourselves. A report by the Parliamentary Budget Officer had some conservative estimates in it. Some people say it would even be upwards of $11 billion a year. It depends, I think, on the discounts we could get on the prescription medications, but the savings would be substantial. In part, as you highlighted, it's because we would be saving money in other areas of the health care system as well, so the government would be saving money in that way.
In terms of a universal public long-term care and home care program, I'm not an economist either, but I would say that it really is a question of priorities. I think we've seen the consequences of the current state of long-term care in this country. I don't think anyone would think that this is acceptable. There's some early data suggesting that there are more deaths in for-profit long-term care facilities than publicly run not-for-profit facilities.
Again, it's a question of priorities. I do think that when the government decides it's an issue that it's going to take on and make a priority, which I think is what seniors really deserve here, then we can find the funding for it. Where there's a will, there's a way.
Liberal
Liberal
The Chair Liberal Ron McKinnon
No. Thank you, Dr. Powlowski.
We go now to Mr. Thériault for six minutes, please.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
I'd like to thank all the witnesses.
It would be very interesting if you could submit your speeches today and, if you wish, add comments in light of the questions you'll be asked.
My first question is for Dr. Dorian.
My blood ran cold as I listened to your testimony. It goes without saying that cardiology treats a vital organ. A number of witnesses have come to tell us that the health care systems that were weakened before a pandemic such as the one we are experiencing, given its severity, were in bad shape. Before this pandemic, the system was barely able to properly treat and care for people.
I understand your concern about collecting information, but based on what you know today, how long do you think it will take to restore the situation and resume care for patients with acute and chronic cardiac problems?
Representative and Department Director, Division of Cardiology, University of Toronto, Canadian Cardiovascular Society
Thank you very much for your question.
We are ready to resume all acute care immediately, just as for a heart attack that must be treated right away. It's possible to resume treatment today, if patients come in when they are in crisis. For chronic problems, for procedures such as non-acute angioplasties, valves and defibrillators, unfortunately, there was a fairly long waiting list, even before the COVID-19 crisis. I don't know exactly how long it will take because we still don't know when we'll be able to resume treatment. In fact, we'll probably resume elective procedures very slowly. However, “elective” doesn't mean that we can wait years to perform these kinds of procedures because, unfortunately, there are deaths among patients who are on a waiting list.
It depends a bit on when we can do more elective procedures than we did before the COVID-19 crisis. Otherwise, since we were already working at full capacity before the crisis, I admit that I don't know how we'll be able to add patients who haven't received care for one, two or three months. At the very least, we'll have to increase the number of procedures we perform by a few percentage points, which will take months or maybe even years.
Bloc
Luc Thériault Bloc Montcalm, QC
I'm not sure if you're aware of the situation in Montreal, including some health care centres where there have been outbreaks. I'm thinking in particular of Hôpital du Sacré-Cœur de Montréal. Don't these outbreaks complicate the delivery of cardiac care to patients who don't have COVID-19?
Representative and Department Director, Division of Cardiology, University of Toronto, Canadian Cardiovascular Society
I fully agree with you.
First, we had to reduce the total number of medical procedures we could perform. We can focus more on certain procedures, such as angioplasty for people with acute heart attacks but, in principle, we had to reduce the total number of procedures.
Second, we aren't ready to reopen yet.
Third, there will be an increase in the number of patients waiting, even after all the doors have been opened.
Bloc
Luc Thériault Bloc Montcalm, QC
Should there be a special protocol to reassure patients who have appointments at these health care centres where there is an outbreak? Should those patients be redirected elsewhere? How is that going to happen over the coming weeks?
Representative and Department Director, Division of Cardiology, University of Toronto, Canadian Cardiovascular Society
I fully agree.
What the patient is told about the appointment will vary from one hospital or group to another, and will depend on the location and the workload whether it is possible or not.
That's why I wanted to emphasize that, as much as possible, hospitals and health care centres across Canada need to work together to know exactly where to send patients when they can't be treated locally.
Bloc
Luc Thériault Bloc Montcalm, QC
Earlier, you seemed to tell us that this could be done fairly quickly. Is the IT infrastructure already in place to do that? How and in what time frame could it be done?
Representative and Department Director, Division of Cardiology, University of Toronto, Canadian Cardiovascular Society
Almost all hospitals already collect the necessary data. This data is collected on site but isn't shared among hospitals, regions or provinces.
The challenge is to collaborate and find a computerized way to share data between hospitals. This will require willingness, discussion and resolution of patient data security issues. Patient data is, in principle, personal data, and patients must first be allowed to share and discuss it.
So the problem isn't so much that the data isn't collected, but rather that it remains local and isn't discussed between regions.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Thériault.
We go now to Mr. Davies for six minutes, please.
Don Davies NDP Vancouver Kingsway, BC
Thank you, Mr. Chair.
Thank you to the witnesses.
Dr. Dorian, I'd like to pick up on that last point. You're one of, it seems, a long lineup of witnesses who have commented on the frustration of not having national standardized data. Would you support the call for national leadership, backed up by federal legislation, to make national standardized data collection mandatory?
Representative and Department Director, Division of Cardiology, University of Toronto, Canadian Cardiovascular Society
Absolutely. I could not emphasize more exactly what you've just said.
Let me give you a specific example about frustration. There's been a lot of discussion, for example, on our lack of understanding whether patients.... Let's take acute heart attacks, for a moment, or cardiac deaths. We know from places that collect this data in real time and publish it immediately there's been about a 40% increase in the number of people dying outside of hospital—in Italy, in New York and in other jurisdictions that have this data where they measure it reliably.
Every time somebody dies outside of hospital, that information is collected in vital statistics, because a death certificate is issued, or it's collected by the 911 paramedics. That data is available in electronic format within four hours of the event. We know where it sits: in the individual's emergency medical system's data repository in each individual municipal jurisdiction. When patients arrive in hospitals we know that data is collected in the emergency department. It's immediately abstracted and uploaded to a computer. That's how we know, for example, how many patients have COVID at any one time. For patients who are admitted to hospital, we have that data within weeks, but we potentially could have that data within days.
The problem is not that highly skilled individuals are not collecting the data; rather, it isn't aggregated. Inability to aggregate the data in 2021 is less an informatics problem than it is a problem of the willingness to share data and the ability to break down regulatory and privacy-related silos. We obviously have to be conscious of the need for privacy protection, but the 21st century privacy protection universe allows us to do that.
NDP
Don Davies NDP Vancouver Kingsway, BC
I take it you're also speaking about metadata. Surely we can find a way to extract the raw anonymized data so we can access the raw numbers and protect privacy.
Representative and Department Director, Division of Cardiology, University of Toronto, Canadian Cardiovascular Society
I totally agree.
To give you an example of metadata, in the last two days I have received metadata—it's not privacy protected—from Alberta, British Columbia, Ontario and some from Quebec. This is from colleagues, but of course I have to be on the Internet, make phone calls and send emails.
The numbers I gave you are accurate from the last 72 hours, but an individual sending emails is not a very efficient way to gather data, as you can imagine.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Ms. Benard, a Toronto Star analysis released just two days ago of public data on long-term care homes in Ontario found that residents of for-profit nursing homes in Ontario are far more likely to be infected with COVID-19 and die than those who live in non-profit and public municipally run homes. In homes with an outbreak, they found that residents in for-profit facilities are about twice as likely to catch COVID-19 and die as residents in non-profits, and about four times as likely to become infected and die from the virus as those in a public municipal home.
In your view, what factors may explain this discrepancy?
National Director, Policy and Advocacy, Canadian Health Coalition
That is the data I was alluding to that suggested for-profit facilities have higher fatality rates in their long-term care centres.
An obvious example is staffing levels. Even at the best of times, when corporations are trying to increase their profits and they're accountable to their shareholders, one of the easiest places to reduce their cost is to have lower staffing ratios and fewer staff on shifts all the time. We've heard of equipment and supplies being locked up so staff members can't access that equipment for basic things, such as cleaning, toileting, basic personal hygiene. Again, this is an attempt to increase the profits and reduce the expenses in these for-profit facilities. That's in normal times. One can only assume that in a time of crisis like this, these problems would be exacerbated.
NDP
Don Davies NDP Vancouver Kingsway, BC
I'm wondering if there's some international experience.
A recent study by the International Long Term Care Policy Network found that Canada has the highest proportion of deaths in long-term care settings among 14 comparable countries, including Belgium, Denmark, France, Germany, Ireland and Norway. Dr. Brian Goldman of CBC's White Coat, Black Art has called this "a statistic that should leave Canadians mad as hell”.
National Director, Policy and Advocacy, Canadian Health Coalition
That's a good question.
We have Dr. Pat Armstrong on our board who is one of the leading experts on seniors care in Canada. She would be in a better position than I am to answer that question. She just released a book in the fall that is looking at the privatization of seniors care in several different countries.
I know, for example, that Norway is a good example to follow. They've had success in bringing long-term care back into the public system after it had been privatized for a long time. I would assume it is in large part due to the vast number of private, for-profit, very large chains that have taken over this sector in Canada.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Davies.
That brings round one to a close. We'll start round two with Dr. Kitchen.
Please go ahead for five minutes.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair.
Thank you, everybody, for being here today. It's greatly appreciated.
Mr. Williams, as I know you're aware, diabetes is a contributing factor in approximately 41,000 deaths in Canada per year. We've heard many times on this committee that the health research has fallen by the wayside, especially with this current focus on COVID-19. In fact, some clinical trials have been halted indefinitely.
Do you see any concern with respect to future diabetes research?
President, Diabetes Canada
Yes, we are quite concerned about our ability to continue supporting. As you know, we are committed to advancing diabetes research, and we're working with a number of research partners to advance it. We're concerned about the research environment and the gains we've been making, given that there's a pullback in both private and public support.
Everybody is trying to work through this, but as you look at 2021 being the 100th anniversary of the discovery of insulin, this is the time we should be focused very much on continuing to support diabetes research through partnerships. We have a great partner with CIHR. We have great partners with some of the private corporations and private donors. However, this is being challenged right now given the negative economic impact of COVID-19.