Health Committee on May 11th, 2020

[The Chair, Liberal, Ron McKinnon]

I call this meeting to order.

Welcome, everyone, to meeting 19 of the House of Commons Standing Committee on Health. We are operating pursuant to the orders of reference of April 11 and April 20, 2020. The committee is meeting for the purpose of receiving evidence concerning matters related to the government's response to the COVID-19 pandemic.

In order to facilitate the work of our interpreters and ensure an orderly meeting, I would like to outline a few rules.

First, interpretation in this video conference will work very much the way it does in a regular committee meeting. You have a choice at the bottom of your screen of floor, English or French. If you will be speaking in both official languages, please ensure that the interpretation is listed as the language you will speak before you start. For example, if you are going to speak English, switch to the English feed. If you're going to speak French, switch to the French feed. This will allow for much better sound quality for interpretation.

Before speaking, please wait until I recognize you by name. Once the questioning starts, the witnesses may feel free to respond as appropriate. When you are ready to speak, click on your microphone icon to activate your mike. Should members need to request the floor outside of their designated time for questions, they should activate their mike and state that they have a point of order. I remind you that all comments by members and witnesses should be addressed through the chair.

When speaking, please speak slowly and clearly. When you're not speaking, your mike should be on mute. If you have earbuds with a microphone, please hold the microphone near your mouth when you are speaking. Should any technical challenges arise, please advise the chair or the clerk immediately. The technical team will work to resolve them. It may be necessary at times to suspend the meeting in order to deal with such technical issues as they arise.

Before we get started, can everyone click on the screen at the top right-hand corner and ensure they are on gallery view? With this view, you should be able to see all of the participants in a grid-like manner. It will ensure that all video participants can see one another.

I would like to welcome our witnesses: from the Canadian Cardiovascular Society, Dr. Paul Dorian, representative and department director, division of cardiology, University of Toronto; from the Canadian Health Coalition, Melanie Benard, national director, policy and advocacy; from the Canadian Nurses Association, Michael Villeneuve, chief executive officer; and finally, from Diabetes Canada, Russell Williams, president, and Kimberley Hanson, executive director, federal affairs.

Coincidentally, this week is National Nursing Week, and 2020 is the 200th anniversary of Florence Nightingale's birth. I would like to take a moment to recognize all the nurses working so diligently in the face of this pandemic and doing critically important work every single day, in all areas of care.

I will start the opening statements with Michael Villeneuve, CEO of the Canadian Nurses Association.

Mr. Villeneuve, go ahead for 10 minutes, please.

[Michael Villeneuve, Chief Executive Officer, Canadian Nurses Association]

Good afternoon. Thank you, Mr. Chair and members of the committee, for inviting the Canadian Nurses Association to appear today. I have worked in health systems for more than 40 years, 37 of those as a registered nurse, and I have had the honour of serving as the CEO of the Canadian Nurses Association since 2017.

I'd like to acknowledge that I speak to you today from my home in Mountain, Ontario, which is the flattest place in Ontario, I think, despite the name, and I speak to you from the unceded territory of the Algonquin Anishinabe people. CNA House in Ottawa also sits on this territory, and we're grateful to be invited to share this space.

There are more than 431,000 registered nurses, licensed practical nurses, registered psychiatric nurses and nurse practitioners in Canada, the largest number of providers in our health systems. The CNA is the national and global professional voice of Canadian nursing, and we represent 135,000 members across all 13 provinces and territories and, of course, many of our members also live in indigenous communities.

I wish I were speaking before you today about a less sobering topic, but that is not the world we live in right now and, as I saw expressed recently, we went to sleep in one world and woke up in another.

I know that the health and safety of the public and the nation’s health care workers are uppermost in your minds and certainly are in ours. The pandemic clearly escalated as broadly and as rapidly as brush fire, and we must maintain our guard in supporting Canada’s nurses and all health care professionals who are confronting and mitigating its impacts.

We are in a situation unprecedented for all but the few who can still recall the flu pandemic of 1918 to 1920, and we have all been scrambling in response. The Canadian Nurses Association appreciates the measures that have been taken by all levels of governments across the country to tackle this problem and minimize the spread of COVID-19, and we have particularly benefited from the incredible and courageous leadership of our public health professionals, including the nurses who are so integral to that sector.

We appreciate the strong communication from Dr. Tam, who leads the Public Health Agency of Canada, and we have had good communication back and forth with Health Canada, including with the minister and with Dr. Tam and her team at the Public Health Agency. We thank them all, as we thank you, members of Parliament, who are members of this committee.

We speak with nurses all the time and certainly very purposefully each week we talk with them and poll them. I want to take a few minutes to share with you highlights of a few ongoing issues, and then I want to spend the last five minutes talking about a larger system issue that I think we need to tackle.

What are the ongoing issues of concern for nurses? You've all heard about personal protective equipment concerns, and three months into the pandemic, that still remains a bit inconsistent across the country. It remains our position at CNA that those decisions around the use of personal protective equipment should be driven by evidence and the clinical judgment of the people using the equipment and not by availability or fear of shortage. That's been an ongoing issue that seems fine in some places and less so in others.

The second issue is around testing. The WHO has urged large-scale testing, but we realize that COVID-19 testing in Canada still falls behind some other nations, and nurses are concerned that, without this information, the recovery efforts will not be informed by evidence.

We're concerned about mental health right across society. This has been very scary. Nurses, in particular, are facing significant challenges to their mental and emotional well-being as a result of the COVID pandemic response and recovery. We are continuing to advocate for access for all health care providers to mental health services at no cost to manage their emotional and mental health coming out of this. We're particularly concerned that, just as many of us will have a chance to step back at some point when the pandemic settles, as we assume it will, or in waves, nurses, doctors and people in the health care system are then going to have to pick up the backlog of all undone surgeries and so on, and they will be really be very stressed during that time.

We're working with the Canadian Medical Association and the Canadian Institute for Health Information around determining the impact of COVID-19 on the health of health care workers. We urge governments to fund the tracking of that important data, which is a long-standing issue.

While they talk about concern for their own safety, one of the top issues that nurses mention is vulnerable populations. We're concerned about people who are more at risk for the spread and its impacts, including many indigenous people, particularly in remote settings, and people in congregate settings such as prisons and shelters and the homeless.

My final point, before I speak about long-term care, is that given the lessons of history, we urge a very guarded, evidence-informed, cautiously paced reopening of services across society. We are concerned that the virus is very much alive, still spreading, not well understood, and may sweep across society in successive waves. We understand there are huge economic implications, but that has to proceed very carefully.

Let me turn to a couple of larger issues that are really of concern to the Canadian Nurses Association and to nurses. Due, at least in part, to a very aggressive “flatten the curve” campaign, which Canadians by and large have taken part in, our hospitals have mainly been spared the devastation of our counterparts in China, Italy, Spain and the United States, for example. However, at the same time, the pandemic has laid bare the crippling lack of standardization, funding, strong leadership, appropriate staffing, training, equipping and so on, of people who deliver services in long-term and home care sectors. These vulnerabilities have been well known for 20 years. As a result, just 20% of COVID cases in Canada are in long-term care, but they account for 80% of the deaths. We understand this is the worst outcome globally.

While our health systems have many strengths, a series of robust investigations since 2000, such as the Romanow commission, have generated a now very familiar litany of places we need to shore up. We can all name them all: pharmacare, home care, mental health care, long-term care and primary health care, based on need and not on the ability to pay. We're seeing some of those weaknesses play out now.

The outcomes of COVID-19 in long-term care this spring are in part the result of decades of neglect of that sector and a growing mismatch between the level of care required by people who live there and the human resources deployed to care for them. I've been around for 40 years in the business. Many of the patients living in those nursing homes now with complex, ongoing conditions would have been in a hospital 20 years ago. It's hard for people now to imagine that in nursing homes 20 or 30 years ago, residents still drove their cars. Those people now are managed in home care.

As we've shifted really complex care away, the response in long-term care has not been concomitant with the demand going in there. The rising pace, volume and complexity of care that has been shifted from hospitals to nursing homes also has coincided perversely with a decline in the proportion of regulated nurses in that sector, fewer clinical educators, fewer social workers and fewer occupational therapists. It's a story of fewer and less, and it has a dramatic impact on the people working there, who are largely unregulated, and delivering 80% to 90% of the care. The workforce there is dominated by caring, loving, well-intended health care aides and support workers who are not backed up with the sorts of professional nursing and other resources they desperately need. The sector is heavily dominated by women, often racialized women, who are paid low wages and often are precariously employed. You've heard stories that they have to cobble together two or three jobs or work a lot of overtime to make a living wage. COVID-19 has really exploited those weaknesses.

In the final report of the national expert commission that CNA conducted in 2011-12, we laid out nine practical recommendations to address many of the same issues brought up by Commissioner Romanow, Senator Kirby and others, that could drive better health outcomes, better care and better value for taxpayer dollars. Many of them have gone unheeded.

If there's any silver lining in this, we have certainly seen that we can do things differently. We have flipped around primary care, for example, so that much of it can be done by telephone and virtually. We know that hospitals are partly empty because of cancelled surgeries, but we see the emergency room wait-list problem has declined. Hallway medicine has disappeared. We believe that we have the capacity to address those problems and sustain those results. We can't go back because we know now that we can do it differently.

Meeting demands of older adults requires major changes to the health system and some immediate attention to personal care assistants and nursing expertise in those facilities in particular. We must reimagine aging in this country, including home care, institutional long-term care and end-of-life care, and then put those bold changes in place we know are needed.

To wrap up, COVID-19 has shown us very strangely, in the year of the nurse, that nurses are an important force for delivering better health. They've certainly shown they're dedicated to the people of Canada, even when they're worried about their own health and safety. Clear information, adequate supplies, additional support for the health system and its workers are needed and are going to be needed in the long term. It's not going away tomorrow.

As the chair said, we meet today in the global year of the nurse and midwife, during National Nursing Week and on the eve of Florence Nightingale's 200th birthday tomorrow. Perhaps, ironically, after 200 years, we find ourselves talking like Nightingale saying, wash your hands; clean the environment; gather good information to make your decisions.

This week we've set aside years of planned celebrations, as you can imagine, out of respect for the tens of thousands of nurses who are out there working at points of care this very minute, some of them even coming out of retirement to do so. They've answered the call.

On behalf of the CNA, let me close by thanking you for including us. I ask that you place nurses in leading roles in the analyses of the COVID-19 responses lying ahead. Listen to them. They have practical, smart information. Know that we will work with you to identify and deliver the best evidence to help governments and health systems make the changes we need and implement real change.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Villeneuve.

We go now to the Canadian Cardiovascular Society and Dr. Paul Dorian for 10 minutes, please.

[Dr. Paul Dorian, Representative and Department Director, Division of Cardiology, University of Toronto, Canadian Cardiovascular Society]

Thank you very much, Mr. Chair.

Good afternoon, everyone.

I'd like to begin by thanking all the members of the committee for the opportunity to represent the Canadian Cardiovascular Society. We are grateful for the opportunity to describe some of the challenges in caring for patients with heart disease during this COVID-19 period and to recommend some solutions.

I'm a cardiologist from Toronto representing the Canadian Cardiovascular Society. Our 2,500 members include cardiologists, cardiac surgeons and scientists. We provide specialized and ongoing care for close to three million Canadians living with heart disease. We're very grateful for this opportunity to present to the committee.

What I'd like to do first is to describe the consequences of a pandemic on heart patients and then suggest some recommendations to help improve patient care in the short term as the first wave of a pandemic unfolds, and in the future as subsequent waves of this or other infections hit.

At the front line, what we are observing is that sick people are not seeking the care they should. You heard that just a few moments ago. When the COVID pandemic struck in Canada, we were quick, as a community, to enact strict measures to contain its spread, including widespread stay-at-home messaging. Canadians have been very good at listening and adhering to this advice, so much so that we have seen a significant reduction in patients seeking emergency care for all illnesses, but particularly for cardiac care. Although the numbers of those seeking care are way down, heart attacks and other emergencies have not stopped occurring.

We believe our patients perceive hospitals to be overloaded with cases of COVID, correctly or incorrectly, and they're afraid of coming to hospital and being exposed to the virus. As a result, patients with emergency needs are staying at home and waiting to see if symptoms go away and some, unfortunately, are dying while they wait. When they finally do seek emergency care, they have often delayed so long that their conditions have become more serious and harder to treat. This is something we've observed over the past month or so.

The later patients present for treatment, particularly for heart attacks, the less we can do for them; and we're seeing more complications, which are harder to treat.

Second, while we deal with COVID patients, wait-lists for cancelled procedures have skyrocketed. To be ready for an anticipated surge, hospitals have appropriately, we think, reallocated resources and freed up beds, but in our efforts to be prepared, hospitals have been operating under capacity. Since March, across Canada, a huge number of planned, life-saving procedures were postponed.

As an example, as of March 15 in Ontario, there were about 2,000 patients waiting for valve procedures and 450 for defibrillators. As of May 3, that wait-list had grown to 2,500 valve cases and 680 defibrillator cases. These wait-lists have unfortunately resulted in patients suffering and, indeed, some have died. My colleagues speak of their valve patients who have been accepted for procedures dying at home before the surgery could be done.

We have avoided a surge in COVID patients, but the backlog of heart patients waiting for treatment has surged. Wait times are now longer than they've ever been in years, in some cases.

A major complicating factor, we think, in planning for and delivering care has been the lack of real-time data. Without real-time data, we have no way to understand local health service supply and demand trends and to make regional comparisons to inform decisions about allocation of services and to inform our patients about opportunities to seek care.

Recently we've collected some hospital data where there have been drops as great as 40% per month in several provinces since March in the number of patients coming to hospital with a kind of heart attack called STEMI, the most serious type of heart attack. This has been observed in other countries as well, but we don't have all the information needed to interpret what's happening. Were there fewer heart attacks occurring? We think probably not. Did the patients delay calling 911? Did ambulances make fewer and slower trips? Did patients in the field arrive at hospital already deceased? Was care in hospital delayed because of COVID precautions? We, unfortunately, don't know.

It's frustrating for us to note that much of the data to answer these questions exists and is collected already in real time, but is tracked in data collection systems that don't talk to each other technologically, or that prevent the data from being shared due to geographic boundaries or for legislative, contractual or policy reasons. Collectively, these barriers prevent health data from being used for the very reason it's collected, which is to enable care through evidence-informed decision-making.

We must note that our national resource, the Canadian Institute for Health Information, CIHI, has responded as best it can throughout the pandemic to supply data; however, CIHI itself is limited by the same barriers I've just mentioned. In this moment, we need data in days, whereas the typical time frame for obtaining data is months.

We're eager to help resolve these challenges brought on by the pandemic. In looking to contribute solutions, the CCS has several that we would like to propose.

First, we think we need to refine public messaging in the face of a pandemic. If we can anticipate that stay-at-home orders result in heart attack victims not seeking or delaying care, public messaging needs to be more precise and widely shared. The federal government, through the Public Health Agency and Health Canada, are well positioned to lead this, and the CCS is willing to help develop and spread these messages.

Second, public health officials, health service planners and care providers need shareable real-time data. Current information that can easily be shared would enable more nimble actions in an emergency. We would know where and whether scheduled and essential procedures might still take place, based on need and in balance with local demand. With better access and sharing of data, we can reduce the impact of national health crises on cardiac and other patients, while still providing crisis-related care to those affected.

In the current situation, COVID-19 patients have been appropriately prioritized. The consequences for other patients, unfortunately, have been higher than would have been ideal. Without data, we don't think we can do better next time. Our ask of the government, colleagues and this committee is to take the lead to improve the sharing of real-time data.

This could be done, for example, by forming a national expert working group to oversee coast-to-coast streamlining of data access and sharing. This expert group would work with federal and provincial health data stewards to identify and resolve the long-standing legislative and technical barriers to rapid, shareable information. Their mandate would be to enhance coordination by locating all the datasets and getting them to talk to each other; I emphasize that this data is already being collected.

This committee would also help aggregate data so that it could legally and virtually be “all in the same place”. Through understanding what's going on locally and comparing that to what's happening in other regions or provinces, we can accelerate best care and resource use.

In the long run, we think improved access to data can refine health care system delivery. Care can be more equitably available and higher in quality; care pathways could be more efficient; virtual care could be deployed in the most effective ways; low-value care can be identified and reduced; savings can be reallocated to where resources are needed the most; and, if we get this right, we can expect to see better patient outcomes during but also beyond any crisis.

For those of you on the committee with whom the CCS has met in the past, you will know that the need for access to high-quality data and national comparative reporting is a call that the society has been making for some time, and we are very grateful for the support we've received from our partners and supporters in government.

The COVID crisis has shone a light on access to data as a major impediment in responding to a pandemic. Drawing attention to this at the highest policy-making level is a key contribution that the CCS aims to make. I'd like to just briefly list the actions that the CCS has already taken to support the pandemic.

Thus far, in the last six weeks or so, we have developed, published and shared clinical guidance for health professionals who care for cardiac patients affected by COVID. We've developed and widely shared clear messages stating that people experiencing chest pain or other signs of heart attack should urgently seek care; we've done this in partnership with the Heart and Stroke Foundation of Canada and others, but I think we can do more. We've also funded research to learn more about COVID and its effects on patients with heart disease.

The CCS will undertake to continue to do all we can to help in this crisis, and if we can be of help, I'd like to signal to the committee that in light of this pandemic we're willing and able to consult and provide guidance on any matter concerning Canadians living with heart disease.

We will all have the most success working together if we align our efforts and support one another. Merci, and thank you for this opportunity. I look forward to your questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Dorian.

We go now to the Canadian Health Coalition.

Ms. Benard, please go ahead. You have 10 minutes.

[Melanie Benard, National Director, Policy and Advocacy, Canadian Health Coalition]

Hello, everyone, and good afternoon.

Thank you for the invitation to appear before you today.

The Canadian Health Coalition has been working for over 40 years to protect and improve public health care in Canada.

We are a national, non-partisan organization made up of health care workers, unions, community organizations, seniors and academics, as well as affiliated coalitions in the provinces and one territory.

Canadians are very grateful to have a universal public health care system that provides care based on people's needs and not on their ability to pay. This system has been put to the test over the past few months. The COVID crisis has highlighted the incredible strengths in our health care system as well as some persistent gaps and challenges. As we slowly begin recovering from this pandemic, we have an opportunity to rebuild our health care system to be even stronger and more responsive to the evolving needs of Canada's population.

Today, I'll be discussing three areas that require the federal government's attention: pharmacare, funding and seniors care.

As you may know, Canada is the only country in the world with a universal public health care system that does not cover prescription medication. As a result, millions of Canadians have been falling through the cracks. Before the COVID-19 pandemic, 20% of Canadian households were struggling to pay for their medication, either because they didn't have a drug plan or because their drug plans were inadequate. One million Canadians were having to choose between putting food on the table and buying the medication they needed. These numbers have increased exponentially during the COVID pandemic. The mass layoffs triggered by the pandemic have left millions more Canadians struggling to afford their medications without work-based drug plans. The need for universal public pharmacare has therefore never been more urgent.

Two years ago, this committee studied this issue in detail. I know a few of you served on the committee at that time. After holding 23 hearings with nearly 100 witnesses, the committee recommended that Canada adopt a universal, single-payer public pharmacare program that would cover prescription medication in the same way as doctors and hospitals.

Over the past 50 years, countless government and academic reports have all made the same recommendation, most recently the government's Advisory Council on the Implementation of National Pharmacare, led by Dr. Eric Hoskins. The Hoskins report from 2019 provides a blueprint for how to build this essential new program. The government must implement its recommendations immediately.

Universal public pharmacare would save money while saving lives. When people skip their medication because they can't afford it, the technical term for which is “cost-related non-adherence”, they end up getting sicker and visiting the hospital and the doctor more often. That's something we want to avoid in normal times, but during this pandemic it's absolutely critical. Research has shown that removing out-of-pocket costs for the medications used to treat just three health conditions—diabetes, cardiovascular disease and chronic respiratory conditions—would result in up to 220,000 fewer emergency room visits and 90,000 fewer hospital stays annually. This could save the health care system up to $1.2 billion a year, just for those three conditions.

Canada's current patchwork of drug coverage is inadequate and inefficient. There are over 100,000 public and private drug plans across this country that each offer different types of coverage. Many plans limit the amount that people can claim per month or per year, and many include expensive deductibles and co-payments that make medications unaffordable.

The current system is also unsustainable. Canada pays the third-highest prices among OECD countries for prescription medications, and spending on medication continues to rise. The number of drugs on the market that cost more than $10,000 per year has more than tripled since 2006. Canada currently spends more on medication than it does on doctors. Universal public pharmacare would allow us to limit this spending by negotiating lower drug prices through bulk purchasing. This new program would allow Canada to save $5 billion every year. Families would save, on average, $350 per year, and businesses would save an average of $750 per employee per year.

Last fall, nearly 200 national and provincial organizations signed a joint statement calling on all parties to work together to implement universal public pharmacare within the current government's mandate. We simply can't wait any longer to implement this program. Canadians are suffering, and some are dying prematurely because they can't access their medication. The government must implement pharmacare immediately as part of its response to the COVID crisis.

Now is also the time for the federal government to reaffirm its commitment to public health care. Public health care is our best defence against the COVID pandemic and other health crises. Regrettably, our health care system has been eroded over decades through systematic funding cuts and privatization. Even in normal times, the system is functioning at capacity.

The federal government must increase health transfer payments to the provinces to expand the capacity of public health care across the country, both in normal times and in times of crisis. The 10-year health accord from 2004 guaranteed the provinces an annual 6% increase to Canada health transfer payments. When that accord expired, the federal government reduced the annual increases to nominal GDP or 3%. We've known for years that this is simply insufficient to keep the system running effectively. At least a 5.2% escalator is needed just to maintain existing services.

In addition to long-term increases to the CHT, extra funding will be needed to handle the backlog of surgeries and services that have been put on hold during the pandemic. Instead of turning to the private sector to address this backlog, the federal government should support the provinces in implementing inexpensive public innovations to reduce wait times such as centralized wait-lists and team-based care.

The government must also protect our public health care system by actively enforcing the Canada Health Act. Many private, for-profit health care companies have taken advantage of this crisis to expand their markets, particularly in the area of virtual health care. Many of these companies are violating the Canada Health Act by charging patients out of pocket or billing private insurance companies for virtual doctors' visits.

In addition to raising concerns about the privacy and security of patients' medical information, this is draining resources from the public health care system. It is also threatening the foundational principle of equity that underlies our public health care system. The government must take action to prevent further erosion of this system and ensure that patients always come before profits.

I think we would all agree that one of the greatest tragedies of this pandemic has been the widespread devastation in our long-term care homes. The suffering of residents, staff and their family members in recent weeks is simply unfathomable. According to recent estimates, approximately 80% of all COVID-related deaths in Canada have been in long-term care facilities. Our deepest sympathy goes out to all those who have lost loved ones during this crisis, and we express our ongoing gratitude to all front-line workers who are putting their lives at risk every day to help care for patients in need.

Although we may not have been able to prevent the COVID pandemic, we could have limited its devastating impact in our long-term care homes if we had implemented fundamental changes to this sector sooner. My colleagues from CUPE testified before you last week on this issue, so my recommendations here will be relatively brief.

To ensure equitable access to safe, high-quality care, we must bring long-term care and home care into our public health care system. Over the past several decades, we've seen widespread privatization in this sector, in part because these services aren't currently covered under the Canada Health Act. We need new, dedicated federal funding for long-term care that is tied to national standards of care. These standards must include things like minimum staffing levels. The federal government must support the development of more public long-term care facilities and home care services, since abundant research shows that public not-for-profit facilities provide higher quality care than private for-profit facilities. All public funding should go toward patient care, not corporate profits.

We also need a national health human resource strategy to help recruit, train and retain high-quality care workers. These workers must be paid decent wages and guaranteed stable, full-time employment. We can significantly improve patient care by improving the working conditions for staff. The seniors and people with disabilities living in long-term care facilities and relying on home care are counting on us to rapidly make these changes. We must not let them down.

We can't undo the harm that has been caused by this crisis, but if we implement these changes, we can help prevent similar harm from occurring in the future. Let's learn from this experience and rebuild a public health care system that we can all continue to be proud of, a system that provides the high-quality care that everyone in Canada deserves.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Benard.

We go now to Diabetes Canada.

Mr. Williams, please go ahead for 10 minutes.

[Russell Williams, President, Diabetes Canada]

Thank you very much for the opportunity to present today.

I thought I would start off sharing some of the calls we are receiving on our information line from people looking for help.

One example is a woman who phoned us about her father, who is an insulin-dependent, type 2 person with diabetes. He was living in a long-term care home, and she had concerns, as we've heard today, as a result of the COVID-19 pandemic. Our caller wanted to bring her father home to live with her, but she needed advice on how to manage his diabetes.

Another woman with type 1 diabetes who struggles to keep her blood sugar within the recommended range reached out to us. She works in maintenance in a hospital and she and her physician were worried about her risk. Despite the advice of her medical team, her employer refused to modify her work arrangements so that she could reduce the risk of catching COVID-19. We needed to help her convince her employer to make accommodations.

We also heard of someone who had just been diagnosed with diabetes and had been released from hospital. A new diagnosis of diabetes is overwhelming at the best of times, but especially in this environment. Discharged with insufficient information and support, this person was scared and confused and uncertain of what to do with their diet, their medications and glucose monitoring.

Countless other people have reached out to us, people who have problems with their injection site or have to manage their diabetes with added problems, such as kidney disease.

What I'm saying is that we've seen a significant increase in demand for Diabetes Canada's services.

Diabetes is a large and growing burden in Canada. Diabetes, as you know, is a leading cause of heart attacks, stroke, kidney disease, vision loss and amputation. Treating the disease will cost our health care system over $40 billion a year. It's a disease that disproportionately burdens vulnerable Canadians, including newcomers, indigenous peoples, seniors and those with lower incomes.

In a moment, we’ll talk about how the pandemic has posed an even larger threat to people living with diabetes and associated conditions, but I want to share with you some of the examples of how it has impacted Diabetes Canada.

Physical distancing measures and the economic impact of the pandemic have reduced Diabetes Canada’s revenue by more than 50%, like a lot of charities. We had to temporarily lay off more than 50% of our staff. Some of them we've been able to bring back because of the CEWS program, and we appreciate that, but we won't be able to keep them. Our revenues will continue to be negatively impacted by the pandemic for the foreseeable future. That directly affects our ability to serve people affected by diabetes.

However, the needs of people with diabetes for trustworthy information, education and advocacy are even greater than ever before, and we are rising to meet that challenge. We are providing timely and evidence-based resources and tools to our community about diabetes and COVID-19, including a frequently updated website, weekly “Ask the Experts” videos, webinars in 12 of Canada's most commonly spoken languages and educational webinars for health care providers. We are providing patient resources and supports via our 1-800-BANTING line, where people can get personalized, expert medical advice from diabetes educators.

We are also collaborating with governments at all levels during this pandemic to support health policy development and implementation, to ensure that diabetes medications, supplies—

[The Chair, Liberal, Ron McKinnon]

Sorry, Mr. Williams, your sound is very choppy, so you might want to speak extra slowly. Thank you.

[Russell Williams]

I hear it as choppy when I listen to you, too. My apologies.

We are collaborating to ensure diabetes medication, supplies and devices remain available and affordable. We are amplifying announcements from provincial governments that support people with diabetes, and we continue to work on our national strategy, which Kim will talk about later.

We continue to work with governments on prevention, nutrition policy and pharmaceutical policy, which affect the daily lives of people with diabetes. We must ensure that the total ecosystem of the world of diabetes is balanced going forward, and there are no effects caused by policies that negatively impact our [Technical difficulty—Editor].

In these respects, like most other charities, we are stepping up during this time despite dwindling resources.

Health charities in Canada are a $670-million sector, supporting 2,500 employees and almost three million patients. We support well over $155 million of research and 1,300 investigators. Supporting research through this is going to be very important. Patients need services and supports more than ever as a result of capacity and the stress you've heard about today on our health care system. Charities must increasingly meet these needs without the help of volunteers, who are prevented from serving by physical distancing, and with reduced donations from households and businesses as they grapple with the economic impacts of the pandemic.

For these reasons, we are united with other health charities in calling for direct investment from the federal government of up to $28 million per month, which represents the monthly revenue decline of our members that we've been witnessing since March 2020. This investment would allow staff and volunteers to focus first on patient support, restarting our fundraising efforts and protecting our gains in research.

I ask for your support in calling for greater federal investment in this vulnerable sector. We desperately need increased support. For example, the emergency rent assistance program is not geared to help charities at this point. Many of these charities have facilities across the country, and other programs do not seem to respond to the day-to-day operational needs of charities. Many of our charities have had to increase care and are filling gaps in the health care system caused by physical distancing and isolation.

Now I'd like to ask my colleague, Kimberley Hanson, to speak about the impact of COVID-19 on people with diabetes.

Thank you.

[Kimberley Hanson, Director, Federal Affairs, Government Relations and Public Policy, Diabetes Canada]

Thank you very much.

Many people with diabetes are at high risk for COVID-19, but as we are learning more about this new virus, research is showing that while having diabetes doesn't make someone more likely to catch COVID-19, it makes the consequences more serious if they do.

Early research shows that people with diabetes are approximately twice as likely to require hospitalization and intensive care as those without and about three times as likely to die of COVID-19. Because of this many Canadians with diabetes are very worried about the pandemic.

Like diabetes, COVID-19 is a disease that exploits health inequities. The more socially and economically disadvantaged a person is, the more likely they are to suffer from diseases like diabetes, heart disease and high blood pressure which put them at greater risk to COVID-19.

People in poorer socio-economic circumstances can also be more exposed to infection. They may be unable to self-isolate due to insecure labour conditions which do not allow for teleworking or provide statutory sick leave. They are more likely to experience overcrowding in their living arrangements. The pandemic has brought out in even sharper relief the critical necessity of addressing underlying health inequities to preserve the health of our citizens.

COVID-19 has also highlighted serious gaps in data and challenges that can exist due to unintegrated health systems across provinces and territories. The critical necessity of making evidence-informed decisions about allocating limited health care resources and implementing health policies during the pandemic has highlighted the lack of health data sharing and systems integration that has plagued our health care system for years.

A lack of easy ways to share best practices and harmonize health care across provinces and territories has contributed to the burdens of COVID-19 being shared unequally among different provinces and their citizens. Conversely, the tremendous progress that is being made to close these gaps in response to the pandemic shows how collective will and a sense of urgency can produce real results in record time.

Provinces are leveraging and sharing medical information as never before and planning to use apps and digital tools to share and track chronic medical conditions. From coast to coast doctors are offering virtual consultations that would have been considered impossible just two months ago, and which are a key tool in preventing the overload of our emergency health care system.

Practices such as these—leveraging virtual care, establishing and using medical data repositories and registries, optimizing and continuously improving patient care pathways—are all key tenets of diabetes 360º, Diabetes Canada's nationwide strategy, which this committee has recommended for implementation.

Developed by 120 stakeholders over more than a year of rigorous effort, diabetes 360º contains evidence-based recommendations aimed at improving patient outcomes. It will enhance the prevention, screening and management of diabetes to achieve better health for Canadians. It will reduce unnecessary health care spending by billions of dollars, improve the lives of millions of Canadians and protect Canada's productivity and competitiveness.

We believe, in light of the pandemic, that diabetes 360º is more relevant than ever. It's implementation will support public health and deliver on the need for collaborative, value-based health care models and a multidisciplinary comprehensive approach to health care. The billions of dollars in savings that will be realized by our health care system when we implement diabetes 360º is an example of the effective use of public dollars to combat chronic disease.

Given that diabetes is one of the most empirically measurable chronic diseases, implementation of a comprehensive strategy to prevent, diagnose and treat diabetes, based on data on patient health outcomes, can serve as a useful test case for managing other chronic diseases.

With the 100th anniversary of the discovery of insulin in Canada in 1921 being right around the corner, we urge governments to embrace diabetes 360º now.

In summary, Diabetes Canada, like all Canadians, is pivoting rapidly to adapt to the new reality we are faced with, given the COVID-19 pandemic. We are serving people with diabetes now more than ever and will continue to strive to do so even with limited resources, but we, along with other health charities, need additional support from the federal government to do so. A key measure that the federal government should take in response to the pandemic and in anticipation of 2021 is to implement a nationwide strategy to address diabetes and the burden of chronic disease in Canada in general.

Diabetes Canada stands ready to collaborate with governments to end the diabetes epidemic once and for all.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Williams and Ms. Hanson.

We will start now with our questioning. We will do three rounds of questions.

I would also like to remind everyone that the committee is meeting for the purpose solely of receiving evidence concerning matters relating to the government's response to the COVID-19 pandemic. I would urge members to do their best to stick to that area.

We start now with Mr. Jeneroux.

Mr. Jeneroux, please go ahead for six minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, everybody, for joining us today. Also, in celebration of National Nursing Week, certainly from our side of the table, we want to recognize that and appreciate the chair's comments.

The first question is for Mr. Villeneuve. Is there a protocol that's consistent for PPE for nurses across the country?

[Michael Villeneuve]

In theory there is, Mr. Jeneroux.

If we look at the advice coming, say, from the World Health Organization and then the Public Health Agency of Canada, it's quite consistent. The advice has been very, very helpful. The challenge we have is when you filter it down through however many lenses—at the regional health authority level, the employer, the organizational level, the level of the manager within an organization—that seems to be where things fall apart a little bit. It's not unusual in a federation, in a profession with multiple regulated categories and lots of people influencing it.

In theory, yes, I think it's pretty clear. Our advice has not really changed. I can tell you from my own experience in a neurosurgical intensive care unit, that if I go to do a procedure, the nurse and the doctor are educated in terms of knowing what is needed for that procedure. We expect employers, governments and everyone to have the materials there. You get what you need for that procedure and you use your clinical judgment. We think nurses are quite capable of making those decisions.

What we have been concerned about in some cases is the interpretation of what seems like a fairly straightforward “if this, then that”. Part of it is that with 430,000 nurses, 13 jurisdictions and hundreds of employers, it gets a little bit mired.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

We had the head of the Ontario registered nurses union indicate that they need nine million masks a week. Is that unique to Ontario, or is that pretty standard across the country to keep them safe and healthy?

[Michael Villeneuve]

I don't know the exact number, Mr. Jeneroux, but the issue with it is that typically, in a situation of plenty, you would change that material quite frequently. You don't leave it on for very long. You've seen some of the pictures of nurses with some damage to their faces and so on. As for nine million, I don't know if that's the right number or not in each province and territory.

What we have heard from physicians, nurses and so on is some concern about using PPE for too long and not being sure if they can use it again. What happens when you don and doff it, and do that sort of thing safely? That's where we've heard, and you've heard, probably, the same thing, “I was told to wear one mask for four hours", whereas when I was in the ICU many years ago, I changed it room to room to room, and so on, throughout the day.

Our concern has been that decisions should always be based on evidence and need, and not on the fear that there will be rationing if there is a shortage in the future.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

As the chair indicated, we're looking at the government's response to COVID-19. Obviously, in preparation for any potential other pandemic, we want to make sure that we get everything right and are able to present that back to the government and to the particular individuals involved.

When was the first time your organization was contacted by the minister or the Public Health Agency with regard to a response, whether it be in terms of PPE or any other issue at the time, from that January-February time frame?

[Michael Villeneuve]

I actually made the first call myself, and I'm going to say it was around January 20. I should have checked this. It was about the third week of January. We were watching and asking the great question of science: What is going on here?

I called Dr. Tam's office—I happen to be a member of her advisory committee of health professionals—and said, “Could we just talk with someone?” I had a very good meeting, within 24 hours, with her team, and asked questions: Is there something we can do? How can CNA be helpful here? What do you think is going on? We had, from that day forward, excellent communication with the Public Health Agency of Canada and with Health Canada.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

At that point in time, we were hearing stories already about the lack of personal protective equipment. Was that something that you raised in that January 20 phone call?

[Michael Villeneuve]

It didn't come up in that first call, Mr. Jeneroux, but that was because what the Public Health Agency said was the same thing that the minister said, which was helpful. When we asked what we could do, the answer back was, “Please tell us what nurses are telling you so that we have a very good sense of what is going on at points of care across the country.”

No, it was not in that very first conversation, but I have to say it was very prominent in many conversations thereafter, although now I see it seems to be shifting. We haven't been hearing quite as much about it in the last three or four weeks as we were in the first four weeks. There are still pockets of it. In other places though, I can tell you that I happen to be board chair of a hospital in Ontario and was told by the nurses that they had every single thing they needed and that it was not a problem.

It's the unevenness of it that seems to be playing out. Of course if Nurse Betty in Saskatchewan hears that Nurse Dave in New Brunswick has something different, it's confusing, or as we heard in a case in another province, a paramedic and a nurse showed up to do some kind of care, whatever they were doing, and the paramedic had the N95 mask and the nurse was told she didn't need it. It's that unevenness in practice settings that causes anxiety for people.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Jeneroux.

We go now to Dr. Powlowski for six minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thank you.

My first question is for Mr. Villeneuve of the Canadian Nurses Association.

By the way, I fully support everything you're trying to do with respect to PPE. I'm a long-time emerg doctor. Keep hammering away on that, please.

I want to talk about chronic care homes and the situation faced by people in those homes. Obviously this crisis has really highlighted the plight of people working in those homes and people living in those homes, as so many of the deaths have been in those homes.

Mr. Villeneuve, you talked about the need for bold changes. You didn't mention it, but would you support the call by CUPE last week for a universal, publicly funded chronic care program for all elderly in this country?

[Michael Villeneuve]

Yes, it has been our position for a long time, Dr. Powlowski, that long-term care and home care, when required, should be provided based on need and not the ability to pay. That patchwork, which one of my colleagues just testified about, as to the way long-term care plays out across the country has not done well for seniors in this country.

Our concern is that we might jump immediately to inquiry or just funnel a lot more money in there and put more registered nurses in there, or whatever the solution would be. We need to step back and look at that population. What is aging in Canada going to mean? Long-term care and chronic care don't just happen, as you know, inside bricks-and-mortar walls. It's in community centres, in primary care. It's part of end-of-life care.

I think we've had a terrible outcome. We need to analyze it and inquire, of course, but we need to step back, take it up a level and consider what aging in Canada is going to mean for the 21st century and how we are going to pay for it.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Yes, I totally agree. I think part of doing better in the future in managing a crisis like this means doing better in terms of providing services for chronic care.

I want to direct my next question to Ms. Benard from the Canadian Health Coalition.

Advocating for both universal, publicly funded pharmacare and presumably universal, publicly funded long-term care, the questions arise: Can we afford one? Can we afford both?

I'm not an economist, but I gather, having listened to her, that some of the arguments made were that for one thing, there are economies of scale and buying in bulk reduces the costs of medications. She also made the argument that it's cheaper to have people take their medications and thus avoid going to the hospital than not taking their medications and going to the hospital. That actually costs a lot more money. Presumably a nationally funded pharmacare system would also allow the money that a lot of people don't get from their employer, because it's going into their drug plan, to go into a nationally funded system. I think the argument you would make is that it is affordable and maybe it's even cheaper to have a nationally funded pharmacare program.

How about a universal, publicly funded long-term care program? Is that something that's affordable? Again, presumably some of the money going into that system is money that individuals currently pay out of pocket as they become older, and if they have money, they have to pay to be in these institutions. Do you think a national, universal, publicly funded long-term care program is financially feasible?

[Melanie Benard]

To the first point, yes, as I mentioned, pharmacare would save us around $5 billion every year. We would be spending $5 billion less with a pharmacare program than we are currently spending without one. It's not a question of can we afford it; it's can we afford not to have it.