Health Committee on March 9th, 2020

[Luc Thériault, Bloc, Montcalm, QC]

It is for you, because I have a feeling you have the scientific data we need.

Mr. Saulnier, if you want to add something, you can.

[Christina Lawand]

Okay.

Making recommendations is not part of the Institute's mandate.

[Luc Thériault, Bloc, Montcalm, QC]

I know.

[Christina Lawand]

However, our data does point to areas where improvements could be made. With this in mind, we could look more specifically at the early identification of patients in need of palliative care and the early introduction of such care. This would greatly improve the situation of end-of-life patients and their families. The problem is that the patients' need for palliative care is established only when their curative treatments are finished. Their situation can deteriorate very quickly and it is then too late to implement palliative care in the community.

That's why we see a lot of emergency room visits and hospitalizations. It is very stressful for families and patients, and it is costly for the health care system. So early detection at the time of diagnosis of a life-limiting illness, for example, would be a good start. This would allow for the gradual introduction of palliative care to support patients and their families.

We have also noticed that there is more community support. Our data indicate that few people receive publicly funded palliative home care. Some provinces have launched promising programs to provide paramedical services at home, for example, as Mr. Saulnier said. This reduces unnecessary emergency room visits for patients receiving care at home.

It was also noted that better training could be provided to health care professionals. Three out of five family physicians do not feel they are truly ready, while 80% of them often see patients who need palliative care. This shows that there is still work to be done in educating health professionals.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Mr. Davies, go ahead; you have six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to the witnesses for being here.

This is a question for Health Canada. We know the federal government announced commitment in the 2017 budget to provide $6 billion over 10 years to the provinces and territories for home and community care. That was through the bilateral health agreements with the respective jurisdictions. Forgive me if I missed this, but what proportion of that $6 billion in federal funding for home and community care will be used by the provinces and territories specifically to improve access to palliative care, either at home or in hospices?

[Marcel Saulnier]

No designated proportion of that funding was set aside for palliative care or for more traditional forms of home care or other community-based services. Provinces negotiated a menu of potential areas of interest of investment with the federal government. The federal government made a strong case to make sure that palliative care was on that menu. Part of the process of completing and finalizing the bilateral agreements with provinces was for them to clearly articulate in their action plans to the government which of those four areas—all four, if possible—they would be investing federal money in, with what objectives in mind, and to have clarity and transparency to Canadians about that.

[Don Davies, NDP, Vancouver Kingsway, BC]

We're about to begin year four of a 10-year plan. Do we have a sense yet of how much of the money the provinces are getting is allocated to palliative care?

[Marcel Saulnier]

In some cases, this information is all public information available on the Health Canada website. The action plans are all posted. In some cases, the jurisdictions in their action plan identified an explicit allocation of funding that was designated for palliative care services. In other cases, there was a mention of palliative care access as one of the objectives of a broader investment in home and community care. It's difficult to come down on what the specific amount allocated to palliative care would be. You could surmise a certain number from looking at the action plans, but it's probably greater, because palliative care investments are embedded in some of the other—

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks, I will check the website.

Would it be fair to say there's a fair bit of variation among the provinces? Some may be allocating a significant amount of the money they got to palliative care and others may not be.

[Marcel Saulnier]

In terms of what they stated publicly as amounts that are specifically allocated to palliative care, yes, there is some variation across jurisdictions.

[Don Davies, NDP, Vancouver Kingsway, BC]

When the framework on palliative care was published in 2018, Health Canada agreed to re-establish an office of palliative care to provide high-level coordination on activities going forward.

Could you inform this committee whether that office has been set up yet? If not, when will it be operational?

[Sharon Harper]

Thank you for the question.

As part of the development of the framework and the action plan, Health Canada did consider re-establishing the office of palliative care. It took into account stakeholder views, work that had already been done to consult provinces, territories, experts and Canadians, and networks that already exist to organize the excellent work being undertaken by stakeholders and other organizations. Health Canada decided to use its end-of-life care unit within the strategic policy branch as a focal point for palliative care policy and programs. Resources, then, have been targeted to supporting action plan activities.

[Don Davies, NDP, Vancouver Kingsway, BC]

It sounds like the office of palliative care was not actually set up.

[Sharon Harper]

It was not specifically an office on palliative care. It was a focal point on palliative care within Health Canada.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

We also know that the bilateral health agreement set out the four different areas: spreading and scaling evidence-based models of home and community care that are integrated with primary health care; enhancing access to palliative and end-of-life care; increasing support for caregivers; and enhancing home care infrastructure, including digital connectivity and other types of technology.

Do I have it correct that we're not going to really know how we're doing on that until five years have passed? I guess I'm asking how we are doing in terms of provinces meeting those goals.

[Marcel Saulnier]

We know now that as a tradition of receiving federal funding, provinces are reporting to the federal government on an annual basis and confirming that the investments they said they would make are in fact being made. In terms of achieving the goals, the measurement on progress is being done through the auspices of the Canadian Institute for Health Information and the tracking of these common indicators that have been developed. That is an unfolding process. The first report came out a year or so ago, and there will be annual reports on that.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'll direct that to Madame Lawand. How are the provinces doing in meeting those goals?

[Christina Lawand]

What we have agreed on with the provinces and territories, as part of the common statement of principles, is that we're working with them to develop 12 indicators to measure progress on all the shared health priorities, not just palliative care.

There is one indicator that we're working on for palliative care around the concept of dying at home rather than in hospital. That aims to inform us about access to palliative care to allow people to die at home. That is still in progress. The indicator won't be released until 2022.

[Don Davies, NDP, Vancouver Kingsway, BC]

I see.

The only three indicators that have been released so far don't relate to palliative care. Is that right?

[Christina Lawand]

That being said, we're still going to continue to work on measures—

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm going to try to squeeze in one more question, if I can. I want to follow up on Monsieur Thériault's questions.

In terms of Canada ranking 11th among other countries, surely there can't just be the existence of a national framework that determines rankings. There must be certain best practices that other jurisdictions are doing that are given ranking.

For the jurisdictions that are doing well and delivering better palliative care to their citizens, can you give us a flavour of some type as to what they are doing that might be instructive for Canada?

[Christina Lawand]

It's a great question.

I think there's a bit of a gap in research. We need to understand more about the countries that are doing better and what they are doing better. For example, when we look at our measure of primary care physician preparedness, the countries that did the best there were the Netherlands and the U.K. Those two countries have focused a lot of effort on their primary care services and their community services. They are quite a bit further ahead of the game than us.

In Canada, we've slowly been pushing toward community care in the last 30 years or so, and it's taken a while to get there. These countries are quite a few years ahead of us in that domain. That could be one possible explanation, but we still need to study it further to understand what those countries are doing well.

[The Chair, Liberal, Ron McKinnon]

I'm sorry; you're over the time.

We don't really have time for a full round two, but I'm going to suggest to the committee that we have an abbreviated round two in which the Liberals and the Conservatives would have one question of five minutes, and the Bloc and NDP would have their two-and-a-half-minute questions as they would in a normal round two.

Would that be acceptable to everybody?

That being the case, we go to Mr. Kitchen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you all for being here. Your taking the time is greatly appreciated.

I come from rural Canada, in the southeast corner of Saskatchewan. I appreciate the fact that both of you talked about rural Canada, because it's a very important aspect. When we look at palliative care in rural Canada, we have big challenges there, and home care is being utilized quite extensively to try to bridge that gap.

We see a lot of funding going to urban centres, but not so much to rural Canada. There are a number of primary health care practitioners we're short of: medical doctors, specialists in palliative care, etc. I like hearing what you had to say about having primary health care practitioners involved in this aspect of things.

One of the things I'd like to hear a comment on is EMS. I get it that in big centres EMS is mainly acute care, but in rural Canada, the EMS services are out there, and the reality is that, in certain rural areas, they might be able to provide those services. My understanding is that they've even looked at offering those opportunities. I would like to hear some comments on those thoughts from both of you.