Health Committee on April 12th, 2021

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Thank you. I'm going to move on to Ms. Metz and domestic violence.

Thank you for being here and sharing the impacts you're seeing with COVID and describing what's been happening. I understand the need for support and the lack of reporting or of people reaching out.

What are some areas where you find successes that we can help support, for example? We need to understand what's happening. We need to know whether it's sexual assault or domestic violence and who that's impacting so we can get supports to those people.

Is there a way that we can help reach out to people? I come from a semi-rural riding, and I know we try to do some different outreach, versus just having clients come to us in the local organizations. Is there something we can do to help find out who these victims are and how to get them support? Also, as you mentioned, we need support for men so that these abuses are not happening in the first place.

Could you maybe elaborate on some ideas there?

[Carol Metz]

Thank you very much for the question. That's a broad question.

When I look across Canada and how we can reach out to people, the rural communities are much more challenged in reaching out to victims of domestic violence just because of the remoteness. One of the things I notice when I'm looking at the remote communities is the need to have bandwidths that are up to date so that people can call. Another thing—just thinking back to rural communities, because I was raised in a rural community—is also having services available in the local communities, perhaps in partnership with another organization, so that someone doesn't have to travel for 50, 60 or even 20 kilometres when they are fleeing domestic violence.

When it comes to services for men, one of the things, as I've said, is that we have started to offer the mentor relationship program and we continue to look for funding in a variety of different places to be able to offer that program. That program is a huge success. If I had the time, I would share stories with you, as I have seen men transform their lives. They too want to make a difference. They too want to be part of their family.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Thank you so much. We're getting a lot in a short amount of time.

If I have time for one more question, I will ask Mr. Wildeman quickly about his ideas. Thank you for sharing them with us. Certainly fitness and health are going to be critical for recovery.

In terms of fitness expenses, would you have some proposal for some type of accreditation similar to massage therapists, for example, with personal benefits or employment benefits? I would think there would be concerns even to your industry and your membership if people all of a sudden started claiming they were personal fitness instructors and flooding the industry. Do you have ideas to help prevent that for your members in terms of the rebuild, and would there be some check and balance in place for the government to review?

[Scott Wildeman]

As an industry, we are self-regulated currently. There are a number of registries in place, so folks who have a fitness certification can be identified. The public can search the registry to see if their fitness professional is accredited.

As an industry association, we work with all the different certification agencies. We are looking at ensuring that the public know where to go to find a qualified fitness professional.

Australia has a very good model, with a tiered certification program. We hope to emulate that. We have great certification agencies from coast to coast. We can definitely leverage them.

I think there does need to be a check and balance and some sort of proof of purchase and proof of certification. That does exist today. Those registries are in place.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. O'Connell.

Mr. Thériault, you have the floor for six minutes. Go ahead.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Thank you to the witnesses for their opening statements.

I would like to begin with Dr. Soulez and Dr. Barry.

Thank you for agreeing to take part in this meeting on the collateral effects of the pandemic, in general, including on non-COVID-19 patients. The pandemic has created two categories of patients: those with COVID-19 and those without COVID-19.

There can be no medicine without diagnosis, and your specialty is hugely important in diagnosing patients. You said the government needed to invest roughly $1.5 billion in equipment. Tell me, if you would, whether your requirements would be met if the government were to make a massive investment in health transfers, sooner rather than later.

[Dr. Gilles Soulez, Vice-President, Canadian Association of Radiologists]

That's an excellent question. As Dr. Barry clearly explained, Canada was already behind in capital equipment investment before the COVID-19 pandemic. Investments were already needed pre-pandemic, with our equipment assets significantly below the average among countries in the Organisation for Economic Co-operation and Development.

At the height of the crisis, the rate of imaging and screening dropped drastically, and we have yet to return to pre-pandemic levels. At best, we are at 90% to 95% of where we were pre-pandemic, and in most cases, that figure is 80%. We are digging ourselves into a deeper and deeper hole.

The $1.5-billion ask covers not just the purchase of equipment, but also things like human resources—which matter a lot. Different provinces have different needs. Some are in desperate need of equipment, such as the Atlantic provinces and Alberta. Other provinces are more in need of human resources. We have to maximize the use of all equipment, even running machines overnight where possible. That means finding ways to train the technologists who run the machines and to keep the technologists in those communities, something that isn't always easy.

Investing in information technology is also essential. Right now, most provinces don't even have a central inventory for wait lists, so patients can't be referred to appropriate IT platforms. There's no way to find out in real time how serious cases are or determine which ones are truly urgent, meaning, the ones that can't wait. That information is extremely important.

I want to draw your attention to one last thing regarding IT investment. Making sure we choose the right tests for patients is crucial. IT systems are now available to support clinical decision-making, helping to guide front-line workers, such as family physicians. The technology provides assurance that the test fits the needs of the patient, thereby ensuring testing is 100% useful.

[Luc Thériault, Bloc, Montcalm, QC]

Wait lists were already a problem prior to the first wave. Procedures were postponed when the first wave hit, and the backlog was not cleared before the second wave hit. The same thing happened during the second wave and will happen during the third wave. People are going to suffer the consequences of being put on the back burner.

As we speak, people are not being diagnosed. That's clear, is it not? Could that not end up costing the health system more? Am I wrong?

[Dr. Gilles Soulez]

You raise a good point.

I'll give you a brief overview of what we are dealing with at the clinical level.

Patients have been broken down into four priority categories. Category one—sometimes called P1—patients have to be seen the same day; in other words, they are emergency cases. P2 patients have to be seen within a week.

Disaster strikes when we are dealing with P3 patients, who are supposed to be seen within a month. An example of a P3 case would be someone with unspecified abdominal pain. It's important to find out what it is. Nearly 90% of those types of cases turn out not to be serious, but 10% can be linked to cancer. Even though P3 patients are supposed to be seen within a month, the current wait time is three to six months.

An example of a P4 case would be someone waiting for an orthopaedic surgery, a hip or knee replacement. Normally, those patients are seen within three months, but the current wait time is almost a year, sometimes more. Patients who are waiting for surgery cannot work and they suffer in pain. They do not have access to the treatment they need. What's worse, they sometimes have to be examined over again because too much time has elapsed since the diagnosis, so they have to go through two examinations.

[Luc Thériault, Bloc, Montcalm, QC]

Isn't it true that a delayed diagnosis of certain types of cancer can make things worse? It can end up costing a lot more to treat the patient, can it not?

[Dr. Gilles Soulez]

Yes, you're absolutely right.

A month is a reasonable time frame. When we strongly suspect a patient has cancer, we have to speed up the process as much as possible. The problem is that we can't confirm the patient has cancer until they undergo medical imaging. Most patients who fall into the P3 category will have to wait three to six months, instead of one month. That gives the disease time to progress to another stage, so instead of performing curative surgery, doctors can merely treat patients with radiation and chemotherapy. The mortality risk is inevitable.

[Luc Thériault, Bloc, Montcalm, QC]

Quebec and the other provinces are the ones who have to provide that care. They need predictability. The government claims it has to provide health care support on an as-needed basis to get through the crisis, saying it will adjust health care transfers once the pandemic is behind us.

Given what we've just talked about, do you think that's a mistake? Shouldn't the government massively reinvest in health care right now?

A total of $28 billion is needed to restore health care funding to an adequate level.

[Dr. Gilles Soulez]

As someone who works in a tertiary and quaternary care hospital, I can tell you that, right now, non-COVID-19 patients, on the whole, are really suffering because of the pandemic. Clearly, they need very serious attention. The health care system is already underfunded, grappling with staff and equipment shortages.

As things stand, we could see higher mortality among patients whose condition is unrelated to COVID-19 than among those who contract the virus. That is a possibility.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We'll go now to Mr. Davies.

Mr. Davies, please go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and thank you to all of the witnesses for being here today.

Ms. McQuaig, I think it's a fair comment to say that one of the most profound problems our country faced in terms of vaccine rollout was our lack of domestic production capacity. As you pointed out, the current Liberal government is negotiating a private model relating to domestic production. Why do you have so little confidence that Ottawa and Sanofi Pasteur can negotiate a contract that would give Canadians priority access to the vaccines and medication that we need?

[Linda McQuaig]

You know, it's not even that I have little confidence; it's that when we're dealing with hundreds of millions of dollars of public money, we have to have more than just confidence. We have to have certainty. We have to have real rules in place.

What alarms me so deeply about this $415-million investment the government is making in Sanofi is that there seem to be no restrictions. There seem to be no strings attached. They say they're negotiating this contract with Sanofi. Hopefully, it will mean that we'll get what we want and we'll get that priority access for Canadians, but without that being really clarified and clearly nailed down, it's just dreaming. That's a tremendous amount of money to be dreaming about.

I would also add that I think this whole way of thinking is based on a fundamental misconception that we often see on the part of people in government—that is, that the interests of government and private business are fundamentally the same. That is just wrong. The interests of government and business are really quite different. The top priority of business is profit maximization for the company. The people running the company ultimately answer to their shareholders, who want to be made richer, and I'm not even saying this to criticize private companies; this is what they're all about. On the other hand, government answers ultimately to the people, to the voters. If they don't defend the public interests that the voters want, they will end up getting defeated and kicked out of government.

My whole point is that there's a different set of interests involved. The way the Trudeau government is approaching this, throwing $415 million at Sanofi, is just way too trusting. It's based on some notion that they have the same interests that we do. They do not have the same interests. We have to be much more careful.

Even more important, we'd be much smarter to not go this private route and to instead go the public route. As we saw with Connaught, we were able to control what happened with Connaught. It turned out to be a wonderful situation. This was an enormously successful company that provided vaccines for Canadians at cost. They used their profits to reinvest in research. This was a spectacular example. I think the point is that we should be more aware of that history and more excited by what was achieved with it and more interested in investigating whether we couldn't try that again.

[Don Davies, NDP, Vancouver Kingsway, BC]

You anticipated where I was going, which was to move to Connaught Laboratories. As you pointed out, it appears that it's pretty common ground that it was a huge success. It was pivotal in producing vaccines for diphtheria, polio and diabetes as well, providing those medicines at affordable prices for millions of Canadians and in fact selling at a cheap cost to the rest of the world.

In 2021, what steps should we take, or you would recommend that we take, to replicate that success today in moving forward?

[Linda McQuaig]

There are two key things that I think we should keep very much in mind. You described the success of Connaught. There was a reason Connaught was so successful. One of those reasons was that it was very explicitly, right from the beginning, committed to the public good. It stated its goals very clearly as making medication affordable and available to all who needed it. Now, that's a public interest definition. That's very different from what private pharmaceuticals do. I think that inspired loyalty in its staff and in scientists.

The other thing I'll just say quickly is that Connaught was based at a university. It was based at the University of Toronto. It expanded way beyond that. That meant it could draw on the expertise of the university, the scientific expertise. In fact, they could share research with private pharmaceutical companies. There tends to be an unwillingness to share any proprietorial information with other scientists. Connaught wasn't like that at all. They were constantly contributing to other medical advances. They became a hub for scientific inquiry. I think it's very important that if we go back to recreating Connaught, we once again replicate that model as a real hub of scientific innovation and collaboration with other scientists.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

It appears I'm out of time.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

That brings our rounds of questions for this panel to an end, and I believe that concludes our business for today.

I thank the witnesses for your time and your expertise and for sharing your insight with us—

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, if everyone consents, we could have a second round of two minutes, as we did earlier, since we still have a bit of time.

[The Chair, Liberal, Ron McKinnon]

Sure, we could do 30-second shots if everyone wants.

We'll start with Mr. d'Entremont for 30 seconds, please.

[Chris d'Entremont, Conservative, West Nova, NS]

Thank you. My question is for Dr. Barry or Dr. Soulez.

We know that we're already backed up in wait times when it comes to diagnostic imaging. Just how far back has COVID brought us?

[Dr. Michael Barry]

If you look at patients—and I think Gilles has dealt with that, particularly the P3s—I suspect that more than 380,000 people are backlogged in the system, but that's one raw number. Nova Scotia and New Brunswick are probably in better shape than the rest of the country. I think the economic cost is upwards of $5 billion a year, with not letting people get back to work, being at home and off the payroll and with all the social issues around staying at home and not being productive.

Certainly it's more than 380,000. We'll know more about how to quantify it as we study it again after this third wave.