Health Committee on April 23rd, 2021

[Dr. Stephen Wile]

Yes. I think one of the obstacles for our clients is that there's often a lack of trust, right? The people they tend to trust are the people who are there to serve them: our shelter workers and our street-level workers.

In terms of one of the difficulties we're facing right now, we have an example in British Columbia. In Kamloops, our shelter service received their vaccinations at least a month earlier than we did in Alberta, and one of the things we discovered in Kamloops is that when we booked our clients for a vaccination, the response rate was about 30% from our shelter clients who wanted to get a vaccination. When we booked our clients in coordination with our staff, with our staff getting their vaccinations at the same time as our clients, the rate moved to 80%.

We've been telling Alberta Health Services that if you want this population to get vaccines, you need to have our support workers get their vaccines at the same time, as an example to them. Unfortunately, that has fallen on deaf ears. In this past week, we have vaccinated 90 of our clients of approximately 250 or so—

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Mr. Wile, I don't want to cut you off, but I have about 30 seconds left and I want to get this on the record. Because I know the federal government is starting to do some education on vaccination, is there anything specifically at the federal level that you would recommend to the committee in terms of that education component—how to target that to your clients and how to partner with you on that information in providing service?

[Dr. Stephen Wile]

Yes. I think that overall there needs to be a deeper level of communication with the people on the street, the service providers, because this is a unique population. If we treat this population like the rest of the population, we will likely have difficulty in getting the level of vaccination that we feel is necessary to protect this group of people.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you for everything you do.

Thank you, Chair.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Rempel Garner.

We'll go now to Ms. Sidhu for six minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

We know that our communities and our medical professionals are under increased stress in the third wave. My community is a hot spot of COVID-19. I want to thank all frontline medical workers, nurses and doctors who are saving Canadians every day.

My question is for Dr. Collins. We know that our government announced new supports for Ontario, including sending federal health care staff and equipment to the front lines and more. In your testimony, you referred to an additional $4 billion from the federal government going towards the Canada health transfer to help provinces get through this pandemic. What are some immediate needs that you think the provinces should be targeting?

[Dr. Ann Collins]

Through you, Mr. Chair, we commend the government for the added $4 billion directed to address the backlog and the million dollars for vaccine delivery. We are not yet fully aware of what the impact of this pandemic will be on backlogs. We know that there have been incredible increases in wait times. We know that people have delayed seeking medical attention. What that will lead to when they arrive, of course, is diagnoses that are much more complex, and the need for diagnostic and treatment services will be that much more complex as well.

We also feel that it's imperative that there be a commitment to a previous promise that every Canadian should and can have a family doctor. We know that primary care is critical in how we deliver care to Canadians, including what is going to be needed post pandemic, and there is also the incredible requirement for what we anticipate is going to be needed to provide mental health care not only to health care providers, but to their patients as well, as we come out of this pandemic.

[Sonia Sidhu, Liberal, Brampton South, ON]

My next question if for Dr. Bloch.

Dr. Bloch, my mother is presently undergoing treatment for cancer. She's fortunate to have family members supporting her. Can you speak to how patients with a serious illness, especially those with COVID-19, are able to cope when they do not have a support network? What issues do you see among low-income and racialized communities, and what solution do you propose?

[Dr. Gary Bloch]

My mother-in-law is also undergoing treatment for cancer, so I've experienced this personally. What I see among my patients is that what it takes to address health issues is truly being magnified. It's being magnified by the COVID pandemic itself and a lack of access to services, both within hospital and primary care services, although we are certainly doing our best to support people. It's also magnifying the social divides and barriers, and the gaps we see in our society, right?

What were previously, for some, lower levels of barriers are now rising. People who live in high-risk neighbourhoods, especially people who are racialized, people who live in higher-risk buildings, especially people who are low income, are finding it even harder to access supports and medical care than they did before.

There are a number of ways we can approach this. For a start, I would echo what Dr. Collins put forward about the need to put primary care at the forefront of our health system response. It is truly primary care providers who can come from within the health care system and dig most deeply into the realities of people's lives.

This is what I spend my time doing every single day. This is true of people who live in low-income situations who are socially marginalized, and as Mr. Wile pointed out, people who are right on the margins and homeless. We are the ones who are truly accessing people everywhere.

We need to look at a higher systemic level of support. When we talk about the fact that people who are racialized and with low income have more difficulty accessing services, we need to think about why that is. We do not need to look at the individuals, but at the systemic factors behind their difficulty in accessing services.

There is real racism built into our systems that pushes people who are racialized away from accessing care. We need to do a deep dive as a health care system into understanding why that is, first, by collecting and looking at data to allow us to understand what the experiences are of people who are racialized, who face other elements of social marginalization, and then by targeting specific health care and social services toward those communities to correct those inequities.

When it comes to addressing the needs of people who are low income, I don't want to sound pat, but the answer is not all that complicated. Living on low income requires a response of increasing access to income. I certainly see that, and I've always seen that as a health-relevant response to a health-relevant issue. We need to urgently ensure that our income support programs provide an adequate income for anyone to live and survive in Canada

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Sidhu, and Dr. Bloch.

We'll now go to Mr. Thériault.

Mr. Thériault, you have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

I'd like to thank all the witnesses for their contributions, which help us understand the collateral damage caused by this pandemic. One of our concerns is patients who haven't had COVID-19. Physicians from the Canadian Medical Association have provided an overview that talks a lot about the management of the pandemic. We've heard very little about the collateral damage to patients who haven't had COVID-19.

Dr. Bélanger, from the Association des gastro-entérologues du Québec, recently told us that urgent matters should not cause us to lose sight of what's important. When we talk about the fight against cancer, we agree that this disease doesn't wait for pandemics or their resolution to spread.

Dr. Collins, I get the impression that you have a very clear idea of what the post-pandemic will be like. When will it take place? You said earlier that something had to be done during the pandemic, that you were pleased with the funding to deal with what happens during that time and that we would have to see afterwards, but what do you mean by “after”? When will this happen?

[Dr. Ann Collins]

Thank you for your question.

I'll ask my colleague, Dr. Abdo Shabah to answer it.

[Dr. Abdo Shabah, Quebec Board Member and French Spokesperson, Canadian Medical Association]

Thank you, Dr. Collins.

Thank you for your question, Mr. Thériault. It's quite relevant.

It's undeniable that the tragedy of the pandemic today is compounded by collateral effects caused by delays in medical procedures. CMA investigated this issue in October of last year and recently released a report on reducing delays.

I'll mention some of the findings of the report. As COVID-19 cases began to increase in Canada, it became clear that there was additional pressure on the health care system. This is what we're experiencing today, on a daily basis.

You talked about what is urgent and what is important. We're dealing today with what's urgent, but the report also talks about what's important. This includes procedures such as joint replacement, which affects quality of life, cataract surgery, or diagnostic imaging, which has a major impact not only on quality of life but also on survival. When we're trying to diagnose cancers, for example, we're facing significant delays that result in a significant backlog of procedures and a significant increase in wait times. The situation surrounding these interventions, which are essential to survival and have a significant impact on [Technical difficulties—Editor], allows us to take a look at the precarious nature of our health care system.

Therefore, we're calling on all levels of government to expand primary health care services and increase support for health care so we can deal with those backlogs that were already starting to build up by the time we realized the situation, during the first wave of the pandemic. There was a second wave and now there is a third wave. It's clear that Canadians will suffer the consequences of that.

[Luc Thériault, Bloc, Montcalm, QC]

Dr. Champagne, from the Association des médecins hématologues et oncologues du Québec, said that the effects would be felt over the next 10 years and would result in a 10% increase in the mortality rate. It was based on a publication of the British Medical Journal. Knowing that four weeks' delay implies an increase in mortality of between 6%, 8% and 10%, it's undeniable that resources must be increased at this time.

Earlier, the Canadian Federation of Nurses Unions told us about the labour shortage. Performing surgery that could solve cancer early still requires respiratory therapists and nurses, among others, in the operating room.

From a medical point of view, do you think it makes sense to say that health transfers will be increased substantially and repeatedly, but only after the pandemic?

That's why I was asking the question. When is “after”?

Does this make economic sense? We know that a colonoscopy costs $1,000. If it isn't done in time, the patient becomes a chronic disease patient who ends up in the system. System costs will increase over the next 10 years. Costs will skyrocket.

Is there a logical medical and economic case for a substantial and recurring post-pandemic investment?

[Dr. Abdo Shabah]

Thank you for your question.

Again, I think it's extremely important to support the provinces and territories during and after the pandemic through federal health transfers. I think your point is well taken: we must act on what is urgent, because the pandemic is now.

What's important is planning ahead. At the Canadian Medical Association, we believe that constructive dialogue on the best funding model would ensure that all patients in Canada receive the same quality of care, today, during the pandemic and after the pandemic. These discussions on increasing health transfers for the post-pandemic period should take place. We look forward to engaging in such conversations in the months ahead.

[Luc Thériault, Bloc, Montcalm, QC]

Can we be content with $4 billion, when the common front of Quebec and the provinces is in the order of $28 billion? That's not to say that when we start negotiating, we can achieve that. The fact remains that the federal government's fair share of health care would allow health care systems to get back on their feet.

It was well known at the beginning of the first wave that the systems were already weakened. They were barely able to properly care for their patients.

Can you imagine them after a third, fourth or possibly fifth wave?

Now is the time to address it and invest. Don't you think so?

[Dr. Abdo Shabah]

That is certainly true.

Much more is needed. However, we already applaud the federal government's commitment to provide $4 billion to the provinces and territories to help them resolve these backlogs. All parliamentarians are being urged, in fact—

[Luc Thériault, Bloc, Montcalm, QC]

But this amount isn't recurring. They key is predictability and recurring investments, which will allow us to anticipate what we can do.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We'll go now to Mr. Davies.

Mr. Davies, go ahead. You have six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Dr. Collins, on April 16, the Canadian Medical Association issued a release that said the following:

...we are at a critical juncture where a truly national approach to combatting COVID-19 will make the difference between more or fewer lives saved.... We act as one country when crisis hits with wildfires, floods and other tragedies. This pandemic has reached a new level that requires a national response.... We are one country, and it's time we started acting as one by deploying resources where they are most needed. If we can't achieve this through voluntary co-operation, then more and stronger measures might be needed.

Right now, we are seeing a severe crisis in Ontario. ICUs are overwhelmed. Doctors are being compelled to take people off ventilators if they don't have a 70% chance of survival. This is an emergency.

In your view, should the federal government play a stronger role and use its authority under the Emergencies Act to deploy resources where they are most needed?

[Dr. Ann Collins]

Through you, Mr. Chair, I'm afraid I'll have to defer to legal experts who would be in a better position to address Mr. Davies' question. I do, however, want to commend the federal and provincial leaders who have signalled their intention to support the crisis in Ontario by encouraging health care professionals within their jurisdiction to answer the call of duty.

I can say that the CMA's members, too, are eagerly seeking ways to help and are ready to volunteer their time and put themselves at risk to help the acute care crisis emerging in certain jurisdictions across the country.

Thank you for the question.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks, Dr. Collins.

On April 20, you released a statement in response to budget 2021 that said the following:

We are...disappointed that this budget did nothing to address the problems faced by the nearly five million Canadians who must navigate medical issues without consistent access to a family doctor or a primary care provider. The federal government has committed on numerous occasions to ensuring each Canadian has access to a primary care professional, but we have yet to see any real commitment to this ongoing issue.

What will be the impact of this lack of action?

[Dr. Ann Collins]

Primary care is clearly the front door to the health care system, and as I've stated earlier, we don't know the full impact the pandemic has had with respect to wait times, and so on, but we know that those Canadians who do not have a family doctor are going to have a much harder time navigating the system to deal with issues such as their mental health care. We know that seniors need strong access to primary care.

We've not mentioned it today, but patients with long COVID are going to need primary care. Thus, we need to see a commitment to delivering on that, to expanding the role of primary care teams. Also, we need to start being more innovative and look at how we deliver health care with respect to the social determinants of health and taking in the many issues beautifully outlined by Dr. Bloch around equity in health care.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Worsfold, on April 19, CFNU put out a new release commenting on budget 2021, and it quotes CFNU president Linda Silas saying the following:

Canada's nurses were counting on the government to honour its previous commitments, including implementing universal public pharmacare, developing national standards for long-term care and meaningfully responding to the growing funding crisis in our health care system. It is disappointing that little progress has been made on these critical issues.

In your view, how will those failures manifest themselves on the ground in the year and years ahead?

[Pauline Worsfold]

Since I'm on the front line, I see it on a regular basis, where people now don't have benefits coverage, so stop taking their medication and end up in the emergency room with a bleeding ulcer, let's say, and then have to have emergency surgery, and so on.

There is a financial cost to the system, as well as a human cost, to not having a pharmacare plan for all people living in Canada. I think the savings that implementation of a pharmacare plan would reap would be able to support some of the things we've heard put forward today by the other witnesses. The cost savings of a national public pharmacare plan would be able to support the programs and plans that so need that coverage, up to and including the long-term care situation that we have going on now. We could support them with additional funds for proper care and levels of care delivery.