Health Committee on June 11th, 2021

[Ansar Ahmed]

One of the findings that came out of our round table, frankly, was the absence of exactly that sort of evidence to support decision-making.

I don't believe a lot of research has been done pan-Canada and from coast to coast in terms of looking at how different jurisdictions manage long-term care, or the standards they use or mandate within their facilities. If anything came out of our round table, it was a desire to push governments to make sure this type of research is done. We are hoping, for example, through our partnership with the University of Toronto, to obtain that sort of information and evidence, which we can then share with governments to ensure they're making the right investments in the future.

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

Thank you.

Ultimately, if we're all doing sort of the same things, then hopefully infection control will be maintained across the system. Whether each has an individual room and an individual bathroom—those kinds of things make a big difference to what infection control actually is within our long-term care facilities.

[Ansar Ahmed]

They do, absolutely. That's why our focus during our round table was on looking at the built environment and all aspects of the long-term care facilities, not just, for example, the number of beds assigned per long-term care home. It was looking really at how the entire long-term care home operates and how it functions.

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

Thank you very much.

I'm going to move on to ask a few questions on the PMPRB.

Mr. Labrie, were you involved in the consultations held by the PMPRB over the past few years?

[Yanick Labrie]

Thank you for the question.

I was not. My involvement was more through the studies I conducted and published, which are in the public domain.

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

When they appeared before our committee, various patient associations told us that the PMPRB collaboration was neither satisfactory nor sufficient.

Did you have an opportunity to pay close attention to it?

[Yanick Labrie]

No, I did not pay close attention to any collaboration between the PMPRB and patient groups. I kept my distance. I'm an independent researcher. To be sure, I paid special attention to the reform being considered and to everything in the public domain. On the other hand, I'm not up to date on any meetings that may have been held between members of that organization and patient groups.

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

In your research, did you see any forms of collaboration, or anything else, that we could draw upon to ensure that all parties are sitting at the same table and can have a useful discussion?

[Yanick Labrie]

Based on my own experience, when the regulatory organization, in this instance the PMPRB, maintains a climate of trust with the other stakeholders, things go much more smoothly. A dialogue on both sides is established. When people are transparent and acknowledge that the proposed regulatory reform has advantages, but also some potential costs, that allows for dialogue.

What I have noticed at the moment is that there is a conflictual climate between the various parties, and I find that unfortunate. That would be harmful not only to Canadian patients, but the entire Canadian population, because they are the ones who would pay the price.

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

The pharmaceutical companies told us that they had already had the launch of some medicines sidelined or at least slowed down by a few years.

Is that because of the regulations being considered or the uncertain outcome of the discussion that has been going on for three years already?

[Yanick Labrie]

It's a bit of both of these factors, but mainly the uncertainty. As you know, uncertainty is the worst enemy of investors and companies, particularly pharmaceutical companies, which don't know what to do at the moment. They are very much afraid that the reform would reduce expected profits, which would make it more difficult to launch medicines in a timely manner in Canada.

Of course, as I mentioned in my first address, Canada is not the only potential market. We only have a very small share of the global market in pharmaceuticals. The companies will very likely focus on other places where the conditions are more conducive to the launch of new medicines.

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

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. d'Entremont.

We go now to Mr. Van Bynen.

Mr. Van Bynen, go ahead, please, for six minutes.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair. I'll be sharing the second two minutes of my time slot with Ms. Sidhu, who also has an interest in long-term care.

Thank you especially to all of our witnesses, and to Mr. Ahmed for accepting our invitation to join us today and for sharing his experience and learnings on long-term care from his round table discussions. My questions will be for him.

Mr. Ahmed, earlier this year, Jacobs brought together health care leaders from across the province, including the Southlake Regional Health Centre's CEO, Arden Krystal, for a productive discussion on long-term care.

I have some questions about the report produced following this round table, but first I would like to ask you to table it with the committee so we can consider it in our study. Would you be prepared to do that for us?

[Ansar Ahmed]

I absolutely would. We will circulate that through the committee clerk's office.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you.

Can you share with the committee today, though, some of the key findings from this discussion? You alluded to two major discussions, but there were nine recommendations. Could you let us know what was in the report that followed?

[Ansar Ahmed]

The report itself focused on Ontario, just because that was where people's experience was in terms of both residing here in Ontario and being active in the long-term care space, but I think the findings were, frankly, applicable to any other province or territory in Canada.

There were nine recommendations that came out of that report, and they've been shared with officials in different jurisdictions. I can tell you right now that one of the first recommendations—and I think one of the drivers for this study, based on the fact that we saw a number of investment plans being tabled and being set into motion—was based on a concern amongst those who attended the round table about over-building.

Obviously we've never come across a global pandemic like this, but in circumstances like that, you tend to throw money at a problem and it can result in over-building. Until you analyze what some of the shortcomings are within these facilities—the structural vulnerabilities I spoke to in my comments—you're really throwing good money after bad. One of our recommendations was essentially to put some brakes on, take the time to do some research, figure out what these structural vulnerabilities are and address those, and then fuel the recovery in these long-term care homes through the planned investments across governments.

The other recommendation centred around making sure they consulted with stakeholders, both residents and those who are active in the long-term space, and then also ensuring there was a robust program for accreditation of these facilities, as well as ongoing monitoring and compliance. Once the standards have been modernized, they have to make sure there is a program executed either at the provincial level or through local health authorities, so that these long-term care homes are frequently visited to ensure they are meeting the planned objectives of the provincial ministries of long-term care and health.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

You've had a round table and you've produced a report with a lot of insight and good findings. What's next?

[Ansar Ahmed]

I think one of the most important steps we've taken is through the University of Toronto and through our partnership with the Ontario Association of Architects, getting that initial research under way.

The University of Toronto is planning a three-month research study that they're undertaking. I believe it's due to start in the coming weeks. It's going to focus on gathering the experiential data I talked about during my remarks.

We're hoping it will then set the groundwork for a larger, broader, more comprehensive study that we hope to move forward. We are in conversation with the Ontario Ministry of Long-Term Care to ensure that we hit that research in the right spot, where it has the most optimal benefit to the public.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

That's a probably a good segue to Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Van Bynen, thank you for sharing your time. I also have a question for Mr. Ahmed.

We can all agree that one of the great tragedies of the pandemic has been the situation in long-term care homes across the country. My caucus colleagues, including my fellow committee member Ms. O'Connell, rang the alarm during the terrible tragedies in long-term care in Ontario.

We know that delivering these services falls to the provinces and territories, but there is a role for the federal government to play in ensuring consistent quality of standards across the different provinces and territories. Would you agree that a national standard for long-term care would be an important step to ensure the safety and dignity of those living in long-term care?

[Ansar Ahmed]

Absolutely there is room for a national standard to be developed and to be adhered to from coast to coast.

I think back now to when the federal government instituted municipal gas tax funding. There was a lot of disparity amongst different municipalities across Canada in terms of how they managed their assets.

I remember that the Public Sector Accounting Board put forward regulations that mandated certain standards for asset management.

In that same [Technical difficulty—Editor] for the federal government and for federal agencies to set up those sorts of basic standards to ensure that there is a level playing field across all long-term care homes across Canada.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Sidhu and Mr. Van Bynen.

Mr. Thériault, over to you for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

Mr. Labrie, tell me if I've understood correctly.

Several witnesses came here to tell us that the PMPRB was flying blind. On the one hand, they told us that drug prices were too high and that this would have consequences. On the other, they did not have all the tools they needed to tell us exactly how much too high people were being charged for their medicines.

And there doesn't appear to be that much of a lack of transparency, since you just told us that it had been possible to determine that the government of Quebec had received a total rebate of $1 billion. So we know the actual price of the medicines.

It's all a bit difficult to understand. There appears to be some doublespeak. We're complaining that it's too expensive, but we can't say by how much.

[Yanick Labrie]

Personally, I've lost confidence in the PMPRB's ability to make accurate international price comparisons.

And of course it's also related to the discounts and rebates that manufacturers offer to different clients, which are confidential. These types of discounts exist in Canada, but also in other countries.

As for transparency, I know that this was addressed in the first part of today's meeting. Transparency does exist at the global level, by which I mean that we can have access to some types of aggregated data. I revealed how this worked for Quebec, when I presented the numbers that you've just quoted. Innovative pharmaceutical companies gave a rebate worth more than $1 billion to the government of Quebec over the past four years.

This should be taken into account, at least when providing an overview of pharmaceutical spending trends. At the moment, the situation is being depicted as out of control, when this is not the case. To begin with, the population is aging and needs more medicines. Inflation also needs to be taken into account, which the PMPRB does not do. We also need to factor in the discounts I mentioned, and our ability to pay, which is based on our economy and the wealth generated. When all these factors are combined, it becomes clear that spending on drugs in Canada's economy and health budget has been decreasing over time. So there's no need to panic.