Health Committee on March 2nd, 2022

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Perhaps I'll continue.

We have one minute left, Dr. Pichora.

We have shortages. There is a lot of fatigue. Our health care system was tired before the pandemic, and this has been highlighted now by the pandemic. There's no quick fix; you're not a magician. How do you see a way out of this? Are there one or two key points you could speak to that you see?

[Dr. David Pichora]

You're right; there is no quick fix. Right now the thing that's impeding our ability to restore care most significantly is our rising ALC rates for the patients who've completed their journey of care in the hospital and are waiting to go to another destination, whether that's home and community care, rehabilitation or long-term care. That would make the biggest difference in the short term to us, to try to implement remedies that will boost capacity in the community so that a hospital can do what it's supposed to do.

[Shelby Kramp-Neuman, Conservative, Hastings—Lennox and Addington, ON]

Fantastic. Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Pichora. Thank you, Mrs. Kramp-Neuman.

Next we have Mr. van Koeverden, please, for six minutes.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much, Mr. Chair.

Before I start, I'd just like to send a huge thank you out to every witness today. You represent the people, the workers, who have been supporting our communities through the toughest time that all of us have ever lived through. You truly are the frontline infantry of our system, and while it is very challenging work, Canadians are grateful. Canada has fared fairly well compared to many of our peer nations, and that's because of your hard work and the hard work of your members. We can't thank you enough.

I have a couple of questions. I suppose my first question will be directed to either the Ontario Medical Association or the Canadian Nurses Association. I was just looking over some of the data provided to us from the Library of Parliament, and I always like to see where Canada ranks internationally among some of our peer countries. I used to be an athlete, and it was always good to see where you were at compared to your competition—not to suggest health care is a competition, but it is nice to see where we rank. We all know there aren't enough doctors and nurses in Canada, but it's good to know whether they're on the rise or going in the opposite direction. The data indicates it has been on the rise, just not quickly enough. It hasn't kept up to our population, and it probably wasn't even adequate 20 years ago either.

It's clear, and I think we all agree, that we need to increase the workforce. That's an obvious statement, I suppose, but the next question is how.

I spoke with a constituent today who is a neighbour and a good friend. She is a personal support care worker, and she would like to become a nurse. We were discussing how she could go about that. She has two kids, so it's going to be challenging financially for her. From the Canadian Nurses Association's perspective, how can Carley find the support that's necessary to go from the work she's doing now and join the workforce as a nurse?

Also, perhaps you could touch on the impact that immigration and foreign credential qualifications might have in ensuring we have the workforce necessary to continue on.

[Michael Villeneuve]

Thank you very much, Mr. Chair, for the question.

Certainly, there has been a move over many years for nurses. There are four regulated categories, and then there's an unregulated group of support workers—and I'll just use the general term—who sometimes want to move from one level or type of nursing to another. One of the areas where we haven't made it easy historically is in how you move, for example, from being a support worker to a licensed practical nurse, to a registered nurse and so on.

There are more bridging programs now, and they are better than they used to be. There is one thing we haven't done as well historically in nursing. You almost had to start over at each level when you went into a program, so it was a bit discouraging for people who might have been at the top of their game at the age of 35 in one category and wanted to go back and move to another. That's been a bit of an issue, but it is being addressed.

In terms of internationally educated nurses—and other health professionals, of course—we hear across the country that many find that the rigours of getting through the regulatory process are quite difficult. I'll give you an example. I spoke with a young man from Tunis just last week, who has a Ph.D. from one of our very good universities, and he is really struggling to get through the regulatory process to get registered in this country, to the point where he's saying he's just going to go back rather than go through it.

We believe there should be some moves made to help smooth those processes to get people in faster. I know regulators are trying to do that, but I think there's a way to go.

I'll close by saying that one of the areas is language. Often these nurses come from very good universities in other countries, and they're very well educated, but they have trouble with the language test. Yet when I talk to them, I can understand them quite well.

I think together we need to look at all those sorts of hoops that seem to get in the way of bringing people into the health care system when they're interested in working or in moving up.

I'll end it there. Thank you.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Mr. Villeneuve.

I would pose the same question to Dr. Kassam, a fellow Adam, at the Ontario Medical Association. Can you provide some insight?

[Dr. Adam Kassam]

Absolutely, and thank you for the question. It's an important one.

As far as health human resources are concerned, you [Technical difficulty—Editor] with what we said earlier. A million people in the province of Ontario don't have access to a family doctor. We expect immigration and population growth in the province. We also expect, and are seeing, an aging population that will invariably require more health care utilization. It's not only a combination of a growing population, but a population that's going to require more health care services down the line.

How do we address this? As you said, we need more doctors. It's very clear that we have a physician shortage. We've had this chronically for quite some time.

How do you do that in an effective way? First, you have to stop the bleeding and make sure that we can shore up what we have right now. That's making sure that physicians don't leave the province, the country or their profession. Second—

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Dr. Kassam.

I'm sorry. I have to cut you off because I have to move a motion, if the committee will indulge me.

I move:

That, pursuant to Standing Order 108(2), the Committee invites the Minister of Health, the Minister of Mental Health and Addictions and Associate Minister of Health, as well as officials, to appear for two (2) hours regarding the 2021-2022 Supplementary Estimates (C), the 2022-2023 Main Estimates, and the 2022-2023 Departmental Plans for the Department of Health, the Canadian Food Inspection Agency, the Canadian Institutes of Health Research, and the Public Health Agency of Canada and that the meeting take place on Monday, March 21st, 2022.

I'm sorry, Dr. Kassam. That was rude. I apologize. I have to get too much done in six minutes.

[Dr. Adam Kassam]

That's no problem at all. I totally understand.

[The Chair, Liberal, Sean Casey]

Colleagues, this is the motion that was put on notice at Monday's meeting. The motion is in order. The debate is on the motion.

Mr. Barrett, go ahead, please.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Thanks very much, Chair.

Through you to Mr. van Koeverden, it would be helpful to know if we're going to have ministers and officials for the combined total amount of time. Sometimes they split an hour and an hour.

Also, having multiple ministers and officials over a two-hour period can be a bit of a tight time frame. Is there any leniency on the amount of time that the ministers are available? Of course, I note that we appreciate that the ministers are making themselves available to be at the committee.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Mr. Barrett.

If you have a preference or a recommendation.... The benefit of having three weeks is that the ministers, particularly the Minister of Health, will potentially have the time. I believe on that date, the Minister of Mental Health and Addictions will only have minimal lines on the estimates. They're not entirely complete, but the Minister of Health will have complete lines.

You're right that there will be a lot of people at the meeting. If you would prefer to have a different balance of officials and ministers, we have the time to discuss it, and I have the time to go and advocate for it with the ministers.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Having the ministers available for the full two hours.... It's important that we're not hiving off the officials. It's important that we also have the opportunity to ask the officials questions. Having the ministers available for two hours and the officials for an additional hour....

Instinctively, I would like to ask for the ministers to be here for three hours. I have lots of questions for both, but if we could focus on the ministers for two hours, members can use the time as they see fit and also ask the officials questions. I appreciate that their time is also valuable, but it's a little less hard to pin their schedules down than the ministers'.

My suggestion is that it would be three hours for the officials and a total of two hours that ministers would be available to the committee.

[Adam van Koeverden, Liberal, Milton, ON]

Just so I'm clear, are you asking that this be covered over two meetings—over two Mondays, as the COVID meetings are on Mondays—or are we asking for a three-hour meeting?

I think we can ask if the officials could come concurrently with the ministers on the first Monday, which is the 21st, and then maybe have just the officials for a subsequent hour on the following Monday, or we could have a three-hour meeting.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Following the completion of the first meeting, the committee could discuss if the officials are required the following Monday. Resources are difficult to come by, so tacking on a third hour, especially if we get jammed with votes or anything like that, might be tough. Potentially there would be—if there's a willingness to extend the questioning of officials on the following Monday, if required—the baseline that the ministers will both be available for the two hours at the meeting that's in the motion you moved.

[Adam van Koeverden, Liberal, Milton, ON]

Yes, the ministers will be present for two hours, and I will ask about a third hour for the officials. For clarity, I think I said this would be a COVID meeting, and I think it's separate, although it is occurring on a Monday.

[The Chair, Liberal, Sean Casey]

Just from a procedural perspective, if I may, Mr. Barrett, the motion does indicate that the ministers would be here for two hours. I would suggest, if at the end of two hours there's a willingness to bring back officials for a subsequent meeting, that a motion could possibly be presented at that time if you think that would be required. Is that okay procedurally?

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Based on the assurance that the ministers are available for two hours, and based on your comments, Chair, I have no objection or further questions.

[The Chair, Liberal, Sean Casey]

Thank you.

Mr. Lake, go ahead.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

What is our deadline for reporting this back? When do we have to complete this by?

[The Chair, Liberal, Sean Casey]

There's a different deadline for supplementary estimates (C) than there is for main estimates. As you know, it depends on when the last allocated day is. We still don't know the deadline for supplementary estimates (C), but we do know it's much longer for the main estimates. Because all of the days have not yet been allocated, the firm date for the deadline at this point is unknown.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

In the spirit of Mr. Barrett's suggestion, then, regardless of when that deadline is, if we decide we want to have officials come, we would have them anyway.

[The Chair, Liberal, Sean Casey]

Yes, the committee is at liberty to study the estimates even when the time is up. It just can't vote on them. It would become a subject matter study.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

While we're on the record right now, I just want to make sure, from Adam, that this would be the spirit of what we're talking about.

Okay.