Health Committee on March 2nd, 2022

[The Chair, Liberal, Sean Casey]

I call the meeting to order.

Welcome to meeting number 10 of the House of Commons Standing Committee on Health. Today, we will be meeting until about 6 p.m. eastern to hear from witnesses on our study of Canada's health workforce. I understand that Dr. Tomblin Murphy has to leave at 5:40, so I would encourage those who have questions for Dr. Tomblin Murphy to pose those questions before then.

Today's meeting is taking place in a hybrid format, pursuant to the House order of November 25, 2021. All members of the committee are present in the room, but the witnesses are on the Zoom application. For those of you who are using the Zoom application, please do not take any photos of your screen or screenshots.

We will be respecting all of the health care directives from the Board of Internal Economy and the public health authorities.

I can inform the members of the committee that all of our witnesses today have completed the required connection tests in advance of the meeting.

To our witnesses, first let me say, welcome. Each organization will be given five minutes to make its opening statement before the rounds of questions.

Colleagues, we have with us today Geraldine Vance, chief executive officer of the British Columbia Pharmacy Association. From the Canadian Nurses Association, we have Michael Villeneuve, chief executive officer, and Dr. Gail Tomblin Murphy, who is the vice-president of research, innovation and discovery, and is also the chief nurse executive for Nova Scotia Health. From the Kingston Health Sciences Centre, we have Dr. David Pichora, president and CEO. From the Ontario Medical Association, we have Dr. Adam Kassam, president, and Dr. James Wright, chief of economics, policy and research.

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

Mr. Chair, it looks like there's going to be another vote. Instead of interrupting the witnesses, see if you can seek unanimous consent now to proceed through the bells, once those bells start. Members can vote electronically, with a brief pause until we get the result.

[The Chair, Liberal, Sean Casey]

Thank you for that, Mr. Barrett.

Do we have consensus to proceed through the bells and to suspend briefly to allow people to vote using the app?

[Some hon. members]

Agreed.

[Chair]

That's great. Thank you, Mr. Barrett.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, I'd like to speak about this issue.

For today, that's fine, because we've already started the meeting. That said, my whip asked me to tell you that the right to vote in the House is a privilege. If someone wants to do so, they should be allowed.

Today, I have permission to vote using the app. However, in the future, I'll need to go to the House.

[The Chair, Liberal, Sean Casey]

Okay, that's clear.

Thank you.

Now, we'll go to our witnesses. First of all, thank you for your patience. The delay, as you know, was caused by a vote in the House. Through unanimous consent, we've agreed that there won't be another delay, but because there is going to be another vote, there will be a brief interruption. Thank you for your patience and for being here with us.

We're going to start off with opening statements, beginning with Ms. Vance.

You have the floor for five minutes.

[Geraldine Vance, Chief Executive Officer, British Columbia Pharmacy Association]

I want to acknowledge that today I'm speaking to you from the traditional territories of the Squamish, Tsleil-Waututh and Musqueam first nations.

The COVID pandemic has shown both the weaknesses in our health care system and the resilience of our health care providers, who have worked for the last two years to meet the unprecedented demands the pandemic has placed on them. It is clear that the federal and provincial governments must renew their commitment to providing the support needed to ensure that Canada has the physicians, nurses and other health care providers ready to face another health crisis of similar magnitude should it come.

The B.C. Pharmacy Association applauds the work of this committee in pursuing much-needed opportunities to recruit and retain a diverse team of health care professionals across Canada.

Today, I want to share the perspective from my province of British Columbia on the resilience that community pharmacists have demonstrated.

As committee members will well know, B.C. has been particularly hard hit since the COVID-19 pandemic was declared. This health emergency was layered on top of B.C.'s other public health emergency—the opioid crisis. Added to that, our province faced a once-in-a-lifetime set of wildfires, heat domes and catastrophic flooding. All of that has added to the stress on the province's health care system. It is a testament to every health care worker in our province that despite the cascade of obstacles, people in communities big and small received the care they needed.

We all know that health care workers have paid the price. They are spent, and they need to know that their governments will put plans in place to make them better able to meet the next crisis. A key part of that preparation is the work of this committee—recruitment and retention of health care professionals.

When B.C. went into a public health state of emergency in March 2020, which included a lockdown on all but essential services, pharmacies were the only community care settings that patients were able to access in person. Pharmacists quickly pivoted to ensure that they met the needs of their patients.

B.C. has more than 1,400 community pharmacies in 158 communities across the province, and nearly every community has a pharmacy within a 30-minute drive. Pharmacies have long served as an important point of first contact for patients seeking medical care. A 2018 review showed that community pharmacists see their patients anywhere between 1.5 and 10 times more frequently than their primary care physicians, and we know that this number has skyrocketed over the last two years. This has meant that more and more patients are calling on their pharmacist to answer questions and to fill in the gaps of in-person care.

In a 2021 national survey, 90% of Canadians said that pharmacy professionals and pharmacies were essential during the COVID-19 pandemic. Three in four Canadians said that pharmacists played a larger role in providing health care services than before the pandemic. In that same survey, 93% of Canadians would trust pharmacists to be the first point of contact in the health care system.

While community pharmacists fill a number of critical roles, there is much more that pharmacists can and should be doing, but unfortunately pharmacists' scope of practice varies greatly from province to province, leaving a patchwork of coverage and patients in different jurisdictions unable to receive the same access to care.

In six provinces and one territory, pharmacists have the ability to prescribe for self-limiting conditions like cold sores and acne. These self-limiting ailments are easy to treat and self-identifiable by the patient. In our view, a national scope of practice for pharmacists should be adopted that ensures all pharmacists are able to deliver the same care at their maximum level of expertise, and this would include prescribing rights. This is particularly important in rural and remote communities that continue to have difficulties in attracting physicians and other health care providers. Allowing pharmacists to practise at their full scope will help patients and those providers already struggling under the pressure of providing care.

Governments have long struggled to harness the expertise of community pharmacists and to leverage the expansive network of community pharmacies. The pandemic has provided opportunities for pharmacists to show that the potential exists. In B.C., pharmacists have been critical in delivering COVID-19 vaccines.

We believe that the federal government should target funding to the provinces that would be used to improve and harmonize a standard scope of practice across the country. We recommend that this committee create a forum of engagement with the Canadian Pharmacists Association and other provincial pharmacy associations to develop a strategy to fully employ the expertise of community pharmacists.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Vance.

Next, we're going to hear from the Canadian Nurses Association, with Mr. Villeneuve.

[Michael Villeneuve, Chief Executive Officer, Canadian Nurses Association]

Yes, thanks very much, Mr. Chair.

[The Chair, Liberal, Sean Casey]

You have the floor for five minutes. Go ahead.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, I have a point of order.

It's about speed. I know that the witnesses don't have much time to speak. However, their pace is so fast that it makes the interpreters' job difficult. It would be helpful if the witnesses slowed down so that we could better understand their comments and ask questions about the things that they want to emphasize.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault.

Mr. Villeneuve, you have the floor for five minutes. If you go a little over five minutes, because we're going to ask you to slow down a little bit just to make sure the interpretation picks it up, I'll cut you some slack.

Go ahead. You have the floor.

[Michael Villeneuve]

Thank you, Mr. Chair and members of the committee, for inviting the Canadian Nurses Association to appear here today.

We applaud the committee's decision to conduct this important and timely study on Canada's health workforce, and we hope the work of members of this committee can help lead to meaningful and much-needed action.

My name is Michael Villeneuve. I'm the chief executive officer of CNA, and I am speaking to you today from the traditional lands of the Algonquin and Anishinabe people in eastern Ontario.

I'm pleased to be joined by Dr. Gail Tomblin Murphy, from Nova Scotia Health. Gail is an expert in the science of health human resources and is chair of the Royal Society of Canada's working group on the impact of COVID-19 on the nursing workforce.

Mr. Chair, I first stepped into health care as an orderly in 1978. During my 44-year career, I have never seen anything like what the nursing profession is going through now. Canada's nearly 450,000 nurses are the backbone of our health systems, but they're completely exhausted and demoralized, and we're seeing many of them leaving their jobs and even leaving the profession. Ninety-four per cent of nurses say they're experiencing symptoms of burnout. Severe burnout among all health care workers has nearly doubled. There are close to 120,000 vacancies in the health care and social assistance sectors, and we've seen alarming rates of nursing vacancies in hospitals across Canada.

These issues are not new, but they've been exacerbated by the pandemic. Nurses have been sounding the alarm for decades on these very same problems, long before COVID-19. There have been studies, reports and literally millions and millions of dollars in research all pointing to some of the very same core problems and many of the same solutions. In modelling work done by Dr. Tomblin Murphy in 2009, CNA predicted Canada would be short 60,000 nurses by 2022, and here we are with the crisis we're living in now.

We know many of the solutions needed to stabilize the workforce. Canada needs a strong, modern, pan-Canadian health human resources strategy. Additional targeted federal funding is needed to help health care systems retain, recruit and provide for adequate levels of staffing.

The federal government has an important leadership role to play in ensuring Canada's health system is sustainable. It needs to work collaboratively with the provinces and territories on both short- and long-term strategies.

In the short term, we need retention incentives for nurses and health care workers to stay on their jobs. This could include retention bonuses, loan forgiveness, tax incentives. Additional funding to the provinces and territories should also be provided to help optimize workloads for health care workers. This could include increasing admin staff, for example, in nursing settings to unlock more time for care.

In the longer term, CNA endorses calls for a national health workforce body that would be responsible for collecting high-quality [Technical difficulty—Editor] to support workforce planning at regional levels. CNA also recommends increasing training and education for health care workers by enhancing the number of seats in schools of nursing and increasing capacity for clinical placements for nurses. Finally, we strongly recommend the development of a national mental health strategy for health care workers, which would include funding for mental health supports.

I'll conclude, Mr. Chair, by saying that in an emergency room one of the first things you do is stop the bleeding, and that's what Canada's health workforce needs right now. We need emergency and definitive interventions with immediate action, and then a multifaceted strategy to address the complex problems of Canada's health workforce.

Thank you, Mr. Chair. Dr. Tomblin Murphy and I will try to answer any questions.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Villeneuve.

Now we'll hear from the Kingston Health Sciences Centre.

Dr. Pichora, you have the floor for five minutes.

[Dr. David Pichora, President and Chief Executive Officer, Kingston Health Sciences Centre]

Good afternoon.

Mr. Chair and committee members, thank you for this opportunity. I'm speaking to you today from my perspective as a tertiary hospital CEO, an orthopaedic surgeon and a professor at Queen's University.

Like our peer hospitals, Kingston Health Sciences Centre has many complex and integrated roles. KHSC is both a community hospital and a large regional academic centre providing specialized tertiary services to urban, rural and remote communities across a wide area of eastern and northern Ontario. During the pandemic, we doubled our ICU capacity and stepped up to be a critical care partner in the life-saving “team Ontario” critical care network. We accepted approximately 150 critically ill patients from the GTA, northern indigenous communities and Saskatchewan.

In addition, with Queen's University and St. Lawrence College, we train large numbers of physicians, nurses, therapists and technologists. We have developed innovative partnerships, like our federally and provincially funded Weeneebayko Area Health Authority, Queen's and KHSC program that provides access to the full range of health care services and training of frontline workers for the James Bay region. Like other tertiary hospitals, we have a research institute that partners in health care research with Queen's and with other universities across Canada and globally. All KHSC attending physicians have a Queen's faculty appointment.

Beyond our direct roles in health care delivery, leadership and innovation, hospitals have a substantial economic impact. We are major employers in our communities. We support a host of affiliated supply chain, pharmaceutical and medical device industries, and we drive research and development.

Previous speakers at this committee have illustrated how the pandemic has exposed and exacerbated long-standing health care human resource deficits and burnout. Canada is not alone in this crisis. The U.S.A., for example, is experiencing high levels of burnout, with projected deficits of 122,000 physicians and 1.2 million nurses. Other countries will be aggressively competing for our top clinical and research talent. We need to stop training regulated health care workers for export, and ensure that this precious resource is enabled and incented to live and work in Canada.

Those of us working at the front line in hospitals have witnessed two decades of disinvestment, with continuing pressure to reduce expenses, reduce beds and divert scarce resources to community and independent health facilities. As health human resources consume 70% of hospital budgets, inevitably funding cuts lead to staffing reductions.

The ongoing pandemic has highlighted the critical role that hospitals play in health system performance and delivering value for money. During the pandemic, hospitals have been the backbone of our health care system. We rescued long-term care homes, anchored IPAC hubs, provided PPE to community partners, created assessment and vaccine clinics, created and adopted digital and virtual platforms, developed and implemented extender roles to mitigate HHR shortages, and pivoted to build new critical care and in-patient capacity. Any future interventions to address HHR challenges and pandemic recovery must acknowledge, respect and support the contributions that hospitals make.

Mr. Chair, at our Kingston General Hospital site, some of our staff still work in the same building that held the very first meeting of the Parliament of Canada in 1841. For us to attract and retain the best and brightest, we must address the mounting infrastructure deficits and modernize our aging facilities and equipment. To mitigate burnout, health care workers must be able to see purpose and achieve fulfillment in their roles while having adequate workspace and work-life balance.

These objectives require modern hospitals with modern equipment. The Government of Ontario is taking steps to invest in hospitals and long-term care facilities, but much, much more will be needed to ensure safe and high-quality care. A human resource and infrastructure challenge of this magnitude requires strategic commitment and action by the federal government.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Pichora.

We will now hear from the Ontario Medical Association.

Dr. Kassam, will you be speaking?

[Dr. Adam Kassam, President, Ontario Medical Association]

I will.

[The Chair, Liberal, Sean Casey]

Welcome to the committee. You have the floor for the next five minutes.

[Dr. Adam Kassam]

Good afternoon. My name is Dr. Adam Kassam. I'm president of the Ontario Medical Association. I am joined by Dr. James Wright, chief of the OMA's economics, policy and research department.

On behalf of Ontario's 43,000 physicians, residents and medical students, thank you for this opportunity to provide the physician perspective on arguably the greatest immediate risk to the viability of health care in Canada, which is the burnout of health care professionals.

Physician burnout is primarily caused by stressors in the workplace including inefficient work processes and environments, and clerical burden. In other words, the inefficiencies and obstacles in the health care system, not caring for patients, are the major contributors to burnout. In fact, the OMA established a burnout task force in 2019. Its objectives were to survey Ontario physicians, residents and medical students to understand the extent of burnout and then to identify specific solutions.

In March 2020, prior to the pandemic, a shocking 29% of Ontario physicians reported high levels of burnout, while another two-thirds reported some level of burnout. By March 2021, one year into the pandemic, that number was even higher, with 35% reporting high levels of burnout and almost three-quarters reporting some level of burnout.

Ontario physicians face years of working above capacity just to clear the pandemic backlog of more than 21 million delayed medical services, let alone reducing the wait times that have plagued the system for decades. Attempting to achieve this within the existing system will only lead to more burnout. Physicians are incredibly dedicated to their patients. However, at some point the stress is untenable, leading some to reduce their workloads, retire prematurely or even leave medicine entirely. This loss of experienced and dedicated physicians will further exacerbate the situation for remaining doctors.

Retention and recruitment of physicians are paramount, given that one million Ontarians currently don't have access to a family doctor. The lack of physicians is even more dire in Canada's north. Today, northern Ontario is experiencing an acute shortage of at least 325 physicians, including family doctors, psychiatrists, anaesthetists and several sub-specialists. Some communities are critically under-serviced.

The OMA's burnout task force has identified the top five system-level actions required to reduce burnout and drive retention and recruitment: first, streamline and reduce required documentation and administrative work; second, ensure fair and equitable compensation for all work done; third, increase work-life balance by making organizational policy changes; fourth, promote the seamless integration of digital health tools into physicians' workflows; finally, provide institutional supports for physician wellness.

These are all system issues. We need to collectively and collaboratively rethink our health care system so that it doesn't contribute to burnout in the first place.

In fact, in Ontario we have developed a plan for solving our system challenges. OMA's “Prescription for Ontario: Doctors' 5-Point Plan for Better Health Care” was released not long ago, in October 2021. It is available at betterhealthcare.ca and it provides a road map of 87 recommendations under five key themes to achieve meaningful and sustainable improvements for the entire health care system in terms of access, equity, efficiency and integration.

As contained in our “Prescription”, the OMA strongly supports the call by Canada's premiers to immediately increase the Canada health transfer from the current 22% to 35% of provincial and territorial health care spending. This will provide the provinces and territories with the resources necessary to make health system improvements within their respective jurisdictions.

Ontario's doctors also recommend other immediate actions by the federal government to reduce burnout and increase retention and recruitment, including, but not limited to, the following. First, incent physicians to practice in the north by offering a federal tax relief of 15%.

Second, fund Canada Health Infoway to develop application programming interfaces, or APIs, to link the electronic medical records systems used within each province. Linking them would allow information to be exchanged among physicians. The lack of interoperability now is one of the most common digital health factors associated with burnout.

Finally, support the development of virtual care appropriateness guidance by the national level specialty societies that would work together to review all procedures within their profession and determine which can appropriately be done virtually and which in person. Supporting the development of such guidelines would reduce decision fatigue for physicians and support equitable, appropriate and high-quality care across the country.

A publicly funded and universally accessible health care system is a cornerstone of Canadian values. On behalf of all Ontario health care professionals, the OMA implores the federal government to provide the tools and resources required by the province to effect sustainable and meaningful change. If we don't fix the health care system, we will never fix burnout. Physicians and other health care professionals are depending on you. Certainly Canadians don't have time to wait.

Thank you. We're happy to answer your questions.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Kassam.

We're now going to begin rounds of questions with Mrs. Kramp-Neuman of the Conservatives for six minutes, please.

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

Thank you, Chair.

I'd like to thank all the witnesses who have agreed, and so willingly volunteered their time and expertise, to contribute to today's discussions and the democracy of Canada.

I'd like to start by directing questions towards our witness Dr. Pichora, from Kingston. However, before I get into specific questions, allow me a few minutes to highlight that under his leadership, Kingston Health Sciences Centre has successfully brought together two of Canada's oldest operating hospitals. Dr. Pichora serves, as he mentioned, as president and CEO of Kingston Health Sciences Centre, an academic tertiary care centre serving people all across Ontario. He's a respected orthopaedic surgeon, CEO and professor, and a true pioneer in his field.

Congratulations and thank you for all the work you have done, Dr. Pichora.

As to my first question today, could you perhaps speak to the complexity and the costs of hospital services? The physicians shortage is most acutely appreciated in rural areas of our country, like my home riding of Hastings—Lennox and Addington. The need for highly specialized individuals has never been higher.

Furthermore, could you possibly elaborate on and speak to the interconnectedness of our health care system, along with the mutual dependencies of hospitals and those of community services?

[Dr. David Pichora]

Thank you. I'll try to address your questions.

Hospitals are very complex and highly integrated organisms, I would say. It's amazing the extent of the just-in-time work we do with teams pulling together. Some of our surgical procedures are just one example of what it takes to deliver this, with highly specialized physicians, nurses, technicians who support various life support systems, etc.

We're the most expensive part of the health care system. It's such a valuable resource that we can't afford to waste any of it. We try to be very good stewards of the resources we receive. People are at the centre of all this. Everything we do requires people. Having a robust and appropriately skilled health care workforce is critical. This is essential to our role in the system.

We don't just look inward. You talked about rural and remote neighbourhoods. Although we're also the community hospital for the Kingston region, like many hospitals would be, we provide a wide range of extended services, including dialysis services in your community. We have satellite dialysis centres in Moose Factory at the Weeneebayko General Hospital, in James Bay. That's just one example of the complex networks. Cancer care is another one. It's a very distributed system. Although we may be the hub for a lot of these activities and the place where the most complex required care comes, we support services throughout the region.

One really good example of this is the Ontario Stroke Network, which has become a highly effective and life-changing network for patients who in the past had a very dismal prognosis in many cases. Now, because of rapid diagnosis, rapid transportation and rapid intervention, we're able to reverse the life-changing effects of strokes and really give people a much brighter outlook. That's an example of the complexity and expense of running a health care system and the role of hospitals.

In terms of interconnectedness, most hospitals are experiencing gridlock at the moment. We certainly are. This is because of increased inflow pressures to our emergency department with patients who are highly complex and critically ill, and then outflow pressures related to home and community care and long-term care, as just two examples. We've heard people talk about the HHR challenges of other sectors of the health care system, and that is having a big effect on hospitals too.

We can't just focus on one element in isolation; we have to have a system-wide look at this.

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

Excellent. Thank you.

[The Chair, Liberal, Sean Casey]

You have another minute if you want it, Mrs. Kramp-Neuman.