Health Committee on March 2nd, 2022

[The Chair, Liberal, Sean Casey]

Is there any further debate on the motion?

You have the motion before you. Can we proceed by consensus or is there a requirement for a standing vote? Is it the will of the committee to adopt the motion as presented?

I see consensus in the room.

(Motion agreed to)

Thank you.

Next we're going to go back to our questions for the witnesses.

The next member who can ask questions is Mr. Thériault.

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

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I want to thank the witnesses for their insightful presentations. A six‑minute question and answer period won't give us enough time to cover everything.

I'll start with you, Mr. Villeneuve. A document that you distributed predicted a shortage of 60,000 nurses in Canada by 2022. That's now. You said that this was predicted 10 years ago.

I have several questions about this topic. What factors were used to make this prediction 10 years ago?

[Michael Villeneuve]

Thank you.

Mr. Chair, with permission, I will turn this to Dr. Tomblin Murphy, who led the study.

[Dr. Gail Tomblin Murphy, Vice-President, Research, Innovation & Discovery, Canadian Nurses Association and Chief Nurse Executive, Nova Scotia Health]

Thank you, Mr. Chair. Thank you for this opportunity.

It was quite clear when that study happened some time ago that there were issues similar to the ones today. If we go to a decade before that, there were similar issues at that time. For the study, we focused on what the health needs were—

[Luc Thériault, Bloc, Montcalm, QC]

Could you identify these issues, please?

[Dr. Gail Tomblin Murphy]

Yes. The issues at the time were that we focused largely in this country on increasing seats—nursing seats, for instance, medical seats—without really thinking about what other strategies could be in place: How do we actually retain the workforce that is already there? Retention at that time, and strategies that are still pertinent today, was in finding ways to value the workers, to have staffing ratios and staffing patterns in place so that services can be delivered to Canadians that match their needs.

Also during that time, it was clear that what we hadn't talked about was how providers work together as teams, wrapping around the needs of Canadians. That looks very different depending on the context—you all understand that—but it also depends on the context in which care is being delivered. How can one say that you need to increase a certain number of training seats, for instance, without thinking about the impact of technology and efficiencies in the system, without thinking about when we work as teams—regulated as well as unregulated workers—to address the needs of Canadians, and that there are other alternatives?

During that study—and, to the question—the strategies that were important.... If we did nothing at all, we would see a shortfall: that is, a shortfall between what Canadians needed in terms of health needs and the supply to deliver the services. It's both components: needs and requirements for care, as well as supply. If we did nothing, we would see a gap of 60,000 predicted in 2022. If we had put strategies in place—things like dealing with attrition rates in universities and supporting students using principles of equity, diversity and inclusiveness, as well as other supports like incenting students, supporting them during employment and looking at other things—that, on its own, would have helped to reduce the actual gap.

However, if we had added to that and looked at strategies to keep nurses working, for instance—that is, physically well and mentally well—that would have helped to reduce the gap. In living through COVID, as an example, we have not necessarily dealt with—but we have seen the light shone on—the mental health problems and issues that continue to be in the way of nurses, as well as deterioration in physical health through exhaustion, heavy lifting and working oftentimes very, very short-staffed.

[Luc Thériault, Bloc, Montcalm, QC]

I was more concerned about what happened 10 years ago, long before the pandemic, that led to this difficult situation.

In Quebec, nurses are leaving the public system to work for private agencies because they have more control over their work schedule and better working conditions.

Doesn't this show the issues within the public systems? Given the situation, is there a way to reinstate the working conditions that nurses find in the agencies?

[Michael Villeneuve]

Go ahead, Gail.

[Dr. Gail Tomblin Murphy]

Mr. Chair, what I would like to say is that we know that health care is a federal but also a provincial and territorial issue. If we look across this country, what the Royal Society of Canada paper has demonstrated is that some of the provinces and territories are taking on innovation and investing in innovation differently from others.

If I speak to the question you have asked, overall this is not a phenomenon that just came into play 10 years ago. The work I do globally tells me that the time when we pay attention to shortages and gaps in the health workforce is when there is a crisis of some kind. A crisis can be fiscal in nature; it can be a pandemic, or it can be a surge or a threat. When those critical points are not in place, then governments across this country oftentimes relax and become quite complacent with putting strategies in place to address the workforce.

In the example you have provided, COVID has helped us to appreciate that, indeed, oftentimes we need to think about alternative arrangements and options to ensure that Canadians across this country are receiving care.

During COVID—

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tomblin Murphy.

Next we have Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to all the witnesses for being with us.

Ms. Vance, I want to start with you, please. We know we have a problem with access to primary care in Canada. I think we all recognize it. Historically, the family doctor has been considered the first point of contact, and I think that's giving way to a more modern notion of better utilization of a team-based approach to health care.

I think you touched on that in terms of the role of pharmacists and how better use of pharmacists and their expertise as allied health professionals may relieve pressure on the family physician. I think the example you gave was perhaps allowing pharmacists to provide prescriptions for common, easily diagnosed ailments.

Could you expand on that? I'm curious whether that could extend to things like prescription renewals or maybe injections. I know pharmacists have played an important role in COVID. What other things could pharmacists do that might take some of the pressure off the family doctor and provide quicker access to care for patients?

[Geraldine Vance]

Thank you very much for the question. I will apologize to the interpreters from earlier for being trop vite. That's bad French, but there you go.

If we look across the country, Alberta really has set the stage for demonstrating what pharmacists can and should be doing in terms of primary care. As I noted in my remarks, Canadians are anxious to interact with their pharmacists and get more care from their pharmacists, so they are not the barrier in any way. In Alberta, there are prescribing rights, and in Saskatchewan, Nova Scotia, Manitoba and pretty much across the country, including the Yukon, they were recently given some authority during COVID for what is categorized as minor or self-identifiable ailments, such as shingles.

If I may, I will use a very personal example. I got shingles about six months ago. My primary care physician has not been in their office since March 2020. I had a call with my physician on the phone, and it was me who identified it was shingles. I went to the pharmacist, who looked at the medication that had been prescribed and intervened with my physician to get a different medication. I showed my pharmacist where the shingles were, and thankfully, it was in not too difficult a spot.

Pharmacists deal every day with their patients. I think no one in this country would disagree that we need more support for doctors and nurses, absolutely, but we are missing a huge opportunity by not better employing community pharmacists, who, as the stats from 2018 show, see their patients as much as 10 times more than patients would see their family doctor.

As we look ahead at the solutions, we need to ensure that we are looking at employing the resources we have, in addition to augmenting those that exist.

[Don Davies, NDP, Vancouver Kingsway, BC]

I think that's where my mind is going, and I will give my own little personal example.

I have been on medication for a long period of time. I have to get a renewal about every six months. This has happened probably 25 times. I have to go back to my doctor for the renewal on something I know I'm automatically going to get.

Is that something that would be just as easily or maybe even better handled by a pharmacist?

[Geraldine Vance]

Yes, absolutely. In British Columbia, we have adaptation and renewal rights, and our college, in fact, is looking at expanding those at this time. Throughout the pandemic, for two years, many patients were getting their prescriptions renewed by their physician over a telephone call.

I think in terms of the notion of saying that patients with stable conditions whose medications do not vary over a period of time should not have those easily renewed at the pharmacy, that case can no longer be made. That frees up family physicians to see patients in person who really need their care. I think, again, it's about better utilizing pharmacists to ensure that family physicians have the time to spend with those patients who need to see them.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm interested in the economics of it too. Is it possible for you to give a comparison between what the cost would be of me going to my doctor for my prescription renewal versus me going to the pharmacist and what the dispensing fee would be?

[Geraldine Vance]

If you were to do an adaptation, if a pharmacist were to renew your prescription, we are talking about a $15 fee. In British Columbia, for a patient to go for a basic 0100 family physician visit, that's in the neighbourhood of $40 to $65, so certainly economically the numbers are there that would allow for redeployment of those resources to do other things.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Vance, I want to put some data collected by the Canadian Institute for Health Information to you. It says the number of pharmacy graduates in Canada dropped from about 1,300 in 2016 to 1,256 in 2019 and 1,255 in 2020, while the number of pharmacists in Canada increased over that period from 34,000 to 44,000. When I looked a little further, the data also showed that in 2020 international graduates accounted for 34% of the overall supply of pharmacists.

What can you tell this committee about where Canada is getting our pharmacists from? It seems to be a bit of a success story in terms of our ability to attract foreign-trained pharmacists and get them working in this country, which is not necessarily the case for other professions. What can you tell us about that?

[Geraldine Vance]

Absolutely. I think we saw 20 or 30 years ago how dependent Canada was on foreign-trained physicians who came from places like England, Scotland and Ireland. We're seeing pharmacists come from around the world. Canada is a good place to practise pharmacy, so we are certainly seeing them easily integrated into the care that they provide in communities and also in hospitals. I think it does serve as a demonstration of what is potentially possible in the other professions.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Vance. Thank you, Mr. Davies.

Next is Dr. Ellis, please, for five minutes.

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

I have a point of order, Chair.

It looks like the vote call will be in just about four minutes, so rather than interrupt Mr. Ellis's time, I'm just wondering if this would be a good spot to suspend until we've completed voting.

[The Chair, Liberal, Sean Casey]

To the witnesses, there's a vote happening in the House now. We do have a capability of voting on our phones, and we'll need to suspend to ensure that it happens. We'll be back with you in about 10 minutes.

The meeting is suspended.

[The Chair, Liberal, Sean Casey]

I call the meeting back to order.

Thanks again for your patience, witnesses.

We're going to resume the rounds of questioning.

I recognize Dr. Ellis, please, for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair.

Thank you to the witnesses for their patience. I hope they enjoy seeing democracy in action here. That's the best part of it all.

I have a question for Ms. Vance.

You talked about trying to ensure that there was some sort of conformity across Canada with respect to skills that pharmacists might use. Would that also include something like a pan-Canadian licence?

[Geraldine Vance]

It's hard for me to speak to regulatory issues. I think it's not dissimilar with positions.... There's a skill set that is applicable regardless of the province in which you practise. You need to meet provincial regulatory requirements, but there's a commonly accepted set of practice expertise. That's what we're looking for.

If you look at prescribing rights across the board, Alberta has the broadest use of pharmacists, in this province. Other provinces, like Nova Scotia, allow for prescribing this and that, and different provinces have different things.

We're thinking that a standard scope of practice would be a good place to start.