Health Committee on March 28th, 2022

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much, Mr. Chair.

Thank you to all the witnesses for appearing today. Thank you for your work. Thank you for your resilience, and thank you for supporting so many Canadians throughout the most difficult time that Canadians have experienced. It's certainly the most difficult time that Canadian health care workers have experienced.

I have two questions. The first is for Mr. Coletto. The fact that we both did some boat racing is not why I'm picking on you. You had a really heart-wrenching testimony today and I wanted to come back to ask about meeting the needs of our health care workforce and making sure that young people look to nursing as an occupation that they'd like to choose. It's essential.

It's also essential that that workplace be safe. It's apparent through your testimony today, and through the testimony of others that we've heard, that that's not the case all the time. It provides me with an opportunity to highlight the recent passing of Bill C‑3, which does a couple of things. One is that it creates an offence for obstructing or interfering with someone's access to health care services. It also adds as an offence if any person who's providing health care services is being impeded by another person, and that could be in the context of providing care.

You mentioned that it was difficult to take medical leave. Perhaps it was because of the status of your employment at the time, but Bill C‑3 also adds 10 days of medical leave in a calendar year.

What are your reflections on the passing of this bill? What needs to be done going forward to ensure that young people choose nursing as an occupation, so that those workplaces are safe and free of the type of harassment that you described to us?

Once again, I thank you for your good work in the face of such challenging circumstances.

[Sylas Coletto]

Thank you very much.

This is my first time doing this, so forgive me if I don't answer in the correct way.

With the experiences of abuse, you never know what's going to come in. You never know what's going to happen on a particular day. I've received training on non-violent crisis intervention, but in the real-world application of that in an emergency room, things can change at the blink of an eye.

When I was working in [Technical difficulty—Editor], a federal inmate got hold of a gun from one of the guards and bullets were shot. There was no way to see that coming. It was terrifying. To make it appealing to young people.... I haven't seen Bill C‑3 work at the hospital level yet. People can start shouting; they get angry and they kind of [Technical difficulty—Editor] sudden, and you have to be very attentive to recognize that happening.

A simple answer would be that it would be nice if someone was close by so that when they can hear someone screaming or yelling, they can come in and assist. Sometimes, that's just not the case, because the distance between me and the next nurse, the next doctor or whoever's down the hall is just so far. They're not right there at the time when they need to be—

[Adam van Koeverden, Liberal, Milton, ON]

I don't mean to cut you off. I was just hoping to seek further clarification on that point in particular.

With respect to the number of nurses on call or on duty at a given time, it seems that what you're saying is that with more nurses, it would be a safer environment.

[Sylas Coletto]

I can't see it being less safe.

That would cover a large number of safety things. We have baseline staff in our unit, for example. There are six baseline nurses and we're not supposed to have more than six baseline nurses unless it's necessary, such as when we have an influx of patients. If there were more nurses there at baseline and somebody was there to help if something was happening, yes, that would definitely help. Increasing the baseline for nurses being there would be a beneficial thing.

However, right now, given the current circumstances and the way the policies are implemented, there has to be a very good reason. If there's no justifiable reason to have more nurses, due to the algorithms they have in place, there won't be more nurses coming in.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Mr. Coletto. I appreciate that. Again, I thank you for your good work.

My second question is for you, Ms. Baker, regarding the nurse workforce. I have the opportunity of highlighting something that I think is relevant to that, which is this morning's news that we signed a child care agreement with Ontario. It means that nurses who would like to can get back to work earlier if they have just had a child, or if they're a new parent who would like to get back to work a little bit earlier. That could contribute in a positive way to our nurse workforce. But I think we can all agree that this won't do it; we need more than just that.

How can we attract more nurses to the profession? How can we ensure that it's an appealing future occupation for young people who are seeking out that opportunity? Potentially, you can touch on nursing as a profession with respect to foreign credentials and qualifications for foreign-trained or internationally trained nurses who immigrate to Canada.

Thank you.

[The Chair, Liberal, Sean Casey]

Please answer as briefly as possible, Ms. Baker. I know it was a comprehensive question, but we're out of time for this round.

Go ahead and answer.

[Dr. Cynthia Baker]

Okay. I'll be very quick.

Actually, there is no problem with the application demand. The pool of applicants for nursing is very, very high. As I said, we have been graduating over 12,000 annually for the last five years. That's higher than it's ever been. There is no problem in terms of attracting applications, and they're high-quality applications. The problem is keeping nurses in the workforce. It's the attrition and the retention of nurses that have been an issue. Many leave within months of entering the profession.

In terms of international education, this has a lot to do with the regulatory bodies that license the internationally educated nurses. The process is slow. There is an evaluation process that is time-consuming. I don't have the statistics, but I believe a high number of internationally educated nurses in Canada would like to join the nursing workforce.

From a regulatory point of view, I cannot speak for those processes and what needs to be evaluated there. But from the education perspective, this is one area where we could have a potential solution—that is, speeding up and standardizing the bridging programs that internationally educated nurses often have to be involved in. I believe there have been some initiatives in Ontario around that, with government support of bridging programs for internationally educated nurses. That is an area that I think is well worth pursuing and could support an increase—

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Baker.

Go ahead, Mr. Thériault. You have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

In your opening statement, Dr. Champagne, you referred to an article in the British Medical Journal about a systemic review and meta-analysis of mortality due to cancer treatment delay.

I want to talk about the human resources side of things first. Oncology is a crucial area of care. You said that 57.5% of professionals were experiencing burnout before the pandemic. According to the article you cited, an eight-week delay increases the risk of death by 17%, so the mortality rate is higher.

In the face of these challenges, what is morale like among health care professionals? You said these delays would have repercussions on oncological care for years.

[Dr. Martin Champagne]

Right now, all practising oncologists are seeing patients who unfortunately need to be referred to palliative care. These are patients who could have been cured had they been seen at the onset of symptoms months beforehand. We are seeing situations like that every day. We are encountering patients whose disease is much more advanced than what we used to see.

Certainly, that affects the morale of health care providers, but I don't have any statistics for you.

That said, we are all professionals, and we are realistic. As oncologists, we don't expect to be able to help everyone, so the idea is to see what we can do. Currently, we are treating people, but the fundamental problem is still access to care.

Before the pandemic, 100,000 people in Quebec were waiting for a colonoscopy, the screening for colon cancer, and now that number has hit 150,000. We need resources to meet that demand. It's a huge challenge, but there are solutions.

Oncology is in a unique position. In orthopaedic surgery, for instance, patients receive treatment on a one-time basis, undergoing a knee or hip replacement surgery. It's unfortunate that they have to wait so long for the surgery because it has a significant impact on their quality of life, but once they have the surgery, it resolves their issue. In oncology, however, studies show that, for every 28 days patients have to wait, the mortality rate for colon cancer goes up by 4%. That illustrates how serious the repercussions are when people have to wait months and months to be seen.

When a cancer is diagnosed early, meaning in stage 1, the patient can have surgery, even an endoscopic procedure. The physician can perform a tumour resection, and the rate of recovery is 80%. If the cancer is in a more advanced stage and has spread to the lymph nodes, it's a stage 3 cancer. Without chemotherapy, the patient has a 30% chance of recovery. If the patient receives chemotherapy and radiation therapy, their chance of recovery goes up to 65%, but at the expense of more demanding treatments. Not only does the patient, the person suffering the most, have to be more involved, but so does the care team. The care trajectory is years long, with economic, social and family repercussions.

It's really a disaster in cancer care. We have to make sure we put measures in place to manage the situation. For patients who can be operated on outside the hospital setting, we have to rely on external medical capacity, in the case of a knee or hip surgery, for instance. We keep patients in hospital who need care in connection with abdominal, thorax, colon and other such surgeries.

What we've seen over the past few months and years is that the situation is less problematic in the case of certain diseases. Patients with breast cancer can undergo surgery in ambulatory care units. Patients with breast cancer face delays that are much less significant than patients with other types of cancer. Older cancer patients tend to be put on hold, but their cancers can be just as devastating as the cancers experienced by younger patients.

We are also behind in treating cancers of the bladder, specifically when it comes to cystoscopies. For patients with prostate cancer who could have been operated on, we are sending them for radiation therapy. We have had to change how we manage patients in response to the pandemic, but there will be a price to pay.

The situation is really dire, and patients are the ones suffering the most. I told you earlier that, in 20% of cases, delays in diagnosis were impacting colorectal cancer surgeries in Quebec. I also told you that 9,400 Canadians with a diagnosed colon cancer were expected to die in 2021. If the mortality rate goes up for such a significant share of the patient population, we are going to see dozens, hundreds, thousands of people dying from various cancer-related illnesses.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Champagne and Mr. Thériault.

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

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

I'd like to thank all the witnesses for their excellent testimony today.

Ms. Boniface, I want to start with you.

Given your testimony that occupational therapy services are not widely covered as part of public or private extended health plans in Canada, could you give this committee a sense of the average out-of-pocket costs that Canadians are incurring to access OT services?

[Giovanna Boniface]

Yes, of course.

Outside of the public system, private occupational therapy services are billed at anywhere from $125 an hour all the way up to $200 an hour, depending on the type and the nature of the service.

A service visit could be, for example, a pediatric occupational therapist who's visiting a family weekly to provide autism intervention. Intervention sessions are about an hour, so that's a typical health care professional rate, along with incurring some expenses related to driving. On a visit like that, you could expect somewhere between $250 and $300 per visit.

This would be the same across private treatment for mental health services or visiting older adults who are looking for aging in place consultation. There are the same kinds of rates even for work site visits for ergonomic assessments to help people who are trying stay at work take a preventive or proactive approach rather than waiting for an injury to happen and then having that funded through a worker's compensation claim. They may not have had that coverage through their health benefits plans.

Per visit, you're looking at something around $250 to $300.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you have an annual figure? Is there an average for what a Canadian who accesses these services might pay in a year?

[Giovanna Boniface]

That's a really great question.

I don't think we collect that data. Again, it really depends on the nature of the services. For someone who is providing treatment on an ongoing basis for a chronic illness that might require weekly or biweekly intervention, that $250 or $300 number is multiplied per visit. For someone who is in a chronic scenario that requires weekly intervention, we're going to take that $250 to $300, multiply it 48 times and subtract holiday and vacation time.

For more short-term intervention, like eight to 12 visits, we're going to take that number and we're looking at maybe $1,500 to $2,000 for a block of intervention.

[Don Davies, NDP, Vancouver Kingsway, BC]

I wanted to explore the aging in place and living at home. I think it's pretty common-sense that if we can keep seniors out of hospital and in their homes, it will relieve pressure on our system.

Could you outline briefly for us how OTs can support aging or living in place at home and in communities?

[Giovanna Boniface]

Absolutely.

Supporting older adults who are choosing to stay home is an area that I have practised in for the majority of my career. Most older adults I meet want to be there.

You're going into the home. You're meeting with the individual in their space where they want to be. You're conducting an environmental assessment and looking at the risk factors and analyzing what is going on in the home. Not everybody lives in single-floor, accessibly designed or universally designed spaces. In fact, for most spaces, we're looking at some type of retrofit, which may be putting in adaptive equipment, say, in the high-risk areas for falls. That would be in bathrooms, kitchens and bedrooms.

For some, we're looking at even more significant architectural renovations if people want to stay in their homes. A lot of homes have stairs. They might require stair glides or some other type of system of modification to make entry accessible. Again, we're looking at universal design principles. You can do that with equipment. There's a piece around getting equipment. Outside of the assessment itself, you're looking for funding to put into place the equipment and recommendations that might be needed for that individual.

There's also education that can happen. For some of that, staying home in place can be around safety to live well at home.

By and large, my experience in that population is that there's a combination of education, equipment and some more significant architectural considerations that need to happen and to be thought about for homes that people are living in.

[Don Davies, NDP, Vancouver Kingsway, BC]

Trying to think systemically, could you outline how upstream investments in preventative care from OTs could accrue benefits in the long term?

I'm particularly interested in whether there are any studies on this or any global figures that would show that we could save our health system money by investing more up front in OT services.

[Giovanna Boniface]

Absolutely.

Hélène, is this something you want to take, or do you want me to continue?

[Hélène Sabourin]

You can go ahead. I can add.

[Giovanna Boniface]

Thanks.

We know from Government of Canada data that injuries cost the Canadian economy almost $27 billion annually. Seniors' falls, according to the Public Health Agency of Canada, are costing around $2 billion annually. These kinds of upstream interventions—this is about being proactive, going into homes earlier, meeting people ahead of a fall, before they get into the hospital, before we see those problems—would be seeing individuals in the spaces where they live, work, study and play. It's about looking at prevention. Prevention of injuries from falls would be the first line of defence, we would say.

There are lots of studies and literature that show that those upfront investments, which could cost between $300 and $500, can make a significant difference in a person's life. Imagine going in and making changes ahead of time so that the fall doesn't happen. There is also a lot of work on health promotion and lifestyle redesign.

Again, these are proactive investments, looking at providing education early, counselling—

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Boniface.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Sean Casey]

Mrs. Goodridge, go ahead for five minutes, please.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you to all the panellists for being here today and providing testimony, and a special thank you to all the medical professionals for the service they have done. It is spectacular.

I am the member of Parliament for the riding of Fort McMurray—Cold Lake. It's a relatively isolated, rural location. We often have struggles attracting health care personnel to come and work in our region, whether that be in Lac La Biche, Cold Lake, Fort McMurray or Fort Chipewyan for that matter.

My first question is directed to Ms. Payne.

You were talking about this not really being a new issue in terms of burnout, and not having enough in many rural locations. Could you expand a little bit on that?