Health Committee on March 28th, 2022

[Dr. Martin Champagne]

Yes, that's right. A colonoscopy is a technical procedure. Colonoscopies to screen for colorectal cancer shouldn't be performed solely by gastroenterologists. In some provinces and U.S. states, nurse practitioners perform colonoscopies, so other health care professionals can be called upon to provide support.

A colonoscopy is ordered further to a positive result from a fecal immunochemical test, which is an analysis to detect occult blood in stool. The individual has to see their doctor for the test to be ordered, and that delays the process. A lot of people don't have a family physician to send the test results to.

The Régie de l'assurance-maladie du Québec sends women 50 and over a letter asking them to undergo a mammogram to screen for breast cancer. The same approach could be used for colon cancer screening tests. Patients could be sent a prescription and asked to go to the pharmacy or a local community services centre, say, to pick up the kit to test for blood in the stool. The test results would then be analyzed, without the family physician having to be involved in the process. There is no reason why only the family physician can ensure that follow-up. All it would take is a test result management system to quickly refer patients to the appropriate health care professional.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Thank you, Dr. Champagne.

The last round of questions for today will come from Dr. Powlowski, please, for five minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Is Mr. Campbell still there? I prepared my questions for him.

[The Chair, Liberal, Sean Casey]

Wouldn't you know it.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

It's okay. I can ask someone else, but is he not there?

[The Chair, Liberal, Sean Casey]

He is not.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I will pose my questions to Ms. Baker.

You talked about licensing foreign graduates, and that would certainly seem to me to be the easiest way of dealing with the shortage of nurses. You talked about this new national portal, which I'm not familiar with, but I know it varies widely between jurisdictions as to what foreign graduates have to do to get licensed in that jurisdiction. For example, my wife went to nursing school in the Philippines. Some of her fellow students are working in California, working in Alberta; however, they can't get a job in Ontario. It seems kind of haphazard as to who requires what qualifications.

With this national portal, does everyone have to go though it? Even if they go through it, isn't it still up to the provinces as to the actual requirements in order to get a licence?

[Dr. Cynthia Baker]

Yes, that's the contradiction in the system. There is the National Nursing Assessment Service. The members of the National Nursing Assessment Service are all the regulatory bodies in all jurisdictions. It's supposed to be a sort of one boutique type of thing, but from my understanding of how it works, it's just the first step of the application. It takes about a year's time to go through this national service, and then it's back to each provincial jurisdiction. I know the regulations vary from one provincial jurisdiction and territorial jurisdiction to another, so there are more hoops to go through and more evaluations to go through. It is a very long and involved process.

I think it has improved, but I was at the International Nurse Education Conference about four years ago. There may have been some improvements, but I heard a presentation from one nurse from London, U.K., who had come to Canada, not because she was seeking out Canada, but because she had married a Canadian. She had just, after seven years, been registered to work in Ontario. She had a baccalaureate degree. I think she even had a master's of business administration. She had been managing units in England. It was a very long process.

I think there have been improvements, but the complication is that there's sort of a national assessment service but then it is a provincial and territorial decision. It varies across the country and there seem to be a lot of steps to go through.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I think the example of the British nurse who took seven years is an apt example of how this maybe isn't working that well. Does it make sense to you—and I guess there are some other nurses on the panel—that they have this national portal that kind of evaluates the standards of education the nurse has and then says that it's actually up to the provinces, and the provinces have other rules?

How can we make it a better system? There are jurisdiction issues, obviously. Most health care delivery is by the provinces. The regulation of professionals is by the provinces. Would having a pan-Canadian health strategy, or a Canadian workforce planning task force, help to address these inefficiencies and to have a system that makes more sense and doesn't require seven years to circumnavigate?

[Dr. Cynthia Baker]

Was that question for me?

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Why don't I give it to you first? I know there are a couple of other nurses on the panel, if they want to comment afterwards.

[Dr. Cynthia Baker]

I know there are others who may want to respond.

I do think there needs to be collaboration among the regulatory bodies that are part of this national organization, and perhaps agreement across the country about what the steps are. Maybe have a good look at how to reduce the steps and make the process a little bit more efficient. Their role is to protect the safety of the public and it is important, but there are probably ways that the public could be protected but people could be moved along a little more quickly.

I don't know if other nurses would like to speak to this issue.

[Sylas Coletto]

I would like to say something to that, please.

It would be wonderful to have a pan-Canadian licensing program. If my licence works in Saskatchewan, B.C., or wherever, then, in each province, I'd pay a governing body, but I wouldn't have to transfer my licence from an Ontario licence to a Saskatchewan licence. Rather, my licence would be accepted within the provinces, and I could pay into each province's college of nurses.

[The Chair, Liberal, Sean Casey]

Ms. Payne, very briefly, go ahead.

[Brenda Payne]

Very quickly, having been registered in a number of provinces in our own country, I can say that even moving from one province to another isn't as easy as one would think. I believe that's another reason—and you've said it all—that a pan-Canadian approach is the only way to go in order for provinces not to deal with this issue in isolation. We need to work together in order to find the solutions to enable nurses to move across the country as well as internationally.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Payne.

Mr. Coletto, I want you to know that your reactions aren't recorded in Hansard, but we got the message.

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

I have a point of order, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Go ahead, Mrs. Goodridge.

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

Thank you.

Just to Mr. Coletto, if you are serious and you want to come to Fort McMurray, please get in touch with my office, and we will get you hired.

[The Chair, Liberal, Sean Casey]

That's not a point of order, but she's persistent.

[Sylas Coletto]

When my wife is done her residency....

[The Chair, Liberal, Sean Casey]

Colleagues, we had some technical difficulties and lost Mr. Campbell, so we're going to reach out to him to afford him the opportunity to respond in writing to the question he was in the process of answering when the screen froze.

To all the rest of our witnesses, thank you very much for your patience as we work through the technological challenges of today's meeting. The workforce crisis in Canada is a huge, complicated and multi-faceted problem, and we had a large and diverse panel to discuss it today—it's only fitting with a problem of this nature.

We thank you very much for your input and advice to the committee. It will serve us very well in our work on this study, so thank you for being with us.

Is it the will of the committee to adjourn?

[Some hon. members]

Agreed.

[The Chair, Liberal, Sean Casey]

We're adjourned.