Health Committee on March 28th, 2022

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Ms. Baker, I appreciate that you mentioned that it's more of a regulatory issue, but I'm curious if you could give us some sense of how easy or hard it is for foreign-trained nurses to acquire the ability to practise in Canada.

[Dr. Cynthia Baker]

Sure. The process, as I understand it, is that there is a national portal, and they apply to that national assessment centre. All the data goes to this group in the United States that evaluates and assesses their credentials and their knowledge. I think that process takes about a year. Following their assessment, they identify what they consider to be gaps in their education or competencies. Then it goes to the provincial jurisdictions, and they take bridging courses to make up what's missing. Then, I believe, depending on the jurisdiction, they may have some OSCEs, based on the entry-to-practice competencies. It's quite a long, involved process.

There is one area I do see that could speed things up. While that first step in the process of assessing the credentials is happening, there are bridging programs. There have been some initiatives, but I think we need more of those initiatives and perhaps a more standardized, one-year program across the country for internationally educated nurses so that they can be moving along with the process. When they get the results from that initial assessment, they would have completed the bridging programs.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Baker, your description presumes there are gaps. Surely there must be people who are trained in U.S., British or European nursing schools where there are no gaps, where they're as well trained as any nurses here. Does our system permit for an expeditious and efficient pathway for those people into practising in Canada?

[Dr. Cynthia Baker]

Again, you're asking the wrong person, because this is regulatory. Yes, they seem to come out with gaps, but I'm not the best person, really, because I don't know the areas from which they come out with gaps.

[Don Davies, NDP, Vancouver Kingsway, BC]

Fair enough. Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Baker, and thank you, Mr. Davies.

Next it's Mr. Lake, please, for five minutes.

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

I'll start with Mr. Campbell. I don't really have a specific question for you, but you've been listening in and no one has asked you a question. I'm wondering, as you're listening to everyone else speak, if you have any thoughts.

[Bradley Campbell]

I do.

The issue of international recruitment is an interesting one, because it used to be a lot smoother. Then we went to the regulatory model and this single agency that we now contract with, which as I understand, and as Dr. Baker said, is in the U.S.

It's always been interesting to me as an observer. I've done work with governments, like the one in Barbados, and The University of the West Indies, and they're very keen to look for partnerships where they can bring foreign-trained professionals, whether those be physicians, nurses or others who are surplus to their needs, and partner with universities in Canada to create these special pathways to get people here without the associated challenges.

Again, to Mr. Davies' point, I think there may be different pathways for nurses trained in the U.S., England and Europe. They also have significant shortages. Our ability to recruit them here is a challenge, whereas there are organizations like The University of the West Indies, the Government of the Philippines and others who train people. They follow what used to be called “test accreditation standards”, which used to be considered acceptable. Then they would come and it would be more of a fast-track process, as Mr. Davies has said, where they would have a bridging program for maybe six months for specific courses.

It's a question of how we speed up that process of identifying what those gaps are, because right now it seems very cumbersome and very bureaucratic.

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

Thanks.

Ms. Boniface, for people who might be watching this or reading it later—not to overstate how many people watch the health committee live online—let's say an occupational therapist were working with someone with autism. What would it look like in terms of what they would do?

[Giovanna Boniface]

Thanks for that. For OTs, as I mentioned earlier, the approach will be the same. It's looking at what a person needs, wants and has to do in their daily life and overcoming some of those barriers. When we're looking at working with people with autism, primarily children but also adults with autism, we're looking at development. We're working through developmentally appropriate goals related to the occupations or the activities of that individual.

For children, we're looking at goals related to play, their socialization and social interaction skills. From a cognitive perspective, it's attention, motor skills and self-care. Again, it's considering the personal goals and interests.

Like other health care professionals, we start with assessment and evaluation. Then we provide activity-based interventions through direct treatment and in consultation, especially when it comes to children, with their families. If the kids are in school, we're working with their educators as well as any caregivers. This could be in the areas of physical needs, sensory processing and emotional health in all environments.

With that population, we also work around transitions, when individuals are moving from one developmental milestone to another, such as going from elementary school to high school, or from high school transitioning to living independently, into the workforce or into post-secondary education.

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

I have many more questions but I have limited time.

You talked in your opening statement about “transforming” to less expensive care. I mean, let's be clear; money is always going to be an issue. We have an aging population and more people using health care. How does OT help to transform to, in some sense, better results overall, let's just say, for the money that we're spending?

[Giovanna Boniface]

Well, this takes in elements that I and other guests here have mentioned already. One is looking at a proactive, preventative approach, making those upstream investments and preventing individuals with preventable diseases or conditions from entering the system.

I'll use falls as an example. This is a high-cost area. We know what it costs. It's highly studied. We know that it can be prevented and what investment in prevention looks like. There are many studies out of the U.K. and the U.S. that look at some very innovative and interesting models of even providing care in the emergency room, before the person.... They've come to the hospital, but before they get into a bed or into the system, they're able to triage with a nurse and an OT. The individual can get back home quite quickly. You can do these preventative investments, as I mentioned, early on in care.

Another scene would be, in these primary care teams, looking at an interprofessional approach. There's a high demand, as you've heard today, with nurses, colleagues I work with every day, as well as physicians. A gap that has not been well tapped into is the utilization of allied health professionals on these teams, including OTs. There are lots of studies, which I'm happy to send you afterwards, looking at these models that are working.

Again, we see some really interesting stuff coming out of the U.K. When you can't make more money, and you're having these challenges with the workforce, just by virtue of this need these models and these creative things are happening. I'm happy to send you some of those things. They are also looking at the cost-effectiveness and the cost-benefit analysis, and the return on investment on those things.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Boniface and Mr. Lake.

Ms. Sidhu, go ahead, please. You have five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

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

Thank you to all the health care workers. You are doing great work on the front line. Thank you so much for that.

Ms. Baker, we regularly heard, even before the pandemic, about trained health care workers not being able to work in their field. They come here as skilled workers but are limited by provincial regulatory bodies. Can you tell me what needs to be done to ensure that these individuals are able to have their credentials recognized so that they can work in Canada? You said that the evaluation process is slow, and you talked about standardization and bridging programs. How can the federal government help work on that?

[Dr. Cynthia Baker]

That's a really good question.

I think the process is very slow, and unnecessarily slow. There is this national assessment portal. It's the national assessment [Technical difficulty—Editor]. It would be to work with that national organization, because that incorporates all the provincial and territorial regulatory bodies. I think if there was more national agreement about the process and about speeding up the process [Technical difficulty—Editor]. I think that's where we would start.

I would also like to see, as I said in my presentation, more national work being done at the level of bridging programs, making them standardized and flexible. Certainly there will be some people coming from some health care systems where there's so little difference, but I think the notion of identifying gaps and then building specific programs, flexible programs, is very long-term and cumbersome, so there needs to be a simpler standardized bridging program.

There's a lot of experience now in Canada with what the needs are that an internationally educated nurse.... Much of the adaptation is at the level of the culture of different health care systems. There is already a lot of knowledge about what the needs are and how to address these needs.

That's not a very clear answer, but I think it's a very important area.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for Ms. Boniface or Ms. Sabourin.

Earlier today I was able to participate in the child care announcement at my local YMCA in Brampton, which widely served as one of the main day cares for our local hospital workers during the pandemic. Based on the provinces where this has already been rolled out, has this had an impact on the health care workers who are parents?

[Giovanna Boniface]

I don't know if we collect data specifically related to measuring that, although I'm going to take note and look at that. Like many other health professions, I think our workforce is 93% or 94% female. As a result, the pressures of child care, culturally and however that is, still largely fall on women.

In the OT workforce, we see a trend where we see some peaks and valleys. We have a higher-than-average rate of part-time employees, which we believe is partially related to not only caregiving for children but also caregiving on the other end, for aging parents. Then we see that same population heading out a little bit early, which could be for a number of reasons.

Although we don't collect data specifically looking at child care, we can definitely make some inferences around the fact that our profession is primarily female, so we know about those pressures.

In my experience, out in my neck of the woods, I'm not familiar with any programs that are supporting, say, our large health authorities, like Vancouver Coastal Health and other larger authorities in the north and on the island. But we'll look with keen interest to how this impacts that area.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Boniface and Ms. Sidhu.

Next we have Dr. Ellis, please, for five minutes.

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

Thank you, Mr. Chair. I appreciate that.

Again, I'll thank all the witnesses here today.

For Mr. Campbell, some of the things we've talked about are internationally trained physicians, nurses and other health care providers. In your international experience, does it make more sense to attempt to accredit more international schools at the school itself or to continue, perhaps, as we are in accrediting individuals?

[Bradley Campbell]

Both options could work, but there are a number of strategies under way [Technical difficulty—Editor].

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

We lost him.

That's unfortunate, but maybe Mr. Campbell will come back to us.

Dr. Champagne, in light of the pandemic, do you think it will be necessary, if not essential, to avoid service closures and triaging?

[Dr. Martin Champagne]

Triaging has had very unfortunate repercussions. It's crucial to ensure the continuity of hospital activities. We have to find a way to make sure patients are moved to appropriate settings after their hospital stay. Patients who are recovering from COVID‑19 should not remain in hospital. All needs that can be met outside the hospital should be. For instance, colonoscopies and knee and hip surgeries can be performed at specialized medical clinics. Certain activities can be performed in other settings to free up hospital resources for patients who genuinely require hospital care.

Without question, we must avoid triaging. We've learned a lot from the pandemic, in particular when it comes to the importance of having a sufficient supply of masks and gowns. The experts have been warning us for years. They knew an epidemic or pandemic was coming eventually, but we didn't listen.

Acquiring a supply of equipment is expensive, but had we been better equipped, we could have continued to perform hospital activities and avoided the consequences of triaging.

Nevertheless, what's done is done. Now we need to work hard on finding the solutions to fix the problem, and I think they are out there. We need to rely on local solutions. Introducing a one-size-fits-all or top-down approach is always very problematic. Local teams have the capacity to be innovative; they know the care settings and they know the needs. I think it's really important to decentralize care management if we want to maximize hospital performance and avoid having to triage patients.

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

Dr. Champagne, you talked about care that could be provided outside the hospital setting.

Did you mean by the private sector?

[Dr. Martin Champagne]

No. I think the public sector has the capacity to continue providing care, but outside the hospital setting. Those services could be publicly funded. As far as I'm concerned, patients should not have to pay out of pocket. I don't believe in that. I think the system is very fair and ensures universal access.

Earlier, my colleagues in occupational therapy highlighted the undeniable need for better access in some sectors. I have no doubt that's true, but I don't think we need to look to the private sector to deliver that care. Whether the private sector should handle the administration side of things is another discussion, but people should not have to pay out of pocket. That would not make care more accessible.

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

Dr. Champagne, you talked about a solution for the 150,000 patients waiting for colonoscopies. What is the solution for that, sir? Is it these “outstanding” clinics or clinics outside the hospital? Is that what you were referring to?