Health Committee on Sept. 27th, 2022

[René Villemure, Bloc, Trois-Rivières, QC]

Thank you, Mr. Chair.

Once again, I have a question for Dr. Roy.

Dr. Roy, I have greetings for you from Mr. Jean-Denis Garon, who couldn't be here this morning.

I'd like you to talk to me about the delivery of health care for children as seen through the prism of the Association des pédiatres du Québec.

What are the greatest challenges in Quebec in terms of the provision of care for children?

[Dr. Marie-Claude Roy]

I'll speak to you about the challenges of greatest concern to us in the delivery of health care. As we know, in the early stages of life, there are many more premature births, chronic problems like encephalopathy or exploited children. These children are rescued and sent home, but the parents receive no support. The caregiver concept is also very important in pediatrics.

For school-age children and adolescents, mental health, psychological, and social and emotional support are also crucial. And for our chronically ill patients who are transitioning from adolescence to adulthood—and I'm talking here about patients who would otherwise not have survived to adulthood—there are few resources. We deal with them up to 18, 19, 20 or 21 years of age and have trouble letting them go because there are no resources for them. Accepting their chronic state is often difficult in adolescence.

I think that those are the main aspects that need to be prioritized. Acute health care and accessibility are challenges, but not the issues of greatest concern. They are at the same level as all the others. The ones I just mentioned, however, are more specific pediatric problems.

[René Villemure, Bloc, Trois-Rivières, QC]

Do you feel that the federal government is spending enough on promoting children's mental health?

[Dr. Marie-Claude Roy]

I believe it is a matter of concern, as confirmed by the work of the committee today. From province to province, the problems are the same. The fact that we are now looking at these issues leads me to hope that major funding will be forthcoming. It is needed. We don't have a choice. We can no longer ignore these problems.

[René Villemure, Bloc, Trois-Rivières, QC]

You spoke about literacy earlier. Are there any studies that document the impact of the pandemic on children's socialization and education?

[Dr. Marie-Claude Roy]

Yes, there have been some from the start. We're lucky because retrospectively, we've been in a position to evaluate the situation over the past two years. We were able to observe, even clinically, very young children who had trouble relating. They would draw pictures of children, but would no longer put a mouth on the face because they couldn't manage to show us a smiling face. There were problems with language. However, there seems to be some improvement, because early childhood has become a priority.

For schooling, goals had to be lowered. I think this applied across the country. It has to be viewed as an adaptation to normal childhood development. It doesn't have to be seen as a highly specific form of educational development. But things are definitely lagging behind and it's obvious. Unfortunately, we can expect waves of dropouts.

Studies have confirmed the phenomenon.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Roy and Mr. Villemure.

Next is Mr. Davies, please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Gruenwoldt, sorry if you've covered this but I want to be clear, do you know what portion of overall health care spending is currently allocated to children's mental health services in Canada?

[Emily Gruenwoldt]

No, we do not.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay, thanks.

Dr. Feldman, in March of this year, CPS then-president Dr. Ruth Grimes wrote a letter to the federal government that said the following:

On behalf of the Canadian Paediatric Society (CPS), Canada’s national association of paediatric health experts, I am writing to ask for immediate action on the federal government’s long-standing commitments to support healthy eating initiatives, namely, finalizing front-of-package nutrition labelling regulations and restricting the marketing of food high in sugar, saturated fats and sodium to children.

Can you outline why the CPS supports these initiatives?

[Dr. Mark Feldman]

Very simply, we want to promote healthy eating.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Roy, the Canadian Paediatric Society says that they would like 30% of federal transfer payments under the Canada mental health transfer to be dedicated to timely and equitable access to mental health care for children and youth under the age of 25, and Children's Healthcare Canada—both are appearing today—is requesting that 25% of the federal health transfer be earmarked for children.

Would you support this, Dr. Roy, that a certain percentage of the federal mental health transfer to provinces be conditioned on it being spent on children?

[Dr. Marie-Claude Roy]

Clearly, the priority has to be children, one way or another.

I believe that the provinces have to be free to take action as they see fit. As I mentioned, there are definitely some provinces for which funding should be increased by more than the 30% earmarked for children. Perhaps other provinces have already made that a priority.

From 25% to 30% of funding should be focused on children's health. I don't think that this should be a federal government requirement, because even though the distress is the same from sea to sea, the measures already in place vary from one province to another. Some may decide to spend more, which would be a good thing.

Once again, perhaps a base level should be established. After that, some latitude should be left to the provinces.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Roy.

Thank you, Mr. Davies.

Next is Mr. Barrett, please, for five minutes.

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

Thanks to the witnesses for joining us today.

I'll throw this question out and see who wants to answer first. I'd like to talk about the backlog for pediatric cancer screening, treatment and care appointments and see what you'd suggest as a remedy for that backlog.

We can start with you, Dr. Feldman.

[Dr. Mark Feldman]

I would probably reflect back on the first meeting that you had with regard to some of the suggestions made regarding cancer care. The pandemic left a big backlog for surgeries and treatments. I think there were a number of recommendations made in the first meeting about that.

It's certainly not my area of clinical expertise, but I not only know of patients who have waited for cancer care, I also have colleagues who have waited six months to get their breast cancer surgery. It's a big issue and it needs to be addressed. But it's not my area of expertise.

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

Would you find helpful things like the scaling up of virtual care and increasing the number of practitioners in the field of medical practitioners by making sure we're licensing and speeding up our training for internationally trained doctors? Would some of these solutions, do you think, be immediately helpful to address this problem?

[Dr. Mark Feldman]

In terms of licensing internationally trained physicians, I've been actively involved in supporting that but with a great degree of caution.

There are a number of international medical graduates who do training at The Hospital for Sick Children, additional training. Over the two to three years of their subspecialty training, we get to know how good their training was before that and what sorts of individuals they are. Then we're in a position to advocate on their behalf to get licensing through a process called “academic licensure” here in Ontario. I've been very involved in that. I think it's an amazing potential resource to address some access gaps, but cautiously, because there are places in the world that don't have the same sort of training we do.

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

Dr. Roy, did you have something you wanted to add or was it just your concurrence with Dr. Feldman?

[Dr. Marie-Claude Roy]

I fully agree with Dr. Feldman. We ought not to deprive ourselves of these resources, but we need to be careful, because we have standards to meet. We are having trouble meeting demand, because currently, we expect nothing less than perfection. As doctors, that's what guides us, and we want what's best for our patients. And, of course, it's essential to establish standards of practice.

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

With respect to virtual care, do you see that as an emerging opportunity—one that was scaled up during COVID and perhaps one that can be expanded on—for alleviating some of the swelling that we have in our primary care offices, as well as in emergency rooms, for non-emergent situations?

[Dr. Mark Feldman]

Maybe I'll start with that one.

There's a real potential for added value with regard to what we've gained in terms of technology advancements, but again...cautiously. For example, if I see a patient who has been referred to me with suspected autism and it's a mild form, I can't tell on Zoom, but I can tell within a few minutes of seeing them in person.

There are limitations to what we can provide with distance care, but it is a great additional tool for certain clinical scenarios.

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

Do you have anything to add, Dr. Roy?

[Dr. Marie-Claude Roy]

Yes, I'd like to add that there are some very specific client groups for whom technology was used, particularly for follow‑up treatment. We were discussing the problem of too much screen time among adolescents, but they can sometimes be more flexible because they're accustomed to interacting virtually. I've had some very good results working virtually. It also provides more access for remote families who don't have services available, and for underprivileged families, for whom it is easier to consult a doctor by telephone or virtually than by travelling.

There is no doubt that this practice should remain in place, but it should not be overused, because human contact is extremely important.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Roy and Mr. Barrett.

Ms. Sidhu, you have the floor for five minutes.