Evidence of meeting #32 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pediatric.
A recording is available from Parliament.
11:35 a.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you.
The next question is for Dr. Munter.
Dr. Munter, you said you're waiting for the surgeon to come from California. How can we attract doctors so that they will stay here in Canada? Lots of our Canadian-educated medical doctors are working in the States. What incentives can we give to them so they will stay and work here in Canada?
11:35 a.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
First of all, thank you for awarding me a medical degree. You can call me Alex or Mr. Munter, but I haven't quite got the MD yet. You can commiserate with my mother about that disappointment.
Just talking about CHEO, earlier this week, I heard we have been able to recruit two star clinical researchers to our research institute. I was doing interviews last week for a medical leadership position, and most of the candidates were from the United States. Then we have these eight doctors—mostly pediatricians, a surgeon and the urologist is in there too—who are signed up and ready to come.
I think there's an opportunity there. There are a whole bunch of reasons for why people might want to leave the United States, without getting into too much of a conversation about that now. The star researchers, for example, are women, and they're racialized people. They're not feeling comfortable in the United States and they want to leave.
I think there is an opportunity for us, if we make it easy. As an organization that sponsors people to come into the country, from the immigration perspective, in terms of the LMIA that we need to produce and then the licensing perspective, it's labourious and it takes a long time. The degree to which, on the federal side, we could speed up the immigration approvals and, on the provincial side, we could expedite the licensing, I think would make a tremendous difference.
Let me say this. We're talking here about physicians. For example, with CHEO—and I can speak about Ontario—most of the major hospitals share a health record with SickKids, but UHN, the Ottawa Hospital and Hamilton Health Sciences are all on a system called Epic for electronic health records, which is the predominant system in the United States.
A nurse at Cincinnati Children's Hospital who is charting on Epic—a skilled pediatric nurse—could start on Monday at CHEO or SickKids in terms of her technical skill and familiarity with the technology, if she wanted to come and if we were able to bring her here. It's just really hard.
I think there's a conversation to have about how we simplify that. It's not the solution. Nobody should think that importing health care workers is the solution for our system, but we actually need dozens and dozens of solutions, and it's one of them.
11:35 a.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Sidhu and Mr. Munter.
Mr. Garon, you have the floor for six minutes.
11:35 a.m.
Bloc
Jean-Denis Garon Bloc Mirabel, QC
Thank you, Mr. Chair.
Thank you to all the witnesses for being with us today. It is very interesting.
I will begin with you, Mr. Munter. Because of my professional background, I would like to talk a bit about money.
In your opening remarks, you pointed out that the government will at some point have to make significant investments in health care again, one way or the other. I gather that is your position, is that correct?
11:35 a.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
Yes, exactly.
11:40 a.m.
Bloc
Jean-Denis Garon Bloc Mirabel, QC
When we look at health care systems to see which are the most effective in certain fields or specialties, we tend to make interprovincial or international comparisons. We look at the various practices in various places and realize that the various systems or governments tend to follow what others are doing, and then try to make improvements.
As to health transfers, the mentality in Ottawa is that, in exchange for those transfers, conditions will henceforth be imposed on each of the provinces. I wonder if that does not prevent each health care system from innovating so that, at a certain point, we will no longer be able to follow what others are doing to make improvements.
What do you think?
11:40 a.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
It would depend on the conditions, wouldn't it?
I understand that there are different views in the federation on the federal government's role in funding the services provided by provincial governments.
That said, if the federal government invests in provincial health care systems, Canadian taxpayers are entitled to expect results. That should be the objective. If the federal government makes its investment conditional on expected outcomes, such as reduced wait times or greater capacity to provide care, and it is possible to report on those results, that it what is important.
The federal government has in the past invested in the children's health care system, for mental health, for instance, but it was not possible to see where that money had been spent or what the results were. That is the issue.
Nonetheless, I do of course understand what you are saying.
11:40 a.m.
Bloc
Jean-Denis Garon Bloc Mirabel, QC
The fact remains that we have the same goal of providing better care for people and children.
I am interested in cases where a federal taxpayer is also a provincial taxpayer, in Quebec. For example, a representative of Quebec's association of pediatricians appeared before us who supports the requests from all the provinces and Quebec to increase health transfers, without conditions.
Your remarks were moving. You said there will soon be no beds left. Pediatricians in Quebec were not of the opinion that giving the government more money on the ground would compromise their objective of improving the care they provide. That is why Quebec's association of pediatricians supports the provinces' request.
Why do you not share the view of the pediatricians of Quebec?
11:40 a.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
I would like to speak with the pediatricians of Quebec. I am sure we would agree that the investment in children's health care, whether by the federal or provincial government, should produce results. That is the goal.
11:40 a.m.
Bloc
Jean-Denis Garon Bloc Mirabel, QC
I understand.
As to imposing conditions, you seem to think that the federal government, which hardly manages any hospitals, has the skills, the public service, and the necessary administrative apparatus to tell the provinces which objectives they must meet and how to do so. The federal government is good at that. Is that what you are saying?
11:40 a.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
The Ontario government does not manage hospitals either. They are managed by organizations...
11:40 a.m.
Bloc
11:40 a.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
The systems are different, but the federal government and the provincial governments can certainly expect results that can be reported on.
11:40 a.m.
Bloc
Jean-Denis Garon Bloc Mirabel, QC
One of the largest transfers the provinces receive, which are based on population size, is the Canada Health Transfer, which in many respects is unconditional. So you think this historical approach is wrong.
11:40 a.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
We could talk about the history of transfers since...
11:45 a.m.
Bloc
Jean-Denis Garon Bloc Mirabel, QC
You are saying this is not the right approach because taxpayers have expectations.
11:45 a.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
It is interesting discussing federalism with you. We could go have a drink and continue the discussion.
The Ontario Hospital Association supports the Ontario government's request to increase...
11:45 a.m.
Liberal
The Chair Liberal Sean Casey
Mr. Munter, can I stop you there? Apparently, we've lost translation.
Mr. Munter, we're out of time, but I cut you off in the middle of your answer.
If you can, please answer that last question, and then we're going to move on.
Thank you.
11:45 a.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
Yes. I would say that we would support, and I would support, the Government of Ontario's call for a 35% increase of total health care expenditures to come from the federal government. I would support the federal government to put realistic conditions on those dollars to ensure that they actually get to the front line and make a difference and help us help kids in beds and in our clinics.
11:45 a.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Munter and Monsieur Garon.
Next we have Mr. Davies, please, for six minutes.
11:45 a.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you, Mr. Chair, and thank you to the witnesses.
Dr. Doan, I will begin with you, please.
Preliminary results from the study that you're leading, entitled “Child and Youth Mental Health during a Pandemic”, found that two-thirds of children and youth in British Columbia have struggled with mild to moderate mental health challenges during the pandemic. You note that this is up from one-third before the arrival of COVID-19.
In an article recently in the Vancouver Sun, you were quoted as saying, “This information is going to be very useful for what they call the shadow pandemic, or what’s going to fall out of the pandemic for years to come.”
In your view, Dr. Doan, what steps should government take to address the impending shadow pandemic?
11:45 a.m.
Clinician Scientist, Department of Pediatrics, University of British Columbia, As an Individual
As I've highlighted, I think that access to primary care is key for kids with mild and moderate mental health issues to be able to access community-based care that exists. There are still a lot of navigational difficulties for families to access these cares. There are new models popping up every day and families don't know how to connect with those.
Then, access to a primary doctor is key to be able to access community-based primary care. That's number one.
Number two, we often look to hospitalization data, because that's data that we collect. We don't really look at the baseline mental health issues in the community, so I would recommend that we facilitate screening, whether it's in school or through a primary care physician, so we can detect these conditions early so they can access cheaper, more accessible mental health support before they become a crisis and end up in an emergency department having to be hospitalized.
11:45 a.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
You anticipated where I wanted to go next because, Dr. Doan, I know in response to the increasing rates of children presenting at emergency departments with mental health issues, you worked to develop HEARTSMAP, which I understand is a tool designed to support clinicians to conduct an efficient, comprehensive psychosocial evaluation for children and youth presenting with mental health concerns.
Could you briefly outline what HEARTSMAP is and how it differs from other psychosocial assessment tools?
