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.
12:15 p.m.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you.
Mr. Squires, I also see you nodding along. Do you have anything further to add?
12:15 p.m.
President, McMaster Children's Hospital, and Chair of the Board of Directors, Children's Healthcare Canada
Thanks very much.
I was going to go where my colleague Alex went. I'll just extend that to point out that, when we think about a child health strategy and a federal government role, it's about ensuring we apply a child health lens to policy decisions, and not only health care policy decisions, but others.
If you think about examples like some of the pharmaceutical shortages and, of course, around immunization, too often, as those discussions are happening, there is not a lens to think about what the implications are for children and youth in Canada. As Alex just described, regarding pharmaceutical trials and decision-making, we very often don't look at children and youth, but that just multiplies across so many other dimensions.
If you have a child health strategy, hopefully a component of that is the federal government's lead in ensuring we always apply that lens: What are the implications, the circumstances, and the needs of children and youth?
12:20 p.m.
Liberal
12:20 p.m.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you very much, and thank you again to all the witnesses. It's been great testimony today.
I'm participating from my constituency of Yukon.
I have lots of specific questions. To frame this, clearly we're addressing a crisis in child health care. We need to look at the short term and the long term, as well as child and youth health, and as a public health physician, of course, that's an interest of mine. We must also recognize the overlap between health care access as a determinant of child health in terms of the backlogs that have been described today. How do we set ourselves up for addressing backlogs, the capacity of our workforce and access to primary care, but also for the longer term?
On the performance side, when we spend so much as a country, why do we seem to be getting less value for our dollar and how do we get more efficient with our dollars? Thus, I think of that federal role. Should we not be demanding results on how we fund on behalf of Canadian citizens? When we're offering money, what are the outcomes we should be asking for? Even though we don't get into the weeds, we need to be able to, I think, demand outcomes in improvement and performance.
Dr. Doan, I was really interested in your testimony. One thing I am concerned about is the access to the family doctors inhibiting access to mental health services. That's worrying to me.
I love how, with development of the MyHEARTSMAP, you're getting more self-management, which is almost like self-triage in a way. However, given that I think we're going to be facing a shortage of doctors for years to come, how do we get beyond...build primary care and self-management and enhance access to mental services, making that whole referral pathway more efficient?
12:20 p.m.
Clinician Scientist, Department of Pediatrics, University of British Columbia, As an Individual
Family doctors have a short amount of time to spend with each patient. I think that if patients come in already with a sense of where the issues are and they have self-screened, that can facilitate the conversation with the family doctor. They can hone in on what types of resources are available and the referral process can be accelerated.
Before the pandemic, I was hoping to work with primary care physicians and pediatric offices to have the screeners available in the office. Then the pandemic hit, so we had to go online and we reached the families directly in their provinces.
Facilitating screening, where they can actually discuss the result right away with a health care provider, is helpful, because if they do a screening at home and they can't access their primary care physician, what happens? They go to the emergency department, and they may or may not need emergency care. I think that the timing of the screening and access to primary care and navigation support are essential.
We also need to support our family doctors, because they didn't train in psychiatry. Their being able to access advice and counselling on how to manage certain situations without having to refer to a psychiatrist and wait for six months is also useful. A referral system for physicians—
12:20 p.m.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you very much.
Mr. Squires, money comes from the feds, and somehow it trickles down to you in your centre. You mentioned improving rural and remote care in place. You're a centre of expertise. What are the innovations and areas for improvement so that, as an urban centre of expertise, you can support care in place in the more remote and rural settings, especially if you had more funding at your fingertips?
12:20 p.m.
President, McMaster Children's Hospital, and Chair of the Board of Directors, Children's Healthcare Canada
Thanks very much, Dr. Hanley. It's certainly great to see you again.
There are a number of different initiatives that I think can help there. I point back to some of the things that you, yourself, talked about 20 years ago, 30 years ago, which really take advantage of the improving technologies that allow us to break down the barriers to the sometimes specialized care and expertise. That really helps in dealing with the challenges that children and youth face in their health and health care.
Again, there is a relatively specialized nature to so much of children's health and children's health care. Fortunately, in many cases, the number of children who need that specialized care can be quite small. We're never going to be able to be in the place where we have as many specialized professionals in every single location, but by virtue of communication technologies, we can do a far better job of enabling and supporting those who are in rural and remote communities. That is particularly primary care and family physicians with that additional level of support and expertise.
If we go back to the role of a national child health strategy and the federal government helping to create the infrastructure both, again, from the hardwiring technology and software perspective but also from the support to networks of researchers at the front line of care providers and then, of course, to parents, youth and families to help them.... Much of this is about the information they need. Put all those things together and we can make a really big difference.
I point first to that. It's not rocket science. It is communication technology, but it's something that we have at our disposal right now.
12:25 p.m.
Liberal
12:25 p.m.
Conservative
Mike Lake Conservative Edmonton—Wetaskiwin, AB
Thank you again, Mr. Chair.
I want to dive into a conversation about dental health for a second. In prefacing, I mentioned my son earlier. At 26, he has some teeth-grinding issues and things that really do impact him. The importance of dental care is not lost on me.
It's interesting that we wound up in this conversation where we're putting together a list of things facing kids. We're talking about dental and we're talking about mental health almost like equal things on the list. Certainly, governments can tackle multiple priorities at the same time. I do notice though that in the Liberal platform there was no mention of anything related to dental investment and a promise of $4.5 billion for a mental health transfer.
I do notice that of the witnesses who have come before the committee, almost none of them have talked about the dental crisis we have in Canada, but many have talked about the mental health crisis. Almost everybody has talked about the mental health crisis that we have in Canada.
I have a really straightforward question. In pediatric emergency rooms across the country, where is the most pressing need, if you were to compare the dental crisis in pediatric emergency rooms versus the mental health crisis in pediatric emergency rooms across the country?
I understand that we can certainly invest in both things, but you are folks who live in the real world where you're making decisions based on priority and triage every day.
Maybe, Dr. Drake, I'll go to you first and put you on the spot.
12:25 p.m.
Chief of Surgery, Hospital for Sick Children
I think what you're asking is actually an extremely complicated question. I don't think there's an easy answer here.
I do think that the health care leaders, such as you have here today, and the health care physicians and nurses are the best ones to try to prioritize what is really important and what is falling behind compared to others.
We get into this discussion all the time. The best one I can give you is you have two patients who are waiting for emergency surgery, and it's up to the surgeons to decide between a neurosurgeon and a cardiac surgeon who's patient needs to go first.
You're talking about very different things. There are universal measures of health care and of well-being. I suppose that's one way of doing this, but to try to compare one group of illnesses to another one is extremely hard to do. The problem is that they are all important. There are ways of looking at what are the impacts to these patients both in the short term and the long term. There are measures out there. I'm not an expert on them. That is one way trying to get at what really is the biggest problem.
12:30 p.m.
Conservative
Mike Lake Conservative Edmonton—Wetaskiwin, AB
Maybe I'll phrase it a different way.
Did you or any of your organizations advise the government that while they made a $4.5-billion promise on mental health, they ought to focus on dental care instead? They've clearly changed directions from what they promised in the election a year ago. Did any of your organizations say to the government, “Hey, dental care is a more pressing priority”?
12:30 p.m.
Chief of Surgery, Hospital for Sick Children
This is above my pay grade. I would defer to our CEO, or Dr. Munter here.
12:30 p.m.
Voices
Oh, oh!
12:30 p.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
If you're going to give me a medical degree in the process, I'm happy to answer the question.
12:30 p.m.
Voices
Oh, oh!
12:30 p.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
Mike, in Ottawa at CHEO—these are the numbers I would be familiar with—only one in eight children whose severe dental pain requires hospital care gets it in the clinically appropriate wait time. We do have a serious issue there. The Canadian Paediatric Society for many, many years has been calling for expanded access to dental care, just as they've called for expanded access to mental health care.
As Jim says, we don't really have the luxury in our organizations of turning away sick children on the basis that their disease, their syndrome or their disability is not a public policy priority. We should be able to do both. That's what I'm getting to.
12:30 p.m.
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
Certainly, we've had a historic underfunding of the mental health and addictions system that has collided against a very significant increase in demand, particularly starting in 2009 in the child and youth health world. That needs to be resourced. That needs to be responded to. At the same time, we have kids in pain because they can't get dental surgery, which is the part of it that we would see, with seven-eighths of them not getting that surgery in time.
So it's both. We need to respond to both.
12:30 p.m.
Liberal
12:30 p.m.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Let me pivot from comparing apples and oranges to talking about some totally different bananas here—surgical backlogs and long wait times. Certainly, this has adverse effects on children's health. It's also very stressful to both the children and their parents. What can we do about it? How much is the solution more money in the system?
Dr. Drake, you already talked a bit about it. There are only so many surgeons, only so many anaesthetists, only so many OR nurses and only so many ORs. Do you have the capacity to ramp it up to do more surgeries to address this backlog? You talked about already working on weekends. How much more could you or would you want to work in terms of working evenings and weekends in order to address this problem?
12:30 p.m.
Chief of Surgery, Hospital for Sick Children
It's a really good question. I think the issue with the backlog is that we think this is a temporary problem that we can get beyond, assuming that we can get the health human resources that we need. But how do we hire into something that's going to last two or three years before we clear this? Then what do we do?
We think this issue about access to health care is going to continue well beyond the impact of this pandemic. We are currently hiring as many people as we can for nursing, and for physicians and surgeons, etc. The issue is, how do we keep these people? At SickKids we are over-hiring as much as we can and we are not able to actually keep our heads above water. At the moment, for example, at SickKids we normally would run 16 ORs. Now we can only run 14, because we don't have the nursing support.
The physicians, the nurses, everyone is willing to do this. We are willing to work evenings and to work weekends, but we need the people in place to do that. It's going to last for several years. Then once we get beyond that, we think it's going to require additional resources to keep things under control.
12:35 p.m.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
I think one of the impediments to ORs is alway OR time and not having enough ORs open. Would more money in the system allow you to open more ORs to be addressing the backlog?
12:35 p.m.
Chief of Surgery, Hospital for Sick Children
There's been a lot of discussion today about money and outcomes and how we compare to other developed health care systems. I think that it's not the only solution.
The issue of efficiency has been brought up today, and it's obviously extraordinarily important. I can assure you that all the children's hospitals are working on how they can become more efficient in what they do—that's certainly something that we focus on all the time—and that's things that we're trying to improve in terms of improving the health care that we can deliver.
Funding is, obviously, extremely important. It's really important, but I think it has to be taken—
12:35 p.m.
Liberal
Brendan Hanley Liberal Yukon, YT
Mr. Chair, I have a point of order.
I'm not hearing anything. I don't know if it's just me.
