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.
NDP
Don Davies NDP Vancouver Kingsway, BC
Can I assume that your pediatric hospital beds are all full at any given time?
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
We are at 105% today. I checked that.
The stats I know are from Ontario. We have approximately 900 pediatric beds, and the bulk of those are in children's hospitals, and then there are some small pediatric units in larger community hospitals principally in the GTA. We have fewer than 100 pediatric critical care beds in Ontario. The Ottawa Hospital has more critical care beds for adults than the entire pediatric critical care system. It's a small system and, therefore, it's a fragile system. It's historically undersized and certainly undersized relative to the demand that we are now experiencing.
The other thing to say about pediatric care that's important is that so much of it is on an outpatient basis. At CHEO, 80% of all surgeries are day surgeries. We've hundreds of thousands of outpatient clinic visits. Much of our activity is not on the bedded side of our operations but on the outpatient side.
Liberal
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thank you, Mr. Chair.
I have two questions for both Dr. Drake and Dr. Doan.
We know there's significant pressure on the health human resource part of our system. The two questions are these: Do we need to change how we primarily pay physicians, meaning, move precipitously away from fee for service? Do we need to pay physicians more?
Just to be clear, I'm not practising at the current time, so it's not a vested interest question.
Chief of Surgery, Hospital for Sick Children
I think there's a particular issue around pediatric care that perhaps isn't recognized. Particularly with pediatric surgeons, we recruit people from all over the world, because the number of specialists in, for example, pediatric cardiac surgery or pediatric orthopaedic surgery, is small. It's a very small pool of people we can access, and we are competing on the global stage. We compete with organizations in the States and the U.K. You name it and that's where we're competing. We really do need to have competitive salaries.
One example I can give you is that, in the last three years, 35 physicians and surgeons have left SickKids, usually for what we would call a lateral move. We struggle to compete, particularly with the United States, but also with other jurisdictions.
The issues around how physicians are funded are important, but I would say we have an even bigger problem at the moment with nursing. It's very hard for us to compete at the moment with the United States in terms of nursing. One solution proposed is to make the certification process much faster, in order to make immigration much easier, because there are many individuals around the world—that's where we need to recruit from—who would be very interested in coming here. We need to make it as convenient as possible for them.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Through you, Chair, Dr. Doan, could you give us a comment on that, as well, please?
Clinician Scientist, Department of Pediatrics, University of British Columbia, As an Individual
I agree with what's been said, but I would also add that, at this stage, the working conditions are so difficult and the moral injuries have been so impactful that it's not just about the funding model. It's also about healing the system and making it available for us so we can do the work we come in to do.
Coming into the emergency department and being told, “There are 10 patients waiting for a bed. You have no beds tonight, so do whatever you can in the emergency department” is demoralizing, so people are leaving the practice. A lot of my colleagues are running a pediatric clinic in the community rather than taking shifts in the emergency department because it's so brutal.
It's not just about how much you pay them. It is also about fixing the system so they can actually do what they are meant to do when they come into work.
The second thing is location. In B.C., we're having a hard time recruiting, because the cost of living is so high compared to the salary. It's not one-size-fits-all across the country, essentially.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thank you very much, Dr. Doan.
Mr. Munter, I really like the idea of this 1Call1Click program you developed in partnership with RBC, funding-wise. What are the barriers preventing other jurisdictions from adopting that same program? I look at our hospital, the IWK in Halifax. To me, this is an ideal program. How do we get better at sharing innovative ideas like that?
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
It's a great question.
It's the only model of its kind in Canada and we're proud of the innovation. The folks who developed it and who are expanding it are certainly presenting it in many environments. I'm sure they'd be happy to go to Halifax, Nova Scotia—it's a beautiful place to visit—and share the model and information. It's certainly a scalable model.
I would say one advantage we have in Ottawa related to child and youth health, but also other parts of the health care system, is that—Nova Scotia might be similar—we are big enough that we have a series of specialized services: a children's hospital, francophone and anglophone addictions treatment facilities, crisis programs and so on. We're big enough that we have a comprehensive system, and we're small enough that we can all get in a room and figure it out.
Some places are too small. They don't have the organizations, or the scale isn't sufficient. Toronto, for example, is too big. It's much harder to organize a larger number of providers and organizations around systems.
I think, in Ottawa, we're in a bit of a sweet spot, but I would expect, knowing the folks at IWK and the role they play in the province, that Nova Scotia is probably a comparable scale and can pull off some of these kinds of innovations.
I'll send you the information about 1Call1Click.
Liberal
The Chair Liberal Sean Casey
The last round of questions today will be posed by Mr. van Koeverden for the next five minutes.
Liberal
Adam van Koeverden Liberal Milton, ON
Thank you so much.
Thanks so much to our witnesses today for their extraordinary contributions to today's meeting.
Mr. Munter, I think our moms would get along very well.
My question today turns to the reality that I think we all agree on, which is that we need a better strategy to address children's health in Canada. Can you talk a little bit about the nuts and bolts of that just with respect to what your priorities would be for a strategy to address children's health in Canada, and your comments or your reflections on the need to address preventative health care?
We did talk a lot about surgeries for spina bifida and childhood cancers and things like that. I'm not suggesting that any of those might be affected by lifestyle, but are there any ways that we can address childhood health from an interventions perspective, a prevention perspective? What would your priorities be in that regard?
Perhaps I would start with Bruce.
It's nice to see you on Zoom. I hope to visit you at McMaster sometime soon. Thank you for the tour a couple of months ago. It was extremely informative.
September 29th, 2022 / 12:50 p.m.
President, McMaster Children's Hospital, and Chair of the Board of Directors, Children's Healthcare Canada
Thanks very much.
Certainly, I would welcome all members of the committee to join us. I know that our colleagues right across the country would always be very keen to show folks around.
I really appreciate the question; I think it's a great way to finish.
Clearly, your question is premised on that we will have a child and youth health strategy put forward for Canada, so where do we start? With such a long list of opportunities, I point back again at a few things. First of all is a source, the “Inspiring Healthy Futures” report which, by the way, was produced by four of the leading national health organizations, including UNICEF and CIHR. They listened to children, youth, health providers and multiple sectors—education, social services, justice—and all of our communities in developing, really, a comprehensive framework and component. I'd really point the committee back to the “Inspiring Healthy Futures” report.
Then I would highlight again that we need a national health data strategy that relates to children and youth. We actually don't track how we're doing in terms of health. As much as we've talked about performance, we don't know, in a comprehensive and ongoing way, the health of children, youth and their families across Canada. As I said, then we can use that to inform a health research agenda, a health information knowledge transfer agenda and, ultimately then, guiding policies around priorities, which, as you've already heard, certainly rest in mental health but also in addressing inequities in health status outcome and access across the country.
Thank you so much for the question.
Liberal
President and Chief Executive Officer, Children's Hospital of Eastern Ontario
I would agree with that.
I have two quick things.
One is that, in overarching policies related to health, there be a dedicated child and youth component. Jim has spoken about some of the challenges in the recruitment of specialized personnel. Again, Ontario is what I know. Ontario data at the moment would tell you that there's no increase in volume in emergency departments, and it would tell you that primary care has recovered its volumes. That's true for the system as a whole; it's false for children. More children are going to emergency departments, and primary care is not seeing as many kids. So when you look at the whole system, kids get washed out in terms of impact. That's the first thing. Any broader strategy needs to have a carved-out, focused attention to children in health.
The second is to remember that one of the things that makes pediatric care different is that intervention can be prevention. If we talk about mental health, we know that two-thirds of adult mental health conditions and addictions trace their onset to adolescence. If we can intervene effectively in adolescence, that is actually prevention. It's treatment. It's treatment in the moment, but it is prevention of illness, need and cost later on.
Liberal
Adam van Koeverden Liberal Milton, ON
Thank you.
I'll ask very quickly if Dr. Doan or Dr. Drake have brief comments to finish this off.
Clinician Scientist, Department of Pediatrics, University of British Columbia, As an Individual
Yes, thank you.
I would like to echo the previous witnesses' recommendations.
From a perspective of someone who applies for a research grant, researchers are always asked if they are working with knowledge users and policy-makers to make their research applicable and useful. I would say for accountability for funding, the reverse should also be applied. When funding is distributed, there should also be a commitment to work with clinicians, scientists and researchers to put in place the measures and evaluation to measure the impact of that funding and investment.
Chief of Surgery, Hospital for Sick Children
I would finish with something you've already heard so far with this group.
It's really important to remember that children are not little adults. They are our future. The decisions that we're making are going to affect them for generations. That's where we are coming from.
Liberal
The Chair Liberal Sean Casey
Thank you very much, Dr. Drake.
It's an excellent, thoughtful note on which to finish.
When we hear the challenges that you are facing in your everyday professional lives, I can't say it emphatically enough: Thank you for what you do. It has to be difficult, clearly.
It also underscores how valuable your time is. We very much appreciate that you came here and so patiently answered all of our questions and provided us with a ton of information that's going to be extremely valuable in our work.
Thank you very much on behalf of the committee.
Colleagues, I understand that we're going to have the draft report on health human resources in our hands, hopefully by the end of today so we're well positioned to review it next week.
Is it the will of the committee to adjourn the meeting?
The meeting is adjourned.