Health Committee on March 7th, 2023

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair, and thank you all for being here. Congratulations on your hard work in becoming pediatricians. I know the big challenges for all of you and the hours you put in just get to that stage, so I appreciate that.

My wife was a pediatric intensive care nurse at the Hospital for Sick Children. We got to know Dr. Tony Addison, a good friend and the pediatrician who delivered our first two children. Unfortunately, we then moved to rural Saskatchewan. That said, we had a fantastic doctor at the time.

That's a big challenge that lots of Canadians have, because they don't have access to pediatricians and they don't have the benefit of getting that education and knowledge from the mindset that you have and what you can provide to that.

I want to ask a very quick question without getting too long-winded answers. The reality is this: How do we educate Canadians?

When I look back to ParticipACTION, I see they put out the advertisement for a 70-year-old Canadian to get out and exercise. That was a fantastic ad.

How do we educate Canadians to get the best evidence, best practices and education out there, so that they understand how to look after their children so they're not clogging up our emergency wards because of things that maybe they could do at home?

I'll start with you, Dr. McLaughlin.

[Dr. Tom McLaughlin]

That's a very good question. I agree. In particular for folks who don't have easy access to subspecialists or to specialists like pediatricians, I think it can be particularly challenging to get good, high-quality information.

Governments can have a role in ensuring that information is available. I think specifically of emergency departments as well. That relates to having a really strong primary care system and having options other than emergency departments.

In British Columbia we've actually developed a virtual pediatrician on-call system whereby anyone in a family doctor's office or a nursing station anywhere can actually contact a pediatrician, who can speak directly to a family. That's called CHARLiE, which is an acronym.

There are lots of different things.

Finally, we should ask Canadians and work with them. What is the best way to get information? I'm in the ivory tower, and I certainly have my ideas, and I think some of them are good, but I think we should also be engaging with people. How do you get information? How can we meet you where you are?

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Dr. Lynk, I'm going to ask you the same thing, but before that, I'm going to throw another question at you quickly that you might want to touch on.

Your number two point was on the national health human resources centre and the collection of data. I'm interested to hear a bit more about that data on practitioners. My wife is now retired, and I recognize that many practitioners have basically felt that they got burned out with COVID-19, so a lot of them have retired at this point in time. How do we get that set up?

[Dr. Andrew Lynk]

Those are both great questions.

I would just say that the Canadian Paediatric Society has a wonderful website, called Caring for Kids, which is written for families, at basic levels, and has all sorts of wonderful information. I'm just going to put that plug in that some of that information is out there. We also have to contend with a lot of misinformation and disinformation around vaccines and other things, and that's another huge issue.

To the health human resource issue, it's huge, and the pandemic exacerbated everything. In lots of pediatric departments—and I can just speak for pediatrics across the country—maybe a third of the pediatric health workforce is doing okay; a third is doing so-so, and a third is struggling with well-being and feeling burnt out, often because people don't have enough colleagues and supports to help them and because of the moral distress of knowing they have long wait times and can't do all they want to do for their patients.

The big thing is just planning. Are we going to be in the same position five or 10 years from now? Again, we're flying blind right now. We don't know. How many pediatric neurologists do we need in the next five or 10 years? I can't even answer that—and I was president of the Pediatric Chairs of Canada—because I don't have that data readily at my fingertips to plan. How many should we be producing? Who might be retiring? Who's thinking about that?

This is where I think the federal government, on the advice of the Canadian Medical Association, the Canadian Nurses Association and others, can have a centre to collate all this information and help us plan, so we don't get burnt on this again.

[The Chair, Liberal, Sean Casey]

Go ahead, very briefly.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Dr. Verchere, I'm not leaving you out. Very quickly, on the issue of T1D and, in particular, the high cost of some of the medications, I'm going to use Jardiance as an example, which is being looked at from the point of view of kidney failure. In fact, you probably are aware that they've discontinued the research on it because of the great evidence they've seen on it. That's a huge cost to families in utilizing the value of that medication. I'm just wondering what your comments are on that aspect.

[Dr. Bruce Verchere]

I'll preface it by saying I'm not a clinician, so the pediatricians here on the call may be better equipped, but I think it's an interesting class of drugs. They lower blood sugar quite effectively, and the clinical trials have shown improvements in kidney and cardiovascular diseases, alleviating those complications of the diseases.

It speaks to the importance of research, the need for clinical trials and partnering with pharma on these trials. Eventually, evidence will drive the decisions that we make around drugs.

There are members of that class of drugs that are still being used and are thought to be safe, but with any drug there are concerns about side effects. There's always a balance.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Verchere.

The final rounds of questions for today's meeting will come from Mr. Jowhari, please, for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair, and thank you to all the witnesses for your testimony today. It was very insightful.

I'm going to focus my line of questioning on data, starting with Dr. Lynk.

A number of times in your opening remarks, when you talked about the national health human resource data.... Recently, you responded to my colleague Dr. Kitchen's question on a planning tool whereby you would be able to see where the supply is, what the situation of supply is and where the demand in the future is going to be. As well, you responded to the role that a national youth commissioner could play in using data to be able to look at jurisdictions where they're producing some really good results and being able to compare them.

Can you expand on where you think the data for children's health should come from? I'd really like to get an understanding.

If you're going to develop a children's health data strategy, who should be developing it? What should be the element of that strategy? Who should be monitoring it? What jurisdictions need to collaborate together to be able to collect that data, and how will that data be able to help us form the policy that we need in the future?

[Dr. Andrew Lynk]

It's a great question. I think we all agree that we need to measure things. What gets counted counts. We need to measure outcomes. We need to see who's doing well and who's doing less well, so that we can share and scale things up.

Should that function and that repository sit with the national child's commission or commissioner? That's one. It could be Health Canada. UNICEF collects this data as well. The key thing is to have all these things in one place, so that when you're making decisions as policy-makers, which you have to do, you have easy access to it—as will the provinces—to share and scale things.

All I can do is agree with the importance of it. I'm not sure, from an efficiency point of view, where it should actually sit, but it's somewhere nationally, with national leadership.

[Majid Jowhari, Liberal, Richmond Hill, ON]

What would be some of the data that we should be collecting as it relates to children's health?

[Dr. Andrew Lynk]

If you look at the UNICEF 2020 report card, there are all sorts of measurements of graduation rates, poverty rates, food security, housing security and well-being. Look at Children's Healthcare Canada, which represents the 17 children's hospitals across the country. They collect data on their wait times, including mental health, surgery, children admitted for mental health issues and suicides, etc.

There is a whole range of data that I think you could probably get a consensus on fairly quickly with your child life and health colleagues across the country and that we could put together in a concise, easy-to-find report.

Some of that's already being collected. It's just putting it in one spot that's easy to access. Again, there's a discussion that needs to be had as to where that should sit and who should be responsible for it.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

I'll go back to you again, Dr. Lynk. On a number of occasions today, you talked about the fact that we need accountability.

I'll give you an example. Back in 2017, the Liberal government allocated $5 billion over 10 years to mental health and spent that money. Today, we still don't know how that money trickled down and which services were improved.

A number of times, you talked about clear accountability measures. What are your thoughts around the new round of conversations that are being had with the provincial and territorial health ministers and the premiers around the fact that we are adding a dimension of accountability through measures and clearer outcomes?

[Dr. Andrew Lynk]

I'm 100% for it. We have to have accountability. We have to have outcomes. We have to measure stuff, and if we're going to spend our tax dollars wisely, taxpayers, whether they live in Chicoutimi; Sydney, Nova Scotia; Comox, B.C.; or up in Iqaluit, have the right to expect that money is being used for the best possible impact.

It is quite right for the federal government to ask the premiers to be accountable, and to have comparable, measurable outcomes on all sorts of different things as they relate to health. It is absolutely necessary if we're going to get better and healthier as a country and be a better place to raise children.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you. Mr. Chair.

[The Chair, Liberal, Sean Casey]

Thank you.

To our witnesses, that concludes our round of questions, and we want to sincerely thank you. I can just imagine that you are all extremely busy people. Your patience and professionalism in handling the questions today was greatly appreciated, as was the expertise you brought to the topic.

We're approaching the finish line in terms of hearing testimony, and then it's a matter of putting it all together and formulating recommendations. This will be of great value to us in that regard.

Thank you so much for being with us. You are free to go.

For the MPs in the room, we'd like you to stay. We have some committee business to attend to, and we need to switch over to in camera for that.

Thanks again, everyone.

[Proceedings continue in camera]