Health Committee on March 21st, 2023

[Dr. Alain Lamarre]

Thank you for your question. It is right on the mark.

There is in fact a chronic problem with investment in research in Canada, for the past 20 years or so, I would say, and research budgets have stagnated while costs have risen, meaning that we ultimately have less money to conduct research.

I cannot say that nothing has been done in the past three years. The federal government has in fact made major investments, but they have been in fields that had been completely neglected over the past 20 years. The fabrication of biological products, vaccine development, fabrication and biofabrication had been underdeveloped or underfunded for decades, so we have started to catch up in these areas.

In addition, certain initiatives focused on the pandemic, and rightly so. Significant research and development investments were made in vaccines and biological products to deal with SARS‑CoV‑2. Nonetheless, it bears repetition that future innovation depends on basic research. We cannot predict future needs in the event of another pandemic. So we must continue to fund basic research in a broad range of areas in order to be better prepared for a pandemic caused by another pathogen, or for a non-infectious health crisis. At least we would have the basic knowledge in order to respond more quickly.

So I think investing in basic research is essential. Canada needs to make a major shift in direction because we are really in free fall. Canada is nearly at the bottom among G7 countries in this regard.

[Luc Thériault, Bloc, Montcalm, QC]

It must also be said that we have some valuable talent and brilliant minds.

Before I give the floor to Ms. Grandvaux, I would like to say something.

There would not have been any mRNA vaccines without all the research—as I learned from a close source—done in the 1980s at the Scripps Research Institute, San Diego. In other words, work on that had already begun. Those 40 years of research got us out of the pandemic. Cutting that research means cutting off our legs and preventing us from dealing with global problems in the future.

Ms. Grandvaux, would you like to add anything?

[Dr. Nathalie Grandvaux]

Yes, two things.

First, it is true that we would not have been able to fight COVID‑19 as we did without all the basic research on viruses, mRNAs, and vaccines that was done in advance. Because of that research, we were able to respond more quickly when the pandemic hit. Basic research is essential and it must be protected.

The second point, which I think is misunderstood, involves the use of basic research funding.

We talked about staff shortages. Yet most of the funding we receive is used to fund lab staff. Apart from us professors and a few professional staff, the people in our labs that we depend on are primarily students and postdoctoral trainees. This is really where we are not competitive. We do not offer the same salaries as other countries and we do not have professionals in our labs, slowing down our research.

When we ask for a bigger budget, we often hear that we can make do as scientists, but the money is for staff. That money goes toward our talent and capability. That is where we are really falling short.

I think we really need to understand that to make our research as effective as possible in Canada.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Grandvaux.

Next we have Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to all the witnesses for their excellent testimony.

Dr. Lamarre, I'll begin with you, please. At your appearance before this committee on June 18, 2021, you said the following:

According to data from the Organisation for Economic Co-operation and Development (OECD), Canada is the only G7 country where gross domestic expenditures on research and development have been declining since 2001. It is now the second lowest in the G7 on this measure, ahead of only Italy.

If you know, Dr. Lamarre, what portion of Canada's gross domestic expenditures on research and development are directed towards child- and youth-focused health research?

[Dr. Alain Lamarre]

I wouldn't guess any number, but as other witnesses have said, it's a minority, for sure. There's a lack of funding, in general, but it's probably even more pronounced for children's research. That goes from fundamental research all the way to clinical trials, which are also difficult to conduct for children. There's probably, also, underfunding for clinical trials in children's diseases or for children's medications that are in development.

I wouldn't want to guess any number, but it's probably even more severe than what we see for adult research.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you have a sense of where Canada might compare with peer jurisdictions in terms of how much we allocate towards research for child- and youth-focused health?

[Dr. Alain Lamarre]

It's probably even worse than the budget allocated to fundamental research in the G7. Yes, we are second-last in that aspect, and it's probably not better than 20th position in the world for children's research. I think there's a lot of ground to be covered.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Skarsgard, if I could turn to you.... Is there national data available on the number of children who are on wait-lists for surgeries?

[Dr. Erik Skarsgard]

There is if we aggregate provincial data. We used to have an organization through what is now Children's Healthcare Canada that kept track of national data. We rely now on provincially aggregated data, so the data that I provided to you is self-reported from children's hospitals.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you see the need for better national data on this? Would that be helpful?

[Dr. Erik Skarsgard]

I do think it would be helpful, as would more national co-operation. Child health, still, is a provincial responsibility. With greater integration across provinces—sharing of what's working and what's not, dealing with some health human resource pipeline issues, sharing technology and technology assessments so that we can drive the approval of pediatric-specific devices more effectively in Ottawa—I think there's great opportunity for national collaboration in data sharing and in operational management.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Skarsgard, in a December 2022 article from the Vancouver Sun, you noted that B.C. Children's Hospital has found ways to add some additional surgical capacity by prioritizing cases that are developmentally timed for the best outcome, such as those for kids with scoliosis or heart defects, for kids with cancer and for those coming from remote areas.

Can you give us a sense of how much additional capacity that strategy has created? Also, what is the current backlog for surgery at B.C. Children's Hospital?

[Dr. Erik Skarsgard]

I would say that we didn't actually create a lot more capacity. Rather, we shifted the capacity that we had to those priority areas that you mentioned.

We certainly do have some capacity-building strategies that include consistently opening additional ORs, running ORs later in the day and even trying to run operating rooms on weekends—doing elective surgeries on weekends.

I'm sorry. I've just forgotten the second part of your question. I apologize.

[Don Davies, NDP, Vancouver Kingsway, BC]

What is the current backlog for surgery at B.C. Children's Hospital?

[Dr. Erik Skarsgard]

I did provide some figures that show that our current wait-list is about 3,800 patients. That's double what it was before the pandemic. It's important to realize that a wait-list is just a number. What you're not capturing in that number is the percentage of children who are waiting beyond their wait-time target, which is really important for some of those developmentally timed surgeries, like surgery for scoliosis or for cleft lip and pallet. Those children are on the wait-list, and they're waiting longer than they've ever waited before.

[Don Davies, NDP, Vancouver Kingsway, BC]

I have some data from 2018 that shows that only 65% of elective surgeries in Canadian children's hospitals were completed within window, suggesting insufficient national capacity even before the pandemic, which I think we all realize has been exacerbated.

In your view—and you've touched on this a bit, Dr. Skarsgard—what steps should the federal government take to expand Canada's pediatric surgery capacity?

[Dr. Erik Skarsgard]

I think we need targeted funding for children's health care with the transfer payments to the provinces. We need co-operation in planning within the provinces between, as I mentioned, the children's hospitals in the community that really target the building and retention of child health care capacity. This can't be something that is just a quality improvement project. This has to be something that is identified as a priority and sustained across annual budgets.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Skarsgard.

Next we have Mr. Jeneroux, please, for five minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair.

Thanks to everybody for joining us here today.

I got scooped a bit by my colleague and friend at the end of the table, Mr. Davies, on the question I was going to go into with you, Dr. Skarsgard, but I'll also address it in a bit more detail.

There are two facts that really stood out in your testimony here today: that 65% of scheduled surgeries were performed within the window and that this goes back to 2007. This is a crisis, as you indicated a number of times, but a crisis that absolutely should be addressed by all levels of government across the country, quite frankly.

However, there are some 2018 numbers that were quoted by Mr. Davies. I see by your 2023 numbers here that it's 58% out of window. Is this trending in a negative direction? Perhaps you can fill us in a bit on that.

If I could, I'll just add my second question to that before I turn it over to you. To unpack some of what you said to Mr. Davies, is this a matter of resources? Should the federal funding go to more nurses? Should it go to more infrastructure, to operating rooms and to more hospitals in general? If you can unpack exactly where some of that would make the biggest difference, it would be helpful.

[Dr. Erik Skarsgard]

Thank you very much for the question.

That figure of 65% out of window requires some interpretation, because in some reports it reflects completed cases. An operation gets done and comes off the wait-list, and we are also interested in how long those children waited to have surgery.

You can also have an out-of-window measure on children who have not yet had surgery, and that's perhaps the group that are at greatest risk, because we don't know when they will have surgery. Maybe they will be 60%, 70% or 80% out of window when they finally get surgery. We've shifted our focus to out of window as being an important measure for children who are waiting for surgery because the wait-lists have grown so greatly over the last three years.

I would say that's still a very important number and one that we need to keep an eye on, but it also needs to be measured in the context of the total corpus of the wait-list in the provinces and across the country.

The other question was with regard to...? I'm so sorry. Would you just remind me?

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Yes, it's no problem. It's about unpacking what would be most helpful. Is it infrastructure, nurses...?

[Dr. Erik Skarsgard]

In my hospital and in the discussions we have with the other chiefs of surgery at the other children's hospitals, it's nurses. It's nurses who keep our ORs and our recovery rooms open and nurses who staff hospital beds, particularly in critical care areas.

We can have a child waiting for surgery, we can have a room and we can have a surgeon and an anaesthetist, but without a nurse to staff a bed for that child to go to after surgery, we can't start that case. Obviously you can see the shift in the allocation of resources away from children who need beds after surgery, which means that we use that time in other ways, but it's usually to treat children who don't necessarily need a bed after surgery.

Some of the other issues around space and equipment are important, but I would have to say that in my hospital, and in most of the children's hospitals across Canada, it is the nurse human health resource that is the limiting factor.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

That's interesting.

From what I understand, in British Columbia everybody has to be in the room. I forget what it's called, but the anesthesiologist, nurse and pediatric surgeon all have to be in the room prior to the start of the surgery and get the patient's sign-off.

I'm going to jump to my second question, but if I'm wrong on that, definitely correct me. It's only because I have about 30 seconds left.

The other fact that jumped out was that less than half of all operations for children are performed by people other than pediatric surgeons.

Are these typically family doctors in rural and remote areas? If someone doesn't have the benefit of living in downtown Vancouver and they're in a remote area in B.C.—if they don't go to your hospital—then are they getting their surgery done by a family physician instead?

[Dr. Erik Skarsgard]

No, definitely not. These are specialist surgeons who may not focus their practice on children, but certainly can provide care for children.

These would usually be children who are older, like teenagers, who don't have comorbidities that would require the care of children's specialists. These would be children who need hernias fixed, gallbladders removed or some minor orthopaedic surgery. All of these things can be safely and effectively done in the community if the community hospitals are set up to provide care and the providers are incentivized to care for children.

They have long wait-lists of adult patients. Quite frankly, the fee guide for a fee-for-service surgeon will not encourage them to do a minor procedure in a child if they have the option of doing an operation in an adult.