Health Committee on Feb. 16th, 2022

[Linda Silas]

Well, in your beautiful province, Doctor, it's 1,300. That is a very clear number. It's easy to go from facility to facility and count the vacant positions. In the province of Ontario, there are over 20,000 vacant positions. Again, it's a very large number. We're not even trying to reach the OECD average. We're trying to retain the workforce we have.

If we did what Nova Scotia did...honestly. Your premier promised jobs for the next five years for every nursing graduate in their region, and those are permanent jobs. We need actions like that from all levels of government.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

If we might continue—

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Chair.

[The Chair, Liberal, Sean Casey]

Next we're going to go to the Yukon.

Dr. Hanley, go ahead, please, for six minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

I want to add my thanks to all of the witnesses. Clearly describing the state of health care human resources in five minutes is challenging for each of you, but I really appreciate the different angles.

I want to note that it's only about every 100 years that a physician is a member of Parliament for the Yukon, and it's only about every 23 years that a Yukoner is the president of the CMA. To honour that occasion, I'm going to direct my first question to my colleague and friend, Dr. Smart.

I want to hear a bit more about how, in your view, burnout has affected not just numbers but the productivity of the physician community in general.

I beg you to keep it reasonably short and concise so I can get all my other questions in.

[Dr. Katharine Smart]

Thank you, Chair.

Thank you, Dr. Hanley. It's such an important question.

Burnout underscores so many challenges we're having in the system. Our understanding of the impact of burnout has really evolved over the last 10 or 15 years. We know that levels of burnout in physicians have doubled, as I stated. We know that burnout is mostly related to working in systems that are not functional. That is the root cause of burnout for physicians and other health care professionals.

We also know that burnout directly links to things like productivity, as well as quality of care and medical error. Addressing burnout and creating a system in which health care workers can thrive and be healthy is critical to delivering quality care to Canadians.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you, Dr. Smart.

Ms. Silas, I'd like to ask you to answer the same question, keeping in mind the scope and optimizing the scope of care of nurses within such a broad profession as nursing.

[Linda Silas]

The numbers are very similar to what Dr. Smart said. We're talking about a 50% increase, but there's a difference. There's a difference between feeling burnt out, as in just wanting to hide underneath a desk or in a corner, and the over 30% who need clinical mental help. That's where we're seeing a big lack, because there's a lack of services everywhere. That's not only impacting the productivity, because when we survey nurses, they do say the care they're trying to give is good, but there's not enough of them. What it does say is that they want to get out. Again, that's why we need to look at retention.

Out west, from Manitoba up, we have registered psychiatric nurses, again in a different role on the Prairies, to do with mental health. We need to be innovative everywhere across Canada in terms of how we're going to deal with mental health, both for those giving the services in health care and for those other Canadians who need it.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

I'll move to Dr. Soulez.

Good afternoon, Dr. Soulez.

Thank you for your presentation.

We know that technology is one of the largest drivers of health care costs. How do you see the balance between evolving technology, adopting a technology and managing the cost driver that newer technology presents?

[Dr. Gilles Soulez]

That's a very good question.

Definitely when you look at imaging, it's true that the capital investment is quite significant, but the cost of not having a timely diagnosis is really expensive. We need to take into consideration that balance of the money we put in, the investment, and the cost efficiency of the benefit we will have on the patient workflow and patient care. In that regard, it's clear there is more and more investment now in information technologies, on new technologies that will facilitate that workflow and that will really put us in a position to treat more patients more efficiently in a shorter duration of time. If we target our investment, we can really have a good return on investment.

Another example is the clinical decision support system. With this kind of information system the first-line physician can really do the imaging requisition, but he is guided when he does that to be sure that the requisition is appropriate or relevant for the patient. Having this kind of system installed across Canada, we can save 10% or 15% of unnecessary examinations, so the return on investment can be very good.

We need to really focus on that balance.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

Also, my former colleague Paul-Émile Cloutier, I'd like to ask you, when you talked about resiliency of the health care workforce, the cadre, do we have the right mix of health care professionals, and if not, what's missing; what's too much?

[Paul-Émile Cloutier]

I don't think that we have the right mix, and I'm not sure I have the answers to what the right mix should be. I think the message that we're trying to give today to the committee is that we need to review this very carefully, taking into consideration all of the professionals who work in the health system.

You were mentioning just a few seconds ago how many people have actually left because of their burnout, the whole bit. We did a survey with the Ontario Hospital Association in Ontario. In terms of all hospital staff, from 2020 to 2021, 45% of people have actually resigned. Of the nurses and RN specialty, we're looking at 71% of the nurses have resigned from 2020 to 2021. In service, which is the service that provides the service to physicians and nurses, about 40% have resigned from 2020 to 2021.

Clearly, there's a message inside the system that it's not working. A lot of people are leaving because they are burnt out. They see that the system is not changing and it's not getting any better.

My fear with this exercise that we're looking at is that if we don't look at the system as a whole first before starting to say, let's do this for the nurses, let's do this for the radiologists, let's do this.... I know there's a need across the board. I'm not being critical here, but if you address only the physicians and the nurses and you don't fix the system as a whole, you will not have done any good service to Canadians and to patient care. That's my view.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Cloutier.

The Bloc Québécois is now up.

Mr. Thériault, go ahead for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

I want to thank all the witnesses for helping us understand the problem and look for solutions.

I will mainly address Mr. Soulez and Mr. Cloutier.

Dr. Soulez, last time we met, we were going through the third wave of the pandemic, and we talked about structural issues. Today, when I am told about workforce retention issues in relation to work conditions, I realize that we are not experiencing economic issues, but rather pre-pandemic issues, which the pandemic has exacerbated. So these are structural problems.

In that sense, aren't structural solutions required?

Add to that the issue of chronic underfunding. During the first wave, it was said that chronic underfunding had made us fragile. We are currently going through an apocalyptic situation. There is a time bomb in health care networks that may affect us over the next 10 years.

So shouldn't we be talking about structural funding?

Dr. Soulez, I will let you answer this first question. I will then turn to Mr. Cloutier.

[Dr. Gilles Soulez]

Your comment is very relevant.

What is happening is that provincial operational budgets enable them to resolve only immediate problems and provide services, but the situation is very difficult for the provinces right now. It feels like there is a strategy for infrastructure and health care reorganization.

There is no question that additional funding is needed to implement those long–term reforms. We are talking about structural investments. In my opinion, excellent collaboration with the provinces is needed to successfully define needs, as they are not the same everywhere. Needs can certainly vary from one province to another. So a flexible strategy that fosters integration is needed that would enable various provinces to invest in priority sectors, but always with the help of the federal government when it comes to structural investments. Therefore, long–term investments are needed.

As I said earlier, a return on investments must be ensured, but without having to pay for the grocery bill, if I may put it that way.

[Luc Thériault, Bloc, Montcalm, QC]

Health transfers are indexed at 3%, and a representative of HealthCareCAN, in a brief submitted to the Standing Committee on Finance in 2021, said that, owing to the pandemic, health care system costs accounted for 8.4% of the budget over the very short term. The indexing is expected to remain at 3% until 2027.

I am not here talking about a minor increase in transfers. It is crystal clear that we cannot be serious if we don't respect budget priorities and we don't make massive and immediate investments in the top priority, which is health.

Mr. Cloutier, don't you think that, if we want to have the means to ensure staff retention, considerable and recurrent structural investments must be made over the long term?

[Paul-Émile Cloutier]

That is a very good question.

I agree with what Dr. Soulez said a few minutes ago. There is a clear lack of funding in Canada to adequately help the health care system. I admit that the needs are enormous.

My biggest concern, Mr. Thériault, is that if we were to provide funding without knowing what goal we want to achieve or what changes we want to make in the system, we may end up in the same situation as in the past, when funds would be allocated to sectors with virtually no results.

I think that Canadians and even provincial premiers have a role to play. I have written to all the premiers as part of the Council of the Federation conference to let them know that we felt the federal government had to play a crucial role in the funding of the health care system, a more significant role than it is playing today. It must play that role strategically to meet each of the provinces' priorities.

For example, we have a $4.5-billion budget for mental health, but mental health encompasses a broad range of areas. Some provinces may prioritize certain areas of mental health, while others will not have the same priority. That is where we are asking our politicians to be a bit more flexible, in the sense that the government would be prepared to allocate funding to priority sectors while ensuring some accountability in terms of obtaining results. I think this is what Canadians really want to see today.

To answer your question, there is a considerable lack of federal funding for the provinces. According to the Deloitte study sponsored by the Canadian Medical Association, or CMA, it may cost up to $1.3 billion just to cover the care that has not been provided. The provinces don't currently have that kind of money, and I don't think they could provide hospitals with it.

[Luc Thériault, Bloc, Montcalm, QC]

We agree that, in your brief—

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault. Your time is up.

Mr. Davies, you have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Okay.

I will come back to this question later.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Witnesses, thank you for being here and lending us your expertise and great ideas.

Ms. Silas, I'll start with you.

I'm just wondering how reorganizing the way we deliver care may impact burnout and the way we can actually retain the staff we have. I'm thinking of things like team-based care or maybe expanded scope of practice.

Do you see any opportunities for reorganizing the way we deliver the services that might actually get us more efficient in terms of how services are delivered to patients?

[Linda Silas]

Well, Mr. Davies, you've been on this committee for a long time. You know that all of us have been promoting and delivering care in a different way. We started back in the 1990s with more community health centres to provide better primary care, and we're still, in 2022, asking for better primary care.

With regard to teams, if I look at team nursing, it all depends on who's going to be on it and what it's for. We have years and years of science in terms of talking about the right nurse for the right patient—the right skills and the right education and the right experience for the patient. It all depends; the sicker your patient, the more skills and the more education, etc., you need. We have to be very careful of what some employers have done during COVID, building these new models of care that are plainly just dangerous. We will work on that.

I totally agree that we need to go more toward home care, community health centres and increases in mental health. It could be a program similar to what the federal government established about a year and a half to two years ago, the Wellness Together Canada program. It is an online mental health resource. It's there. It's available for everyone. Okay, now what do we do next?

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I think you just very diplomatically called me “old”.

[Voices]

Oh, oh!