Health Committee on Feb. 16th, 2022

[Bacchus Barua]

Thank you so much for the question. That's quite a big one.

To start, I just want to clarify. I don't think I explicitly said that underfunding is an issue. We are one of the highest spenders. I think there is an imbalance between how much we spend and what we get in return.

When it comes to the policies that separate us, I want to reiterate that there are actually three. It's not just private health care and user fees, but it's also how hospitals are funded through activity-based funding.

On what you said in terms of the identification of universal health care as a core Canadian value, it's important to stress that universal health care does not in any way mean only a government-mandated health care system the way Canadians have been led to believe. Most other countries with universal health care have really a hybrid system with most of these policies.

Switzerland and the Netherlands, for example, are at one extreme of universal health care, where they simply mandate all their residents to purchase private health care in a market that includes both public and private providers. Most other countries, including Australia and Germany, have both public and private hospitals delivering public services. All these countries have some level of user fees. Some of them are deductible; some of them are a small copayment like 10% of the cost of care. All of them have exemptions. All of them have caps on the total level of out-of-pocket payment. These are all universal health care countries and all of them fund their hospitals in a different way.

To your last question regarding political appetite and also the Canadian appetite, I can't answer anything regarding politics. I'm not a politician or a political pundit. What I can say is that there are a lot of new surveys that do indicate that Canadians are changing their view in terms of how they perceive reform and their willingness to experiment and try different things that have been shown to work in other countries. This is obviously a result, partly, of our overburdened public health care systems, but also as a result of a better understanding of how other countries with universal health care simply do universal health care differently.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Can you maybe cite in a little more detail those studies as to the acceptability?

Although other countries that provide universal health care may allow extra billing and some privatization, I think most countries, when they think of universal health care, do not think of those things as being part of it.

Do you have further numbers and evidence? Maybe you don't, and if you don't, that's fine. Again, I'm figuring the Canadian public will not buy this. They will consider this as being an unwarranted compromise to the universal health care system that is so important to all Canadians.

[The Chair, Liberal, Sean Casey]

Provide a brief response if possible, Mr. Barua.

[Bacchus Barua]

[Technical difficulty—Editor] don't have the numbers on hand, but I believe that the study that you might find useful was conducted by secondstreet.org in Alberta.

With regard to Canadians' accepting these sorts of reforms, I will say this. I have great faith in Canadians and their ability to understand new information. I think that the pandemic has shone a wonderful light on how other countries do universal health care, how many of them do it differently and how many of them have features that are probably valuable in the Canadian system.

Of course, all of this would be understood to be within a Canadian framework, which would be unique in its own way.

[The Chair, Liberal, Sean Casey]

Okay, thank you.

Mr. Thériault, you have the floor for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Soulez, you practise medicine in Quebec. You will know that, since 1992, Quebec has restructured three times to try to do more with less.

Based on your assessment, what should be done over the short and medium term? Over the longer term, I imagine that we will focus on training, which has been deficient because of underinvestment over the past 30 years. We need people to overcome these issues.

In the short term, what are the most important measures to take? At the end of your response, please tell me if you would support a summit on health care funding.

[Dr. Gilles Soulez]

Your question is a very broad one. I will focus on medical imaging, our field of expertise.

Overall, two urgent needs must be addressed quickly. First of all, the working conditions of our radiology technologists must be improved to ensure their retention. This is a really important piece because there is a shortage of technologists. Therefore, a retention strategy is required immediately. The profession is somewhat undervalued.

The other truly urgent need that can be addressed quickly is the integration of an information technology system. Currently, it makes no sense that a patient is still sending off a fax to book a medical imaging appointment. When you look at the patient treatment process, from the moment the doctor writes the prescription to the moment the patient books an appointment until the moment they undergo the examination, you see that several of the information systems used are not integrated. Serious priority needs to be given to system integration. In my opinion, it would spur huge savings in staffing and lessen the burden on staff.

The next, longer-term priority for investment is equipment. That investment would certainly provide us with more modern equipment than what we currently have. Concerning staffing, the focus needs to be on training. For example, in Saskatchewan, there is no training for technologists. In Quebec, we could do more training. We also have a lot of technologists who are leaving the field. Therefore, there needs to be improved training, greater value placed on technologists and efforts to retain them.

I think that if we focus on those components, we can improve performance, but, once again, I am a big proponent of integrated IT. That can help us a lot.

[Luc Thériault, Bloc, Montcalm, QC]

What about the summit on health care funding?

[Dr. Gilles Soulez]

I support it.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault.

We have Mr. Davies, please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

I've made it my mission in life that whenever anybody says health care is provincial jurisdiction, I must intercede. The Constitution does not even mention the words “health care” and does not give it to either the provinces or the federal government. In fact, the Supreme Court of Canada has said the following:

In sum, “health” is not a matter which is subject to specific constitutional assignment but instead is an amorphous topic which can be addressed by valid federal or provincial legislation, depending in the circumstances of each case on the nature or scope of the health problem in question.

The only thing given to the provinces is the establishment and maintenance of hospitals. Of course, in 1967 we didn't even have universal health care.

The reason I point that out is I want to drill into something. It sounds to me that, as Ms. Silas said, we have to develop our homegrown talent here. That means more seats. It means more seats in nursing schools, medical schools, for technicians—everything.

Would the witnesses support a federal fund that was targeted to the provinces specifically for the purpose of expanding seats in professions? The province could determine where the scarcity is, but I'm referring to tied funding in that regard. I know that some people refuse any kind of tied aid from the federal government; I don't.

Is that one way to get more seats in these schools to create the bodies we need?

[Linda Silas]

I totally agree, Mr. Davies.

We need support from the federal government, and we need support from committees like yours not to throw in the towel on our universal public health care system. There are close to a million health care workers who have worked their hardest and their best over the last two years, and the worst thing they could hear right now is, “We're throwing in the towel, and we're going to privatize the whole thing to make a few very rich.”

Help us educate more. Help us improve the working conditions. That will help and reduce all the wait times. We know how to do it; we just need help.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Cloutier, is that something that we should consider doing—targeted federal funding conditional upon provinces using that funding to create more positions?

[Paul-Émile Cloutier]

I totally agree with the position that Ms. Silas pointed out to you. I think that would be a way to address a component of the problem.

My biggest fear is that you have a number of stakeholders here who all have interests with their stakeholders. I think it would be totally wrong, especially at this juncture, to do something that would only address certain components of the health care system when in fact I think that what we need to do as citizens and as governments is to start to rethink what kind of health care system we want and need for Canadians post-COVID.

COVID has given us a number of lessons. We weren't prepared, and we need to prepare for the next virus that might come over to our place. I think that reflection has to be global. It can't be just about nurses. It can't be just about schools. It can't be just about funding. You have to look at the system as a whole, and that's why I come back to Mr. Thériault's comment.

Yes, I think there needs to be a dialogue at the federal and provincial levels, including some of the stakeholders around this table, to try to explain what's happening and to try to find a solution that will be acceptable for all Canadians.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Cloutier and Mr. Davies.

Next is Mr. Lake, please, for five minutes.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

That's a good segue into my line of questioning.

Mr. Cloutier, that was in our platform. We talked about that in the election campaign, coming together within the first 100 days.

I listened with interest to Mr. Soulez talk about technology and innovation, and come back to it time and time again. I talked about the cost of the health care system and the fact that all of the parties agree that we need more investment in terms of the transfers. I want to see how we can get more efficient with the money that we're spending right now.

I have a very specific question for each of the witnesses, maybe starting with Mr. Cloutier and Dr. Smart.

What innovations in terms of either technology or structure would result in...? I'm not talking about spending more money. It might be a little bit more money, but what innovations would result in more productivity per hour of work for the folks that you represent?

[Paul-Émile Cloutier]

Dr. Smart, do you want to go first?

[Dr. Katharine Smart]

I think there are several aspects that are challenging. We're talking about increasing productivity on a backdrop of people who are incredibly burnt out and already working really extensive hours in conditions that are very challenging to sustain.

You've heard from Ms. Silas about nurses being mandated overtime. It's very common in medicine to work without a break for 24 to 36 hours in acute care settings, which is really shocking in this day and age. We have family physicians providing care throughout the day and then spending hours and hours at home due to the administrative burden now of health care delivery, after hours and in unpaid ways.

When we're talking about efficiencies, we need to recognize that right now our system really puts a lot of burden on individual practitioners to overcome a lot of the system's issues that make the delivery of care challenging, and those things need to be addressed.

Again, it comes back to what Dr. Cloutier was saying about integrated planning. We can't solve any of these issues as individual practitioners or at individual levels of government. We really need integrated care plans to look at what are our health human resources and how we deploy them in a way to meet the needs of Canadians. How do we allow everyone to be at their full scope of practice so that we do get those efficiencies in the system.

I don't think it's a question that any of us can answer in our own silo. We really need to come together, look at what the barriers are, what the challenges are and then come together with actual solutions.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Mr. Cloutier, do you want to weigh in? Ms. Silas can answer afterward.

[Paul-Émile Cloutier]

I totally support what Dr. Smart said. When we speak about integration, it's integration that includes home care and long-term care. We saw during COVID that long-term care was like the poor cousin of the system, and it was just left there on its own.

The integration has to be primary care, acute care, long-term care and home care. It's starting. People realize that the system is wrong in the way it was structured, and that now is the time to have that reflection and dialogue as to how we integrate all the components of the health care system to make it an excellent system for Canadians.

[Linda Silas]

I totally agree with the previous two speakers, but also Dr. Soulez, who talked about integration. For the last two years, I haven't seen my primary health care provider. Everything's been virtual, either on the phone or on Zoom, so we need to expand that and we need to make it safe. That's an area where we'll all have to be at the same table from scope of practice, integration and the virtual world of health care.

Let's think about it as innovation and not degrading the health care services we give to Canadians currently.

[Paul-Émile Cloutier]

If I may, I like the innovation, I like the virtual care, but in that equation we also have to examine what the risks are. If we don't examine the risks, we'll never know if what we're putting forward in terms of innovation is actually going to be helpful and that we're going to have positive outcomes. That has to be part of the equation.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Lake.

The last round of questions will come from Mr. van Koeverden, please, for five minutes.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much, Mr. Chair.

I'd like to thank all of our witnesses today for their testimony, their experience and their efforts over the course of these very challenging last two years. This has been a very productive meeting, and I'm really grateful for all of the wonderful testimony.

My first question is for Ms. Silas. It relates to the way the government has demonstrated a practical approach to partnering with provinces and territories. It's relevant to consider how well our child care agreements have gone over the course of the last couple of years. Maybe this presents a model for potential future investment partnerships with provinces to provide targeted support in certain areas.

I'd like to hear your reflections on how we might invest in and partner with provinces and territories in strategic ways that would improve the quality of care and potentially result in the hiring of more nurses, nurse practitioners, physicians' assistants and doctors. What are your reflections on how the federal government can partner with provinces and territories to increase that workforce participation?

[Linda Silas]

I mentioned earlier the 2004 health accord. All the premiers, the prime minister and health ministers got together and signed an agreement for 10 years. I've worked with many premiers over the years—almost all of them—and if you show them the money, they will make changes. That's what we're seeing for child care. It's “What kind of money” and then there are standards.

That's what I expect we will see with long-term care. It will be, “Show me the money” and then we'll get the standards. We need to do it with mental health. We need to do it with our acute care sector. In our acute care sector right now, the crisis is the health human resource crisis. If we don't fix that, we won't have anything to worry about, because we won't have a system.

You heard from all the stakeholders here. We're calling for an agency of experts with the proper data and the proper funding for strategies to help us to do our jobs.

The worst thing I hear from nurses almost on a daily basis is, “I go into work every day and I know I'm not able to provide the care I should be providing. The sad thing is, I know I'm going back in tomorrow to do the exact same thing.” We need to stop that. We need to give them hope. I have trust in all of you that this is what will happen. You will give them hope with an amazing report from this committee, just like you did in 2019 on violence in health care. It was the best report.

Now we need to work together and fix it.