Human Resources Committee on March 28th, 2022

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

The question goes to whoever would like to answer.

[The Chair, Liberal, Bobby Morrissey]

Yes, she did not direct it to anybody in particular.

Mr. Villeneuve, and then Dr. Smart.

[Michael Villeneuve]

Chair, yes, I'll just make a very quick comment.

Although the CNA does not have an official position on the federal and provincial split, I think it would be safe to say that we would support a return to a better balance for the provinces and territories, but I think we would also say that that return of a higher per cent being paid federally, in the sense unconditionally, could also be accompanied, as it has been in the past in accords.... And I know FPT health accords chill the blood of some people, but they worked in some places to provide change.

So I don't see that it has to be one or the other, but rather, could you not have both?

Thank you, Chair.

[Dr. Katharine Smart]

I can also comment.

We certainly support and recognize that there's a need for the Canadian health care transfer dollars to increase as well, and that predictability and sustainability of funding is important. However, we do also support the idea of targeted funding for the reasons I mentioned earlier, which is to improve collaboration at the federal-provincial levels to allow us to scale up things that are working in certain parts of the country into other parts of the country, and to create accountability for where those dollars are going, to make sure that they're actually achieving the outcomes that Canadians want to see in the system.

[James Janeiro]

Mr. Chair, if I could also add, certainly the Canadian Centre for Caregiving Excellence hasn't weighed in on this particular issue quite yet, but I will say that, similar to Monsieur Villeneuve's comments about the federal spending power buying change in the system, our submission is that the core issue among paid caregiving is wages. It's difficult to address wages without some conditionality, some strings, or however you'd like to put it, from the federal government as these funds transfer, to make sure that particular problem is addressed, which has knock-on consequences for the overall quality of the system.

Thank you.

[The Chair, Liberal, Bobby Morrissey]

You have 20 seconds, Madam Chabot.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

I think that wages are a provincial matter, and they have their own employment policies and their own labour policies and legislation. In Quebec, the Pay Equity Act has been in place for 25 years. I therefore don't think that compensation is a federal matter.

[The Chair, Liberal, Bobby Morrissey]

We've run out of time.

If somebody wants to respond in writing to that, they can.

We will now move to Madam Zarrillo for six minutes.

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Thank you, Mr. Chair.

It's certainly been wonderful to hear from the witnesses today and at the last few meetings. I think what's clear, and one of the reasons I was motivated to see this study happen, is that there is systematic and systemic gender discrimination as well as discrimination towards immigrant women, more so than for others. This is the root of the problem.

We have an opportunity to expose it here in this study and to set conditions for those working in the care economy, and also to elevate the reality that this is part of the economy which underpins every other part of the economy. So I really appreciate the comments today.

My first question is for Dr. Smart about the asking and asking that has happened and the federal government's not necessarily listening. Are there any thoughts or conversations around why your organization might feel the federal government hasn't been listening?

[Dr. Katharine Smart]

I think right now where we find ourselves is feeling that people are listening and hearing our concerns. We certainly appreciate the opportunity to present to you today and at other parliamentary committees, as well as in other contexts.

I think the concern and the challenge you're hearing from all of us is how we can move from laying these problems out to the actions and solutions to solve them.

I think, as Mr. Villeneuve said, these are not necessarily new issues. We've been talking about the same things now for a long time. The same issues keep coming up. If anything, I think the pandemic has made the issues more acute. It's brought them more to the awareness of the average Canadian at home, who's been hearing about this every day.

I think the challenge our organizations are finding is how to move from having our concerns heard and the opportunity to share what we're finding and learning on the ground, [Technical difficulty—Editor] to help us solve these problems. I think where we find ourselves today is really needing to move to action.

And our concern, I believe, is that if we stay with the status quo, we're very close to having Canadians not being able to access care at all in different contexts. I think that's extremely worrisome for the future.

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Thank you so much.

I agree. Just on that topic of actions and solutions, my next question is for Mr. Villeneuve on the studies he referenced that were done back in the early 2000s.

Mr. Chair, I wonder if we could have those studies come to the floor and be part of the information for the analysts.

But I did want to ask Mr. Villeneuve how we make these studies, these insights and this information, actionable. What needs to happen?

[Michael Villeneuve]

I think we're actually at a strange point of opportunity, Mr. Chair, just because of COVID-19.

We've talked about this, as I said, for 20 years or more. We predicted the shortages of 60,000 this year, and here we are.

But COVID has accelerated what would have been a more protracted period of retirements of older nurses. I can tell you, for example, that in my time serving as a patient care manager at Sunnybrook in Toronto in the areas of neuro-ICU and neuro-surgery and so on, you could often find ways to make conditions a little easier for older nurses by reducing their hours and giving them different jobs and so on to keep them longer. We've had this compressed, and they're now saying they're not going to do that any more.

What I would say to the member is that I feel, for the first time in a long time, that people are hearing us. I think the crisis at points of care.... For example, at a Toronto, 905-area hospital that I won't mention, staffing was all set up for next week. This was a couple of months ago. I came in Monday morning and 25% of the nurses were off—25%. So when you become at material risk of not being able to actually run an organization, it gets people's attention.

I'm not giving a very good answer to the member, but I hope that the emergency nature of it now will propel us forward into some actual action, because the solutions aren't new.

Thank you.

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Thank you for that. I agree with you that the critical nature of it is forcing a response. Hopefully we can do a little bit more planning as well as respond to the critical....

I want to go back to Dr. Smart. I've heard over years—I'm talking about a decade, at least—that it's the provincial professional organizations that limit the number of doctors and health care workers that can come through. I'm just wondering if there's any truth to that, that the professional organizations in health care are limiting the number of seats at universities to get people graduated and these foreign credentials recognized.

[Dr. Katharine Smart]

I think in the past there have been some limitations at the government level in restricting billing numbers for physicians in order to try to direct the health workforce into certain locations. To my knowledge, I don't believe that we see the provincial and territorial medical associations at all limiting numbers of training spots, either at medical school or at the post-graduate level.

What we do have is a lack of coordination between the outputs that we're trying to achieve in terms of practising physicians, in primary care specialities as well as other specialty areas, and post-graduate training opportunities. Again, this also speaks to the issue also with credentialing and licensing. This is another reason that we feel there is a strong opportunity for a pan-Canadian licence.

When you look at IMGs and their ability to be credentialed and then brought into the Canadian system, you see that it looks different in every province and territory, and the cost associated with that is significant. It is a definite barrier to our being able to mobilize those physicians into our workforce.

We believe that when we start talking about things like decreasing those regulatory barriers and looking at things like a national licence, it would allow us to remove some of that administrative burden. It would also give the federal government an opportunity to fund and support those physicians to be credentialed, trained and brought into our system. Those are examples of solutions, I think, where the federal government definitely has levers it could pull that would have a strong outcome.

We also believe that by creating a pan-Canadian human health resource strategy, we're then able to go to the medical school and post-graduate training level and make sure that those things are aligning to create the outputs of both numbers and types of physicians needed in the system.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Dr. Smart and Madame Zarrillo.

Now, we go to Mr. Liepert for five minutes.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Thank you, Chair.

Thanks to the witnesses for being here today.

Dr. Smart, I appreciated all of your comments throughout the pandemic. Like many other Canadians, I was sitting in my living room watching way too much TV, but your comments were well voiced during the pandemic.

I want to start my comments, and then ask questions ultimately. I'm probably going to ask all three witnesses to comment at the end.

As a bit of background, I had the privilege of serving as health minister in Alberta from 2008 to 2009. One of my first observations was that health care had multiple structural problems. We were already spending 50% of our provincial budget on health care, and what has happened since then, as you have described today, Dr. Smart, similar to being on life support and a crisis. One of the first things I did when I was health minister was to fire 12 regional health boards, three other boards and to create the Alberta Health Services Board, which runs all of the health system in Alberta today very successfully.

For too long, in my view, politicians have simply buried their heads in the sand and said they can't look at making changes to how we do health care in this country. What do we do as politicians? Well, we do another study, like we're doing here today.

I can just about tell you what's going to come out of this study, with all due respect to all of the witnesses who have appeared before us. I know Mr. Long doesn't liked to be called part of a “coalition”, so I'll call it an “NDP-Liberal marriage” that happened last week. I can predict what this report's going to look like when we table it, and there will be another report—

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Mr. Chair, I'm going to ask for a point of order.

[The Chair, Liberal, Bobby Morrissey]

On a point of order, Madam Zarrillo.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

This is not going to cut into my time, I hope.

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Mr. Chair, I'm concerned about parliamentary language here. We're talking about a very gendered, discriminatory reality for many women over the years, and the member's going to use words like “marriage”.

It really is non-parliamentarian to try to belittle women and the importance of the work they do by using ridiculous terms like “marriage” in regard to government.

This is an important study. It's important to women and people who need care in this country. It's unparliamentary.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madame Zarrillo.

We're now moving into debate.

Mr. Liepert, you have the floor.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Well then, why don't we call it a “coalition”—which it really is anyway—if that will make our NDP member a little happier?

We have, in my view, a structural problem in health care. Until we address that, we could commit double the money that we're committing today and it'll simply change nothing. We won't go off life-support and we won't get out of the crisis.

Here are some of the structural problems. Dr. Smart, I'd appreciate your comments on.

We have an outdated model of how we pay doctors. We have doctors doing work that clearly other professions could do, but that's the way they get paid. It's not the doctors' fault. Again, that's the elected people's fault.

Secondly, we have professions within health care that are not prepared to change their scope of practice. A lot of things could be done in health care at different levels, but professions are pretty strident in what they stand for.

Finally, we have public sector unions that wield far too much power in the public health care system.

I'd be interested in comments from all three of our guests today on whether money is the solution or whether we have a structural problem within health care, which, if we don't address at the federal level.... It's not a case of not getting off life-support; it will crash and burn.

[The Chair, Liberal, Bobby Morrissey]

Okay, he's directed it to all three.

You have a minute and 20 seconds left to respond.

[Dr. Katharine Smart]

I can start.

Thank you, Chair, for the question.

I certainly agree, and the Canadian Medical Association agrees, that we have both issues at hand. There's no question that there are many structural issues within the health care system, including outdated payment models, outdated structural models and outdated ways of trying to provide primary care in a traditional, siloed, fee-for-service model. These aren't serving Canadians by any means and certainly aren't serving or attracting newer physicians into that style of practice.

That's why you've heard us advocating for integrated, team-based care and the creation of medical homes for patients where they're able to access a variety of health care professionals to address their needs. It's absolutely true that our current systems don't necessary allow for or incentivize that type of care. It often leads to unnecessary visits and unnecessary things in the system that aren't benefiting patients.

It's also why you have heard us speak to the idea of scaling virtual care, as that's another tool that could be used to allow patients better access. It would also allow more collaboration amongst health care professionals to make sure that patients are really seeing the right person at the right time.

We do also agree that just by...more dollars into a system that's not functioning well, we're not going to have the level of accountability and the deliverables that Canadians deserve. However, it is also clear that the dollars going into health care are declining. That's against an aging population with more complex health care needs.

We certainly agree that we need to reimagine the system. We need to look deeply at what these structural barriers are, understand how we can work in a more integrated and team-based environment and how we can have people working within their full scopes of practice to benefit Canadians. At the same time, we need to be increasing those investments so that the health care system is sustainable.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Dr. Smart, you are just in time.

Mr. Liepert, thank you for your question.

Now we go to to Madame Ferrada for five minutes.