moved:
That, in the opinion of the House, the government should encourage and assist provincial and territorial governments, the medical community and other groups to lessen the burden on Canada's health care system through: (a) an increased adoption of technological developments; (b) a better recognition of the changing roles of health care professionals and the needs of Canadians; and (c) a greater focus on strategies for healthy living and injury prevention.
Madam Speaker, I am very pleased to rise in the House to speak to my private member's motion. It is a lengthy motion but it is a very important motion.
The purpose of this motion is to continue a very important conversation regarding our health care system. I would like to focus this conversation on three areas which have significant potential to lessen the financial burden on government and, more important, to improve the health of Canadians. These areas include: an increased adoption of technological developments; a better recognition of the changing roles of health care professionals and the needs of Canadians; and finally, a greater focus on strategies for health living and injury prevention.
Surveys currently indicate that Canada ranks health care as the second most important area of concern after the economy. They also take note when international benchmarking studies consistently report that our Canadian health care system's comparative performance is not ranked anywhere near the top in the OECD. I believe it is imperative for the government to reflect on what changes we can make while respecting our unique history and context.
This motion is about promoting a discussion on the appropriate role of the federal government as it relates to our health care system. It is about acknowledging that our needs have changed since the 1980s. It is about recognizing the worrisome, unsustainable, ever-increasing cost of our health care system on provincial and federal budgets, soon to be 50% and growing in most provinces and territories.
The Kirby report, the Health Council of Canada, the Canadian Medical Association and the Canadian Nurses Association, to name just a few, have scrutinized our system over the last few years and what has emerged is a remarkable consensus. An improved system is possible without compromising the founding principles of our Canada Health Act, such as universal access and sustainability. It will require transformational change with the patient's interests placed at the centre. It will require leadership, commitment and partnership from all stakeholders in the system.
I want to say unequivocally that this motion is not about two tier medicine or amending the principles of the Canada Health Act. It is not about interfering in the constitutional jurisdiction of the provinces and territories. It is about our responsibility under the Canada Health Act to encourage and to assist in providing the best system possible for Canadians.
As a brief aside, I personally believe that someday we should engage in a separate discussion regarding the Canada Health Act's very narrow definition of the continuum of care which currently focuses on physicians and medically necessary procedures in a hospital setting. Over time, as the amount of health services delivered outside these institutions and in the community has increased, the Canada Health Act has diminished with respect to ensuring coverage. This will result in an uneven system in terms of the continuum of care across the country. Perhaps we need to reflect on what basket of services should be included and excluded but that is a discussion for another day.
Health care needs are changing. The days of acute episodic care that typically required intervention by a physician or short-term support in hospital have changed forever. Young children with measles, ear infections and broken arms no longer predominate the practice of a physician. They are now faced with daily complex medical conditions requiring frequent long-term support, expensive medication and regular diagnostic monitoring.
Dr. Ross Reid, a prominent Kamloops physician, said:
We know the absolute number of patients is increasing as the population continues to grow and age. Elderly people need more surgery than young people. This holds true for all health services; persons 85 or older require 3 times the acute care, 12 times the community care, and 25 times the residential care of the rest of the population.
Chronic disease is now the principle cause of disability, the major reason for seeking health care and accounts for 70% of all health care expenditures. Although the aging population has contributed to these increases, the prevalence of chronic disease has risen in virtually every age group. Chronic diseases create large adverse, and underappreciated, economic effects on families, communities and countries. It is estimated that Canada stands to lose $9 billion in national income over the next 10 years from premature deaths due to heart disease, stroke and diabetes.
Our expectations of our health system have risen dramatically. Again, using Dr. Ross's examples, I take the case of Terry and his grandfather. When Terry's grandfather developed arthritis in the hip in the 1960s, he bought a cane and spent a lot of time watching TV. When Terry developed the same condition last year, he was scheduled for a hip replacement operation so he could continue to downhill ski.
In another example in the 1970s, 60 years of age was pegged as the upper age for consideration of coronary artery bypass surgery. In the case of Lucas, he has a good quality of life and last year he was successfully operated on at the age of 89. This is not to say that Terry and Lucas should not have been treated, just that the treatment options that Canadians are pursuing today represent a significant and costly change in practice.
How do we deal with this emerging reality? As noted by the Canadian Medical Association, over the last number of years we have demonstrated improvements in quality and access to care without a dramatic change in costs. However, these stories often take the form of time limited pilot projects that have been applied in isolated programs and usually have not been adopted on a system-wide basis. We have yet to achieve the tipping point and this is especially true in the case of technological developments.
What could our health care system look like in 10 years with continued committed focus on an increased adoption of technological developments, better recognition of the changing rules of health care professionals and the needs of Canadians and, finally, a greater focus on strategies for healthy living and injury prevention?
The following are some examples of what health care might look like in a decade from now.
Jane is a 70-year-old patient with congestive heart failure. She has always lived in rural Canada and wants to continue to live near her family and friends. The nearest health facility is 100 kilometres away but the community now has broadband access. Each morning she connects to her small home monitoring machine that measures a number of her symptoms. The results are transmitted to her health care team and are monitored by a nurse with special expertise in congestive heart failure. Jane also receives direct feedback from the equipment on her results and understands the warning signs and the actions she must take. She has become increasingly comfortable managing her condition at home, deteriorations are dealt with rapidly and expertise is only a phone call away.
Since Jane started on this program, her hospital admissions have decreased dramatically and her quality of life has markedly improved. This scenario is not a fantasy but a current reality of care in the Kootenays. A recent evaluation of the program has shown significant improvement in both hospital stay and quality of life. This pilot initiative was funded by Health Infoway Canada and in the 2010 budget we have included $500 million so we have continued support for the implementation of the e-health strategy in Canada. This will be part of the many keys to our future sustainability.
In another example, Jim was diagnosed with a mental health illness in his early 20s. Although usually well controlled by his medication, there are times when he neglects to take his pills and he can quickly spiral downward. His primary care team is well-coordinated and includes a mental health clinician, dietician and family practice physician. The team also recently formalized a shared care relationship with a psychiatrist. There is one health record which is electronic and shared among all the practitioners. Jim also has access to his own health record through a secured Internet connection. The mental health clinician routinely supports Jim and is able to quickly identify when his mental health status is slipping and respond accordingly. Jim, therefore, has been able to maintain his job and home which contrasts dramatically with others with the same condition who do not benefit from this coordinated care.
A strong primary health care system, as illustrated in these examples, has been consistently associated with improved health outcomes and system performance at a national level. Seminal research by Dr. Barbara Starfield from John Hopkins University has effectively proven this link and also provided very interesting international comparisons. Using a team concept for primary care provision, we can dramatically reduce the burden on primary care physicians and improve outcomes for patients.
In addition, electronic patient records are imperative for proactive care of chronic disease. Patients and their families can and should be more fully engaged through access to their personal health records. As patients become proficient at understanding their conditions, including interpreting lab results, the concept of self-managed care will start to become the norm. Work by Dr. Kate Lorig, professor at Stanford University, has demonstrated the importance of patients and their families developing skills to become a full partner in their own team.
Across Canada, we are taking important steps on an improved primary care system and that work was significantly kick-started by the federal government's primary health care transition fund, but again, we have not yet embedded this within our health care system. Work done to date is best described as tinkering at the edges.
National Nursing Week is an opportune time to highlight one of the newest health care providers in our system, the nurse practitioner. Nurse practitioners are nurses who are able to provide a full range of primary care support. As increasing numbers of nurse practitioners enter our health care system, there are structural challenges around how to best integrate their skills into our system. A number of my own family members have a nurse practitioner supporting their health care delivery and have benefited from the unique approach to primary care service.
As everyone knows, many communities have a shortage of family physicians. In spite of this need, there is a limited mechanism to allow the nurse practitioner to provide additional support in these communities. Predominantly, this is provincial-territorial jurisdiction, but it must be noted that the evolution of the nurse practitioner is rooted in rural and remote aboriginal communities where we do have a responsibility. Canadians would benefit from a review of the role of nurse practitioners for groups we are responsible for, such as veterans, aboriginal communities, Correctional Service of Canada, and others.
Rooted in historical necessity, allied professionals have provided care where there have been limited resources. For example, in our military the physician assistant has assumed a very important role as a team member in the provision of care for our men and women in uniform. In another case, the community health representative provides essential culturally appropriate services on first nation reserves. Further, dental therapists provide a hybrid of hygienist service, basic dental care and community prevention interventions.
Clearly, our federal government has a long tradition of creative uses of para-professionals in order to meet their community needs. I believe that these lessons have some value for the provincial and territorial governments as we look at the looming health human resource shortage.
In addition, pharmacists, dieticians, respiratory therapists and physiotherapists all provide great value to patient care. We must continue to be creative and flexible using their skill sets to best meet the needs of the patients and the communities they serve.
It is interesting to note that the health committee has reviewed health human resources in great depth over the last year and we look forward to tabling a report prior to rising in June.
The final area but certainly not the least important is a greater focus on strategies for healthy living and injury prevention.
At least 80% of premature heart disease, stroke and type 2 diabetes and 40% of cancer could be prevented through healthy diet, regular exercise and avoidance of tobacco products. Cost-effective interventions exist. The most successful strategies have employed a range of population-wide approaches, combined with interventions for individuals.
As stated by Dr. Andrew Pipe from the University of Ottawa Heart Institute at the recent health committee meeting, we need to make healthy living the easy choice. This is important whether it relates to diet, exercise or choices around tobacco. Through regulatory mechanisms, transparency and public education, it must be easy to make the right choice. In Canada, we are making good progress but we are not there quite yet.
Turning to injury prevention, as included in our March 2010 Speech from the Throne, we have made the commitment as follows: to prevent accidents that harm our children and our youth, our government will work in partnership with non-governmental organizations to launch a national strategy on childhood injury prevention. This pledge was greeted positively by all who understand the tragedy and the cost of preventable injury.
In conclusion, I have discussed some important measures in progress and also provided the context and imperative for serious discussion regarding the future of health care in Canada. This general discussion in the House is particularly timely with the expiry in 2014 of the accord reached at the first ministers' meeting on health care in 2004.
I submit that my three areas of focus have an important role to play in the future of a sustainable health care system. Fifteen minutes is a very short time to give a full account of these issues that are pertinent to this complex discussion but, again, this is part of an important conversation for Canadians. I hope I have the support of all members in the House for this motion.
