:
Time and time again, I think we have learned that trying to develop work plans by motion is not a good way to go, and we need to be able to have a constructive discussion about how we would go forward.
I think this motion is totally inadequate to allow the supervision of this outbreak in a comprehensive way. We need to find a way that should the level rise to level 5, level 6 on a weekend, we can have updates. We need a way of going forward.
I hope the House leaders will make a decision about that, but the idea that this motion moves us any further forward to an active supervision of this outbreak is not good enough, I think, in terms of the Liberal position. We don't need a motion to call public health officials, but we also have been, I think up until now, heartened by the fact that when I spoke to the minister on Sunday and asked for a briefing on Monday, we got it.
We then spent two hours this morning trying to get an update, a briefing for today, and finally got it. I don't want to spend two hours of every day trying to negotiate with the minister's office about whether we get a briefing or not. We want an ongoing way that we can do this so that we can know on the weekend if there's a way that members....
Madam Chair, today in the briefing what we heard from Dr. Grondin was so important, in terms of just how we as parliamentarians can accidentally use the words “travel advisory” instead of a “travel warning”. These kinds of things make it hugely important that we all be on the same page at all times. An extra meeting here or there is not going to do the job of having parliamentarians seriously in the loop at every decision taken.
I was told this morning by the minister's office that nothing had changed since the briefing yesterday and we didn't need one. In fact, the WHO had raised the level up to level 4. In fact, Canada had issued a travel warning, and therefore we had to fight back.
I do not want to spend my time as a parliamentarian fighting with the minister's office to get briefings. I want something formal and I want it ongoing, and this motion goes nowhere near what we need.
:
My name is Linda Silas. I'm the president of the Canadian Federation of Nurses Unions and a proud nurse from New Brunswick. We represent nine nurses' unions across the country, and we have excellent working relationships with the Fédération interprofessionnelle de la santé du Québec. As you know, over 80% of nurses in Canada are unionized. We thank the Standing Committee on Health for the opportunity to share our views.
I realized this morning when preparing my notes that I've been in this job for six years and have presented more or less the same recommendations and more or less the same data on a yearly basis to more or less the same committee or committee members. The federal government itself has spent millions on HHR sector studies. The evidence is clear: there is a nursing shortage and it's not getting any better. Nurses across the continuum of care, in hospitals, long-term care, home care, and in our communities, are living the symptoms of the shortage every day, and we need action on a long-term basis.
CFNU's first recommendation is the creation of a national observatory on HHR. Provinces are spending health care dollars competing with each other to attract nurses and other health care workers from one jurisdiction to the other. There's not one jurisdiction in Canada that's currently producing a nursing surplus. The existing federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources would need to have its mandate expanded and membership expanded to include active participation from stakeholders in order to have realistic and attainable goals. Or maybe a better idea is to start afresh with the national observatory on HHR that stakeholders have been requesting for a number of years.
We stress again the engagement of stakeholders, the only way to ensure appropriate and accountable actions, targets, and timeframes. We have to remind ourselves once again that health care is not only a government issue, it's everyone's issue.
Our second recommendation is to continue and increase the data collection and reporting on HHR. This role must be filled by the federal government. Repeating the national survey of work and health of nurses conducted by CIHI and Statistics Canada and expanding it to other health care professionals is a must. It will also measure the impact of change in policy and practice from the perspective of the workforce.
Third, fund innovative projects related to retention and recruitment in HHR in Canada and across the continuum of care. Forty-nine per cent of nurses retire before the age of 65. That's compared to 43% of any other field. We cannot afford to lose this experience in patient care. For example, CFNU receives support from HRSDC for a project in Cape Breton to provide an opportunity for nurses to upgrade their skill set and meet a serious nursing shortage in critical care while remaining in the rural region. We also had a project in Saskatchewan where valued, experienced, and seasoned nurses were allowed to work on a mentorship program. This year we received funding from Health Canada for nine pilot projects to apply evidence-based retention recruitment strategies. This is a start.
This kind of innovation in the workplace, supported by macro-level resources, will ensure retention of a skilled workforce. How often do you hear and see federal funding applied and evaluated directly in the workplace? This is the only way to make real and sustainable change.
Of course we have to talk about child care. Most of our population are women and child-bearing, so we have a fourth recommendation on supporting the creation of a child care program that addresses the need for shift work.
Our fifth and last recommendation is the creation of a federal HHR fund to support education and lifelong learning. As CFNU mentioned before, the federal government can use the EI program to provide educational support to health care workers entering nursing and for nurses to expand their scope of practice through job laddering and specialty training. This would complement support given to the building trades apprenticeship program that already exists under EI. These strategies would help attract more aboriginal Canadians to the health care workforce and would help underserved communities, supporting local residents to enter and progress in the health care profession, and would bring best investments to build sustainable services in those regions.
As a conclusion, what is the price of inaction? A high workload leads to a high turnover rate, and turnover is really expensive in our profession. It can be up to $64,000 per nurse. A shortage means the present workforce is doing a large amount of overtime, a costly solution for an inadequate supply of nurses. In 2005 it was 18 million hours of overtime, 144% more overtime than was worked in 1987.
Currently, CFNU is updating this study, but the preliminary reports are suggesting that the numbers are even worse. Let's remember that 66% of young nurses are showing signs of burn-out.
The extensive and growing body of research showing the relationship between nurse staffing levels and patient outcomes should be the most compelling reason for government and policy-makers to address the nursing shortage. But using the shortage as an excuse to bring in less skilled, less knowledgeable workers—similar to what the Canadian Blood Services is trying to do today—is plainly dangerous and should not be supported by any policy-maker concerned about public policy.
We thank the committee for undertaking this important study. Hopefully, we will meet again next year to provide you with a progress report and not a whole bunch of further recommendations. This problem is ongoing, and we all need to stay very focused on this issue.
Merci beaucoup.
Good afternoon, everyone.
I am Dr. Robert Ouellet. I'm a radiologist from Laval, Quebec, at least when my duties as president of the Canadian Medical Association allow me.
It is essential to address the labour shortage in the health sector in Canada if we want to transform the Canadian health system into a truly patient-centred system. The research conducted as part of the Canadian Medical Association's health care transformation initiative shows that the European countries that have universal access and do not have significant wait times all have a higher physician-to-population ratio than ours.
[English]
During the 2008 federal election campaign, four of the five parties represented in the House of Commons heard the CMA's warning about serious shortages in the health care workforce. They all promised to act. We haven't seen action on that front yet.
The CMA is here today to present a plan of action in three specific areas: capacity, the retention of Canadian physicians, and innovation. In our brief, you'll find 12 practical recommendations within the jurisdiction of the federal government.
Canada lags behind other countries in our capacity to educate and train physicians.
[Translation]
Currently, between four and five million Canadians do not have a family doctor. The problem doesn't just affect the rural areas. We're talking about places like Barrie, Ontario, as the honourable member from that riding very well knows. The same problem exists in Quebec.
More than one-half of Canadian physicians are over 55 years of age, and I am one of them. Many of them will be retiring soon or will be reducing their workload. Most are no longer accepting new patients.
At the same time, medical progress and better living habits are enabling Canadians to live better and longer, which further increases demand for health professionals. As you know, chronic diseases are increasingly a burden.
[English]
But with better coordination among jurisdictions to allow HHR planning on a national scale, we can respond to these challenges. Canada's doctors and other health professionals are ready to assist policy-makers in their planning and coordination to better meet the health care needs of Canadians.
International medical graduates, or IMGs, also play a huge role in Canada's supply of doctors. Close to one-quarter of all physicians in Canada are IMGs, and the CMA fully supports bringing into practice the qualified IMGs already in Canada. However, poaching doctors from countries that cannot afford to lose them is not an acceptable solution to our physician shortage. Canada must strive for greater self-sufficiency in the education and training of physicians.
[Translation]
The Canadian Medical Association also believes that the same evaluation standards must be applied to foreign graduates as to the graduates of Canadian medical faculties. The CMA further recommends that greater funding be made available to the provinces so that they can offer mentoring programs to foreign graduates to enable them to obtain their licences.
[English]
It is also important to note that up to 1,500 Canadians are studying medicine abroad. Two-thirds of these homegrown IMGs want to come home to complete their post-graduate training. We must increase training opportunities so that we don't lose Canadians who have studied medicine to other countries. We must understand that Canada's teaching centres are bursting at the seams as they try to meet demand. This must be addressed.
[Translation]
Competition to attract physicians is raising a few challenges for us here in Canada and internationally. The new Agreement on Internal Trade within Canada and other agreements will ease the movement of health professionals from region to region, but could make it even more difficult to retain physicians in under-serviced areas. The international demand for medical staff has never been as great. Canada must continue to strive to retain the health professionals it has trained and to facilitate a return to Canada by physicians wishing to return and practise here.
[English]
While Canada must do more to increase both our supply and retention of HHR, we must also support innovation in order to better use existing health resources. Collaborative models of care and advances in information technology can help create a more efficient health care system that provides higher-quality care. In fact, new collaborative care initiatives are popping up across the country to the great benefit of patients.
[Translation]
Information technologies can help create a more efficient health system, but Canada lags far behind the other OECD countries in the adoption of electronic medical records. Recent investments in Canada Health Infoway will help, but an estimated $500 million should be invested to equip all points of care in the communities.
[English]
Canada's doctors believe we can build a health care system where all Canadians can get timely access to quality care services regardless of their ability to pay. To do this, we must shift our attitude and implement new strategies, new ideas, and new thinking. This is what the CMA's ongoing health care transformation project is all about.
[Translation]
A national health human resources strategy is the turning point for our efforts to build a patient-centred system. All we're lacking is action.
Thank you.
:
Thank you. Good afternoon. My name is Kaaren Neufeld and I am the president of the Canadian Nurses Association, which represents some 136,000 registered nurses and nurse practitioners across Canada. Thank you for the opportunity to present to you as you are studying health human resources.
The brief I'm presenting to you today is organized into three main areas. I want to talk about the RN shortage, health and safety in the workplace, and national-level HHR planning. However, first I want to acknowledge the federal government's commendable leadership so far in health human resources, particularly with regard to a number of issues: the health accord in 2000, the allocation of $85 million to the renewal of health human resources, the annual $20 million it committed to the national health human resource strategy in 2003, the creation of a 10-year plan in 2004, and the creation of the framework for collaborative pan-Canadian HHR planning.
However, challenges remain, as we all know. I will discuss the nursing shortage first.
In 2002, CNA used past workforce patterns to project a shortage of 78,000 registered nurses by 2011 and 113,000 RNs by 2016. Next month, CNA will release its new report on Canada's RN workforce, entitled Tested Solutions for Eliminating Canada's Registered Nurse Shortage. This report will estimate the number of nurses we'll need in clinical care in Canada from 2007 to 2022. We will use those numbers to estimate how far we'll fall short of those estimates.
More importantly, this time the report will highlight what we can do about the shortage by quantifying the impact of six specific policy scenarios that can reduce or even eliminate the shortage. One of the key solutions to the nursing crisis outlined in this report lies in more effective and efficient use of existing resources, including better use of technology, changing work processes, and addressing workplace issues that lead to absenteeism and turnover.
For example, one employer in Ottawa found that 30% of the work RNs were doing could be done by staff who did not have a registered nurse's skills or knowledge. The facility added support staff to complement its workforce of registered nurses and thereby reduced the time nurses were spending on non-nursing duties.
In light of the successes of this initiative and many others like it, the Canadian Nurses Association recommends that the government establish a formal mechanism or tool to promote the sharing and adoption of innovative yet practical solutions to the health workforce crisis.
Now I'd like to turn to the second point in this brief: the issue of workplace health and safety and its impact on health professionals. Four years ago, the national survey of the work and health of nurses ranked nursing as one of the sickest professions in Canada. Nurses' absenteeism due to illness and injury was 58% higher than the average found in the labour force overall. A similar study for physicians found that almost one-quarter of physicians had been depressed in the past year.
Those surveys were just a snapshot in time. We don't know if these trends have continued since then, and we don't know if the investments in workplaces have made a difference, so the Canadian Nurses Association recommends that the federal government fund an ongoing national survey of the work and health of nurses, and that the survey be expanded to include other health professionals as well. We also recommend that the government implement a national occupational health and safety strategy for the health workforce.
I come now to my third point, which is national-level planning in health human resources. Although provinces and territories are primarily responsible for health care deliveries, CNA and the Health Action Lobby believe that the health workforce is a national resource. Health professionals and students of health programs are mobile. The federal, provincial, and territorial governments themselves recognized this when they recently revised chapter 7 of the Agreement on Internal Trade. In addition, research shows that factors affecting the recruitment and retention of nurses do not differ greatly from one province or territory to another.
The federal government invested $12 million in six sector studies, including nurses, physicians, and pharmacists. They produced concrete strategies addressing the health workforce crisis. Unfortunately, very little action has been taken on these reports.
Similarly, federal, provincial, and territorial governments developed the framework for collaborative pan-Canadian HHR planning. Progress is slow, and CNA is concerned that implementation of the action plan is not receiving the attention and support it needs from governments.
The Canadian Nurses Association recommends that annual funding for the pan-Canadian HHR strategy continue for at least another decade and be increased to $40 million per year to support the activities identified in the action plan of the framework for collaborative pan-Canadian HHR planning.
We recommend that the federal government create a pan-Canadian HHR institute or observatory. The concept of an HHR institute was put forth by several of the sector studies that I mentioned a few moments ago, as well as by CMA and others.
Health human resources institutes and observatories have been implemented in Europe, Africa, Latin America, and the Caribbean. In Canada, the observatory would bring together researchers, governments, employers, health professionals, unions, and international organizations to monitor and analyze trends in health outcomes, health policy, and HHR to provide evidence-based advice to policy makers. It would also spread information about promising advances in HHR activities across the country and would coordinate HHR research.
In conclusion, we understand that these are difficult economic times, but having a healthy, stable, and sufficient supply of health professionals is necessary to keep Canadians healthy and productive.
CNA's upcoming report on the shortage of registered nurses in Canada will show that the shortage can be resolved, but it requires both political will and resources on the part of the federal government. CNA has invited all MPs to the release of this report on May 11, and we urge the committee to attend.
Thank you for your time today and for this opportunity for CNA to continue to work with the federal government on this important issue.
:
Thank you, Madam Chair, honourable members, and colleagues. It is a pleasure to appear in front of you today. My name is Andrew Padmos. I'm the CEO of the Royal College and a hematologist by training. I continue a small but very important clinical practice in hematology in Halifax, Nova Scotia, where I recently lived before moving to Ottawa.
The Royal College was created by a special act of Parliament in 1929 to ensure the highest standards for the training, evaluation, and practice of medical and surgical specialists. We now supervise the training and certification of 61 specialties and subspecialties and represent a population of 43,000 specialists out of the approximately 70,000 members of the medical workforce in Canada.
I would like to commend the work done by governments, health planners, and policy-makers at the federal level in addressing health human resources shortages. My colleagues have mentioned several specific projects. These have improved our understanding, but they have unfortunately not eliminated the shortages and the misdeployment of health human resources across this country. Many citizens, including members of our families and our circles, have suffered from these shortages on a daily basis.
Our analysis in our brief addresses five areas that the committee has identified as important. The first concerns the supply in the medical workforce. These comments are not confined to physicians, however. They are echoed in literally all of the health professions and consider all of the health care providers that make up our important resource in the health system.
Some particular factors make the issues more concerning for physician members of the workforce. Among them, we're aging at a rapid rate, and the number of our members in the medical workforce who have become age 50 or over is up 9.3% since the year 2000. Probably more important, in terms of the number of services provided, we know that the new members of the medical workforce have commitments to a better work-life balance that limit their productivity, and it is often said that for every retiring physician we need to find and train two replacements.
One of the things that is of particular concern and I think is relevant to today's news, the news that's not related to swine flu virus, is the concern over loss of capital in human health research. Our government has made small, incremental, and augmented changes to the health research funding that pale in comparison to the significant additional investment in other countries, particularly the U.K. and the U.S.A. Even today, President Obama of the United States announced a commitment of 3% or more of gross domestic product to the research and scientific agenda in that country, and this is important in retaining the best and the brightest of our physician workforce, our other health care providers, and our medical scientists.
Our recommendations resonate with those made by colleagues. We commend the federal government and recommend its further investment in training, education, and continuing professional development of medical and other health professionals. We would like to see the Conservative federal election campaign promise to invest additional millions of dollars a year for four years to create additional residency training spots in teaching hospitals. We suggest that commitment should be extended by a further 10 years.
We also recommend that the government expand and sustain Canada's investment in both biomedical and psycho-social research for the health system in order not only to improve health care but to retain leading health, scientific, and biomedical researchers who are otherwise going to follow investments made elsewhere and leave our country.
Anyone who has worked at the front lines of health care knows that it is truly a teamwork-based operation, and our members fully support that.
We commend federal-provincial-territorial initiatives to enhance interprofessional education and collaborative practice. We would also like to acknowledge that other health professionals need support so that their work can ensure that Canadians can access more and better specialty care.
For this, we recommend the federal government support the enhanced supply, deployment, and evaluation of such other health professionals as physician assistants and advanced clinical nurses, including nurse practitioners and clinical nurse specialists.
We follow our colleagues in the Canadian Medical Association in identifying internationally educated health professionals as a crucial component of the medical workforce and the health workforce. We suggest targeted funding to expand medical school capacity and postgraduate medical education positions to develop and augment the incorporation of international medical graduates into our practice.
We also identify that not all Canadians have the luxury of living in urban environments where sophisticated health care services are readily available. For northern, rural, or remote areas, we recommend the federal government study the feasibility of creating a special federal infrastructure fund to provide exceptional relief and assistance to rural and remote communities that lack, or are losing, adequate health services.
I'd also like to identify aboriginal peoples and other federal groups as worthy recipients of federal targeted funding. The funding should integrate the framework for aboriginal core competencies developed by the Indigenous Physicians Association of Canada and the Royal College of Physicians and Surgeons into medical curricula in medical schools across Canada. I'd also like to point out that we should have scholarship programs and we should recruit and place first nations, Inuit, and Métis health professionals in practice.
Last, I'd like to return to the recommendation that appears to be common among all groups. At the risk of identifying Madam Silas' concerns in a light fashion, a repetition of the same thing with no discernible result is a definition of insanity. However, I do hope that we're able to see progress on the idea of the federal government working with provinces to establish a pan-Canadian HHR observatory or institute to address the manifest gaps and deficiencies in data research and analysis and to disseminate knowledge about health outcomes, including those outcomes that relate to the amended Agreement on Internal Trade, which we feel will certainly have deleterious results on migration and distribution of health professionals in the short term.
Madam Chair, thank you for the opportunity to present to you today. We commend these recommendations to your committee.
Good afternoon, everyone, ladies and gentlemen, members of the Standing Committee on Health.
My name is Richard Valade. I am a doctor of chiropractic and the president of the Canadian Chiropractic Association. With me today I have Dr. Deborah Kopansky-Giles. She's a chiropractor on the staff of St. Michael's Hospital in Toronto. We thank you for the opportunity to be here today.
We in the chiropractic profession feel strongly that our services are not being properly utilized for the public good. Chiropractic has been rigorously evaluated by the scientific community so that we now have a solid body of evidence that chiropractic care is effective for neuromusculoskeletal disorders such as back pain, neck pain, and headaches. But it's not being used as much as it should be.
We are well aware that the delivery and administration of health care takes place primarily at the provincial and territorial levels. Provinces make decisions about what services their residents are offered. So we know that it's pointless to ask this committee to comment about decisions that are made provincially and territorially. Instead, we confine our remarks to those cases where federal resources are applied directly to health.
We feel that we can do much more to help people whose health services are paid directly from the federal purse. There are some obvious cases. First, the service provided to members of the Canadian Forces is inconsistent. Did you know that a soldier in Afghanistan cannot get any chiropractic care to relieve back or neck pain, but at the same time, back at home, members of his or her family have access to care for back and neck pain through the public service health care plan? It is regrettable that soldiers in the field do not have the choice of highly effective, non-invasive chiropractic care for their back and neck pain. Chiropractic is well established to provide prevention of injury and to relieve major and minor injury to muscles, nerves, and joints, and it is appropriate to those who serve in rocky, unpleasant, and harsh terrain. We feel there is much that we can do to make reasonable health services available in the places where our soldiers serve their country.
The chiropractic profession is represented by several officers currently serving in the Canadian Forces. Dr. Denis Tondreau and Dr. Lison Gagné both serve as active reservists. They are both fully prepared to offer their skills as doctors of chiropractic while on duty at no charge, and yet there is no precedent to allow them to do that. In the past, they have both used their skills to aid their colleagues in spite of there being no regulation to support their work in the forces. Dr. Tondreau served in Afghanistan in 2008 and was welcomed and supported by the medical chief of staff at the base for his chiropractic skills to treat his injured colleagues. However, he could not get his orders changed to reflect his service as a chiropractor. We think this type of situation needs to be rectified. In fact, we think that chiropractors should be in uniform and actively serving in the forces. However, it would be a step forward if service personnel even had reasonable access to chiropractic care, so they wouldn't be second-class citizens compared to their families in Canada.
Dr. Tondreau most recently was deployed to Sierra Leone in November 2008.
Dr. Gagné has been in the Canadian Reserve Force since 2007. During training, Dr. Gagné attempted to alleviate her colleagues' musculoskeletal ailments, an area in which chiropractic excels. However, she was met with hostility from her superior officer and was told not to use chiropractic skills to treat people, regardless of positive results. Most recently, Dr. Gagné trained in Mississippi in January 2009, and she awaits deployment overseas with hopes of utilizing her chiropractic skills for the benefit of her colleagues.
This system in the Department of National Defence is especially concerning when one looks at the RCMP, which has long recognized the value of chiropractic care. For some years, RCMP members have had 2.5 times as many acute care treatments available to them as the Canadian Forces makes available to its members at home here in Canada. The RCMP is currently exploring ways to improve and enhance services and rehabilitation for acute and chronic pain. The RCMP is considerably ahead of the forces in making comprehensive care available to their members.
In terms of Canada's use of chiropractic care, we are significantly behind the United States military. In the United States, the Department of Veterans Affairs calculates that the number one reason veterans seek care when returning from Iran and Afghanistan is lower back pain. In addition, over 20% of U.S. military treatment facilities employ doctors of chiropractic for treatment of military-related injuries.
Let us consider another example: our first nations aboriginal population. Canada's history in dealing with first nations is a blot on our reputation as a dignified and enlightened country. First nations people suffer many health problems, and in many cases their levels of diabetes are higher and their overall levels of health lower than they are in other Canadian populations.
What we see is a highly inconsistent approach to chiropractic services available to the first nations people. Services vary widely, depending on such factors as the province of residence, the particular nation or group they belong to, and the arrangements they have made. This is not the Canada that reflects the values of the Canada Health Act's national principles of portability, accessibility, universality, comprehensiveness, and public administration.
In contrast, as an example of successful first nations care, the Joe Sylvester clinic in Anishnawbe Health Toronto is a pro-service, multidisciplinary clinic that has been offering health care to Toronto urban aboriginal communities since 1996. Health care professionals available at the clinic include chiropractors, physicians, nurses, traditional native healers, and complementary and alternative health care providers.
In this unique setting, comprehensive, traditional, and conventional care is delivered in the spirit of true multidisciplinary cooperation. Dr. Kopansky-Giles has first-hand experience with this clinic.
Building on this example, we would like to see first nations people have equal access to qualified, comprehensive health care services.
Chiropractors are second to none in keeping people healthy and efficient at a very reasonable cost. Essentially, we believe federal populations should have equitable access to chiropractic without gatekeeping. People who have sore necks, sore backs, or headaches should get care right away, get back in action right away, and lose as little time as possible from work and family.
The chiropractic profession prides itself that patients have quick access to practitioners and quick access to treatment. We feel this is a healthier way for the population to stay alive, focused, and engaged. In the long run we feel that not allowing people to become debilitated is a much better way to have a healthy Canada.
We now turn to a very solid example of how care should be offered across the full spectrum of a federally serviced population. It is a wonderful case study of cooperation and efficient service that can serve as a beacon for the best use of health dollars.
St. Michael's Hospital in Toronto offers chiropractic services in one of Canada's first hospital-based chiropractic care clinics. This clinic incorporates the expertise of a health care team of chiropractors, medical doctors, and physiotherapists to deliver comprehensive, appropriate, and high-quality care.
The St. Michael's Hospital department of family and community medicines welcomed the clinic to the hospital in 2004. The initiative was made possible by the Ontario Ministry of Health and Long-Term Care's primary health care transition fund. This successful example of interprofessional collaboration has benefited the hospital, the staff, and, most importantly, the patients.
Because we regard this initiative so highly, we thought it best to send the practitioner who knows most about it to join us here today so that the committee members can explore the working of a program that runs so smoothly and so well.
This finishes my oral comments. Both Dr. Kopansky-Giles and I will be pleased to answer any questions you may have regarding any issue related to our profession's submission.
Thank you.
:
Thank you, Madam Chair.
What a wealth of comments and suggestions. Thank you for that.
I have four questions. I'll try to make them quick, and I'll lay them out first so that there will be time for you to answer.
Dr. Padmos, do you have any assessment or estimate of the impact of cuts to the research granting councils or the absence of funding to Genome Canada? How might that impact human health resources in the coming years?
Dr. Ouellet, you talked about patient-centred care. I took a look at your presentation. What I didn't see was any recommendation around the kind of continuous quality improvement initiatives that I know have been very successful in British Columbia, Deming-based frameworks for quality and process improvement. They've been used by the Vancouver health authority at Vancouver General Hospital. I'm interested in your comment on the role of that kind of initiative in increasing quality and productivity.
Ms. Neufeld, thank you for your list of all the very positive initiatives that have happened in the early years of the 2000s. It's too bad there wasn't much after 2005.
You talked about the health human resources observatory, and I'd like your comment on the possibility of that observatory including complementary and alternative modalities. CIHI leaders told me they don't even collect information about naturopathic physicians and traditional Chinese doctors, and probably chiropractors, because there's no level playing field from a regulatory perspective. How can we address that?
Dr. Valade, this committee will be making recommendations through the study. What would you like to see as a recommendation to the federal government on how we can rapidly increase the number of collaborative clinics and practices and facilities that integrate complementary and alternative modalities?
Thank you.
:
Thank you very much, Madam Chair.
First I would like to thank you for being here with us.
I have a comment for Dr. Valade. Thank you for telling us about a number of very specific cases concerning populations that are directly served by the federal government. A little later in our study, we'll come back with workers from those areas and we'll be able to pass on a number of your questions to those people to enhance the study we are conducting.
Madam Chair, last Tuesday and today, we heard witnesses tell us about the situation of nurses. They told us about overwork, changes to ways of doing things and continuing education.
I'm going to ask you the same question I asked the witnesses we heard from last Tuesday. Don't you think that the right forum to state those problems isn't Parliament, but that it would be preferable to speak directly to the stakeholders in Quebec and the provinces, who are the ones who govern education, ways of doing things, health, practices? Have you also made those observations to people who, in everyday life, work or have direct responsibility for the delivery of health services?
It's an excellent question you've just asked all of us to consider answering, because we are commonly asked the question, “Why don't you just go to the provinces and have the provinces solve those issues?” But we have a perfect example through the primary health care transition fund, where a federal amount of money led to innovative, excellent programs that were distributed provincially and have produced excellent results about collaboration, for example.
Also, we have the example about enhancing the interprofessional or interdisciplinary education initiative. That was a federal initiative that has transcended to provinces. For example, at the University of Toronto they have embarked on a major initiative for interprofessional education. Effective September 2009, every health science student across 10 faculties will have to have 20 credits in interprofessional education to graduate. This was a federal initiative that is actually going to have a local effect.
We've seen the benefits of that. We're engaged actively in these IPE projects. In fact, the team I lead at St. Michael's Hospital, where I actually chair our working group on interprofessional education for our department, has won two awards from the University of Toronto on these initiatives in the last year.
So yes, I think there is a very strong role for you to play in actually guiding provinces to look at issues more broadly that transcend local jurisdictions.
Thank you.
:
Thanks, Madam Chairperson. Thanks to all of you.
At our last session we heard from a number of umbrella organizations, and they seemed to suggest that our major focus as a committee should be on looking at scope of practice and the service delivery model. I don't disagree with that and I think there is a lot to be gained from it, but I'm a little worried about what Canadians are saying now about the shortage of doctors, nurses, and technologists, and some of you have talked about that.
In my view, we're reaching a crisis situation where in fact if we don't do something urgent, all the analysis of our service delivery models in the world won't do anything to deal with people's need to have access now to quality health care services.
I want to ask specifically, starting with Linda and then Kaaren first, with nurses, what specific recommendation do you make for the federal government so we can get away from this jurisdictional football and start to give some clear direction to the federal government for things that we could do? I think, Linda, you touched on EI. I need to hear more about what we can do to change the EI system to make it useful for training of nurses. I'd like to hear a little bit more about the idea of this observatory, and if it's such a common-sense idea, why isn't it happening?
Then I'd also like at some point to hear from Andrew about the whole impact of the interprovincial trade agreement on what we're trying to achieve.
But let me start first with the crisis and what we could be doing immediately.
Linda.
:
I will take the example of EI, which we've been working on since 1999. I'm not sure if the committee knows, but if you're a plumber in this country, you can apply with your employer to take an apprenticeship program under EI, get your education, your salary paid, and then you get the next level of being a plumber. But if you're under a category of a professional, that is not available.
So if I look at LPNs, licensed practical nurses, in lay terms they are assisting nurses. A lot of them would like to become registered nurses. But you need to leave your job; you have to go to a full-time, four-year program, and there's no bridge funding or anything that could help them. A lot of registered nurses are from the old school program, the two-year or three-year program. They would like to do their baccalaureate program--again, no bridge funding--or, even better, to go as a nurse practitioner--again, no bridge funding. It's those kinds of issues that we could apply under EI immediately if we modify the apprenticeship program.
When we look at the shortage and the service delivery model, yes, it's a crisis. I've just been to Saskatchewan and Manitoba, and I arrived with Kaaren on a flight this morning. We have nurse practitioners in both of those provinces who are eager to work in their full scope of practice and they're not allowed to because of either a provincial regulation or the team they're working in. So I get very nervous when I hear a different health care worker as a physician's assistant. Well, we're going to introduce something else when what we currently have is not even put into practice. I have issues and concerns with that.
Even if Andrew is a specialist in the blood sector, thank God, and not in psychiatry...I'm not completely insane, to put it on the record; I'm just very determined, Andrew.
Thank you.
:
Thank you very much for the question.
The observatory is an opportunity, as I indicated, for researchers, governments, employers, health professionals, for us, to be able to come together and to really take stock of the innovative practices that are there that can be applied to provide new models of care.
The Canadian Nurses Association just recently published a paper on wait times, where we pulled together all of the information that showed the new models of care, whether it's nurse practitioners working in personal care homes...so long-term care situations, not just in primary care, but certainly also in primary care--to show the difference that can be made when a family practice nurse is able to work to her full scope in primary care.
Those are just short examples of innovations. The idea of the observatory is really a knowledge translation opportunity where you can bring people together who have the opportunity to spend that time thinking about these innovations, because it is the application of them into new, novel situations, whether it's in the north or whether it's within a provincial setting, that is going to make the difference. We need to provide that opportunity for health professionals, for international organizations, for researchers, for governance for us to come together.
:
Thanks very much for the question about collaboration.
I would like to expand a little bit upon the really unique, and I believe creative, work that has been funded under the primary health care transition fund. In Ontario, for example, we received approximately $2 million to fund three integration projects. I was a principal investigator for the one that received about $700,000 to fund integration in a hospital setting. It was not just about chiropractors. The ministry actually funded us to look at how an integrated model of care would work in a department of family and community medicine. We also received funding for the same type of study in a community health centre, as well as in family health teams in Ontario.
This covered all three sectors of how services are delivered in Canada. All of these integration projects actually were featured at the primary health care summit that the health ministry put on. They were three of 60 projects that were presented at that national level, receiving that recognition.
We learned very clearly from the establishment of that model that when services are delivered across a team, and that team has eliminated the hierarchical structure such that team members are actually equal players, with their roles appreciated and respected, then patients greatly benefit from the delivery of services.
As well, we did an ethnographic type of study that looked qualitatively at the attitudes and perspectives of the other health care providers, and we saw a major shift in those perspectives over a two-year period with the inclusion of chiropractic services.
At the end of our study, we also did a physician satisfaction survey. We have approximately 45 physicians in our department, and they were 100% supportive of the continuation of chiropractic services. Several of them commented--it's been published in two papers--that they felt it significantly affected their ability to manage their patients appropriately.
:
Thank you, Madam Chair.
Thank you all for coming. It's very good to listen to you.
I'm going to take a different tack. We used to focus strictly on marks when looking for medical students. I know that's changing, but how do you look for students who are going to have the right compassion, empathy, and ethics?
We need foreign-trained graduates, and I'm wondering what the average cost is to become a practitioner here, for someone who was trained overseas. I know it varies by specialty and at what point in the system they come in, but are there numbers on that?
Do we capture data on how many start to take their exams? I come in contact with a lot of people who take the first exam and then can't afford it. I've met about 50 physicians in the last three months who aren't practising--one was a senior house officer in the U.K.
How many spots exist for foreign-trained grads in Canada? I know it differs by field, and a few years ago there were eight spots for pediatricians.
My last point is that we really need foreign-trained physicians. We need their language abilities and cultural understanding. I'll share a story. A gentleman in my riding was frantic. He thought his one-year-old grandson had smallpox, because when he was growing up smallpox still existed. It took me 20 minutes to assure him that the baby did not have smallpox. The physician didn't have the language ability to share that with the family.
We need to find a way around this. We have many languages and cultures, and we have to make sure that when people go to physicians they'll be understood and looked after.
Those are my comments.
:
This question is for Dr. Ouellet. I enjoyed your presentation. I thought you had some great suggestions. I particularly liked the suggestion on capacity building.
In my riding of Barrie we just set up a satellite campus for the U of T, to start training on July 1, with five and then nine students. It will be a full-time satellite medical campus. The challenge the community has is they're told if you want to do that, you have to raise $6 million on your own to pay for the building. That's tough for a community to do. The community will find a way to do it, but it's obviously not fair.
So suggestions of how you can make it easier for communities, such as a federal loan capacity, like we have in other infrastructure programs, is a noteworthy suggestion.
What I wanted to ask you about is this. You talked about self-sufficiency and repatriating some of these physicians we have abroad. The challenge of self-sufficiency is that it's a long-term goal and it's not going to happen overnight. We have this huge challenge immediately.
An interesting aspect about getting some of these physicians back...there are so many who are practising abroad; I think you're right on that. The challenge is, what if these physicians have the same problem getting into the system? Wouldn't the physician who went to medical school in Ireland or a physician who went to medical school in the Caribbean have the same challenge coming back to Canada, in that there wouldn't be a residency spot available? Wouldn't we run into the same problem we're facing with IMGs?
:
Thank you, Madam Chair. I certainly appreciate all of the presentations.
Before I proceed, I just can't let one comment go unremarked. I am also from British Columbia, and last year I attended an amazing conference about health care innovation and the projects that were happening that were funded both federally and provincially. I just wanted to reassure Ms. Murray that great work continues even to this day.
I had to actually just make that particular comment.
I think there are a few things that have stood out for me. One, I really appreciate Dr. Valade's comments around the opportunity within the federal government and where we're going with alternatives, whether it be chiropractors or other services. I think those are very valuable.
I really like the comment around a special fund for rural and remote. At some point we need to do some uptake on that. But there are two areas that I would really like to focus my five minutes on. We hear about--and I think I'm hearing the same--great innovation happening across the country. How are we going to bring it altogether and create that actual change?
We talk about collaborative care. We know we have pockets of great work. What do we need to do to actually make that a reality?
The other piece I can focus on--and I'll open this up to everyone, both of these questions--is the potential use of physician assistants. But I also appreciate that in our primary health care system, the way we pay doctors doesn't really allow for any kind of collaborative care. It's very difficult for nurse practitioners, nurses, to work in a primary care environment with family physicians by virtue of our payment model. So would physician assistants add value, or do we really need to look at a collaborative primary care team? Someone who knew that we were doing this study, who is a physician, said we should have the foreign-trained doctors be physician assistants as a pilot project.
I want to throw all those comments out and open it up to everyone. Again, it's around innovation and how do we actually create change with all the good things that are happening, the interdisciplinary team, and where we go.