Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 3 - Evidence - October 5, 2011
OTTAWA, Wednesday, October 5, 2011
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:11 p.m. to examine the progress in implementing the 2004 10-Year Plan to Strengthen Health Care.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[English]
The Chair: Honourable senators, I call the meeting to order.
[Translation]
Welcome to the Standing Committee on Social Affairs, Science and Technology.
[English]
My name is Kelvin Ogilvie, from Nova Scotia, and I will ask my colleagues to introduce themselves by starting on my left.
Senator Eggleton: Art Eggleton, from Toronto, Deputy Chair of the committee.
Senator Cordy: Jane Cordy, from Nova Scotia.
Senator Martin: Yonah Martin, from Vancouver, B.C.
Senator Seidman: Judith Seidman, from Montreal, Quebec.
Senator Braley: David Braley, from Hamilton, Ontario.
The Chair: We have a slightly unusual day today in that senators will need to leave at 5:15 to get to an important vote in the Senate chamber. As a result, I would ask senators and witnesses to agree to the following procedure. We will certainly have time to get the prepared statements on the record. I would like to go around each of my colleagues and get their questions on the record. Then, any questions that we do not get to before we have to leave could be responded to in writing by the witnesses, if they are agreed, subsequent to the meeting. We would be extremely grateful.
Are honourable senators in agreement with that procedure?
Hon. Senators: Agreed.
The Chair: Thank you. Again, at 5:15 senators have to leave for the vote in the chamber.
As part of our Senate order to review the 2004, 10-Year Plan to Strengthen Health Care, our theme today is health and human resources. We will hear witnesses from the Royal College of Physicians and Surgeons of Canada, from Human Resources and Skills Development Canada, from Health Canada and from the Société Santé en français.
I invite you to present in the order that you are listed on the agenda, if that meets with your acceptance. I invite one individual first and ask you to introduce yourself and your colleagues. I understand we have a considerable depth of bench in a couple of cases in the event that they are needed. Perhaps we will stick with those who are at the table initially in terms of introduction. Beginning with the Royal College of Physicians and Surgeons of Canada, I ask Dr. Padmos to introduce himself and his colleague.
Dr. Andrew Padmos, Chief Executive Officer, Royal College of Physicians and Surgeons of Canada: Thank you, Senator Ogilvie and senators; it is a privilege to be here. I would like to introduce my colleague, Ms. Danielle Fréchette, Director of Policy and External Relations at the Royal College of Physicians and Surgeons. I am the CEO of the Royal College and have been so since 2006. The Royal College of Physicians and Surgeons of Canada is the custodian of the professional ethos of Canada's 33,000 specialist physicians and surgeons. We do not represent their economic interests. We represent their professional ambitions. We do so because we set the standards for education, training and lifelong learning for those physicians. We are very interested in human resources for health, and always have been, because our starting point is those individuals who graduate from medical school and enter into the workforce as resident physicians. We follow them through until they retire. Due to recent economic circumstances, this retirement seems to be postponed in many cases.
Canadians are proud of their health system and pleased with many of the responses from the 2004 accord, but we are not uniformly satisfied that we have solved all the problems. Frustration continues with access to health care. On a personal note, I continue to practise haematology slightly, mostly for my sanity but I hope for the patients' benefit. I do so in Windsor, Nova Scotia, at the Hants Community Hospital. When I look at the list of patients I see on my monthly clinics, I find that more than half of them have waited six months to see a consultant physician after the referral from the family physician. This is not good enough, as one small example.
The other concern is at the other end. Physicians in general are working too much. Physicians on average are working 53 hours a week, but that only is the time they are in the office or the clinic. In addition, they are working 120 or more hours a month on call. I would like to make the point that being on call is being at work in almost every case. We are not playing golf while we are waiting for the telephone to ring.
Our concerns are really shared by Canadians, and we have three recommendations we would like to place in front of you. The first is to continue and augment investments in patient-centred medical education and training programs that support lifelong learning. The only effective way to transform the health care system is to make sure that the education and training program for health professionals is up to standards. Patient-centred care, inter-professional care and comprehensive care are all things that deserve and require additional investment and attention.
The second recommendation we would like to repeat is one you have probably heard many times and is still very topical. We need a pan-Canadian human resources for health observatory function to provide evidence and data on which to plan. Our workforce science in Canada is at a very primitive stage, and we are lurching from one crisis in one locality or one specialty to another.
Our third recommendation is something that needs emphasis. We are all affected by injuries and accidents. Canada needs an injury prevention strategy to elevate in the public's attention and bring resources to bear to reduce needless injuries in our life. The reason for this is that injuries cause a lot of loss of life, disability, long-lasting disability and painful disability, and they cost a lot of money.
Mr. Chair, there are many other good recommendations to be brought forward, but these are the three we would like to isolate. I would ask Ms. Fréchette to comment in part because she represents our organization at the International Health Workforce Collaborative.
[Translation]
Danielle Fréchette, Director, Office of Health Policy, Royal College of Physicians and Surgeons of Canada: I would like to focus on the opportunities for sharing knowledge and expertise we are losing in Canada.
[English]
At the International Health Workforce Collaborative, we bring together four countries with similar health care systems: The U.S., the U.K., Australia and Canada. It is evident to those of us who come together that there are so many vast opportunities for international collaboration, knowledge sharing and knowledge transfer, where everyone is doing some wonderful things. This year we will be examining, among other things, the impact that health human resource observatories in our partner countries has had in ensuring that the citizens of their countries have access to high quality and timely care. Canada has yet to have one of these institutes, but we are not the poor cousin because we are doing some wonderful things at the provincial-territorial level. Again, when our colleagues from the provinces and territories come to the group IHWC, they find it to be an opportunity to learn from others and from ourselves. It is high time that we do think of an observatory as a likely measure. The last recommendation that Dr. Padmos mentioned was injury reduction. Why is that germane to human resources for health? When we think of the number of traumas and procedures that are not planned for in our health care system and that really derail our good planning, it is worthy of further attention.
We are thinking of $20 billion in health care dollars in recognizing that health care is such a very human intensive endeavour. I think it is worthy of further attention as well.
The Chair: Thank you very much.
We will now move on to Human Resources and Skills Development Canada. I would ask Jean-François LaRue to begin.
Jean-François LaRue, Director General, Labour Market Integration, Human Resources and Skills Development Canada: Thank you, Mr. Chair and distinguished members of this committee.
[Translation]
I am the Director General of the Labour Market Integration Directorate, within the Skills and Employment Branch. On behalf of Human Resources and Skills Development Canada, I would like to extend my thanks to the committee for the opportunity to discuss foreign credential recognition as it pertains to the 2004 health accord.
[English]
Today, I would like to provide the committee with a brief overview of the important work that the HRSDC's Foreign Credential Recognition Program, or FCRP, has been doing to improve the labour market outcomes of foreign-trained individuals and, in particular, internationally-educated health professionals. First and foremost I would like to highlight that although the recognition of foreign credentials is largely an area of provincial and territorial jurisdiction, the federal government has a pivotal facilitation role to improve foreign credential recognition processes.
The Government of Canada facilitates national coordination, helps build capacity among provincial and territorial governments, engages stakeholders to lead projects that improve foreign credential recognition processes, and helps individuals with information and targeted financial support.
Since 2003, HRSDC's FCRP program has been providing strategic financial support to key stakeholders responsible for assessing and recognizing foreign credentials, including health professionals. Our support enables organizations such as the Medical Council of Canada and the Canadian Nurses Association to develop processes and practices that are fair, consistent, transparent and timely.
[Translation]
We have played an important role in facilitating the emergence of pan-Canadian partnerships. Since its inception, the program has funded over 160 projects worth more than $90 million, including funding to seven provincial and territorial governments to develop foreign credential recognition systems and tools.
[English]
The projects HRSDC supports are pan-Canadian in nature. For example, the department has engaged with the Association of Canadian Occupational Therapy Regulatory Organizations. The association will develop a single competency-based assessment, as well as a national certification exam and language standards. What does this mean? It means that internationally-trained occupational therapists will be able to apply for licensure through one system instead of 13.
As another example, in conjunction with regulators representing registered nurses, licensed practical nurses and psychiatric nurses, HRSDC is currently supporting the establishment of a national nursing assessment service. Not only will this project create a single entry point for all foreign-trained nurses, but having this type of process provides nursing stakeholders the ability to move the application process so that it can be initiated overseas.
[Translation]
To address the issues foreign-trained individuals face in Canada, first ministers agreed to take concerted action by tasking labour market ministers with developing the Pan-Canadian Framework for the Assessment and Recognition of Foreign Qualifications.
[English]
Launched in 2009 and led by HRSDC in collaboration with CIC, the framework is a historic public commitment that establishes a shared national vision, guiding principles and desired outcomes to improve the labour market integration of internationally-trained workers. Through the framework, regulators and stakeholders are working with governments to ensure that the processes used to assess foreign qualifications adhere to the framework's principles of fairness, consistency, transparency and timeliness. Given the broad scope of the work — we have more than 500 regulated occupations — governments agreed to target 14 occupations over three years for individual and collective actions. Nine of the 14 target occupations are health related occupations such as physicians, registered nurses and medical radiation technologists.
Work with health stakeholders has been significant and progress continues. However, achieving desired outcomes requires the ongoing commitment of all parties involved and it will take time. In our discussion with various stakeholders, we often heard about the financial difficulties that foreign-trained workers face when seeking to have their credentials recognized. In particular, the certification process can be very costly for some health professions. A lack of Canadian credit history and work experience can be quite an obstacle for individuals in obtaining loans from Canadian financial institutions. Recognizing this, the federal government introduced in Budget 2011 a complementary financial assistance pilot project initiative proposing to help them cover the costs associated with the FCR process.
[Translation]
My directorate is also responsible for reducing labour mobility barriers faced by Canadians as they move from province to province and by internationally trained workers who are trying to integrate into the Canadian economy.
Full labour mobility improves workers' employment opportunities and gives employers access to a larger and richer pool of human resources. Labour mobility and foreign credential recognition go hand in hand.
[English]
In summary, national consultations with stakeholders validated that not only are foreign credentials assessment and recognition systems complex, lengthy and costly, but the organizations responsible for these systems have a limited capacity to address these issues in their entirety. Common key messages identified include a need for long-term commitment from all parties involved, including employers, and for additional financial support. To maintain the momentum all governments and key stakeholders, including those in health professions, must commit to ongoing collaboration, build upon successes and lessons learned, and continue to take concerted action.
In closing, I would note that the FCR program will continue to be a key piece of the Government of Canada's response to the FCR issue. Building on the lessons we have learned over the years, the FCR program will replicate the early successes we have had with groups like dentists and nurses to address systemic labour market barriers on a larger scale.
Marc LeBrun, Director General, Canada Student Loans, Human Resources and Skills Development Canada: It is a pleasure to be here today to discuss the work that is underway with respect to Canada student loan forgiveness for family physicians, nurses and nurse practitioners, as introduced in Budget 2011.
As you know, in Budget 2011, the Government of Canada committed to forgiving a portion of Canada student loans for new family physicians, nurse practitioners and nurses that agree to practice in underserved rural or remote communities including those that provide health services to First Nations and Inuit populations.
[Translation]
Starting in 2012-13, practising family physicians will be eligible for federal Canada student loan forgiveness of up to $8,000 per year to a maximum of $40,000.
Nurse practitioners and nurses will be eligible for federal Canada student loan forgiveness of up to $4,000 per year to a maximum of $20,000. This initiative will complement initiatives that are currently under way in provinces and territories to combat the shortage of health care professionals and expand the provision of primary health services to Canadians in these communities.
[English]
As this initiative touches on both student financial assistance and health human resources, HRSDC is working with representatives from Health Canada to coordinate consultation activities, including discussions with provincial and territorial partners with perfect species in these fields.
Over the coming months we will also be undertaking consultations with key non-governmental stakeholders, including groups that represent family physicians, nurses and nurse practitioners, in order to obtain their input on how best to implement this initiative and to help define some of the key parameters.
[Translation]
I want to thank you very much for the opportunity to discuss this initiative today.
[English]
The Chair: For those who may have arrived after we had our initial introduction, I will remind my colleagues that we agreed that we would go around and give each senator a chance to get a question on the record. Our witnesses agreed that they would provide a written answer following this meeting. If there is time left after we get all your questions on the record, I will start from the beginning and see if we can actually have some in situ discussion. I just wanted to make sure everyone is on the same page in that regard.
I will now turn to Health Canada. Mr. Shearer would you begin?
Robert Shearer, Acting Director General, Health Care Programs and Policy Directorate, Strategic Policy Branch, Health Canada: Thank you for having both my colleague and myself here today. Shelagh Jane Woods will be introducing herself toward the end of the presentation.
It is a pleasure to be here on behalf of Health Canada. I would like to thank the committee for the opportunity to report on progress made in the area of health human resources, fondly known as HHR, which is often referred to by many of our colleagues, since the 2004 health accord.
You may know that in 2004 the federal government committed to the following: accelerating and expanding the assessment and integration of internationally trained health care graduates across the country; targeting efforts in support of Aboriginal communities and official language minority communities to increase the supply of health care professionals in these communities; implementing measures to reduce the financial burden on students in specific health education programs, in collaboration with our colleagues in other federal departments; and participating in HHR planning with interested jurisdictions.
Although Canada does not have a single national health human resources plan at this point, Health Canada remains dedicated to addressing HHR challenges and promoting innovation within its jurisdiction, as well as supporting provincial, territorial and stakeholder capacity in areas of identifiable need.
Health Canada plays a leadership role in HHR by supporting a range of targeted projects and initiatives of national significance. Key investments include: $20 million annually for the Pan-Canadian Health Human Resource Strategy; $18 million annually for the Internationally Educated Health Care Professionals Initiative; $174.3 million over five years, which will end in 2013, to support increased access to health services for official language minority communities, including the recruitment and retention of health care professionals; $34.5 million over five years to establish the nursing innovation strategy for remote and isolated First Nations communities; and last but not least, $80 million over 5 years, which will end in 2015, for the Aboriginal Health Human Resources Initiative.
I will begin to say a few words about the Pan-Canadian Health Human Resource Strategy, which has supported now over 100 projects to advance health human resources planning, increased inter-professional education and practice, and the recruitment and retention of health care professionals.
For example, through this strategy, Health Canada is investing $39.5 million over the next six years to train more than 100 family medicine residents in rural and remote communities across our country.
Next, I would like to briefly touch on the Internationally Educated Health Professionals Initiative, again fondly known as IEHPI, which has supported over 140 projects since 2005 to promote access to information and path-finding, competency assessment, training and orientation to help internationally educated health professionals integrate into their workplace.
For example, in British Columbia, they are using Health Canada funding to support courses and skills development to address language and communication challenges faced by internationally educated health professionals and their employers, when they arrive in our country.
Currently, IEHPI aligns with the objectives and target occupations identified in the Pan-Canadian Framework for the Assessment and Recognition of Foreign Qualifications, and Mr. LaRue has provided you with an overview of that particular program.
[Translation]
Another important component of Health Canada's work is to improve the health of all Canadians by increasing the supply of bilingual health practitioners. In some parts of Canada, francophone communities comprise a very small percentage of the population — less than 2 per cent in Newfoundland and Labrador, British Columbia, Saskatchewan and Alberta.
Through the Official Languages Health Contribution Program, more than $143 million has been invested to train health professionals during the first seven years.
In Quebec, English-language training is offered to health personnel and health practitioners in order to improve their ability to communicate with approximately one million English-speaking people across Quebec.
Outside Quebec, Health Canada funds a consortium of 11 colleges and universities offering 90 post-secondary health training programs in French across Canada.
These initiatives have resulted in over 2,200 post-secondary graduates of the French-language component during the first seven years of the accord, and over 8,200 health personnel who received English-language training in Quebec during the same period.
The official languages program evaluation of 2008 concluded that, while the program had already contributed to an increased number of health personnel able to meet the needs of official language minority communities, it remained relevant, as language barriers continued to exist for English- and French-speaking minority communities across the country.
[English]
Finally, I would like to note that cooperation and collaboration are essential in our pan-Canadian work on HHR. Health Canada supports collaborative efforts as co-chairs of the federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources known as ACHDHR. This committee was created by the conference of deputy ministers of health back in 2002, to link issues of primary health care, service delivery and HHR.
I understand that the ACHDHR will be providing a written brief to the clerk regarding their work for your consideration.
The federal government also participates on ACHDHR as a jurisdiction that directly employs health care providers and has responsibility for the funding and delivery of certain health care services for populations under federal responsibility, such as First Nations and Inuit, eligible veterans, refugee protection claimants, inmates of federal penitentiaries, and serving members of the Canadian Forces and the Royal Canadian Mounted Police.
I would now like to welcome my colleague, Shelagh Jane Woods from Health Canada's First Nations and Inuit Health Branch, to share highlights of the Aboriginal Health Human Resources Initiative.
Shelagh Jane Woods, Director General, Primary Health Care and Public Health Directorate, First Nations and Inuit Health Branch, Health Canada: Thank you to the senators for inviting us.
[Translation]
In Budget 2010, the Aboriginal Health Human Resources Initiative was renewed for five years at $80 million to build on the work accomplished during the first phase of the initiative. This is a small sample of successes achieved through the initiative to date.
[English]
We have supported over 2,200 Aboriginal students studying in a wide range of health careers through what we call the AHHRI's bursary and scholarship program.
[Translation]
We have funded over 240 projects carried out in conjunction with post-secondary institutions that provided students with support, bridging programs, and access to post-secondary health programs, curriculum adaptation and other projects.
[English]
Our work with professional associations, universities and colleges has produced frameworks for cultural competency for medicine and nursing that are being implemented in universities and colleges across Canada.
The AHHRI is now turning its attention to First Nations and Inuit community-based health workers to ensure that they have the skills and certification comparable to workers in the provincial and territorial health care system.
[Translation]
While there is still much to be done, the foundations that have been established through the AHHRI are going to result in a First Nations and Inuit health workforce that better meets the needs of their people.
That workforce will have a skill level equivalent to that found in the provincial and territorial health systems.
Dr. Brian Conway, President, Société Santé en français: Good afternoon. I am an infectiologist by trade and a registered member of the Royal College. I am speaking to you today as the President of the Société Santé en français, and I thank you for the opportunity to share the views of French- and Acadian-speaking minority communities on the result of the 10-year plan to strengthen health care, adopted in 2004, while focusing on human resources issues.
As you all know, I represent Acadian and francophone communities outside Quebec. Those communities account for over a million Canadians who need access to quality health services in their own language.
In reports produced as early as 2002, a committee similar to this one was already listing five levers that have formed the foundation of the Santé en français movement: networking, training, development of service points, new technologies, and implementation of structures for disseminating information. We at the Société Santé en français, founded in 2002, have based our approach on the World Health Organization's pentagram model, which promotes concerted action by all partners, including the community, health professionals, training establishments, service facilities, and federal, provincial/territorial and regional policy makers to advise the existing organizations within the health care system on how to provide services to francophone and Acadian communities. We have created 17 networks in the 12 provinces and territories we service and, over the years, we have had some resounding successes. We have been able to provide funding for more than 225 initiatives that have had an impact on seniors, children, youth and immigrant families, and often, on those who are most vulnerable and impoverished.
I will give you a few examples of successes achieved through the action plan. In Fredericton, New Brunswick, a small group of francophones partnered with the Société Pierre-Armand-Landry to initiate a study on access to health services in French in the area. Two years later, the group became the Comité Santé en français de Fredericton and set about compiling a directory of health professionals and services and making them aware of the importance of language in health care. The initiative eventually resulted in the Noreen-Richard Health Centre, a community health centre that serves over 2,000 francophones from the greater Fredericton region. The study of the needs has resulted in tangible services that can already be measured.
In Nova Scotia, approximately 70 paramedics are bilingual; they offer emergency services in French. In addition, the 1-800 service provides health advice on request 24 hours a day, 7 days a week, for that region's Acadian population.
In Ontario, we recognize that a list of entities responsible for francophone planning has been created for all the regions — the north, the south and the east — to meet the needs of francophones and most regions. Société Santé en français networks are the entities responsible for planning. There is solid harmonization with federal programs that wish to support the services provided to francophones and Acadians and the delivery of health services on a provincial basis.
In my own province, British Columbia, more than 10 per cent of the most destitute individuals living in Vancouver's Downtown Eastside are native francophones. Measures have been taken to integrate these individuals into the health system. The Pender Community Health Centre and UBC's Downtown ID Clinic, which I run, see some of the most vulnerable individuals and provide general medical services, addiction services and leading-edge treatment for HIV and hepatitis C. All those services are provided in the clients' mother tongue with the support of provincial authorities. The best possible service is provided immediately, in the best possible way and in the mother tongue of the person requesting the service.
My colleague from Health Canada already mentioned the significant accomplishments of our consortium friends with post-secondary training establishments, be they colleges or universities. He quoted the same figures I have in my document, so I will not repeat them.
Over 2,000 individuals have completed their French-language training outside Quebec. From now on, I could just talk to you about the major successes and we could say that we have been successful in everything, but we have not yet been able to reconcile training or consultation with a solution to the human resources problems in our francophone and Acadian minority communities. There is still a gap between the needs, the demand and the deployment of human resources that are necessary for serving our communities.
The Société Santé en français believes it is necessary to work with health professionals, existing institutions and our francophone and francophile communities, to determine how to optimize French-language services using the resources currently available in the health system.
It is our hypothesis that the resources are already available, but the way they are deployed is such that they are not effectively balanced with needs. Under an ideal initiative, all partners would come together to identify the conditions and practices to be implemented, be they new ways to recruit and post professionals, or new scheduling practices and ways to group services.
A very important element, which we lack in order to be able to achieve what we need to achieve while using limited financial resources, at least in the near future, is truly the linguistic variable that must be included in data collection. We believe that the discussions surrounding the renewal of the health accord in 2014 are an ideal opportunity to address that shortcoming.
We would like to make the following recommendations: that the 2014 health accord include a clause recognizing Canada's linguistic duality and the commitment of all governments to take linguistic duality into account when planning and funding the health of the population and the available health services; that the federal government continue to support our organization during the upcoming period of financial support, 2013-18, and continue to support the consortium in order to improve upon the fruits of our labour over the last 10 years and take advantage of including the linguistic variable in data collection as we have recommended; and that the governments undertake to systematically compile data on the language spoken by patients and health professionals in order to be able to measure the results of efforts to improve access to services and the health of francophones, and to more effectively plan for the future.
We feel that very significant progress has been made since 2002. Buoyed by this success, we believe the time has come to officially recognize linguistic duality and its role in health care in Canada. Constitutional responsibility and the Charter of Rights and Freedoms aside, francophones are full citizens of every province and territory. A significant element in terms of health service excellence has to be considered.
With your support, I foresee, in the fairly near future, a time when health care in minority francophone communities will be so improved that the anglophone majority surrounding us will ask us to share our best practices. Thank you for your attention.
[English]
The Chair: Thank you very much.
I will start through the list. I urge you to keep your preambles short. Experience shows that sometimes they can be a little long. We will have to go through the questions fairly quickly to get them all on the record.
Senator Eggleton: I have three questions to which you can respond in writing later.
To Health Canada: Mr. Shearer, your presentation talks a lot about what the goals from 2004 were and what the key investments are. You list many amounts of money. However, the only program that I saw that seemed to sense outcomes was the one relevant to language training. What other outcomes have we had from all these other investments, and what kind of evaluation process has been conducted in that regard?
To Human Resources and Skills Development Canada: This foreign credential recognition situation has been kicking around for a long time. I know it is tough because you are dealing with a whole lot of different proving entities, and there is more than just credentials in the medical profession. For doctors, there is residency.
I also keep hearing about the language problem. Are we doing enough to help people overcome the language difficulty? They may qualify at immigration as having enough knowledge of either English or French to be able to communicate in the general community, but it is another thing to be able to communicate in the health care professions. What are we doing to help expedite all of that? I sense that this is still taking a very long time to achieve. I see you have targets and are moving along, but it is taking a long time.
My third and final question is to the college: I am interested in the injury prevention idea. We hear of it from time to time. Do you have some specific thoughts on what an injury prevention program or strategy might look like and how it might fit in with the health accord?
One of the things the health accord brought about in 2004 was the federal government saying to the provinces, ``If you do this and you do that we will give you money here and there.'' Maybe we should be doing that here. Maybe we should ask the federal government to provide an incentive for the provinces to be able to do something. It would be interesting if you could come up with a vision of what that strategy might look like.
Senator Seidman: Dr. Padmos, on page 2, paragraph 3, of the summary section of the Royal College's brief submitted to our committee, you present the challenges associated with what you refer to as the quantification of efficiency and effectiveness of care, which are important in evaluating sustainability. What role should the college play in assuring quality from the vantage points of care and cost? Specifically, can the system build in norms for care and oversight through some system of monitoring? How does the observatory that you propose play into this, or does it?
Senator Merchant: I believe it was also Dr. Padmos who made a reference to wait times. I think this is something that is concerning Canadians the most. What we hear the most is that it is worrisome how much time people have to wait. Can you, or anyone else, provide an answer? I would welcome your response.
I am interested to know if this is a function of money. Is a shortage of funds related to wait times? Is it overutilization of services? Is it a shortage of health professionals in certain areas? What are the key areas where you see that we can improve wait times?
Senator Martin: I am from Vancouver, B.C. It is a very ethnically diverse region, and to be bilingual in Vancouver could mean Mandarin, Cantonese, Korean, Punjabi, et cetera.
Mr. Shearer, in your presentation, you mentioned targeting efforts in support of Aboriginal communities and official language minority communities. With all respect to my Quebec and francophone colleagues, I am also curious about what targeted funding or efforts there are for other minority communities, especially in places like Vancouver.
I am also aware that there is quite a dearth of health professionals, like homecare professionals and clinicians, in the Vancouver Health Authority, who speak Korean or other ethnic languages. There is increasing demand and a shortage of workers.
The foreign credential process could be one way to answer the labour market needs that we have. How can the federal government, through this health accord, build in whatever language to ensure that that process of foreign credential recognition can be expedited or improved?
Senator Callbeck: On the matter of foreign credentials, it was my understanding that, by the end of 2012, an individual who wishes to practise in Canada will be able to get an answer within a year as to whether they can practice or whether they have to take other courses. I am wondering how close we are to getting to that.
The other matter was costs. We often hear about financial difficulties of foreign-trained workers seeking qualification recognition. Roughly, what are we talking about here in terms of dollars? I would like to know about the pilot project that was announced in the budget in 2011.
I was surprised to find that wait times do not include the time you are waiting to see a specialist. If you want a knee replacement you go to your GP, and you may wait six months to see that specialist. That six months is not counted in the wait time. What are your thoughts are on that?
How is the Pan-Canadian Health Human Resource Strategy working? Has there been any formal evaluation done? If so, I would like to know the results.
[Translation]
Senator Verner: Thank you all for being here today. In a previous life, Dr. Conway, I was the Minister of Official Languages, so I am happy to see how far health care in minority communities has come. That brings me to my question: Under the funding initiative, money was allocated to train human resources abroad and to encourage them to come and practise in francophone communities. Can you tell us whether that program was at all successful? In your opinion, is it a good way to improve the professional services offered in francophone communities, and should the program be enhanced? What are the main challenges when it comes to attracting francophones to minority communities and keeping them there, be it abroad or domestically?
[English]
Senator Dyck: I have two questions, one on foreign-trained physicians and credentialing. It is a follow-up to what Senator Martin was asking. Is any consideration given to not only their competence in either English or French, but also the possibility that their own language might be an asset that may be taken advantage of by placements in certain areas, like Vancouver or Toronto, that are very diverse? Is there any thought of matching up in that way, in terms of the shortage of doctors?
The second question regards the Aboriginal Health Human Resources Initiative. It looks like it is a very new program. You listed several different areas. I am wondering how the $80 million is split up in the five different areas. How much would go to, for example, the bursary and scholarship programs, and how much to things like curriculum adaptations? Are there things like targets? Do you wish to increase the number of Aboriginal graduates in medicine or nursing or that kind of thing? It is probably too early, but maybe you have an indication of whether it has been successful in increasing the number of students in those programs.
What has the uptake been like with the various universities? The one in Saskatchewan, for example, has had an Aboriginal nursing program for probably more than 20 years now. How would they benefit from the program? They have done a lot of the groundwork. What benefits would there be to those who have already been there, doing that kind of job?
Senator Cordy: My first question is for Dr. Conway and the Société Santé en français, which has been around since 2002. I remember being on the committee studying health care at that time. In what way does the recognition of linguistic duality in the health agreement make a difference? Are the guarantees in the Charter not sufficient? When you were speaking, you said that it should be in the agreement.
Mr. LeBrun, in the loan forgiveness program, can you give us the criteria: What is the definition of an underserved rural community? How large does it have to be? What is the definition of a remote community? Does a rural area in Nova Scotia count as remote?
Dr. Padmos, I want to go back to the waiting times for referrals. I was quite surprised to find out that the waiting time for referrals does not count. Do you have any statistics or any anecdotal evidence on that front that you could share with us?
Senator Braley: I see we have witnesses from both Human Resources and Skills Development Canada and Health Canada. I believe that doctors are trained provincially under our education system. Do we have enough analytical data? If I were running my business I would need to know how many people I needed to do what. Do we have the data? Do we need 6,700 of one kind of doctor and 47 of another to handle the people in a community? Is that training being done and what percentage of the training is it? Can the money be diverted to make sure that the needs are met on a constant basis with 2.7 per cent or 3 per cent growth? Are they coordinating that? Are you reviewing any statistical data with regard to that? If not, why not?
[Translation]
Senator Rivard: I share the concerns expressed by some of my colleagues with respect to doctors who receive their training abroad, be it in countries like France or Great Britain, and obtaining a licence to practise here, so I am rehashing things a bit to understand why.
There is something I would like to know, and I am not sure whether the statistic exists or not, but we often hear that Quebec has a shortage of family doctors. Is that the case Canada wide? Do you have any figures on how many patients a single physician treats in Quebec versus Ontario or other provinces?
My last question is not meant to be sexist or in any way misogynous, but given that admission to faculties of medicine is subject to quotas, at least in Quebec, do you have any figures on the number of hours female doctors spend practising? I was listening recently to a speech given by a future candidate hoping to become Quebec's premier, and he said something staggering about how many hours female doctors spend practising versus male doctors. It was roughly a third, and I want to know if that is true.
[English]
The Chair: Senator Braley, do you have an addendum to your question?
Senator Braley: Yes. I mentioned doctors but I would like the witness to break that down to GPs, specialists, nurses and nurse practitioners. What can GPs hand off to nurse practitioners? I would like all the basic information to make us more cost-effective in the delivery of our health services. It may be that we have enough money to be able to pay for those things, if it were done properly.
The Chair: I thank senators for being very efficient. I hope we can take that forward.
I also thank our witnesses today for understanding the time constraints we face today. We are pleased that we were able to get this meeting under way today because your presence is extremely important to our study. The questions asked by senators deal with important issues that arise quite regularly.
I adjourn the meeting.
(The committee adjourned.)