Good afternoon Madame Chair. The Canadian Medical Association is pleased to address the committee as part of its ongoing study of H1N1 planning and response.
In the broad context of pandemic planning, the CMA has focused on developing information and education tools on cma.ca to ensure Canada's doctors are equipped to provide the best possible care to patients.
We have also engaged in discussions with the Assembly of First Nations to address workforce shortages in First Nations and Inuit communities during a pandemic.
Despite the work of governments and others, there remains much to do.
To provide optimal patient care, individual physicians - primary care providers and specialists alike - require:
* Regular updates on the status of H1N1 in their community;
* Timely and easy access to diagnostic and treatment recommendations with clear messages tailored to their service level;
* Rapid responses to questions; and
* Adequate supplies of key resources such as masks, medications, diagnostic kits and vaccines.
The CMA commends federal, provincial and territorial governments for creating the Canadian Pandemic Influenza Plan for the Health Care Sector.
The CMA was pleased to provide feedback on elements of the plan and we are participating on the anti-viral and clinical care task groups.
There are three issues that still must be addressed:
First, the communications gap between public health officials and front-line providers; Second, the lack of adequate resources on the front lines;
and finally, variability that exists across the country.
The Communications Gap
Physicians must be involved in the planning stages and must receive consistent, timely and practical plain-language information. They should not have to seek information out from various websites or other sources, or through the media.
This communications gap also includes a gap between information and action.
For example, we are told to keep at least a six-foot distance between an infected patient and other patients and staff. This will not be possible in a doctor's waiting room, nor will disinfecting examining and waiting rooms in-between each patient.
Patient volumes may increase dramatically and there are serious concerns about how to manage supplies if an office is overwhelmed. There is also considerable concern over whether we can keep enough health care professionals healthy to care for patients, and whether we have enough respirators and specialty equipment to treat patients.
Intensive-care units of hospitals can also expect to be severely strained as a second-wave pandemic hits. This speaks to a general lack of surge capacity within the system. Also, pandemic planning for ICUs and other hospital units must include protocols to determine which patients can benefit most when there are not enough respirators and personnel to provide the required care for all who need it.
Beyond the need for more supplies, however, there is also the concern that there are only so many hours in a day. Doctors will always strive to provide care for those who need it, but if treating H1N1 cases takes all of our time, who will be available to care for patients with other conditions?
Variability across the country
CMA has consulted with provincial and territorial medical associations and their level of involvement in government planning as well as the general state of preparedness varies greatly. There is also marked inconsistency province-to-province around immunization schedules. We need a clear statement of recommendation to clear up this variability.
In summary, there remains a great deal of uncertainty among physicians about: the vaccine, the supply of antivirals, the role of assessment centres and mass immunization clinics, delegated acts, and physicians' medico-legal obligations and protections.
The bottom line is that there is still more work to do at all levels before front-line clinicians feel well prepared with information, tools and strategies they need.
The CMA was pleased to meet with Dr. Butler-Jones to discuss our concerns last week and will continue to work closely with Public Health Agency of Canada to identify gaps and to prepare user-friendly information for clinicians.
Thank you and I welcome any questions.
Bill C-38 covers a lot of ground and we welcome the occasion to discuss it.
Right at the outset, let me remind you that the Canadian Medical Association has a long tradition of staunch non-partisanship. Our mandate is to be the national advocate for the highest standards in health and health care.
In a bill as wide-ranging as this one, there is a great deal I could talk about. In the time allotted, however, I am going to frame my brief remarks around three themes... namely:
First, what is very clearly in the bill;
Second, what is lacking in the bill, and
Third, what I would characterize as a general lack of clarity and consultation on certain aspects of the federal government's actions on health care.
First, I will comment on one of the key measures contained in the budget bill.
We are greatly concerned about the move to raise the age of eligibility for Old Age Security.
Many seniors have low incomes and delaying this relatively modest payment by two years is certain to have a negative impact.
For many older Canadians, who tend to have more complex health problems, medication is a life line. We know that, already, many cannot afford their meds.
Gnawing away at Canada's social safety net will no doubt force hard choices on some of tomorrow's seniors... the choice between whether to buy groceries or to buy their medicine.
I think it is safe to say it would not hold up to a cost-benefit analysis.
People who skip their meds, or lack a nutritious diet or enough heat in their homes, will be sicker.
In the end, this will put a greater burden on our health care system.
Let me now turn to a couple of things we were hoping to see in the budget but that are not there.
As we all know, the Finance Minister announced the government's plans for the Canada Health Transfer in December.
The CMA was encouraged when the Minister of Health subsequently spoke about collaborating with the provinces and territories on developing accountability measures for this funding.
We look forward to this accountability plan for the minimum of $446 billion that will flow to the provinces and territories in federal transfers for health over the next twelve years.
In both 2008 and 2009, the Euro-Canada Health Consumer Index ranked Canada last out of 30 countries in terms of value for money spent on health care.
We believe that federal government should lever its spending on health care to bring change to the system.
It could introduce incentives, measurable goals, pan-Canadian metrics and measurement that would link health care spending to comparable health outcomes.
This would recognize, too, that the federal government is itself the fifth-largest jurisdiction in health care delivery.
We believe the federal government has a role to play in leading this change and that transferring billions of federal dollars in the absence of this leadership shortchanges Canadians.
This budget thus represents an opportunity lost to find ways to transform the health care system and help Canadians get better value and better patient care for the money they spend on health care.
The other major piece missing from this budget is any move to establish a national pharmaceutical strategy.
A pharmaceutical strategy that would ensure consistent coverage and secure supply across the country remains unfinished business from eight years ago.
Access to pharmaceutical treatments remains the most glaring example of inequity of our health care system.
I should point out that the Senate Social Affairs Committee in its recent report on the 2004 Health Accord also recommended the implementation of a national pharmaceutical strategy.
Now I come to the third part of my remarks, which is about a general lack of clarity in regard to certain aspects of the federal government's responsibilities vis-a- vis health care.
Since the budget was tabled, the federal government has announced $100 million in cuts to the Interim Federal Health Program and eliminated the National Aboriginal Health Organization.
As far as we know, no one was consulted on these changes, and since they are not in the budget bill, there is no opportunity for debate on the potential implications on the health of Canadians.
We are also uncertain about the impact of changes in service delivery at Veterans Affairs Canada, changes in the mental health programs at the Department of National Defence, and plans to consolidate some of the functions of the Health Canada and the Canadian Public Health Agency.
There are many unknowns and these are serious matters that warrant serious consideration.
The government committed that it would not balance the books on the backs of the provinces, yet there appears to be a trend toward the downloading of health care costs to federal client groups or the provinces and territories or individuals.
As we have seen in the past, cost downloading is not the same as cost saving.
In fact, when health is impacted, the costs will be inevitably higher, both in dollars and in human suffering.