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Framework on Palliative Care in Canada

Hon. Nicole Eaton moved second reading of Bill C-277, An Act providing for the development of a framework on palliative care in Canada.

Your Honour, colleagues, I'm pleased to present Bill C-277, an Act providing for the development of a framework on palliative care in Canada. I'm very pleased to support and sponsor this private member's bill that received unanimous support in the House of Commons.

This bill provides for the development of a framework designed to facilitate improved access to palliative care in Canada. I wish to commend the member of Parliament for Sarnia—Lambton, who developed this bill. She worked very hard to consult, discuss and build consensus around important issues such as the need for medical training, more research and greater access to patient-centred palliative care through home care, community-based settings, long-term care facilities and hospitals.

The development of such a framework will ensure that the key issues in palliative care get the attention needed while still respecting the federal and provincial roles in the delivery of health care. The Minister of Health has been very receptive and positive towards Bill C-277.

We know that the minister has allocated $3 billion to home and palliative care over the next four years. We realize that resources are stretched and woefully inadequate. However, priorities must be set based on current knowledge and best practices and in concert with health care providers to make palliative care the best it can possibly be for Canadians.

The minister has said, "Ensuring better access to home, palliative, and community-based care leads to better support for patients, at a more affordable cost." I agree with that statement and I want colleagues to keep that in mind as we think about the issue of palliative and end-of-life care.

I was also pleased to hear the remarks by the parliamentary secretary to the Minister of Health during debate, when she said, "Our government believes that Bill C-277 would provide us with a timely opportunity to take a leadership role on this issue, and we support the creation of a framework of palliative care."

There have been a number of parliamentary studies over many years on end-of-life palliative care. In 1995, the Special Senate Committee on Euthanasia and Assisted Suicide released its report and called for governments to make palliative care programs a top priority in the restructuring of the health care system.

In 2000, the subcommittee of the Standing Senate Committee on Social Affairs, Science and Technology recommended that quality end-of-life care become an entrenched core value of Canada's health care system.

In 2005, the Honourable Sharon Carstairs released a report, Still Not There: Quality End-of-Life Care: A Progress Report. This was followed by the Special Senate Committee on Aging in 2009, chaired by Senator Carstairs and deputy chair Senator Keon, which included palliative care in their study of the needs of the aging population, and in 2011 an all-party Parliamentary Committee on Palliative and Compassionate Care released its report, entitled Not to be Forgotten: Care of Vulnerable Canadians. This committee produced a number of recommendations and serves as the basis of Bill C-277.

Bill C-277 calls on the Minister of Health, in consultation with representatives from provincial and territorial governments, in conjunction with palliative care providers to develop a framework designed to support improved access to palliative care through hospitals, home care, long-term care facilities and residential hospices. Among other things, Bill C-277 defines what palliative care is; identifies the palliative care training and education needs of health care providers as well as other caregivers; identifies measures to support palliative care providers; promotes research and the collection of data on palliative care; identifies measures to facilitate consistent access to palliative care across Canada; and takes into consideration existing palliative care frameworks, strategies and best practices; and evaluates the advisability of re-establishing the Department of Health's Secretariat on Palliative and End-of-Life Care.

In conclusion, the Minister of Health must initiate the consultations within six months after the day the act comes into force; and the minister must prepare a report setting out the framework on palliative care and table the report in Parliament within one year after the act comes into force; and within five years after the report is tabled in Parliament, the Minister of Health must prepare a report on the state of palliative care in Canada and table that report in Parliament.

A palliative care framework like the one set out in Bill C-277 targets important areas where resources, capacity-building, and cohesion are lacking, which leads to fragmented service delivery or even the absence of services across the country.

This framework provides guidance and gets both levels of government working together with front-line palliative care providers. It doesn't create more red tape, and it homes in on what needs to be done now based on what we already know and current best practices.

This is the right approach: respecting provincial and federal jurisdiction and working together to effectively address all of these issues and implement change to give Canadians more consistent and high-quality care.

There is already substantive work that has been done developing a framework structure through the support of the Quality End-of-life Care Coalition, made up of 37 member organizations across the country. This framework structure is a road map for integrated palliative care contained in the document The Way Forward. This road map is helping guide health care professionals as they adopt more integrated approaches to palliative care.

Right now in Canada there are more people aged 65 or over than children aged 14 and under. Given the number of seniors now and only increasing in the future, we need to be more prepared than we currently are.

I would like to turn to a few critical areas that are of particular concern. One of these is the lack of access to palliative care in this country. On May 30, during hearings as part of our study on the economic impacts of our aging population at the Senate Committee on National Finance, we heard from the Honourable Sharon Carstairs and former New Brunswick premier Bernard Lord.

Former Senator Carstairs, who has done extensive work in the area of aging and palliative care, told our committee that when she began her work on death and dying in 1994, about 5 per cent of Canadians who needed palliative care had access to it. That number is now closer to 35 per cent, which means there is still 65 per cent of dying Canadians not receiving quality end-of-life care.

Colleagues, for a country such as ours, these are sobering statistics. Both former Senator Carstairs and Mr. Lord provided some interesting demographics that hit Atlantic Canada particularly hard, as higher numbers of seniors live in Atlantic Canada. Mr. Lord outlined that over a 15-year period between 2001 and 2016, population growth in Canada was 17 per cent, while in Atlantic Canada the population grew by just over 2 per cent. Looking at the population of those who are 65 and older, the population grew by 52 per cent across Canada and by 50 per cent in Atlantic Canada.

Former Senator Carstairs told the committee that there are no hospices in Prince Edward Island, Newfoundland and Labrador or Nova Scotia. There are only two hospices in New Brunswick.

The most recent report of the all-party parliamentary committee, which was issued in 2011 and, as I mentioned, served as the basis for Bill C-277, drew similar conclusions. For example, one of the witnesses that appeared before the committee, Dr. Fred McGinn, from the Hospice Society of Greater Halifax, indicated that, at the national level, there are only 30 free-standing residential hospices in Canada compared to 200 in the United Kingdom and over 1,300 in the United States.

The same committee also heard testimony about the comparative costs for the delivery of palliative care. It costs about $200 a day to have a palliative care bed at home; it costs about $300 a day to maintain a hospice bed; it costs $600 to $800 a day to have a palliative care bed in a hospital; and in many provinces, people are dying in acute care beds at $1,200 a day or more.

Accessing services in urban versus rural or remote areas of the country can also highlight an inequity for those who need palliative care. Not only are there fewer resources or sometimes non-existent services in more remote and rural settings but transportation becomes an even greater challenge. For example, it is not easy for an 85-year-old patient or family member who needs to drive 30 or 40 minutes to a medical appointment in another community compared to a younger person making that same drive. Also, if a patient enters a care facility miles from home, it further isolates them from the very people they need close, their family and friends.

A key reason why accessing palliative care is of such concern is due to the significant lack of trained health care professionals to provide palliative end-of-life care.

This is another reason why I strongly support Bill C-277, because it emphasizes the need for training and education to address the shortages and help to establish standard training requirements for various levels of service providers.

According to Dr. José Pereira, who has over 20 years of experience as a palliative care physician and is the co-founder and Chief Scientific Officer with Pallium Canada, a non-profit organization that trains the health care profession in palliative care, he believes there is a need to train generalists in palliative care. He told the House of Commons Health Committee in March:

If we provide . . . those . . . competencies from a palliative care perspective — how to assess symptoms; how to start managing them; how to ask about the understanding of the illness; what the psychological, social, or spiritual needs are; and how one can help — then we start implementing that palliative care approach.

Dr. Henderson of the Canadian Society of Palliative Care Physicians advises that the majority of the 17 medical schools in Canada report less than 20 hours of training in palliative care. Nursing students also spend as little as 20 hours of training studying palliative and end-of-life care.

In addition to insufficient training, what is really acute is that there are fewer than 200 geriatricians in Canada in 2011, and today Canada needs an estimated 600 geriatricians.

Dr. Laura Diachun, from Western University's Schulich School of Medicine and Dentistry in London, Ontario, told the committee in 2011 that it was essential to understand how to better teach students the principles of care for seniors. She believes that as baby boomers grow older doctors will spend half of their time seeing patients over the age of 65.

Honourable senators, these are serious challenges we are currently facing with the lack of training and its impact on access to care in 2017. What is going to happen as the population continues to age?

This rather stark information certainly causes one to realize that the need is great and structurally things must improve. There is a lack of good research and data on palliative care in Canada, and Bill C-277 also addresses this as part of the framework.

There needs to be more data collected on patients who need palliative care, where they are going for care, how the services are being delivered, where they are effective and where the gaps are. This type of information is important for all partners as more resources and structures are developed and implemented in providing better access and care.

All of us here and the population in general are becoming increasingly aware of issues related to palliative care in light of the passage and recent implementation of the medical assistance in dying bill.

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