I call this meeting to order.
Welcome to meeting number 28 of the House of Commons Standing Committee on Health. Today, we're meeting for a one-hour briefing on labour shortages in the health care sector and the foreign credential recognition program. In the second hour, we'll have a briefing from the Public Health Agency of Canada in relation to the study of the emergency situation facing Canadians in light of the COVID-19 pandemic.
I'll forgo the usual announcement on hybrid proceedings. We're all quite familiar with them at this point, as are the officials who are appearing before us.
I would like it if we could do this right off the top, folks, because I always tend to forget this at the end. I'd like to set a deadline for the submission of witness lists for the children's health study that we will be resuming in September. After discussions with the clerk, I'm going to make a suggestion of July 18. The clerk will send out a reminder a couple of weeks before the deadline.
Is July 18 for witness lists on the children's health study okay?
Some hon. members: Agreed.
The Chair: It's adopted by consensus. Thank you.
In accordance with our routine motion, I'm informing the committee that all witnesses have completed the required connection tests in advance of the meeting.
I will now welcome our witnesses who are with us for the first hour this afternoon. From the Department of Employment and Social Development, we have Andrew Brown, senior assistant deputy minister of the skills and employment branch, and Erin Connell, director, skilled newcomers, employment integration and partnership, of the skills and employment branch.
We're going to begin with the five-minute opening statement, if one of you has an opening statement to present.
Welcome to the committee. You now have the floor.
Thank you, Chair and committee members.
I am joining you from the traditional unceded territory of the Algonquin Anishinabe people.
I'm pleased to join you today to provide an overview of labour shortages in the health care sector. As you may know, labour market pressures are affecting practically all sectors of the economy and most regions of the country.
As of March 2022, there were more than one million job vacancies across Canada, which is significantly higher than prepandemic levels. These vacancies will take longer to fill, given the scarcity of such highly qualified workers among the unemployed and the need for specialized training.
Canada's health sector is not immune. This sector was already experiencing a shortage of workers prior to COVID‑19, and these shortages have been further exacerbated by the pandemic.
In fact, as of the fourth quarter of 2021, this sector had the second-highest number of job vacancies in Canada, 126,000. Over the medium-term, forecasted job openings over the next 10 years will be particularly acute for key occupations, including registered nurses and licensed practical nurses, physicians and personal support workers.
ESDC has placed a priority on helping to address the health human resource crisis through its skills and training programs.
For example, budget 2021 announced $960 million for the sectoral workforce solutions program to help key sectors of the economy implement solutions to address current and emerging workforce needs. The health sector is a key sector for investment under the SWSP. The program launched a call for proposals in January that closed in March of this year, and these proposals are currently under assessment. Projects are expected to begin as early as summer 2022.
Additionally, as announced in the fall economic statement of 2020, ESDC is funding a $38.5-million pilot project to help address labour shortages in long-term and home care. This pilot will train up to 2,600 supportive care assistants through a microcertificate program and paid work placement. Of these, 1,300 are expected to continue on to pursue full personal support worker certification.
There is also the foreign credential recognition program, FCRP, which is a contributions program that supports the labour market integration of skilled newcomers through enhancing foreign credential recognition processes. This includes funding projects to standardize national exams, centralize information portals and provide alternative assessment processes.
The FCRP also provides loans for expenses related to training, licensing exams as well as support services, in order to help skilled newcomers navigate foreign credential recognition processes.
Lastly, the FCRP provides employment supports, including training, work placements, wage subsidies, mentoring and coaching, to help skilled newcomers gain Canadian work experience in their field of study and fully use their talent.
Indeed, internationally educated health professionals play a critical role in the Canadian health care system. These foreign-trained professionals account for a full 25% of Canada's health care and social services workforce, compared with just 10% of working adults for the wider population. However, despite our increasing need for health care workers and reliance upon internationally educated health professionals to fill these roles, these international professionals still face some barriers to licensure and re-entry into their professions, such as costly qualifying exams, limited access to residency training, language barriers and navigating the foreign credential recognition process.
Foreign credential recognition and licencing for regulated occupations, such as nurses, physicians and paramedics, is a provincial or territorial responsibility, and in most cases they further delegate that authority and legislation to regulatory authorities. Within Canada, there are more than 600 regulators overseeing more than 150 regulated occupations.
Nonetheless, the Government of Canada recognizes the challenges faced by internationally educated health professionals. This is why addressing their labour market integration has been a key focus of the foreign credential recognition program, particularly since the onset of the pandemic. The program is currently investing $22 million in 20 projects focused on the labour market integration of internationally educated health professionals.
Additionally, since 2018, over $13.5 million in loans have been issued through the program's foreign credential recognition loans to more than 1,500 borrowers, two-thirds of whom work in health care.
Budget 2022 announced an additional $115 million over five years, with $30 million ongoing, to expand the foreign credential recognition program. Along with existing investments in the program, the incremental funding will help up to 11,000 skilled newcomers get their credentials recognized and find work in their field. For example, these investments will support projects to standardize national exams, make it easier to access information, improve timelines and reduce red tape, in order to reduce barriers to foreign credential recognition, starting with a focus on the health care sector.
In addition to investments already mentioned, labour market transfer agreements delivered through ESDC provide approximately $3.4 billion in funding for individuals and employers to obtain skills training and employment supports through labour market development agreements and workforce development agreements with provinces and territories. Over a million Canadians benefit from programming and supports under these agreements.
ESDC will continue to work collaboratively with federal partners, counterparts in provincial and territorial governments, and regulatory authorities to help alleviate current and future labour market pressures in the health sector.
I certainly have had a lot of international medical graduates reach out to me personally and certainly as a member of Parliament to help them understand the system and help them navigate it.
I guess the fact of the matter is that it's very difficult for them to meet these requirements. Specifically, there was a Ukrainian medical graduate willing—think about this—to take a family medicine spot anywhere in Canada who was able to apply to the CaRMS matching system and, in the second round, there are 99 unfilled family medicine spots in Canada this year for residents in training. There are 99. For some reason, he didn't get one, which is absolutely shocking because he tells me he's willing to go anywhere in Canada to get a residency spot.
It seems like all we're doing is talking and talking, and I guess the question that remains is.... Let's look at what happens in Nova Scotia. You need requirements for licensure, which means you need to be accepted from the World Directory of Medical Schools. It also means that you need to have some part of your LMCC, and you need to have documentation that you are certified with the College of Family Physicians or that you completed a one-year rotating internship in Canada before 1993.
Does this mean that all we're going to do is ask international medical graduates to, again, compete in the CaRMS matching system in round two?
Thank you both for being here. This is certainly a problem we've been trying to wrestle with. How do we make it easier for foreign-trained graduates to get licensed?
Apparently, we budgeted $150 million, I believe, to help the foreign credential recognition programs. I think that was broken down so some of that money could be used to help with costly exams. Okay, I can see that. There's the cost of navigating the difficult credentialing program. Okay, I can see that.
Then there was some mention of more residency programs, although I think someone here then mentioned that was provincial jurisdiction. I would suggest, with the federal spending power, the federal government could work with the province to help create further residency programs. Could it not?
During this study, I remember asking the dean of Queen's University's medical school, I think, or it may have been the nursing school, if they would or could take more people to train. They said that, yes, they could.
Is some of the money in the $150 million going towards creating more residency programs?
Obviously, like always, we hope those commitments include respecting Quebec's jurisdiction.
Finding people to work in health care is hard because the health system lacks funding, which makes working conditions especially challenging. I'm talking about Quebec's health system, specifically.
Nurses have to work mandatory overtime. Things have only gotten worse with the pandemic, so much so that, in the government's last budget, the was forced to make $2 billion in urgent health care funding available. There were no strings attached to the transfer, which was meant to help the provinces address the backlogs of delayed surgeries.
Do you think inadequate federal funding for health care, coupled with the government's refusal to provide transfers unconditionally and the fact that working conditions are worsening as a result, is a barrier to recruitment?
Who wants to work in an underfunded health care system with poor working conditions? Do you think that hinders recruitment?
Thank you to both officials for showing up today.
In both of your responses, Mr. Brown and Ms. Connell, you talked about collaboration. I specifically recall that when you, Mr. Brown, were responding to my colleague Monsieur Garon, you talked about the strategy. You said that the best thing we can do is that we can put a strategy together.
As I'm sure you've followed HESA over the year, we have consistently been hearing about the theme of a pan-Canadian framework or strategy, whether it's for health workforce planning or for licensure for physicians across the country. We also talked about the role that the federal government needs to play to be able to make a difference. We realize that these are provincial and territorial...and also some of these professional organizations.
Mr. Brown, as well as Ms. Connell, can you help us understand what lever the federal government has to be able to play a much more effective role in addressing some of these issues? Whether it's the licensure or the length of time, the residency spaces or making sure of the supply and demand of physicians in the jurisdiction, what lever do we have that we could apply as the federal government?
At one time, Quebec was losing doctors and health professionals because they were leaving to work elsewhere. Today, however, the federal government is really doing us a favour, since people aren't leaving anymore because they can't get passports.
Another problem with the federal government is immigration. It's putting the cart before the horse, in my view. This discussion is about making it easier to bring foreign professionals to the country, and yet, the Department of Immigration and Citizenship is the most dysfunctional department in the whole federal government. It can't even manage to get temporary foreign workers into the country on time.
That's why I'd like the witnesses to tell us whether they think a functional federal immigration department would make their job easier as far as the foreign credential recognition program is concerned.
I call the meeting back to order.
We will now proceed to our briefing from Public Health Agency of Canada officials under our study of the emergency situation facing Canadians in light of the COVID-19 pandemic.
We're pleased to welcome, from the Public Health Agency of Canada, Kathy Thompson, executive vice-president; Cindy Evans, vice-president, emergency management branch; Stephen Bent, vice-president, vaccine rollout task force; Kimby Barton, acting vice-president, health security and regional operations branch; and Dr. Guillaume Poliquin, vice-president, national microbiology laboratory.
Thank you all for taking the time to appear today.
I understand, Ms. Thompson, that you're going to be delivering opening remarks on behalf of the agency, so you have the floor for the next five minutes. Welcome to the committee.
Thank you very much, Mr. Chair.
Thank you for inviting the Public Health Agency of Canada back to provide an update on the COVID-19 situation in Canada.
We continue to monitor COVID-19 epidemiological indicators, so that we can quickly detect, understand and communicate any emerging issues of concern.
As Dr. Tam reported on Friday, COVID‑19 disease activity indicators, from daily case counts and lab test positivity to waste water signals, are stabilizing at the national level, with most areas continuing to decline.
Severe illness trends are also declining in most jurisdictions. However, the virus is still circulating in Canada and internationally, and factors such as virus evolution and waning immunity could have an impact on COVID‑19 activity moving forward. At this time, we are observing early signals of increased activity in some areas.
As we and Dr. Tam have said on a number of occasions, we are not expecting our progress to be linear. We need to continue to prepare in case there is a resurgence in COVID‑19 activity. This means we need to keep up with our personal precautions, including staying up to date with our COVID‑19 vaccines and wearing a well-fitted mask. This is especially important as summer approaches, and Canadians get together more and participate in larger events like fairs and festivals.
The steady improvements we have been seeing in epidemiological indicators have allowed us to continue to relax and pause some of our measures.
Last week, the Government of Canada announced it is suspending the vaccine mandate for federally regulated transportation sectors and federal employees. In Canada, we now have better levels of immunity from vaccination and infection, antiviral drugs are more widely available, and our hospitalization rates are lower, relative to when the mandates were first introduced. This means we're now better equipped to effectively manage the COVID-19 pandemic and reduce the pressure on the health care system.
The suspension of vaccine mandates reflects an improved public health situation in Canada at this time. However, the COVID-19 virus continues to evolve and circulate in Canada and globally. COVID-19 remains a public health threat. Our best line of defence against serious illness, hospitalization and death is staying up to date with vaccinations, including booster doses.
Because vaccination rates and virus control in other countries vary significantly, our vaccination requirements remain in effect at the border. This includes an existing vaccination requirement for most foreign nationals entering Canada, and the quarantine and testing requirements for Canadians and some travellers who have not received their primary vaccine series. These requirements will help reduce the potential impact of international travel on our health care system. They will also serve as added protection against any future variants of concern.
The Government of Canada is transitioning to a model in which testing occurs outside of airports for both random testing and testing for unvaccinated travellers. Random testing will continue to occur at land border points of entry across Canada, with no changes.
While we continue the fight against this virus, we are taking every opportunity to improve. We continue to learn from both our past actions and our evolving knowledge of the virus.
Although the agency was able to rapidly mobilize, and adapt and respond to the evolving COVID‑19 situation, as we move forward, we will look to strengthening our pandemic preparedness by building on the lessons we have learned.
As we look to the future, we are optimistic; however, we also need to prepare for various scenarios. In doing so, we will use science and data to help inform our response to new or evolving situations—just as we have done from the beginning of the pandemic.
We would be happy to answer any questions you have.
Thank you, Mr. Chair.
On the question of genomics, the national microbiology lab continues to work very closely with provinces and territories under the guise of the “variant of concern” strategy. Under this initiative, we have seen a significant acceleration in the capacity to do genomics studies in Canada, going from a capacity of approximately 3,000 sequences per month in December of 2020 to 25,000 to 30,000 sequences per month currently.
Canada has become the fifth-largest contributor of sequences to the global database, with approximately 400,000 sequences coming from Canada. What that translates to in real terms has been the ability, in essence, to monitor viral evolution in close-to-real time here in Canada. Through that, we have been able to look at the arrival of the delta wave. We were able to detect the arrival of omicron within days of its arrival in Canada. We have been able to use that information, in partnership with public health authorities, to help with decision-making.
Moving forward we continue to use this capacity to monitor for the emergence of new variants. We have seen more recently the sublineages of omicron—BA.4 and BA.5, for example—and we are able to track these very closely to inform public health decision-making.
On the issue of modelling, genomics modelling and other monitoring activities work hand in hand. Through our modelling programs we have two main thrusts of work.
The first is on short-term forecasting, for which we use real data from cases, from vaccinations, and we are able to provide an estimate of the trajectory of the pandemic in the coming weeks. We supplement that with dynamic modelling, in which we are able to add new science about how SARS-CoV-2, the virus that causes COVID-19, transmits and evolves. These dynamic models give us a longer-term view of expected changes in the pandemic. Through these models, for example, we continue to look for what may come in the fall, which reinforces the need for Canadians to stay up to date with vaccination and to be mindful of their health choices as we navigate the pandemic.
I'd like to start by thanking all of our witnesses for their work over the past years in what have been some pretty extraordinary circumstances for our country.
I'd like to pick up where my colleague, Mr. Garon, left off on talking about the travel mandates. This issue has affected a lot of people in the riding I represent. I know that several of those measures have since been lifted, but at the same time, people are frustrated by the lack of explanation as to what the criteria were and how the decision-making process worked.
I'd like to start by going back to earlier in the pandemic when the vaccine became widely available and the government chose to put the vaccine mandate for domestic travel in place. These were rules that prevented unvaccinated people from travelling on airplanes and trains within the country.
Ms. Thompson, could you speak to how those rules were designed to work? I'm trying to get at the heart of this. What is the mechanism or what was the specific risk that was being managed when those rules were first brought in?
I have to say, Ms. Thompson, I'm frustrated at the generality of your responses. I think what Canadians are looking for is a very specific explanation of how these rules work, and that is what we've been failing to get for so many months now. It's incredibly frustrating.
I'm a layperson. I'm not an epidemiologist. I'm not a health professional of any kind. I studied glaciers in university, but I feel like I should be able to understand what we're trying to do with these rules, and the explanation is not making sense. Can you try again to tell us how keeping people off of airplanes and off of trains very specifically protected them or protected the people around them?
I'm failing to see it. I thought I understood the mechanism, which was, if you are unvaccinated and carrying the virus, there is less chance of you transmitting it to people around you. I think that's how most Canadians understood those rules to work. In addition, there is this piece around trying to convince people to get vaccinated. However, the piece around transmission is particularly interesting because of what we've been told about how the virus evolved and the changing impact on transmission.
I'm looking for something here, because I'm not clear on how these rules were supposed to work.
Certainly we want to be as clear as we can with Canadians. Dr. Tam always makes sure, during her briefings, that she communicates to Canadians what the situation is in Canada, as well as do other departments that have imposed measures, whether it's Transport Canada for a domestic vaccine for federally regulated sectors, or the Treasury Board for the public service.
With respect to the federally regulated sector, as I indicated, there was strong evidence from international and domestic sources to conclude that vaccines were very effective at preventing infection and, consequently, transmission of the COVID-19 variants that were circulating at the time, namely alpha and delta, and protecting against severe illness and hospitalization and death. That is one of the reasons why we were indicating that the evidence was there to support a vaccine mandate at the time.
I would like to reassure Canadians that the Public Health Agency of Canada is taking the monkeypox situation extremely seriously. We have had a number of concrete actions with respect to monkeypox.
First, following the international reports from the U.K. on May 17, the national microbiology laboratory relaxed instantly its criteria for testing to remove the need for travel to make sure that all Canadians were able to access the testing they needed. In addition, there was an emergency meeting of the Canadian Public Health Laboratory Network on May 19, prior to the confirmation of the first two Canadian cases, to ensure there was readiness on the laboratory side.
In addition, we have been working hand in glove with our provincial and territorial partners to provide guidance. Within eight days of the first cases being detected in Canada, we issued guidance on the prevention of infection, as well as recommendations to prevent spread. Through the national emergency stockpile, we have made available vaccinations—third-generation vaccines intended for smallpox but also with an indication for monkeypox—for a targeted vaccination campaign to help reach those most at risk.
In addition, ongoing communication has been occurring both through provincial health authorities and through a number of community organizations in order to ensure that messaging is out but respectful, so that we do not enter into an area of engendering unnecessary stigma. The Public Health Agency stands firmly against stigma generation. As such, our communications strategy has been very mindful both to reassure Canadians and to also get the message out to those who need to hear it.
Thank you, Ms. Thompson and Mr. Bachrach.
To all of our witnesses from the Public Health Agency of Canada, we appreciate your being with us. We appreciate your patience and your professionalism. I don't know that the work of the Public Health Agency of Canada has ever been more visible than in recent times. We certainly appreciate your being here with us and so patiently and professionally handling the questions that were posed to you today.
I wish you all a good evening.
Colleagues, I have a very pleasant task for you before we wrap. Today is the last meeting for our analyst Sonya Norris. Sonya will be retiring in exactly nine days.
I'll say little bit about Sonya. She earned a master's in biochemistry and spent almost a decade in clinical research. She started with the Library of Parliament 24 years ago, in 1998, and was assigned to this committee. Her first study on this committee was on natural health products. Some of the other studies she has penned include organ donation and transplantation, and assisted human reproduction.
From 2012 to 2019, she worked in the other place—on the social affairs, science and technology committee. She wrote a number of reports, including a series on pharmaceuticals, as well as healthy eating, dementia and robotics. In all, she has drafted about 26 committee reports.
I can tell you that, as the chair, I get to meet weekly with the analysts from the Library of Parliament and the clerk to plan the business of the meetings. Sonya has always been professional, pleasant and good-humoured to deal with. I'm sure that you join me in wishing her a happy and productive retirement.
Some hon. members: Hear, hear!
The Chair: To Sonya's left is Kelly Farrah. Kelly is going to be attempting to fill the large shoes left by Sonya. She certainly has the credentials, including a Master of Science in epidemiology, as well as a Master of Library and Information Science, and 15 years of experience working in the field of health technology assessment. Prior to joining the Library of Parliament, she was a pharmaceutical review manager with Canada's Drug and Health Technology Agency.
As I read it, she sounds very much like a witness as opposed to somebody who will be on our side.
She has worked with PHAC as a research analyst and with the NACI secretariat. Areas of expertise include clinical and economic evaluation of drugs, vaccines and medical devices, and methods for knowledge synthesis in the health sciences. Please join me in welcoming Kelly to our committee as the analyst.
Some hon. members: Hear, hear!
An hon. member: She only has 24 years to go.
Some hon. members: Oh, oh!
The Chair: Is it the will of the committee to adjourn the meeting?
Some hon. members: Agreed.
The Chair: We are adjourned. Thank you.